Addyi Passed by FDA; Will it Help Low Libido?

This past August, the Food and Drug Administration (FDA) approved the first prescription drug designed to increase women’s sexual drive. Addyi (rhymes with Daddy, don’t ask me how they come up with these names), developed by Sprout Pharmaceuticals, has been dubbed the “Female Viagra.” However, unlike Viagra used primarily by men to help them with their erections and other PDE5 inhibitors which allow more blood flow to a penis, this medication works on the brain. Another important difference is that Viagra (and the medications for a man’s Erectile Dysfunction) is taken as needed and works pretty rapidly whereas Addyi is taken every day, much like an anti-depressant and one may not see improvement until 4 weeks have passed.

Addyi is being hailed as the first of its kind to treat the root of the issue formerly known as Hypo Sexual Desire Disorder (or HSDD), now called Female Sexual Interest/Arousal Disorder (FSIAD) in the new DSM 5 (Diagnostic and Statistical Manual)
in pre-menopausal women. The new DSM 5 merged the experience of not feeling frisky or interested with the experience of not being able to get physically aroused.
HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance. HSDD is acquired when it develops in a patient who previously had no problems with sexual desire. HSDD is generalized when it occurs regardless of the type of sexual activity, the situation or the sexual partner. (

Originally developed as an antidepressant, Addyi works on the neurotransmitters in the brain to increase desire. While it is without question that the FDA and pharmaceutical companies often discriminate towards women in drug development and manufacturing, before women across the United States can truly claim victory, there remain strong concerns that this miracle pill (dubbed the little pink pill as a marketing ploy to resonate with the little blue pill that is Viagra) might actually bring more harm than good.
pinkpill One of the biggest concerns surrounding Addyi is whether the drug actually does what it claims. Approval for Addyi (when it was called Flibanserin) was actually previously rejected by the FDA twice – in 2010 and 2013 – for many reasons, including lack of effectiveness.

Even in the most recent studies, women taking Addyi only saw just one more sexually satisfying event (SSE) per month than those participants just taking the placebo. What my clients come in discussing is the loss of their intrinsic desire (or what some would call horniness, a physical tingling that alert them to their desire, an erotic fantasy or awareness that one is turned on) versus receptive desire (prompted by flirting, a fun date, or an intimate connection for example). Some in my field are not clear whether the Addyi study really were able to tell the difference in these types of issues by looking mainly at SSEs.

Moreover, many women do not realize the power their erotic mind has in boosting their drive and they do not understand that intrinsic physiologic triggers wear off naturally over time – which is why many in my field are asking whether we know enough about women’s desire to a) called it a medical pathology in the first place and b) offer them a medication versus educating women on other ways to increase their desire through other means? Considering that there was a high placebo effect in the study confirms my belief that some women need more education on how to enhance their erotic triggers besides intrinsic biological triggers.

In addition to the minimal evidence that the medication provides any substantial benefit to a woman’s sexual desire, I also share others concerns surrounding the side effects of this medication. As I mentioned above, the FDA previously rejected Addyi and another reason for those rejections were due to the high risk of side effects. First, there are the common side effects which including fainting, drowsiness, nausea, dizziness, and low blood pressure. While these are common for many other medications, women taking Addyi are also heavily counselled to abstain entirely from alcohol while on this medication because of the increased risk of severe hypotension and syncope due to the interaction between Addyi and alcohol.

The FDA felt so strongly about these side effects that each Addyi box will contain strong labeling highlighting these risks. Moreover, any doctor wishing to prescribe Addyi and any pharmacist that sells this medication must complete an online training course. It seems unrealistic to ask women – who may use alcohol as a means to relax prior to a sexual encounter – to abstain from alcohol and experience strong side effects from a pill that might only minimally increase their sexual arousal.

Finally, it also remains unclear that insurance companies will even cover Addyi. Some argue it would be equivalent to a monthly dose of traditional Viagra which is approximately $400, not an affordable medication for most folks. This means that even for a patient who does experience increased libido with no side effects, cost might continue to be a barrier. But pharmaceuticals are big business and when Sprout Pharmaceuticals was acquired by Valeant for $1 billion dollars, it was clear they were investing for a huge long-term gain on investment. You have probably heard about Valeant as recently as this past week, since it has reportedly raised the price on its brand name medications an average of 66% this past year.

While I am hopeful now that the FDA are taking women’s medical issues more seriously, and that they are interested in helping women who indeed have HSDD, I think we have to help women strengthen their Sex Esteem® by
a) figuring out if their low desire fits the criteria for the diagnosis of FSIAD
b) continuing to educate women on the many-layered causes for lower desire over long-term relationships
c) help them make an educated decision whether they need a medication.
d) ensure that they aren’t going to use alcohol when on the medication.

Latest Blog: Engagements & Weddings: 5 Topics to Cover

Dissatisfied wedding couple

It’s Spring again and a new crop of couples are preparing all the details for their upcoming nuptials.   Unfortunately, many people get caught up in the romance, erotic excitement, and wedding and dress plans of that first year to two years of their relationship that they neglect to talk about some critical elements that will help them safeguard their marriage and fidelity for the long haul.  Since June is one of the most popular months to marry and Americans are spending an average of $30,000 on a wedding according to ,  I thought I would use this month’s blog to offer some sage advice to those out there that are getting ready to invest their hearts and money to wed.

Frequently in the media we have heard engagements and weddings called off by celebrities like  Bristol Palin and  Miley Cyrus . The actual statistic of cancelled weddings have been estimated at 20%,  and the issues can be about lies discovered, financial concerns or frequent arguments that never seem to get resolved.  I have done a lot of pre-marital counseling and have helped some couples who decide to delay their wedding until they are able to nail down some pretty challenging issues before they can say “I do” with the skills and confidence needed to fulfill their vows.

Wedding couple conflict, bad relationships. Woman bride and man groom looking at each other with angry expression. Isolated on white

Some of the issues couples come in to discuss before their weddings include: sexual incompatibility, concerns about cheating, alcohol or substance abuse, disagreements over financial habits, whether and/or when to have children, and differing religious beliefs.  After 20+ years of counseling couples who have been traumatized by infidelity, financial secrets, or constant arguing, I can state that EXPLICIT agreements are needed at the beginning of a marriage and need to be updated continually as situations change and people grow.

Relationship agreement? I know, some of you are scratching your heads and thinking: “ What agreement? We get married and we vow to honor, love and be faithful to one another, isn’t that all we need?”  The definitive answer is no, one needs to discuss these issues as seriously as where they want to hold the ceremony, reception and go for their honeymoon.  (As a note, I think the following tips could also be helpful to those committed couples that haven’t sat down in a while to discuss critical aspects of the marriage/relationship agreement).

Young couple finding out results of pregnancy test at home

  1. Make sure you share the same bottom line goals in life.

I am always surprised when couples have gotten engaged without discussing things like whether they both want or don’t want to have children, the religion in which they would raise their children, what city in which they would live. Make sure you and your fiancé(e) have a thorough discussion about these questions and make sure you’re agreed on the decisions. Leaving what I call deal-breaker decisions until after the honeymoon can frequently derail a marriage later on.

2. What do you consider cheating?

I know this sounds obvious but I have to reinforce the idea that couples frequently have different ideas about what they regard as broken commitments to their oath of fidelity.  Most people don’t have what I have termed Sex Esteem™, the confidence, education and skills to discuss sexual issues with one’s partner and yet sexual fidelity is a critical part of the agreement you’re creating with your partner.

Cheating his wife, young men chatting with his mistress while his wife sleeps

If this topic is too challenging to discuss on your own,  or you have already run into questionable situations of trusting your partner, seek out an experienced sex therapist to have some sessions on this topic before the wedding. It could save you a lot of heartache later on. An example of what partners might disagree on would be: a one-time kiss at a company party after having drunk too much, watching certain types of sexually explicit material, dancing all night with another man/woman, and a hook-up during a bachelor/bachelorette trip to Vegas.

3. How much time do you each want to spend on your own, with your friends/family and with one another?

It’s hard to judge what your baseline needs are when you are in the throes of a new relationship because all those hormones are making you want to spend every minute with one another. But once that stage settles down you each have your own sense of lifestyle that makes one feel balanced. Your partner may have a very different expectation about how much time you’ll spend as a couple going forward.   Make sure you’re clear about how many times a week and the amount of time you want to work out, how many times you like to speak to your parents/sister/brother, how many nights you want to have dinner together, and how frequently you want to have a date and/or sex etc. Mark-Zuckerberg-and-his-wife-Priscilla-ChanTake some inspiration from Priscilla Chan, wife of Mark Zuckerberg who asked her fiance to agree to 100 minutes of time each week, 1 dinner date a week and a 2-week trip abroad at the very minimum.

4. Commit to being your partner’s emissary to your parents


Some of the most stressful times couples experience as they plan a wedding is with their soon-to-be in-laws. Remember you are creating a new family with your own beliefs and traditions from your family of origin. You each need to explain to your own parents why you and your fiancé(e) have made your decisions and that they need to support you both and not blame or criticize her/him because they’re disappointed. ( I think this role needs to last for the first 2-3 years of a relationship until the son/daughter-in-law can forge their own relationship with their in-laws)

5. Plan business meetings to discuss finances

coin couple

Marriages are about mutual love and support, fun and erotic connection in addition to being a financial partnership. I find that many couples discuss their financial goals and budgetary concerns as frequently as they discuss their sex life. Meaning, not as often as they should. I find those in long term partnerships or marriages need to carve out time (that is not designated for fun or sex) to discuss each of their goals, the steps they each are going to take to get them there and who is responsible for what aspect of their financial plan. Whether it’s how much to save for retirement, what each of you consider a reasonable rent, or how to plan for a vacation, preparing for a meeting and the considerations you each want to address can help keep underlying tension and anxiety from building. You can then move ahead to your fun time together more unified and eager to bond romantically.

Fifty Shades of Grey Movie Review

Can Dakota Johnson and Jamie Dornan Fulfill Their Roles as Ana and Christian?

I got a sneak preview of the much anticipated movie Fifty Shades of Grey last night and I was surprised to see that Dakota Johnson does a great job creating the nuances needed to express the innocence, wonder, and inner strength of Anastasia Steele. Johnson was able to express a dry humor that shows her intelligence and assertiveness in a tension filled scene as they negotiate hard and soft limits. And her handling of a drunk dial call to Christian is quite cute and funny.

Unfortunately, I felt Jamie Dornan seemed pretty blocked off emotionally as Christian Grey until close to the end of the movie when the audience glimpses his little boy fear as the reality of Ana’s potential rejection becomes more apparent. Some of the lines showed the arrogance and entitlement Christian Grey’s character has regarding his type of sexuality. When Ana asks: “Why would you want to do this” Christian responds: “To please me”. Unfortunately he leaves out the pleasures and excitement the arrangement might bring to Ana based on the limits they set. In another scene Ana asks: “What would I get out of it?”, alluding to the contract. His answer is simply: “Me”. But this shows the limits and inexperience of Christian Grey integrating love and lust due to his history of early trauma that affects his attachment abilities.

I actually expected the movie makers to keep it more PG and leave the audience wondering if they’d get to see the explicit scenes in the book visually expressed on the screen. Well, Hollywood delivers with many visual depictions of both the vanilla and kinky scenes between Ana and Christian. I was concerned in the first sexual encounter Ana has with Christian in that the audience never sees Christian stimulating Ana externally before he penetrates her. What a shame I thought, since this is her first sexual experience. However, there are plenty of variations of his arousing her to heights of passion after this scene to illustrate his mastery of touch and tongue.

The faults of Christian’s character in the book are expressed in the movie in that he loses control when it comes to making the right decision of not introducing extreme BDSM experiences to a woman who is a beginner. He also doesn’t know the rules when it comes to the pacing of a dating relationship and respect for Ana’s personal space. However, his Christian expresses his vulnerability through his mournful tunes he plays on the piano in the middle of the night to signal Ana that there is more to his rigidity as a person. What she does respond positively to is his striving for excellence, his extreme wealth and generosity, his love of adventure and surprise and his singular pursuit of her as a playmate.

The audience will get to see quite clearly how floggers, ropes, and cuffs are used in a BDSM room. This may be a turn off for some viewers while others might be drawn in to the technical and erotic aspects to this type of sexuality. They will also see how the characters take on roles of dominant and submissive when playing in the Red Room.

This movie illustrates Ana’s initial steps of growth in confidence and knowledge (the prime ingredients of Sex Esteem™), as she falls in love for the larger than life, complex character of Christian Grey. Enjoy the film, would love to hear your comments.Can Dakota Johnson and Jamie Dornan Fulfill Their Roles as Ana and Christian?

Women Who Don’t Orgasm

Why are women having sex without orgasms in their relationships?

I saw an older rom-com last weekend titled: “Because I Said So” (link is external) with Diane Keaton playing a neurotic mother trying to find a partner for her youngest still single daughter. While the movie is not one of Keaton’s best (hands down Annie Hall (link is external)), the moment that touched me the most (no big spoiler alert here) was when she let her daughter know that she had never experienced an orgasm.

Because I Said So
The female orgasm is under the microscope again in the media but for different reasons. n the recent HuffPost article (link is external) by Catherine Pearson, women discussed their acceptance of not orgasming with their partners while still being able to bring themselves to orgasm through masturbation. A few women expressed the wish to stop faking having them during intercourse, and one woman said she wished her partner would try harder. It occurred to me that what wasn’t fleshed out fully in the article was the anxiety and fear these women had in their partner’s reactions when they brought up the fact that they weren’t orgasming. One man became enraged that his wife was faking and keeping it from him for so long and yet didn’t attempt to bring her to orgasm in their subsequent sexual sessions. The other man sobbed for all the years his wife had missed out on the pleasure she could have received and at his failing to give to her.

Orgasm-less Woman

The other point was the fact that many of these women hadn’t developed enough Sex Esteem™ to show their partners how they bring themselves to orgasm when they self pleasure. Sex Esteem™ is my term for the confidence and ability to bring yourself the erotic pleasure and intimacy you want. While most of my clients say they feel too shy to masturbate in front of their partner or spouse after years of doing it in private and not considering it part of partner sex, it can be so helpful for women to pump up their confidence to do this if need be. Perhaps due to their upbringing and their love for their partner, the women in this article were protecting their partner’s feelings and ego when they kept the information to themselves and didn’t let on that they weren’t orgasming and that they wanted to put effort into figuring out how.

If these women had more Sex Esteem™ they would desire to further their discovery of sexual practices on their own, show their partner with their hands, or by watching a video together to grow as a couple. An exception in this story was Lisa, who did coach her husband as he tried oral and manual touch. When they tried a vibrator, though, he became excited very quickly, which caused him to climax quickly, so he nixed the idea of the vibrator completely. Instead of pursuing the vibrator which would have challenged him to work on his ejaculatory control while she could build her arousal, she backed down. She says in a surrendering way: “It still really bums me out, whenever I think about the fact that I can’t have that with him”.

While an orgasm is not the be-all end-all of any sexual encounter by any means (in fact, putting too much emphasis on ‘finishing’ may create performance anxiety and inhibit couples’ ability to linger upon and savor other sensual acts), it nevertheless upset me that so many women are in relationships with a sexual disparity without a healthy way to address it if they want to. I am not judging women who seem happy without a partnered orgasm, I just wonder if they had more Sex Esteem™ which=education+communication skills+ confidence, they might feel even closer to their partners. While there are certain medications and medical issues or past trauma which may inhibit a women’s physical ability to orgasm with or without a partner, the majority of these women had relationship or power dynamics, and/or lack of their partner’s technique in resolving their dilemma.

We have come (pun intended) a long way since the 1970s when my colleague Betty Dodson (link is external) began running her Bodysex (link is external) groups where women learned about their bodies and how to self pleasure. Betty was and still is a disruptor of accepted myths. At that time, the accepted theory was still Freud’s (link is external) that a clitoral orgasm wasn’t a mature one and that a “real” orgasm was a vaginal orgasm.

Betty Dodson in the 1970s

Most women need direct clitoral stimulation to reach climax, and about 25-30 percent of women may climax with vaginal penetration. While there are a variety of types of orgasm which I’ve previously discussed (link is external) in articles, the majority of women need a longer warm up and more clitoral stimulation before climaxing.

However, I still see women of all ages in my private practice who have challenges achieving orgasm for a variety of different reasons. Some women are capable of achieving orgasms alone, but not with a partner; others have never had an orgasm, and others still who are generally dissatisfied with the quality of their sex lives (solo or partnered). Some of them still feel shame and embarrassment that they aren’t climaxing with their partner and/or with intercourse. Others may feel that they’re rejecting their partner or being antisocial as was suggested in a recent NY Magazine articl (link is external)e if they pleasure themselves alone.

Female Orgasm
In my view, masturbation can be approached as a practice (much like yoga or meditation) allowing a person to explore and find new ways of attaining pleasure and relaxation. Orgasmic ability does not decrease with age, and just as one’s taste for food might change throughout their life, so too might the type of stimulation they find pleasurable and erotic. Women who have had their first orgasm after years of trying are often moved by the extreme pleasure their bodies are capable of and the sense of mastery and Sex Esteem it brings to their relationships. We are seeing more references to self-pleasuring in the pop music world (link is external) thanks to St. Vincent, Rihanna, and Miley Cyrus. Women need more films that show a partner stimulating a woman either manually or orally so that women understand what physical arousal is needed. It’s Valentine’s Day coming up, and the Fifty Shades of Grey movie is about to premiere. Give yourself or your partner a V-Day gift; time alone to explore your inner Goddess.

After discovering that her mother had never had an orgasm, I wish the daughter character in the film “Because I Said So” had said: “Mom, I’m ordering a vibrator online for you right now, you are going to love it!”

Taste, Texture & Sex; Food’s Sultry Senses for the Holidays

Taste, Aroma & Touch can enhance both your dining and sensual intimacy

Eroticism and food have long been paired together in the annals of history—with references to culinary pleasures found in literature, film, and pop culture. Pleasure taken from eating and drinking often falls into a category of sensual experiences. Indeed, the definition of sensual is “of or arousing gratification of the senses and physical, especially sexual, pleasure”. Certainly, while food itself may not bring about sexual excitement or orgasm per se, the act of eating and drinking bring to many a profound and visceral pleasure. The intersection of food and sensuality is often portrayed in popular culture when one partner feeds their blindfolded lover—who, deprived of one of the five senses, is overwhelmed by their heightened sense of taste. Popular culture has also used this pairing for comedic effect—notably, I recall a Seinfeld episode in which George, pairs his love of food and sex (link is external)unconsciously and ends up sneaking pastrami sandwiches into bed. While Katz’s may be delicious, perhaps it’s best to choose an item a little less messy.

There have been many cultural and artistic depictions of the link between food, sensuality, and sexuality. Take for example an infamous scene (link is external) from the 1963 film Tom Jones, based on Henry Fielding’s 1749 novel. Two couples gaze longingly at one another has they feast on delicacies such as crab, wild game, oysters, and fruit. They flirt with one another through the seductive manner in which they eat—practically acting out their sexual desires upon the food in front of them. In this instance, the food has become both a symbol of and a part of their passion. The shared meal is a slow seduction—culminating in the couple’s passionate kiss.

Readers might be familiar with a Sex and the City episode (link is external) in which Samantha Jones covers her nude body in sushi upon request from her boyfriend, as an erotic treat for when he returns from work. Samantha hopes that the sight of her body as a literal serving dish, coupled with the smell and taste of delicate sushi, will encourage her partner to experience her body in a similar way to the tiny morsels. Sushi is pristine, beautiful, and delicate—a work of art in and of itself. By presenting her body in such a manner, she is inviting her partner to take the same approach to savor her appearance, smell, and taste.

Social media has ushered in not only the age of the “selfie”, but that of “food porn”. Food porn is a term referring to images of food that are so succulent and enticing they provoke deep reactions in viewers akin to viewing pornography. As with viewing erotic art, there is an anticipation which builds when one sees an image of a particularly inviting meal. The viewer salivates, eyes widen, and pulse may quicken, just like a sexual response. Additionally, terming images as “food porn (link is external)” connotes a form of teasing between the artist and viewer.

Social media sites such as Facebook and Instagram are full of photos of friends’ meals. Going out for a meal and photographing your food prior to digging in has become so common that some restaurants have had to ban (link is external) the practice. Like sharing images of attractive partners or talking about sex with your close friends, there is an element of braggadocio here.

Pop culture references aside, Thanksgiving and winter holiday celebrations often center around food. Certain foods are eaten due to tradition or their status as a delicacy and rare treat. Think of sugary butter cookies or chocolate truffles thst melt in your mouth, the exquisite velvet texture of foie grois, or champagne bubbles giddily poppingin your mouth. Holidays like Thanksgiving, Hanukkah, Christmas, and Kwanza, prominently feature special foods. Turkey, stuffing and potatoes are classic Thanksgiving (link is external) fare; Potato latkes (link is external) are a traditional and symbolic Hanukkah dish; Christmas culinary traditions (link is external) vary around the world, but some notable examples include fruit cake, eggnog, mulled wine or cider, and a vast array of sweet and savory pies. Kwanza cuisine encompasses classic Southern dishes with an African flair, such as sweet potato pie and collard greens. While all of these holidays feature special and culturally significant foods that are a cause for celebration themselves, these holiday gatherings are typically intended as times to be with large groups of family and close friends.

Unfortunately it is not until New Year’s Eve that it is deemed culturally appropriate to share a glass of champagne (and perhaps sex) after the kids have gone to bed or the party with friends have ended. This long stretch of holiday festivities can be extremely stressful for the individual and couple at hand. Often, clients tell me they feel guilty for taking time to themselves during purportedly family holidays. However, there is no need to feel guilty—it’s okay to be a little selfish and take some time for yourself and your partner to honor your relationship in the holiday spirit. Taking some alone time to enjoy some culinary delights might bring you closer, aid your communication in and out of the bedroom, and give you some much needed alone time amidst the holiday rush.

Many of the words we use to describe sexuality and food are similar—both areas of experience deal with different textures, tastes, and smells. If couples can connect over what tastes good and pleasurable to them, they can have the same types of discussions about what feels good to them.

The holidays are often a stressful time—planning parties, travel arrangements, gift buying and giving—it’s no wonder that by the time New Year’s Eve rolls around, many people feel completely depleted.. I encourage you to carve out time between now and when the ball drops to ring in 2015 for sensuality.


Perhaps it can be the night before the big office party or a sleepy Sunday morning before the next holiday open house, when you create a sexy tasting menu for two (or more depending on your “tastes” (link is external))

You don’t have to blindfold one another to enjoy it, either. Pick a few things that you and your partner(s) enjoy—perhaps a decadent truffle, juicy pineapple, or a nutty cheese—the food itself doesn’t matter, but it should be something that tastes good to you.

Take turns feeding each other a bite and describing all the sensations: How does it smell? How does it feel? How does it taste? The best part about this kind of activity is that it’s a great way to relax and be flirty in the midst of holiday gatherings. If you’re short on time, you could do something like this for only five to ten minutes. Thinking about the sensual nature of food can bring out sensual communication and intimacy in other areas of your relationship as well, and help you de-stress over the holidays!

The Power of Dressing Up: Comicon NYC, Halloween, and BDSM

Six ways that Halloween and role playing can enhance one’s erotic sex life

With the runaway popularity of the 50 Shades of Grey (link is external)trilogy of novels, and the hotly-anticipated film adaptation (link is external) (due in theaters this upcoming Valentine’s Day) women and couples across the country have been inspired to experiment in the bedroom (link is external), with Lelo reporting an 82% increase in sales of vibrators and vibrating rings at the end of 2013.

Power Exchange Role Play
Once considered deviant or bizarre sexual behavior, role-playing, power exchange, and BDSM are becoming mainstream as more and more people experiment with this type of sexual play. There is a musical parody of Fifty Shades playing off-Broadway in New York (link is external) where women and men come to laugh and get titillated by the sexually-charged scenes between Christian Grey and Anastasia Steele. Many of my clients have experienced greater intimacy and passion after bringing an element of fantasy into the bedroom. On the heels of New York City’s recent Comic-Con (link is external) (the most widely-attended event of it’s kind; this year’s surpassed the famed San Diego Comic-Con) and with Halloween approaching, the playful spirit of dress up and fantasy are in the air.

New York Comic Con attendees
For couples who are curious about exploring role play and fantasy in ther sex lives, now is a wonderful opportunity.

1. Openness About Fantasies Can Increase Intimacy

The old saying that “the brain is the biggest sex organ” still holds true. How we become aroused in a sexual scenario—either solo or with a partner—begins with fantasy and imagination. Often, my clients are shy about sharing personal fantasies out of fear of being perceived as strange, bizarre, or disgusting by their partner. Not being fully open about one’s sexual desires and needs can lead to problems down the road in the relationship. I work with couples to navigate ways in which they can share and explore their fantasies to achieve a fulfilling sex life. Role-playing is one of many options that provides a safe, non threatening way for couples to explore.

2. Novelty Creates Excitement and Spark

The novelty of a role-playing scenario—whether it is doctor-nurse, teacher-student, or involving bondage, dominance, and submission—transforms a sexual encounter into something utterly new and exciting. Role-playing may help couples who feel they have “lost the spark” are in a “rut” or whose lovemaking has become routine and stymied. One of my clients was so amazed and enthralled when he saw his wife in a corset and stockings—he was able to see her in a new light. Novelty can help partners increase their desire and libido in the long run.

3. Using Fantasy in the Bedroom To Balance the Reality Outside

Role playing allows couples to enact scenes that are very different from their daily lives. Each person is able to step out of themselves and take on a new, exciting role. The harried career woman who feels powerless at work with a demanding boss can take control and power over her husband via safe and consensual bondage. In this way she is balancing her lack of control in her day-to-day existence by engaging into this kind of play. It is a way of subverting her frustrations and playing them out through sex play.

4. It’s All About Communication

To have a successful and stimulating role-play encounter, clear, direct, and honest communication is necessary. Especially for those exploring BDSM, knowing when to stop, and when to say “no” is extremely important. It is vital that activities remain consensual and safe, and the easiest way to do so in a BDSM scenario is to use a “safe word”. As many BDSM scenarios involve one partner overpowering another—by force, rope, or command, sometimes a submissive partner’s cries of “No!” don’t necessarily mean “stop”. It is required as part of a contract or agreement made beforehand that a neutral word like “red” be used as a safeword. Couples should respect one another’s limits and boundaries—and clear communication is at the heart of navigating these encounters. BDSM’s main rule of Sane, Safe and Consensual is at the heart of playing with power during play. Here’s a link for those interested in keeping sex-play with power safe.

5.. Enhancing Trust

Engaging in roleplay and/or BDSM is something that can enhance trust between partners. Roleplay and BDSM put individuals into vulnerable positions. One might feel silly and absurd acting out a teacher-student scenario, not be able to control their giggles, or feel worried about what their partner will think if they reveal their curiosity about being tied up. To expose one’s fantasies—and then explore them—is an act of putting tremendous trust in one’s partner. It not only takes trust to engage in these activities in the first place, but couples might find a newfound sense of trust after engaging in roleplay. This type of sexual activity pushes one’s boundaries and comfort zones, and doing so with someone you love or feel strong affection for can strengthen the bonds of trust and the erotic connection with one another. One has to realize that the play created in role play is just that: play. It is not necessarily the way a couple relate to one another outside the bedroom.

6. Boosting Confidence in the Bedroom Can Increase Confidence Outside the Bedroom

Naming your fantasy and figuring out how to enact it in your sex life can be an empowering experience sexually and help you gain power in other areas of your life. Mustering up the courage to act out a fantasy with your partner might just give you the courage to ask for that raise, promotion, or more vacation time.

Best Mother’s Day Gift Ever: Sleep

Mom’s Day can be the beginning of better sleep routines.

This Mother’s Day give Mom what she needs: more sleep. More than 60% of women get less than the seven to nine hours of sleep (link is external) a night they need to function at their optimal level. With modern moms’ identities often encompassing partner, professional, and parent, mothers need sleep more than ever.

I attended Ariana Huffington’s Third Metric Conference (link is external) this year. She and Mika Brzezinski “woke” up in bed on a stage and Arianna joked about “sleeping your way to the top”, using the old fashioned saying as a pun to let women know that getting sleep is crucial to one’s personal and professional success.

Hogging the Covers: Sleeping with your Partner

One culprit of Mom’s sleep deprivation may be sharing her sleep space. Nearly everyone who’s shared a bed can tell a story about winning or losing the battle for blankets, trying to sleep while their partner snores, or playing defense while their restless sleeper spouse thrashes about. At times, one of you might be suffering from Sleep Apnea (link is external), a serious disorder that sometimes gets overlooked and can cause you to feel tired and causes your breathing to actually stop for a moment. If you snore or wake intermittently you should report it to your doctor. It may also be due to anxiety, depression or drinking too much alcohol.

Chronic sleep deprivation can impact the emotional and sexual well being of a relationship. Studies (link is external) show people who regularly do not get enough sleep have more trouble regulating their emotions and interpreting emotional information. This means that the endearing albeit irritating habit of your spouse could trigger a heated argument if you are not getting enough sleep. It can also cause low desire which can leave a marriage hungry for intimacy and connection.

While it can sometimes be difficult, sharing a bed has benefits. While the research is still in its early stages, what we do know is that women in long term relationships sleep better and may experience some impressive health benefits (link is external)from sharing a bed with their partner. Couples in my practice have found a deeper sense of security and intimacy from their healthy sleeping habits.

Professional Powerhouse

We’ve already established that sleep deprivation impacts emotional health in romantic and family relationships, but what does that mean to Mom as a working professional? Lack of sleep lowers cognitive flexibility—a person is less capable of switching between tasks and understanding multiple perspectives when they have a sleep debt.

The women in my practice often forgo sleep to get that extra bit of work in, with the understanding that success at work will lead to greater happiness along the way. While professional success can be a source of pride, forgoing sleep can lower levels of happiness. To put in monetary terms, a 2012 study by Dr. Norbert Schwarz from University of Michigan found that an extra hour of sleep for the sleep deprived can do more for a person’s happiness than a $60,000 raise.


Being a mother, especially a mother of an infant or toddler, can be exhausting. Your sleep habits are no longer your own but rather dictated by that tiny human you want to nurture. All of the neural impacts of sleep deprivation from the previous sections apply to parenting as well. In these situations, quality sleep becomes key as the recommended 7 to 9 hours becomes nearly impossible.

Take advantage of your child’s nap time by taking a nap as well. Leave the chores for later, and take a full 90 minute nap, the length of the standard REM cycle. You will wake up feeling more rested and alert than a shorter nap. And remember as a mother, you are a role model for your children; this includes your sleep habits. Modelling good sleeping behaviors can help your children adopt them as well.

Make a Commitment to Self-Care this Mother’s Day

Here are 11 ways you can increase your quality of sleep today.

1. Change your perception of sleep. We as a society have this notion that sleep is optional, that functioning with inadequate sleep is a badge of honor. Start to honor need for sleep by tracking your sleep habits in a two-week challenge by WNYC to get an extra hour of sleep.

2. Listen to your body. Everyone has a natural sleep schedule that balances sleep and wakefulness. Tailor your sleep habits to your natural sleep pattern. While a full night’s rest is ideal, it’s not always possible. Work with your circadian rhythms to wake up feeling refreshed. Sites like will help determine wake up times that leave you feeling like you got the sleep you needed.

3. Lose the stimulants. Yes, I am talking about coffee, energy drinks, and really anything with caffeine. While caffeine temporarily makes us feel more awake and alert, consumption can lead to insomnia, irritability, and disturbed sleep. Some of you are laughing at this seemingly absurd notion of living without coffee, even though you know the facts. That’s okay. For better sleep, keep your caffeine intake at a moderate level. That’s about 24 ounces of coffee or 250 milligrams of caffeine in any form. Since the caffeine affect lasts hours, even after you no longer feel energized, keep the caffeine regulated to your morning routine.

4. Build a good sleep environment. Your bedroom should be a sensual sleep sanctuary. Make the only activities you do in your bedroom sleep and sex. Create the best environment for sleep by keeping the room cool and dark; it should be a relaxing place without distractions like TVs. How you make it a sensual place is up to you.

5. Unplug. It can be tempting to browse the Internet and catch up on email when you’re waiting for that magic moment of sleep to come. The light from your devices can actually throw off your circadian rhythm and lower the quantity of your sleep. Make a commitment to charge your phones in another room other than your bedroom, it will help to keep you present in your bed.

6. Use guided imagery. This is the modern take on counting sheep. Most guided imagery exercises will help you visualize a relaxing and calming fantasy. Studies show guided imagery can be effective in reducing stress, depression, and anxiety, all components that contribute to poor sleep. There are some great guided imagery options on YouTube, just be sure to turn off your device’s screen.

7. Meditate. Research out of Harvard shows meditation can facilitate relaxation and ease anxiety while protecting against hypertensions and infertility. You don’t need to become a yogi to get these benefits. Short intentional mediation practices, 5 to 10 minutes a day, can be enough to support quality sleep.

8. Find a relaxing activity to do to prepare for bed, if mediation isn’t your cup of tea. For some people, this may be a literal cup of decaffeinated tea, a warm bath, or gentle stretching. For others, it may be reading. Try to avoid using electronic devices.

9. Journal. If you’re a person who just can’t shut your mind off before bed, try journaling before sleep. Whether you’re writing whatever thought pops into your mind or a deliberate list of things you’re thankful for, journaling can help you stop ruminating and ease anxiety you may have.

10. Orgasm. Whether it’s alone, with a partner, orgasms release oxytocin into the body. This chemical increases feelings of love and trust, allowing you to relax.

11. Create a sleep routine. Use these tips to design a routine to prepare yourself for sleep. Like Pavlov’s dog and the bell, consistent implementation of the routine will signal to your body that it is time for sleep, relaxing you and inducing drowsiness.

My Sexy Valentine

As Valentine’s Day approaches, I am enthralled again by the many ways people love, lust and languish in their sexual lives.  This holiday is not just for the newly fallen-in-love or just engaged. No, it is celebrated by older, younger, married, living together, living apart, heterosexual, gay, lesbian, bisexual, transgender and polyamorous lovers.  As a sex therapist who hears many stories of desire, conquest, and loss, I never tire of contemplating the various ways in which people create relationships or systems to get their needs met.  As someone who loves the arts, I immerse myself in the imaginations of artists to discover many truths that could help me in my work as a sex and couples therapist.  I decided to review some of the peak experiences I’ve had at the movies these past couple of months to reveal some aspects of sexuality that play out among couples at the different stages of loving.

I spent some time watching the first two films of Richard Linklater’s trio titled “Before Sunrise” and “ Before Sunset” (made nine years apart with the same actors) before I watched his latest installment,       “Before Midnight”.  The brief outline of the story, (without offering too many spoilers) revolve around the meeting of a French girl and American boy on a train who decide to spend one day together before parting.  The second film has them meeting nine years later after they have matured, created new partnerships and they continue their initial spark for discussing all that is beautiful, messed up and hopeful in life.  In this most recent film the characters Jesse and Celine are married and are on vacation with their young children in Greece.  Unlike the first stages of lust and love, we see a couple ripened over time so that the membrane of young infatuation is torn open to view their longings, fears and frustrations expressed in a variety of conversations not only with one another but with others.

Ethan Hawke and Julie Delpy in Before Midnight

When couples have been together for years, there are the fears that one is not enough for the other along with the sense that their lives might not be as full as they had originally imagined.  Especially for couples who are raising children, the lure of spontaneous sex seems a far-off memory and the routines upon which children need to depend, bog down the erotic escapes once treasured by the very same couple.

How can one create novel experiences, discuss new desires and needs when there’s barely time to catch up about who’s cooking dinner.  I counsel couples to dig in and do the work of erotic discovery while creating play time to explore new and old games, talk about their feelings around their work, getting older, new and old dreams they have yet to achieve and take a break from discussing who emptied the dishwasher last, what the kids will do on their vacation from school, etc.  The focus in Before Midnight is on the ever streaming dialogue, like a stream-of-conscious poem pondering long term love’s challenges and the ever present Look out for my next blog which will look at another film.

Renegotiating Sexual Contracts in Monogamous Relationships

This month I want to discuss how partners can talk to one another about what their true sexual desires are when it breaks the code promoted in the popular culture of true love? In our popular American movies, novels, magazines and television shows the individuals who are in love are portrayed declaring to one another: “You are the most beautiful and most important person in the world to me”.  And while there may be chemistry and sexual connection early on in a relationship, the chemicals that are pulsing through one’s body during the first 18 months to 2 years of a relationship begin to decrease as the relationship enters the phase of building a life together.  So the question is what happens to the erotic and sexual desires that may either not have been discussed, experimented with, or developed over the next years of the relationship?

In the new upcoming play “The Goddess” produced by The Looking Glass Theater the playwrights explore the non-monogamous relationship of a married couple and how they navigate the rules, issues, and boundary crossings that ensue along the way.    I have been asked to lead several talk backs after the performances on October 17th  @ 7:30 pm, October 27th @ 3 PM and October 31st Halloween evening performance.  To receive a discount on the tickets, use the code Cooper when you buy your tickets.  Please come and bring your friends to learn how one couple redesigned their marriage and discuss the issues and questions you have about the alternative choices they made.

Showtime’s new series Masters of Sex about the world renowned sex researchers Bill Masters and Virginia Johnson, Virginia Johnson states in the first episode: “Women often think that sex and love are the same thing, but they don’t have to be, they don’t even have to go together”.  And while this was a revolutionary idea during this period of the late 1950s in the white middle class culture of the time, there are still many who share these beliefs in our country today.  So much so that the discussion of one’s erotic tastes and interests may never come up when a heterosexual couple date and decide to marry.   After the initial stage of limerance (that period of the first 2 years) has quieted down, the influx of obsessive thoughts, anxiety over the loss of that special person, higher desire for that person gradually fades to the background.  In other words, the feeling of being “head over heels in love”.

What then comes to the foreground is the thought that we know everything there is to know about our partner.  Included in this perceived knowledge is the sensitivities, old wounds, and non-verbalized boundaries around what can or cannot be expressed.  So if one person has always wanted to try anal sex, or handcuffs or include a third person in the sexual relationship, he or she usually feels like the opening for that conversation is no longer available to them.

How can one say to one’s life partner that while you love them deeply you still want to explore sexuality with others?  That is a hard conversation to have especially if you’ve agreed to a monogamous relationship way back when?  The partner might feel devastated personally, feeling they are no longer attractive to their partner, they are no longer cherished as a special one.   In our mainstream culture we are led to believe that to be in love with someone, one has to forsake all others and that you would want to forsake all others.  This is inherent in most marriage vows.  While there might be the understanding that your partner will be attracted to other people, the choice one makes each time one doesn’t pursue that attraction into action is a show of love, respect and fidelity.  I agree that this is the way one remain faithful to one’s spouse and it is a choice one practices each and every day.

Although I believe commitment to monogamy should be a daily practice I don’t see it as a gag order not to discuss what sexual innovations or improvements partners want out of their relationship.  Why?  Because we are human beings who change each day, grow as we go through different experiences and hopefully understand ourselves and the world better as we learn and grow through those experiences.  While that may mean that each day you each choose to remain sexually monogamous, or have a similar sexual routine, or have sex the same day(s) of the week, it may also mean that you have to discuss these choices a few times a year or once a year to see if it still holds true for your partner.  These are not easy conversations to have because partners’ don’t want to feel rejected or hurt nor do they want to tell their partner they aren’t satisfied sexually.

As a sex therapist I coach couples on a daily basis who are bravely forging ahead to carve out new understandings around their individual and joint sexuality with their partners.

I recently went to a celebration honoring Erica Jong, the author of Fear of Flying, a book that broke barriers in 1973 because it unveiled the raw, uncensored sexual thoughts, desires and actions of a white, educated married woman.  It became a sensation because before this time white educated women were seen to have little desire or education around their own sexuality and were viewed as objects for men to lust after not as adventurers who wanted to pursue what they found erotic or sexy.

Erica Jong created a novel whose ideas appealed to the masses in the same way Masters and Johnson’s research had done for the field of science and sex therapy.  The prevailing term “zipless fuck” represented the sexual encounter about which the main character Isabel Wing continually fantasizes.  The “zipless fuck” is an encounter with a sexual partner that is solely focused on lust and chemistry.  One will know very little details about the partner because the focus will be about the sexual connection.  Similar to the modern hook-up, the “zipless fuck” was a novelty when it was introduced and continues to be a lightning rod for writers exploring what women want sexually in a post-feminist society.  Many individual clients of mine many years just having hook-ups that when they meet someone with whom they want to develop a more emotionally connected relationship, don’t have the communication and sometimes sexual skill to establish it.

So are these just fantasies that coupled individuals have in their imaginations but when faced with the opportunity to try the act doesn’t live up to expectations, similar to what occurs in Fear of Flying?  Or can a couple negotiate new boundaries around sex and love that include other people in their bedroom or outside of the home with a don’t ask/don’t tell policy?  What if one of the partners falls in love with an outside partner while just playing?  Can people be so disciplined that they don’t develop feelings for another person which might threaten the stability of a marriage, a home with children, or a partnered couple?  That is what some of my clients discuss when they process the idea of going out of the relationship with consent from one another.  What about bringing other lovers that become part of the loving family as some people do with Polyamory?  In another Showtime series Polyamory: Married & Dating,  we see different couples and groups navigate the complex feelings and boundaries that need to be discussed if one is going to bring other lovers into established relationships.

Most people do not have the confidence and communication skills to express their changed desires effectively to their partners, whether it’s to add to the repetoire of sexual activities with one another or to invite others to play with them.  Some of the clients I work with instead stepped out on their fidelity agreement hoping that they could have their needs satisfied outside the home without upsetting their own and their partnership’s applecart of complex feelings by renegotiating their contract.  We have certainly seen many examples of infidelity over the years with politicians, celebrities and actors that wreak havoc on their partners, children, constituents, and business partners.

After working with couples and individuals for over 20 years at various points in their relationships (dating, pre-marital, trying to get pregnant, with small children, and retirement) my belief is that no one in a love relationship gets away with hiding their fantasies, thoughts, desires and unrest forever.  At some point the truths are revealed and I encourage people to share them in a safe, respectful way so that wives, husbands, partners and children are not faced with the heartbreaking debris upon discovering a betrayal.  This choosing and contracting is not for the faint of heart, it requires courage and love to stay in the conversation.  I also don’t believe that open relationships or polyamory relationships are the right way to go by any means.  What I want to emphasize is the importance of keeping the practice of discussing one’s desires a regular event.  That the conscious choosing of the boundaries is a regular practice that occurs without malice, criticism or disdain but one that may be painful but also incredibly healing.

Hope you can make it to see  “The Goddess” produced by The Looking Glass Theater on the days of my talkback to continue the conversation.

Moms in the Middle of Daughters and Mothers on Mother’s Day

How to Deal with Critical Mothers, Demanding Daughters and the Super-Mom Myth

If you’re a daughter and a mother to a daughter you sometimes feel you’re getting the same messages in stereo from both sides of the generational divide. These messages can sometimes be the most cutting, hurtful and critical messages which can leave moms feeling depressed, lonely, underappreciated and exhausted.

This Mother’s Day I want to send a shout out to all those moms who are working so hard to raise daughters to be self-confident, ethical, technologically and street-wise while providing their own mothers with the emotional, psychological, physical and financial support as they get on in years. The percentage of mothers working full-time is now up to 74% and 66% work either full-time or part-time. Many women feel like they need to be perfect in all areas of their life. Since this is an impossible task they constantly left feeling less than. Unfortunately, there is still the pervading myth that moms need to still provide a home-cooked meal each night, arrange play dates for their youngsters, check up on their child’s Instagram and Facebook statuses and then plan all the thousands of details that go into running a household week-in and week-out to be considered a “good mother”.

So many mothers end up feeling guilty if they aren’t doing what their stay-at-home mother did for them when they were growing up with their own children while they’re holding down a full-time job. In my office each week I hear from mothers and wives who feel like failures if they can’t cook up a Betty Crocker-style birthday party with a homemade birthday cake and creative gifts to hand out to the children in their loot bags as they walk out. Trying to live up to the Mom Myth of being the “super-mom” who does everything perfectly causes moms to feel more depressed than those women who reject that notion.

Now if you’re one of those moms who happens to be trying your best to balance work outside the home, home-making, parenting and marriage, you know the challenges you face in terms of trying to find time to check off all the items on your list. Most women feel more anxious about trying to push ahead at work or feel worried to “lean in” at their job outside the home as Sheryl Sandberg discussed in her most recent book, for fear of it requiring more time away from their families. I hear working mothers discuss how fatigued and stressed they feel because they’re trying to give to everyone else but leave very little time to re-nourish their bodies and spirits. They talk about how their libido has left them and they feel badly for their spouses who are more interested in sex than they are.

Many of these same women discuss how guilty they feel when they listen to their own mothers who may give advice on how to run a more elegant, efficient or frugal household. When visiting their mom, one of my clients might hear that her children are acting out of control and then be given tips on how she
should really discipline them more effectively. What these moms and you might be experiencing are feelings of inadequacy and self-criticism that may at times overwhelm you. Since most mothers of past generations did not have to balance a job, a household, e-mail, texting and technology policing responsibilities themselves, they are not attuned to the overwhelming informational overload of today’s mom.

Then, on the other side of the generational bridge today’s mom may be berated, wined at or ignored by a tween or teen daughter who is not satisfied with her clothes, or the meal that her mom cooked while her daughter sits on the couch texting or posting on Instagram or Snapchat with her friends and rolling her eyes if her mother attempts to ask a question about how her life is doing or ask her to help out with the household chores. Yes, some of these exchanges are as old as time itself when girls become teens but I do feel the technology provides more fuel to the fire and frankly, cell phones are this generation of teen’s new drug of choice in my opinion. Even if your daughter hasn’t hit her tweens or teens yet, there are a myriad of online games that need to be monitored so that private information is not given in error. So the new job title for a parent is that of techonology cop! And yes, one needs to keep up with learning and monitoring every new app that comes up in order to educate your daughter on the consequences of sending a text or posting an image while perhaps learning how to follow their movements through new monitoring apps.

Moms in the middle have my utmost empathy because they were sold a bill of goods fantasizing that their moms and daughters would understand them better than their spouses or sons would, due to the simple fact of having the same gender. Even mothers in that stage of early childhood when your daughter runs up to you as you walk in the door of her daycare or nursery program with a huge hug and kiss, the manual chores required can be physically fatiguing. Moms give, they plan, they remind, they cajole, they comfort and they empathize. What most moms are not good at though is asking for help because they think others will see it as a chink in their perfect mom armor. They have difficulty demanding that their spouse contribute an equal 50% to the household chores. They also feel like they could not possibly let their mothers know how demanding their day-to-day lives truly are for fear of appearing like a failure.

What I’d like to say to you moms out there is that this is really a new age and the old parent manuals do not always apply. So for this Mother’s Day I encourage you as I do to my own clients to:

• get over believing in the Mom Myth, you’re not perfect (nor is anyone else) and you’re on the frontier of re-defining what a good mom is on your own terms.

• make a list of all the homemaking jobs you do (including planning, calling for doctor’s appointments, calling or e-mailing for playdates), have your partner or spouse do the same and sit down to divide up the chores in a more equitable way.

• Make one on one dates with each of your children doing something simple like a walk in the park, watching a movie or playing a game so you and they feel like they can reconnect.

• Have a few talks with your mother to explain all the hats you are wearing and let her know in direct actionable behaviors how she could be most helpful while letting her know that giving advice when it’s not asked for can be experienced as critical. Let her know that you are carving out new territory as a 21st century parent.

• create a weekly time that’s just about your own nourishment, whether it’s having coffee with a girlfriend, going to a yoga class or reading a book.

• make a date time with your spouse/partner to keep your libido engaged.

Happy Mother’s Day to you. Please share this with your friends and let them know they can receive my monthly blogs if they ask to be put on my mailing list. Please like my Facebook page and/or follow my Twitter account @asksaricooper.