Tag Archives: Couples Sex Therapy

It is not uncommon for a couple to seek out sex therapy and for the sex therapist to discover that one of the partners has been struggling for years with undiagnosed Attention Deficit Hyperactivity Disorder (ADHD/ADD). A recent research literature review by Soldati et al in the Journal of Sexual Medicine found “that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population.”

For partners in which relational intimacy is their primary erotic impulse, a partner with ADHD may struggle to foster and sustain sexually intimate relationships —be it brief or enduring due to the symptoms of the disorder including: impulsivity, novelty seeking, forgetfulness, rapid mood changes and challenges in consistency. Part of this break in intimacy may also be due to the dynamic of the partner who doesn’t have ADHD taking on more responsibilities in the relationship, household and/or with their children. Over time the non-ADHD partner feels more and more resentment and may begin to feel more like a parent while the partner with ADHD may feel a combination of emotions including feeling: nagged, disrespected, embarrassed and angry. These feelings all contribute to a less than desired relational pattern that can spark sexual passion. Part of the work a couples therapist can focus on is to have each partner write blocks of time or deadlines when tasks can realistically get completed in a joint family calendar and have the partner with ADHD utilize reminders or sounds to help them transition into chore time.

Another point in this study was the pattern of partners going to bed at different times when the ADHD partner has extra work to catch up on or who may have poor sleep hygiene. One of the interventions a therapist can help couples with is intentional times that partners can go to bed together and help them create intimacy dates. In terms of the actual sexual experiences, partners who have ADHD/ADD report having trouble attending to some types of physical stimulation when the sexual script becomes repetitive, predictable and less novel over time leading to a lowering of sexual desire, a lost erection, or an inability to orgasm. When involved in a sexual script that is un-varied, the mind of an ADHD person wanders to places that do not include the bedroom like work related tasks that they’re behind on which is a turn-off or alternatively the mind searches for more novel types of erotic fantasies that they’ve watched on sexual explicit media, have had in the past or wish they’d like to have in the future. In fact some of the studies reviewed in this literature review found that the person with ADHD/ADD themselves may has less sexual satisfaction in partnered sexual experiences which may be due to their mind continually wandering. The potential problem when their focus goes to erotic imagination is that it might look like an emotional detachment to their partner, in fact some clients in sex therapy have described this occurence as their partner “ just going away”. These clinical observations are supported by a 2008 survey by Gina Pera of partners of people with ADHD who reported that “30% felt no connection when having sex with their ADHD partner, as if their partner was not there.” In order for emotional intimacy and sexual intimacy to form and grow, it is imperative there be an environment that is built on—and promotes—relaxation and playfulness and a sense of embodiment (a body/mind connection). One can cultivate this through present-focused techniques like yoga or meditation or introducing sex games that both partners would find fun and novel.

There are extensive other sexual difficulties that those with ADHD deal with aside from a lack of focus during partnered sexual activity: Medical News Today found that another desire issue was found in folks with ADHD; hyposexuality—that is, a level of interest or involvement in sexual activity lower than the norm, which is sometimes symptomatic of ADHD and sometimes an effect of medications used to treat ADHD symptoms; a healthy sex drive yet a struggle to reach orgasm despite prolonged stimulation, which is often due to boredom, trouble with focus, or an influx of other feelings; hypersensitivity—that is, a sense of discomfort in response to tactile stimulus, such as painful sensations in response to genital stimulation. It’s important to find out what kinds of touch a partner with ADHD finds pleasurable when working with a couple who have avoided sexual connection due to this issue.

ADHD can cause a person to thrive on excitement and to be fulfilled by an ever-changing landscape. This restlessness, only satiated by new phenomena, grows exponentially and often involves sexual fantasies as well for men. According to a 2019 study by Bothe et al, ADHD symptoms might be a critical driver in the severity of hypersexuality or out of control sexual behavior for folks of both sexes, whereas ADHD symptoms might only be significant with problematic porn use solely among men. The literature review by Soldati et al noted that people with ADHD have demonstrated an extensive use of online pornography, which, in such excess, leads to a difficulty in the formation of secure attachments. However, the studies reviewed bySoldati et al were not fully conclusive that people with ADHD were more likely to struggle with out of control sexual behavior or CSBD (Compulsive Sexual Behavior Disorder). In a study by Bejlenga et al, the most common sexual disorders among men who had ADHD vs. men who didn’t have ADHD were orgasmic problems (10-14% vs 3%), premature ejaculation (PE) (13-18% vs 10%), sexual aversion (12-13% vs 1%), and negative emotions during/after sex (10%, no data in the control group), whereas women reported sexual excitement problems (8-26% vs 3%), orgasmic problems (22-23% vs 10%), and sexual aversion (15% vs 4%). There were no significant differences in the results between patients treated with ADHD medication and patients without psychostimulant treatment.

It is critical for those folks seeking help for these sexual problems to be sure their therapist has the experience to conduct a thorough biopsychosocial assessment to explore the possibility of an ADHD/ADD diagnosis. A therapist needs to address the ADHD/ADD diagnosis, the consequences of this disorder on the couple’s relationship over time and the sexual disorders to which it has contributed. I will add some Sex Esteem tips for couples in a future blog.

Remembrance of Sex Past: Talking to Kirra Cheers about The List

April 30, 2018

Sari Cooper

Sex Therapy Theater Uncategorized No Comments

Modern sex, digital dating, hookups and contemplating past sex with a partner are all topics covered in THE LIST Kirra Cheers’ upcoming immersive photography project in NYC. I am so looking forward to leading a talkback after the May 19th show which poses the question “what would your exes say about you?” after a friend gave her a list he had made of all the sex partners and experiences he had had.

Here’s a preview interview with her. For those of you who don’t know Kirra’s work, she is the photographer behind the viral sensation Tinderella in which she photographed the men with whom she went on dates gleaned from Tinder to explore different aspects of modern digital dating life.

WHY?

SC: It seems like this piece flowed out of your first show Tinderella, that was a study on digital dating, what was the initial spark that was triggered when you were gifted the List? What were some of the questions about sex you were looking to answer?

KC: I saw the list of names as a puzzle. Each name represents a moment in time they shared together. I wanted to know, if I could piece together the moments, what would the narrative of his life look like? As with Tinderella, I play the role of the unreliable narrator, calling for the audience to reflect on their list and how people might judge them based on their time together. This experience of self reflection is different for everybody based on age, gender and individual experiences. Where one person might question, how many is too many? Another might reflect on how much they have changed as a person or who they may have hurt along the way.

HOW?

SC: In the work of sex therapy, we help clients get comfortable, get embodied, and help them articulate what it is they’re looking for in a sexual scenario? Did you find that the majority of partners with whom K had sex were open about their needs with him?

KC: As a society, we are used to being fed this lie that men want sex more than women. I think that women are more sexually adventurous than we give them credit for. There was definitely this conversation about wanting sex and expecting so be satisfied but there seemed to be a communication breakdown in exactly how to achieve that goal. This might be because they didn’t feel comfortable expressing their needs or perhaps they were still exploring their sexual desires.

SC: Often I hear from men who are single and dating that they aren’t as concerned about their partner’s sexual pleasure if they’re clear the sex is a hook-up and they’re not interested in getting emotionally close with them. Did you hear a range of reflections on how giving K was in the bedroom? Did it tend to coincide with how long they saw one another?

KC: Reviews on his sexual performance vary greatly. Everything from, the sex was “transactional” to it’s “the craziest sex I’ve ever had”. Hard to believe they were talking about the same person. I think it had more to do with how attractive he perceived them to be and therefore, how much time and effort he was willing to invest.

CONSENT

SC: Given the viral nature of the #CatPerson story in the New Yorker this past December, were there many women who expressed ambivalence during the act that they felt unable to express? Did many partner regret the experience? It sounds like one woman felt that the hookup was not consensual on their part? Did she ever tell him?

KC: I spent some time reflecting on why she opened up to me and chose to share her experience. I think that this was her way of telling him. It’s a hard read and unfortunately an experience that I believe most women will relate to in some way. There seems to be this accepted grey zone where it’s ok to pressure someone into an experience they’re not comfortable with. I used to think it was a matter of education but I’m not so sure anymore. Men understand consent, they just choose to ignore it. I think the problem lies in a power dynamic that has been exploited for far too long.

SC: Were these hookups freeing for some of the women who, like K were looking for sexual expression without commitment? What else did they discover about themselves in the process?

KC: Absolutely – many of the women on ‘The List’ are at a stage in their early adult life where they are exploring what they like and don’t like. It was refreshing to hear about women taking control of their sex life and feeling “empowered” by the experience.

TRANSFORMATION

SC: When sex therapists conduct what’s called a sexual history in therapy, we are looking to find out the influences on the way a person regards themselves as a sexual person, the influences of home, culture religion and how they explored their desire if they were allowed to. Did you feel his journey through these encounters/relationships had an intention behind it, questions he wanted answered or was their more emphasis on proving something to himself or others?

KC: I ended the project at no.38 because I felt that he was beginning to have experiences just so they could be documented. In fact, I would go as far to say that he enjoys having an audience and has continued to explore that thrill in his sex life. As a somewhat quiet or shy person in his day to day life, I think he enjoys exploring a different side to himself when it comes to sex.

SC: What most surprised you about the way your own relationship changed with K over the period of the project? Did you discover further vulnerabilities of his as you delved further into the project? Do you feel his choices of partners reflected a wide palette of facets to his personality or were they more similar than you could have guessed?

KC: We definitely became closer friends over the time that I worked on the project. He allowed me full access to his personal life and at no time seemed embarrassed or uncomfortable with the information that was shared. I was very impressed, if the tables were turned I may have had a crisis of identity. He seemed content to accept that this was their experience, even if it differed from his own.

INTENTION

SC: Why do you think K gifted the list to you in the first place?

KC: K enjoys surrounding himself with interesting or eccentric people that can orchestrate different experiences for him. For K, this was the ultimate walk down memory lane. He is now in a committed relationship and I often wonder whether the experience was somewhat of a sexual renaissance, allowing him to grow in a new direction. Perhaps we should all reflect on our list and learn something along the way.

THE LIST runs for a limited engagement Fridays & Saturdays, May 18-26 at 10pm at the Steve and Marie Sgouros Theatre (115 MacDougal Street). Tickets can be purchased online for $20 at https://thelistbykirracheers.com/.

How to Say Yes, No, or Some: A Post #CatPerson Sex Esteem® Guide to Dating #2

February 9, 2018

Sari Cooper

Sex Therapy No Comments

Since my last post on the #CatPerson story in The New Yorker, we have had numerous sexual stories come out including the babe.net piece in which a woman identified as Grace had with comedian Aziz Ansari which she described as sexual assault, the highly researched story in the WSJ of sexual misconduct and assault allegations against Steve Wynn and the NY Times’ Maureen Dowd interview with Uma Thurman

finally opening up in more detail regarding her sexual harassment allegations against Harvey Weinstein.

The Ansari story left the more than 2.5 readers split on what exactly the experience had been; consensual or coercive or assault? Grace wrote that her experience left her feeling violated while others have described the Ansari date as badly-mannered, insensitive badly communicated or plain ‘meh’ sex. The critical nature of the post #metoo movement requires a much more nuanced, articulate languaging of what is desired, what is possibly of interest, what is considered intrusive, coerced, and unwanted by both partners. The directives of consent need to be discussed at the beginning of an evening and then right before the sexual actions begin as well as during. Why? Since many people drink or use some sort of recreational drugs when hooking up, their ability to give consent changes over time, and especially if they are under the influence.

Have people gone too far in conflating bad sex in which people don’t take responsibility for what they do and don’t want with coercive sex and out-and-out assault in which a person is threatened physically and emotionally by the power of the other person? I think in the first wave of a reckoning the rage that had been building for so long can create a reaction that offers only a black and white, guilty/non-guilty verdict that does not reflect grey.

Given the upcoming Valentine’s Day when singles and newly dating couples go out to have fun, create some romance and potentially have some sexual fantasies in their expectations, I hope these further explicit discussion tips help to create a date that is remembered as sexually consensual, safe, sexy and sweet.

Dating Tips Post #CatPerson

Don’t Have Any Sexual Activity if You’re Drunk, Period!

While I think the main character Margot, a college student obviously regretted her decision to move ahead with having sex with Robert, the 30-something man she met at a university town bar, the sex was not coerced or forced by Robert. Similar to the real Grace of the babe.net story who thought Ansari would have more sensitivity about what she would want and not want to do given his public comedic routines about his avowed feminist identity, both these women had agreed to go ahead with a sexual scenario perhaps for different reasons.

In my sex therapy practice CLS, we frequently see heterosexual women who have felt like they should have sex with a guy for all sorts of reasons that have nothing to do with healthy sexuality. Some of these reasons include internal dialogues similar to what Roupenian wrote of Margot’s sudden erotic revulsion to the idea of having sex with Robert: “But the thought of what it would take to stop what she had set in motion was overwhelming; it would require an amount of tact and gentleness that she felt was impossible to summon.”

This is one of the key moments to this story. As a sex therapist one of the things I ask clients is to describe their last encounter slowly and describe not only their actions but their internal emotional and cognitive states as well. If these aren’t aligned then the sex will be experienced as mechanical, empty, ‘meh’ or bad. “Cat Person” is not a story of active coercion on Robert’s part, it’s not a story of an older man putting pressure on a younger woman, but it’s a story of woman incapable of expressing her desires in the moment that a certain sexual activity is signaled.

I think that many women related to this story because they felt they weren’t comfortable saying or didn’t have the education to say yes to some sexual activities and no to others.

In the #Catperson story Robert states: “You’re drunk” after she suggests they leave the bar for somewhere else. Margot is drunk and says: “No, I’m not,” though she knows she is. Where is her personal responsibility here? If one has enough awareness that one is drunk they need to state the fact, and go home by themselves. And where is Robert’s confidence in what he perceives as her state to non only insist on driving her home but actually following through and driving her home to wrest on the side of caution? I am not siding with either of these characters but actually holding both of them responsible for creating a safe, sober and perhaps more sexy encounter.

Check In with A Partner EACH STEP OF THE WAY During a Sexual Encounter

In my last blog I talked about all the ways partners can (sexily) describe what they’re interested in doing, what they’d consider and what are hard limits BEFORE a sexual encounter. What needs to be included in all enounters (whether they’re hookups or between longstanding partners) is a checking in along the way with the full understanding that THINGS CHANGE from moment to moment. Sex is a dynamic, living enactment of desires, fantasies, physical movements, that shift in the process.

In the #Catperson story Margot experiences a major shift in desire when she sees Robert bend down to take off his shoes after removing his shirt and pants.

“Looking at him like that, so awkwardly bent, his belly thick and soft and covered with hair, Margot recoiled.”

These moments happen a lot more often than people admit either to their friends afterwards or to themselves, even when someone isn’t drunk. And it’s okay to change your mind. Let me say this again, it’s okay to change your mind and tell someone: “I think I’m good for now” or “I would rather just cuddle” or “I’m not feeling well now and would like to remain clothed”. In the same way, you can say: “I’m good for now, would rather not drink any more”, without shame, or embarrassment or feeling so uncool or stiff.

But this is how Margot felt about the idea of letting him know her desire had changed:

But the thought of what it would take to stop what she had set in motion was overwhelming; it would require an amount of tact and gentleness that she felt was impossible to summon. It wasn’t that she was scared he would try to force her to do something against her will but that insisting that they stop now, after everything she’d done to push this forward, would make her seem spoiled and capricious, as if she’d ordered something at a restaurant and then, once the food arrived, had changed her mind and sent it back.

Margot (and Roupenian) likened the thought of changing her mind to the embarrassment of returning food at a restaurant and what he would think of her for doing so. This to me is the crux of the story because what so many female readers of this story have described is the pressure they feel in following a man’s directives during a sexual scenario or what they had originally stated (if they did at all) wanting at the beginning of an encounter.

The woman called “Grace” in the babe.net encounter with Aziz Ansari stated:

“He sat back and pointed to his penis and motioned for me to go down on him. And I did. I think I just felt really pressured. It was literally the most unexpected thing I thought would happen at that moment because I told him I was uncomfortable.”

One of the crises in our culture is this moment, the moment of asking and the moment of owning your authentic response. If Ansari was signal-blind, ignorant, drunk or plainly assertive in wanting what he wanted, Grace needed to say:

“Look, I’m really into your massaging my shoulders right now and that’s about it. I don’t want to go down on you, I don’t want to have penetrative sex, this is my limit now so please stop asking for more. It’s turning me off.”

What I hope is that my suggested statement above gets into the “sexual gray area between enthusiastic consent and resigned acceptance” as described by Carolyn Framke in the thoughtful Vox piece as the place the babe.net story fits in the conversation we are having in this post #metoo reckoning.

Know How to Say Yes, Thanks or No, Thanks or a Bit More of That

Whether it’s more sexual acts or the next date, be compassionate about your partner’s feelings. Many of my clients who are dating complain of ‘ghosting’ from people with whom they may have had long text threads, several dates or a 4 month-long relationship. Ghosting is the equivalent to not calling ever again, vanishing without a trace, or being stood up in the old days. One of the elements of Sex Esteem® which I teach to my groups is compassion. If you want to be treated with compassion by others, build a practice of compassion in all parts of your life. This means thinking about how the other person will feel, empathize with them without going beyond your limits and let them know if you’re done.

In The #CatPerson story, Margot avoids letting Robert know she is no longer interested. She thinks about ways to text him but perseverates about the perfect way to do it since they’d had sex but either texts excuses for not being in touch or ignores his texts altogether. And what Robert finally texts is what becomes one of the aspects of the story so many readers reacted to because of his inflammatory misogynistic message calling her “whore”.

Robert is a character, one we know about whom we know very little. But in this rageful, rejected pain expressed in this age-old insult for women who don’t give someone what they want, or who take their own sexuality into their own hands, or who reject someone who wants them, the story depicts a man who can be dropped into what many readers deem a bucket of deplorable men. That is the assumption that most men are perpetrators who you can’t trust. If Roupenian allowed the reader to get to know Robert, to figure out how this rejection triggered other old wounds perhaps, and offered him the opportunity to end by staying in the vulnerable state she had his character initially express when he didn’t hear from Margot, it might have offered a more dramatic view of a man than the original story offered. That of the male human who is openly hurt and vulnerable and remains in this expression.

“O.K., Margot, I am sorry to hear that. I hope I did not do anything to upset you. You are a sweet girl and I really enjoyed the time we spent together. Please let me know if you change your mind.”

Robert could have added: “I’m sorry you feel differently than I do.”

So if you have a date on Valentine’s Day or some time soon please try some of these Sex Esteem® steps before, during and afterwards. If you don’t feel you want to see the person again, think about ending with compassion and grace without malice, without humiliation, without sexist insults.

May we teach our children that speaking out without the fear of retribution is our culture’s new north star.”

Laura Dern on the Golden Globes

How to Fall in Love & Have Great Sex

September 14, 2017

Sari Cooper

Uncategorized No Comments

Mandy Len Catron recently published her book: How to fall in Love with Anyone: A Memoir in Essays, which explored the ingredients of closer intimacy. The book is based on her popular NY Times piece “To Fall in Love with Anyone, Do This”, where she reenacted the famous social experiment by psychologist Arthur Aron, “The Experimental Generation of Interpersonal Closeness: A Procedure and Some Preliminary Findings”, In the original psychological study, pairs of strangers spent 45 mins asking a series of 36 increasingly deep and personal questions in a lab setting. The purpose was to see if a sense of intimacy could be established in a relatively short amount of time. When Mandy Len Catron completed the questionnaire, she ended up forming a romantic relationship with a casual acquaintance.

Why did the 36 questions work so well for Catron personally and for many of the original study’s participants? I commented on this article when it first appeared on CBS This Morning but would like to expand on my observations here. The questionnaire starts off with seemingly innocuous inquiries, for example asking people to describe a perfect day scenario. Soon enough, the tone shifts to asking more serious questions such as best and worst life memories and views about death and mortality. Toward the end of the experiment, people are asked to share what they honestly feel about their partner and what they would like their partner to know if they wish to become close with them. After all the questions are answered, both participants then stare in each other’s eyes for about four minutes in silence. With each question, each participant is slowly becoming more vulnerable, exposing parts of themselves about which they feel embarrassed or anxious. These are aspects of oneself rarely shared with an acquaintance, let alone a complete stranger. As researcher Brene Brown has expressed: “Vulnerability is about showing up and being seen. It’s tough to do that when we’re terrified about what people might see or think”. And for those moments when one is finally truly seen, the desire to merge with them sexually may be activated as a further way to retain this emotional union.

In Catron’s original article she admits she was in a bar and drinking bar while undertaking this experiment. As an aside, many shy or introverted folks commonly use alcohol or recreational drugs as a social lubricant.

Unfortunately it may lead folks to a sense of false intimacy and potentially a consensual sexual experience that both people regret the next day. While I am not writing about non-consensual assault or rape here, I am clarifying that even with consensual sex under slight influence, the element of intimacy can be shrouded or missing.

Why This Works:

There are also some biological reasons as to why the study works in bringing people feeling closer. For example, research has shown that when people speak with direct eye gaze the listener is more likely to trust the speaker compared to a speaker looking elsewhere.

The ancient practice of Tantra includes eye-gazing as a method to encourage more relaxation and connection. Many partners find their breathing becomes aligned when gazing at one another’s eyes. In fact, our first instincts as babies is to look into our caretaker’s (parent’s) face for comfort and this is our way of calming our system and finding confidence in our world.

In a recent study out of the Kinsey Institute, researchers found that “over 50% of respondents ages 18-24 indicated that their most recent sexual partner was a casual or dating partner.” but they also found that “for all other age groups, the majority of study participants indicated that their most recent sexual partner was a relationship partner”. Even more fascinating, “men whose most recent sexual encounter was with a relationship partner reported greater arousal, greater pleasure, fewer problems with erectile function, orgasm, and less pain during the event than men whose last sexual encounter was with a non-relationship partner” . In another study, the researchers stated: “Men and women both were likely to report sexual satisfaction if they also reported frequent kissing and cuddling, sexual caressing by the partner, higher sexual functioning, and if they had sex more frequently.”

And for middle-aged men who reported having had more casual sex partners in their lifetime, they also reported less sexual satisfaction leading one to consider how deeper connections if combined with what I have coined as Sex Esteem® can lead to better discussions on what one desires, how one wants to grow in their sexual connection, and perhaps an emotional comfort that increases frequency.

This data illustrates that for many people, romance combined with sexual intimacy is an important recipe for sexual and relationship satisfaction for men and women (most of this research was based on heterosexual relationships). Does this mean that fulfilling sex cannot or should not occur outside a romantic relationship? Does it tell us that casual dating, sex with outside partners in a non-monogamous lifestyle or friends with benefits will not fulfill a person sexually? My answer is that it reports that for most straight folks, intimacy enhances their sexual pleasure AND that perhaps for some people sex without emotional intimacy is also pleasurable.

The clients we see at Center for Love and Sex range from monogamous couples who are so intimate it restrains their courage to request their desires, or couples who are locked in power struggles, bitter arguing or cold avoidance due to unresolved conflict so their sex life has been put on a shelf. We see people who are working on maintaining trust and intimacy in their primary relationship while openly exploring more sexually oriented partnerships outside the relationship.

Although American media frequently sets up a premise of casual sex as a titillating option in many movies, however the conceit quickly falls apart as the main characters “fall in love” by the end of the story. One can see examples of these situations in films like: Friends with Benefits, No Strings Attached or About Last Night. There is too often a one-size-fits-all script in terms of love and romance in Hollywood in which casual sex is shown to be too frail, less acceptable or not a true goal by the heroine or hero as the case may be. As a sex therapist I help clients discover what level of intimacy they’re looking for whether they’re single, married, or in a long-term relationship (whether it’s monogamous or contracted as non-monogamous). Some people rush into casual sexual agreements so quickly that they don’t spend time anticipating what feelings might get stirred up, or how to set up boundaries so that each partner doesn’t have ulterior or unconscious desires for a more romantic relationship. We use the therapy or coaching sessions to help people make realistic decisions given the type of person they are and what they’re looking for at this time in their lives.

Catron mentions another reason to her experiment’s success, which is the experience of love as an action as opposed to something that merely happens to someone externally . According to her, both she and her partner came to the experiment open and willing to take the steps to meeting someone new and falling in love. In addition, the study itself asked a series of questions that many long-term couples do not routinely ask one another, such as the last time a person cried alone or with another person. These types of questions may be considered too vulnerable even for couples who have been together for years. So I recommend learning to take the leap to connect deeply with vulnerability to someone through practicing vulnerability on a regular basis. Whether they’re your long-term partner, your spouse or someone you’ve recently began to see., the feeling of freedom and connection could be equally important to your emotional bond and increased sexual pleasure.

Embrace Sexual Liberty This July After the Fireworks

July 17, 2017

Sari Cooper

blog Sex Therapy No Comments

We have just celebrated another July 4^th which marks this country’s liberty from the restraints of despotism. When the fireworks went off we honored the declaration of independence that promised Americans “with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” How do these rights influence your sexual life? Many in Washington seem to be challenging the meaning of these ideals in as far as sexual liberty goes, including the right for a woman to choose whether she has an abortion, the right for a transgender student to use a bathroom that aligns with their identity, and the question of whether a business owner’s claims of religious freedom override the discrimination wrought when they refuse to sell their products based on the customers’ sexual orientation.

In this July blog I wanted to focus on the theme of liberty as it relates to a couple’s sexual relationship because as an AASECT Certified Sex Therapist and Director of Center for Love and Sex, the majority of our clients come to us seeking help in identifying and/or expressing their unique erotic “pursuit of happiness”. According to Merriam Webster’s definition, liberty is alternatively described as

the quality or state of being free:

a : the power to do as one pleases

b : freedom from physical restraint

c : freedom from arbitrary or despotic control

d : the positive enjoyment of various social, political, or economic rights and privileges

e : the power of choice

When a couple first meets and they seem to click or hit it off they may feel hopeful that they finally found the ‘one’ with whom they can be totally authentic; free of restraints, or arbitrary control, and fantasizing about how they will enjoy one another to the fullest including in their sexual connection. Perhaps after that first date where they make out or the morning after they lay next to one another in the nude, the endless imagined erotic freedoms seem to pop like Independence Day firecrackers during passionate daydreams. The last definition of liberty, namely “the power of choice” is where I find many couples get stuck. What do I mean by this? Once the first couple of years have passed, many couples find that the original sexual fireworks have mellowed to the flickering of candles with an occasional pop of a sparkler or firecracker. At this point, many couples tell us that they have become so close to their partner they feel like they have literally become ‘family’, experiencing the other more like a sibling or best friend. What happened to that erotic thrill they felt when their partner was less known? Why has their erotic connection lost its sizzle?

Once partners become joined, very frequently they may unconsciously regard the other under the same category as a member of their family of origin. What can become triggered are the many restraints one felt growing up in their particular family including restrictions dictated by: religion, community, and their particular culture. Those rules, boundaries and traditions may cause them to erect walls inside their minds leaving them powerless to choose who they want to be in their sex life.

A client at CLS who was engaged to be married was working hard with her sex therapist to recover from the Genito-Pelvic Pain Penetrative Disorder so that she could honestly tell her priest that she would be ready to “perform her wifely duties” once they wed. This priest had not asked about what she looked forward to in her sex life, nor did he ask her fiancé if he was ready to give pleasure to his fiancée once they were wed. The Roman Catholic ideal of wife and husband having intercourse was focused more on procreation than bonding, pleasure and intimacy for both partners.When I use the phrase “who they want to be in their sex lives”, I mean what fantasy they want to enact, what sexual acts they may want to try with their partner(s), and/or what kind of erotic power exchange they may have dreamt of playing in the bedroom. Do they want to be consensually taken, ravaged, or overtaken by their lover? Are they hoping to play out a scene from a movie that turns them on? Do they want to dress in particular clothing that heightens their arousal?

Couples can become what David Schnarch in his respected book Passionate Marriage describes as “emotionally fused” when they fall for one another and the idea of a person making the choice to express a desire that might differ from a partner/spouse’s can lead to their partner expressing ridicule, disdain, disgust or abandonment because it is alien, kinky or frightening. The partner who is hearing the request or fantasy may not even have to say a word but the roll of the eye, or raising of an eye brow may be all it takes to indicate surprise scorn. Like a firecracker going off the partner quickly shuts down further requests of new or different sexual interests for fear of losing their partner, not to mention wanting to avoid feeling put down, rejected or just plain weird.

Recently when I asked a married het couple (I’ll call them Chloe and John to protect their identities) who were having trouble infusing their sex life with more passion and excitement, if they had seen, read or heard something recently that turned them on and kept it to themselves. The wife tentatively began telling me how she and her husband loved to watch Showtime’s series Billions together. When the scene of the lawyer Chuck Rhoades (played by Paul Giamatti) is being tied up by his wife Wendy (Maggie Siff) she quietly said that she noticed some tingling in her genitals. Her husband looked at her in surprise in the session as if seeing a new woman emerging. I asked her what happened next with this awareness and she said: I was turned on by the sensation and the scene but didn’t think I could share this with John, he would think it was weird.

So what happened in your body after you edited yourself, I asked. She looked down and said, the sensation went away and we continued to watch the show. I reflected that she had chosen to let the feeling go because she didn’t feel permitted to include what she considered transgressive turn-ons with John. Then I checked in with him and wondered what was going on in his body and mind when he heard this sitting next to her and he said: I was getting a bit turned on hearing her describe the scene, and felt surprised that she didn’t share it with me since I never knew she was into that. In fact, I was turned on watching the scene myself at the time but chose to keep it to myself to protect Chloe from my dirty mind. Each of these partners has remained behind their wall of excitement and passion for fear of how their partner might judge them negatively.

I helped them to anchor their physical experiences so that they don’t run off into analytic explanations and remain true in the session that is free of judgment and shame, so that they stay present with their authentic selves in the presence of their partner who is equally as vulnerable. In various ways with clients, I ask them these questions:

What aspects of ourselves do we choose to keep hidden or private from our partner?

What could shift in an erotic partnership if we choose to become more vulnerable, playful and curious with ourselves and one another?

These are the questions that have been continually asked by artists, scientists and creative thinkers for generations. My colleague Esther Perel asks in her latest Podcast, Where Should We Begin?, how can you want what you already have? The teacher and writer Alton Wasson offers participants of his Contemplative Dance workshops the metaphor of moving and witnessing the mover as an experience akin to a “chest of drawers”. Similar to partnered sex in which one partner is engaged in and witnessing/experiencing a partner, the choice to open a drawer to experience an aspect of ourselves and our partners happens only when there is “freedom from arbitrary or despotic control” (Declaration of Independence), meaning free of limits set by an external power. In this case it could mean external societal values, misunderstandings/myths of meaning when it comes to one’s fantasies, or limits placed on gender roles.

Myths or misunderstandings about sex, fantasy and erotic desire begins with a child’s learning from their family, religion and schooling about sexuality. Unfortunately, due to limited subjects being allowed in schools due to Abstinence Only education in the US, and heteronormative focus of sex education, people grow up with the kind of limited information that inhibits them around speaking of their sexual desires with a partner. They may have learned about STIs (formerly known as STDs), or protection like condoms, oral contraceptives and the IUD (why oh why are doctors not telling folks about the female condom, stay tuned for an upcoming blog on this topic!). Many people also believe that their partners should be able to read their mind and automatically know what turns them on. I can say from my clinical experience that it is almost impossible for people to be mind readers and know exactly what turns their partners on sexually without active and open communication.

According to relationship therapy research conducted over many years by John Gottman, open and continual communications are the building blocks of a satisfying relationship). There is often a misperception that too much communication and frankness about sexuality in a relationship may lead to the end of relationship; however, couples who are emotionally and verbally expressive (whether strongly or even in moderation) tend to have long and satisfying relationships. In other words, it is important that partners in a relationship be comfortable expressing themselves in constructive forms of communication. Since partners don’t get this training early on, nor is it modeled for them, they are lost in the woods and revert to silence and emotional shutdown on this critical aspect of their lives. After the early novelty wears off, a couple need more nuanced language to describe what they desire. Couples come to us months and sometimes years into a relationship that has been reduced to a tapering spark.

My mission in creating CLS and the Sex Esteem® model is to provide people the education, the confidence and the curiosity to become more aware of their erotic triggers, their sexual fantasies, and explore the play space of their sexuality with their consciously chosen partners. My background in modern dance and improvisation taught me from a very young age that exploration is fun, that there are no wrong movements (as long as all around you are safe and consensually there) and that you can create

from nothing an experience that is new, unique and fortifying when you are fully free.

Being able to constructively communicate sexual desires to a partner/spouse is not only freeing and gratifying for oneself and one’s partner(s), but the freeing nature of co-creating an experience serves as a bridge to a more intimate, authentic relationship. The rocket needs to be ignited again and again by each person to produce a sustaining spark of passion. And as the Declaration of Independence states “we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.”

Be mindful of your erotic liberty and honor your intentional choices this July to enhance your sex life.

Painful Sex: Best Therapy Practices for Women and Couples

January 17, 2017

Sari Cooper

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Women who experience painful penetrative sex due to Provoked Vestibulodynia (PVD), Vulvodynia and other forms of Pelvic Pain may have suffered in silence for years. They may have thought that the pain was due to being new to intercourse and that it would subside. Or perhaps they may have mentioned it to a gynecologist, only to be told that there was no evidence of any diagnosis, or that they had a bacterial infection and prescribed a medication that didn’t help. For some women who had painful sex that was intolerable, they may have avoided going to a gynecologist for their entire adult life.

Women we see at Center for Love and Sex who are in heterosexual relationships where penetrative sex is an expected part of the sexual repertoire over time develop tremendous shame, anxiety and fear of any sexual encounter if they feel it will lead to intercourse. Their partners may gradually avoid initiating sex due to the obvious reason of not wanting to cause their partner/spouse pain but in addition, of wanting to avoid being turned down which they experience as outright rejection, lack of desirability and at times shame.

As a consequence to the painful sex, some male partners/husbands may develop their own sexual disorder like erectile dysfunction or premature/uncontrolled ejaculation due to the anxiety that develops around their penetration hurting their partner. Couples like this tend to self refer to a CLS therapists when sexual avoidance has gone on for some time and couple is in crisis or fear of losing their sex life altogether. The physical ailment causes intra-personal and interpersonal challenges that have to be addressed in therapy. Many times these women can treat and heal their pain when working with a pelvic pain physical therapist.

When I mention pelvic floor physical therapists to friends and even other therapists, they have never heard that this specialty even exists. As a systemic sex therapist, I frequently see women and couples who present with painful sex and collaborate with pelvic floor PTs to coordinate treatment in a holistic manner. I have had general therapists refer some of these cases to me after seeing clients for many months or years assuming the pain was a somatic outcome of early trauma.

It is critical for all therapists to understand the structure of the pelvis and causes of pain so that they know how to support, advocate and refer their client to the right doctors and pelvic floor PTs so that they can move ahead quickly with a treatment protocol that addresses their particular issue. It is also important for pelvic floor PTs to understand the consequences the pain has had on the client’s primary relationships, her Sex Esteem®, and shame level around discussing the specifics of her condition so that they can collaborate with the therapist. I will often assign homework assignments that will echo or support the exercises being assigned by the pelvic floor physical therapist.

In my upcoming webinar for therapists, sex therapists and physical therapists titled The Collaborative Clinical Care Model Between Therapists and Pelvic Floor Physical Therapists Involving Sexual Pain, I’ll be collaborating with Amy Stein, DPT Founder and Director of Beyond Basics, a specialty PT practice in NYC and the author of Heal Pelvic Pain, a self-help book for people dealing with painful sex, urination and other physical activities involving the pelvis. I invite you to spread the word about the webinar which will be live and take place on Monday February 6^th from 12:30-2:30 PM EST and is geared for professionals.

For those of you reading this who suffer from any sort of pain during sexual activity, I invite you to contact my practice, Center for Love and Sex via email sari@saricooper.com or coordinator@saricooper.com to discuss your situation and set up an appointment for an in person session or a coaching session if you’re outside of the NYC region.