Tag Archives: Erectile Disorder

Embrace Sexual Liberty This July After the Fireworks

We have just celebrated another July 4th 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.  couple in loveThe 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.couple marryied by Catholic priestWhen 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. Billions couple enact a BDSM sex sceneWhen 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. lesbian couple expressing sexual passion  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.

 

 

Wedding Season Worries for Grooms with Erectile Dysfunction

Given that it’s June and peak wedding season begins this month, I invited my associate Lauren to contribute a blog about the erectile issues that might cause havoc as a straight or gay couple ready themselves to walk down the aisle. 

With the peak of wedding season approaching for the spring and summer, heterosexual and homosexual couples that are getting ready to tie the knot may begin reflecting more on their relationship and their issues within it. Some feel like it’s crunch time and instead of avoiding these concerns, couples might want to finally tackle them before taking on married life. Sexual issues such as erectile dysfunction (ED), which is the difficulty to attain or maintain an erection or remain firm enough for penetration can frequently be put off by a couple and/or a groom because it is a vulnerable and sensitive subject for most partners to address. This procrastination can also lead to avoidance of intimacy in general, which is not a beneficial way to begin a marriage.

What I have found in my clinical work providing sex therapy at Center for Love and Sex is that ED is a common presenting problem for younger men as well as older men. Research has shown that 26 percent of men 40 years of age and younger are effected by ED, with half of them having severe ED.  Given that men are getting married at older ages, the fact that a quarter of these men (and their partners) may be secretly suffering from ED is a concern and one that we see frequently as couples are in the throes of planning their weddings.  Men are also well known avoiders of getting an annual physical.  As part of the CLS model we ask our patients to get a physical, as medical conditions can be a factor in the persistence of ED. The following medical conditions have been associated with ED: high blood pressure, kidney disease, diabetes, obesity, Parkinson’s disease, multiple sclerosis, side effects from medication, and treatment of prostate cancer. 

The young men I see coming in struggling with ED usually discuss performance anxiety, low self-esteem, relationship problems, anxiety, depression, stress, guilt, fear of intimacy, difficulty transitioning between porn and masturbation to partnered sexual experiences, as well as excessive alcohol intake. Other contributing factors may include questioning their sexuality,  having had a negative sexual experience, childhood trauma or worry over the lack of control they feel with their climax. It has been shown that ED and PE (premature or rapid ejaculation) often are presented together and that “ED is increasingly being recognized as the single greatest risk factor for PE”

Many young men who come in for help at Center for Love and Sex report that when they first begin talking about the problem, they feel vulnerable and at times worried about what their partner thinks of them, they feel a lower self-esteem.  However once I let them know these are common feelings that most men have when confronted with ED and that I will guide them slowly on how to address the issue, they begin to open up about the consequences this issue has had on their relationship.  Having sessions with both partners is critical to allow for the partner w/o ED to express their own concern, ask for guidance from the therapist and offer support to their fiance.  

Helping a client track their thought patterns during the sexual scenario with their partner can be extremely helpful.  Here are some thoughts that frequently occur before or during a sexual experience: “I’m not a man if I cannot get an erection,” “I am disappointing my partner because I cannot give them pleasure,” “this is all my fault that our sex life isn’t good,” or “my partner must want someone else because I cannot get an erection.” It is also common in gay relationships for the partner who identifies as the top to have more pressure to obtain and maintain an erection more than the partner who identifies as the bottom.  The anticipatory anxiety (the anxiety leading up to an event) can be just as stressful as the anxiety a man experiences during a sexual experience because it is setting oneself up for failure before anything even happens.

American society in general contributes to many of these negative thinking habits. For most straight teenagers and more recently gay young adults the dream of your wedding night, honeymoon, and marriage is presented like a Hollywood movie, complete with endless love making, excitement and passion. There is a lot of pressure on getting every detail down for the ceremony, ensuring your relatives get along, making sure the first dance goes off without a hitch that thinking about the penis responding properly can be overwhelming.  Given that many young men are now growing up with porn available at any time, comparing oneself to the exaggerated bodies and pharmaceutically assisted behavior of porn actors can only offer more heartache since one can never live up to one’s own and one’s partner’s expectations.   In films and porn men are presented as totally in control, exuding confidence and pleasuring their partner, at times for extended periods of time.

When you come into Center for Love and Sex, ED will be initially be addressed with both members of the couple if this is possible. This is important because sometimes there is unresolved anger or conflict, and difficulty in communication that could also being playing a role in sustaining the problem. It is also important to realize what effect each person has on what is going on in the couple’s system. ED can be the symptom that hides or exacerbates other behaviors, such as the non-symptomatic partner rushing to orgasm very quickly before their partner’s erection is lost.  Therefore, not only does this put pressure on the man with ED, it also puts pressure on the partner to rush through their pleasure.

Lastly, ED could also be masking a lack of sexual desire that one of the partner’s may have, so the man expressing the erectile issues may be in fact reacting to insecurities he feels around his partner’s lack of sexual desire towards him. In order to address these issues, we would discuss and evaluate the feelings each person has around ED, how they feel about their sex life as a whole,  and help each partner understand the relationship between their anxiety and the symptom of ED. It is easy to forget that the partner usually also exhibits anxiety during sexual experiences wondering if things will work out this time or thinking about how the partner with ED is feeling. So the couple must become more mindful of the pleasure of the sexual feelings, instead of putting themselves in a negative thinking pattern which diverts their focus away from the sexual arousal. In addition to that, it is important that when given home exercises to practice between sessions, they do it together in a non-judgmental, relaxed atmosphere where the couple learn to be better intimate partners and use the home exercises to increase pleasure and decrease anxiety as a team. So CLS and I invite you to a place of better understanding, more intimacy, and better communication that can help you not only on your honeymoon but for years to come.

 

Painful Sex: Best Therapy Practices for Women and Couples

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.

Amy Stein Co Presenter

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 6th 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.