I think one of the biggest problems that I see in my office is untreated anxiety. I guess when people think of someone that is anxious, they think of young Woody Allen, Mr. Chicken, or Edith Bunker. (Hey, I did turn 52 yesterday, so yes, I am dating myself…and?)

But anxious people often do a very good job of looking outwardly placid and calm. I know, because I used to be incredibly anxious but people often told me how calm I always appeared. If they had only known! Anyway, in my office sometimes even I am fooled by someone’s laid back manner, surprised to find out that underneath lives a total worrier.

I guess here I could make a quip on how to go from “worrier to warrier,” but that’s not really the point. The point is that anxiety, especially performance anxiety, throws cold water onto more sexual encounters than just about anything.

There are so many ways to learn how to cope with anxiety. Notice I said “cope.” You don’t want to make anxiety disappear, because sometimes anxiety is good–it gives you a jolt of adrenaline to get through a presentation, for example (or run from a T. rex, depending on your circumstances). But too much anxiety doesn’t help you at all.

People are sometimes surprised when they come in for lack of desire, ED, PE, or other sexual problems to find out that they have anxiety. Sometimes anxiety presents as negative thinking, abundant self-criticism, and fears about performance or rejection, not racing heart or shortness of breath.

Cognitive behavioral therapy and relaxation techniques can be very helpful. Once learned, these techniques will always be with you. Sometimes medication is helpful at the beginning of treatment, and later find that they can, with their physician’s help, wean themselves off. Learning these techniques can take a bit of time and effort, but are well worth doing.

Seems like everything is tied in with the Olympics in Beijing this week. Well, why not sex? Taoist sexual practices hold wisdom for every lover, whether Asian or not. If you know anything about the practice of Tantra, then you will find many of the Taoist practices to be similar.

There are several primary principles behind Taoism that can be applied to sexual practices. First and foremost is “chi,” or energy. If you watched the opening ceremony of the Olympics, you saw a celebration of chi. Chi is the energy that is part of everything that exists. Another related concept is “jing,” an energetic substance in the human body. When you lose all your jing, Read the rest of this entry …

Well, here we go again. Yet another public figure admits having sex outside of marriage. I guess at a certain point we’re all just going to throw our hands up in the air and collectively give up on monogamy as a “lifestyle choice.”

The part of the affair between John Edwards and his former videographer that sickens me is that he and his wife put up this astounding front that he was all about being the supportive husband, right there on “60 Minutes.” They had me teary-eyed as together they declared that he was going to run for office despite her cancer diagnosis Edwards swore up and down that he wasn’t using his wife’s health as a way to gain attention and sympathy for the campaign. Makes me wonder, though.

As a psychologist, I’ve worked with many clients with diagnosis, including women who survived breast and other cancers. And in the privacy of my office, it is not unusual for a woman to confess that her cancer diagnosis made her think long and hard about whether or not she wanted to stay in her marriage.

Cancer can be a turning point, and a test of the strength of a relationship. As I heard about Edwards’ confession of the affair, I couldn’t help but wonder if Mrs. Edwards had the same thoughts–but chose instead to “stand by her man.”

It’s all very confusing. Edwards acted like yet another foolish politician, unable to keep his pants zipped because the attention he garnered made him narcissistic and grandiose. A certain personality type is drawn to run for office. Or, is it that we choose to be lead by someone with that personality: attractive, charming, and capable of lying.

Many people have been disappointed and hurt by the fact of a father who has cheated on mom. Often all is forgiven and made nice. So it goes with our politicians.

Maybe it is time to hold men (and women, of course, but I am talking about male politicians here) more accountable for the emotional destruction they cause by their behavior. If you are unhappy in your marriage, deal with it like an adult and tell your partner. Better a divorced politician than a hypocritical politician, I think. If you need sexual variety, for goodness sakes, there are other ways of getting it than going outside of your marriage. If you want to have multiple partners, explore polyamory (the practice of loving more than one partner at a time–much too complicated for me, I always say, as it’s complicated enough just keeping one relationship working).

But don’t sneak around. And if you’re a politician, please don’t play us, the public, as well.

Some of you may know that I edit the Women’s Sexual Health Journal for the Women’s Sexual Health Foundation. Last year, the founder of TWSHF, Lisa Martinez, RN, JD, had a double mastectomy–and folks, she kept working on behalf of the foundation the entire time. She is an awesome person, someone I truly admire.

Anyway, US News and World Report interviewed Ms. Martinez for their blog. If you want to know how to prepare yourself and your partner for the sexual side effects of breast cancer, please read.

My colleague Dr. Joy Davidson wrote an interesting–and balanced–article on men who love big beautiful women (BBW). Dr. Davidson points out that for the most part, the type of body a man is attracted to is a simple preference. However, some men take their love of BBW to the level of being a fetish. That’s when things get off track, when a man cares more about the physique than the woman.

Of course, men objectify women all the time, seeing them something like works of art to be admired and possessed. And women do the same.

Always best to put your energy into loving the person within. The flesh changes as we age, or, unfortunately, as we may encounter illness. If we love the soul within, then those involuntary changes aren’t likely to shift our attraction to a partner.

Today the Journal of the American Medical Association (JAMA) published research that suggests women who experience sexual side effects from the use of antidepressants may obtain relief by taking sildenafil (Viagra).

For the thousands of women who take antidepressants, decreased sexual desire is a huge problem. The Women’s Sexual Health Foundation, of which I am editor of the organization’s Women’s Sexual Health Journal, has been surveying the problem through an on-going internet poll.

All of this information is sure to cause a huge buzz among those of us who treat women with sexual problems. On one side will be feminists like Dr. Leonore Tiefer, who argue that women’s sexual problems cannot be treated with a pill. On the other, physicians who genuinely want to help their female patients with, well, a pill.

Having worked in medical settings and in my private practice with women (and men) who experience sexual side effects from antidepressants, I don’t think the answer lies in entire answer lies in the use of a pill, either. I think it lies in the way in which we treat depression, and the way in which we understand women.

This is a big, complicated topic, too big, perhaps, for a blog. But doctors tend to hand out antidepressants like Pez, medicating situations that need and deserve to be explored in therapy. So that’s the first problem right there. Some people absolutely need medication. But all people in that group also need psychotherapy. And then there are those who do get tripped up by life–perhaps a job loss, or the traumatic death of a loved one. If they have trouble climbing out of a dark mood after a few months, then they may also benefit from medication–and psychotherapy.

The largest group by far, those with mild depression clouded by longstanding automatic negative thoughts (”ANTS”) can be helped with psychotherapy alone. This group, however, often receives Pez instead, with the belief that it’s just easier. Given the potential sexual and other side effects, it’s quite clear that it’s not that easy at all.

The fact is, too often it is physicians–GP’s–who are prescribing medication. Psychological issues are often much deeper than lay people–including, dare I say it, physicians–realize. In my ideal world (never gonna happen, but you can view it anyway), all folks who visit the physician for an antidepressant would get a recommendation to have an evaluation by a mental health professional. Going further, they would all be required (definitely never gonna happen) to have 6-12 sessions of cognitive behavioral therapy.

But remember I said that it’s complicated? Well, of the women who go on antidepressants and have sexual side effects, how many of them do you suppose had pre-existing sexual concerns? You don’t know, do you? Well, neither do I. But I’m guessing it’s a large number. And who knows, maybe some number of women are going on antidepressants because they cannot have an orgasm, or are inhibited, or were sexually abused and cannot enjoy sex. I know I recently treated a woman who had been treated for deep depression who realized that part of the reason she was so depressed is because she couldn’t have an orgasm. Think about that–never experiencing something that comes naturally, like being able to laugh or cry. I wonder if anyone–physician or psychologist–had ever asked her about sexual function.

So we could go in all kinds of directions with the thoughts generated by this one small study. I’d love to hear what you think–I invite you to comment, and I’ll write more on this topic, based on my own ponderings as well as any comments I receive.

The Los Angeles Times has an article on the G-spot in today’s “Health” section. If you are or have been a woman in my practice, and we’ve talked about the G-spot, then you already know what’s in the article: Not every woman seems to have a G-spot, and not every woman who locates the G-spot finds stimulation to the area pleasurable.

The reporter also mentions the G-spot shot, an injection of collagen where the G-spot is supposed to be and that is also supposed to increase a woman’s pleasure during intercourse. It’s a silly procedure that has never received FDA approval and that, like so many other things, puts pressure on a woman to have orgasm in a particular way at a particular time or face feelings of inadequacy and failure.

If you are a woman who wants to try G-spot exploration, then use your fingers, use a G-spot wand (usually an acrylic toy with a long handle), or a G-spot vibrator and see what happens. Have fun trying, and don’t put any pressure on yourself. If you enjoy it, great! If you don’t enjoy it, great! You had the experience of trying.

I already knew this–did you? Couples that share in fun more frequently report that their marriage is a happy one, according to an article in USA Today. “Fun” is defined as leisure activities that the couple enjoys doing together. It does NOT include watching TV or noodling on the Internet!

My husband Mark and I just returned from a lovely weekend in Palo Alto, tasting wine and eating great food. We consider such getaways essential to keeping our marriage happy. In the middle of a blah period, we can cook a great meal and take out one of the bottles of wine that we purchased on our trip. Drinking the wine helps us remember good times. Maybe that’s why this August we’ll celebrate the fact that we met 26 years ago.

In my practice, it is sad how many couples never plan to do anything fun together. They become glum about the marriage–and other things as well. Did you know that scheduling fun is part of treatment for depression? Fun and play are just as important for adults as for kids.

Not sure any more what feels like fun? Sit down and think about things that you enjoyed as a kid or adolescent. One woman recently decided that she most enjoyed dirt biking when she was young, which motivated her to get her cyclist’s license and get back on her scooter. Once you figure that out, invite your partner to join you.

Or go back to your dating days and recall what you enjoyed doing back then. Did you like to go out dancing? Maybe it’s time to take some lessons and learn new steps. Or were you always at the game together? Were romantic comedies your thing? Or did you see plays? Go to the museum? Take photos? Hike?

But people do change over time. Some interests are enduring, some not so much. If you find that what used to interest you now makes you yawn, time to pick something new. Have fun trying it together, and if it turns out that it’s not as much fun as you thought, big deal. Just try something else!

And btw, on a last note, ahem, sex is fun! Interesting that the article left out this recreational activity…

A story in the BBC News reports that more people in their 70s are having sex–and enjoying it. Studies suggest that women are more orgasmic than they once were as they aged, and men find that their erectile function improves if they have sex at least once a week.

What are your stereotypes about people aging and sex? I remember a 30-something client whose sex life with his wife had diminished commented, “We need to have sex now because we won’t be having it later.” I remember looking at him with shock. Did he really think that people became sexually dead as they aged?

As one therapist quoted in the story suggests, not every elderly person will choose to stay sexual, but the key word is, I think, “choose.” When we buy into stereotypes of aging people losing interest in sex, we also buy into the idea that our sexual expression ends in our 50s, 60s, or 70s.

I would guess that people who enjoyed sex early in life and in midlife would choose to stay sexual, unless serious illness prevented them from doing so. But even someone who is ill can still have sex. We just need to broaden our ideas about what sex is–does it necessarily have to be intercourse? And does one need to have a partner to still be considered a sexual being?

Sex serves many functions, from physical well-being to emotional connectedness, whether with a partner or to one’s self. There’s really no reason for people to worry about becoming old and sexless. You can choose to stay sexual as long as you wish. You may need to talk to your physician for help with hormones or medications, but if you want to imagine yourself enjoying a romp or a long, slow session, go ahead. It’s well within reason.

A highly respected colleague of mine sent me a NY Times story on a physician who started a “pelvic health spa” for women modeled after dental offices that whiten teeth. The idea is to lure women into the office to teach them how to exercise their Kegel muscles, though the physician calls them by their newer name, pelvic floor exercises.

There may be some merit to having a strong pelvic floor, because weakness can cause incontinence, or involuntary leaking of urine. The muscles of the vagina are also connected to the pelvic floor, so exercises can tone the vagina and, for some women, improve sexual sensation and orgasm.

But not every woman needs this type of treatment. It isn’t like teeth whitening–pretty much if you live on the planet you are guaranteed to have teeth stained from tea, coffee, wine, etc., though if you ask me there are a lot of people running around who, when they smile, make me think, “Oh, you’ve had your teeth whitened!” Back to the pelvic floor, though. Young women usually don’t need treatment. And just because a woman is near or in menopause doesn’t mean her pelvic floor muscles are slack.

In any case, the physician has discovered a way to prey on many women’s already low self-esteem. Like the G-spot shot and “revirgination” surgery, here is yet another message that women’s bodies are just not okay “as is.”

If you do have problems with incontinence or you have noticed that you aren’t feeling as much sensation, then by all means you should discuss this with your gynecologist or a urogynecologist–a urologist for women). But don’t just go running out to pay for yet another service you might not need.