Most couples have great difficulty talking about sex, and when they do manage it, they often bungle the conversation.   From a sex therapist, here are seven ways to make communicating about sex easier.

1. Identify what you want to talk about.  Do you want to talk about orgasms that fizzle, sexual boredom, or your partner’s lack of attention to after play?  Saying vague things, like “Sex with you is boring,” isn’t going to solve the problem.
2. Keep your communication style assertive.  Don’t put your partner on the defensive.  Focus on what you want, not on what your partner does or doesn’t do.
3. Help your partner help you.  Be specific about what you want your partner to do.  “Change things up” isn’t as clear as, “I would like to have a little more manual attention before we have intercourse.”
4. Speak in language your partner appreciates.  If your partner doesn’t like you to use coarse language, then don’t use it when you are giving feedback or asking for what you want.
5. Be sensitive to your partner.  If your partner is awkward or hesitant in bed, telling him or her that they are as exciting as a flounder won’t help.  Tell your partner something you like, then what you’d like them to do differently, then thank them again for doing what you enjoy.
6. Don’t bring up the past unless absolutely necessary.  That means both things that happened between the two of you, and things that happened between you and another partner.  Move on and focus on the present moment and what you’d like to see change in the immediate future.
7. Give feedback at an appropriate time.  Right after having sex isn’t it.  Choose a time when you are both likely to be relaxed and your partner will be receptive.  Let your partner know what you’d like to talk about ahead of time.

Have any tips you’d like to add?  Leave a comment and I’ll post those that I think are helpful.

As important as our sexuality is, I doubt very much whether many people review their sex life over the past year and ponder a vision of what could be possible in the New Year.

The “oh” decade (years 2000 through 2009) brought us a war over abstinence-only sex education, an injection was introduced to help women avoid HPV, and more pills and potions were created to ensure an erection, create desire, or make sex feel better.  We were also witness to multiple sex scandals, from Larry Craig sending Morse code in a public bathroom to Mark Sanford lying about hitting the Appalachian Trail when in actuality he was winging his way to see his soul mate in Argentina.

Also in this decade were a slew of books about low desire, no erection, no orgasm, ejaculating too quickly or not at all, tantric sex, no sex, and the difficult-to-define too much sex aka “sex addiction.”   (More on this latter topic next week.)  It’s difficult to tell if the world is really a better place despite the efforts of so many well-meaning authors.

If I could make some wishes for the year ahead, they might include:

• Couples would talk to one another about their sex life in the same way they talk about what breed of dog to get or what refrigerator to purchase
• Men would stop measuring their self-worth by their erections, and women would do the same.
• Women that don’t enjoy sex would admit it’s because they have never told their partner what to do to make sex enjoyable.
• People would understand that sexual problems that take years to develop can’t be resolved in a single 50 minute session.  Couples wouldn’t wait years to see a therapist, making their problem all the more complex.
• Pharmaceutical companies would state in their ads for antidepressants, anti-anxiety medications, sleep medicines, and sexual aids, “Try psychotherapy first.  You may not need medication at all.  And if you do, your therapist can refer you to a psychiatrist for treatment.”  Ideally, however, such advertising would be banned.
• Sex education would include information about the serious decision-making and responsibility involved in choosing to be sexually active.
• Every pregnancy would be a wanted pregnancy.
• People that are frustrated by monogamy (more…)

Every once in awhile I like to write a bit about my experience of being a sex therapist in Orange County.  The end of the year seems like a good time to reflect on my experience.

My practice is definitely a microcosm of the macrocosm.  As the economy slowed down, so did my practice.  Whereas I used to have lots of people in the real estate industry, they now rarely cross my threshold.  And where I used to see some people that were fishing around for answers, I now see mostly clients that are in more dire straits–and that’s the way, frankly, I like it, because then I’m not so much just an actor in someone else’s drama, but working with people paying for a real service.  (I apologize if that sounds a bit callous, but I’m just writing it as I experience it.)

Having my practice slow down has been a good thing.  I have had time to work on a book that’s already been purchased by a publisher.  The book has required a great deal of reading and reflecting, which has in turn informed my practice, making me a stronger therapist in various areas of my work.

Orange County is such a diverse place, and is becoming more so all the time.  This past year I have, once again, seen people who have moved here from all over the globe or who are visiting here from another country or state.  It isn’t easy to find a sex therapist in many places, and Orange County is a cultural and business center, and people do seek help here.  Since I worked as a teacher in Los Angeles for a decade, I thrive when I get an opportunity to learn about different cultures and religions.  The LGBT population also seems to be growing, and I have worked with more gay people that are sorting out various issues.

What will happen in 2010?  First, I am already seeing signs that my practice is picking up, so I think the economy as a whole must be improving, albeit slowly.  Second, I think I will see more people that are looking for non-medical interventions for their sexual problems.  No one really likes to think they are so bad off that their only recourse is a pill!  (Of course, sometimes medication is an important part of treatment, but at least the person will know that they have made an informed choice.)

Third, I will be attending at least two conferences, one on how to better help men that have been sexually abused, and one for AASECT, an organization for which I serve as the Western Regional Representative.  That, too, has been a positive part of 2009, because I have met and networked with plenty of other AASECT member, people that I think of as not just colleagues but friends.

Fourth, I am some plans for providing continuing education, but I’m keeping that under wraps until they’re ready for debut.

As for the blog:  It will still be here.  And, if you are reading this and haven’t yet done so, you can also sign up to receive my newsletter.  You’ll get a free ebook, “Sexual Discoveries: 25 Secrets for Incredible Sex,” plus a monthly article from me.  I also include “Really Weird Sex Stories,” for which I scan the Internet.

If you’ve been a faithful reader, you know that I frequently comment on upcoming developments in the area of sexual medicine and pharmaceutical interventions.  Get ready for a new one:  A prescribed topical spray that will numb the penis and delay ejaculation for men that have premature ejaculation.

An article in the NY Times reports that this new spray will help men that ejaculate early–on average, 36 seconds–to last another 2 minutes or so.  And the pharmaceutical company is betting that men will line up around the block for this medication–especially with the proper marketing.

The whole issue of how long intercourse “should” be is at stake.  Most men only last a few minutes, so that indicates that’s pretty much normal.  But men feel embarrassed because they know it’s possible to last longer.  And women complain, because they think that if their partner lasts longer, they will be able to have vaginal orgasm.

The fact is that a man’s lasting longer won’t necessarily lead a woman to have vaginal orgasms.  Only about 20% of women have orgasm this way; clitoral stimulation is needed instead.

Also, there are lots of ways a man can learn to last at least as long as what they’d be able to achieve with a topical spray.  (Other topical sprays exist, but they tend to numb a woman’s genitals as well; this new one isn’t supposed to have that side effect.)  Men that want more self-control can learn some methods of awareness that can help them during intercourse.  Also, couples can learn to change their sexual “script” so that both partners have more satisfying sex, regardless of who lasts how long for whatever activity.

In addition, men that have this issue often also have chronic anxiety that has gone undiagnosed and untreated.  In therapy, we can work on both issues so that a man has more overall confidence and control in various aspects of his life.

Yes, therapy costs money.  Yes, it takes effort.  But you don’t learn a skill from a pill–or a spray.  Besides, with our paltry sex education–plumbing + prevention–coming to sex therapy may give you a whole different perspective on sexuality and pleasure that you’ll never get from a visit to the pharmacy.

The University of Warwick and the University of Manchester just sent out a press release about a study that shows that psychotherapy will make you happier than having more money.  They compared the effect of several sessions of therapy vs. a sudden windfall of 25K pounds in cash and found that therapy by far had the larger effect on a person’s sense of well-being.

How can that be?  Because no one can really put a price on mental health.  You know how people say that if you don’t have health, you don’t have anything?  Well, that includes mental health, too.  Yet mental health is the unarguably the most neglected aspect of overall wellness.  And sexual health is a tiny but even more neglected part of mental well-being.  Sexual health is considered an extra, a frill.

Don’t let money stop you from pursuing better mental health.  As I’ve written recently, there is always some way to get help.  Every licensed psychotherapist does a few thousand hours of work in agencies across the country where low- or no cost mental health services are offered.  Therapists also usually will see a client or two for low fee; some therapists, like myself, have an intern that can accommodate a few clients as well.

So if you are miserable and dreaming about winning the lottery as an answer to happiness, dream on.  It’s good mental health that will bring you more contentment.

What a treat I had in store when I contacted Kim Airs, the “sexpert” for Pipedream, a humongous manufacturer of sex toys.  Not only is she incredibly humorous, but she also suggested that we could invite local members to learn about sex toys and tour the factory.

Talk about having a blast and a half.  I’m the Western Regional Rep for AASECT, the largest organization of sexuality therapists, educators and counselors, so I get the opportunity to call and welcome new members.

So we aimed for Friday, November 13.  We only had a few members attend, including AASECT past president Patti Britton and new member Holly Richmond, but a good time was had by all.  First, Kim gave us a tour of the giant showroom filled with racks and racks of toys of every type, color, material, and purpose imaginable.  She pulled vibrators out and put in batteries so we could feel the difference in intensity.  She let us examine Japanese-style masturbation sleeves for men.  And we learned all about the different lubes (Pipedream’s bestseller is a lube called Moist).  Then there’s the Fetish line—not for the faint at heart, but certainly intriguing for anyone who wants to try roleplay.  Dominatrix and slave in a box!

Sex toys can be an important part of sex therapy treatment.  They let men and women experiment with sensation, either privately or together.  They help with orgasm in a way that is low key and non-pressured but still very arousing.  Things like lubricants permit both vaginal and anal intercourse to be more comfortable.  For people who don’t have a partner, they can be essential.  For people that do, they are a terrific adjunct.

Okay, so seeing a giant tub filled with disembodied purple penises is a little weird.  And watching the mild-mannered Latino men and women going about their jobs as if they were making widgets was unexpected.  The factory is incredibly clean and organized, though.

One of Kim’s jobs is to answer questions from people that have bought their products, even though they don’t sell anything directly to the public.  She told us that when one woman complained that her husband bought her a dildo that was too large, she naturally told the woman that the product couldn’t be returned, “but perhaps you can use it as a doorstop.”  In the anything goes world of sex toys, it’s a perfectly fine answer.

Last words from Kim for women on how to pick a sex toy:  “Use your eyes.  If one sense is drawn to a certain shape or color, that’s your body telling you something, so pay attention.”

Thanks, Kim, for an entertaining and fascinating morning.

(In photo L to R, Dr. Patti Britton, yours truly, Holly Richmond, and Kim Airs.)

I am in the midst of researching and drafting a book manuscript on sexuality and mental illness and coming to the increasing realization that because the field of psychology hasn’t embraced sexual dysfunction, things have gotten way off track.

Here’s what I mean:  In my studies as a psychologist, sexuality was kept out of most coursework.  Even in courses about child development, there was little that was specific to sexual development outside the usual Freudian psychosexual framework (oral, anal, phallic, latency, genital stages).  So if I was learning about generalized anxiety, hypochondriasis, or eating disorders, I was learning about every aspect except sexuality.

This splitting off of sexual dysfunction from other types of disorders means a couple of things.  One is that psychologists, marriage and family therapists, and social workers don’t ask about sexual problems when someone comes into their office complaining of, say, panic attacks.  A second is that when people have a sexual concern, they see it as being distinct from other aspects of their psyche.  And a third is that it allows pharmaceutical companies to develop symptom-targeted medications that don’t address the root cause of many sexual problems.

If you are experiencing a sexual concern, try not to see it in a vacuum.  Have you always had anxiety?  Depression?  Is there a history of trauma in your background?  Does your partner complain that you are “obsessive”?  Do you have issues with becoming truly intimate with another human being?  What else is going on with you that you haven’t wanted to address and that is now coming out as a sexual symptom?

Sexual symptoms send people to a sex therapist because, in general, people like sex and want to be physically and emotionally close to a partner.  But sexual symptoms like erectile dysfunction, vaginismus, and lack of sexual arousal can be more difficult to keep hidden than other types of psychological problems.  After all, if you have a fear of spiders, you can just avoid walking in the woods.  But if you have an intimate relationship, it becomes rather obvious that something is wrong.

In my ideal world, all therapists would be knowledgeable about sexual dysfunction, and all clients would accept the connection between other psychological problems and sexual symptoms.

But I think we have a long, long way to go.

I wanted to share this interview with a sexual medicine specialist in the Bay area, which I think is an excellent introduction to the common problem of painful intercourse.  I especially liked that they started out the segment by letting women know that if they have painful sex, they are not alone; about 10% of women have discomfort with intercourse.  They talked about three conditions:  vulvodynia, dyspareunia, and vaginismus.

As stated in the interview, there are treatments for painful sex, and they vary by condition.  What is not stated in the interview is that even if you do find a physician that understands and treats sexual pain disorders, it is sometimes tough to get as good an outcome as hoped.  For example, some women learn that they may have to live with some degree of discomfort.  Other women may be given a course of treatment, such as using graduated dilators, but may have psychological difficulties that preclude them from following the prescribed behavior.

The role of the sex therapist as part of the treatment team is an important one.  Many women that have sexual pain disorders balk at seeing a therapist because of the stigma and because of the lack of understanding of how seeing a sex therapist can be helpful.  Not all women may need the help of a sex therapist, but for those that may benefit, here’s how.

Because sex becomes associated with pain, motivation to stick with a treatment plan can wane.  Also, the woman’s partner can become discouraged and withdraw support.  There may be relationship difficulties that impede progress.  Also, a small percentage of women with these problems have had negative sexual experience such as molest and date rape.

A sex therapist can often spend more time with a woman understanding how the condition developed.  Again, the condition is not in the woman’s head, but there may be psychological factors that contributed to its development.  For example, sometimes a woman is in a bad relationship and has repeated yeast or other chronic infections at the same time.  She then develops vulvodynia, which is pain in the vulvar area surrounding the vagina.  The stress of the infection and the relationship may have simultaneously helped to manifest the vulvodynia.  Understanding and processing this can be very helpful for some women.

Also, sometimes women have developed negative attitudes about sex, or what is called a sexual aversion.  As you might imagine, this can have an impact on a woman’s relationship.  Sometimes, this gets in the way of healing.  A sex therapist can help a woman overcome her aversion and discover, or rediscover, a healthy attitude toward her sexuality and her sexual partner.

Yet another sexual myth to explode:  It’s always the woman in the relationship that doesn’t want sex.

Not true.  Not by a long shot.  It may not happen as often, but it happens more often than most people think.  And women are just as affected when their partner doesn’t want sex as men are when their partners turn them down over and over again.

Women in sexless marriages complain of feeling unloved, rejected, and unattractive.  In part because of the myth that “men always want sex,” they sometimes feel even more desperate than their male counterparts.  They experience intense sadness–and frustration.

When it comes to sex, even if you’re not talking about it, you’re communicating something.  When a man withholds sex from his partner, more often than not, he’s expressing displeasure with some aspect of the relationship.  What that is differs from situation from situation.  But getting a man to open up and talk about it directly can be difficult.  Quite often, he himself has no idea why he’s upset.  All he knows is that he doesn’t much feel like having sex, and there the story ends, leaving his partner frustrated.

I do frequently advise that physical problems be ruled out.  Unless you’re trained in medicine, you really can’t tell just by looking or studying someone’s behavior what might be going on in someone’s body.  Low testosterone and other medical problems can interfere with desire.

Also (and here I must admit I gave a big sigh), it can be difficult to convince a man to come into therapy, if a woman thinks this might be helpful.  He may call it “hocus pocus,” accuse the therapist of “just wanting to make money off of us,” or feel too embarrassed to talk about his problems.  Both male and female therapists, if they are worth their salt, understand this and know how to talk to men about their concerns.

Even though this is a difficult situation, it can be important that a woman supports her partner with the understanding that this may be difficult for him, too.  Instead of making threats or saying things designed to hurt, work on the problem together to find a solution.

That’s the question that someone recently posed to me, wanting to know if a marriage could continue if both spouses simply agreed that their sex life wasn’t very interesting, that sex wasn’t very important, and that their relationship worked well enough in other departments–parenting, finances, socializing–that they could stay together and simply do without.

Answer:  I suppose.  Before I moved into the field of sex therapy and had a more general practice, there were folks that confessed to me that they hadn’t had sex with their partner in a year, or two, or five.  Generally, they stayed in their marriage because of children and finances.  And generally, they were unhappy with the state of affairs, but felt that this was the best course of (in)action.

But being in a sexless marriage didn’t mean that they weren’t having sex.  Probably about half of those folks eventually drifted into an affair or, in the case of men, availed themselves of prostitutes. And then there was always the internet and the comfort of one’s own hand.

In my view, this is simply solving a problem with a problem, creating yet another level of complexity to a poorly resolved situation.  Affairs take energy, prostitution is still illegal, and both carry the risk of an STD.  These two solutions, plus the use of porn, create a huge but silent divide in terms of any intimacy that might be afforded by the marital relationship.

Rather than putting effort into avoiding sex, why not tackle the problem of an impoverished sex life?  Put on your emotional hip waders and splash into the river of relationship to try to sort things out together.  What is missing that you need?  Is it more respect and intimacy outside the bedroom?  Mutual interests that create a feeling of togetherness?  Permission to explore one’s inner fantasies with one another?  Better technique?  Improved lifestyle so that there is energy for sex?

Can a sexless marriage be normal?  Perhaps, but why would you want it to be?