But before talking about the role of feelings, here is a bit of general information about premature ejaculation (also known as rapid ejaculation).  Often the first question I ask is, “How long do you actually last?”  When a man answers three or four minutes, I tell him that he’s doing fine, because on average men last from three to 10 minutes.  However, the caller is often unhappy with this answer.  Generally, the partner is disappointed because she cannot have orgasm within the time that the couple has intercourse, or he once enjoyed better control but has noticed a change.  Some men have control for a minute or two, if that, which leads to the most frustration.

What to do?  It depends on the cause as well as perspective.  Some people, including many medical doctors, see premature ejaculation as a physical problem.   The thinking goes that a man’s penis and his mental responses to stimulation are overly sensitive, causing ejaculation before the man and his partner want it to occur.  When the medical model is used to explain and treat the symptom, then a medical treatment is used, such as a numbing cream or an antidepressant.  (Antidepressants can have the side effect of delaying ejaculation.)

However, premature ejaculation can also be a psychological problem.  Anxiety and stress are common culprits.  When a man is anxious about how long he will last, whether or not he will please his partner, or about some other aspect of sex, then his brain is primed to react quickly to stimuli.  Stress does the same thing by causing the body and mind to be “keyed up” in high alert, making it difficult to stay focused and manage all the sensations going to the brain.

But feelings can also contribute to premature ejaculation.  If a man is feeling sad, for example, about his relationship, he may find it difficult to last as long as he’d like while being intimate with his partner.  Men often contact me about this problem after the breakup of a relationship.  The problem starts seemingly for “no reason,” but upon reflection, the relationship was actually on shaky ground for quite some time.  Fears about one’s ability to please a woman not just sexually, but emotionally, can be subtle but still create an effect in the bedroom.

Anger can also disrupt a man’s sexual performance, as can feeling exploited or used by his partner.  He may not feel like being close to his partner under such circumstances, even though he mostly wants to please her.  He also may be too distracted by his negative feelings, unable to push them aside.  Though it may be a stereotype, men do tend to pride themselves on their ability to put aside feelings in favor of thought.  But try as a man might, if his negative feelings are strong enough, or if he is under stress or tired, they will make themselves known through various symptoms, including premature ejaculation.

When feelings are absent, there can also be problems.  If a man is with a sexual partner with whom he has little emotional connection, he doesn’t have an incentive to last a long time.  He also may not want to have a long period of intercourse because he doesn’t want to seem or become interested or involved with his partner.  Though there are some men who want to appear as “studs,” able to last a long time under any circumstance, the truth is that feelings do play a role in sex for most men.  After all, men are simply human; they shouldn’t dismiss the important information that their feelings hold for them, including when it comes to sex.

It is a myth that it is always the male partner that has higher sexual desire.  In my sex therapy practice, it is about 50/50 men to women that have higher desire than their partner.  Another myth is that most partners stop having sex once children have arrived.  If couples had a decent sex life before pregnancy, they will figure out a way to regain their sex life.

What causes differences of sexual desire?  The reasons are as varied as what causes differences in participating in different sports or liking different kinds of food.  Some people have a hormonal profile that makes them naturally more interest in sex.  Other people find that sex is a good way to relax, or feel connected, though their partner may not find sex as effective.  Some partners find that their desire to be with their partner never fades, while others discover that their desire diminishes over time.  People differ in how they were raised to view sex.  They also differ in how important it is to them personally.

Differences in sexual desire can cause a lot of friction in a relationship.  What never works is to nag, harass, beg, argue, or avoid the issue.  If you accept that it is okay, even normal, to have those differences and not read too much into them, then you can calmly and kindly discuss how you can both be happy.  Most couples find that simply compromising on how often they will have sex works well enough, while others prefer scheduling so that both know what to expect.  Some couples find that if the high desire partner has his or her needs met regularly, they are happy, whether or not the encounter is romantic or matter-of-fact.

If you can’t seem to resolve your differences, then you might benefit from the services of a sex therapist.  A sex therapist is a psychotherapist with specialized training in sexuality and human relationships.  The sex therapist can help you understand why you are stuck, give you each an opportunity to voice your concerns, and help you work toward a satisfactory solution.  This involves good communication, compassion for your partner, and a willingness to accept differences.

Asperger’s seems to be current vogue disorder.  HBO recently had a documentary on Temple Grandin, the fascinating woman agriculturalist who has written books about her own experience of Asperger’s.  Last year, three movies were released that featured characters with Asperger’s.  Asperger’s, it seems, is everywhere.

But is it? Asperger’s has a short history, because it was only first diagnosed in 1994 by Viennese pediatrician Hans Asperger, the number of people in the U.S. who have Asperger’s is actually unknown.  Many adults may have Asperger’s without knowledge of the disorder.   Today, however, many children are diagnosed sometime in their early childhood.  In any case, Asperger’s is

How does someone know that they or someone they know has Asperger’s, anyway?  People with Asperger’s usually have poor social skills, obsessions, odd speech patterns, unusual posture, and other peculiar mannerisms.  In an adult, the person may have difficulty understanding social behavior that others take for granted, for example, laughing loudly or at inappropriate times.  (One male client with Asperger’s, horribly embarrassed when he told me about his Peyronie’s disease, then went out to the reception area after his appointment and confided so loudly to the receptionist that the entire clinic heard him.)  They may have strange collections, such as one physician with whom I’m familiar who collected all things having to do with bees; even his office was decorated in black and yellow.

When people with Asperger’s speak, they may not make sense, not because they speak gibberish but because they don’t know how to segue into normal conversation.  Generally, they learn how to get along socially by observing and copying others.  Since they don’t do well with change in any case, this only contributes to behavior that may appear strange or robotic.  A common myth about Asperger’s is that everyone who has it is a “genius.”  Not true.  There are people with average intelligence that also have Asperger’s.

Because people with Asperger’s don’t fit in socially, they often apply themselves in school or in their careers.  This makes them stable and dependable, which can be attractive to a partner that is looking to settle down.  Many people who partner with someone with Asperger’s will marry in the belief that feelings and intimacy will grow over time.  While this can happen, more often than not the non-Asperger’s partner becomes disappointed and frustrated.

Sometimes this disappointment and frustration becomes focused in the couple’s bedroom.  While adults with Asperger’s vary, many non-Asperger’s partners find the lover with Asperger’s mechanical and emotionally disconnected during sex.  Even if they have sexual experience, they may not understand what is expected of them, e.g., mutual pleasuring, vocalization, or emotional expression.

Besides misunderstanding social cues and lacking in empathy, the partner with Asperger’s may also be overwhelmed by the sensory experiences of sex.  One man, for example, disliked the smell and feel of his partner’s hair.  Another couldn’t stand the little bumps and irregularities of his partner’s skin and asked her to wear a body stocking when they had sex.  A woman with Asperger’s complained that she felt “completely smothered” by her husband during lovemaking and decided it was better to divorce than to put up with having to have sex.

Is there any hope for couples in which one partner has Asperger’s?  Yes, of course.  If both partners are motivated to change, then they can have a more satisfying sex life, one that makes each partner feel wanted and accepted.  But a satisfying sex life generally starts outside the bedroom.  Partners first need to educate themselves about Asperger’s so that they can understand how it is affecting their intimate relationship.  They need to be able to communicate to each other; both need to develop some empathy for the other’s position.

Sensate focus activities may also be helpful in slowing down both partners so that they can concentrate on what feels good, instead of on performance.  Learning to give verbal feedback about sex without creating defensiveness is another valuable skill.  Being realistic about what may or may not change in the bedroom is another facet of acceptance of the diagnosis of Asperger’s.

You’ll have to wait until January 2011 to read a copy of my book, which discusses how various psychological problems, from addiction to learning disabilities, affect a couple’s sex life, but until then here are some links to resources about Asperger’s that may be helpful to you:

Asperger Adults

WEGO Health on Asperger’s

The National Autistic Society

A word about diagnosis and treatment:  Different people react to a diagnosis of Asperger’s in different ways.  Some people are relieved to discover an identity that answers questions for them.  Others are curious.  Still others are upset or go into denial.  No individual should ever be forced into being diagnosed or treated.  However, therapy can be helpful for people with Asperger’s and spouses or other family members who are trying to understand and give them support.

Really?  That’s not what I see.  When a so-called sex addict comes into my practice, I usually have before me a man who:

• Was exposed to pornography at a young age

• Learned to cope with many adolescent challenges by looking at porn
• Used porn to “self-medicate” stress, anxiety, and depression
• Has difficulty sustaining an intimate connection with his partner
• Doesn’t readily share what will turn him on
• If not yet partnered, may have social anxiety or feel unlovable
• Has a partner that doesn’t understand his sexual needs
• May have been sexually abused and is now trying to figure out how sex is supposed to work
• Is confused by his own secretive nature about sex
• May use porn to satisfy a need for sexual arousal that his partner doesn’t understand

My preferred label, if one must used, is “problematic sexual behavior.”  Usually, what makes the sexual behavior a problem is that it interferes with a person’s relationships or ability to function in other ways.

A man that pays a prostitute instead of talking to his partner about his real sexual needs is avoiding conflict or embarrassment.  If the secret behavior is revealed, the focus is on the fact that he had sex with another woman, and not on other, perhaps deeper problems that may exist.  A man that works at home and misses calls while looking on the computer may be underachieving at work; why is that?  A man that never dates despite his desire for companionship and hides behind his computer screen has another type of problem.

As a psychologist and AASECT-certified sex therapisty approach to treating problematic sexual behavior is unique to each individual.  I don’t sell a fancy program or follow a set course of therapy.  I want to work with someone to understand what function pornography or other types of sexual behavior serve in their life.  When do they look at porn?  What is the trigger?  What do they gain?  Lose?  If they weren’t looking at porn, what might they be doing instead that would make them feel better about themselves?  How is affecting their relationship, if they are in one?  If not in one, is using pornography holding them back?  If so, how?

Who comes in for help with problematic sexual behaviors?  All kinds of people, from high-powered executives to students, from newly weds to men in their 70s, from atheists to pastors.  Often they come in alone, forced by their partner.   For all of them, my goal is a better understanding of one’s sexual behaviors, one’s intimate needs, one’s relationships, and one’s choices when it comes to pursuing pleasure of all types.  If possible, I want to meet with the partner so that they can be part of the process of learning about sexual health, as well as help them process any feelings of anger, hurt, or betrayal.

If you have given yourself the label of “sex addict,” I’d ask you to look behind those words and give yourself the opportunity to learn how to get more of what you really need to be happy, without hurting yourself or your partner in the process.

But foreplay isn’t just about orgasms.  It is also a way to connect with your partner.  You can take turns giving one another pleasure.  You can choose to be passive and let your partner give to you, or to be active and please your partner.  Or, you can have mutual foreplay, both giving and receiving pleasure at the same time.  It’s more about sharing an intimate, fun experience than about preparation for intercourse.

If foreplay is imaginative, there may be no need for intercourse; orgasms may be experienced in other ways.  Foreplay can also allow you to explore one another’s bodies, to understand what is erotic for each of you.  It is a time to free yourself and be creative, to try out scenarios that turn you on.  You may find out that you enjoy some of the same things, or that you need to make adjustments so that your fantasy is fun for both of you.

Foreplay builds a sense of connection and intimacy.  When someone doesn’t want foreplay, for me as a therapist, I am always curious about whether they are able to be truly intimate with a partner, to let a partner get into what they are really about in the bedroom and to get into their partner’s thoughts and feelings.  Foreplay is one of life’s great free experiences, right there in the privacy of your own home.

Women’s sexual desire is more complex than a man’s.  Especially for women in long term relationships, sexual desire is less driven by hormones, though they do play a role.  What seems to be more important is the quality of the relationship between a woman and her partner; her mood, energy, and stress level; her feelings about herself and her body; and her overall enjoyment of sexual activity.

Also, while men feel horny and then want sex, women in long terms relationships often need some loving before they feel horny.  If a man approaches his wife or partner with his motor on “idle” and gives her some time to warm up without pressure, letting her tune in to her own needs to see if a “no” might become a “yes.”

Another way to help a woman enjoy sex more is to take the time to find out what she enjoys.  If she can’t communicate it verbally, ask if she can show you by guiding your hand with her own.  Encourage her to explore her own body so that she can share what she has discovered with you.

If your wife complains that she doesn’t have any energy, help her out.  If you are feeling amorous, take over a few chores so that she can put her feet up or take a warm bath.  Try doing this regularly, whether or not you are looking for an opportunity for sex.  It’s a fact:  Men that help out have sex more frequently.

There are some rather serious reasons that women may lack desire.  One is that they experience sexual trauma.  Another is that intercourse is painful.  A third would be medical problems, both gynecological and non-gynecological; a woman that has no drive should definitely seek a medical examination.  Problems with depression and anxiety can also interfere with drive.  Finally, changes such as the birth of a child or menopause can have an effect on libido.  These experiences are real and need to be addressed; they just don’t go away on their own.

There is nearly always a reason a woman’s drive goes missing.  Invite your wife to do some detective work with you and then work on the problem together.  If you solve it, great.  If not, perhaps you are both too close to the problem or haven’t considered some of the other many reasons this happens; try using the services of a AASECT certified sex therapist to help you.

It isn’t just men that feel sex is only about intercourse and resulting orgasm.  Women often say that it’s the only part of sex they enjoy.  Perhaps it’s because it’s the only part of sex that has an official stamp of approval as being sex.  After all, most people are taught that “Sex is for after you get married
because it can result in pregnancy.  Since pregnancy nearly always occurs as the result of intercourse, it only makes sense that sex means such an act has occurred.

Of course, there’s nothing wrong with intercourse.  It’s just that it’s very limited.  It requires that both partners be aroused, that the genitals are in good working condition, that the participants have the strength and stamina to follow through with the act.  That is, I think, part of the reason that people think of “sex” as being for young people.

If sex included every act of pleasure, people–both individuals and couples–would be much better off.  Including self-, oral, and manual stimulation would take the pressure off of having intercourse.  It would decrease unwanted pregnancy and disease.  It would make it easier to imagine having sex as one ages, or sex if one is alone.  And if a woman had discomfort with intercourse or a man struggled with erectile dysfunction as the result of temporary illness or stress, then they could still be affectionate and comforting with one another.

If you are someone that balks at the idea of venturing beyond sex = intercourse, it might be interesting to think about why that is.  Is it due to stereotype?  Inhibitions about other types of sexual activities?  A belief that sex is only for procreation, so if one is going to have sex for recreation, it had better be a reasonable facsimile?  If going outside your sex = intercourse comfort zone is truly distasteful, well, so be it.  But it could be that you realize you are holding back from exploring all types of sex, starting with cuddling and kissing.  And then what would be the harm of exploring your sexual potential?

My last post was on a potential new medication that would help women with low desire feel a bit more like having sex.  And when I say “a bit,” I mean a bit; the data suggests a mean of about one more incidence of sexual activity a month, either masturbation or intercourse.

If you want to feel like having sex one more time a month, what else might you do besides taking an antidepressant?  Here are 10 ideas:

1. Get more sleep.  If you are always too tired for sex, then you need more rest.  Go to bed earlier instead of doing one more load of laundry or watching one more episode of CSI.
2. Eat a healthier diet.  Junk food affects mood and energy levels.  Eat a Mediterranean diet that includes fruits, vegetables, whole grains, and lean meat.
3. Get exercise.  Exercise gives you more energy to do the things you need and want to do, and improves mood.
4. Communicate with your partner.  Let your partner know that you are struggling and try to come up with some solutions together.
5. Just say yes.  If you want to have sex one more time a month, the next time your partner initiates check in with yourself.  No headache, stomachache, or backache?  Then just say yes.  You might find yourself in the mood before you know it.
6. Create a mood.  Buy some fresh flowers to put beside the bed.  Add candles and music.  Take a relaxing shower or bath.
7. Talk to your doctor.  Problems like low thyroid can also interfere with libido.  Take care of your health.
8. Work on your relationship.  A lot of women with low drive have relationship issues that they aren’t willing to look at.  Take some time to reflect and think about what you might do to make your relationship work better.  Ask your partner to do the same.
9. Relax, it’s just dust.  If I had a dollar for every woman who says she can’t relax and enjoy sex because the house is dusty!  Unless your house looks like it was ravaged by the Dust Bowl, put down that rag, put up your feet, and let your partner make love to you instead.
10. Have orgasms.  One reason women lose interest in sex is when they don’t have an orgasm; it just seems to become pointless.  Self-pleasure to learn more about what you like, then let your partner in on it.  You may not have an orgasm every time, but you can have fun trying.

A couple more points.  One person made a comment in my last post that not everyone has access to a sex therapist.  True, but most therapists know that they can consult with a sex therapist if they have someone come into their office with a problem.  So don’t let lack of access stop you from talking to a therapist.

Also, she made the point that talk therapy doesn’t work for everyone.  Also true.  But in my practice, it helps about 80-90% of folks that make a commitment to change.  So the odds are pretty good that talk therapy can help.  Talk therapy is a much safer route.  Yes, it costs money.  But again, most therapists have a sliding scale or can refer you to a very low cost or free center where you can get therapy.

She also pointed out that I had said in a past blog on pot and sex that people shouldn’t use mind-altering drugs, so I was reversing myself when I said that a medication could be helpful for extreme cases.  Not true.  There is a big difference between self-medicating with pot or alcohol or whatever and taking a prescribed medication.

Finally, a wise woman on one of the listserves I belong to pointed out that the “Viagra for women” is a dopamine agonist.  Dopamine agonists are typically prescribed to people with Parkinson’s disease.  These medications disinhibit a person.  So the action of this drug is to make women feel less inhibited about sex.  But what else might it make a woman feel less inhibited about?  People that take drugs for Parkinson’s sometimes get into trouble with compulsive behaviors such as gambling.  Trying a

But since marijuana seems to have unpredictable effects, it’s probably not the best drug of choice.  Chronic marijuana use–usually defined as smoking pot 4 or more times a week–can affect a man’s sex drive and his ability to have an erection.  Some percentage of women that call my office about their partner’s lack of interest in sex actually have a partner that smokes pot–not just a few times a week but a few times a day.

With problems like marijuana addiction there is always a chicken-and-the-egg question of which came first, the sexual concern or the drug / alcohol escape mechanism.  In my experience, sometimes there is a lack of sexual knowledge, difficulties with self-esteem, or relationship / attachment problems that interfere with having a good sexual relationship with one’s partner.  Smoking marijuana or using other drugs can help a person deflect, rather reflect, on issues that consequently never get resolved.

Marijuana is a drug like any other.  It’s easy to minimize its effects, which actually seems to be part of the addiction.  Marijuana causes a myriad of changes.  If you’ve ever seen a SPECT scan of a pot smoker’s brain, you’ll see that the blood flow in the brain is really crummy.  And, it takes longer for pot to get out of the brain than almost any other drug.

So the next time you or your partner say, “Well, it’s just pot,” think again, especially when it comes to sexual health and relationship issues.

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.