When most people think of sex, they naturally think of intercourse.  Remember Bill Clinton saying, “I did not have sex with that woman!”  Ahem, he most certainly did.   But even a “zipless” encounter can be quite passionate and can quite definitely be counted as a sexual act.  Just watch “The Young Victoria” to see that people have sex all the time without having intercourse.

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?

The Los Angeles Times ran a couple of articles on January 11, 2010 on the issue of whether or not a Doctor of Psychology (Psy.D.) was worth any more than the paper it was written on.  Apparently, there is a group of psychologists that feel (since research does not back them up) the Psy.D. is a lowly substitute for lazy folks that don’t quite have what it takes to handle the rigor of the more highly prized Doctor of Philosophy (Ph.D.) in psychology.  Their reasoning is that because more schools that turn out Psy.D.’s are independent schools, which have a higher acceptance rate than Ph.D. programs that are attached to a university.  Psy.D.’s, they argue, don’t do research and therefore aren’t equipped to provide science-based psychotherapy.

Horse rubbish.  I am a proud possessor of a Psy.D., the only drawback of which is that Ph.D.’s like to take pot shots at my degree.  In fact, when I was in grad school I remember dreaming that a fellow Ph.D. student parked her Cadillac on my then rather sad-looking front lawn; talk about an inferiority complex.  I’ve gotten over that, though–and my lawn has been replaced with water thrifty plants, to boot.

What the heck is a Psy.D., you might be asking yourself.  Well, it is based on the so-called “Boulder model” of training, which came out of the University of Colorado at Boulder.  The idea was that those psychologists that wanted to practice psychotherapy needed to have more clinical training and supervision.  In order to provide top notch services, the Psy.D. needs to be able to evaluate research and implement it in the clinical setting.  To that end, the Psy.D. writes an extensive review of an area of research literature for a dissertation, as opposed to doing a piece of original research.

For my doctorate, Read the rest of this entry …

As a sex therapist, one of the most heartbreaking scenarios in my office must be when one person announces with their partner in the treatment room that they don’t love their partner any more.  But perhaps worse than saying the words “any more,” are saying the words, “I never loved you.”  I can’t imagine what kind of turmoil it puts both partners into at the moment the words are spoken, but I can tell you that for me all the air gets sucked out of the room.  Is this couple’s relationship going to make it?

Recently, an article in USA Today discussed people that walk down the aisle, even though they know with some certainty that the marriage could fail.  Why do they do it?

• They thought they could make their partner change.
• They just didn’t want to be single.
• There was an unplanned pregnancy.
• They felt pressured by family.
• They wanted financial security.
• They figured they could make it work.

Obviously, for the most part these aren’t great reasons to get married.  Even in the case of an unplanned pregnancy, if there is no love, then there probably shouldn’t be a marriage.

Sometimes a person struggling with the issue of whether or not to divorce a partner because they never felt chemistry nor a connection will decide that they will stay for the sake of the children.  If the person’s partner isn’t drinking, cheating, or being abusive, then that is probably the best decision.  Once the children have grown, they can choose to stay or go, but giving offspring the best possible chance for success can be a sacrifice worth making.

If there are no children involved, then statistically the marriage probably will not last.  While children put a great deal of strain on a marriage–so much responsibility, so little time–they are also paradoxically the “glue” that can hold a marriage together.  Unless someone is very religious, there is little incentive to stay in a loveless marriage.

A loveless marriage is different, though, from a sexless marriage, or a marriage in which sex has never really worked very well.  Love may never be there the way it is portrayed in the movies or novels, but if someone has a decent sex life with their partner (regular, satisfying sex), they may choose to stay in the marriage.  If there is caring and respect, as well as sex, the marriage may survive despite the lack of passion, however that might be described or imagined.

If, however, there are long term sexual issues, even if the relationship is good in other respects, it may not survive Read the rest of this entry …

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 Read the rest of this entry …

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.

If you regularly read my blog, you may have noticed I haven’t posted anything in over a week.  Here’s why:  I have a book contract, and most of my creative energy is going into that endeavor.  It isn’t an easy book to write, and it isn’t a book that is going to make me rich, but it is, I think, an important book, one that takes another step toward de-stigmatizing mental illness and helps couples struggling with sexual issues.  There is no other book available that is like it, and as we go into the next year, I’ll share more about it.

So forgive me for not being current. The blog is important not just to me, because let’s be honest, a blog is a marketing tool, but it is also important to my readers.  Most of them are unseen, but occasionally people email me to let me know that they read something helpful in one of my posts.  I am contacted by people around the globe, folks that have very little access to good information on sexuality.

I enjoy sharing what I have learned and my perspectives.  Sex really is important to quality of life; when it isn’t working it makes people quite miserable.  If I can help someone untwist some strange myth, or identify the name of a problem, or give some good information or a link to something important, that is gratifying for me.

I was an elementary school teacher for a decade, so I am always teaching.  I don’t always know if I am having an effect, but I assume that I am and keep marching forward.

I hope the next decade brings us all closer to true sexual health–the freedom to express our sexuality in the way each person sees fit, without exploiting or being exploited.  I hope I can add to that effort in a meaningful way.  I hope more people have want they want:  Satisfying sex with a loving partner.

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.

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 Read the rest of this entry …