Category Archives: Sex Therapy

Fear of Sex, Lasting Longer, Performance Anxiety, Preorgasmic Women, Sensate Focus

Talking With Both Daughters and Sons About Sex

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Parents play a key role in shaping sexual decision-making among adolescents — especially for girls.

A 2016 review of more than three decades of research found that teenagers who communicated with their parents about sex used safer sexual practices. Likewise, new research from Dutch investigators who studied nearly 3,000 teenagers found that young adolescents who reported feeling close with a parent were unlikely to have had sex when surveyed again two years later.

Notably, both research teams found that daughters benefited more than sons, and that the effective conversations and relationships were typically had with mothers.

According to Laura Widman, lead author of the review study and an assistant professor of psychology at North Carolina State University, “parents tend to talk about sex more with daughters than with sons, and we can speculate that that’s what’s probably driving these findings. Boys may not get the messages as frequently or have the kind of in-depth conversations that parents are having with girls.”

Given the results of her research, Dr. Widman said that she “wouldn’t want parents to get the idea that they only need to talk to daughters. In fact, it may be the opposite. We need to find a way to help parents do a better job of communicating with both their sons and daughters so that all teens are making safer sexual decisions.”

That parents have more frequent conversations with their daughters about sex and sexual development may be prompted by biological realities. Menstruation, HPV vaccination (which remains more common in girls than boys), and the fact that birth control pills require a prescription might spur discussions that aren’t being had with sons.

Yet experts also agree that gender stereotypes play a powerful role in sidelining both fathers and sons when it comes to conversations about emotional and physical intimacy. Andrew Smiler, a psychologist who specializes in male sexual development, noted that women generally “have a better vocabulary for talking about feelings and relationships than boys and men do. Fathers may be a little more stoic, more reserved and more hands-off.” And, he added, “they may play to the stereotype of trusting boys to be independent and able to care for themselves.”

These same stereotypes can also tend to steer the conversation in one direction with daughters and another direction with sons. When parents do address sexual topics with their teenagers, they typically adopt a heterosexual frame with boys playing offense and girls playing defense.

“We usually view our girls as potential victims who need to be protected from pregnancy and rape,” says Sheryl Ziegler, a psychologist who provides mother-daughter seminars on puberty and sexual development, while boys are often cast as testosterone-fueled prowlers looking for nothing but sex. These assumptions often drive how parents approach the conversation. Dr. Mary Ott, an associate professor of pediatrics at Indiana University and the author of a research synopsis on sexual development in adolescent boys observed that, “when parents talk with boys, there’s an assumption that they’ll have sex and they are advised to use condoms. Whereas for girls, there’s more of a focus on abstinence and delaying sex.”

Parental concern about the negative consequences of adolescent sexual activity can reduce “the talk” to a laundry list of don’ts. Don’t get a sexually transmitted infection, don’t get pregnant or get a girl pregnant and don’t proceed without gaining consent. Critical as these topics are, Dr. Ziegler points out that they can “become the focus, so much more than having a quality conversation about why we are sexual beings, or talking about all of the ways we can express love.” And failing to acknowledge the pleasurable side of sex can, according to Dr. Smiler, hurt the credibility of adults. “When parents only acknowledge the scary side of the story,” he said, “teenagers can devalue everything else the parents have to say.”

So how might we do justice to conversations with both our daughters and sons about emotional and physical intimacy?

Over the years in my work as a clinician, I’ve come to a single tack that I take with adolescent girls and boys alike. First, I prompt teenagers to reflect on what they want out of the sexual side of their romantic life, whenever it begins. Why are they being physically intimate, what would they like to have happen, what would feel good?

Following that, I encourage each teenager to learn about what his or her partner wants. I urge them to secure not just consent, but enthusiastic agreement. Given that we also grant consent for root canals, gaining mere permission seems, to me, an awfully low bar for what should be the joys of physical sexuality. Dr. Smiler adds that any conversation about consent should avoid gender stereotypes and address the fact that boys experience sexual coercion and assault and “include the idea that boys can and do say no.”

Finally, if the parties are enthusiastically agreeing to sexual activity that comes with risks — pregnancy, infection, the potential for heartbreak, and so on — they need to work together to address those hazards.

Research suggests that this shouldn’t be a single sit-down. The more charged the topic, the better it is served, and digested, in small bites.

Further, returning to the topic over time allows parents to account for the rapidly shifting landscape of adolescent sexual activity. We should probably be having one conversation with a 12-year-old, an age when intercourse is rare, and a different one with a 17-year-old, half of whose peers have had sex.

Is it better for mom or dad to handle these discussions? Teenagers “want to have the conversation with someone they trust and respect and who will show respect back to the teen,” Dr. Smiler said. “Those issues are more important than the sex of the person having the conversation.”

How families talk with teenagers about their developing sexuality will reflect the parents’ values and experiences but, Dr. Ott notes, we’re all in the business of raising sexually healthy adults.

“We want our teenagers to develop meaningful relationships and we want them to experience intimacy,” she said, “so we need to move our conversations about sex away from sex as a risk factor category and toward sex as part of healthy development.” And we need to do so with our sons as well as our daughters.

Complete Article HERE!

For Veterans, Trauma Of War Can Persist In Struggles With Sexual Intimacy

U.S. Marines march in the annual Veterans Day Parade along Fifth Avenue in 2014 in New York City.

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Much has been said about the physical and psychological injuries of war, like traumatic brain injury or post-traumatic stress disorder. But what we talk about less is how these conditions affect the sexual relationships of service members after they return from combat.

Since 2000, service members who were deployed received at least 138,000 diagnoses of PTSD. More than 350,000 have been diagnosed with traumatic brain injury since 2000. Evidence suggests the numbers are actually higher because many don’t seek treatment.

These conditions cause their own sexual side effects, such as emotional numbness, loss of libido and erectile dysfunction. And the long list of medications used to treat PTSD, TBI and other medical conditions can worsen those side effects.

‘He would sleep for days’

Chuck and Liz Rotenberry of Baltimore struggled with their own challenges when Chuck returned from Afghanistan in 2011. He’s a former Marine gunnery sergeant who trained military working dogs. He left active duty in 2012.

For Liz and Chuck, sex had never been a problem. They’ve been married for 14 years and they’re still very much in love. Liz says she fell for Chuck in high school. He was that guy who could always make her laugh, who always had a one-liner ready and never seemed sad.

But when Chuck returned from Afghanistan, their relationship would soon face its greatest challenge. Baby No. 4 was just two weeks away; for sure, it was a chaotic time. But Liz noticed pretty quickly, something was terribly wrong with her husband.

“I wouldn’t be able to find him in the house and he wouldn’t be outside, and I’d find him in a separate bedroom just crying,” Liz says. “He would sleep for days. He would have a hoodie on and be just tucked away in the bed, and he wouldn’t be able to get out of bed. He would have migraines that were so debilitating that it kept him in the bed.”

When Chuck was in Afghanistan, an IED — improvised explosive device — exploded 3 feet behind him. Shrapnel lodged into his neck and back.

It would take three years for someone at the Department of Veterans Affairs to explicitly lay out for Liz that Chuck had developed severe post-traumatic stress and suffered a traumatic brain injury — and that she would need to be his caregiver.

The Marine self-image

During that three-year period, there were times Chuck estimates he was taking 15 to 16 different medications twice a day.

Sex was usually the furthest thing from his mind.

“I didn’t think about it. I wanted to be with Liz, I wanted to be near her,” he says. “When the desire was there, it was unique. It was rare, as opposed to the way it was before. And a lot of times, with the mountains of medication I was on, you know, in my head [it was] all systems go, but that message didn’t go anywhere else.”

Liz noticed that Chuck stopped initiating physical affection.

“The thought of him reaching out to me to give me a hug wasn’t existent. It was like I had to give him the hug. I now had to step in and show him love,” she says.

Sometimes months would go by before they would have sex.

“It started off as being pretty embarrassing, pretty emasculating,” Chuck says. “It was like, ‘Really? This too doesn’t work?’ You blame it on, ‘Oh, it’s just the medication,’ or ‘You’re tired,’ or whatever initially, and you don’t realize it’s stress or my brain just doesn’t work like it used to.”

Liz and Chuck had never really talked about sex in any serious way before. So they kept avoiding the conversation — until this year. That’s when Chuck finally asked his primary care provider for help. The doctor prescribed four doses of Viagra a month. Liz and Chuck say the medication has improved things substantially — though they joke about how few doses the VA allots them every month.

But asking for just those four doses took Chuck three or four visits to the doctor before he could work up the nerve. He says it can be especially hard for a Marine to admit he’s having problems with sex because it contradicts a self-image so many Marines have.

“You know, as a Marine, you can do anything. You believe you can do anything, you’ve been trained to do nearly anything,” he says. “You’re physically fit. You’re mentally sound. Those are just the basics about being a Marine.”

If he has any advice for a Marine going through the same thing he and his wife are facing, he says you need to talk about it. Bring it up with your spouse. Bring it up with your doctors.

“Marines always jokingly hand out straws. You got to suck it up. You got to do what you need to do to get it done,” Chuck says. “It’s just a different mission. … Don’t let your pride ruin what you worked so hard for.”

 Complete Article HERE!

Caught in the modesty bind: Why women feel shy to consult doctors for their sexual well-being

By Aditi Mallick

“I was 17, when I first got sexually intimate with my boyfriend,” says Kriya (name changed), a 23-year-old IT professional from Hyderabad, while speaking to The News Minute.

“Later we were very scared, as it was the first time for both of us,” she recalls. She missed her periods that month. The 17-year old who had never once been to hospital alone, was scared and unsure of what to do next.

Trying to glean more information online just added to her worry over getting pregnant. Finally she discussed the issue with her boyfriend, and both of them decided to consult a gynaecologist.

“I was already very scared. After I told the receptionist my age, she kept staring at me. It made me so uncomfortable. While other patients were called by name, when it was my turn, she said ‘Aey, hello.…go!’ I felt so bad.

I expected at least the doctor to act sensitive. She first asked me what happened. When I told her, she started lecturing to me about our culture, and how young I am. It was a horrible experience. After the check-up, once I reached home, I burst out crying,” she shares.

From then on, Kriya has always felt too scared to discuss any sexual health problem with a gynaecologist. She is now 23, but in her view, nothing much has changed.

“Last month, I had rashes all over my vagina right up to my thigh. I just could not walk. It was painful. In the beginning, I used anti-allergic medication and antiseptic cream. But I was finally forced to go to a doctor. But even this time, I was ill-prepared for those weird looks.

The receptionist first asked for my name, then my husband’s name. For a moment, I panicked. After a pause I said, I am unmarried.”

Kriya feels that such unnecessary queries have nothing to do with a particular health problem and should not be asked: “We are adults and should not be judged for such things. After all, it is my decision. But society does not think so.”

Dr Kalpana Sringra, a Hyderabad-based sexologist agrees:“Doctors should not interfere in a patient’s personal life. But sadly, some do. A few are open-minded. They do not care whether the patient is married or not. We do at times have to ask about how frequently they have sex to ascertain the cause.”

Kalpana believes the rigid cultural restrictions and undue secrecy about anything related to sex are what makes patients uncomfortable sharing sexual health issues with their doctors.

Prapti (name changed), a 21-year old second year engineering student says: “Ï had  quite a few relationships, and faced initial problems like bleeding and pain during sex. I sometimes lose interest while having sex, due to this immense pain in the vagina.”

But she does not want to consult a doctor: “I prefer advice from friends. At least, they will not judge me.” She remembers the time she had to consult a doctor two years ago, when after having sex, the pain persisted for a whole day.

“The doctor did not even try to explain the reason. I kept asking her whether it was anything serious. But she deliberately chose to ignore me. Later I heard her murmur ‘this generation….uff’! When I shared this with my friends, I realised they too had been in similar situations.

According to Kalpana, only ten percent women come forward to consult a doctor for sexual well-being, of which the majority are planning to get married soon and want to get themselves checked for infection and related advice.

No woman ever goes to the doctor for this, unless it is absolutely avoidable. Not just unmarried women, but even married ones are ignorant in this regard. Young unmarried women are only more hesitant to ask or seek medical help, fearing society and parents, she says.

“Both married and unmarried women are not comfortable. They mostly come with their partners. To make them feel comfortable, we talk to the women alone. After a while, they open up about their problems.”

She also claims that 20% of women who suffer from vaginal infection like UTI and rashes after marriage too feel shy to discuss it with the doctor: “Men seem more comfortable discussing their sexual problems. 90% of our patients are men. But they tend to come alone.”

That was not the case with Jayesh (name changed), a 27-year old. He used to earlier hesitate to talk about his sexual health: “It was only a year back that I consulted a doctor for premature ejaculation, something that I suffered from the age of 23. I used to think if my friends get to know, they would make fun of me.”

The common issues that men in the age group of 18-80 are premature ejaculation and erectile dysfunction. “Most men confess that they force their wives to use contraceptive pills, as they do not want to wear condoms,” Kalpana says.

Gaurav (name changed), a 29-yearold unmarried man insists that he has never forced his girlfriend to use contraceptive pills, but they do sometimes prefer pills over condoms.

Gaurav who is sexually active does not feel ashamed or uncomfortable consulting a doctor, but that is not the case with his girlfriend: “Four years back, she once started bleeding after we had sex. Honestly, I was clueless how to handle the situation and whom to contact. We did not go the doctor, fearing prejudice.

My girlfriend is not at all comfortable consulting a doctor. She usually avoids going to a gynaecologist, as they ask whether we are married or not. It makes her uncomfortable. It happened a few times with us in Hyderabad. That’s why sometimes she prefers to use emergency contraceptive pills rather than consult a doctor.”

“Sex jokes are allowed, but people are otherwise shy talking about sex. Parents do not talk freely on the topic. It is still a taboo for Indian society,” Gaurav remarks.

When Preeti (name changed) -who is now doing an event management course- was in her final BCom year, she led an active sex life:

“I went for a party and got drunk. That night my friend and I had sex. I did not then realise that we had forgotten to use a condom. After missing my periods, I freaked out. I was confused and went to see a doctor. They first asked if I was married. I lied.”

She also admits to feeling uncomfortable while buying I-pills, condoms or pregnancy test devices: “Once a medical shopkeeper asked whether it was for me, with those around giving me judgmental looks.”

Fearing societal disapproval, several unmarried women tend to take medications, after consulting the internet.

“They go to medical stores or send their partners to buy medicines without consulting a doctor. Emergency contraceptive pills have several side-effects like, dizziness, vomiting etc. Some even try to abort through pills, which is life-threatening and can affect their health in the long run,” warns Kalpana.

Complete Article HERE!

Staying Married Through a Gender Transition

“Sometimes I see myself as a lesbian, and sometimes I don’t.”

By Evan Urquhart

Six years ago, Cassie and I met and began dating as lesbians. At the time, I didn’t know I was transgender. Then about two years ago, just nine months after we were married, I told her I thought I might want to transition and live as a man. It’s hard to overstate how difficult this was for us at first, but we stuck with one another and managed to preserve our marriage. I spoke with Cassie about staying together, and about being a lesbian (or maybe not) in a relationship with a trans man.

Think back to when I first told you I thought I might want to transition. What was your initial reaction?

When you first told me, I was surprised by how angry I was. I mean, you weren’t my first experience with a trans person. I’ve had a number of friends come out, and it’s never been hard to adjust. Plus, I was in the queer dorm at UMass, and many of the kids I lived with were trans. I always figured I was well prepared for the possibility of a romantic partner coming out. I didn’t know what I’d do, exactly, but I didn’t think I’d be angry. But when you told me, I don’t know … We were trying to get me pregnant at the time, and all I could think was that you were fucking up my adorable little lesbian life.

I wasn’t!

I know. It just felt like you were. I know that’s unfair, but it’s true. I was also angry at myself, because I wasn’t actually that surprised by the news. There was no way I could convince myself that it was just a passing thought. I knew it wasn’t. We’d talked about your gender in the past, and I told you I thought you had some issues to work out. We had so many conversations about how you thought every woman would want to be a man if they could, and I would tell you, no, I wouldn’t want that, and you wouldn’t believe me. It was frustrating, but I forgave it, because I sensed you had some internal issues to work out. But I guess what I thought (or maybe hoped) was that one day you’d recognize a sort of queerness in yourself and stop arguing with me about my own gender, not that you would go full-on with testosterone, surgery, changing your name, everything. Now I tell people I have a husband.

It’s been really tough. How do you think we’ve managed to stay together?

A lot of things. I think I was scared at first because I didn’t think I’d end up breaking up with you. We’re so compatible in so many ways. Part of me was afraid that your personality would change so much I’d not want to be with you, but I didn’t really think that I would leave.

You felt trapped?

Marriage is a trap. That’s a weird question.

Argh. My nonjudgmental leading questions don’t work on you—you’re on to me. What eventually made it OK, when at first it didn’t feel OK?

We talked a lot, all the time, about everything. Even when it was hard, we hashed things out rather than ignoring them. And should I talk about the open relationship? We opened things up, as we’d done before, but I think it was especially important in this case.

The release valve. Not feeling like you’d never be with a woman again. Being able to explore other relationships with other people without ending everything we had to do it.

Something like that.

Do you still consider yourself a lesbian?

Oh, geez. We’re jumping to that question now?

It seemed relevant.

Sometimes I see myself as a lesbian, and sometimes I don’t. Part of me thinks it’s wrong to consider myself a lesbian because if I do, and I remain in a relationship with a trans guy, or even admit attraction, on a certain level, to any other trans guys, I’m effectively invalidating their gender. That said, coming out to myself was such an important thing for me. It made so much about myself make sense, not just who I was attracted to but my personality and how I interacted with the world. It made me so much happier. I don’t want to let that go.

I always said I didn’t have the power to unilaterally change your orientation.

Right, but your transition did make me think about my sexuality in a different way. A number of different people that I’ve been attracted to, whether I dated them or not, were people I thought at the time were cis women who came out later as trans men. If it was really just you, well, you could be the exception. You could be grandfathered in. But I feel like it might say something about me—about the sort of people I like—that you’re not the only one.

I’ve always butted heads a little with the lesbian community, anyway. But at the same time I feel like that’s part of what it means to be a lesbian, to butt heads with the lesbian community. I once got into a fight with a girl who said I wasn’t a real lesbian because of what I was wearing. I got kicked off a lesbian forum for saying I thought you could still be a lesbian if you had enjoyed sex with a penis, even once. God forbid.

This reminds me, we’ve been talking about trans men, but what about trans women? Are you attracted to trans women? Have you ever been with a trans woman? Do you think you can be with trans women and still be a “real lesbian”?

Yeah, I’ve been attracted to and been with trans women. I know it’s a point of contention for some people, but I think that’s silly. At least for me, if I’m hanging out, flirting, feeling attraction and chemistry with someone, then there’s a good chance I’m going to enjoy having sex with that person if I get the chance. I guess if you’re only attracted to genitals, that could be more limiting, depending on the specifics, but I feel like you’re probably having pretty boring sex. Maybe I’m wrong, and to each their own, but it’s not an issue for me. And I kind of suspect it would be less of an issue for other people than they think, but they just don’t want to think about it.

So, my being a trans man was more of a threat to your sexuality than your being attracted to a trans woman was.

Yeah. I’m really not worried at all about sometimes being attracted to trans women.

Talk about my physical changes, and how you feel about them.

Well, it’s better now that you’ve come out of the weird little hole you were in. You were spending all your time on Reddit or in the other room, alone, doing God knows what. You acted so weird at first, so totally in your head about things. You never wanted to have sex, and having a conversation with you was like pulling teeth. I was more annoyed with that than anything. The actual changes didn’t bother me as much as I’d feared. I guess they’ve been gradual enough it’s been easy to get used to. But then you’d do things like repeat the same phrase three times in a slightly deeper voice, and I just had no patience for it. I was finishing a master’s degree and dealing with infertility, and I didn’t have time for your issues.

And I’ve settled down now?

Definitely. We’re about back to normal, I’d say. I’ve settled, too. At this point I’m just kind of embarrassed by how I reacted early on. I think that once I just chilled out and accepted your transition as what was happening, and as a good thing for you, our relationship could just be what it was. No pressure. We started getting closer again, and you started relaxing. Plus, we had a friend at the time, a trans girl, who helped a lot.

Because she was very political.

She was very no-nonsense. She handed you a trans pride flag at the pride parade when you were still only partially out. I’ll never forget the look on your face when that happened. She also started using male pronouns for you and calling you Evan and told me to just get over it. And I did. Probably in part because I liked her, and I didn’t want her to think I was mean. But still, it helped.

So, how are things now for our relationship?

They’re really good. I mean, there are no guarantees. Changes are still happening, and I’m sure we’ll have some ups and downs in the future. I don’t want to jinx anything. But we’re connecting again, we’re having sex again, and sometimes when someone from your family forgets and uses your old name, I have a moment where I’m not even sure who they’re talking about. You’re just my Evan. It works.

And, how do you feel about your sexuality?

I think I still see myself as a lesbian in a lot of ways, and I don’t know if I’ll ever completely change that, but I’ve been referring to myself as queer more often, and I like that as a compromise. I feel like that word fits me pretty well, and maybe I’ll ease into using it completely in the future. But right now I’m not completely over thinking of myself as a lesbian, especially since I’m still generally more attracted to women.

Complete Article HERE!

Sexual Health

from Health World Education

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