Category Archives: Sex Therapy

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

Coming down from the high:

What I learned about mental health from BDSM

By Jen Chan

Not too long ago, I took my first step into the world of kink. I was a baby gay coming to terms with my borderline personality disorder (BDP) diagnosis, looking for any and every label that could help alleviate the lack of self-identity that comprises my BPD.

I knew I was queer. I knew I identified as femme. But I didn’t know if I was a dominant (top), a submissive (bottom), or a pillow princess; I didn’t even know if I was kinky.

So I tried to find out.

I began to notice a pattern. The sheer rush of euphoria and affection created a high I felt each time I “topped” my partner, and it would sharply drop the minute I got home. I was drained of energy and in a foul mood for days, often skipping work or class. I felt stuck on something because I wanted to feel that intensely blissful sex all over again, but I couldn’t figure out how to get it back.

If you’re familiar with the after-effects of taking MDMA—the crash, the lack of endorphins, the dip in mood for up to a week later—then you’ve got a pretty good idea of how a “drop” felt for me. Just add in an unhealthy serving of guilt and self-doubt, a pinch of worthlessness and a dash of contempt for both myself and my partner, and voila! Top drop: the less talked about counterpart to sub drop where the dominant feels a sense of hopelessness following BDSM—bondage and discipline, domination and submission, sadism and masochism—if after care is neglected.

In the BDSM community, it’s common to talk about the submissive (sub) experience: To communicate the expectations and needs of the submissive partner before engaging in consensual kinky play, to make sure the safety of the sub during intense physical and/or psychological activities is tantamount, to tend and care for the sub after the scene ends and they’re brought back down to earth.

Outside of this, the rush of sadness and anxiety that hits after sex is known as post-coital tristesse, or post-coital dysphoria (PCD). It is potentially linked to the fact that during sex, the amygdala—a part of the brain that processes fearful thoughts—decreases in activity. Researchers have theorized that the rebound of the amygdala after sex is what triggers fear and depression.

A 2015 study published in the Journal of Sexual Medicine found that 46 per cent of the 230 female participants reported experiencing PCD at least once after sex.

Aftercare is crucial and varies for subs, depending on their needs. Some subs appreciate being held or cuddled gently after a scene. Others need to hydrate, need their own space away from their partner or a detailed analysis of everything that happened for future knowledge. But no matter what the specific aftercare is, the goal is still the same: for a top to accommodate a sub and guide them out of “subspace”—a state of mind experienced by a submissive in a BDSM scenario—as directly as they were guided in.

I asked one of my exes, who’s identified as a straight-edge sub for several years, what subspace is like. As someone who doesn’t drink or do drugs, I was curious about what it was like for them to reach that same ephemeral zone of pleasure.

“It gets me to forget pain or worries, it gets me to focus only on what I’m feeling right then,” they told me. “It’s better than drugs.”

My ex gave up all substances in favour of getting fucked by kink, instead. I’m a little impressed by how powerful the bottom high must be for them.

“The high for bottoms is from letting go of all control,” they added. If we’re following that logic, then the top high is all about taking control.

We ended the call on a mildly uncomfortable note, both trying not to remember the dynamics of control that ended our relationship.  Those dynamics were created, in part, by my BPD, and, as I would later discover, top drop.

In the days to follow, I avoided thinking about what being a top had felt like for me and scheduled a lunch date with another friend to hear his perspective.

“Being a dom gives you the freedom to act on repressed desires,” he told me over a plate of chili cheese fries. This is what his ex said to cajole him into being a top—the implied “whatever you want” dangled in front of a young gay man still figuring himself out.

He was new to kink, new to identifying and acting on his desires, and most of all, new to the expectations that were placed on him by his partner. He was expected to be a tough, macho top to his ex’s tender, needy bottom. His after-care, however, didn’t fit into that fantasy. If that had been different, maybe he wouldn’t have spiraled into a place where his mental health was deteriorating, along with his relationship.

The doubt and guilt that he would often feel for days after a kinky session mirrored my own. We both struggled with the idea that the things our partners wanted us to do to them—the things that we enjoyed doing to them—were fucked up. It was hard to reconcile the good people that we thought we were, the ones who follow societal expectations and have a moral compass and know right from wrong, with the people who are capable of hurting other people, and enjoying it.

For my friend, there was always a creeping fear at the back of his mind that the violence or cruelty he was letting loose during sex could rear up in his normal life, outside of a scene.

For me, there was a deep instinct to disengage, to distance myself emotionally from my partner, because I thought that if I didn’t care about them as much, then maybe I wouldn’t hate them for egging me on to do things I was scared of.

My friend has since recognized how unhealthy his relationship with his ex was. These days, he identifies as a switch (someone who alternates between dominant and submissive roles). The deep-seated sense of feeling silenced that was so prevalent in his first kinky relationship, is nowhere to be seen. He communicates his sexual needs and desires and any accompanying emotional fragility with his current partner. He’s happy.

I’m a little envious of him. My second-favourite hobby is rambling about all of the things I’m feeling, and it’s a close second to my favourite, which is crying. I credit my Cancer sun sign for my ability to embrace my insecurities, but there’s still something that makes me feel like I’m not equipped to deal with top drop.

There’s an interesting contrast between how a top is expected to behave—strong, tough, in control—and the realities of the human experience. When a top revels in the high of taking control, but starts to feel some of that control fading afterwards, how do they pinpoint the cause? How do they talk about that insecurity? How do they develop aftercare for themselves?

One of the hallowed tenets of BDSM and kink is the necessity of good communication; to be able to recognize a desire, then comfortably communicate that to a partner. Healthy, consensual, safe kink is predicated on this.

Complete Article HERE!

Why are some women never able to orgasm? A gynaecologist explains

Dr Sherry Ross says there has long been a gender bias in the way women’s sexual dysfunction has been treated compared to men’s

 

By Olivia Blair

Despite modern society being able to openly discuss female sexuality, there remains a number of existing taboos.

One of the most glaring is female orgasms. Women are rarely taught about the intricate details of their anatomy and often work these things out through their own experimenting.

What is the best way to get an orgasm? How often should I have one? Should I be able to have one during penetrative intercourse? Why have I never had one? – questions not uncommon to hear among small friendship groups of women over a bottle of wine.

Dr Sherry A Ross, an LA-based gynaecologist with 25 years experience aims to educate with a complete guide to the vagina in her new book She-ology: The Definitive Guide to Women’s Intimate Health. Period.

In the foreword of her book, Dr Sherry notes that “talking about the mighty V outside of doctor’s offices and bedrooms has remained a major taboo” and devoted an entire chapter to the female orgasm. The Independent asked the gynaecologist and obstetrician all the questions about female orgasms that are rarely spoken about.

Why might some women never orgasm?

Attitudes regarding sex, sexuality and gender vary greatly between different cultures and religions. Certain sexual practices, traditions and taboos are passed down through generations, leaving little to the cause of female pleasure or imagination.

For some women, finding and/or enjoying sexual intimacy and sex is difficult, if not impossible. Research suggests that 43% of women report some degree of difficulty and 12% attribute their sexual difficulties to personal distress. Unfortunately, sexual problems worsen with age, peaking in women 45 to 64.  For many of these women the problems of sexual dysfunction are treatable, which is why it is so important for women to share their feelings and concerns with a health care provider.

Unfortunately, there has been a history of “gender injustice” in the bedroom. Women have long been ignored when it comes to finding solutions to sexual dysfunction. In short, there are twenty-six approved medications for male erectile dysfunction and zero for women. Clearly, little attention has been paid to the sexual concerns of women, other than those concerns that involve procreation.

How many women might never orgasm?

During my 25 years in private practice, I’ve met a number of women in their 30s, 40s and 50s who have never even had an orgasm. In fact, 10 to 20% of all women have never experienced one.

Issues related to sex are not talked about enough even with a health care provider. Let’s just start by saying, 65 per cent of women are embarrassed to say the word vagina and 45 per cent of women never talk about their vagina with anyone, not even with their doctor.

Some patients say they have pain with sex, have problems with lubrication, don’t have a sex drive or don’t enjoy sex.  My first question is “Are you having problems in your relationship?”, “Do you like you partner?” , “Are you able to have an orgasm?”, “ Do you masturbate?” These open-ended questions tend to bring out sexual dysfunction including the inability to have an orgasm.

There is a great deal of embarrassment and shame when a woman admits she has never experienced an orgasm.

Is the inability to not orgasm normal?

The inability not to have had an orgasm can reflect women’s inability to know they own anatomy and may not be a disorder at all. In a survey of women aged 16-25, half could not find the vagina on a medical diagram. A test group of university- aged women didn’t fare much better with one third being unable to find the clitoris on a diagram. Clearly, if you can’t find it, how are you going to seek enjoyment from it?

Women must first understand what brings them pleasure and in their pursuit of happiness they have to understand where their clitoris is and how to stimulate it. Masturbation is a skill.  It has to be learned, just as walking, running, singing and brushing your teeth.

What is an orgasm disorder and how would you categorise one? 

The inability to have an orgasm falls under the category of Female Sexual Dysfunction of which there are five main problems: low libido or hypoactive sexual desire disorder, painful sex, sexual arousal disorder, an aversion to sex and the inability to orgasm.

Hypoactive sexual disorder, the most common female sexual dysfunction, is characterised by a complete absence of sexual desire. For the 16 million women who suffer from this, the factors involved may vary since sexual desire in women is much more complicated than it is for men. Unlike men, women’s sexual desire, excitement and energy tend to begin in that great organ above the shoulders, rather than the one below the waist. The daily stresses of work, money, children, relationships and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms or a history of physical or sexual abuse.

You are the person in charge of your vagina and clitoris. First and foremost, get to know your female parts intimately. Understanding your sexual response is a necessary health and wellness skill. Make mastery of that skill a priority.

Complete Article HERE!

Childhood cancer treatment may hinder later-life sexual relationships

 

Neurotoxic treatment for cancer during childhood may influence sexual activity and relationships in adulthood, according to new research.

Study co-author Vicky Lehmann, Ph.D., of Nationwide Children’s Hospital and Ohio State University – both in Columbus, OH – and colleagues found that adults who received high-intensity neurotoxic treatment for cancer as a child were less likely to meet certain sexual and romantic milestones.

However, the team found that childhood cancer treatment did not affect overall satisfaction for sexual and romantic relationships in adulthood.

Lehmann and team recently reported their findings in the journal Cancer.

According to the American Cancer Society, it is estimated that around 10,380 children aged 15 and under were diagnosed with cancer in the United States last year.

Leukemia is the most common form of childhood cancer, accounting for around 30 percent of all cases, followed by brain and spinal cord tumors, which make up around 26 percent of all childhood cancer cases.

Childhood cancer treatment and psychosexual development

While cancer was responsible for more than 1,200 childhood deaths last year, over 80 percent of children diagnosed with the disease will survive for at least 5 years. This is due to significant advances in cancer treatment, which include surgery, chemotherapy, and radiation therapy.

However, such treatment is certainly not without risk. For example, studies have shown that cranial radiation – often used to treat brain tumors – may cause harm to the developing brain, leading to long-term neurocognitive impairment.

Previous research has shown that neurocognitive impairment as a result of childhood cancer treatment may impact social interaction in adulthood, but studies investigating the effects of such treatment on psychosexual development are few and far between.

“Psychosexual development entails reaching certain milestones, such as sexual debut, entering committed relationships, or having children.

It is a normative part of becoming an adolescent or young adult, but only comparing such milestones without taking satisfaction into account falls short. These issues are understudied among survivors of childhood cancer.”

Vicky Lehmann, Ph.D.

To address this gap in research, the team enrolled 144 survivors of childhood cancer aged between 20 and 40. A further 144 participants who were not treated for childhood cancer (the controls) were matched by age and sex.

All participants completed questionnaires on psychosexual development, sexual satisfaction, and relationship satisfaction.

To determine the brain toxicity of cancer treatments in childhood, the researchers used data from the participants’ medical charts.

Neurotoxic cancer treatment might predict later-life psychosexual issues

Overall, the team found that adults who were treated for cancer in childhood did not differ significantly from the controls in terms of psychosexual development, sexual satisfaction, and relationship satisfaction.

However, on analyzing subgroups of childhood cancer survivors, the researchers found that those who previously received treatments high in neurotoxicity were less likely to have had sexual intercourse, be in a relationship, or have had children, compared with controls.

The type of cancer treatment in childhood did not appear to affect sexual satisfaction, the team reports. “This highlights the subjective nature of psychosexual issues, and the importance of addressing any concerns in survivorship care,” notes Lehmann.

The researchers say that their findings indicate that the neurotoxicity of cancer treatment in childhood may predict the likelihood of psychosexual problems in adulthood. They add:

“Additional research is needed to delineate how neurocognitive impairment undermines social outcomes for survivors, as well as other related factors.

Given the findings of the current study, healthcare providers should assess romantic/sexual problems among survivors, especially those who received high-dose neurotoxic treatments. Referrals to psychosocial care could prevent or reduce potential difficulties.”

 
Complete Article HERE!

Have you ever had ‘unjust sex’?

Unthinkable: Examples include ‘women being pressured – not quite to the point of outright coercion – to have sex, or to have sex without contraception’, says philosopher Ann Cahill

“We need to remember that sexual assault is not the only kind of sexual interaction that is ethically problematic,” says author Ann Cahill.

By

Uncertainty surrounding the boundaries of ethical sexual activity is not confined to boozed-up young adults or American presidents. Among academics there is discussion about what distinguishes rape and sexual assault from another category of “ethically problematic” sex.

Examples of “unjust sex” include “women being pressured – not quite to the point of outright coercion, but pressured uncomfortably nonetheless – to have sex, or to have sex without contraception,” explains Ann Cahill, author of a number of books on gender issues including Rethinking Rape.

Cahill, professor of philosophy at Elon University in North Carolina who is visiting Dublin this week, says she has tried to “figure out in more detail” what distinguishes sexual assault from “unjust sex”, drawing on the work of New Zealand psychologist Nicola Gavey.

Her analysis has led her to challenge the traditional feminist concern with “objectification”: treating women’s bodies as objects. Instead, she uses “derivatisation” – treating women as “stunted persons, persons whose identity and behaviour is primarily or entirely limited by the desires of another person” – as a standard by which to measure actions.

Cahill says “we need to remember that sexual assault is not the only kind of sexual interaction that is ethically problematic. Too often our approach to sexual ethics is limited by relying solely on the presence of consent, a reliance that obscures other crucial elements in sexual interactions that are ethically relevant”.

How do you distinguish “unjust sex” from rape?

“Briefly, I argue that examples of unjust sex and incidents of sexual assault share an indifference to women’s sexual preferences, desires and wellbeing, and that’s what explains how unjust sex perpetuates and upholds rape culture. In both cases, the specific sexuality of the woman is not participating robustly in the creation of the sexual interaction.

“What distinguishes the two examples, I then argue, is the specific role that the woman’s sexual subjectivity plays. In the case of examples within the grey area of unjust sex, women’s agency plays an important role: if a man repeats a request for or invitation to sex multiple times, for example, that very repetition indicates that the woman’s consent is important.

“However, I also argue that the role that the woman’s agency plays is a problematically stunted one that limits the kind of influence she can have on the quality of the interaction that ensues, and does so to such an extent that it renders the interaction unethical.

“In the case of sexual assault, the woman’s agency is either overcome – by force, or coercion, or other methods – or undone entirely, by use of drugs or alcohol.”

Where does “objectification” come into this, and does sexual attraction always entail some element of it?

“Feminists have long used the notion of objectification as an ethical lens, and specifically, as an ethically pejorative term. And certainly I do think that many of the social and political phenomena that feminists have criticised by using the term ‘objectification’ – dominant forms of pornography, oppressive medical practices, common representations of women’s bodies – are worthy of ethical critique.

“However, I worry about what the term ‘objectification’ implies, and when I dug into the philosophical literature that sought to really unpack the term, my worries only intensified. If objectification means, roughly, to be treated as a thing – a material entity – and if it is virtually always ethically problematic, then it seems we are committed to a metaphysics that places our materiality in opposition to our humanity or moral worth.

“But what if our materiality, our embodiment, is not contrary to our humanity or moral worth, but an essential part of it? If we approach embodiment in this way, then to be treated like a thing is not necessarily degrading or dehumanising. In fact, having one’s body be the object of a sexualising gaze and/or touch could be deeply affirming.

“Getting back to your question: does sexual attraction require objectification? The short answer is yes: sexual attraction requires treating another body as a material entity. But that does not mean that sexual attraction is necessarily ethically problematic.”

You say women “are encouraged, and in some cases required, to take on identities that are reducible to male heterosexual desires”. How do women avoid being so “derivatised” while in a relationship?

“This is a tricky matter, because human beings are intersubjective.

“Equal and just relationships among individuals require the recognition that they have a substantial contribution to make to those relationships, and that no relationship should position one of the individuals involved in it as the raison d’être of the relationship itself.”

Is the power dynamic always working in one direction, however? Women are capable of objectifying men. Should that concern us too?

“As I state above, objectification is not necessarily ethically problematic. And so to the extent that women have the capacity to treat men’s bodies as material entities, yes, they can objectify them.

“However, in our current political and social situation, women’s objectification of men’s bodies is far less common than men’s objectification of women’s bodies; even more importantly, it rarely amounts to derivatisation and does not serve to undermine men’s political, social, and economic equality.

“When I say that it does not amount to derivatisation, I mean that heterosexual men are less likely to view their bodies solely or persistently through the lens of how they appear to heterosexual women, and they rarely see male bodies represented in dominant media as defined primarily or solely through how those bodies appear to heterosexual women.

“While it’s not impossible for women to derivatise men – one can imagine, for example, a woman evaluating a man as a sexual partner solely on the basis of whether he matches her sexual preferences – structurally, those examples of derivatisation don’t add up to the kind of persistent inequality that still tracks along gender lines.

“For example, as political candidates, men don’t suffer for failing to meet the aesthetic ideals of heterosexual women, while women do suffer for failing to meet the aesthetic ideals of heterosexual men. Of course, they also suffer for meeting those ideals too well, because feminine beauty, while allegedly admirable in women, is also associated with shallowness and lack of intellect.

“Although I haven’t written about this before, however, it seems to me that hegemonic masculinity does have a derivatising effect on heterosexual men, to the extent that it requires them to derivatise women. In this sense, the subjectivity of heterosexual men is stunted to the extent that it is required to engage in the kinds of behaviour that demonstrates disrespect of women as moral equals – behaviour that is necessary for other heterosexual male subjects to be confirmed or affirmed in their own forms of masculinity.

“To the extent that heterosexual men can find their standing within homosocial relations threatened or troubled if they refuse to derivatise women, or at least pretend to, then they are also subject to a failure to recognise their own ontological distinctness.”

Complete Article HEREvi!

Should Shame Be Used to Treat Sexual Compulsions?

By

The concept of “sex addiction” has become deeply embedded in our culture — people toss the term around pretty easily, and it’s the subject of TV shows, documentaries, and a profitable cottage industry of treatment centers. The problem is, as Science of Us has noted before, the scientific evidence for sex addiction being similar to alcohol or drug addiction is very, very thin, and it may be the case that people who believe or are told they have sex addiction actually have other stuff going on.

And yet, it’s undoubtedly the case that many people show up at therapists’ offices worried about sexual behavior that feels compulsive. How do therapists who are skeptical of the idea of sex addiction deal with these patients? That’s the question at the center of an interesting article in SELF by Zahra Barnes.

Barnes does a good job laying out the strong majority view that “sex addiction” shouldn’t be viewed in the same way as other, more scientifically validated forms of addiction, and she also contrasts the way different sorts of therapists deal with sexually compulsive behavior. As she explains, therapists who hew to the majority view often take a “harm reduction” approach to patients who are complaining of compulsive behavior.

“It’s humanistic, meaning it privileges the subjective experience of a person and doesn’t try to apply some external model on what they’re describing, and it’s culturally libertarian, meaning as long as they’re not hurting anyone, you allow people to behave the way that they want and give them the space to do it,” said Michael Aaron, Ph.D., a sex therapist in New York City and author of Modern Sexuality.]

This method can work for people troubled by their sexual urges and those with compulsive sexual behavior. “Rather than trying to change something, we need to acknowledge it and embrace it,” Aaron says. He offers the example of someone who has fantasies of traumatizing children sexually or being sexually violent toward women: “The harm reduction approach asks, can you play out some of these themes with a consenting partner?” The aim is to satisfy these desires with a willing partner instead of suppressing them, which can just make them stronger, he explains.

Therapists who do believe in the addiction model work differently, and where this difference manifests itself most strongly is in their approach to shame. While Aaron and other harm-reduction researchers try to stay away from shaming their patients, which they say can worsen compulsive behaviors, believers in the sex-addiction model see things differently:

“Sex addicts need to feel some shame about what they’re doing, because they are shameless. When people are shameless, they rape and murder and steal and pillage and get into politics,” [says Alexandra Katehakis, clinical director of the Center for Healthy Sex.]. But this is different from shaming someone, she says. “Shaming in an unprincipled way is out of bounds [for a mental health professional],” she explains. That would include saying or even implying that someone is disgusting based on what they’re doing. Rather, she asks questions designed to make someone reflect on what their actions have wrought, like, “What do you think that feels like for your partner?” It’s helpful, not damaging, she explains, because, “It challenges them to see what they’re doing, and it brings them into the reality of their behavior.”

It seems like one of the key philosophical differences here is the question of the extent to which people can control their most primal sexual urges. The therapists who don’t believe in sex addiction appear to view people’s sexual preferences (for lack of a better term given they probably aren’t preferences) in a holistic context — if people are “acting out” sexually in a way that harms others, it could be because of other stuff going on in their lives. You address the behavior by addressing the root causes. The believers, on the other hand, focus more on the urges and finding ways to address the behavior and urges in and of themselves.

These approaches aren’t fully compatible, so it’s no surprise there’s tension between the majority of sex researchers who don’t believe in the addiction model and the minority who do.

Complete Article http://nymag.com/scienceofus/2017/01/should-shame-be-used-to-treat-sexual-compulsions.html!