Category Archives: Sexual Inhibitions

Sex Therapy—What Is It and Who Needs It? – Part 2

(Look for Part 1 of this series HERE!)

Of course, there are plenty of individuals—and couples—who haven’t waited until the last minute to seek help. These people want to be proactive about their concerns. Some people simply need some clear, unambiguous information about human sexuality. A surprising number of people are trying to piece together their sexual lives, but are hampered by misconceptions and misinformation.

Sometimes a momentous event motivates a person to address arising sexual or intimacy issues. The birth of a child, a disease process, a death in the family, or an accident can fundamentally alter the power dynamic of a relationship, which will require a rethinking of the entire relationship.

Or perhaps someone comes to a new realization about him or herself: Perhaps they are finally able to acknowledge their bisexuality, or that he’s gay, or she’s a lesbian. Maybe they are finally able to acknowledge a fetish—he’s a crossdresser, or she’s into another kink. Things like this obviously impact the individual, but if that person is in a relationship, the relationship is also affected. People in these self-revelatory situations are often unsure how to talk about their discoveries with a partner, which is another reason they seek counseling.

Some couples don’t fret when the sex vanishes from the relationship; other couples are devastated. What does one do when one partner still has sexual needs, but the other doesn’t? Often, there are unexplored options that can hold the relationship together, but will address the disparity in sexual interest and desire.

In this case, I can help the couple make compromises without losing their moral compass. Some couples navigate this with ease; others not so much. It can be extremely challenging, but there are ways to preserve what’s sacred about a primary relationship, while contemplating opening the relationship to include others. I can help a couple establish guidelines and ground rules for making the necessary adjustments.

Sometimes the relationship is really wonderful and fun. The couple really loves each other, but they’ve noticed their sex life together is pretty boring and stale. I’m often approached to simply help a couple spice things up. In this instance, my work is sheer joy. Mostly, I just give them permission to experiment and have fun.

You’ve probably noticed that a good portion of the work that I do as a sex therapist is merely giving permission. That may not sound like therapy at all, but when you consider that our sex-negative culture is so full of prohibitions; permission giving is often the front line of sexual rehabilitation. Most of the permissions I give are for an individual to educate him or herself about his or her body and his or her sexual response cycle. Personal exploration, such as masturbation, is the very best means to that education. I’m a huge proponent of partners masturbating together.

Happily, our need to reacquaint and reeducate ourselves about our bodies and our sexual response cycle is a life-long process. There is always something new to explore. As we age, our bodies change, and if we don’t keep up with those changes, we can become frustrated and disoriented. Older people, menopausal women and andropausal men, take longer to build up “a head of sexual steam,” so to speak. If they’re not attuned to the changes they’re going through, they can easily miss the important cues their body is sending to slow down and enjoy the sensuality.

Of course, I could go on and on, but now I want to leave you with what is the distillation of years my thinking about the role sexuality plays in our life:

I believe that sex is like food. We can enjoy it alone, or with others. We can be abstemious, or gluttonous. We can nosh or nibble; dine or devour. And we can be certain there will be both times of feast and famine.

Sex is like food. It can nourish and sustain us, or it can make us sick. We can consume all the available bounty, or restrict our diet. It can completely satisfy, or leave us devastatingly empty. We can employ it to express our highest aspirations, or allow it to rob us of our soul. We can give it as a gift, or use it as a weapon. It can be both bacchanal and sacrament.

One thing is for sure, whether purely physical or transcendentally spiritual, no one can live without food…or sex.

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The Heartbreak of Male Performance Anxiety

I get a dozen or so messages a month on this topic. I’ve written about it in numerous postings and spoken about it in several podcasts, but still the email comes.

One of the real bugaboos for anyone, regardless of gender, is living up to our own expectations of sexual performance. So many things can get in the way, literally and figuratively, of fully enjoying ourselves and/or pleasuring our partners.

The arousal stage of our sexual response cycle is particularly vulnerable to a disruption. And when there’s trouble there, there’s no hiding it. A limp dick or a dry pussy can put the kibosh on all festivities that we may have hoped would follow.

However, performance anxiety can strike any of us, regardless of age, and at just about any point in our sexual response cycle. This is a particularly galling when it seems to come out of the blue. And regaining our composure can be more far more difficult than we imagine.

Today we will be focusing on male performance anxiety.  I’ll address female performance anxiety at a later date.

Here’s Bob, he’s 26:
Doc, this has never happened before. But I couldn’t get it up tonight, and this chick was H.O.T. Now I’m not gay at all, but I haven’t had sex in about 3 years because I was locked up…so I masturbated pretty regularly, about 3 or 4 times a week. But I can’t figure out why I was soft… the only thing I can think of is I ate clams tonight and I’ve never had them before. Could it be that or should I get checked out?

It weren’t the clams, darlin’! And I don’t think you need to get “checked out” either…at least not right away. If you could back away from the situation a bit and stop freaking out, I think you’d discover the source of your problem all on your own.

Here’s the thing—while you were out of commission there in the slammer, you relied, as you say, on jerking off. Okay, cool. We all do what we gotta do. Now the first time you try to score after your release…you go soft. This tells me you have a mild case of performance anxiety. We all get that from time to time.

There’s probably nothing wrong with you or your johnson. You just got the jitters first time you tried to get you some after being away, that’s all.

The anticipation of boning this H.O.T. chick—fueled by some predictable self-consciousness; what with just getting out of the big house and all—pulled the plug on your wood. No surprise there, right?

What I don’t want to see happen is for you to replay the incident over and over in your mind’s eye til that’s all you can think about. If you do, this proverbial molehill will become a mountain. You’ll then bring all this anxiety to your next encounter, setting yourself up for even more disappointment. You can see how this shit can snowball? If you interpret every less than satisfying encounter as a failure, your fears will become self-fulfilling. You’ll begin to avoid partnered sex and you’ll develop a full-blown sexual dysfunction. And your self-esteem will take a nosedive, too.

If you’re preoccupied with your performance, it’s less likely that you’ll be fully present during sex with a partner. This pretty much fucks up your sexual responsiveness and any hope for spontaneity. Why not just relax into the whole sex thing and not try to prove your manhood with your pecker?

Then there’s Steve with a slightly different take on this meddlesome problem:

My partner and I have been together for just over 3 years now in a monogamous relationship. I am the top and he the bottom. Our problem is not premature ejaculation on his part, but his inability to have an orgasm at all. No matter what I try and even if he masturbates, sometimes it is impossible to get him to cum. Is this a medical issue? Have you ever heard of this?

Delayed ejaculation is the difficulty one has ejaculating even with a firm erection and sufficient sexual arousal and stimulation. This problem is not uncommon. For most men, delayed ejaculation occurs during partnered sex more frequently than while masturbating. In fact, 85% of men with delayed ejaculation can usually cum by jacking off. However, in partnered sex, the guy may be unable to ejaculate at all, or only after prolonged partnered stimulation. This problem can be very frustrating and cause distress for both partners involved, as you already know.

What causes delayed ejaculation? Well, it could be a number of things. It could be something as simple as performance anxiety, or inadequate stimulation, or there could be neurological damage.

I don’t want to be too reductionist here, but most of us experts believe that the majority of instances of delayed ejaculation aren’t physical in nature, but rather are the product of psychological concerns. Simply put, there’s a difference between the psychosexual response we have when we are alone and the one we experience with a partner. There’s probably nothing wrong with your partner’s unit. It’s all in his head…or his mind, to be more exact. If I had to guess, I’d say he’s got a real bad case of performance anxiety.

When I see this sort of thing in my private practice, I always begin the therapeutic intervention by calling a moratorium on fucking of any kind. This immediately takes the pressure off the couple. From there we begin to rebuild the partnered psychosexual response one step at a time. We begin with sensate focus training (Sensate Focus is a series of specific exercises for couples that encourage each partner to take turns paying increased attention to their own sensations. More about these helpful exercises in the weeks to come.), stress reduction and relaxation exercises. These applications are designed to reduce performance pressure and instead focus on pleasure. The idea is to get them to stay in the moment; absorb the pleasure present without worrying about what is “supposed” to happen.

Finally we address as frankly and openly as possible any fears or anxieties that they may have—as individuals or as a couple. I have the greatest confidence in this method; it succeeds over 90% of the time.

Ok, let’s recap shall we?

Overcoming sexual performance anxiety is dependent on five simple things.

  • First, a guy needs to be attuned to his sexual response cycle — arousal, plateau, orgasmic and resolution phases. He should know what kind of stimulation he needs at each phase to fully enjoy himself and satisfy his partner.
  • Second, the more worried a guy is about a performance issue, the more likely that problem will present itself. A bad experience in the past can often set the stage for its recurrence.
  • Third, don’t be afraid to talk this over with your partner. Withdrawing from your partner or shying away from sex altogether will only increase the likelihood that the problem will persist.
  • Forth, be proactive! Fearing the loss of your sexual prowess or feeling sorry for yourself is counterproductive. Confront the challenge head on. Employ sensate focus training stress reduction techniques and relaxation exercises to help you push past this temporarily impasse and regain your self-confidence.
  • Fifth, free yourself from the mindset that your dick is the center of the universe. Your manhood or your capacity to be a great lover does not reside in your genitals. Expand your sexual repertoire. Remember, pleasure centers abound in your body as well as your partner’s.

Good luck!

A Scary Halloween Q&A Show — Podcast #306 — 10/31/11


Hey sex fans, welcome back!

It’s time, once again, to delve into my email in-box to see what’s up with the sexually worrisome. I know I’ve billed this as a scary Halloween show, but to tell you the truth; it’s always a bit scary opening the email I get. I never know what frightful question or dreadful situation will pop out at me.

So ok; maybe it’s not all that scary all of the time, but regardless of what my correspondents toss my way, you can count on me, your intrepid sex therapist, to respond with clever, resourceful and oh so informative answers. Hey, it’s what I do!

This week we hear from

  • Alexia wants to know about genital warts and getting her tubes tied.
  • Stevie O wonders if butt fucking will change the color of a butthole. He also laments getting older.
  • Aaron and his GF are experiencing a major dry spell.
  • No Tan Lines wants to swing, but is afraid to let her man touch another woman.
  • Jai is missing the good sex she had with her BF, but he don’t care no more.
  • Luke says sex with his GF is painful…for her.

Today’s podcast is bought to you by: Dr Dick’s Sex Advice and Dr Dick’s Sex Toy Review.

BE THERE OR BE SQUARE!

Check out The Lick-A-Dee-Split Connection. That’s Dr Dick’s toll free podcast voicemail HOTLINE. Don’t worry people; no one will personally answer the phone. Your message goes directly to voicemail.

Got a question or a comment? Wanna rant or rave? Or maybe you’d just like to talk dirty for a minute or two. Why not get it off your chest! Give Dr Dick a call at (866) 422-5680.

DON’T BE SHY, LET IT FLY!

Look for my podcasts on iTunes. You’ll find me in the podcast section, obviously, or just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Something Wicked This Way Comes

Name: Sofia
Gender:
Age: 54
Location: Arizona
You are sick Dr DICK! I believe that porn is a sign of weakness in men and women. They cannot control their need and put their personal relationship in harm. Its degrading towards women and it gives off the wrong message to men about women. Porn is very harmful in peoples daily lives. Relationships come to an end because of men’s porn addiction. Men have lost families, wives, girlfriends etc. because of porn. Men find themselves defending it so much that they end up losing the people in their lives who do not agree with it (wives, GF, BF, etc.) What does porn leave them? Nothing! Lonely nights with no one by their side and a PC full of nasty images. Porn leaves men lonely and pathetic. Men are destroying their lives to make a porn filmmakers more wealthy. What a great exchange.

So nice of you to drop by, Sofia, and thank you for being so solicitous about my health. Yes, I was sick; I had a little cold there for a couple of days, but now I’m better.

Oh wait, you’re saying I’m sick because I don’t share your repressive opinion about porn. I get it; you’re another moral crusader who needs to denigrate those who don’t share your beliefs. What’s up with that?

Ya know the thing is, darling, I actually agree with you; a lot of porn is harmful and exploitative. It also can be very disruptive to people’s lives and can cause serious damage to otherwise healthy relationships. I mean how difficult was it for you to come up with that critique? Taking pot shots at porn in this sex-negative culture is like shooting fish in a barrel. Get over yourself, girlfriend.

And ya know what else, ma’am, all the things you accuse porn of being — harmful and exploitative, disruptive, damaging to otherwise healthy relationships — you could say about organized religion, the fast food industry, our government, the credit card industry, the pharmaceutical industry, the medical industry, the war machine and it’s horrific profiteers, like Halaburton. And the list goes on and on.

Hell, everything humans touch has the potential for becoming harmful and exploitative; it’s in our nature.  We can just as easily fuck things up as make them up-lifting and life-affirming. Even your own tirade is harmful and disruptive to those of us who are and have been trying to make a difference in the adult entertainment industry. Trust me, you would have made a better case if you said you wanted to help change the status quo in porn, not just point out its inherent flaws.

And what’s all this; “Porn leaves men lonely and pathetic”? What, are you saying you’re the alternative? Perhaps, if you weren’t so bitchy, condescending and mean-spirited the men in your life wouldn’t need to turn to porn. Your abrasive personality and moral rectitude would drive the pope to porn.

Oh, and have a nice day!

Name: Phillip
Gender:
Age: 31
Location: Austin, Texas
Dr. D, I’ve never had a problem with my sex life up until now. My wife and I have been very happy with our physical relationship. But, about 8 months ago, in a very vivid nightmare, I dreamed we were making love and when I came, the ejaculate was blood. I came blood. Everything in the dream stood still as I watched, almost as a third person, as my life flowed out of me. I woke in a sweat, and we’ve not made love since. We’ve talked about the dream, tried to be intimate, but I’m simply not able to enjoy the contact anymore. This is someone about whom I care deeply and with whom I am deeply in love. I’m considering professional help but would like your take. Thanks, Phillip in Austin

Interesting! Here is yet another instance of how one’s psyche can override one’s eroticism.

Trust me, Phillip, this is nothing to toy with; you are spot on thinking this is a matter for a professional. Like an earthquake, this vivid dream has jarred you out of your happy, healthy sex life with your wife. And like anyone who has survived an earthquake, or a similar natural disaster, you need to put your life together again as quickly as possible. I encourage you to seek a sex-positive therapist to help you break the spell of this nightmare.

To that end; I suppose you know that I offer counseling and therapy to all who visit Dr Dick’s Sex Advice, right? Thanks to the wonders of the internet and phone, my practice is not limited to the Seattle area. In fact, I have had remote clients from all over the world. Here’s what you do; look for the tab in the header that reads: Therapy Available.  You will find all the information you need to make an educated decision about joining me for some counseling.

Regardless if you choose to work with me or someone else, closer to home, the object here is to get on this ASAP. The longer you let this thing hang out there the more perverse it will become.

Good Luck ya’ll

SEX WISDOM With Pamela Madsen — Podcast #279 — 05/18/11


Hello sex fans! Welcome back.

Ya know I was thinking some weeks ago that we haven’t had a kick-ass SEX WISDOM podcast since Carol Queen was on my show way back in early march. This is, of course, the podcast series where I chat with researchers, educators, clinicians, pundits and philosophers who are helping us take a fresh look at our sexual selves. So I started to rummage through my little black book to find us the perfect person to break this sex wisdom drought. And guess who I found?

Well, I’ll tell ya. She is an amazing woman — she is a fertility/sex educator, blogger, author of:  Shameless: How I Ditched the Diet, Got Naked, Found True Pleasure… and Somehow Got Home in Time to Cook Dinner, a motivational speaker and founder of The American Fertility Association. Here with me is the irrepressible Pamela Madsen. Prepare to laugh your ass off, sex fans. I know you will enjoy her as much as I do.

Pamela and I discuss:

  • All of her “parts”;
  • Her crooked mainstream life;
  • Permission giving;
  • Being a swell mommy;
  • How her book got its title;
  • It’s only kinky the first time;
  • Tips for becoming visible;
  • Her martini circle;
  • Erotic massage for women;
  • Her surrender.

Pamela invites you to visit her on her site HERE!  Her Psychology Today column is HERE!  Look for her on The Fertility Advocate HERE!  She’s on Facebook HERE! And enjoy her twitter feed HERE!

(Click on the book art below to get more information about her book.)

BE THERE OR BE SQUARE!

Check out The Lick-A-Dee-Split Connection. That’s Dr Dick’s toll free podcast voicemail HOTLINE. Don’t worry people; no one will personally answer the phone. Your message goes directly to voicemail.

Got a question or a comment? Wanna rant or rave? Or maybe you’d just like to talk dirty for a minute or two. Why not get it off your chest! Give Dr Dick a call at (866) 422-5680.

DON’T BE SHY, LET IT FLY!

Look for my podcasts on iTunes. You’ll find me in the podcast section, obviously, or just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s Podcast is bought to you by: Adam & Eve.com.

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