Sexual pain after cancer treatment an unspoken affliction for many women, UC Davis oncologist says

Sexual pain is a common, but unspoken, aftermath of women’s cancer treatment. Doctors can be reluctant and patients too embarrassed to discuss it.

But it’s an all-too-real aspect of cancer treatment for women, according to Dr. Vanessa Kennedy, a gynecological oncologist for the UC Davis Health System.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

“Some patients are two to three years out of treatment and they’re dealing with sexual pain and no one’s talked about it. Patients hesitate to bring it up because it’s a sensitive issue,” said Kennedy, who recently discussed the problem in the journal Obstetrics & Gynecology. Her co-author, Dr. Deborah Coady of New York University Langone Medical Center in New York, is author of the book, “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain.”

Kennedy estimates that about 50 percent of female patients with cancer – of any type – experience some form of sexual pain, due to physical changes caused by surgery, chemotherapy and radiation. It can range from vaginal dryness caused by early menopause to anatomical changes that can make sex uncomfortable.

Some women feel guilty they’re even concerned about their sex lives, given what they’ve been through battling cancer. “There’s some guilt that they should just feel lucky to be alive and shouldn’t ask about these other things,” she said. But when sexual health is addressed, “They’re actually relieved to know they’re not alone.”

Twice a month on Fridays, Kennedy holds a regular clinic, seeing UC Davis patients who’ve been referred for post-cancer problems with sex. She works with patients on a number of interventions, including physical therapy, lubricants (even coconut or olive oil), vaginal dilators and couples counseling to re-establish intimacy.

Kennedy said doctors and medical students need to learn to be comfortable broaching the topic. “A lot of students and providers are still a little bit nervous asking about sex,” she said. “How do you get comfortable talking about these things? You just do it. It’s just like asking a patient about changes in appetite or changes in sleep. Sex is another thing (on the list). Get over it and ask about it.”

There’s a difference in how men and women cancer patients deal with sexual health, Kennedy contends. For men who’ve undergone prostate cancer treatment, there’s an emphasis on restoring their sexual function. For women, there’s often physical pain and a loss of intimacy, along with the added fear by some that their partners view them as less desirable. In some cases, where sex has become nonexistent, patients confide that their partners have threatened to leave or cheat on them.

Kennedy, who did fellowship training at the University of Chicago, which has a sexual health program for women cancer patients, says research on women’s sexual health issues is lagging, compared with that for men with prostate cancer. Next April, she’s hosting a national gathering of the Scientific Network on Female Sexual Health and Cancer, which promotes research and information for women patients and their providers.

“Sex is a quality-of-life issue and a core of our well-being,” Kennedy concludes. “We have to bring back the intimacy and make this a part of the body that’s associated with pleasure, rather than an uncomfortable, negative place.”

Complete Article HERE!

A graphic history of sex: ‘There is no gene that drives sexuality. All sexuality is learned’

Changes in sexuality over time have made the modern family what it is. What next? Homa Khaleeli asks the authors of a groundbreaking graphic guide, The Story of Sex

The Story of Sex … some images from the book. Illustration: Laetitia Coryn

The Story of Sex … some images from the book. Illustration: Laetitia Coryn

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Philip Larkin famously announced that sexual intercourse began in 1963 (“Between the end of the ‘Chatterley’ ban / And the Beatles’ first LP”). Being French, and a psychiatrist to boot, Philippe Brenot takes a rather longer view. In his latest book, The Story of Sex, a bestseller in France, he runs an anthropological eye over the sexual mores of human societies from prehistoric times to today. Yet Brenot believes that the sexual revolution did spark a dramatic change, creating the modern couple, which is the basis of our families today. Now, however, he thinks this partnership of equals is under assault from all sides.

The academic, who has the wonderful title of director of sexology at Paris Descartes University, has spent his life studying sexuality. The Story of Sex is an irreverent, graphic novel (in both senses), filled with fascinating – if alarming – history. Cleopatra used a vibrator filled with bees; the word “trousers” was considered to be positively pornographic in Victorian England. Illustrator Laetitia Coryn’s extremely cheeky, but never sordid, pictures liven up the page and keep the narrative zipping along. The book was a real collaboration, says Coryn, who says it was made easier by Brenot’s firm ideas – and the fact he liked her jokes.

The illustrator admits she hesitated slightly over collaborating on the book. “I told my publisher we have to be careful with the drawings and with the jokes – we have to be sensitive,” she says, because she wanted the book to have as wide an audience as possible. “I didn’t put any porn in it!” As a reader, however, the frankness of the pictures still shocked me (you, er, might not want to whip out the book on public transport or in the office).

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Philippe Brenot and Laeticia Cory.

Talking to Brenot over the phone (through charmingly accented English that becomes somewhat eccentric as he struggles with the complexities of his ideas) it’s impossible to escape the psychiatrist’s anxiety about our attitudes to love and intimacy today. We have never been freer to define our own relationships, and follow our own pleasure, he says, but despite this we are far from satisfied; and the modern couple is looking dangerously fragile.

“It’s incredible the difficulties couples have,” Brenot declares, in a tone that makes me imagine he is throwing his hands in the air in despair. Of the couples he sees in therapy, he says, “there is nothing wrong with them psychologically, but still they cannot communicate quietly, live calmly and have sexual fulfilment”.

While we think of lovers as a timeless relationship model, it has been the family that has been paramount in society for most of history, the 68-year-old says. “The couple used to get together for the sake of the family,” he explains. And the idea of equality in long-term pairings is even more recent, with “traditional” marriages putting men firmly in charge of their spouses.

“Love marriages have only been widespread for a century or so, and homosexuality was condemned until very recently,” Brenot notes.

“Since the 1970s, we have begun to invent modern couples with respect for each other and equality between the sexes,” he says. “This only came about after ‘marriage’ as a concept began dying out. Not because people stopped getting married, but because marriage stopped being seen as a sacred union – couples instead started developing on their own terms.”

Yet the rise in divorces since the 1970s and breakups of long-term relationships shows that the modern couple is not surviving, Brenot argues. In part, he says, this is because we are demanding more than ever before.

“It is difficult to live intimately, because we want perfect love and perfect sex and that is very difficult in a long-term relationship. We want a lot more than a reliable person to raise kids with.”

The solution, he says, is for us all to learn more about sex – which is where his book comes in. “It’s not possible to understand our intimate sex lives without looking at centuries of history, and even the origins of human life,” he says. “We understand what we live today if we understand from where we came.”

For instance, he says, if we look at the way relationships were formed in early human societies we can see echoes of our own problems. “We came from primates, but in chimp society there are never couples or families. There are lone males and females with children.” It was only as our brains evolved and emotions developed – including love – that monogamous relationships set in. For the first time (“somewhere between 1 million BC and 100,000BC”), it was possible to know the paternity of a child.

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While the beginning of family life may sound like a wonderful moment, Brenot argues that it was also the start of women’s subjugation, with men taking possession of their female partner and offspring – which traditional marriage legalised. “Paternity is the beginning of male domination,” says Brenot simply. “The day that happened, men took possession of women.”

In the animal kingdom, Brenot argues, there is none of the domination of female partners that has been a hallmark of human societies through history, nor is there domestic violence. Instead, among animals “males fight against other males and females fight with other females,” he says.

“Violence between men and women is only in humans – because of marriage, which puts men above women.”

During antiquity, meanwhile, a woman’s role was to provide a child – and female sexual pleasure was dismissed. But this role was also a dangerous one. “There were so many impediments to female pleasure. In the 18th and 19th centuries, one in six pregnant women died in childbirth. Then there were the infections and sexual violence.”

For men, of course, things were different. “Men have always done what they wanted,” says Brenot.

Even for men, sex for pleasure was something that happened “outside the home – for instance with prostitutes. Women were seen either to provide offspring or pleasure.” In ancient Rome, these rules were so strictly upheld that women could take their husbands to court for ejaculating anywhere but inside her body during intercourse, “because sex within marriage was for procreation, and the wife’s role was to receive sperm”.

Even during periods that today we think of as being golden ages for same-sex relationships, such pleasures were “reserved for the elite” – and the reality was often less accepting than we think. In ancient Greece, for instance, it was only the man who was “receiving” who was not stigmatised in a pairing. Similarly for the libertines in the 18th century, “there was a fluid sexuality, but it was also the top end of society – the intelligentsia and aristocracy. Throughout the centuries and the world’s rural populations, to be gay – or for women to have control of their own sexuality – has always been frowned upon.”

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Today too, Brenot argues, while much has been written about more people exploring fluid sexualities, entering polyamorous relationships and breaking down gender norms, “we shouldn’t make the mistake of thinking that this is trickling down to all sections of society”. And he warns too about a backlash from “new moralists” who oppose gay marriage, and will, no doubt, do the same for trans rights and alternative relationships as they gain more legal rights. Coryn says this is one of the reasons she enjoyed creating the book. “In France, people who don’t want gay people to be married, is a huge phenomenon. It’s awful. We say in the book this is a misunderstanding of sexuality; homosexuality is normal. I hope this is one topic on which people will change their mind in reading the book.”

For heterosexual couples, relationships began to look up about the time of the Renaissance and Enlightenment. Up until this period, “men were having fun outside the home – hunting animals or chasing women. While women were always at home,” says Brenot. But the new spirit of education and the pursuit of knowledge changed this. Finally, says Brenot, men and women could be friends and even have platonic love.

Yet it took contraception for men and women to gain a semblance of equality. Previously “women were immobilised by marriage. They can’t get out of it, they don’t have the possibility of working or being free. The story of sex is, first of all, the story of marriage and the difficulties [it creates] for women.”

To start combating the problems that these historical inequalities have left us with, the psychiatrist insists, we need better sexual education, and one that starts at an early age. “People think sexuality is just an instinct,” he says, “that it is natural like eating and drinking. No. There is no gene that drives sexuality. All sexuality is learned.”

Because of this, says Brenot, the models for our sexuality are very important. Today, talking about sex is still taboo, and the dissemination of pornography has filled the void. “People say pornography changes adolescent life. But it changes everyone’s sexuality,” he says. “We have sex differently now; we try to imitate what we see [on our screens]. People feel bad and say, ‘I can’t do what they do.’”

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To displace this dangerous model, “sexual education should teach the rules that should govern relationships; it should teach us about communication, about consent and respect. This is not natural [to us]. We have to learn this.”

Coryn says that while the Story of Sex is not a sexual education manual, “we wanted it to be uninhibited”, to make talking about sex seem as natural as it should be.

“From the time children are little girls and boys, we have to teach them that everyone should be respected and to start accepting difference,” says Brenot. But, he says, while men and women are equal, that does not mean that they are the same. Railing against the teaching of “gender studies” departments, he says that a refusal to admit this difference is allowing gender inequality to become entrenched.

“They say, ‘Don’t speak of differences – a man is the same as a woman. Society is guilty of making differences, but underneath we are the same.’”

Unpicking these ideas, he says, is the only way to combat our most pressing problems. For example, “physical strength is different from a very young age. So [children] need to understand boys are stronger and take that into account – because that is the start of domestic violence, which is a real problem.”

If we leave this teaching too late, he says, the battle is already lost: “In children’s fairy stories it is the boy who seduces the girl, so there is power play early on.” Then there is the fact men have always been free to have multiple partners throughout history, because men don’t get pregnant. It is only by introducing the idea early on that “contraception is a joint responsibility” that we can challenge this.

Today’s modern couple, he points out, faces new challenges from the rise in options for dating to “new forms of relationship,” says Brenot. Yet Coryn stresses, as does Brenot, that there has never been a better time for people to live in terms of sexuality. Yet one thing has not changed, says Brenot – everyone still wants to find somebody to love. “People are afraid to be alone at the end of their life. They are afraid not to find the perfect person to live with. It is a difficult problem for everyone today.

“We have to learn how to live together anew.”

Complete Article HERE!

Why Can’t I Orgasm During Sex? Chronic Pain And 5 Other Factors That Affect Ability To Climax

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Imagine this: You and your partner are getting hot and heavy in between the sheets. You’re feeling sexually aroused — but you’re unable to climax. In frustration you ask yourself: “Why can’t I orgasm during sex?”

The Kinsey Institute indicates 20 to 30 percent of women don’t have orgasms during intercourse, compared to only 5 percent of men who don’t climax every time they have sex. Men and women who are unable to sustain an erection or reach orgasm, respectively, are usually labeled as having some type of sexual dysfunction. However, the inability to orgasm could be triggered by several issues that range from physiological to psychological.

Below are six causes of why you have trouble orgasming during sex.

Tight Condoms

Condoms are often seen as an “evil” necessity that reduces sensitivity and sensations for men. The truth is condoms can inhibit male orgasm if they do not fit properly. A condom that is too tight can feel like the penis is in a chokehold, which can be distraction, and make it difficult to keep an erection. A 2015 study in journal Sexual Health found about 52 percent of men report losing an erection before, or while putting a condom on or after inserting into the vagina while wearing a condom.

Stress

High levels of stress impact your psychological and physiological health, which can interfere with the ability to orgasm. This makes it harder to concentrate on the sensation and relax during sex. Women with high salivary cortisol and stress levels have significantly less desire to masturbate or have sex with their partner.

Stress causes us to produce fewer sex hormones, like estrogen and testosterone, and more cortisol and stress hormones. When the body releases cortisol, a fight-or-flight response kicks in, and redirects the blood flow away from the sex organs, causing you to breathe shallowly.

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Depression

Depression affects your mood, and even the desire to have sex. A 2000 study in the American Family Physician found 70 percent of adults facing depression without treatment had problems with their sex drive. This is because sexual desire starts in the brain as sex organs rely on chemicals in the brain to jumpstart your libido, and change blood flow. Depression disrupts these brain chemicals, making sexual activity more difficult to initiate and enjoy.

Chronic Pain

More than 75 million people live  with persistent or debilitating pain, according to the national pain foundation, which can often lead to a low sex drive. Chronic pain sufferers find it difficult to feel pleasure during sex since the body hurts all the time. This is unfortunate since having an orgasm can alleviate some pains and aches.

Prescription Meds

Drugs tend to be among the most common causes of sexual problems. Prescription meds are responsible for as many as one of every four cases of sexual dysfunction. A 2002 study published in Family Practice found statins and fibrates (used in lowering LDL “bad” cholesterol) may cause erectile dysfunction, while later research has found both men and women taking statins showed increased difficulty achieving orgasm. The levels of sexual pleasure declined along with LDL cholesterol.

Negative Body Image

When you feel good about your body, you tend to feel better psychologically as well. The mind-body connection is imperative in sexual pleasure. For example, if you feel bad about your body, it;ll become more difficult to enjoy sex and have orgasms. A 2009 study in The Journal of Sexual Medicine found women between the ages 18 to 49 who scored high on a body image scale were the most sexually satisfied. Positive feelings associated with weight, physical condition, sexual attractiveness, and thoughts about our body during sex help promote healthy sexual functioning.

Complete Article HERE!

Dating experts explain polyamory and open relationships

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open-relationships

To start, they are not the same thing as polygamy (that’s when you have more than one spouse). They are also not maintaining secret relationships while dating a person who believes he or she is your one and only (that’s just cheating).

Polyamorous open relationships, or consensual non-monogamy, are an umbrella category. Their expression can take a range of forms focusing on both physical and emotional intimacy with secondary or tertiary partners , though some relationships can veer toward strictly the physical and resemble 1970s-era swinging or group sex.

To better understand open relationships, we talked to several experts: Dan Savage, an author and gay-rights activist who writes a column about sex and relationships called Savage Love; Elisabeth Sheff, who over two decades has interviewed more than 130 people about non-monogamy and written three books on the topic; and Karley Sciortino, sex and relationships columnist for Vogue and Vice and creator of the blog “Slutever.”

We distilled their thoughts into seven key points.

1. Open relationships aren’t for everyone. Neither is monogamy
Among people who study or write about interpersonal relationships, there’s a concept known as sociosexuality, which describes how willing people are to engage in uncommitted sexual relationships. Sociosexuality is considered an orientation, such as being gay, straight, bisexual or somewhere in between.

If you’re on one end of the sociosexual scale, it might be hard to match with a potential partner on the other . “Growing up, you’re told to find people with the same interests and hobbies, but never told to find someone sexually compatible to you,” Ms. Sciortino said. She recommends figuring out early on whether the person you’re dating is a match on the scale.

Mr. Savage explained that people who would prefer an open relationship sometimes avoid asking for it as they drift into an emotional commitment because they’re afraid of rejection. But “if monogamy isn’t something you think you’ll be capable of for five or six decades, you should be anxious to get rejected,” he said. Saying quiet about your needs can lead to problems down the line and result in cheating.

That said, a lot of people aren’t on opposite ends of the scale. Mr. Savage, who is in a non-monogamous marriage, said that when he first brought up being open to his husband, he rejected the idea. But several years later, it was his husband who suggested they try it.

“If I had put that I’m interested in non-monogamy on my personal ad, and my husband had seen that personal ad, he wouldn’t have dated me,” Mr. Savage said.

2. Polyamory is not an exit strategy.
Open relationships aren’t the way to soften a blow or to transition out of a committed situation. “If they cheat first, and say, ‘Honey, I’ve found someone else; we’ve been together six months,’ it’s very hard to successfully navigate that,” Dr. Sheff said.

Doing something with other people before discussing it essentially betrays your partner’s trust. And trust and communication are crucial in any relationship, whether it’s monogamous or not.

3. Nor is it an option to just keep a relationship going.
“If it’s to avoid breaking up, I have never seen that work,” Dr. Sheff said. “I’ve seen it limp along for a few months. If it’s out of fear of losing the polyamorous person, that’s a disaster in the making. It’s like a lesbian trying to be happy in a relationship with a man.”

Pretending to be happy with a situation while suffering inside doesn’t work for anyone.

4. Rules and situations can change.
“Non-monogamy is a basket of possibilities,” Mr. Savage said. He said that sometimes a person’s first reaction to a suggestion of opening the relationship is anxiety. “They’re going to have this panic response and assume you’re going to have 7,000 partners in a year and they’re never going to see you,” he said. But non-monogamy can be expressed in a range of ways: Some couples only have sex with other people, others date them and fall for them, others are open about being open and yet others keep their openness “in the closet” socially.

“It seems boundless,” Ms. Sciortino said. “But actually, there are so many more rules in non-monogamous relationships than in monogamous ones. There’s only one rule in monogamous relationships.”

For her, pushing her boundaries and talking about them forced her to be honest with herself about what she prefers and to learn to communicate well and clearly. “I don’t think it’s possible to understand your comfort zone until you try,” she said.

5. Prioritizing a primary partner is key.
A term familiar to people who practice non-monogamy is “new relationship energy.” It’s that excited feeling when two compatible people are getting to know each other and want to spend every minute together.

The problem with new relationship energy is that it can make a primary partner feel forgotten. “Your long-term partner can feel hurt if you’re taking your relationship for granted,” Dr. Sheff said. “Wear your special lingerie, surprise them, bring them flowers.”

For some people, it’s not a big deal if their partner has sex with someone else, but they can feel slighted if they are being emotionally neglected.

“It’s emotional cheating that people want to protect themselves from,” Mr. Savage said. He brought up an example from when he was dating his now-husband, who bought a Christmas tree with a good friend. The situation made Mr. Savage jealous in a way that his boyfriend’s having sex with someone else wouldn’t have. “Going Christmas tree shopping is what you do with your boyfriend,” he said.

So his pro tip? “Demonstrate that they are your first priority.” It’s called a primary partner for a reason.

6. Those sharing a lover can get along too.
Dr. Sheff said that in her experience, the most successful non-monogamous relationships are the ones in which the lovers’ partners (the ones who aren’t sleeping with each other) get along. As an example, she brought up a married couple in which the woman developed a relationship with another man when she was pregnant with her second child.

“The boyfriend and husband would do all sorts of stuff together,” Dr. Sheff said. After eight years, the relationship between the woman and her boyfriend ended, but her husband maintained his friendship with the other man.

“They had lunch every other Saturday where the husband would bring the kids,” Dr. Sheff said. “It worked because the husband didn’t have a sexual relationship with the boyfriend.”

In this polyamorous situation, and others she has seen succeed, the partners who are not sexually involved are the glue that kept the group together.

7. Jealousy is present, but not unique.
“A woman once asked me, ‘Don’t you get jealous?,’ ” Mr. Savage said. “And I looked at her and said, ‘Don’t you?’ Monogamous commitments aren’t force fields that protect you from jealousy.”

Jealousy is a universal emotion that transcends sociosexuality states.

“I always say I want to do whatever I want, and I want my partner to be in a cage when I’m not around,” Ms. Sciortino said. And while that kind of setup is possible, it’s not exactly the one she’s looking for.

So what does she recommend? “Put yourself in their position,” she said. “If you can have sex with someone else and it doesn’t take away from your love and even enhances it, you have to allow them the same freedoms.”

Dr. Sheff suggested taking a close look at the underlying causes of the jealousy: Is it insecurity? Fear? Maybe it’s even justified? “Sometimes jealousy is a signal that you really are being slighted,” she said.

Tips for confronting jealousy in open relationships are the same as in most other relationships: writing down your thoughts, talking out your feelings with your partner, seeing a counselor.

And that, all three experts were quick to note, may be the most important point to understand: In many ways, open relationships aren’t all that different from monogamous ones. The best way to feel comfortable is up to individuals and their partner(s).

Complete Article HERE!

A BDSM Game That Lets Me Explore A New Type Of Sexual Experience

By Heather Alexandra

ladykiller

Ladykiller in a Bind is a visual novel by Christine Love. It’s about affection, sex, consent, manipulation, and expression. Video games can often be a vector for experimentation and escapism. Playing Ladykiller in a Bind has taught me a surprising amount about myself.

The core conceit of Ladykiller can feel a bit flimsy. You play as a woman impersonating her brother on a school cruise. There’s a contest going on; whoever gets the most votes will receive a heap of cash. This conflict ends up feeling largely secondary to the main interactions you have with many characters, which often focus more on sex and power dynamics.

There is a message at the title screen: “In real life, all power exchange must be negotiated. That is to say, there’s nothing more important than clearly communicating your desires and limits in advance, without either party feeling uncomfortable or pressured.

Mystic Messenger’s Jumin Han

Mystic Messenger’s Jumin Han

A focus on power dynamics is what makes me far more comfortable with Ladykiller in a Bind than my previous visual novel/otome game Mystic Messenger. While many of the routes in that game are tame, things escalate quickly during the route for Jumin Han. Jumin is a detached billionaire who gets very possessive once you start a relationship. At a later point in the route, he refuses to let you leave his apartment. You remain there for days.

In our discussion about the game, I mentioned my discomfort with this moment. My co-worker Cecilia D’Anastasio pointed out that some people might be into it. This is a completely fair point. Captivity and notions of ownership can be very powerful as a sexual fetish. Viewed in this light, Jumin functions as an incredibly commanding dominant.

The thing that made me uncomfortable with Jumin was my inability to approach the situation with nuance. My choices were to gleefully assent to his domination or largely equivocate and rationalize his possessiveness in a way that felt incredibly enabling. I felt forced into a role that I was not ready for and ill equipped to handle.

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Ladykiller in a Bind has a mechanic were you generate suspicion for acting differently than your brother might. A way to remove all accrued suspicion is to spend the night with another classmate. These liaisons are distinctly BDSM affairs. Unlike Mystic Messenger, I had much more ability to express myself. I could get greedy and press for kisses, I could struggle when tied, or I could completely submit. If I felt uncomfortable, I had the option to signal my discomfort. The power dynamics flowed in multiple directions. I was not helpless.

I eventually found myself submitting more and more often in these scenes. Safe within the confines of a virtual realm, I was free to experiment with sexual exchanges far different than any real world experience I’ve had. Without kissing and telling too much, it is enough to say that I’ve never particularly considered sexual submissiveness as a significant form of intimate expression. Yet here I was actively, excitedly, and consensually submitting in scenes. Game or no, I was engaging in a form of sexual exploration, sampling an experience previous foreign to me. I liked it.

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A notable thing about Ladykiller’s interactions is how much they still stress the act of being a sub as an active decision. To be submissive is to make a choice and it’s actually pretty remarkable how clear the mechanics of a visual novel make this. While video game systems can often feel reductive and lacking when it comes to simulating the real world, Ladykiller’s format makes decision making incredibly clear.

I had my character largely remain silent during these scenes. To do so I still had to make a conscious and continued decision to pass up dialog options up in favor of remaining passive. The process was still engaging and deliberate. I was never forced to do anything. I chose to play along. I trusted that the situation would never move beyond a point where I did not feel secure.

I’m not suggesting that my exploration in Ladykiller constitutes anything equal to real world experience but I do believe that the game provided a significant vector for me to experiment with certain sexual arrangements and behaviors while maintain a remarkably safe space for said experimentation. It was illuminating and respectful to me as a player. That respect is appreciated and I hope that more games might extend the same courtesy to me in the future.