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Sex Therapy—What Is It and Who Needs It? – Part 1

I’m often asked about my work as a sex therapist. I’m surprised at how few people have any sense of what a sexologist does. While I can’t speak for all my fellow therapists, I can tell you a bit about my own practice.

Most of the work I do is Cognitive Behavioral Therapy (CBT): short-term, goal-directed and personally liberating (I don’t believe this kind of therapy should become a lifestyle). Basically, I suggest that people with sexual issues change the behaviors that contribute to their problems as a surefire way to solve them. I try to give my clients all the tools they need to successfully work things out on their own once the therapeutic intervention is over. This approach doesn’t fit everyone; however, 99.9 percent of the people I work with respond positively.

I encourage my clients to give themselves permission to investigate their sexuality. This in turn assists them in taking charge of making themselves feel better and/or perform better. And as soon as they do, they almost immediately have a greater sense of wellbeing. Like they say, nothing breeds success like success.

Once we identify an area of concern, my client and I create a plan of action for them to implement. I believe the more an individual is part of their own healing process, the more productive that process will be.

Sadly, I find that fewer and fewer people are willing to give their sexual issues the attention they deserve. Rather than investing the time and energy to get to the bottom of their issues, many opt instead for the quick fix—the “Give me a pill for that” mentality. They’re often unwilling to make the necessary lifestyle changes to actually solve their problems. For example, I encounter people who are eating themselves to death, or abusing alcohol or drugs. Of course they have the accompanying sexual response issues—erection problems for men and arousal concerns for women. They may desperately want to resolve these issues, but without committing to any change in behavior—i.e.: “I want my erection back, but I won’t stop drinking”—such interventions almost always ends in disappointment.

Sexual dysfunction of one sort or another is the issue I see most recurrently in my practice, although the reason why a client reaches out varies. Sometimes an individual’s tolerance level peaks, and they finally decide to do something about an issue that may have been smoldering for years. Sometimes it’s a partner who brings in their proverbially “broken” partner, telling me to “fix him/her.”

Couples often seek sex therapy together, as sexual problems tend to be more obvious within relationships. However, by the time the couple comes for therapy, the issues have most likely been plaguing them for some time. The relationship often comes close to ending before the couple agrees to address the problem. For example: Say a guy brings his wife in because she’s “frigid,” whatever that may entail. They’ve been married for X-number of years, and he’s finally had it. She, on the other hand, doesn’t want to be in therapy, because she doesn’t really think there’s anything wrong with her. She just doesn’t want to have sex anymore, and she doesn’t want to discuss it. Period.

This is a difficult way to start therapy. Resentments are high and frustrations rage. If the couple does continue, we usually discover that there’s also something desperately wrong with the husband. Inevitably, we ascertain that he’s an ineffectual lover—and his inability to pleasure his wife is the root of her “problem.” It’s often painfully clear that he knows little (if anything) about his wife’s sexual needs or desires. Meanwhile, the wife has never had permission to know her body, so she’s unable to help or direct him. As you can imagine in a case like this, there’s a load of remedial sex education that must come before anything else is resolved.

Couples also seek therapy when one spouse has cheated on the other. The “cheat-ee” declares, in no uncertain terms, that this therapy is the last-ditch effort before “the end of the road.” Often in such cases, it’s too late for a successful intervention, because each partner is so angry and shamed that the chance of turning the situation around is slim. Sometimes the best we can do is end the relationship with as little acrimony as possible.

In difficult couple counseling situations like this, my first effort is to get the couple to disarm. There will be no sex therapy—and God knows there is a need for sex therapy—until there is some semblance of peace between partners. If we don’t establish at least a small bank of goodwill, our efforts are doomed.

We’ll pick this up next week at this time.

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The Erotic Mind of David Peterman — Podcast #311 — 11/28/11


Hey sex fans, welcome back.

Today I have the honor of introducing you to an exquisite photographer from right here in the Emerald City. Join us as we scrutinize The Erotic Mind of David Peterman.

Despite David’s protestations that he is not an erotic photographer, I think you’ll agree with me, all his other friends as well as the juries at the annual Seattle Erotic Art Festival that he is a master of his craft.

Ok, so David’s photography isn’t erotic in the conventional sense of that word. In fact, there is a whimsy and playfulness in his work that often flies in the face of what most of us might consider erotica. But to my mind, this is precisely what makes his work so satisfying, delightful and intriguing. He unabashedly celebrates the human form in a most extraordinary and riveting way.

David and I discuss:

For more of David, his amazing work and vision, I encourage you to visit his website HERE. And there, you will find a link to his insightful blog. Also look for him Twitter HERE.

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 all my podcasts on iTunes. You’ll find me in the podcast section, obviously. 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: DR DICK’S — HOW TO VIDEO LIBRARY.

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A Kink In Her Pink

Name: Dena
Gender: Female
Age: 32
Location: NYC
I love my cunt. In fact you could say I have a cunt fetish. I love to stuff my cunt with really big toys. My current BF introduced me to fist fucking and I love it. I guess what I want to know is can this be dangerous?

I love it, a chick who refers to her pussy as a cunt! You go, girl!

But what’s this…you’re just now gettin’ around to askin’ if fisting is dangerous? Not before, but AFTER you’ve had a fist in your cunt? Well, so much for being proactive. I’d be willing to guess that you probably already have some data on the advisability of this form of extreme sex play. You certainly have enough information to declare that you LOVE IT.

Ok, for everyone else in my audience (both those with a cunt and those who are cunt-less) who haven’t heard of fisting, let’s start at the beginning. I trust everyone knows what fingering is, right? Whether it’s fingerin’ a pussy or an asshole, it’s loads of fun to diddle someone’s insides. We already know that fingerin’ a dude’s hole will stimulate his prostate, which more and more non-gay men are discovering to be way fun. And fingerin’ a pussy can stimulate a chick’s G-spot, which a lot of women find delightfully pleasurable. Ok sex fans, take fingerin’ and multiply that by 5. That’s right, fisting is inserting a whole hand/fist into a cunt or asshole.

For all you folks who haven’t fainted away, yes, it is anatomically possible, and yes, it can be EXTREMELY pleasurable. I hasten to add that gettin’ a whole fist inside a pussy is somewhat easier than gettin’ a fist in an asshole. But for folks like you, Dena, those who are into massive penetration, nothing is a bigger turn-on.

To your question…is this practice harmful? Well not if ya do it right. First off, the fisting top does NOT make a fist and ram it home. Fisting aficionados say that handballing is the most intimate and complete way to touch another human being. This kind of extreme penetration has to be worked up to slowly and gently.

Trust and communication between partners is essential, as is tons of lube. Some folks swear by Crisco, others think the legendary J-Lube — a handy-dandy concentrate that veterinarian use — stands apart from the rest because it’s the most slippery and gooey.  If you choose this stuff, you simply follow the recipes for reconstituting the concentrate. These recipes are available on several handballing sites. (Here’s another tip, instead of schlepping down to your local veterinary supply warehouse, you can find J-Lube in the Dr Dick’ Stockroom. See the swell banner in the sidebar to your right and make your purchase through there. How freakin’ convenient is that?

The fisting top must, of course, respect his/her partner’s limits and pain threshold. Safe fisting is happy fisting. And to that end, keep the following concerns in mind.

First of all, cut and file all your nails until every finger is as smooth as it could possibly be. Your fingers will be in some very delicate places — places that may not have pain receptors. You’ll want to insure that you minimize all chance of causing injury.

Make sure your partner is relaxed, comfortable and turned on. When a woman is aroused, her vagina relaxes, expands and lengthens; all very important for accommodating a fist, don’t ‘cha know.

Even the wettest cunt will need lots and lots of lube during fisting. There’s no such thing as too much lube, so prepare for a big fat mess. Lube your hand, the back of your hand, between your fingers. Keep applying lube as you go. Push the lube into the pussy (or asshole) with your fingers. Remember if you’re using latex gloves, oil-based lubricants dissolve latex.

Start with one or two fingers and work your way up to three and then four. Most people need some time to further relax their muscles, and some may require several stretching sessions, over weeks or even months, before they can actually accommodate your whole hand.

Tops, be sensitive to your bottom’s feelings. You are trying to persuade part of her body to open for you and to admit part of your body deeply inside her. If you take your time, the energy exchange between you and she will move you both into an altered state. Communication and relaxation is key.

Once you’ve reached a five-finger insertion, you’re almost there. But it’s at this precise point that the handballing top needs to be the most attentive. Your partner’s pussy is being stretched to its near limit. Your partner is going to be riding a wave of pain/pleasure. If you find her cunt has reached its limit for the time being, respect that and pull out slowly. But if your partner wants more, then slip your knuckles inside. Be sure to fold your thumb “inside” your fingers, so that your hand will NATURALLY form an elongated fist. Think of the shape of a duck’s bill. This makes your hand into a wedge shape that allows you to gradually stretch your partner open as you press on. Apply steady but slow pressure.

Your partner should be telling you when to push and when to back off. Careless fisting can cause muscle and tissue injuries if the top goes too fast or too hard. Obviously, there’s gonna be some discomfort during handballing. Listen to the owner of the pussy being fisted, she will let you know the difference between hurts so good and hurts real bad.

The knuckles are the widest part of the hand and the most difficult part to get past the opening of the cunt. If there’s gonna be resistance to the insertion of the fist, this is probably that point that it will happen. Wait until your partner is ready before making the big push. She may be able to help by bearing down (as if she were giving birth or having a bowel movement). Once your knuckles slip past the ring of muscles around the vaginal entrance, the pressure will ease off. Now gently roll your hand into a fist.

At this point, the owner of the pussy or asshole may want a gentle pumping movement with your hand. Fisting can produce extremely intense sensations; so ask her what feels good to her.

When the session is done, make your hand into the duck bill wedge shape again, and gently slide it out slowly.

Good luck

Dear Abby

Hey sex fans,

We have another video review lined up for today’s edition of Product Review Friday.

This is the second of three vids from the folks at The Romance Series.  You didn’t miss the first of these reviews, did you? Well not to worry if you did, because you can find it HERE.  And remember all our adult product reviews, going back 5 years, are archived at Dr Dick’s Sex Toy Reviews.

Let’s check in with Dr Dick Review Crew members, Kevin and Gina, to see what’s on their mind.

Dear Abby — $23.43

Gina & Kevin
Gina: “Kevin and I were reminiscing about the first review we did together. It was for the WE-vibe.  That was way back in August of 2008. I was shy and clueless about most sexual things. I was your average recovering Catholic girl, back then, who couldn’t wait to discover the big bad world out there.”
Kevin: “And I’m happy to report that I was the corrupting influence in her life. Although I must say she didn’t offer much resistance. Since that fateful We-vibe review, we’ve been all over the map, so to speak. We get such a hoot out of looking back on all the reviews we’ve done since then. You can find them HERE.”
Gina: “Yeah, it’s like looking at an old yearbook. I was such an innocent back then. Well, all that has changed. Now I’m as sexually adventurous as they come.”
Kevin: “But do you remember when you discovered my stash of porn movies on one of your first over-nights at my place? Do you remember your reaction?”
Gina: “Yes, I do. I was so disillusioned. I couldn’t believe you were into that stuff. I thought you were so cool and progressive; how could you watch porn? Back then I though all porn was disgusting and exploitative of women. I had so much to learn. Now I’m able to tell good porn from bad. And that’s why I jumped at the chance to review Dear Abby.”
Kevin: “She’s right! But I didn’t share Gina’s opinion when she brought home the DVD. The packaging looks exactly like what a major Hollywood studio would produce for a mainstream romantic comedy. I thought for certain this was going to be a dud. My taste in porn is way more edgy.”
Gina: “I knew he was going to say that. I immediately saw the disappointment in his eyes when I showed him the package. However, The Romance Series has a reputation for delivering great watchable sex along with really convincing non-sex performances by the same performers. I don’t find that too often, even in the porn that I’ve come to like very much.”
Kevin: “This is a great adult movie for couples. I hesitate to use the term ‘porn’, because it may turn off some in our audience who have yet to discover that sexually explicit movies, like Dear Abby, can be enjoyed without the guilt associated with watching mainstream porn. But just so you know, this is not soft-core sex. On the contrary; the sex is full-on and totally hot and sweaty. It is, however, of the vanilla variety. And there’s no flimsy storyline just to string together a bunch of unrelated sex scenes. No, this is a real movie movie.”
Gina: “Dear Abby is the story of a young couple, who have broken up, but eventually find their way back together. Ok, so I’ll admit the premise is pretty trite, but movie is not. There are four sex scenes featuring four very attractive couples. Unlike a lot of the porn I’ve seen, these couples seem to have real chemistry together. The camerawork is first-rate and the viewer is treated to an over all view of the couples enjoying themselves, not just fucking. There are no intense close-ups that make some porn really creepy. The sex is never hurried and the female characters are believable. In fact, they are presented as multidimensional people, not mindless sex dolls for the gratification of the guys. And there’s kissing, lots and lots of kissing.”
Kevin: “Both the guys and the gals are very attractive. And the blowjobs scenes are fantastic. Did I mention I LOVE blowjobs? But wait; are all the guys in porn these days shaving their pubes? Looks like it from this feature. Not one of the male performers has a bush. WTF?”
Gina: “Yeah, I wondered about that too. I like to see a man’s bush.”
Full Review HERE!

ENJOY!

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!