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Female Sexual Dysfunction, Another Perspective


Hey sex fans,

It appears that my posting of last week, Female Sexual Dysfunction Is A Fictional Disorder, caused quite a stir.  As you recall, I was answering a question from a woman who asked if FSD, or female sexual dysfunction is real or a fictitious “ailment” that is being promulgated to sell pharmaceuticals to unsuspecting women.  I replied; “I think that, for the most part, female sexual dysfunction, or FSD, is a fictional disorder. I also think pharmaceutical companies are trying to hit on a female version of Viagra to treat this imaginary disorder so they can make a bundle, just like they did with as the male version.”

Well, that didn’t sit well with some friends and colleagues. One among them, Dr. Serena McKenzie took the most exception. She sent me a little note: “Your blog on female sexual dysfunction being fictitious is – respectfully – fucking bullshit sir.” Ok then!

I invited Serena to make her case not only to me, but to all my readers. What follows is Serena in her own words.

Flibanserin, the first and only medication available for use in reproductive aged women with low libido, becomes commercially available this week after a rocky and controversial road that led to its FDA approval Aug. 18. The view on the medication whose brand name is Addyi (pronounced ADD-EE) ranges from a historical achievement in women’s health care to an epic failure of commercialized medical propaganda. Despite the lengthy debate that has surrounded flibanserin, what most people want to know is whether it will help their sex life or not now that it is here.


First Things First

While sexual concerns can be difficult to discuss for many women and their partners, it is important to acknowledge that sex and intimacy are some of the great extraordinary experiences of being human. When sex goes badly, which statistically it does for 43 percent of U.S. women, the consequences can devastate a relationship and personal health. One of the biggest applauds I have for the FDA is their statement of recognition that female sexual dysfunction is an unmet clinical need.

Sexuality Is Mind-Body But Not-Body?

Sexuality is usually complicated, and problems with sex such as loss of libido are multifactorial for most women. Antagonists to flibanserin cite psychosocial contributions such as relationship discord, body image, or history of sexual abuse to be the most pinnacle causes of a woman who may complain of problematic lack of sexual desire, and that sex is always a mind-body phenomenon. While these factors often implicitly correlate to loss of sexual interest for a woman, they don’t always, and you cannot advocate that women’s sexuality is all inclusive of her mind, body, and spirit — and assert simultaneously that a biochemical contribution which flibanserin is designed to address in the brain to improve satisfying sexual experiences does not exist.

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

The Biochemistry of Sex

Antidepressant medications that alter brain biochemistry are notorious for having sexual side effects which can be prevalent up to 92 percent of the time, and are known to decrease sexual interest, disrupt arousal, and truncate orgasm in some women. Ironically, flibanserin was originally studied as an antidepressant, and while the exact mechanism of how a medication can impair or improve sexual interest is unknown, it should not be difficult to consider that if biochemical tinkering can crush sexual function, it may also be capable of improving it.

Efficacy Data Dance

Flibanserin is a pill taken once nightly, and has been critiqued as showing only modest increases in sexual desire, with improvements in sexually satisfying events rising 0.4 to 1 per month compared with placebo. However just because flibanserin has lackluster efficacy data, that does not mean it is ineffective, and even small improvements in sexual function can be life altering for a woman struggling with disabling intimate problems. If only 1 percent of women with low libido were to improve their sexual function with use of flibanserin, that equates to 160,000 women, or the population of Tempe, Arizona.

Blue Sky Side Effects

Flibanserin has side effects, and the sky is blue. All medications have pro and con profiles, and for flibanserin the most common consequences of use include fatigue, dizziness, sleepiness, and a rare but precipitous drop in blood pressure. Women may not drink alcohol while taking this medication. Providers who will prescribe it and pharmacies that will dispense flibanserin must be approved through what is called a Risk Evaluation and Management Strategy, or REMS, which means they are educated on advising women on how to take flibanserin safely. While a REMS program is arguably overkill compared to numerous higher risk, common prescriptions which do not require a REMS, it is an excellent opportunity for clinicians who have a background in sexuality to be the main applicants since they are far more qualified to assess proper candidates for treatment as well as continue to endorse holistic measures alongside flibanserin. Women who are interested in trying flibanserin should only obtain it from sexuality trained professionals.

The Proof Is In The Sexy Pudding

If flibanserin is worthless, the marketplace will bury it in a shallow grave quickly. Women will stop paying for it, and conscientious medical providers will stop prescribing it. Yet 8,500 women taking flibanserin were studied, over a 1,000 of them for one year, and the data suggests it will help some. Women deserve to be educated on their options, because sexual health is worth fighting for.

Changing The World, One Orgasm At A Time

We simply cannot overlook how astronomical of an achievement it is to even have a mediocre medication approved for female sexual dysfunction. Women’s sexuality has been ignored by medicine for most of history. At least now we have something to fight over.

The controversy about flibanserin is in fact magnificent, and frankly, the entire point. We must talk openly about sexuality and sexual concerns to improve them, personally for one woman at a time, but also uniformly to embrace female sexuality as a vastly larger societal allowance.

A satisfying sexual life is far more than the restoration of sexual dysfunction, it’s a thriving, multi dimensional, ever evolving weave of psychology, relationships, life circumstances, and yes can include a milieu of biochemistry and neurotransmitter pools.

Is a pill ever going to replace the vastly complicated arenas that fuse into our sexual experience? Of course not — it’s absurd and lazy-minded for anyone to suggest that is even being proposed. But it is necessary and inherently responsible to allow for all possible puzzle pieces to be utilized through the ever evolving navigation of sensuality, intimacy, and erotic fulfillment.

So will flibanserin make your sex life better? Maybe. But considering the conversation about it valuable as well as its use as merely one tool among many options to improve sex and intimacy would be the better bet. Ultimately, we “desire” sex that is meaningful, erotic, and dynamic. The journey of seeking sexual vitality deserves every key, crowbar, heathen kick, graceful acrobatics, or little pink pill that lends its part to the process, no matter how small or big, for the opportunity to discover and embrace a sexual aliveness.

Holistic physician, certified sexual medicine specialist, sex counselor, medical director of the Northwest Institute for Healthy Sexuality

These Volunteers Give Handjobs to the Severely Disabled

By Nelson Moura and Yun jie Zou


Hand Angels helping Andy from his wheelchair into bed.

Andy is a muscular dystrophy patient who lives with his parents in southern Taiwan. Due to his severe physical disability, he was home-schooled and couldn’t leave his house alone, so never really had the opportunity to develop either an active social life or a romantic relationship.

When the Taiwanese NGO Hand Angel—an organization promoting the sexual rights of disabled people—first spoke to Andy, they realized this situation meant he’d also never been able to have a frank conversation with anyone about his sexuality. And as a young gay man who didn’t want to speak to his parents about his feelings, this wasn’t exactly the healthiest situation to be in.

So, over the course of a few months, representatives from the NGO counseled Andy online, helping him to understand his own sexuality and place in the world. Next, they “smuggled” him out of his house and took him to a motel for a handjob.

Taiwan—officially known as the Republic of China—has one of the best health systems in the world; its million or so disabled citizens receive some of the most thorough medical attention you’ll find, including everything from long-term care to traditional herbal medicine. What they don’t receive from this system, however, is any kind of aid when it comes to slightly more intimate issues, namely: orgasms.

It was for this reason that a group of social campaigners and volunteers took it upon themselves to create Hand Angel, an NGO whose main service is giving handjobs to the severely disabled. Members say that their work raises awareness of the fact that disabled people are often depicted as desexualized—as well as having their sexuality constantly neglected—despite the fact they share exactly the same desires as anybody else.

In the Netherlands, the national health system provides a grant scheme for people with disabilities to receive public money to pay for sexual services up to 12 times a year. In Taiwan, sex remains a taboo, and some Buddhists—the sovereign state’s primary religion—believe that someone suffering from a disability means they’re paying for bad deeds in a past life. So not the best mix for those like Andy, really.

“I can’t tell my parents that I also have sexual desires, and I can’t come out of the closet in front them,” he told me. “My family’s care puts lots of pressure [on me] and sabotages me from normal romantic relations.”

Vincent, the 50-year-old founder of Hand Angel, lost his legs to polio and says his disability allows him to better empathize with applicants’ needs, without any of the patronization disabled people can sometimes face. He emphasized that “disabled people share the same physical and emotional needs as any others, and therefore should have the right to pursue them.”

In order to decide who’s entitled to use their services, Hand Angel first assess an applicant’s level of disability. The person has to be recognized by the government as having a serious physical impairment, but can’t be mentally disabled. Once they’re cleared, the service is totally free, but each applicant can only receive three bouts of sexual stimulation.

Volunteers—the group of 10 people actually giving the handjobs—come from varied backgrounds; some are gay, some are straight, some are disabled, some are PhD students, some are social campaigners and some work in the media. It’s made very clear to me that these volunteers only use their hands for second-base kind of stuff—that hugging, caressing, and kissing on the face are all fine, but anything penetrative (fingering, oral sex, vaginal sex, and anal sex) is not.


The hands of Hand Angel volunteers

When Hand Angel took Andy to the motel, the volunteer caressed him thoroughly and gave him a handjob. He described the intimacy being so intense that, for a minute, he believed he was in love. He knew it was only temporary, of course, but the experience provided him with an emotional connection he’d never felt before.

This is part of Hand Angel’s mission: not just providing a sexual service, but also bringing forth an emotional and social transformation in applicants.

“[Andy] was very introverted before, and didn’t really know how to interact with people,” said Vincent. “However, through months of talking online, I discovered something changed inside him. When our group was reported by the media and got lots of criticism, I saw Andy joined the public debate and argued with those [critical] internet users, trying to illustrate his opinions.”

In Taiwan, where a discussion of sexuality is restrained by strict moral codes, there was also plenty of mockery leveled at Hand Angel. Internet users starting posting comments like: “Do they also offer ‘Mouth Angels?'”; “I’m retarded; can I apply for Hand Angel service, too?”; and “Only three times in a lifetime?”

There even appeared to be negativity on an official level. The executive secretary of the Taipei United Social Wealth Alliance, Yi-Ting Hu, commented on the NGO, saying: “Speaking from personal opinion, I don’t think we need to bring up disabled people’s sexuality as an independent issue. There are more important and urgent problems we need to deal with. Don’t you think if you advocate their sexual rights, it is like another form of discrimination?”

Of course, he seemed to only be proving Hand Angels’ point; to suggest that advocating a disabled person’s sexual rights is a form of discrimination is, first, patronizing in itself, and secondly, just completely bizarre—how is consensually receiving a handjob in any way discriminatory?

Andy summed it up: “I didn’t feel I was the target of pity. The whole process was full of respect and equality. This might be deemed as controversial by society, but as long as you’re willing to look into it, what we desire is no different from others. Just ask yourself: do you need to consult your parents before having sex?”

Complete Article HERE!

A Poisonous Relationship

Name: Clare
Gender: Female
Age: 40
Location: St Louis
My best friend can’t bring herself to sever her ties with her ex-boyfriend. Even though their last attempted reunion ended in a very violent fight. My friend has this weird nostalgia for the relationship she had with her ex at the beginning. Back then, before he started drinking and drugging, they did have a couple of good years, but that was a long time ago. I’m very concerned for my friend. She’s often depressed and she is pulling away from her friends. I think she is seriously considering getting back with her no-good, two-timing ex. I know that my role as a friend is to love and support her, but her ex is not to be trusted. I fear as much for her safety as for her heart. What’s a friend to do?

So many things are going on here, Clare. It’s hard to know where to begin. Your friend can’t sever her ties with her ex because she doesn’t want to. Even if she wanted to end it once and for all, it’s not an easy thing to do.

Anyone who has been there will tell ya that quitin’ a bad relationship is as difficult as quitin’ booze or dope…maybe even harder. Most folks in poisonous relationships can’t extricate themselves because they are part of the toxicity. Bad relationships, like the good ones, are completely dependent on the participation of both individuals in the couple. Each one feeds off the other and each one’s bad behaviors rewards and facilitates the pathologies of the other.

crying girl

There is no such thing as a good, psychologically healthy person in a bad relationship. There may be one in the couple that is less culpable, or less abusive, or less self-destructive, but there is never one that is without blame.

Like all junkies, your friend is hooked. Her depression and withdrawal are outward signs of the pathology. Nothing is gonna change this for her until she acknowledges that she is caught in a downward spiral. Domestic violence — and we ought to label the nature of your friend’s relationship for what it is — will escalate. It always does. Will your friend get out in time? There’s no guarantee. Is there anything you can do? Well that, Clare, is a more difficult question to answer. If you do too much you are at risk of supporting her habit. Or worse, you could be co-opted into the pathological dynamic of the relationship.

The best you can do is to tell your friend how you feel about her predicament. Speak your mind in no uncertain terms. If you decide to confront your friend with an intervention, I suggest that you have some well-considered resources to hand her while you are doing so. For example, you could do some legwork and find some local domestic violence resources — a hot line, a shelter, counseling referrals and the like. Once you make this intervention and it’s over, drop it. Drop it for good. This is the hardest thing a friend has to do, but constantly badgering someone in your friend’s condition is counterproductive. If you can’t stand to witness the self-destruction, take your leave of the friendship and hope for the best.

However you play this, don’t hold your breath for a happy ending. They happen sometime, of course, but real life is so not like the movies.

Good luck

What’s Your True Sexual Orientation? The Purple-Red Scale Is Here to Help You Find Out

The Purple-Red Scale

By Nicolas DiDomizio

When reality TV dumpling Honey Boo Boo Child declared that “everybody’s a little bit gay” three years ago, she was unknowingly taking a page out of sexologist Alfred Kinsey’s book. His famous Kinsey scale, which identifies people’s levels of same- or opposite-sex attraction with a number from zero to six (zero being exclusively straight, six being exclusively gay), has been a favorite cultural metric for measuring sexual orientation since it was created in 1948.

But even though asking someone where they fall on the Kinsey scale is now a common dating website opener, the Kinsey scale is far from an all-inclusive system. As Southern California man Langdon Parks recently realized, the scale fails to address other aspects of human sexuality, such as whether or not we even care about getting laid in the first place.

So Parks decided to develop a more comprehensive alternative: the Purple-Red Scale of Attraction, which he recently posted on /r/Asexuality. Like the Kinsey scale, the Purple-Red scale allows you to assign a number from zero to six to your level of same-sex or heterosexual attraction, but it also lets you label how you experience that attraction on a scale of A to F. A represents asexuality, or a total lack of interest in sex “besides friendship and/or aesthetic attraction,” while F represents hypersexuality.

Pick your letter-number combo below:

What's Your True Sexual Orientation? The Purple-Red Scale Is Here to Help You Find Out

Parks told Mic that he came up with the idea for the Purple-Red scale after learning about asexuality and realizing that he was a “heteroromantic asexual, or a B0 on the scale” — someone who is interested exclusively in romantic, nonsexual relationships with the opposite sex.

“I then thought, not only are there sexual and asexual people, [but] there are different kinds of sexual people as well,” he said. “I thought of adding a second dimension to Kinsey’s scale to represent different levels of attraction.” (As for the color scheme, Parks opted for purple because of its designation as the official color of asexuality, while “‘red-blooded’ is a term often used to describe someone who is hypersexual.)

The scale represents all possible degrees of sexual attraction, from those who only want to have sex when they’re in a relationship to those who are ready and rarin’ to go pretty much whenever. For instance, if we use Sex and the City as an example, Carrie would likely be an E1, while the more prudish Charlotte is probably more of a D0 and uptight Miranda an E0. Our beloved bisexual, sex-crazed Samantha? Totally an F2.

What's Your True Sexual Orientation? The Purple-Red Scale Is Here to Help You Find Out

Busting myths about sexual attraction: Back in 1978, Dr. Fritz Klein tried to update the scale to make it more inclusive of a wider range of sexual experiences, as well as sexual fantasies. His final product, the Klein Sexual Orientation Grid, came out a bit clunky, however, and was still based on the assumption that everyone using it was capable of experiencing sexual attraction in the first place.

Parks’ Purple-Red Scale accounts for those who experience sexual attraction at different times in different contexts, as well as those who don’t experience it at all. That’s notable in part because although asexuality is not exactly rare — according to one estimate, approximately 1 in 100 people are asexual, though they might not self-identify as such — it’s one of the most widely misunderstood sexual orientations, with many people assuming that asexuals are just closeted gay people or too socially awkward to have sex.

But asexuality is a legitimate sexual orientation with many unique shades of its own. As the Huffington Post reported back in 2013, many asexual people don’t just identify as asexual. For instance, they can also self-identify as “heteroromantic” (meaning they’re interested in having exclusively romantic, nonsexual relationships with members of the opposite sex) or “demisexual” (meaning they’re open to experiencing sexual attraction within the context of a strong emotional connection or committed relationship).

“Some people don’t want to have sex in a relationship at all, and others view it as the whole point of the relationship,” Parks told Mic. “Yet others typically start off having no feelings but build them up over time. Still others don’t want sex for themselves, but are still willing to have it for other reasons,” such as to procreate or make their partner happy.

That’s why Parks’ Purple-Red scale is so important: It acknowledges the shades of grey in sexual orientation and sexual interest. Both, he explained, are fluid and largely dependent on context.

Why do we need scales in the first place? While the Purple-Red scale is helpful in classifying sexual attraction, some people might argue that we don’t need a cut-and-dry system for classifying our sexuality in the first place. If the burgeoning “label-free” movement of sexual fluidity is any indication, coming up with clinical labels like “E2” or “B0” might be purposeless or even counterproductive to achieving true sexual freedom.

But Parks believes that having a simple tool like the Purple-Red Attraction Scale can be useful, particularly as a way to improve communication in the dating world. “The scale was designed to provide a quick and easy way of scoring a person’s view of relationships on forums and dating sites,” he said. Imagine, for instance, if you logged onto OkCupid and entered your sexual orientation as D5, instead of simply self-identifying as “gay,” “straight” or “bisexual.”

Parks also noted that the Purple-Red scale is a great way to match partners who have similar or compatible sex drives. “Attraction type is every bit as important as orientation,” he told Mic. “We see it all the time: John wants sex, sex, sex, while Jane doesn’t have the feeling right away.”

Because discrepancies in sex drive can cause problems in same-sex and opposite-sex relationships, Parks wants people to use the scale as a way to establish sexual compatibility right off the bat.

“Instead of relying on assumptions like ‘Oh, he’s a guy, go for it!’ or ‘She’s a woman, wait for it,’ people can now use their letters to describe their basic outlook on relationships,” he said.

“Attraction type is every bit as important as orientation.”

Perhaps one day, we’ll live in a world where we don’t need something like the Purple-Red scale to tell us about our own sexuality; a world where we don’t need to fit who we want to have sex with into boxes or spectrums or scales. But for the time being, whether you’re a B2 or an F5 or a D6, it’s cool that we have something like Parks’ scale to help us answer the nagging questions about sexual orientation that our culture keeps asking us to answer — and maybe it can help us find out a little bit more about ourselves.

Complete Article HERE!

Sexual Frustration Reigns

Hello Dr. Dick

First time question to you. I’m sure you’ve probably heard this one a million times, but I could use some advice :-)

I married my best friend. Sex has never been frequent or great. Most of the time he finishes in less than five minutes of penetration and I rarely if ever get to orgasm. The first and last time I think I did have an orgasm I think was the day we conceived our little girl.

He’s a great guy in all other aspects, but when it comes to the bedroom, it doesn’t happen. I’ve tried seducing him (which he responds to eagerly, finishes and then rolls over and goes to sleep), tried asking if we could try different things (different has ended up being one of two positions – missionary and woman on top – he does not like and will not do anything else). He also does not want to and won’t do stimulation with his hands or anything else for that matter. He also does not like or want toys in the bedroom, for him or me.

Any ideas on how I can convert him into a wife pleaser? I’m at my wits end. Last time I seduced him to get some “cock” in me was two months ago and needless to say I didn’t get any satisfaction. For the first time though I took care of things myself and at least I slept without really resenting him :)

I’ve been trying to not care, but I’ve found out I’m a very passionate woman who only gets more passionate with time… and with those needs not being met, I’m wondering if it’s the end? Can people be happy without sex? I haven’t found a way to yet but if you know of something, please let me know.

Anyway, if you have a chance to respond to my ramblings it would be appreciated… even if you have some insight into his actions/non-actions it would be greatly appreciated.


You’re right; I have heard this a million times.

sexual frustrationI’m gonna spare you the niceties and get right t the point, Coral. Your husband is clearly not up to the task of being your lover. His behaviors and his disinterest in finding a solution to the problem you have together tells me that he is a selfish lout. And how in the world can he be your best friend. Best friends don’t behave like this.

Let me put it to you another way. If you were writing to me to tell me that your husband hordes all the food in the house to himself. That he has you feed him till he is satisfied, but offers you only crumbs to sustain you. And that he won’t even negotiate you getting the food you need to survive and sustain yourself. What do you think I would say about that?

I suppose you see where I’m going with that, right? Listen, you oughtn’t be beggin’ for shit that is rightfully yours.

I have one real simple premise that I live by. And that is, each of us has a right to a happy, healthy, integrated sex life. If there is something that is getting in the way of achieving that, whatever it might be, it is a problem that needs to be addressed immediately.

As far as relationships go, I am of the mind that we ought, first and foremost, work to honor our commitments of fidelity and mutual support. Are there ways that these two moral principles — a right to a healthy sex life and one’s relationship commitments — can coexist when one’s relationship excludes the possibility of happy sexual expression? Yes, I believe there are. And many couples achieve this balance, because they have an overriding love and concern for one another.

Now the facts — not all loving relationship have a sexual component. Many, for one reason or another, simply don’t. But if a partner is unwilling to provide sexual satisfaction to his/her partner and he won’t even begin negotiate an amicable solution or other accommodations then, I believe, this a form of sexual abuse.factors-of-sexual-dissatisfaction

If what you report about your husband’s distaste for anything sexually adventurous is accurate, then you have a very hard row to hoe. (BTW,are mutually enjoyed sex toys in the bedroom all that adventurous these days?) Trying to negotiate a satisfactory solution to a problem is all the more difficult when your partner is opposed to even discussing the issue. Here’s what I suggest. Have a frank talk with the bonehead. Tell him, in no uncertain terms, that he has first right of refusal to you and your long-suffering naughty bits. If he isn’t interested in keeping you sexually satisfied, that means the door is open for you to get your groove on elsewhere. If he balks at that, stand your ground. Insist that he has just the two options of taking it or leaving it.

If this means the end of this relationship, as I suspect it might. Then have the spine to make a clean break of it. Because, if you don’t, then you are complicit in the abuse you are suffering.

Good luck

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