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Heightened Awareness: Anxiety Can Lead to Pain During Sex

Clearly anxiety can be an obstacle to a healthy sex life and needs to be talked about.

By Carrie Weisman

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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!

How to Have a Sex Life on Antidepressants

When quitting isn’t an option, is it possible to overcome the sexual side effects that come with an SSRI?

By Shannon Holcroft

So, you’ve finally filled the antidepressant prescription that’s been acting as a bookmark for the most recent novel you’re feigning interest in. Somewhere between missing your own birthday party and watching everyone else have fun without you, you gave in. After a few medicated weeks, things are starting to look up. Except for your sex life, that is.

Just last week, you were tied to a kitchen chair enjoying an amazing (albeit rather mournful) few minutes of escape through sex. Today, getting naked seems less appealing than all the other pressing tasks you have new-found energy to complete.

“Is it the meds, or is it just me?” you wonder as you deep-clean the fridge with new vigour. After some soul-searching, it becomes clear that you’re still the same person—just with fewer festering foodstuffs and a lot less crying.

“It must be a side effect,” you decide. But months after filling your prescription, your genitals are still giving you the physiological equivalent of 8d2cc2c1a43108301b149f7f33e1664d.png

Why Antidepressants May Be a Downer for Your Sex Life

“[Sexual dysfunction] is a difficult, frustrating, and very common issue with this class of medications,” says Jean Kim, M.D., clinical assistant professor of psychiatry at George Washington University.

Twelve percent of American adults reported filling an antidepressant prescription in the most recent Medical Expenditure Panel Survey. Not just for clinical depression, but for all kinds of off-label conditions like chronic pain and insomnia.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant class. And between 30 percent and 50 percent of individuals taking SSRIs experience sexual dysfunction. Desire, arousal and orgasm may be affected by changes in function of neurotransmitters like serotonin and dopamine; the very mechanisms through which SSRIs treat depression.

How to Work Around the Side Effects

When fighting to survive a potentially fatal mental illness, there are often more important concerns than getting it on. It’s frequently not an option to stop taking life-saving medication to avoid side effects. So what’s a sexual being to do?

Despite SSRIs being pretty pedestrian, there’s no concrete answer to addressing sexual side effects. “Unfortunately, not much is reliably effective to deal with this [sexual dysfunction],” Dr. Kim notes.

This may sound pretty gloomy, but there are plenty of things you can try to bring sexy times back around. “Don’t hesitate to bring up the issue with your prescribing clinician, as there might be some helpful interventions available,” says Dr. Kim.

Here are other ways to work around the sexual side effects of antidepressants:

1. Time It Right

“Some literature advises trying to have sexual activity when the serum level of a daily antidepressant might be lowest in the bloodstream,” says Dr. Kim. In other words, the ideal time to get it on is right before you take your next daily dose.

If your dosing schedule makes it tough to pencil in sexual activities, chat with your clinician about changing the time of day you take your meds. In many cases, there’s room for flexibility.

“This would not work much with some SSRIs that have a longer half-life like fluoxetine (Prozac),” Dr. Kim adds. Those taking antidepressants that exit the body quickly, like Paxil and Zoloft, could be in luck.

2. Switch It Up

Switching to a different medication, with the support of your prescribing clinician, may make all the difference. Certain antidepressants have a greater incidence of sexual side effects than others. Commonly prescribed SSRIs associated with a high frequency of sexual dysfunction include paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac).

Besides exploring the SSRI class, venturing into atypical antidepressant territory is another option. Buproprion (Wellbutrin) is an atypical antidepressant observed to present the lowest sexual side-effect profile of all antidepressants.

It may take some trial and error, mixing and matching to identify what works best for you, but it will all be worth it when you can [insert favorite sex act here] to your heart’s content again.

3. Augment

Some treatment add-ons may act as antidotes to SSRI-induced sexual dysfunction. “Supplementing with other medications that have serotonin blocking effects (like cyproheptadine [Peritol] or buspirone [Buspar]) or enhance other neurotransmitters like dopamine (like Wellbutrin) might help,” says Dr. Kim. She is quick to note that these findings are yet be confirmed by “larger-scale randomized controlled clinical trials.”

“Another common strategy is to prescribe erectile dysfunction drugs like sildenafil (Viagra) and the like for as-needed use before activity,” says Dr. Kim. Viagra has been found to reduce sexual side effects, even if you’re not in possession of a penis. In Dr. Kim’s clinical experience, “[Viagra] seems to help in more than a few cases.” Discuss with your doctor before adding any more medications to the mix.

4. Exercise

Now’s the time to take up aquacycling, indoor surfing sans water or whatever fitness fad tickles your fancy. Keeping active could be the key to preventing sexual dysfunction caused by SSRIs.

“Sometimes sexual dysfunction is not just a primary SSRI drug side effect but part of underlying depression/anxiety as well,” Dr. Kim explains. “Anything that helps enhance overall blood circulation, mood and libido might be helpful, such as exercise.”

Complete Article HERE!

A stressful life is bad for the bedroom

If you are consistently emotionally distressed due to social, economic or relationship pressures, you can be sure to lose erections. Being annoyed with your intimate partner all the time, and feeling undermined or frustrated are bad for your erections.

By JOACHIM OSUR

Lois came to the sexology clinic because she was sexually dissatisfied with her husband. It had been six months of no sex in their 11-year old marriage. Before that, her man had suffered repeated episodes of erection failure. “The few times he did get an erection, it was flaccid and short-lived,” Lois explained. “You can only imagine how that can be frustrating to a faithful wife.”

Lois suspected that her husband was getting sexual satisfaction elsewhere, and had angrily told him she didn’t want to have sex with him anymore. “I thought he was no longer interested in me because I had gained too much weight after bearing our two children, a very hurtful thought,” she explained sadly.

And so for six months the couple kept off each other. The relationship got strained and unfortunately Andrew, Lois’ husband, threw himself into his work. He stayed late at work and came home after everyone was asleep. He woke up and left the house early. He paid no attention to their two children anymore.

“So how can I help you?” I asked, lots of thoughts going through my mind due to the complexity of the case. You see, the man, who was the one having a problem, had not come to the clinic. Erection failure or erectile dysfunction (ED) is a complex symptom that requires a thorough assessment for its cause to be pinpointed. I needed Andrew to come see me himself.

VICTIM OF THE RELATIONSHIP

“What do you mean that it is a symptom of complex problems?” Lois asked, frowning. ED is simply a failure to be aroused sexually. This could be due to the derangement of some chemicals in the brain such as dopamine. It could also be due to hormonal problems such as low testosterone, high prolactin and so on.

What we are also seeing at the clinic is a rise in cases of diabetes and hypertension, usually accompanied by obesity. Most of the affected people have high cholesterol. These diseases destroy blood vessels, including those in the penis, making erections impossible. Further still, the diseases can destroy nerves, and if the nerves of the penis are affected, erections fail. People with heart, kidney, liver and other chronic illnesses may similarly get ED either from the diseases or from the medicines used to treat them.

Stressful lifestyles are also contributing to ED quite a bit these days. Many people work two jobs to get by, and have no time to relax or get adequate sleep. A physically worn out, sleep-deprived body is too weak to have an erection and you should expect ED to befall you any time if this is your lifestyle.

But emotional distress is even more dangerous for ED. If you are consistently emotionally distressed due to social, economic or relationship pressures, you can be sure to lose erections. Being annoyed with your intimate partner all the time, and feeling undermined or frustrated are bad for your erections. Further, feeling like a victim in the relationship can lead to ED. All these are further complicated by anxiety and depression, which are bound to set in as part of the relationship problem or as a result of the ED itself.

“So can’t you just give me some medicine for him to try then if it fails he can come for full assessment?” Lois asked, realising that my explanation was taking longer than she had anticipated.

Unfortunately that was not possible. We get this kind of request all the time at the clinic. In fact, people make phone calls asking for tablets to swallow to get erections immediately. Sometimes they call from the bathroom with their partner in the bed waiting for action yet the erection has failed. There is however no alternative to a thorough assessment and treatment of the cause of the ED.

Andrew came to the clinic a few days later. A full assessment found that he had a stressful career and relationship difficulties, and both had taken a toll on his sex life. He had to undergo a lifestyle change. Further, the couple went through intimacy coaching. It was another six months before they resumed having sex.

Complete Article HERE!

Sexual & Racial Politics in the Age of Grindr

Much like Facebook and Twitter, Grindr is a community of people interacting politically, revealing how our desires are shaped and politicized by culture.

By Senthorun Raj

Why am I on it? What do I want? Who do I talk to? Which profile picture should I use? Where should I hook up? When am I going to delete this?

For those of us who use Grindr, these questions probably sound familiar. I know that they haunt my subconscious pretty much every time I load the app. Some of my friends even like to joke that I spend so much time talking about Grindr, as opposed to talking on Grindr, that I’m just a “Grindr Academic.” To them, I’m the person who writes about my sex life (like I’m doing right now) and then cites Michel Foucault to give it academic legitimacy. I find the joke endearing. But, we should not trivialize the politics of Grindr.

So, what can this space of hooking-up teach us about sexual and racial politics?

Whether you are cruising for casual sex or complaining about love or procrastinating online, Grindr has rapidly transformed the way we negotiate intimacy and frame sexuality. Erotic, platonic, and/or romantic relationships are now just a “click” away on our smartphones. With millions of users worldwide, Grindr has become a source of sexual sustenance. From the moment I tap on to Grindr, I’m connected to a range of other profiles via my geographical proximity to them. I am enmeshed in a process of—as one user so neatly describes—“window shopping.” What I choose to shop for as I scroll through profiles, however, tends to vary. Some profiles display semi-nude selfies that invite “NSA” (no strings attached sex) while others display a photo of a night out in a club to indicate their interest in “friends, dates and maybe more.”

I can use Grindr to organize casual sex, professional networks, neighborhood parties, friendship, and dating. There are infinite intimate possibilities. In the words of Lauren Berlant and Michael Warner, these new “sexual counterpublics” emerge to facilitate new forms of emotional and sexual labour that do not just revolve around the traditional imaginaries of reproductive or matrimonial relationships.

With such titillating possibilities, I could easily herald Grindr as a transformative and revolutionary space for queer connections. My optimism, however, comes with concern: filters cannot block the everyday cruelties of ignorance and inequality. Grindr, for example, relies on standard categories of defining bodies (ethnicity, height, weight, age) in order to mediate sexual desire. Many of the app users fashion their online identities through both visual and written statements that they are “masc” (masculine) and “str8 acting” (appearing heterosexual). In doing so, Grindr users mimic and reproduce norms of what is socially desirable.

Discussing our desires can evoke feelings of embarrassment or anxiety. We like to protect our intimate attachments from public interrogation. Apps like Grindr, however, blur such distinctions. When “personal preferences” take shape in rhetorical statements like, “Don’t be another old, ethnic, nelly bttm” or “If people can tell you’re gay … you’re not masculine,” private desires are woundingly public. Even if it is a virtual platform, much like Facebook and Twitter, Grindr is a community of people interacting politically.

Grindr users respond to these disaffecting profiles in various ways: some people angrily use the block button, more patient people try to challenge the rhetoric online, and others just take screenshots and vengefully send them to Douchebags of Grindr. For those who have not stumbled upon it, it is a website where we can revel in shaming those who shame. The idea of shaming arrogant Grindr users seems both fair and funny. But, despite this, the public “outing” and breach of privacy involved raise a number of ethical questions about how we should respond to the “Douchebag Politics” we encounter online.

We need to recognize that bigotry is a social malaise—not a personal pathology.  Grindr makes bigotry painfully apparent but this is not unique to the online platform. In making spectacles out of the purported douchebags on Grindr, we can make the more insidious forms of racialized activities seem palatable by comparison. After all, why does using overtly racist words in your profile attract moral opprobrium, while using an automatic filter to exclude certain kinds of bodies does not?

Making spectacles out of unrepentant bigots may satisfy or entertain us, but it does little to ensure that the intimate worlds we are building are inclusive and respectful. Whether we are on public transportation or networking online, racism is a systemic problem that is not just isolated to highly visceral tirades. Isolating people or profiles in order to stigmatize the individual person, rather than challenge the problematic behavior, is counterproductive. It just makes most of us more defensive (no one likes being labeled as a racist or homophobe even if they obviously are). Moreover, this usually limits our ability to confront the more insidious forms of prejudice that underscore such problematic behavior or that which is coded in terms of “preferences.”

This is not to suggest we can turn to anti-discrimination law in order to redress our sexual grievances. We should not treat desires as justiciable. There is little value in policing ourselves to desire others on the basis of exclusion. Finding someone solely attractive because of, or in spite of, their difference—whether it is their perceived “Asianness” or a specific body type—turns people into fetish or pitied objects to be consumed.

But, we do need some uncomfortable reflections. We live in a society that privileges certain kinds of body types, genders, ethnicities, and ages. From eroticizing heterosexual masculinity or whiteness to repudiating effeminacy or fatness, Grindr is saturated with social hierarchies that are pervasive in society. Grindr shows us how our desires are shaped and politicized by culture. Few of us would deny that.

While we are often quite willing to confront the scenes of bigotry that our visible to us in public forums, we need to extend this ethic when reflecting on the prejudices that operate at the most banal and emotional level of our lives.

Grindr is a tool for sex. It’s also a tool for politics. In the words of Audre Lorde, “our visions begin with our desires.” So, let’s be open about that. The political is personal.

Complete Article HERE!