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Heightened Awareness: Anxiety Can Lead to Pain During Sex

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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

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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!

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Why society should talk about forced sex in intimate relationships, too

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In the wake of the deluge of news about sexual harassment and alleged assaults by several high-profile and powerful men, it is important to look at the causes and consequences of forced sex in the workplace – but also in intimate relationships.

Although forced sex by a boss and by an intimate partner considerably differ, they have these two things in common: They both disempower women and make women sick.

Sex is a double-edged sword. It enhances our well-being and boosts our relationships if it is consented. It becomes detrimental, however, if it is forced.

My research on sexuality focuses on causes and consequences of forced sex in intimate relationships. My studies have been on individual and environmental risk factors that increase risk of sexual abuse by male partners. I have studied the co-occurence between sexual and nonsexual violence in intimate relations. Finally, I have also studied the consequences of sexual abuse on mental health and relationship quality among women.

The recent news events provide an opportunity to address forced partner sex, a long-overlooked but insidious practice.

All too common

Let’s look at the numbers.

According to one report, one in four women experiences sexual violence by an intimate partner. According to another report, up to 50 percent of all sexual coercions are done by intimate partners. Around one-third of adolescent girls also report that their first sexual experience was forced.

About 15 percent of women also experience sexual harassment at their workplace.

Worldwide, 30 to 35 percent of women in a relationship experience some form of violence by their intimate partner. In the United States alone, more than 12 million adults, mostly women, experience intimate partner violence each year.

A sickening effect at home

In addition to the moral and human right violations of individual women, intimate partner violence imposes huge costs to society. According to a CDC report, the costs of intimate partner violence, including rape, physical assault and stalking, in the United States exceed US$5.8 billion each year.

Sexual abuse has a number of health effects, including higher risk of suicide. Individuals who experience sexual assault are also at higher risk of several chronic diseases such as asthma, irritable bowel syndrome, diabetes, chronic pain conditions and heart disease.

Individuals who are forced into sex by a partner show depression and high psychological distress. In fact, sexual abuse increases risk for almost all forms of psychopathologies.

Forced sex reduces women’s ability to enjoy sex in the future. Although some victims exhibit an increase in sexual activity, in most cases, forced sex is a risk factor for sexual avoidance.

Shame is a key aspect of the emotional suffering of those who experience sexual abuse. Shame is a core element of anxiety, depression and suicide, and is a barrier against help-seeking. As a result, victims typically continue to suffer in isolation. This is more so in societies where the rape victims are also blamed for their victimization.

My own research has shown a link between forced sex and relationship distress among married couples. By being forced to have sex, the women lose a sense of control of their bodies. Forced sex shakes women’s trust and attachment security.

Some believe that sexual violence is probably most depressing when it is committed by a spouse, partner or relative. When a woman is victimized by a stranger, she has to live with a frightening memory. When she is being forced into sex by a spouse or a partner, she lives with the “rapist” all the time.

A sickening effect at work

Sexual abuse can become chronic when it happens at the workplace. Given the imbalance in the power, fighting an assault in the workplace may be an uphill battle for women. Many powerful forces, such as human resources directors and lawyers, can serve to protect the company or to discredit and blame the victim.

Sexual harassment has a major effect on women’s careers. Some women leave their jobs to escape their harassing environment. Some people stay and fight. In both scenarios, sexual harassment causes career disruption for women.

Much of workplace harassment is a result of unbalanced power, and some scholars have called sexual harassment “gendered expression of power.”

This inappropriate expression of power imperils young, minority and poor women in the workplace in particular. Studies have shown that power differences can increase sexual abuse of young, minority and low socioeconomic individuals.

So who does force women into sex?

My research shows that sexual abuse does not occur in a vacuum. It tends to co-occur with relational dysfunctions as well as other types of violence. Women should consider psychological or verbal abuse by a partner, co-worker or boss to be a warning sign for future risk of sexual assault.

They should also know that men who show other types of violence, including verbal, psychological and physical violence, are more likely to commit sexual violence. Men who are very controlling verbally, economically and emotionally are also more likely to be sexual perpetrators.

And, it is important to know that alcohol and drug use contribute to sexual violence. Many men who force people into sex are intoxicated. Also, impulsive traits increase the risk. Men who express more anger and aggression are also at a higher risk of committing sexual violence.

Power plays a corrupting role

Social psychology research reminds us that power corrupts people, independent of their level of morality. So, when humans are given unconditional power, authority and dominance (over others), they are very likely to abuse it. Philip Zimbardo’s Stanford Prison Experiment showed that it is not evil people who do evil behaviors. Evil action is often about unconditional power and authority that people gain, rather than their immorality.

This may explain why the list of high-profile people who have been accused of sexually harassing women is mostly composed of powerful white men. This is not, I would argue, because white men are immoral, but because white men have the highest authority, dominance, social power and job control over their co-workers.

While the U.S. is undergoing a surge in awareness around workplace sexual harassment and abuse, people should also be mindful that the same dynamics are playing out among intimate relationships.

Complete Article HERE!

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Some drugs can cause unwanted sexual side effects in men

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You might assume that erectile dysfunction, or ED, is a normal problem that men face as they age. But because men (and women) take more medications as they age, the experts at Consumer Reports’ Best Buy Drugs report that side effects from those drugs are a little-known yet common cause of ED.

“Many medications can affect things like erectile dysfunction, desire and ejaculation in different ways and through different mechanisms of action,” says J. Dennis Fortenberry, former chair of the board of the American Sexual Health Association and the Donald Orr Professor of Adolescent Medicine at Indiana University School of Medicine.

Medications that can have these effects include high blood pressure drugs such as beta blockers, including atenolol (Tenormin), clonidine (Catapres), metoprolol (Lopressor) and methyldopa (Aldomet), and diuretics such as hydrochlorothiazide (Hydrodiuril).

Popular antidepressants and anti-anxiety drugs such as alprazolam (Xanax), diazepam (Valium), duloxetine (Cymbalta), fluoxetine (Prozac) and paroxetine (Paxil) can cause sexual problems such as delayed ejaculation, reduced sexual desire in men and erectile dysfunction. Lesser-known drug types that can also cause such sexual problems include antihistamines such as diphenhydramine (Benadryl) and antifungal drugs such as ketoconazole (Nizoral).

Surprisingly, heartburn drugs, including famotidine (Pepcid) and ranitidine (Zantac) are known to reduce sexual desire in men. In addition, reduced desire and erectile dysfunction have been reported in men taking the powerful painkillers oxycodone (OxyContin) and hydrocodone (Vicodin), muscle relaxers such as baclofen (Lioresal), and even over-the-counter ibuprofen (Advil, Motrin).

And perhaps not surprisingly, the more drugs a man takes, the greater his odds are of experiencing an issue. For example, in a 2012 study of men ages 45 to 69, those who took three to five drugs were 15 percent more likely to have erectile dysfunction than men taking two or fewer. Men who took six to nine drugs were 51 percent more likely to have erection problems.

What you can do

Before making any change to your medications, talk with your doctor, says David Shih, a board-certified emergency medicine physician and executive vice president of strategy on health and innovation at CityMD, a network of urgent care centers in the New York metro area and Seattle.

If appropriate, your physician can make changes such as “lowering the medication dose, switching to a new medication or a combination therapy of lower doses each,” notes Shih.

Your doctor may also suggest temporarily stopping a medication — often referred to as taking a “drug holiday” — before having sex, if that is possible.

If you’ve just started taking a new drug, sexual side effects may disappear as your body adjusts. But if after a few months they don’t, discuss it with your physician. He or she will want to rule out other conditions that could cause your sex drive to take a nose-dive.

“The prescribing physician will need to explore if these symptoms are from cardiovascular disease, depressive disorder, diabetes, neurological disease and other illnesses,” says Shih.

Even suffering from sleep apnea is known to affect sexual interest or response.

That’s why, if you experience ED, it’s important to get to your doctor’s office for a detailed discussion about what could be causing it.

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Lessons In Love For Generation Snapchat

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Tatiana Curran, right, and her boyfriend Jake Cowen-Whitman say their three-year relationship is an anomaly amongst their peers. But they readily concede that even they have serious issues around intimacy.

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Along with explicit sexual education classes, some schools are beginning to offer more G-rated lessons on love. Experts say the so-called “iGen” is woefully unprepared to have healthy, caring romantic relationships and young people need more guidance. So schools are adding classes that are less about the “plumbing” of relationships, and more about the passion.

At Beaver Country Day School, a private school near Boston, Matthew Lippman has taught whole courses on love and relationships. He loves teaching about love so much, he finds ways to delve into it every chance he gets.

In his American Literature class recently, he launched into a discussion about love songs.

“This is my favorite” he announces as he blasts “Despacito” by Luis Fonsi. The students howl.

“Are you kidding me?!”

“It’s so dirty!” the students say.

“Just kidding!” Lippman laughs. But now that he’s got their attention, he starts drilling them on what the song says about love — and lust.

Senior Tatiana Curran wades in cautiously. “It’s sexual,” she says. “But that doesn’t mean it’s love … y’know what I mean?”

“I understand,” Lippman reassures her, gently buttressing what may be a subtle distinction to some.

Lippman then introduces the class to what really is one of his favorites: “The First Time Ever I Saw Your

Matthew Lippman loves teaching about love so much he finds ways to slide in a lesson comparing contemporary and decades-old love songs during an African-American Literature class.

Face” by Roberta Flack. The song starts to unfurl so slowly, you can literally see these millennials getting antsy. Several seem relieved when Lippman finally stops the song, and starts pressing them on its underlying message.

“It’s showing that love takes time, that it’s not something that you rush into,” offers Joddy Nwankwo, noting how incongruous that is in today’s culture of high-speed everything and blithe hook-ups.

“A lot of (students) have short attention spans,” says Aiden Geary. “People don’t have a lot of long term relationships because we want everything like now, and then once we have it we’re bored with it.”

Curran and her boyfriend Jake Cowen-Whitman, who’ve been together for three years, are something of an exception. “I was asked literally the other day … ‘Aren’t you bored?'” Curran laughs.

But as one of those “iGen” teens who tend to text more than talk, even Curran readily cops to having some serious issues with intimacy.

“I get really uncomfortable, when it comes to like really romantic things,” she says. “Like I hate eye contact. It took me almost two years to actually fully make eye contact with Jake for a full sentence.”

The struggle to be present

“I think that’s the biggest piece to all of this,” says Lippman. “So much of this intimacy thing is being present, and that is hard for them.”

For sure, not all of them. Some young people are persevering and managing to forge meaningful, intimate relationships. And in some ways, technology can actually enable some difficult conversations. Some teens text things they wouldn’t have said at all if they had to do it face-to-face.

But, Lippman says, a significant number of young people are clearly struggling to make those real connections, and classes like his dovetail with a trend toward whole-child education.

He doesn’t pretend that one class can be a cure, but his lessons do seem to be resonating with his students.

“Walking into the class, I felt like I knew a good amount about love,” says Jade Bacherman. “But now I’m realizing that there’s a lot more to learn.”

“I don’t think we’re prepared to know what a healthy relationship looks like,” says Lisa Winshall. While kids get instruction on things like consent and sexual violence, she says they desperately need more coaching “on a much deeper level [about] what really taking care of someone else means.”

It’s exactly what Harvard Graduate school of Education Senior Lecturer Rick Weissbourd has found. His recent research shows young people are struggling with how to conceive of romantic relationships, let alone how to actually navigate them. “It’s a deep underlying anxiety,” he says, “so they’re looking for wisdom.” And it’s not enough to just give them “disaster prevention” kinds of sex ed classes, that only deal with pregnancy, STD’s and sexual violence, he adds.

“I think we are failing epically to have basic conversations with young people about the subtle, tender generous, demanding work about learning how to love,” he says. According to his data, about 70 percent of young people crave those conversations.

For them, the motivation may be a more fulfilling love life. But Weissbourd says the societal stakes are high; healthier relationships, he says, will pay dividends on all kinds of social ills, from sexual harassment and domestic abuse, to depression and alcoholism.

Relationships beyond Snapchat

Another school that’s trying to answer the call is The Urban school, a private high school in San Francisco. Health teacher Shafia Zaloom says she too was alarmed by teens’ social struggles and their belief that they “can build relationships over Snapchat or Instagram.” So she started a kind of “Dating 101” curriculum that covers things as basic as how to ask someone out. In one recent class, students brainstormed out loud.

“Like ‘Do you want to, like, go see a movie some time?'” suggests Sophomore Somerset Miles Dwyer with a nervous giggle.

“Yeah,” Zaloom nods, but then reminds the student to add “with me” at the end of the question, “to clarify things, because it’s not like ‘Oh, come hang out with us’ and chill with the group.” When you say “with me,” she explains, “that communicates more clearly your intentions that you want to be spending time together and getting to know each other.”

Zaloom’s course also tutors the kids on everything from how to break up to how to take things to the next level.

In one lesson they critique Hollywood love scenes. “That’s totally unrealistic,” says Miles Dwyer, as multiple romantic kisses and dreamy declarations of love unfold seamlessly, over a dramatic musical soundtrack . It all unleashes a slew of confessions about how much more awkward their own encounters usually are, and how insecure that makes them.

“On TV, the awkwardness isn’t there,” says Dominic Lauber. So when things don’t go as smoothly “in your real life, it feels like you’re doing something wrong,” he says. “So it could just feel like something you’d want to avoid. Kids nod and snap their fingers in agreement.

“Yeah, that’s definitely a fear,” says Abby Tuttle. “It’s all about vulnerability.”

Pushing through awkwardness

Boston College Professor Kerry Cronin says the insecurity and aversion to taking risks persist, so even the older students she sees on campus, still struggle with basic dating protocol. “You know they’re really just sort of numskulls about basic social steps,” she says. “They really aren’t sure how to handle themselves.”

It’s exactly why she now gives students a homework assignment — in an introductory Philosophy and Theology course — to actually ask someone out, in person.

“It’s mostly about pushing thru awkwardness,” Cronin says, “and finding out that even if you get rejected isn’t going to kill you. Because [this generation is] terrified of failure. And resilience is a major issue.”

Data is hard to come by, but anecdotally, private schools seem more apt than public schools to expand the usual “reading writing and ‘rithmatic” to also include romance.

“Our teachers are already burdened enough,” says Ashley Beaver, a public school substitute teacher and mom in San Diego. She says educating kids about love should come from parents, not schools, especially given how schools have handled sex ed.

“I mean they talked to middle schoolers about flavored condoms,'” she says. “It’s just too much too soon. So, no, I just don’t trust the institution to do it correctly.”

Indeed, G-rated discussions are not likely to be any less controversial in schools than the old-school X-rated ones says Jonathan Zimmerman of University of Pennsylvania Graduate School of Education. He agrees that the instruction is critically needed, but he says “we shouldn’t pretend that we have anything like agreement on these subjects.”

“Frankly, it’s a lot easier to get consensus on the sperm and the egg than it is on lust vs. love,” he says. “These are issues of values and ethics and culture, and in a country that is so irreducibly multicultural, we should expect there to be profound controversy and disagreement about this approach.”

Ideally, Harvard’s Weissbourd says, the lessons should come from school and home. And while many parents may think their kids don’t want to hear it from mom or dad, Weissbourd’s research shows they actually do.

As Professor Cronin put it, this generation was raised by helicopter parents — they expect to be coached on everything.

Complete Article HERE!

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