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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!

Why Aftercare Is The BDSM Practice That Everyone Should Be Doing

By Sophie Saint Thomas

If you’re unfamiliar with the BDSM scene, you might think it’s all whips, handcuffs, and pleasurable pain, but there’s one important element that BDSM practitioners have built into their sex lives to make sure that everyone involved feels safe and cared for after play time is over: a practice known as aftercare. And whether you’re into BDSM or have more vanilla tastes, aftercare is something everyone should be doing.

In the BDSM world, aftercare refers to the time and attention given to partners after an intense sexual experience. While these encounters (or “scenes,” as they’re called) are pre-negotiated and involve consent and safe words (in case anyone’s uncomfortable in the moment), that doesn’t mean that people can forget about being considerate and communicative after it’s all over. According to Galen Fous, a kink-positive sex therapist and fetish sex educator, aftercare looks different for everyone, since sexual preferences are so vast. But, in its most basic form, aftercare means communicating and taking care of one another after sex to ensure that all parties are 100% comfortable with what went down. That can include everything from tending to any wounds the submissive partner got during the scene, to taking a moment to be still and relish the experience, Fous says.

Specifically, with regards to BDSM, the ‘sub-drop’ is what we are hoping to cushion [during aftercare],” says Amanda Luterman, a kink-friendly psychotherapist. A “sub-drop” refers to the sadness a submissive partner may feel once endorphins crash and adrenaline floods their body after a powerful scene (though dominant partners can also experience drops, Fous says).

Of course, you don’t have to be hog-tied and whipped to feel sad after sex. One 2015 study found that nearly 46% of the 230 women surveyed felt feelings of tearfulness and anxiety after sex — which is known as “postcoital dysphoria” — at least once in their lives (and around 5% had experienced these feelings a few times in the four weeks leading up to the study). Experts have speculated that this may stem from the hormonal changes people (particularly those with vaginas) experience after orgasm, but many also say that it can come from feeling neglected. The so-called “orgasm gap” suggests that straight women, in particular, may feel that their needs in bed are ignored. And Luterman says that people in general can also feel lousy post-sex if they’re not communicating about what they liked and didn’t like about the experience.

Clearly, taking the time to be affectionate and talk more after sex — a.k.a. aftercare — can make sex better for everyone, not just those who own multiple pairs of handcuffs. So what does that mean for you? It depends on the kind of sex you’re having, and who you’re having it with.

Taking the time to be affectionate and talk more after sex — a.k.a. aftercare — can make sex better for everyone, not just those who own multiple pairs of handcuffs.

Like we said, there are lots of guidelines for BDSM aftercare, specifically. If you’re having casual sex, aftercare can mean simply letting your guard down and discussing the experience, something that can be scary to do during a one-night stand. It’s definitely dependent on the situation, but Luterman says that you can just express that you had a good time and see if they’re interested in seeing you again (if those are thoughts you’re actually having). “People want to be reminded that they still are worthwhile, even after they’ve been sexually gratifying to the person,” Luterman says. If your experience didn’t go well, it’s important to voice that, too.

And those in long-term relationships are certainly not exempt from aftercare, Luterman says. It’s something couples should continue to do, especially after trying something new (such as anal sex), she says. Did the sex hurt? Do they want to do it again? What did they like and not like about it? You can’t know what your partner is thinking unless you ask them. Plus, it can be easy for long-term partners to feel taken for granted, so making sure to cuddle, stroke each other’s hair, and savor the moment after sex can make even the most routine sex feel special.

One thing we should all keep in mind? It can also be helpful to continue these conversations when everyone’s vertical (and clothed) and any post-orgasm high has faded.

At the end of the day, aftercare is just a fancy term for making sure everyone’s happy once the sex is over. And while communication needs to be happening before and during sex as well, having these discussions afterwards comes with an added bonus: You can learn from the experience so that the sex is even hotter the next time.

Complete Article HERE!

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!