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

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

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

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

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

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

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

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

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

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

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

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

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A Kink In Her Pink

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Good luck

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!

Oh sweet mystery of life at last I found you

In lieu of Product Review Friday, we have some interesting Q&A about sex toys.

Name: Tadd
Gender: Male
Age: 31
Location: Arizona
In one of your podcasts you told some guy about a strap on kit he could buy for his GF. Could you repeat that? I’ve been trying to find one.

I responded to an inquiry from Karol from Poland a while back. He asked about a strap-on kit. I told him: “As to your question about a strap-on and what a guy should know about buying one for his female partner. I suspect the overriding concern for the amateur butt pirate is to get his gal a comfortable harness that can accommodate a couple different sized dildos. I suggested that he turn his attention to the Dr Dick’s Stockroom banner in the sidebar. I told him to click through there and search for the Bend Over Beginner Harness Kit (B664).  The good people at Dr Dick’s Stockroom have painstakingly put together everything you need for your first pegging!”

  • Is there someone in your life who is curious about strapping it on, but doesn’t know quite where to begin? Well, we have the perfect starter kit! Everything a beginning sensuous player would need to strap it on is included in this package (except their favorite water-soluble lubricant – sold separately).
  • This strap-on harness is low-riding with a fuzzy, deep purple velvet front and highly adjustable nylon straps. The kit has 2 color coordinated, shimmery purple dildos. These hypoallergenic silicone dildos are shaped and sized appropriately for those just beginning anal play adventures. The smaller is approximately 4″ long and 3⁄4″ wide, while the larger one is 5″ long and 11⁄4″ wide.
  • A powerful variable-speed mini-vibe sits in a secret pocket behind the dildo to give the wearer an extra jolt of fun. The straps are adjustable, fitting up to 50″ hips. The 1.5″ O-ring can be exchanged for play with other sized dildos (sold separately). Washable, smart, and sexy. Bottom line – this is one hot strap-on package!

Name: Gary
Age: 58
Location: Tampa
I’m a widower; my wife of 29 years died a little over a year ago. I’m just now getting back into the swing of thing. The sex I had with my wife was very conventional now I want to try something different. I want to go to a dominatrix. I’ve always had a fantasy about a woman owning and punishing my privates. It’s a big turn on. Is there anything I should know about this?

I love it, another kinkster in the making. Coming out as a perv, in my opinion, is better done late than never. My first suggestion is that you find a better term for your privates than “privates”. You sound like your mommy. I suggest cock and balls, it pretty much says it all very succinctly.

Have you done your homework in terms of finding the right dominatrix? I suppose you have at least a couple in mind, right? Might I suggest that when you make contact with one or another of these professional women that you be very specific about what you want and how you want it. You can ask for some hot CBT (cock and ball torture). Ya see, knowing the right vocabulary will often expedite your getting precisely what you are looking for.

Here’s a tip…a good submissive, or sub — that’s you, Gary, will want to bring his dominatrix, or dom a little gift to start things off on the right foot. May I suggest this little number: A Male Chastity Kit (B702). Look for it in the Dr Dick’s Stockroom.

  • The CB-3000 represents the latest design in modern male chastity devices from the same designers who invented the best-selling CB-2000 and The Curve. Some customers wanted a size mid-way between the CB-2000 and The Curve. The manufacturers listened to our customers’ requests and have allowed us to bring you this exciting new male chastity device.
  • The natural flow of lines in this model represents the cock and conforms to the body. The slim, smooth lines permit the CB-3000 to be worn easily under clothing. It is slightly vented with curving lines and custom openings for comfort and hygiene. The material, a highly durable transparent polycarbonate, is functional and appealing, and its strength exceeds that of acrylic and many other plastic blends.
  • Some men find it possible to use the urinals while wearing the CB-3000, though most find it more practical to sit. When locked with a plastic lock, the device will not set off metal detectors in airports or at other security checkpoints. So it is possible to wear the device 24/7 without interfering with travel or business routines. (Just make sure to use the plastic lock and not the brass lock under these circumstances.) This compact design involves no uncomfortable belts, straps or chains.
  • The CB-3000 consists of two main parts, the cage portion (inside length 3″ – inside diameter 1 3/8″) and the cuff ring. They easily slide together by means of two guide pins and a locking pin. The guide pins extend from the cage portion. Different-sized spacing rings are provided to allow a personalized fit.
  • The five rings included in the kit have inside diameters of 1_”, 1 5/8″, 1_”, 1 7/8″, and 2″. Once you find the right spacing, simply use a pair of side cutter pliers to snip the ends of the guide pins and then smooth the edges with an emery board or file. The locking pin is slightly recessed into the body cuff.
  • The Body Cuff comes in five different sizes, and swivels open at the bottom so that it can be closed easily around the cock and balls. Align the locking pin holes with the locking pins on the main part of the cage, add the proper amount of spacers, and then install the cage portion. The balls will then be trapped between the cuff and the cage. The smooth, rounded design minimizes pinching and chafing while being worn.
  • Finding the right-sized Body Cuff is extremely important for reasons of comfort and security. It should be as tight as possible without cutting off any circulation. If you are wearing a cuff that is too tight, it will cause some swelling and discoloration of the ball sac. If you see any discoloration, or experience numbness or aching discomfort, you definitely need to go to the next larger size. If you have a particularly high (short/tight) ball sac, you may find that you will need to stretch the ball sac slightly before the CB-3000 becomes comfortable and suitable for longer-term wear. For the most comfortable fit, the balls should hang below the cage and cuff ring. to prevent pinching.
  • I highly recommend applying baby oil/gel (or a similar product) to your cock with a cotton swab after showering. This practice allows your willie to move naturally up and down in the cage portion. Then you should be able to wear it 24/7 for indefinite periods of time. Some people have kept it on for months.
  • The CB-3000 kit includes the following: One brass padlock with 2 keys, 5 individually numbered, tamper-proof plastic locks, 3 different lengths of locking pins and 5 differently-sized spacers.

Good luck

LORDY, LORDY, LORDY!

Hey Dick!
As you know, I am an escort. My business is doing very well. In fact, so well I need to ask if you know of any meds, besides Viagra, that I can take that will help me maintain an erection over a longer period of time?
Can I be frank? Here’s the deal, let’s say I have I have two one-hour clients during the day. Then a regular of mine calls and wants an all-nighter. That’s not a problem other than the fact that this particular client wants to get fucked hard. I mean real hard, for hours at a time. He’s an insatiable power bottom.
I want to be able to ride his ass, like the bitch he is. Hell, I’m even attracted to him. I just can’t stay hard enough to fuck him like he likes (especially after having had the two clients before him that same day). Sometimes I have difficulty getting it up for him, and wind up finger-fucking him till my hand is sore. I do not want to lose this client. And shifting days is not the solution. Because when he wants it he wants it and I have to produce. That’s what I do, I sell “muscle.” I have a reputation for giving the best hard driving, dominating and controlling sex around.
Again, is there a medication I can take to maintain the erection?
— Works Hard

Dear WH,

Your life reads like a cheap porn movie script. Lordy, the good doctor nearly got the vapors simply reading through your very explicit missive. (As you can see, I had to edit out some of the more gory details so I could protect your identity in this public forum.) Of course, as you suggest, it never hurts to advertise. You’re so bad!

I thoroughly understand the pressures you and other sex workers face. It’s not as glamorous a life as it is often portrayed, huh? Ok, so you’re beautiful, men idolize you and crave your attention. You’re getting loads of sex, putting all those “bitches” in their place, and crying all the way to the bank to boot. It’s a tough job, but someone’s got to do it. But then again, there are all those sniggling performance issues that even a he-man like you must contend with.

The trouble lies in the fact that you are a workaholic. And that’s never good, regardless of the work one does. Sex work, like any other work, will burn you out if you’re not careful. If you don’t learn to pace yourself, darlin’, you’ll fizzle. (How’s that for an appropriate euphemism?) And from what you tell me, this is already beginning to happen. Keep it up (no pun intended), and you won’t be the first causality in this line of work, nor will you be the last. But If you ask me, and I happen to know a little something about sex work myself, the object here is to grow old (or older in your case) in your chosen profession.

I’m tellin’ ya, WH, if the erectile burnout don’t get ya the psychological torment will. I’ll bet you’re terrified the word will get out that Mr. Big-Beautiful-29-year-old-Stud-Power-Fucker can’t get it up. That would be real bad for business. And you know how those johns can gossip. Bitches! They don’t know that you’re servicing men at a rate that would make a superhero blush. All they see is limp willie and that spells trouble right there in River City.

It’s not surprising that you are having erection concerns given the number of clients you are seeing in one day. I mean, girlfriend, when do you find time to eat? You don’t need a new med, you need a vacation. If Viagra and a good cock ring don’t do the trick, then, in my humble opinion, your body is telling you to slow the fuck down.

And here’s another tip; research is beginning to show that prolonged and persistent use of Viagra can have some very unpleasant side effects. Those who overuse this potent cardiovascular drug, particularly young men who use it recreationally, may be in for some very unpleasant surprises down the road. So, I have one simple suggestion, WH, have a care about your sexual wellbeing and treat your dick gently. Despite the pounding you can inflict with it, it is a very delicate mechanism.

Good Luck

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