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

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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

Parts is Parts!

Name: Charles
Gender: male
Age: 47
Location: Northridge CA
I’ve heard a lot about checking your balls for possible problems — but none ever say what lumps you have naturally. At the low point of my testacles I feel a lump (I would explain it as an area that would feel more or less like a cracked egg, you have that part that is globules and is string-tethered to the yoke. Is that exactly what’s happening? Should you feel any pain if you squeeze it — especially trying to figure out if it is a lump or not?

My friend, I’m clever as all-get out about lots of things, but the lump on your balls ain’t one of those things. I’m not a medical doctor; I don’t even play one here on the internets. And I can assure you, no reputable doctor anywhere would hazard a guess about what you present without first seeing you in person. That’s just good medicine.

That being said, I applaud you taking note of your balls in an inquisitive sort of way. Good for you! But you should also have at least a rudimentary understanding of your testicular anatomy. So that when you do your self-exam, you can have some sense about what it is you are examining. To this purpose, I offer the diagram to the right. Is there anything in the diagram that looks even remotely like what you are feeling in your ballsack?

Finally, if you have a concern about what you think may be an abnormality, isn’t it high time for you to high tail it to a doctor for a look-see?

Good luck

Name: Tom
Gender:
Age: 18
Location: New York
Okay so I’m not sexually active yet so I’m not in a rush to solve this but I just had a question for you. Is it possible to have too much foreskin? I mean even when fully erect the skin still overhangs by like 1 quarter inch or so (never measured so not exact). So a few times I’ve tried to do it by hand and yet still it doesn’t fully go back and gets to a point that it starts to hurt and I can’t continue. So do I probably have to get cut some day or something? Also what if I decided not to get cut would this cause problems, just asking because if I didn’t have to go in and get cut I’d prefer that but you gotta do what you gotta do. Well thanks for the help.

Too much foreskin? Never heard of such a thing!

That being said, it does sound like you have been blessed with an abundance of lace curtains. What’s also obvious is that you’ve yet to learn how to manage a foreskin…particularly a wild and unruly foreskin, like yours.

Phimosis, or tight foreskin, can be a real pain. But stretching, not circumcision, is the cure for all but the most severe cases. I’d be willing to guess that you’ve never been taught to stretch your foreskin to make it more elastic, right? Alrighty then, let’s start with a few stretching exercises.

Exercise 1 — While you’re dick is soft; retract your foreskin as far back as you can. Work two fingers in under your hood till you can touch the head of your dick. Now attempt to roll your hood forward and over your fingers. It’s like docking another dick, only you’re using your fingers. This exercise depends on you having your fingers inside your foreskin for it to be effective. In time you’ll be able to add three fingers, instead of just two. This will stretch your skin to the point you’ll be able to easily retract it over your erect dick head.

Exercise 2 — Grab each side of the foreskin opening and gently pull each side apart. Stretch the opening till it’s stretched with a tension you can tolerate, but not actually painful. Hold for a count of 10 and release. Repeat for 5 sets of 10 pulls per day, more if you can handle it. Here’s a tip, these stretches are best done after soaking in a warm bath or a long hot shower.

Exercise 3 — This is a variation on exercise 1. Insert a smooth cylindrical object into your foreskin opening, like the cork from a wine bottle. This object needs to be just large enough to stretch the skin without pain. Once inserted, leave it there for as long as you can during the day, or for over night. As your foreskin stretches you want to swap one object for another with a larger diameter. If a wine cork is too big to start with, consider a smaller smooth wooden or plastic dowel. You can find these sorts of things at the Home-O Depot. You might need to use a bit of surgical tape to keep these stretchers in place.

These exercises may sound a bit invasive or uncomfortable, and perhaps they will be at first. But they’re nothing compared to getting cut as an adult. In a short period of time you will achieve the success you are looking for. Remember, properly caring for your foreskin will insure that you’ll be able to keep this amazing piece of your anatomy. So that when it’s time for you to become sexually active it will work flawlessly and exponentially increase your pleasure.

Good luck

Trouble in Paradise

Name: Carey
Gender:
Age: 33
Location: Kansas
My fiancée is 27 and in the past 3 to 4 years her libido has become virtually extinct I have tried everything and she just blames her birth control what do I do

You’ve been engaged to a woman for more than 4 years? Oh wait, maybe you’re trying to tell me that you proposed to this woman in spite of knowing she has an extinct libido? Either way, darling, that’s messed up, huh? Are you hoping this is “dry spell” is gonna somehow magically resolve itself once you’re married? I wouldn’t hold my breath for that, if I were you.

It’s true of course, birth control pills can seriously impact on a woman’s desire for sex. Your fiancée is probably one of these women. Maybe she ought to consult her physician about finding another type of pill that may have a less severe impact on her libido.

Many women find that triphasic birth control pills (which deliver differing amounts of hormones every week) interfere much less with their sex drive than monophasic pills (which deliver the same amount of hormones each dose).

She could also decide to discontinue the pill altogether, and choose another form of contraception, such as a condom or diaphragm. Just realize that once off the pill, her sex drive may only return very slowly.

You see how this predicament is a double bind for your fiancée. If she is more lax with her contraceptive efforts, just to please you and your sex drive; then she opens herself up for an unplanned pregnancy. And that’s not good for her, or you. Is there anything YOU can do to free her up from shouldering the full burden of contraception? Have you’ve considered a vasectomy? Probably not, huh? What man ever imagines he ought assume the responsibility for controlling reproduction?

While I wholeheartedly support the notion that married people deserve a rich and fulfilling sex life, unless there’s mutual agreement for another arrangement; that can’t happen if one of the partners is inequitably burdened by one thing or another. Perhaps, it’s time you and the little woman to have a frank talk about sharing the responsibility for contraception. And if this little talk is successful, maybe, just maybe, you’ll get laid again.

Good luck

Name: Tony
Gender:
Age: 40
Location: Houston
I’ve loved several women and even married and divorced one. Over the last few years, I notice having similar feelings for men around me…longing, sweaty palms, difficulty thinking and wanting to be with them alone. Is this love? Am I bisexual? Am I a sick man better of dead? I have not crossed the line and I still having great sex with women. But there’s now a guy that I think about when I’m with her! Am I gay? Bisexual? Sick in the head?

My first reaction is that what you present is not particularly uncommon. Many people, just like you, inexplicably find themselves behaving in a completely unexpected sexual manner. I’d love to know what triggered you to veer off your comfortable and predictable sexual path?

There’s never a scarcity of sexual fascists out there, people who believe that sexual tastes and preferences are carved in stone, or there’s only one “right” way to be sexual. They’ll persecute anyone who doesn’t conform to their strict immutable notions of sexuality and eroticism. Despite the proliferation of these hetero-fascists, homo-fascists, what have you; they are all very wrong about the indomitable human spirit.

For the most part, humans are not sexual automatons. Given a more permissive and sex-positive culture then our own, we’d all be more fluid in our eroticism and sexual expression. Are you one of the lucky few who has discovered the joy of this fluidity? Doesn’t quite sound like it to me, at least not yet. I think you’re still in the “scared shitless” stage.

For a guy who has yet to “cross the line” and actually act on your fantasy, you sure are preoccupied with your identity. Are you afraid that someone will take away your breeder card if you actually touch a dude in a sexual way? Does having same-sex feelings…sweaty palms and all…make you a gay? Doubt it! Being gay entails a lot more than a sense of longing for something you’re not supposed to have. Are you bisexual? I can’t say for sure, but you’re certainly not exclusively straight either. I suppose you have to come to grips with the self-identify thing when you have a bit more information about your burgeoning eroticism. What I know for sure is that you are not sick.

Who knows, your homoeroticism might very well be situational. It might not extend any farther than the guy you think about when you’re fucking chicks. I know all of this is can be pretty disconcerting and it can really mess with your head. But at least you know you are still alive sexually. So many people are sleepwalking through their erotic lives.

Will you act on your inclinations? Will you test the waters, so to speak? What harm could it do? Might just open up a whole new sexual world for you. On the other hand, if you do nothing, or try and repress these natural feelings, you’ll always know in your heart of hearts that you have the desire, if not the capacity, to express yourself sexually with a much wider range of humans than what you are currently used to. And something tells me that if you choose the path of self-denial, it will eat away at you until you satisfy your curiosity.

Good luck

Come Out, Come Out Wherever You Are

Just in time for National Coming Out Day, which just so happens to be today, October 11th, we have this from Craig:

Doc,
I’m 19, and I’ve decided that I’m gay. But I don’t know how to tell anyone. I’m afraid that I’ll lose my friends and family. I come from a very religious family, and they’ll never understand. I don’t want to hurt them, but I want to be honest about who I am. Just wondering if you could help me.

Coming out is never easy—or almost never—but having to do so to bigoted people makes things worse. There are many different aspects to the coming out process. It means both owning and valuing who you are, and sharing that information with others. You’ve apparently laid the groundwork by self-identifying as gay. Unfortunately, coming out also means learning to deal with the hostility many people have toward us sexual minorities.

Owning your sexual identity and integrating it into your overall sense of self is the first step in what I believe is a lifelong process. Your sexual preferences are just a small part of who you are. It is indeed an important part, but it’s not necessarily the defining element that some would make it out to be. In this instance, LGBT folks are not all that different from everyone else who is awakening to his/her sexuality. We can take some comfort from the fact that we are not alone. So many other segments of the population are marginalized and discounted because of their race, gender, age, religion, ethnic origin, you name it. Let’s face it, pup, our culture doesn’t do real well with diversity.

And ya know what else? There are a whole lot of us who are marginalized and who are discriminated against, who then turn right around and discriminate against and marginalize others. This just breaks my heart! Hopefully you’ll avoid the temptation to do this yourself.

Being different in our society is a double-edged sword. Obviously, it’s a challenge to the status quo, but it also frees us up to tread a less traveled path. To compensate for the difficulties of being a minority, we get to define ourselves in ways that are unavailable to the dominant culture.

I don’t suppose any of us is ever entirely really free of our own internalized homophobia, any more than other marginalized minorities can rid themselves of their internalized self-doubt. No one can completely escape the prejudices and biases that surround them, but most of us make our way, regardless. That’s why coming out is so important. It empowers us. It increases our self-esteem. Honesty increases personal integrity. And when we stop hiding or denying this important aspect of ourselves, we have greater freedom of self-expression, and we become more available for happy, healthy and honest relationships.

So, how much do you know about LGBT history? Knowing that you belong to a big and vibrant community with a long and illustrious history will enhance your queer identity. You’ll find positive role models in every era of human history, and in every human endeavor—and affirmative role models will help you achieve a positive sense of self. (However, you’re gonna have to do some digging. The dominant culture suppresses queer history, which often leaves those who are just coming out feeling isolated, alone and unsure. Fear of rejection from the dominant culture is greatest for those who don’t know they belong to something bigger and stronger than themselves.)

Knowing your gay history will also give you ammunition to refute those around you who will try to label you as sick or sinful. Loads of LGBT folk have enriched civilization through science, religion, music, politics, art, theater, sports and literature, to name just a few. Long before you and I showed up on the scene they were paving the way for the freedoms and tolerance we currently enjoy in this country.

If you’re not already involved in your local gay community, it’s high time you got hooked up. Practice your coming out skills with other LGBT people. Coming out to those who are most likely to be supportive will make this phase easier. And in doing so, you’ll be creating a natural support system of friends who will be your gay “family.” You will also find helpful resources, including support groups, crisis lines, gay-friendly churches and synagogues, social outlets and political and cultural activities and organizations.

Once you’ve honed your coming out skills with the queer community, you’ll be ready to move on to straight folks. This will probably be a mixed bag. Some won’t give a hoot. Others may have a lot of hoot to give. The best advice I can give you is the same advice I received from my gay elders when I was coming out at about your age: Make your coming out a celebration.

Listen, if you carry your hat in your hand, shuffle your feet and look all dejected when you make your announcement, your audience will have little choice but to receive the information as bad or troubling news. However, if you stand up, look the person in the eye, and tell her or him that you have some wonderful news to share with them, you will be giving them a running start on receiving the information as good news. Besides, a positive presentation will help short-circuit some of the initial shock or confusion they may experience.

Expect that most straight folks—particularly those of a religious bent—will need some time to get used to the idea of you being queer. And as you suggest, it is quite possible that some family members or friends may reject you initially. But it’s not the end of the world, and lots of people, even some religious folks, come around in their own sweet time.

Coming out to others will be a more positive experience if you’re comfortable in your own skin. Hopefully you’re not overly dependent on others for your sense of self—a tall order for someone of your tender age and background. But remember, thousands of people, young and old from every corner of the world, are making their first tentative steps out of the closet right this minute. You are not alone.

How well you do fare may ultimately hinge on controlling, as much as possible, the time and place you come out. If you “out” yourself as opposed to being “outted” by someone else, you’re more likely to succeed. Being able to judge the receptiveness of your audience is also important. The best time for you might not necessarily be the best time for the person you’re about to tell. (F’rinstance, grandpa’s funeral may not be the ideal time to announce to your family that you’re a big fat flamer.)

While some friends and family may have figured you’re queer long before you have, give everyone the time and space he or she needs to work through the news. Be prepared for some negative reactions. (Having some supportive friends available to talk things through afterward, or retreat to, will help.) If you do your best to bring the news in a life affirming way and your audience still rejects you, that’s not your fault; nor does that make them right. You have the right to be who you are. You have the right to be out, proud and open about all the aspects of your life, including your sexuality. Never let people unable to accept that, even if they are family, diminish your self-worth.

Coming out may be difficult, but it’s also very rewarding. Coming out affirms your dignity, as well as underscores the dignity of other queer folk. Finally, never take for granted the freedom and tolerance the dominant culture begrudgingly gives us. It’s only through vigilance and political action that we secure our rightful place in society.

Good luck.

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