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Staying Out Of The Closet In Old Age

By Anna Gorman

Partners Edwin Fisher, 86, and Patrick Mizelle, 64, moved to Rose Villa in Portland, Oregon, from from Georgia about three years ago. Fisher and Mizelle worried residents of senior living communities in Georgia wouldn’t accept their gay lifestyle.

Partners Edwin Fisher, 86, and Patrick Mizelle, 64, moved to Rose Villa in Portland, Oregon, from from Georgia about three years ago. Fisher and Mizelle worried residents of senior living communities in Georgia wouldn’t accept their gay lifestyle.

Patrick Mizelle and Edwin Fisher, who have been together for 37 years, were planning to grow old in their home state of Georgia.

But visits to senior living communities left them worried that after decades of living openly, marching in pride parades and raising money for gay causes, they wouldn’t feel as free in their later years. Fisher said the places all seemed very “churchy,” and the couple worried about evangelical people leaving Bibles on their doorstep or not accepting their lifestyle.

“I thought, ‘Have I come this far only to have to go back in the closet and pretend we are brothers?” said Mizelle. “We have always been out and we didn’t want to be stuck in a place where we couldn’t be.”

So three years ago, they moved across the country to Rose Villa, a hillside senior living complex just outside of Portland that actively reaches out to gay, lesbian and transgender seniors.

As openly gay and lesbian people age, they will increasingly rely on caregivers and move into assisted living communities and nursing homes. And while many rely on friends and partners, more are likely to be single and without adult children, according to researchpublished by the National Institutes of Health.

Rose Villa Senior Living, located just outside of Portland, Oregon, has made a point of welcoming LGBT elders. The community, which offers independent and assisted living, also has a nursing home on site.

Rose Villa Senior Living, located just outside of Portland, Oregon, has made a point of welcoming LGBT elders. The community, which offers independent and assisted living, also has a nursing home on site.

But long-term care facilities frequently lack trained staff and policies to discourage discrimination, advocates and doctors said. That can lead to painful decisions for seniors about whether to hide their sexual orientation or face possible harassment by fellow elderly residents or caregivers with traditional views on sexuality and marriage.

“It is a very serious challenge for many LGBT older people,” said Michael Adams, chief executive officer of SAGE, or Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders. “[They] really fought to create a world where people could be out and proud. … Now our LGBT pioneers are sharing residences with those who harbor the most bias against them.”

There are an estimated 1.5 million gay, lesbian and bisexual people over 65 living in the U.S. currently, and that number is expected to double by 2030, according to the organization, which runs a national resource center on LGBT aging.

Andrea Drury, 69, and Kate Birdsall, 73, got married in 2014 and moved to Rose Villa last year. Birdsall said she wanted to grow old together in an accepting environment. “We are just one of the couples who are here,” she said. “It just so happens we are both women.”

Andrea Drury, 69, and Kate Birdsall, 73, got married in 2014 and moved to Rose Villa last year. Birdsall said she wanted to grow old together in an accepting environment. “We are just one of the couples who are here,” she said. “It just so happens we are both women.”

Nationwide, advocacy groups are pushing to improve conditions and expand options for gay and lesbian seniors. Facilities for LGBT seniors have opened in Chicago, Philadelphia, San Francisco and elsewhere.

SAGE staff are also training providers at nursing homes and elsewhere to provide a more supportive environment for elderly gays and lesbians. That may mean asking different questions at intake, such as whether they have a partner rather than if they are married (even though they can get married, not all older couples have).  Or it could be a matter of educating other residents and offering activities specific to the LGBT community like gay-friendly movies or lectures.

Mizelle, 64, and Fisher, 86, said they found the support they hoped for at Rose Villa, where they live in a ground-floor cottage near the community garden and spend their time socializing with other residents, both gay and straight. They both exercise in the on-site gym and pool. Fisher bakes for a farmer’s market and Mizelle is participating in art classes. Fisher, who recently had a few small strokes, said they liked Rose Villa for another reason too: It provides in-home caregivers and has a nursing facility on site.

But many aging gays and lesbians — the generation that protested for gay rights at Stonewall, in state capitols and on the steps of the Supreme Court — may not be living in such welcoming environments. Only 20 percent of LGBT seniors in long-term care facilities said they were comfortable being open about their sexual orientation, according to a recent report by Justice in Aging, a national nonprofit legal advocacy organization.

Ed Dehag, 70, at the Triangle Square Apartments in Los Angeles, California, in August 2016. The retired floral designer moved into the building when his partner passed away and he couldn’t afford the rent on his old apartment by himself.

Ed Dehag, 70, at the Triangle Square Apartments in Los Angeles, California, in August 2016. The retired floral designer moved into the building when his partner passed away and he couldn’t afford the rent on his old apartment by himself.

This summer, Lambda Legal, a gay advocacy group, filed a lawsuit against the Glen Saint Andrew Living Community, a senior residential facility in Niles, Illinois, for failing to protect a disabled lesbian woman from harassment, discrimination and violence. The resident, 68-year-old Marsha Wetzel, moved into the complex in 2014 after her partner of 30 years had died of cancer. Soon after, residents called her names and even physically assaulted her, according to the lawsuit.

“I don’t feel safe in my own home,” Wetzel said in a phone interview. “I am scared constantly. … What I am doing is about getting justice. I don’t want other LGBT seniors to go through what I’ve gone through.”

Karen Loewy, Wetzel’s attorney at Lambda Legal, said senior living facilities are “totally ill-prepared” for this population of openly gay elders. She said she hopes the case will not only stop the discrimination against Wetzel but will start a national conversation.

“LGBT seniors have the right to age with dignity and free from discrimination, and we want senior living facilities to know … that they have an obligation to protect it,” Loewy said.

A photo of Dehag’s partner sits on the dresser in his bedroom. Dehag moved into one of the apartments shortly after his partner passed away.

A photo of Dehag’s partner sits on the dresser in his bedroom. Dehag moved into one of the apartments shortly after his partner passed away.

Spencer Maus, spokesman for Glen Saint Andrew, declined to comment specifically on the lawsuit but said in an email that the community “does not tolerate discrimination of any kind or under any circumstances.”

Many elderly gay and lesbian people have difficulty finding housing at all, according to a 2010 report by several advocacy organizations in partnership with the federal American Society on Aging. Another report in 2014 by the Equal Rights Center, a national nonprofit civil rights organization, revealed that the application process was more difficult and housing more expensive for gay and lesbian seniors.

Recognizing the need for more affordable housing, the Los Angeles Gay & Lesbian Elder Housing organization opened Triangle Square Apartments in 2007. In the building, the first of its kind, residents can get health and social services through the Los Angeles LGBT Center. The wait for apartments with the biggest subsidies is about five years.

Residents display rainbow flags outside their doors throughout the building. On a recent morning, fliers about falls, mental health, movie nights and meningitis vaccines were posted on a bulletin board near the elevator.

Lee Marquardt, 74, at the Triangle Square Apartments in Los Angeles, California, in August 2016. Marquardt moved into the apartment building two years ago. She said she didn’t want to spend her elder years hiding her true self as she had as a younger woman.

Lee Marquardt, 74, at the Triangle Square Apartments in Los Angeles, California, in August 2016. Marquardt moved into the apartment building two years ago. She said she didn’t want to spend her elder years hiding her true self as she had as a younger woman.

Ed Dehay, 80, moved into one of the apartments when they first opened. His partner had recently passed away and he couldn’t afford the rent on his old apartment by himself. “This was a godsend for me,” said Dehay, a retired floral designer who has covered every wall of his apartment with framed art.

His neighbor, 74-year-old Lee Marquardt, said she came out after raising three children, and didn’t want to spend her elder years hiding her true self as she had as a younger woman. Marquardt, a former truck driver who has high blood pressure and kidney disease, said she found a new family as soon as she moved into the apartment building two years ago.

“I was dishonest all the time before,” she said. “Now I am who I am and I don’t have to be quiet about it.”

Tanya Witt, resident services coordinator for the Los Angeles LGBT Center, said some of the Triangle Square residents are reluctant to have in-home caregivers — even in their current housing — because they worry they won’t be gay-friendly. Others say they won’t ever go into a nursing home, even if they have serious health needs.

Marquardt holds an old photograph of herself of when she was married. Marquardt, a former truck driver who has high blood pressure and kidney disease, came out after raising three children.

Marquardt holds an old photograph of herself of when she was married. Marquardt, a former truck driver who has high blood pressure and kidney disease, came out after raising three children.

In addition to facing common health problems as they age, gay and lesbian seniors also may be dealing with additional stressors, isolation or depression, said Alexia Torke, an associate professor of medicine at Indiana University.

“LGBT older adults have specific needs in their health care,” she said. And caregivers “need to be aware.”

Lesbian, gay and bisexual elders are at higher risk of mental health problems and disabilities and have higher rates of smoking and excessive alcohol consumption. They are also more likely to delay health care, according to a report by The Williams Institute at UCLA School of Law. In addition, older gay men are disproportionately affected by some chronic diseases, including hypertension, according to research out of UCLA.

Torke said LGBT seniors are not strangers to nursing homes. The difference now is that there is a growing recognition of the need to make the homes safe and welcoming for them, she said.

The Los Angeles Gay and Lesbian Elder Housing organization opened Triangle Square Apartments in 2007. In the first of its kind building, residents can get health and social services through the Los Angeles LGBT Center.

The Los Angeles Gay and Lesbian Elder Housing organization opened Triangle Square Apartments in 2007. In the first of its kind building, residents can get health and social services through the Los Angeles LGBT Center.

At Rose Villa, CEO Vassar Byrd said she began working nearly a decade ago to make the community more open to gays after a lesbian couple told her that another facility had suggested they would be more welcome if they posed as sisters. Today, several gay, lesbian and transgender people — individually and in couples — are living there, Byrd said. Her staff has undergone training to help them better care for that population, and Byrd said she has spoken to other senior care providers around the nation about the issue.

Bill Cunitz and Lee Nolet, who began dating in 1976, didn’t come out as a couple until they moved to Rose Villa last year. Cunitz is an ordained minister and former head of a senior living community in Southern California. He said he didn’t want to be known as the “gay CEO.”

Nolet, a retired nurse and county health official, said it’s been “absolutely amazing” to find a place where they can be open— and where they know they will have accepting people who can take care of them if they get sick.

“After 40 years of being in the shadows … we introduce each other as partner,” Nolet said. “Everyone here knows we’re together.”

 Complete Article HERE!

Expert Shares Tips for Talking Sexual Health With Cancer Survivors

by KATIE KOSKO

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Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer and survivors it can feel even more awkward. Nevertheless, sex ranks among the top 5 unmet needs of survivors, and the good news is, proactive oncology practitioners can help fill that void.

Sixty percent of cancer survivors—9.3 million individuals in the United States alone—end up with long-term sexual problems, but fewer than 20% get professional help, according to Leslie R. Schover, PhD, founder of the digital health startup, Will2Love. Among the barriers she cited are overburdened oncology clinics, poor insurance coverage for services related to sexual health, and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients about these issues.

And, oncologists and oncology nurses are well-positioned to open up that line of communication.

“At least take one sentence to bring up the topic of sexuality with a new patient to find out if it is a concern for that person,” Schover explained in a recent interview with Oncology Nursing News. “Then have someone ready to do the follow-up that is needed,” and have other patient resources, such as handouts and useful websites, on hand.

Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health for healthcare professionals.

“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” said Schover. “I submitted a grant four times before I retired, to provide an online interprofessional training program to encourage oncology teams to do a far better job of assessing and managing sexual problems. I could not get it funded.”

In her webinar, she offered tips for healthcare practitioners who want to learn more about how to address sexual health concerns with their patients, like using simple words that patients will understand and asking open-ended questions in order to engage patients and give them room to expand on their sex life.

Schover suggests posing a question such as: “This treatment will affect your sex life. Tell me a little about your sex life now.”

Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.

Sexual dysfunction after cancer can often lead to depression and poor quality of life for both patients and their partners.

According to Schover, oncologists and oncology nurses should provide realistic expectations to patients when they are in the treatment decision-making process.

“Men with prostate cancer are told they are likely to have an 80% chance of having erections good enough for sex after cancer treatment,” Schover says. “But the truth is it’s more like 20 to 25% of men who will have erections like they had at baseline.”

To get more comfortable talking about sex with patients, Schover advises role-playing exercises with colleagues, friends, and family—acting as the healthcare professional and then the patient. When the process is finished, ask for feedback.

Brochures, books, websites and handouts are also good to have on hand for immediate guidance when patient questions do arise. But Schover is hoping for a bigger change rooted in multidisciplinary care and better patient–provider communication to find personalized treatments tailored to each individual’s concerns and needs.

Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, she explained. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.

“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stressed. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”

Schover wants to make sure that those resources are easily accessible to patients and survivors. Thus, she has created the startup, Will2Love, which offers information on the latest research and treatment, hosts webinars, and provides access to personalized services.

“Sexual health is a right,” concluded Schover, and both oncology professionals and patients need to be assertive in getting the conversation started.

Complete Article HERE!

Trust a Scientist: Sex Addiction Is a Myth

By Jim Pfaus

A psychologist explains why sex addiction therapy is more about faith than facts, as told to Tierney Finster

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Self-labeled sex addicts often speak about their identities very clinically, as if they’re paralyzed by a scientific condition that functions the same way as drug and alcohol addiction. But sex and porn “addiction” are NOT the same as alcoholism or a cocaine habit. In fact, hypersexuality and porn obsessions are not addictions at all. They’re not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by definition, they don’t constitute what most researchers understand to be addiction.

Here’s why: addicts withdraw. When you lock a dope fiend in a room without any dope, the lack of drugs will cause an immediate physiological response — some of which is visible, some of which we can only track from within the body. During withdrawal, the brains of addicts create junctions between nerve cells containing the neurotransmitter GABA. This process more or less inhibits the brain systems usually excited by drug-related cues — something we never see in the brains of so-called sex and porn addicts.

A sex addict without sex is much more like a teenager without their smartphone. Imagine a kid playing Angry Birds. He seems obsessed, but once the game is off and it’s time for dinner, he unplugs. He might wish he was still playing, but he doesn’t get the shakes at the dinner table. There’s nothing going on in his brain that creates an uncontrollable imbalance.

The same goes for a guy obsessed with watching porn. He might prefer to endlessly watch porn, but when he’s unable to, no withdrawal indicative of addiction occurs. He’ll never be physically addicted. He’ll just be horny, which for many of us, is merely a sign we’re alive.

There haven’t been any studies that speak to this directly. As such, the anti-fapper narrative is usually the only point discussed: Guys stop masturbating after they stop downloading porn, and after a few days, they say they’re able to get normal erections again. This coincides with the somewhat popular idea that watching porn leads to erectile dysfunction, a position that porn-addiction advocates such as Marnia Robinson and Gary Wilson state emphatically. (Robinson wrote a book on the subject, though her degree is in law, not science, and Wilson, a retired physiology teacher, presented a TED Talk about hyperstimulation in Glasgow.) These types of advocates are wedded to the idea that porn is an uncontrolled stimulus the brain gets addicted to because of the dopamine release it causes. According to their thinking, anything that causes dopamine release is addictive.

But there’s a difference between compulsion and addiction. Addiction can’t be stopped without major consequence, including new brain activity. Compulsive behavior can be stopped; it’s just difficult to do so. In other words, being “out of control” isn’t a universal symptom of addiction.

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Then what, exactly, does it mean when Tiger Woods and Josh Duggar go to rehab for sex addiction? Or when Dr. Drew offers it up on TV for washed-up celebrities? The answer is simple: They’re giving free marketing to the new American industry of sex addiction therapy. Reformers Unanimous, the faith-based treatment program chosen by Duggar, is likely to gain a number of new patients thanks to the media frenzy surrounding his admission to their facilities after the Ashley Madison hack exposed the affairs Duggar blamed on porn addiction.

These programs are similar to traditional 12-step models, except even more informed by faith. By misdiagnosing patients from the start, they gloss over the underlying issues that might make someone more prone to compulsive sexual behaviors, including Obsessive Compulsive Disorder and depression. Plenty of compulsive and ritualistic sexual behaviors aren’t addictions; they’re symptomatic of other issues.

Unfortunately, that’s just scratching the surface of the faulty science practiced by these recovery centers. For instance, according to proponents of the sex addiction industry, the more porn someone watches, the more they’ll experience erectile dysfunction. However, my recent study with Nicole Prause, a psychophysiologist and neuroscientist at UCLA, showed that’s absurd. While advocates of sex and porn addiction are quick to correlate the amount of porn a guy looks at to how desensitized his penis is, our study showed that watching immense amounts of porn made men more sensitive to less explicit stimuli. Simply put, men who regularly watched porn at home were more aroused while watching porn in the lab than the men in the control group. They were able to get erections quicker and had no trouble maintaining them, even when the porn being watched was “vanilla” (i.e., free of hardcore sex acts like bondage).

There is, of course, other evidence that porn isn’t a slippery slope to physical or mental dysfunction. A paper just came out in the Journal of Sex & Marital Therapy from German researchers that looked at both the amount of porn consumed by German and Polish men and women and their sexual attitudes and behaviors. It found that more porn watched meant more variety of sexual activity — for both sexes.

Despite these results, there’s still an entire publication, Sex Addiction & Compulsivity, committed to demonstrating that porn creates erectile dysfunction. Its very existence suggests sex addiction and its treatments are real, yet the journal doesn’t take a stance on any particular treatments. And while its resolutions come from peer-reviewed articles, these articles only get reviewed by people who already believe in the notion of sex addiction.

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Which is why the journal has zero impact. The number of times a scientific journal gets used in other scholarly work is measured by something called the Journal Citation Reports (JCR). That number determines a journal’s official impact factor. So far, Sex Addiction & Compulsivity has a JCR impact factor of 0.00. Nobody cites anything from it, except maybe their own cult of followers who publish on blogs and personal websites.

The journal benefits from a very 21st century way of creating a veneer of objectivity. As long as there are papers in it, people can cite them as “scientific.” Even if the work — and the people who oversee it — are anything but. An influential associate editor there is David Delmonico, a professor who runs an “internet behavior consulting company” that offers “intervention for problematic Internet behaviors.” He believes sex addiction is real because he’s wary of the supposedly horrible effects the internet (and all the porn there) can have on human behavior.

Such porn-shaming isn’t all that different from the guilt conservatives attach to sex, even though conditioning men to feel bad about their sexual behaviors only leads to the kind of secretive, damaging behaviors evidenced in the Duggar story. What’s worse: when sexuality is labeled a “disease” like addiction, guys no longer have to own their sexuality — or their actions. It’s unnecessary to explain why they cheated because it’s beyond their control. And so, the “addict” stigma is preferable because it’s one they can check into rehab and recover from. Being considered an “adulterer,” on the other hand, is harder to shake.

Complete Article HERE!

Down, but not out

Name: Roger
Gender: Male
Age: 70s
Location: Saugatuck Michigan
Hi– linked to your very interesting site via Allkink. My question: last year I underwent radiation on my prostate; it was enlarged and had cancer cells. Apparently it did the job, since my PSA is way down and the Dr. says I’ve shrunk, and am healthy otherwise. But since then I am almost totally impotent (don’t get erect when I want to, though sometimes get semi-erect at random times). I can still orgasm, but don’t ejaculate; sometimes a little clear fluid dribbles out afterwards. Curiously, I could still ejaculate during and right after the radiation treatments, but not now. Also in general a noticeable decrease in libido. Needless to say, very annoying.

I’m gay, solo, in my 70s, celibate since mid-1980s when I tested HIV-, and a dedicated bottom. I knew I was at risk, and “safe-sex” just didn’t turn me on. I’ve been using dildos of all sizes for years. Now, insertion has become a little painful (kinda stings, like the first times way back when), but after several tries they go in OK. Those of larger girth or not-very-smooth texture are really difficult, and I’ve pretty much given up on them (though “John Holmes” still works!). There is occasionally a little blood on the dildo afterwards, but bleeding doesn’t persist, and Dr. says I have no hemorrhoid. The radiologist did warn me that the treatment might produce scar tissue in the colon. Is that a possibility?

I hate to think that I ought to give up altogether on my little pleasures, but would welcome you advice/opinion. I haven’t discussed this with my urologist, whom I don’t know very well, but did bring it up with my (female) GP, who didn’t seem overly concerned and merely suggested lots of lube, which was not news to me.PMB110

Wow, Roger, that was a mouthful. I am so delighted that you wrote in. I love hearing from folks in their 60’s 70’s and 80’s who are still enjoying a rich and fulfilling sex life, even if it is by themselves. I am of the mind that self-pleasuring can be some of the most rewarding sex available to a person at any age. And nowadays, with all the amazing sex toys on the market, one can enjoy solitary sexual pleasure like never before.

I’ve written and spoken a lot about prostate issues including the aftermath of cancer treatments. May I suggest that you take a look at the CATEGORY section on the sidebar of my site? There you will find a category labeled “Health Concerns.” There are subcategories for “Anal Fissures,”  and one for “Prostatectomy.”  I realize that you haven’t had a radical prostatectomy, but your situation is very similar to those men who have. If you click on either of those two subcategories you will find loads of useful information in both written and podcasts form.

In the meantime, let me see if I can address some of your questions in a nutshell. You ask about possible scar tissue from radiation therapy. The short answer is; yes, scar tissue is possible, even probable. And as we all know scar tissue is not nearly as pliable as regular tissue. Scar tissue also MR01034has fewer nerve ending than normal tissue. You could be injuring yourself without even knowing it since the sensations in your ass are considerably less then they once were. I’d be willing to guess that this might be the source of the bleeding you report. Maybe you need to retire the really big toys, like the John Holmes, and enjoy something more modest for the time being. Another suggestion is to try an inflatable dildo.  or a smaller insertable that vibrates.  There are several on the market. You can find several in My Stockroom. The advantage to something like the inflatable dildo is that you could insert something relatively narrow  and inflate to a larger size once inside. This would avoid ramming a big dildo in bum from the get go. And a vibrating insertable would add stimulation without the length or girth.E477

As to your erection issues; yeah, I hear ya. Aging alone will take its toll on the hydraulics that give us wood. When you couple that with the trauma of invasive surgery and/or radiation therapy, well it’s no wonder stiffies elude us. I tell the men that I see in my private practice, who are similarly challenged as you, to use a cock ring  to assist in getting the best boner possible under the circumstances. A penis pump works pretty well too, if you want to go the distance.  I have lots more to say about these devices if you care to hear about it.

C923Also, several men I know with erection concerns are taking a cue from the women folk and employing a vibrator in their sex play. There are the insertable kind, as I’ve already mentioned, and there are external ones too. Have you given this option a thought? The extra stimulation a vibrator can produce will increase blood flow and thus a more substantial boner. I have a whole lot more to say about this too if you care to write to me for that information.

In the end, it will be desire that will continue to propel you to further enjoy yourself and the pleasures your body has to offer. I wish you continued lust and many more years of healthy and life-affirming sexuality.

Good luck

Libido Disparity, A Common Problem

Name: Chris
Gender: male
Age: 29
Location:
I’m 29 and I’ve been married for the last 3 years. I was seeing my wife for 5 years prior to being married so I guess it’s been a total of 8 years that we’ve been together. When we first got together everything was great the sex was outstanding ya know 69 all types of positions tons of oral, tons of foreplay and she had an orgasm every time. It seems that just in the last couple of years everything has dwindled away to the point where it’s her on top for a little bit, me on top for a little bit till I finish then we go back to the living room and hang out. Whenever I bring up the subject she gets very uncomfortable and won’t talk about it. And it’s really starting to freak me out in every aspect of our relationship. I love the girl, so I don’t want to go anywhere. I’m wondering if there’s any hope to get things back to the way they used to be that fresh hotness and spontaneity. How can I bring the heat back?

Like I always say, If I had a nickel for every time I’ve heard this same complaint from a frustrated and desperate man or woman trapped in an undersexed marriage, I’d have enough money to lay down my keyboard, give up my status as the most fabulous and revered sexpert in the universe and retire to Maui.

Despite the frequency of the grievance, it still breaks my heart to hear the despair. I mean it’s one thing to have the sexual connection between partners drift away by mutual consent. It’s another thing all together to have one partner dissolve the sexual connection unilaterally while leaving the other partner bewildered and disoriented.

And what gives with a partner who refuses to talk about why the sex has taken a nosedive? That is so wrong. I can understand not knowing exactly what to say about things goin’ south, or even how to say what may be on your mind, but to clam up all together, that’s just unfair. Suppose the problem had to do with finances instead of sex. What if one of you decided to start splurging on major purchases without consulting the other? There’d be hell to pay then, huh? There’d be no duckin’ out of the responsibility by clamin’ up in this instance, I’ll bet. But when it comes to sex, somehow the same rules for accountability don’t always apply. Why is that?

Sexuality is both a personal expression and a means of bonding with another. Thus sexual wellbeing in a relationship is way more than just the old in and out. It means taking responsibility for one’s eroticism as an integral part of relationship. Sex is a way of expressing one’s self as well as our love for the other. The confusion, unhappiness and anxiety that results from the breakdown of this fundamental tenet will, as you suggest Chris, spill over into and contaminate other areas of the relationship. But it doesn’t need to happen.

When I encounter this predicament in my counseling practice, I always build in some individual time with each partner even though the couple is there for “couples counseling.” I often get a much better sense of what’s causing the breakdown in these private sessions than I do when the couple and I work together as a threesome. Sometimes it’s easier for the individual to talk to me privately than to be open, honest and forthcoming about his/her feelings with his/her partner sitting right there.

My experience tells me that more often than not, a refusal to discuss sexual concerns has more to do with not knowing how to express oneself without hurting the feelings of the other. Sometimes an individual simply doesn’t know herself why things are different than they once were. Sometimes there are lifestyle issues at play — family concerns, work concerns, lack of sleep, drugs and alcohol consumption, etc. Sometimes there are medical and psychological issues that impact on a person’s libido — weight gain, birth control, other pharmaceutical drugs, diabetes and depression to mention a few.

There’s also something we in the business call: “desire discrepancy disorder,” which is just a fancy-schmancy way of saying one partner has a stronger libido then the other. But often the simplest and most ordinary explanation is that the partnered sex has become stale, rote and boring.

Whatever the cause of the imbalance, it needs to be addressed as a couple. Once the couple has identified the problem the next step is learning how to talk about it in an effective yet non-threatening way. This can be tricky, to say the least. But it is still so much easier than trying to avoid the issue all together.

Ok, so your wife is reluctant to discuss the matter with you, Chris. That just means you’re gonna have to be proactive in bringing this issue to a head. And I’m not suggesting that you browbeat your wife about her unwillingness to talk about the issue. It’s gonna be all about you leading by example. Here’s what I suggest. Set up a time for you and your wife to have a sit-down. This needs to be scheduled in advance so that both of you know it’s coming. There ought be no surprises. This conference should not immediately follow sex, especially disappointing sex. Set aside at least 30 minutes when you guys are fresh and relaxed and then start preparing what you want to say. Take notes if necessary.

When the time comes for the sit down, I encourage you to use “I” statements instead of “you” statements. Begin by laying out how you feel and owing your feelings. “I feel confused. I feel frustrated. I feel that our relationship is in jeopardy.” Stay away from statements like “you make me feel…blah, blah, blah. These kinds of pronouncements will only muddy the waters. Then I suggest that you invite your wife to do the same. If she can’t, or won’t, move on to what steps you will take to get to the bottom of this. Something like, “I don’t want to continue the status quo. I’ve decided that I am going to seek some professional help for this. Maybe there’s something I’m missing. I can’t get to the bottom of this on my own, so maybe a sex therapist will help me understand what’s going on.” Again, invite her to join you in this effort. If she refuses or stalls out, move on to closing the discussion. You might say something like, “thank you for hearing me out on this. I don’t mean to put you on the spot, but I think our relationship is worth the effort to preserve it. And I’m actually gonna do something to make sure that we stay together. My invitation to you to join me in this effort will remain open.” End of discussion!

Of course, if you take this route, you will have to follow through on your commitment. If you don’t you will sabotage the whole damn thing, which will only make matters considerably worse. I encourage you to find a sex-positive therapist to work with. A good resource for this is The American College of Sexologists. Visit the directory page on their website. You will find listings for certified sexologists and sex therapists all over the world. If there is no one near you, contact the person closest to you and ask for a referral. Often my fellow ACS therapists and sexologists are very well connected to the broader sex-positive communities in their area.

You may also wish to consult me, even if you’re not here in Seattle. Check out the Therapy Available link in the header of my site for all the information you’ll need to make an enlightened decision about working with me.

Whatever you do, don’t settle for the path of least resistance. Your leadership might be just the thing your wife is looking for to muster her own strength to face the facts. Either way, the problem you are facing will not go away simply by ignoring it. Disappointments will become resentments and resentments will inevitably lead to acting-out and that will surely fuck things up royally.

Good luck