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Sexuality at the End of Life

By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

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!

Healing Sexual Trauma through Sensate Focus

One of the most difficult things for me to deal with as a therapist is the aftermath of sexual trauma. And I know that the trouble I have with this is only a tiny fraction of the difficulty my client has as he or she faces his/her past. I share with you a correspondence I’ve had with a 36-year-old man from Boston named Trent.

Dr. Dick,
When I was 10 years my parish priest molested me. It went on for over a year. Mostly, I’ve been able to put this behind me. I’ve been married over a year to this really great gal. She’s been very understanding and supportive, and we love each other very much. A couple of weeks ago when we were having sex, my wife started to massage my bottom. This was the first time someone touched me there since I was 10. At first it felt good, but then I remembered how I felt when I was a kid and freaked out. I started to cry. My poor wife was devastated at the thought of triggering this painful memory. I told her it wasn’t her fault, but we haven’t had sex since. I’m worried, but I don’t know what to do.

Working through a sexual trauma, like the one Trent experienced as a kid, is difficult. But it is essential for regaining a healthy sense of the sexual self. I told Trent—and this applies to any anyone else who has had regrettable early sexual experiences in their past—that I strongly suggested that he and his wife engage a sex-positive therapist to help them get back on track.

Many people have dealt with some kind of sexually related trauma in their lives.  However, some trauma is more severe than others. Emotional scar tissue and painful memories may linger, but you can learn to insulate yourself from the disruptive effects of the past in the present. Thanks to the indomitable human spirit, most of us live through our difficulties and go on to develop healthy, integrated sex lives.

Sensate focus is a process that helps individuals move through painful sexual memories and heal the rift between the affected parts of the body and the pleasure they can produce. I thought this technique would be of particular value for Trent because of something he’d said: “At first it felt good, but then I remembered how I felt when I was a kid and freaked out.” This tells me that he was able to enjoy the sensations before the association with the molestation kicked in and ruined everything. Sensate focus offers a way to short-circuit this disruptive connection and rewire it for pleasure instead of pain.

What follows are structured therapeutic touching exercises for couples. They are not a prelude to sex. You need to be clear on that. Your genitals will be involved. There will be pleasure and arousal, for sure. But the object of this process is to desensitize the trigger (in Trent’s case, his butt), then re-sensitize it for pleasure. These exercises take about an hour one day a week over the course of a month. If you embark on this course, make sure that you dedicate that kind of time commitment. Please, don’t short-change yourselves; this is an investment in your sexual health and wellbeing.

You and your partner will take turns being the one touched and the one doing the touching. Both of you will have 30 minutes to touch and 30 minutes to be touched: 15 minutes lying on your front; 15 minutes on your back.

Week 1—Breaking the Ice
Structured touching will be unfamiliar to you at first. I want you to use this first session to connect with each other in a sensual and playful way. I want each of you to explore every inch of your partner’s body from head to toe, first the back of the body then the front. This first week, however, avoid one another’s genitals.

This isn’t massage, where touch is directed toward pleasuring your partner. Sensate focus exercises are about gleaning information. Focus on how it feels to touch different parts of your partner’s body in a non-seductive way. Be aware of the different textures contours and temperatures. Use different pressures—heavy and light; different strokes—long and short. Use fingertips, palms, the back of your hands and forearms.

When you’ve finished the first 30 minutes, swap places. This will work best if the one being touched relinquishes control as much as possible. Keep verbal communication at a minimum. Once the hour is over, thank one another for the experience and get on with the rest of your day. Don’t try to process things right then and there, just sit with the sensations. Or better still; write your feelings in a journal that you might want to share later.

Week 2—Making Things More Interesting
Building on what you learned in the first week; this time, kick it up a notch by expanding the structured touching to include anal and genital areas. These are sexually charged zones, but the touch must remain non-seductive. Begin the exercise with some full-body touching before moving on to the new areas. Again, the emphasis is on obtaining information and awareness of physical sensations.

This is where things got a bit challenging for Trent. When his wife touched his butt, I told him I wanted him to want stay in the moment and focus on who was touching him and why. Trent’s wife was not touching him in a sexual manner; she was gathering information.

Staying in the present helps take the edge off. If anxiety builds, deep breathing can help you to relax. Your partner will probably be very nervous too, so breathing together can be helpful.

A guided touch technique can also be useful. Place one of your hands on top of your partner’s and guide it over your trigger area. Try using more or less pressure as you see fit. Remember your trigger spot is just like every other part of your body. Even though an early trauma has sensitized this area to be off bounds, sensate focus exercises will re-sensitize and reintegrate it with the rest of your body. You’ll have to trust me on this.

Week 3—Mutual Touching
This week, we move on to mutual touching. However, it must remain structured and non-seductive, both in the giving and receiving. Mutual touch will provide a more natural form of physical interaction than the previous weeks. You’ll also be shifting attention from how it feels to touch to being aware of how your partner is receiving your touch. Keep verbal communication to a minimum. Let your body tell your partner how you are enjoying the touch. If you must talk, assign a number code to the touch you are receiving: 5 being, ho-hum, 1 being Yowsa!

Remember, no matter how sexually aroused you become, this is not a prelude to sex. If you need to release your sexual tension, feel free to masturbate afterward. No partnered sex during the exercises. Okay?

Week 4—Bringin’ It Home
This last week of exercises continues the mutual touching, with a focus on overcoming any final reservations you have about your trigger zone and the pleasure you derive from it. More of your partner’s touch should focus on that area. For Trent, I advised that his wife include a nice lotion or personal lube for this investigation. (Touching with a wet hand is different from touching with a dry hand.) While concentrating on his butt with one hand, I suggested she fondle his genitals with the other. By playing with the energy around Trent’s sphincter, his wife was able to redirect it and help him reconnect his ass to the rest of his body.

Try receiving your wire’s touch in different positions. Being proactive will facilitate the healing. While she is touching your trigger area, move your butt toward her to meet the caress. You’ll immediately see how being in control will help you move beyond any remaining anxiety. You are not just being passive recipient anymore; you are actively involved with inviting the pleasure. If there are still reservations, take it slow until they too, melt away.

Once he’d freed up his ass for pleasure, I told Trent be sure to incorporate butt play into his future lovemaking repertoire, but I also reminded him to take as much time as he needed to resolve the issue. There is no quick fix. I assured him, though, with diligence and care, sensate focus would remove the fear and shame of the molestation, and replace it with a sense of wholeness, joy and pleasure.

Good luck

Making a Marriage Work; A Primer For Sexual Success

I’m preparing a workshop for recently engaged couples. I expect there will be about a dozen couples attending. While most of the participants will be preparing for their first marriage, there will be at least two couples working on their second marriage. My experience tells me that regardless of how many turns one takes on the merry-go-round anxiety about sexual compatibility, particularly for the long haul, abounds.

One of the best resources out there for those considering a sexually exclusive traditional marriage is Esther Perel’s controversial book, Mating in Captivity: Reconciling the Erotic and the Domestic.  Her thesis is that increased emotional intimacy between partners often leads to less sexual passion. I’ve been preaching the same sermon for nearly 30 years. But I assure you; there are ways around this predictable stumbling block.

Here we have Paige, age 22 from Tulsa. OK.

I am engaged to a wonderful guy. I’m excited about my upcoming marriage, but I’m also afraid that it will fail. I know you are going to think we’re freaks, but my fiancé and I have decided to save ourselves for after we are married. Some of our friends even our recently married friends are having trouble with their relationship and with the divorce rate so high, what are the chances that my marriage will work? Do I just have cold feet or am I not ready to get married?

First off, I don’t think you’re a freak for reserving full sexual expression till after you’re married. It wasn’t too long ago when that was the norm. But even people who enter marriage as established sex partners aren’t assured success.

I caution you to jettison any Pollyanna notion you might have about marriage being a breeze, or that all you need is love. These are dangerous fictions. Your recently married friends have problems because there are always problems in a marriage. It’s the nature of relationships. Hopefully, the problems you guys will face won’t be insurmountable, but sure as shootin’ problems will be your constant companions, even big problems. So count on it and prepare yourself accordingly.

You can also be assured that the problems you will encounter, regardless of their nature, will impact on your sex life together. Money concerns, the stresses of a career, kids, in-laws, you name it will all influence how you perceive your spouse. Nothing dampens ardor like financial difficulties or meddlesome relatives.

So Paige, rather than focus on the nature of your sex life as you enter your marriage, may I suggest that you concentrate on the bigger picture. And in order to do that you need to ask; why do most traditional, sexually exclusive marriages flounder? They crumble because they can’t bear up under the strain of the couple’s expectations for each other. Simply stated, they want too much from their spouse. They expect companionship, economic support and family for sure, but they also expect their partner to be their best friend, confidant and passionate lover. That’s a pretty tall order to fill for a single individual. Who wouldn’t have cool feet, or even be frozen in place, faced with those daunting expectations.

A lot of engaged couples overly concern themselves with the sexual viability or their relationship. My sense is that sexual concerns, by themselves, don’t tax a marriage to the point of breaking. You’ll notice that I said, ’sexual concerns, by themselves’. While sex and intimacy issues are indeed real and sometimes overwhelming, it’s the underpinnings of the relationship that bring these sexual issues into stark relief. Let me give you an example.

Say I’ve just spent 60 hours this past week at work; I get snarled in traffic on my commute every single day. I drag my sorry ass home to a loving partner, who may have been looking forward to an amorous night of sex play. But I’m completely fagged out, so to speak. I simply don’t have an interest in the old slap and tickle. It’s not that I don’t love my spouse; I do! I don’t have the energy to even squeeze one off by myself, let alone please and pleasure my partner.

Or say I’ve been caring for a house full of sick, ornery kids all day; and freaking out about our family’s precarious financial situation. I have barely the time and energy to rustle together some grub for the brood, when my loving partner, who may have been looking forward to an amorous night of sex play, arrives back at the homestead with stars in his/her eyes. I’m exhausted; and the idea of a tussle in the sack is the last thing on my mind. It’s not that I don’t love my spouse; on the contrary. I just don’t feel attractive, interesting, or more importantly, randy.

As these examples point out it’s not that the sexual energy has flown the coop. More often than not couples who face the tribulations of life together redirect their energy into resolving more pressing concerns than gearing up for sex. The reason I know this for certain is, if I were to take this stressed out couple away from the humdrum of their day-to-day, and land them on a tropical beach without a care in the world; I know for certain they’d fuck like bunnies.

Another example, say a couple is joined at the hip; you know the ones I’m talking about. Where one or the other partner can hardly take a trip to the loo without their spouse traipsing along. Many couples think this kind of closeness is a sign of their love and fidelity, and it may very well be for them. But I can guarantee this kind of familiarity will also stifle sexual passion. The truth of the matter is erotic fervor is dependent on at least a modicum of mystery. If I know my partner like the back of my hand, I’m less likely to see him/her as a sexual object; in the same sexual way as when we were courting.

This also can be proven. Why is the chick at work, who I have virtually nothing in common with, such a turn on? How is it that my yoga instructor, someone I hardly know and who pays me no attention, make me wet? It’s the mystery or the forbidden that jacks up the sexual tension.

The way I see it is passionate sex is dependent on a good deal of sexual tension. This kind of tension dissipates with time and it takes a great deal of work to keep that tension alive. Most couples don’t invest that kind of energy; even though they may pay lip service to the notion that they want the passion to continue.

Intimacy, on the other hand, is dependent on domestic tranquility, in other words, the elimination of tension in the relationship; regrettably this also includes sexual tension. And since most couples desire intimacy over sex they choose (either consciously or not) the path of domestic tranquility. But the result can be the kind of sexual frustration so many married people report.

I’ve been to a lot of wedding; and I’ve officiated at more than I can count. I’ve helped numerous couples construct their vows. Generally the first thing they want to say to each other is something like: “I promise to be your best friend, your confidant; your constant companion. Sound familiar? I thought it might. What I never hear is: “I promise to always be up for all your hot monkey love.” Not only would that vow be a showstopper; it would be an impossible promise to keep, unless you’re a blow-up doll. Frankly, it’s so much easier being a best friend or confident than the sexual siren that will be the answer to all your erotic dreams after we’re married for a few years.

Sexual exclusivity is at the heart of the romantic ideal. That’s why sexual infidelity is such a bugaboo in our culture. But the truth of the matter is, sustaining a model where marriage is the font from which all fulfillment flows is simply unrealistic. Maybe if we expect sexual exclusivity from our spouse, we ought to manage our other expectations of him/her (best friend, confidant, etc.) more pragmatically.

I am of the mind that since more than 50% of marriages in this country end in divorce; we must look at the relationship model we are laboring under. Maybe the romantic ideal is simply an illusion. I mean we can’t honestly try to explain away the divorce rate by saying all these couples simply married the wrong people. Know what I mean?

The parameters of a healthy, successful marriage will need to expand and contract with the stresses put upon it; it is after all a living entity. The balance between dependence and independence will constantly shift; so will the power dynamic in the relationship. Carve these things in stone and you will be mark a grave, not milestones on a path to growth.

Good luck

Screw Science: The Futuristic Sex Tech Aiming to Penetrate Your Bedroom

From fully customizable vibrators to bioelectronic headsets, smart sex toys are on the way up. But does personal pleasure necessarily make for better health?


Pleasure is personal, mostly because it has to be, and not least because female scientists continue to face grinding discrimination regardless of their area of research. And when it comes to sexual health, breakthroughs are few and far between: in spite of increasing documentation of associated health risks, birth control hasn’t really been reformulated since the 60s, and last year’s much-anticipated release of Addyi, a pill meant to fix female sexual dysfunction, only worked for ten percent of the women who tried it.

It’s clear that sexual emancipation has not yet been freed from the bedroom. In spite of its roots in scientific misogyny—the vibrator was developed in the 19th century to cure women of hysteria, after all—a swathe of new devices have people looking hopefully to sex tech (or sextech, as it is also known) as the answer to systemic gaps in sexual health. History, it seems, is coming full circle; where the 1960s saw the vibrator de-medicalized and uncoupled from science, today’s consumer market is beginning to see pleasure and health unified in the pursuit of wellness. Yet what we call “sex tech” is tied more to the lucrative sex toy industry—worth $15 billion this year—than it is to scientific institutions, with much of its promise linked to idea that personal pleasure makes for better health.

These days, more people than ever understand that a woman’s ability to understand what turns her on and why is a crucial step in developing a healthy perspective on her sexual life. So it makes sense that we’re seeking out masturbatory experiences that are more tailored than your average stand-in phallus. It’s the driving force behind the popularity of devices like Crescendo, the first-ever fully customizable vibrator, which raised £1.6 million in funding to date and shipped out over 1,000 pre-orders after a successful crowdfunding round.

Designed to cater to the inherent complexities of female arousal, the vibrator can be finely customized, equipped with six motors and the ability to be bent into any favorable shape. An accompanying app allows users to control each motor individually; it remembers favorite behaviors, provides pre-set vibration patterns, and responds to mood-setting music.

“We were inspired by the concept of tech designed for the human, rather than the human having to adapt their behaviour to tech,” says Stephanie Alys, the co-founder of Crescendo creators Mysteryvibe. “Human beings aren’t just unique in terms of our size and how we’re put together genetically, but also in terms of what we like. What turns us on can be different from what turns another person on.”


Mysteryvibe’s flagship product is the Crescendo, a customizable sex toy.

But in spite of the life-improving promises of consumer sex tech, the reality is that official, peer-reviewed studies remain crucial to reforming policy and education. Founded by Dr. Nicole Prause, Liberos Center is one of the few sex-centric research institutions in the United States. Much of its work investigates the relationship between psychology, physiology, and sex, with an emphasis on the hard data that is often lacking in sex tech.

Liberos presses on in a particularly antagonistic climate; the American government is famously skittish about sexual content. Sexual material is banned from government-funded computers, says Prause, making it difficult for researchers to, say, screen porn to test subjects as part of a study on arousal. She adds that congressional bodies actively seek to pull funding from research that addresses the topic head-on—four recent studies that had already been awarded funding were re-opened for assessment because of their sexual content.

“People report having certain types of experiences all the time,” says Prause. “But they’re often poor observers of their own behaviour, and don’t see anyone’s behaviour but their own. They don’t really have that external perspective, which is why I think it’s important to take both a psychological and laboratory approach. For example, in science, people haven’t been verifying that orgasm actually occurs. So we’ve been developing an objective way of measuring that, and of measuring the effects of clitoral stimulation—on how to best capture the contractions that occur through the orgasm.”


Liberos is also investigating the effect of transcranial magnetic stimulation (TMS) and direct current stimulation (tDCS) on sexual responsiveness. Both are non-invasive treatments, meaning anyone seeking a cure for low libido may not require anything more than the use of a headset. TMS holds potential for long-term changes to a person’s sex drive; the technique, which uses a magnetic field generator to produce small electrical currents in the brain, has already been used to treat neuropathic pain and otherwise stubborn cases of major depressive disorder. DCS, on the other hand, uses a headset to deliver a low-intensity electrical charge, stimulating the brain areas where activity spikes at the sight, or touch, of a turn-on.

If using the brain’s electrical signals to control the rest of the body sounds like a dystopian fantasy, the reality is that these medical treatments aren’t far off. Bioelectronic firms are now backed by the likes of Glaxosmithkline and Alphabet, Google’s parent company, and similar applications have already been established for hypertension and sleep apnea, while chronic conditions like asthma, diabetes, and arthritis are targeted for future development.

According to Dr. Karen E. Adams, clinical professor of OBGYN at Oregon Health and Science University, anywhere from 40 to 50 percent of women experience varying degrees of sexual dysfunction. Medication that targets neurotransmitters, like the SSRIs used to treat depression and anxiety, can fluctuate in efficacy depending on the unique makeup of the person using it.

Combined with the trickiness of locking down the nebulousness of desire (and lack thereof), it’s no wonder that Addyi, a failed antidepressant pursued because of its unexpected effect on serotonin levels in female mice, was a flop. Non-sex-specific studies have shown that electrical stimulation can be more adaptive to the brain’s constantly-shifting landscape than medication that interacts with its chemistry. For the 90 percent of women who found Addyi to be a sore disappointment, bioelectronic treatments could soon offer an alternative solution to low sexual responsivity.

“By giving women information about their bodies that they can decide what to do with, we’re enabling more female empowerment,” says Prause. “And by allowing women to decide which aspects of sex they want to be more responsive to, we’re giving people more control, and not with charlatan claims. We actually have good scientific reasons that we think are going to work, that are going to make a difference.”

Yet the field’s burgeoning successes are only as good as the social environment they take hold in. Sociopolitical hurdles notwithstanding, money remains a significant roadblock for developers, as the controversial nature of sex research has many investors shying away from backing new projects in spite of consumer interest. Whether they’re seeking government funding or VC investments, sex start-ups and labs alike are often forced to turn to crowdfunding to raise money for development.

“It’s pretty unsurprising that heavily female-oriented tech products do so well on crowdfunding sites; these are solutions to problems faced by half of the population, that are overlooked by a male-dominated industry where male entrepreneurs are 86 percent more likely to be VC funded than women,” says Katy Young, behavioral analyst at research firm Canvas8. “But the audience is clearly there—Livia, a device which targets nerves in order to stop period pains, raised over $1 million on Indiegogo.”

Outdated sex ed programs, which emphasize procreation and normalize straight male sexuality without addressing female sexual development, are ground zero for unhealthy social perspectives on sex. Acknowledging that change can’t just come from devices alone, New York’s Unbound, a luxury sex toy subscription service, is teaming up with “campus sexpert” app Tabù to bring both sex education and affordable masturbation tools to colleges across the country.

“There’s a national discussion right now surrounding consent, which is 100 percent needed and super important,” says Polly Rodriguez, CEO and co-founder of Unbound. “But for women to be able to engage in sex and address consent as equals, they need to learn about female pleasure—they should understand their own bodies so that when they are engaging in sexual activities with someone else, they know what feels good to them, they know how to communicate that, and they don’t feel uncomfortable about it.”

It’s tempting to buy into the idea of tech as freeing: that the increased presence of smart devices in our lives will help us form healthier habits and a better understanding of our ourselves, or that the availability of medically-approved tech will be a panacea in the intricately fraught landscape of female sexual dysfunction—which is as socially determined as it is biological, and as cultural as it is psychological.

But sex tech is still far from being paradigm-shifting. Its success will be dependent not only on consumer dollars but on government policies and public attitudes; at a level of engagement this intimate, tech is only any good if people feel free to use it.

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