Search Results: Sexual Desire

You are browsing the search results for sexual desire

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 Yin and Yang of Desire

Today I’d like to talk about: The Yin and Yang of Desire — Dopamine, Prolactin and Testosterone.

Let’s talk about love, lust and desire. But instead of looking at these things as social phenomena, let’s look at the chemical reactions going on inside our bodies that make us feel and behave the way we do.

sex-on-the-brainThere are clear links between certain chemicals and our most basic drives, which explains, for example, why we feel horny one moment and utterly disinterested the next. Or why our sex drive peaks after exercise. At the core of our sexual and affectional interests and behaviors lie the two chemicals — dopamine and prolactin. In many ways they are complimentary to one another; dopamine turns on desire and prolactin turns it off.

Dopamine is a neurotransmitter. This is basically your body’s pleasure and reward system. Our brains releases dopamine, to one degree or another, when we see, read or think about something sexy, taste something sweet, puff a cigarette, or come into skin-to-skin contact with another person. When dopamine levels are high, our libido goes into overdrive. Sometimes levels can be so dramatic that a person will neglect other essential bodily functions like eating and sleeping. Some “street” drugs —meth and coke among them — can mimic the body into thinking it’s dealing with dopamine.

Dopamine is critical to the way the brain controls our movements. If there’s not enough dopamine, we can’t move, or control our movements. If there’s too much dopamine, we are plagued with repetitive moments like jerking, tapping and twitching.

Get this; novel situations can increase dopamine releases. For example, hooking up with someone for the first time triggers especially high levels of dopamine. Curiously enough, these same high levels will not occur again during subsequent hookups with that same person. This is called the one-night-stand phenomenon; it’s why you can be attracted to someone at first encounter but not afterward.hormones and the brain

However, falling in love with someone can sustain high dopamine levels for a longer period of time. This explains why physical infatuation is at its peak in the beginning months of a relationship. Also dopamine floods the brain when we get drunk or take certain drugs, which is why drinking alcohol can make a potential partner look more attractive.

Prolactin is dopamine’s foil. It causes dopamine levels to plummet. Prolactin is a hormone, as opposed to a neurotransmitter, like dopamine. It floods the body during orgasm, virtually shutting down the sex drive, which is nature’s way of allowing us to attend to other essential bodily functions like eating and sleeping. Prolactin release in men will temporarily disable our ability to have an erection. This is called the refractory or recovery phase of our sexual response cycle. And prolactin is at least partially responsible for that happy, relaxed state after we cum. This is precisely the release women get while breastfeeding; in fact, the word “pro-lactin” directly indicates its role in milk production.

growing larger and largerProlactin primes the mind for long-term attachment — a role that helps the mother bond with her suckling child as well as lovers to each other. This means that if you stick around cuddling with your partner right after sex, you may actually start to like him/her more and more. This is called the pair-bonding effect. But prolactin’s dopamine-reducing action has a darker side. It cancels the tolerance you may have for your partner’s flaws.

While dopamine and prolactin are good indicators of the immediate workings of sexual pursuit, it is testosterone that best explains long-term changes in courtship. Testosterone is responsible for the masculinization of the adolescent male body during puberty. And it increases the dopamine levels that regulate our sex drive. But testosterone leaves its fingerprint on the body as much as the brain. It’s the catalyst for changes in skin tone, fat distribution, musculature and demeanor, which are signals to others that this individual male is sexually mature and in good health.

However, if you get a fever or become depressed, your testosterone levels can drop significantly. Malnutrition or high levels of anxiety or stress will also interfere with testosterone levels. The most immediate effect of this is a decrease in libido, and a noticeable drop-off in energy levels as well as confidence. There’s no doubt about it; testosterone levels will signal to potential mates that you are in the throws of depression, stress, anxiety or malnutrition. You will appear a little less attractive to people subconsciously. That’s why a confident, dominant male with high-testosterone levels generally enjoy more mating success.tits

Testosterone levels are highest in the morning, then wanes throughout the day. It’s also much higher in men in autumn and lowest in the spring.

However, sexual desire is still more complicated than is known to science, and there may be multiple archetypes of partners we’re drawn to — there is evidence that aggressive high-testosterone men appear sexier to women and gay men for a one-night stand. But softer, more sensitive balanced men are more likely to tug at our heartstrings in a relationship. Scientists reason that the bulkier mate is more likely to be physically powerful and carry good genes to create strong children. While the slimmer guy is a more loving, reliable partner likely to help raise the kids so they survive to adulthood. The effect of this strange contradiction seems to be a biological predisposition against monogamy and sexual exclusivity.

But none of this is carved in stone. A man’s hormone’s levels increase when he is in a competitive environment or carries out acts of aggression, which can explain how guys seem to bulk up quickly when they go to prison or join sports teams. These levels decrease when he feels intimidated or humiliated, which might explain why those who get picked on at school stay skinny and mild-mannered compared to their peers. This in turn made them easier targets and only increased the likelihood of them being bullied.

butt shakeThis is not uncommon behavior among primate colonies that have huge alpha males looming over a population of smaller, submissive males and females. While this is not a perfect parallel to human social groups, it does go a long way in explaining how a social environment can be a precursor to physical body changes. And just so you know, our testosterone levels also drop during long-term relationships, giving the male brain a sense of stability and mellowness, easing off the drive to forage for new sexual partners.

Science alone lacks a moral element, and fails to explain, in a modern context, why we should desire to be masculine, aggressive, potent or dominant in the first place. In nature, the alpha-male is the most likely to enjoy reproductive success, but that isn’t what gives our lives value today. We might have more success being an average male that falls in love and becomes a good provider. And in the modern world it’s probably the more stable and sensitive man who is most likely to sire children.

Still, science gives important clues to what’s going on in our minds and bodies and that of our potential partners. A lot of our basic inclinations are out of our control, but when we know what causes them or what to expect, we can work with them for the best outcome.

Sexual Tension or Domestic Tranquility

Name: Barbara
Gender: Female
Age: 48
Location: Santa Cruz, CA
I’ve been with my current lover for 5 years and I dearly love him. A couple of years ago he had hemorrhoid surgery and was in the hospital for a month. When he got home he refused to have sex with me but once a month of so. After two years his sexual interest is less and less. We have a wonderful time together, except for the sex. He’s a great guy and I know he loves me. We talk about it, but he tells me that he doesn’t need sex and he wants a platonic relationship. He’s not open to therapy. If he doesn’t want to be physical, I don’t want to force it but I’m masturbating all alone and I’m very frustrated. I don’t what to leave him, but I can’t stand the status quo.

This is a classic lament, Barbara. So many couples struggle with much the same thing. Love, intimacy, and sex—three very different things—yet we are socialized into thinking that they should always come to us as a package deal. And anything that doesn’t is less than optimum and often downright bad or sinful. What a tiny little box we’re all supposed to fit in.

sexual-FrustrationI believe there is a fundamental difference between love, sex, and intimacy, but so many people confuse or conflate these very different needs to their detriment. Some go so far as to destroy an otherwise good and vibrant relationship just because it doesn’t conform to what we perceive as the norm…ya know the big package deal I just mentioned.

I don’t know how we got it into are head that the only legitimate or wholesome sex is the sex that happens in a loving relationship, or that if there is no sex in a loving relationship, then that relationship is somehow flawed or defective. That’s simply not the case.

The way I see it, passionate sex is dependent on a good deal of sexual tension. Ya know, like the grips of hot monkey love that happens at the beginning of a relationship. In time this sexual tension dissipates. I might add that it takes a great deal of work to keep that kind of tension alive. Most couples don’t invest that kind of energy, even though they may pay lip service to the desire for it.life is too short

Intimacy, on the other hand, is dependent on domestic tranquility, in other words, the elimination of tension in the relationship, which often also includes sexual tension. And since most couples desire intimacy over sex they choose (either consciously or not) the domestic tranquility option. But the result is the kind of sexual frustration you report, at least for some.

Those who wish to have both sexual passion and intimacy need to be creative in developing both. It simply isn’t enough to believe that loving someone is enough to make it happen. It takes a lot of very hard work.

That being said, Barbara, if your partner refuses to join you in any effort to find a solution to the problems that plague your relationship, he is telling you that your sexual concerns are unimportant to him. My counsel is always the same under these circumstances. If your sexual needs are as pressing as you say they are, then confront him in no uncertain terms. No beating around the bush, darlin’, it’s ultimatum time. Tell your partner that dragging his feet, or obstructing all together your efforts to solve your relationship problems signals to you that the relationship, at least as it is currently configured, is in desperate trouble.

As I’ve suggested earlier, you can tell him that there are several ways of keeping the relationship going without expecting he fulfill all or any of your sex needs if he’s gonna be fulfilling your intimacy needs. But living without sex in your life is a deal breaker. He needs to know that you are serious about the crisis that exists. Of course, if you do this you will have to follow through on the ultimatum. To do otherwise would tell him that you don’t believe your concerns are all that important either.

If you ask me, life is too short to be living with all that sexual frustration. Don’t tolerate the frustration make it work for you. Your sexual frustration could be the very thing that motivates you to create better your situation for yourself and possibly your old man too.

Good Luck

Teenage Sexual Assault

Name: TC
Gender: Female
Age: 13
Location: indiana
I really dont know that much about sex, so i let my boyfriend do it all. He keeps calling me a scardy cat cuz i wont touch his dick or give him any pleasure, and he is getting really bored with me

I am so sorry to hear of the trouble you are having with your boyfriend. Actually, he’s no friend at all. Real friends honor their friend’s limits and boundaries, and he’s not doing that.

You can’t be expected, at your tender age, to know much about sex. Hell, you don’t even sound like you are particularly interested in the topic. You don’t mention your boyfriend’s age, but it sure sounds like he is way more advanced than you, at least when it comes to his interest in sex. Unfortunately, he’s not so advanced that he’s man enough to leave you alone when you ask him to. And that really makes me angry. Bullying, belittling or harassing someone for sex, particularly when it’s clear that person is not ready or not interested is abuse. And that is never a good thing.

I hasten to add that in the eyes of the law he is a criminal. He is taking advantage of an underage person for his own sexual gratification and that’s against the law. If you guys get busted, there will be hell to pay.

I know the kind of pressures you are experiencing. You want a BF and you want your BF to like you. But if you let him take advantage of you, it’s not the same thing as him liking you. It’s more an indication that he’s focused on his needs and desires, not yours. I don’t think his behavior indicates he cares for you, but he is showing you that he has power over you and is able to manipulate you into doing what he wants. And what kind of relationship is that?

Listen, TC, you don’t have to submit to him. You can stand tall and tell him NO. He will, in the end, respect you more for your courage to defy and deny him than if you just cave in to his will.

I’m not sure I know what you mean when you say that you “let your boyfriend do it all.” But it sure doesn’t sound like a good thing to me. If he’s having his way with you, even though you are being very passive about it, doesn’t make it right. I hope this isn’t how you intend to interact with other males who will come into your life in the future. And there will be plenty of them. If they sense that you are weak and vulnerable, you will be a goner for sure. You could easily wind up being a victim for the rest of your life. Please, TC, don’t let that happen to you.

I know you’d probably rather be thinking about a lot of other stuff at this time in your life, but the situation with your BF demands that you grow up fast and get savvy about the fundamentals sex right away. I’ll have a number of resources for you in a second, but I can’t emphasize enough how important it is for you to wise up about pregnancy protection. I wish I didn’t have to say that to you, but I must. If you are being sexually active, even if you are just letting your BF do everything, you absolutely must protect yourself from an unwanted and unplanned pregnancy. If you don’t you will find that you will be the one having to deal with the consequences. If your BF is not considerate enough to respect your wishes when it comes to sex in general, you know for sure that he’ll not be around to look after you and your unborn child.

Ok, here are those resources I mentioned. Planned Parenthood, SCARLETEEN, Sex Ed 101 and Midwest Teen Sex Show.

Promise me that you will take this seriously. That you’ll not just roll over (literally or figuratively). Promise me that you will respect yourself and take a stand and not allow your BF to manipulate you into anything you don’t want to do. More hangs in the balance than you can comprehend. You’ll have to trust me on this.

One last thing, if you were wise enough to find my sex advice website and you were mature enough to write to me, then I believe you are strong and resourceful enough, despite your tender age, to stand up to your BF. Do it now. Demand that he respect you, your body and your wishes.

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