— Vaginal dryness, erection challenges, safe sex and more
By Ellen Uzelac
With most physicians ill prepared to talk about sexual health and many patients too embarrassed or ashamed to broach the subject, sex has become this thing we don’t discuss in the examining room.
“So many doctors talk about the benefits of nutrition, sleep, exercise — but they don’t talk about this one really essential thing we all share: our sexuality,” says Evelin Dacker, a family physician in Salem, Oregon, who is dedicated to normalizing sexual health in routine care. “We need to start having this conversation.”
Starting the conversation about sexual health
Sexual wellness experts suggest first talking about a physical problem such as a dry vagina or erectile challenges and then segueing into concerns about desire, low libido and intimacy.
As Joshua Gonzalez, a urologist and sexual medicine physician in Los Angeles, observes: “Patients sometimes need to be their own advocates. If you feel something in your sex life is not happening the way you would like it to, or if you are not able to perform sexually as you would like, never assume that this is somehow normal or inevitable.”
Often, there are physiological issues at play or medications that can alter your sexual experience. “If you’re interested in having sex,” Gonzalez says, “there are often real solutions for whatever the problem may be.”
Here are six questions to help steer the conversation in the right direction.
1. What can I do about unreliable erections?
Erectile dysfunction is common in older men — 50 percent of men in their 50s will experience erectile challenges, Gonzalez says, and 60 percent of men in their 60s, 70 percent of men in their 70s, and on up the ladder.
The good news: There are fixes. “This doesn’t mean giving up on having pleasurable sex at a certain age,” Gonzalez says. The two primary things he evaluates are hormone balance and blood flow to the penis. A treatment plan is then designed based on those results.
Some older men also find it often takes time and effort to ejaculate. Gonzalez suggests decoupling the idea of ejaculation and orgasm. What many men don’t realize: You can have an orgasm with a soft penis and without releasing any fluid at all. “Your orgasm — the pleasure component — is not going to change.”
Also good to know: Sexual health is a marker of overall health. As an example, erectile dysfunction can be a predictor of undiagnosed health issues such as heart disease and diabetes years before any other symptoms arise, says Gonzalez.
2. Sex is different now. My body is no longer young but I still have sexual urges. How do I accommodate this new normal?
Dacker often asks her older patients: How is the quality of your intimacy? Is it what you want it to be? Have you noticed a shift as you’ve gotten older and what does that mean to you?
“Naturally, as we age our bodies start working differently,” she says. “I like to reframe what it means to be sexual by expanding our intimate life, doing things that maybe you haven’t thought of doing before.”
Dacker, who teaches courses on how to be a sex-positive health care provider, suggests exploring each other in new ways: dancing, eye gazing, washing one another while bathing, giving hands-free coconut oil massages using your stomach, arms and chest. She’s also a fan of self-pleasure.
“There’s so much pleasure that doesn’t involve penetration, orgasm and erections,” she adds. “It’s not about performance, it’s about pleasure.”
3. My vagina hurts when I have penetrative sex to the point that I’m now avoiding it. What can I do?
A lack of estrogen in older women can cause the vaginal wall to get really thin, resulting in dryness, irritation and bleeding when there is friction.
“It can be uncomfortable with or without sex,” says Katharine O’Connell White, associate professor of OB/GYN at Boston University and vice chair of academics and the associate director of the Complex Family Planning Fellowship at Boston Medical Center. “What people don’t realize is that what they’re feeling is so incredibly common. A majority of postmenopausal women will experience this.”
White offers a three-part solution for vaginal dryness: If you’re sexually active — and even if you’ve never used a lubricant before — add a water-based lube during sex play. Also, consider using an estrogen-free vaginal moisturizer, sold in stores and online, to help restore the vaginal lining. Finally, think about adding back the estrogen that the body is craving through medically prescribed tablets, rings or creams that are inserted into the vagina.
White also advises patients to engage in 20 to 30 minutes of foreplay before penis-in-vagina sex. “The whole body changes and the vagina gets wet, wider and longer, which can go a long way to alleviating any discomfort,” she says.
4. Urinary incontinence is interfering with my sex life. How can I control it?
Because the bladder is seated on top of the vagina, the thinning of the vaginal wall can also impact the bladder. When you urinate, it can burn or you will want to pee more often, symptoms typical of a urinary tract infection, according to White.
Some women feel like they need to urinate during sex, which, as White says, “can pull you out of the mood.” Her advice? “Pee before sex and pee after sex.” She also suggests using vaginal estrogen to plump up the walls of the vagina and, by extension, the bladder.
5. I’m interested in dating again. What screenings for sexual wellness should I get — and require of a new partner?
Fully understanding the importance of reducing your risk for sexually transmitted infections (STIs) should be front and center as you reenter the dating scene, according to nurse practitioner Jeffrey Kwong, a professor at the School of Nursing at Rutgers University and clinical ambassador for the Centers for Disease Control and Prevention’s “Let’s Stop HIV Together” campaign.
“Individuals should be screened if they’re engaging in any sort of sexual activity — oral, vaginal, anal — because many times, some of these conditions can be asymptomatic,” he says. “You can transmit without symptoms and vice versa.”
Screening may involve a urine or blood test or swabs of the vagina, throat or rectum. With STIs soaring in older adults, Kwong suggests testing for HIV, hepatitis C, hepatitis B, chlamydia, gonorrhea and syphilis. In early 2024, the CDC reported that syphilis cases had reached their highest level since the 1950s.
6. My doctor was dismissive when I brought up sex, basically saying, At your age, what do you expect? What should I do now?
Sex is a special part of life no matter how old you are. “If you’re with a doctor who brushes aside any of your concerns, it’s time to find a new doctor,” White says.
Finding a good doctor, she adds, is no different from looking for an accomplished hair stylist or a reliable mechanic: Ask your friends.
“I’m horrified when I hear about things like this,” she adds. “Any good doctor really wants you to bring up the things that concern you.“
The beautiful thing about non-monogamy is that it can take on many, varied forms: A non-monogamous dynamic can look like one polyamorous person having multiple romantic and sexual partners, or several individuals all in a non-hierarchical relationship together. One term you might’ve heard is ‘throuple,’ or triad, which describes a certain kind of committed relationship structure between three people.
Not to be mistaken for an open relationship (where people in a relationship have sex with people who are not their partner) or a threesome (sex between three people), a throuple is a balanced, consensual, and committed relationship. And while the term might be new to you, there’s nothing new or unusual about the concept, says Ann Rosen Spector, PhD, a clinical psychologist in Philadelphia. ‘It’s totally possible to be in love with more than one person at one time,’ she says.
So, what is a throuple, exactly—and what should you know if you’re interested in being in one? Read on for the full lowdown, according to therapists and social workers who work with polyamorous folks.
What is a throuple relationship?
A throuple, or triad, is a balanced, consensual, and committed relationship between three people. ‘What it means is that each person is in a relationship with another—it’s a three-way relationship,’ says Carolanne Marcantonio, LCSW, an AASECT-certified sex therapist with Wise Therapy in New York.
Like a couple, or a relationship between two people, the members of a throuple might have a ‘closed’ relationship, or an ‘open’ one. In some cases, ‘one person could be open to dating others, but another person in the triad isn’t,’ Marcantonio adds. ‘It really just depends.’
Different people in different dynamics might have their own definition and rules for the three-way relationship, so if you meet someone in a triad (or you’re about to join one!), it’s always a good idea to clarify what being in a throuple means to them.
What’s the difference between a throuple and other forms of polyamory?
Anything that isn’t a monogamous, exclusive, two-person relationship falls under the non-monogamy umbrella, says Anna Dow, LMFT, a therapist with Vast Love. And there are infinite types of polyamorous relationships, adds Marcantonio: ‘The sky’s the limit.’
Here are a few more polyamory-related words to know:
Quad: Four people who are in a committed relationship with each other
Polycule: A network of individuals who are all in relationships with each other
Kitchen table polyamory: A network of individuals who are in relationships with each other; if someone new is brought into this dynamic, they must generally get along with the rest of the group (think: feel comfortable sitting together at a large kitchen table)
Parallel polyamory: When a polyamorous person has multiple partners who don’t really interact with each other (essentially, the opposite of kitchen table polyamory)
Polyfidelity: When a throuple, quad, or larger polycule are ‘closed’ and do not see people outside of their group
Why might someone want to be in a throuple?
In some cases, a couple might meet a third person, become interested in them, and decide to bring that person into their relationship, says Spector.
In other instances, someone might know they’d like to join an existing couple, and seek out this kind of relationship dynamic. ‘If someone is oriented towards knowing that they can love more than one person responsibly, and if they feel like they can enter a relationship with an existing couple—and there’s chemistry, and connection between both and everyone agrees that they’d all like to be dating together—wonderful,’ says Marcantonio.
‘Being in a healthy throuple requires consistent communication and trust’
Aside from the joy of getting to date two people you like (or love), being in a throuple can help you get all your needs met, adds Spector. Think about it like this: When you have a third person involved, chances are, you’ll expose yourself and your original partner to qualities that both of you may want but can’t offer each other.
If you feel like you’re fully ready and wanting to add a third, Spector suggests letting your current partner know by gauging their interest. You can say something like: ‘I’d like to invite someone else into our relationship. How would you feel about having X join us and becoming a throuple?’
What are some tips for being in a healthy throuple?
Just like in any kind of relationship, being in a healthy throuple requires consistent communication and trust. ‘It’s the same as a monogamous relationship—the only difference is, it’ll be happening with two other folks,’ says Marcantonio.
However, there are some specific things you’ll want to watch out for, per relationship therapists:
1. Make sure you set ground rules first.
Different triads have different preferences, needs, and boundaries. Some examples of questions you’ll want to discuss, according to Marcantonio: ‘If everyone is open to all having other partners outside the triad, what does cheating look like? Do we all tell each other and have complete transparency when we’re talking to someone on the app, when we’re planning something, when we’ve had sex?’
Aside from discussions about sex and dating outside of the throuple, you’ll want to talk about your own dynamic as a trio, too, adds Spector. Would you prefer to only have sex as a throuple, for example, or is it okay for two people to have sex without the third?
‘It really depends on the triad and how they would like to set up the rules,’ says Jennifer Schneider, LICSW, LCSW, a psychotherapist specializing in LGBTQIA+ clients and those who identify as polyamorous or ethically non-monogamous. ‘It may be that a throuple sits down with each other and actually spends a few hours hammering out what might be relationship agreements.’
2. Continue to communicate.
People’s needs can fluctuate over time. So, continued communication is important, says Marcantonio. Spector recommends setting regular check-in times with your partners—and also checking in on your own needs, too.
3. And be sure you’re communicating *directly*, too.
One of the biggest issues a throuple might face is triangulation, says Marcantonio. ‘Triangulation in a relationship is when there’s one person who avoids directly interacting, usually with the person they have a conflict with,’ she explains. ‘So instead, they use the third person to confide in, to talk to.’
This can inadvertently put one person in the middle, Marcantonio adds. It can happen in friend groups, family dynamics, and—of course—romantic relationships that involve more than two people. So, if you have an issue or frustration with one of your partners, make sure you’re talking to them directly.
4. Get comfortable with any feelings of jealousy that might crop up.
It’s a common misconception that polyamorous folks don’t deal with jealousy. But, in fact, they can and do, says Schneider. It’s a natural human emotion. ‘It does take a lot of self-awareness and reflection to be in a poly relationship, because you will have feelings that come up that you need to sit with,’ Marcantonio adds.
If you find yourself feeling twinges of envy, Marcantonio recommends ‘staying curious’ and digging into the root of the issue. Is this something you can navigate on your own? Is this something you’d like to discuss with your partners? Did something trigger this emotion? These can be tough questions to work through, so if you’re struggling, you might want to check out a resource like The Jealousy Workbook by Kathy Labriola, which is chock-full of tools and exercises for people in polyamorous ‘ships.
What are some of the myths about throuples?
1. They’re purely sexual relationships.
When some people hear ‘throuple,’ they might hear ‘threesome.’ But this dynamic signifies an emotional, intimate relationship between three people. They go on dates together, have deep conversations together, and confide in one another.
‘It’s not all about sex,’ says Marcantonio. ‘It’s people who really uniquely enjoy having deep, intimate connections that go beyond sex.’
2. You have to have a certain sexuality, or be a certain gender, to be in one.
Throuples can be made up of people of any gender identity and any sexual orientation who choose to be together, Spector says.
‘Pop culture depicts them as primarily female-female-male threesomes in an imbalanced way that often fetishises the relationship structure,’ adds Dow. ‘In reality, however, throuples are just typical relationships comprised of people of any genders. And like all relationships, each one has its own set of benefits and challenges.’
3. They’re not natural.
News flash: throuples, quads, and other forms of polyamory are nothing new. Marcantonio recommends checking out the book Sex at Dawnby Christopher Ryan for further reading on the history of non-monogamous relationships. ‘We were much more communal many, many decades ago,’ she adds.
Ultimately, being in a throuple might not be for everyone—as humans, we all have different needs and preferred relationship structures. ‘Some people are more wired for monogamy, and that’s what they like and want. Others are able to do poly; they might be more wired for that, and that works great,’ Marcantonio says. ‘There’s no one ‘natural’ way to have a relationship.’
Meet the experts: Ann Rosen Spector, PhD, is a clinical psychologist in Philadelphia. Anna Dow, LMFT, is a therapist who specializes in non-monogamy at Vast Love. Carolanne Marcantonio, LCSW, is an AASECT-certified sex therapist with Wise Therapy in New York. Jennifer Schneider, LICSW, LCSW, is a psychotherapist specializing in LGBTQIA+ clients and those who identify as polyamorous or ethically non-monogamous.
Stacy Watnick: The first thing that I do with clients is I tell them that we’re going to go slow—because there are three things that most clients … do not talk about in therapy, and those are religion, politics and sex.
[CLIP: Intro music]
Kate Klein: There’s this, like, whole world underneath people’s clothing that no one talks about.
Sari van Anders: Our science, in some ways…, is…catching up with people’s existences.
Meghan McDonough: I’m Meghan McDonough, and you’re listening to Scientific American’s Science, Quickly. This is part one of a four-part Fascination on the science of pleasure. In this series, we’re asking what we can learn from those with marginalized experiences to get to the bottom of BDSM, find the female orgasm and illuminate asexuality. In this episode, we’ll discuss new ways to question your sexuality, according to science that draws from feminism and queer theory.
But first, let’s get real basic.
Stacy Watnick: Tell me, when I say the word sex or sexuality to you, what comes up?
McDonough: That’s Stacy Watnick, a clinical psychologist based in San Diego, California. She specializes in relationship issues and sexuality. She’s noticed certain patterns in her clients when she asks this question.
Watnick: First, surprise—that there’s such a range of experiences in their body and in their mind about it…. Frequently, I get some shame and discomfort. They’re not sure what words they’re supposed to use: “Are those bad words?”
A little lean forward…. they’re sort of excited and there’s some tension in wanting to tell me—or a little lean back because they’re not sure it’s safe.
McDonough: Stacy asks her clients if they’ve heard of gender and orientation. They talk about the words they know. And then she brings up the zine.
Zine is short for “magazine.” But zines are different from traditional magazines. They tend to be self-published and not typically what you’d find in an academic setting.
This particular zine invites readers on a “journey through the landscape of your sexuality.” The front cover features a drawing of five people on a path leading into the horizon. Each is holding a map labeled “SCT.” SCT stands for sexual configurations theory, a term coined by Sari van Anders, a gender, sex and sexuality researcher at Queen’s University in Ontario.
>Sari van Anders: I was doing some work about multipartnering and things like polyamory…, I was at a conference where there was … a session about asexuality…. And I started thinking about the way these two … identities claimed by different people might come together.
McDonough: Here’s Sari, the creator of this theory. She and her team created the zine as a more accessible offshoot of her 2015 academic paper on the topic.
Van Anders: It was the most exciting piece of work I’ve ever done. I’ve never really done work where it just felt like it had to come out, and it was sort of bubbling out of me.
I think we can maximize our pleasure when we understand what it is that we’re wanting, what the options are, who we are. We can think through some things that we might never have had prompts to do before.
McDonough: Oxford Languages defines sexual orientation as “a person’s identity in relation to the gender or genders to which they are typically attracted.” Sexual configurations theory asks: What if this sort of definition is incomplete?
Sari’s theory basically complicates the idea that sexual orientation is only based on gender. She built it on the existing academic literature and on what people shared about their sexualities.
Van Anders: And it was really important to me to include not just diverse sexualities and genders and people with diverse sexualities and genders but people with marginalized experiences, and so on …
McDonough: Such as people who are LGBTQ+, disabled, into kink or BDSM, asexual or non-monogamous.
Van Anders: Our science, in some ways, is, if anything, sort of, like, catching up with people’s existences…. I think many women know that, like, not all women who are attracted to men, maybe including themselves, that means they’re attracted to, like, penises or that’s the thing only that turns them on. And, and so there’s sort of an assumption that gender/sex sexuality, or what people typically call sexual orientation, is about, like, genital match-ups, like, “I have these genitals, and I’m attracted to people who have those genitals.” But really, like, we rarely see people’s genitals until we’ve already decided we’re attracted to them, right…. Usually there’s so much else going on.
McDonough: Sari uses the term “gender/sex” to mean features that are both socialized and biological and considers it to be just one aspect of sexual orientation.
>Van Anders: You know, it’s not always bodies; there’s also ways of being in the world or clothes, appearance, presentation, the way people talk, how someone treats you. And research on attraction is pretty clear that a lot of other things are rated pretty high up, like kindness or sense of humor or things like that.
McDonough: Sari refers to this as “sexual parameter n”—all the other things that make us attracted to a person.
The way she visualizes these aspects is through cone-shaped diagrams where people can pinpoint their preferences.
Aki Gormezano: As an example, you could think about the tornado for gender/sex sexuality…. So there’s a space on top where there’s a ring going around the outside that SCT calls the binary ring.
McDonough: This is Aki Gormezano, a sexuality researcher who did his Ph.D. with Sari at Queen’s. The ring he’s describing represents what most people know as the sexuality spectrum.
Gormezano: And then there’s a whole space beyond that, falling inside of the binary ring, completing that circle, where you’re not just thinking about women and men, you’re thinking about gender/sex-diverse folks who are occupying spaces outside of that binary ring.
McDonough: This is called the “challenge area.”
Gormezano: That circle I described is on the top, but then it moves all the way down to a point forming what kind of looks like a cone. And there’s a little meter ranging from zero to 100 on the far left of that, and that’s to indicate the strength of your attractions.
McDonough: In lay terms, if gender/sex was an important part of your attraction to people, you’d mark a place higher up on the tornado. If it wasn’t, you’d mark a place farther down. There are also tornadoes for partner number—one, multiple or none—as well as for sexual parametern, representing the other factors Sari mentioned, such as kindness and sense of humor.
Gormezano: Growing up, I was, like, pretty uncritical of my sexuality for the most part… Like I identified as straight by default. And a lot of my attractions, you know, as a cis boy at the time, or, like, now a cis man, were to cis women.
McDonough: In case you don’t know, “cis” here refers to cisgender, when a person’s gender identity matches their sex assigned at birth.
Gormezano: I had a point in high school where I realized … I did have attractions to people who were not cis girls or cis women…. I think I was just, like, confused and upset and didn’t really feel like it was something I could talk about. You know, especially as someone who played sports and was known as an athlete, where that was a big piece of my identity—like, I played soccer all the way through and still do…. I think, for me, the hardest part about realizing that I had interests and attractions that didn’t fit with being straight was that it challenged a lot of my identity around being a man or, like, wanting to be.
McDonough: Aki says that studying sexuality as an adult has helped him see that this isn’t a problem and that sexual orientation, identity and status don’t necessarily line up perfectly. Sexual configurations theory calls this “branched.”
Van Anders: Orientations have to do with, like, attractions, interests, arousals, desire [and] pleasure, and those might be different, or they might be the same. Like, you might really enjoy the thoughts or have fantasies about being with a man. And then when it comes to the actual sex you do, you find people of any gender are really enjoyable…. And status refers to, like, what you’re kind of actually doing, have done or will do…, who you’re actually with, for example.
McDonough: In a 27-country survey conducted by the market research company Ipsos in 2021, for example, 80 percent of self-identified heterosexual people reported that they were only attracted to the opposite sex, and 12 percent of them said they mostly were. Meanwhile 60 percent of self-identified lesbian and gay people said they were only attracted to the same sex, and 24 percent of them said they mostly were. These “branches” of sexuality can all be mapped on separate “tornado” diagrams. If you’re still struggling to picture them, you’re not alone. Between gender/sex, partner number, and other factors—plus identity, orientation and status—it’s a lot. But portraying sexuality as complex is also kind of the point.
McDonough (tape): To what extent do you think sexuality labels are limiting or expanding? If you could imagine your ideal world of how people conceive of sexuality, would everyone have a label?
Gormezano: I think when you just have identities and you just have labels, especially when identities and labels are really narrow…, you might not have the language to articulate the ways in which you don’t perfectly fit with that identity or label…. And I think the more people … who are able to understand the ways in which they might branch from their label or, like, perfectly coincide with it, the more open everyone will be around, you know, just like understanding that, like, around each identity is, like, a collection of people who might vary from that in different kinds of ways.
McDonough: Stacy, the therapist we heard from earlier, commonly meets clients who are working through their sexualities.
McDonough (tape): How do you help them kind of figure that out?
Watnick: We kind of try labels on like clothes…. I’m gonna try this sort of sweater on and see: Does that feel snuggly? Do I feel comfortable? Is there, like, a resonance in my body and in my mind and my heart and my genitals, all over me, that this feels true…? And much like the sweater I put on, I don’t have to wear it all the time…. There’s a very flexible return policy on this kind of content: if they decide they don’t want it; they don’t have to keep it. But we’re trying it on. Let’s see how it feels.
McDonough: Stacy first saw Sari speak at a virtual conference during the pandemic.
Watnick: And my whole brain lit up.
McDonough: The two of them have since formed a working group to bring sexual configurations theory into more clinical settings.
Van Anders: Those of us with marginalized or minoritized or oppressed genders, sexes or sexualities are often not given the tools from science or scholarship to make sense of ourselves. And so this can be helpful in that way. But also people who are majorities…, our culture tells everyone…, you’re just a cisgender man; that’s that; there’s nothing more complex; the complexity is for, you know, the other “complicated,” quote, unquote, people. But our research finds that the majorities actually have a lot of complexity and often have had even less prompt to think about it.
McDonough (tape): I’m wondering if you’ve had any pushback from the scientific community or otherwise?
Van Anders: We get a fair bit of skepticism from academics that what people might call laypeople, just you, people on the street, could actually do SCT diagrams because they are a bit more complex than “What is your attraction…?”…. So we sometimes get people who say, “This is pretty hard” or “I’m kind of confused.” And then we’re like, “Okay, can you describe yourself?” And then we look at the dot, and it matches. So people are actually able to do it anyway.
Van Anders: And we sometimes get pushback, too, from majorities who get, like, a little bit angry, who are like, “Okay, well, here, I can locate myself, but, like, I don’t believe in all these other locations….” You know, they’re usually seeing questions that have heterosexual first if there’s a checklist. And here it’s, like, you know, if you’re interested in women, that’s just one little dot in this whole diagram, and that can be a bit disorienting for people who are used to being with the center.
McDonough: Sari thinks that accounting for this complexity is not only helpful for individuals but also for future scientific research.
Van Anders: People sometimes forget that every measure we use is sort of telling a story about what the world is…. They’re kind of almost like a sieve that you sieve the world through. And depending on what that sieve looks like—whether it’s SCT, whether it’s a one-word question with a checkbox or answer or something—is going to let kind of different kinds of things through…. What is empirical in science is to try to measure the world as it is.
When you first meet a new love interest, the surge of feel-good hormones makes them the center of your world—and of course, the object of your sexual desire.
But fast-forward a few years, and you’ll likely find desire has a way of ebbing and flowing the longer you’re with someone. It’s completely normal, but you still might want to spice things up when you’re in a sexual rut.
If that sounds familiar, here’s what to do.
Why does desire fade, anyway?
And it happens for so many reasons. Not only do the hormones we associate with falling in love start to drop off in general as the honeymoon phase ends, Gunsaullus says, but other hormonal factors are at play as well, especially if you’ve been together for years.
From childbirth to perimenopause to menopause to declining testosterone, we’re all susceptible to less sexual drive as we age. And of course, life happens too.
Kids’ schedules keep you busy, one or both partners might be stressed about work or finances, and even new medication can influence libido. If resentment has been brewing in the relationship, Gunsaullus adds, you better believe that’s a buzzkill as well.
It’s also worth noting that a lot of couples defer to having intimate time right before bed, which according to Gunsaullus, doesn’t always work out. “If folks are only thinking to have sex when they’re crawling into bed, most people just want to go to sleep or read or scroll—they want something that doesn’t feel like work. And if you’re the lower-desire person, sex can feel like work,” she explains.
5 tips to cultivate more sexual desire
1. Know that you’re not broken
If you and your partner aren’t all over each other like you once were, remember that this is completely normal—and, honestly, to be expected.
“Low-desire people often feel guilty or like they’re broken, and then higher-desire people feel rejected and unwanted and undesired,” Gunsaullus tells mindbodygreen, adding, “So just being able to call out those feelings and know that you haven’t done anything wrong—this is a very normal thing that happens to many folks in long-term relationships.”
With that in mind, she says, remember that both of you might not feel great about the decrease in desire, so be mindful not to get stuck in a cycle of pointing fingers, guilt, blame, and shame.
2. Schedule “HNFT”
Once of the best ways to boost desire in your relationship is to schedule time to be intimate, or as Gunsaullus calls it: Happy Naked Fun Time (HNFT). For 45 undistracted minutes once a week, simply enjoy each other.
If “scheduling” doesn’t sound very sexy to you, keep in mind that spontaneity doesn’t always bode well for lower-desire people, according to Gunsaullus. “They’re more responsive to creating a context, you know, an environment and a connection that helps facilitate arousal and desire,” she explains.
And the best part about this time, Gunsaullus adds, is it’s not meant to have an agenda. You don’t even need to have sex—it’s just about creating an environment in which you’re having fun, playing, connecting, and happen to be undressed.
“Bring a lightness to it, because if there’s expectation or pressure, that’s where you then get the disappointment and the blame and shame. So cuddle with each other, massage each other, talk about your day, play a game—something that feels intentional and out of the ordinary but is a sacred time,” Gunsaullus says.
3. Sit down with each other weekly
Even if you don’t schedule your HNFT every week, Gunsaullus does emphasize the importance of checking in with each other for 15 minutes every week, opening up the conversation around your sex life, needs, and desires.
Remember during this time to be nonjudgmental and open, even if it’s uncomfortable. Talking about these topics and normalizing them will ultimately help you and your partner get more comfortable with that discomfort so you can understand each other more deeply—which brings us to our next point.
4. Learn each other’s needs
If you’re on the shyer side, we’re not gonna pretend like it isn’t a little awkward to talk about your fantasies or sexual desires. But as Gunsaullus tells mindbodygreen, pushing through that awkwardness will only help your partner understand how to please you and vice versa.
She recommends filling out some sort of erotic play worksheet online in order to get super specific about what does (and doesn’t) turn you on. (Here’s a list of the most common kinks and fetishes, if you’re curious.)
Once you and your partner have both done the worksheets, compare your results. You might just find you have some overlap! And if you don’t, have no fear; Gunsaullus says that’s incredibly common and you can still meet each other halfway.
5. Consider working with a professional
Finally, Gunsaullus says, if you feel like you’ve been stuck in a sexual rut for quite some time, it might be worth working with a professional, whether a couples therapist, a sex therapist, or a sex/intimacy coach.
The takeaway
As with all matters of relationship, communication is key. Talk to each other, honor your needs, and remember that pleasure is something we all deserve.
Sex is the most talked-about, joked about, thought-about topic in our culture. Every grown adult is expected to know how to do it, but beyond the basic mechanics we’re not taught about it and fiction is coy. We are not short of information on sexual practices – thank you, Fifty Shades of Grey – but there is a general absence of accurate detail of what happens to our bodies during, and as a result of, the act.
Yet sex is good for our mental and physical health. It lowers the heart rate and blood pressure. It may boost the immune system to protect us against infections and it certainly lowers stress. The NHS even recommends it, in a section tucked away on its website, where few are likely to find it, that advises: “Weekly sex might help fend off illness.”
The consultant obstetrician and gynaecologist Dr Leila Frodsham thinks we should be better educated about it. She’s even supporting a project to open a Vagina Museum in Camden, London – after all, there is a Penis Museum in Iceland. More information could make us healthier, happier and save the NHS lot of money, she believes.
“People who have difficulties with sex are much more likely to present with other problems,” says Frodsham. She would like to see more investment in sexual health as preventive medicine. When hooking up is working out
Sex can be good exercise, although that rather depends on how energetically you go at it. A study in the open-access journal Plos One in 2013 found that healthy young heterosexual couples (wearing the equivalent of a Fitbit) burned about 85 calories during a moderately vigorous session, or 3.6 calories a minute. It’s unlikely to be enough. The NHS says: “Unless you’re having 150 minutes of orgasms a week, try cycling, brisk walking or dancing.”
Tales of men having heart attacks and expiring on the job are much exaggerated. Sex raises the heart rate, which is generally a good thing. A study in the British Medical Journal of 918 men in Wales in 1997 found that sex helped protect men’s health. Men who (admittedly from their own report) had more frequent orgasms had half the risk of dying over the 10 years of the study compared with those who had the least orgasms. As a general rule, if you are able to walk up two flights of stairs without chest pain, you are probably safe to have sex, experts say.
The key to many of the health benefits of sex is the love hormone – oxytocin. Also sometimes called the cuddle hormone, it can even be released when petting your dog. The same hormone causes contractions in childbirth and is in the pessaries given to induce labour. It’s even in sperm. It’s not a myth that sex can help an overdue baby get going. When she was working as an obstetrician, Frodsham says, male partners used to “leave grinning from ear to ear because I’d suggest having sex on all fours to make labour come on”. There’s plenty of oxytocin around when people have sex or even just get friendly. “Any touch releases oxytocin,” says Frodsham. Keeping up physical activity affects libido, she says. “If you don’t use it, you lose it.”
She doesn’t often see people with intrinsically low libido, she says. “But we do see people who kind of get into a sexual rut and it sort of disappears. I often encourage people to schedule sex. A lot of couples feel that it is not natural and it is forcing things, but sometimes you need to get them to become habitual so they can become spontaneous.”
Sex helps with sleep, and allows the brain to switch off. “If you are having sex, you should be getting into a zone where your brain is not in overdrive,” she says. It’s like mindfulness. “I don’t think there are many people who actually give themselves time to relax any more,” she says.
Prof Kaye Wellings, at the London School of Hygiene and Tropical Medicine, blames our busy lives for a decline in sexual activity in Britain. Her large recent study of 34,000 men and women, in the British Medical Journal, suggests we are having less sex than we were a decade or more ago. Half of the women and two-thirds of the men told researchers they would prefer to have sex more often. Wellings says the digital age is partly to blame. “We are bombarded with stimuli. I can see that the boundary between the public world and private life is getting weaker. You get home and continue working or continue shopping – everything except for good old-fashioned talking. You don’t feel close when you are on the phone.”
The sexual response, step by step
The best explanation of what actually happens during sex is still credited to two scientists who started work in 1957 – William Masters and Virginia Johnson – although later researchers have criticised parts of their work.
Masters and Johnson worked at Washington University in St Louis, Missouri. Masters convinced Johnson to have sex with him in the interests of research while he was married to someone else. He eventually divorced and they married in 1971, splitting up 20 years later. Together they founded the Masters and Johnson Institute where they carried out their research and trained therapists.
In a book called Human Sexual Response, published in 1966, they described a four-stage cycle in heterosexual sex. First is the excitement or arousal phase in response to kissing, petting or watching erotic movies. A small study by Roy Levin in 2006 found that almost 82% of women said that they were aroused by their nipples being fondled – and so did 52% of men.
Half to three-quarters of women get a sex flush, which can show as pink patches developing on the breasts and spreading around the body. About a quarter of men get it too, starting on the abdomen and spreading to the neck, face and back. Men quickly get an erection but may lose it and regain it during this phase.
Women’s sex organs swell. The clitoris, labia minora and the vagina all enlarge. The muscles around the opening of the vagina grow tighter, the uterus expands and lubricating fluid is produced. The breasts also swell and the nipples get hard.
Masters and Johnson say there is then a plateau phase, which in women is mostly more of the same. In men, muscles that control urine contract to prevent any mixing with semen and those at the base of the penis begin contracting. They may start to secrete some pre-seminal fluid.
The third stage is orgasm, in which the pelvic muscles contract and there is ejaculation. Women also have uterine and vaginal contractions. The sensation is the same whether brought about by clitoral stimulation or penetration.
Frodsham says about a third of women easily have orgasms from penetrative sex, a third sometimes do and a third never do. “I have never seen anything that could be a G-spot,” she says. But the clitoris is much larger than some people assume. “The clitoris actually surrounds the vagina. The protuberance is only 5% of the clitoris.”
Women can quickly orgasm again if stimulated, but men cannot. Last is the resolution phase, when everything returns to normal. Muscles relax and blood pressure drops. But, says Cynthia Graham, a professor in sexual and reproductive health at the University of Southampton, “we still don’t understand everything about what happens even though research has been going on since Masters and Johnson’s early lab studies”.
Take the female orgasm, for instance. “Women report so many different sensations. Some women describe orgasm in a much more focal way. Some describe it in a diffuse way with, for instance, a tingling down their legs. Some women describe losing consciousness.”
And then there is the male erection. A healthy man may have three to five erections in a night, each lasting around half an hour. The one many wake up with is the last of the series. The cause is unknown, but there are suggestions of a link with REM (rapid eye movement) sleep, when people are most likely to dream. Even in the daylight hours, erections are not necessarily under conscious control. Usually they are associated with sexual arousal, but not always.
There is an assumption that sexual desire and libido are strongest in the young and fade out as we age. But there is plenty of evidence of people wanting sex and having sex at older ages. For women, the menopause can be a real obstacle. The loss of oestrogen leads to vaginal and vulval dryness. Frodsham points out that hormonal treatments, from oestrogen tablets in pessaries delivered locally into the vagina to creams and gels, are safe and effective. But so is having regular sex, she says. It’s like exercising a muscle.
“There is very good evidence, particularly in menopausal women, that the more they have sex, the better their physiology is,” she says.
But she cautions against the current enthusiasm for promoting the health benefits of sex for all ages. “There can be a kind of pressure on older adults who don’t want to. A lot of older adults do, but not everybody. There’s no norm about sexual desire.”
However biologically similar we may have been at birth, the one thing that is certain is that sexual desire and preference – as well as means of achieving satisfaction – differ from one individual to the next. Frodsham, for one, thinks enhanced understanding could boost our mental and physical health. And, she believes, it needs to start early.
“Many schools present sex as something that is going to cause STIs and pregnancy,” she says. They’re missing something important, she adds: “They don’t talk about the very natural reason to want to have sex, which is pleasure.”
Psychedelic substances, including psilocybin mushrooms, LSD and others, may improve sexual function—even months after a psychedelic experience, according to a new study.
The findings, published on Wednesday in Nature Scientific Reports, are based largely on a survey of 261 participants both before and after taking psychedelics. Researchers from Imperial College London’s Centre for Psychedelic Research then combined those responses with results of a separate clinical trial that compared psilocybin and a commonly prescribed selective serotonin reuptake inhibitor (SSRIs) for treating depression.
Authors say it’s the first scientific study to formally explore the effects of psychedelics on sexual functioning. While anecdotal reports and and qualitative evidence suggest the substances may be beneficial, the study says, “this has never been formally tested.”
“It’s important to stress our work does not focus on what happens to sexual functioning while people are on psychedelics, and we are not talking about perceived ‘sexual performance,’” said Tommaso Barba, a PhD student at the Centre for Psychedelic Research and the lead author of the study, “but it does indicate there may be a lasting positive impact on sexual functioning after their psychedelic experience, which could potentially have impacts on psychological wellbeing.”
“Both studies and populations reported enhanced sexual functioning and satisfaction following psychedelic use.”
Authors noted that sexual dysfunction is a common symptom of mental health disorders as well as a common side effect of certain medications, such as SSRIs.
“On the surface, this type of research may seem ‘quirky,’” Barba said in a statement, “but the psychological aspects of sexual function—including how we think about our own bodies, our attraction to our partners, and our ability to connect to people intimately—are all important to psychological wellbeing in sexually active adults.”
Co-author Bruna Giribaldi said that while most studies ask whether depression treatments cause sexual dysfunction, this study attempted to go further.
“We wanted to make sure we went deeper than that and explored more aspects of sexuality that could be impacted by these treatments,” Giribaldi added. “We were interested in finding out whether psychedelics could influence people’s experiences of sexuality in a positive way, as it appeared from existing anecdotal evidence.”
The team’s analysis found that respondents typically experienced improvement in sexual function for as long as six months after a psychedelic experience, observing upticks in reported enjoyment of sex, sexual arousal, satisfaction with sex, attraction to their partners, their own physical appearance, communication and their sense of connection.
“Naturalistic use of psychedelics was associated with improvements in several facets of sexual functioning and satisfaction, including improved pleasure and communication during sex, satisfaction with one’s partner and physical appearance.”
The most striking improvements were around seeing sex as “a spiritual or sacred experience,” satisfaction with one’s own appearance and one’s partner as well as the experience of pleasure itself.
“Sexuality is a fundamental human drive. For example, we know that sexual dysfunction is linked to lower well-being in healthy adults, can impact relationship satisfaction, and is even linked to subjective happiness and ‘meaning in life,’” Barba said.
The only marker of sexual function that did not go up significantly was “importance of sex,” which could be read to mean that psychedelics did not cause hypersexuality or an excessive focus on sex.
In the clinical trial portion of the study, which compared psilocybin therapy to the SSRI escitalopram, authors found that while both treatments showed “similar reductions” in depressive symptoms, “patients treated with psilocybin reported positive changes in sexual functioning after treatment, while patients treated with escitalopram did not.”
Barba said that’s especially significant because “sexual dysfunction, often induced by antidepressants, frequently results in people stopping these medications and subsequently relapsing.”
David Erritzoe, clinical director of the Centre for Psychedelic Research at Imperial College London, said the findings “shine more light on the far-reaching effects of psychedelics on an array of psychological functioning” but said more study is still needed, especially in light of the currently illicit nature of psychedelics.
“While the findings are indeed interesting, we are still far from a clear clinical application,” Erritzoe said in a release, “because psychedelics are yet to be integrated into the medical system. In future, we may be able to see a clinical application, but more research is needed.”
As the study itself says, “These findings highlight the need for further research utilizing more comprehensive and validated measures to fully understand the results of psychedelics on sexual functioning. However, the preliminary results do suggest that psychedelics may be a useful tool for disorders that impact sexual functioning.”
“Use of psychedelic drugs might foster an improvement in several facets of sexual functioning and satisfaction, including experienced pleasure, sexual satisfaction, communication of sexual desires and body image.”
Both studies are part of a growing body of research demonstrating the potential of psilocybin and other entheogens to treat a range of mental health conditions, including PTSD, treatment-resistant depression, anxiety, substance use disorders and others.
As for other entheogens, a separate peer-reviewed study published in the journal Nature recently found that treatment with MDMA reduced symptoms in patients with moderate to severe PTSD—results that position the substance for potential approval by the Food and Drug Administration (FDA).
Another study published in August found that administering a small dose of MDMA along with psilocybin or LSD appears to reduce feelings of discomfort like guilt and fear that are sometimes side effects of consuming so-called magic mushrooms or LSD alone.
At the federal level, the National Institute on Drug Abuse (NIDA) recently started soliciting proposals for a series of research initiatives meant to explore how psychedelics could be used to treat drug addiction, with plans to provide $1.5 million in funding to support relevant studies.
As for other research into controlled substances and sex, a report last year in the Journal of Cannabis Research found that marijuana could also enhance sexual enjoyment, especially for women—findings authors said could help close the “orgasm inequality gap” between men and women.
A 2022 study out of Spain, meanwhile, found that young adults who smoke marijuana and drink alcohol had better orgasms and overall sexual function than their peers who abstain or use less.
Yet another, however, cautioned that more marijuana doesn’t necessarily mean better sex. A literature review published in 2019 found that cannabis’s impact on libido may depend on dosage, with lower amounts of THC correlating with the highest levels of arousal and satisfaction. Most studies showed that marijuana has a positive effect on women’s sexual function, the study found, but too much THC can actually backfire.
The key to sex and intimacy like you’ve never known it before.
By Nina Miyashita
In a world where we’re constantly bombarded by sex—how to have it, how often you should have it, what it should feel like—it’s easy to get overwhelmed. Regardless of if you’re in a long term relationship or you’re single and dating around, far too often, we can easily become disconnected from sex, in more ways than one. So if you find yourself disassociating from the practice, physically or mentally, and starting to struggle in your sex life, rest assured you’re far from being the only one.
Whether you’re dealing with performance anxiety or sexual dysfunction, or you’re just feeling detached or distant from your sexual partner and you want to shake things up, there’s an old sexual practice that can help you get back on track, teach you how to be more present in the moment during sex, and help enhance your lovemaking to a whole new realm. Like the sound of what you’re hearing so far? You might want to consider tantric sex.
A ritual that has been the centre of growing interest in recent years as a way to increase and strengthen sexual connection, tantric sex comes from the word Tantra, an ancient spiritual practice that focuses on a deep sense of bodily, mental and spiritual intimacy—essentially, sex and intimacy like you’ve never known it before.
What is tantric sex?
“Tantra is an artform that has continuously evolved over the centuries, and today, there are many different variations on the teachings of Tantra,” says Scarlett Wolf, a certified tantric facilitator, educator and massage therapist based in Sydney.
“There are 64 Arts of Tantra, such as the Art of music, poetry, martial arts, language, astronomy and philosophy, to name a few. One purpose of practising the Tantric Arts is to bring vibrancy and creativity into your life, as opposed to living a limiting existence. Tantric, or Sacred Sex, is one of these Arts, and can be practised to a level of mastery.”
Wolf points out that performative, goal-oriented sex can often feel unfulfilling, an issue that we can often run into either in a long term relationship or thanks to all the unhelpful cultural messaging we get around the purpose of sex.
If there’s only one goal for sex, to have an orgasm or to reproduce for example, it can start to feel a bit like a chore—especially for couples who’ve been together for a long time—and you might start to get the sense that it’s just something to get over with. On the other hand, Tantric sex is a slow and intentional way of connecting sexually.
What are the principles of tantric sex?
Mindfulness, intimacy and presence define tantric sex above all else, and it largely centres on a process of energy cultivation and exchange. “Harnessing the power of your sexual energy can open the doors to deep spiritual experiences, personal self-actualisation, and healing,” Wolf says. “The path of Tantra goes beyond the act of sex, as the pathway to an incredible sex life is through, first and foremost, knowing yourself.”
Seeing as our intimate experiences and relationships often reflect how we are in other ways, Wolf says that learning how to hold depth, passion and presence through different aspects of tantric sex can also positively impact so many other areas of our lives.
What are the benefits of tantric sex?
According to Wolf, tantric sex is for “anyone who has a desire to get to know themselves on a deeper level, feel more confident and reach their full potential with sex and intimacy”—and don’t we all? The benefit and goal of tantric is, in turn, multifaceted.
For men specifically, Wolf says there are some specific areas it can really assist in. “It’s extremely helpful for premature ejaculation, performance anxiety and in some cases, erectile dysfunction, if it’s not a medical condition but rather a psychological pattern,” she says. “A man who struggles with premature ejaculation can also reprogram his body to last for extended periods of time and enjoy being in the moment, rather than in fear of how he performs.”
As for couples, practising together can lead to deeper connection and better communication skills, helping you both to better understand your individual emotional and sexual needs—something seemingly simple yet very common that can often be a big barrier to meaningful sex between couples. Always remember that if you’re going to try introduce tantric sex to a partner to get their full and verbal consent to the practice.
Along with more satisfying orgasms and a reduction of stress and anxiety, there’s a whole plethora of benefits with tantric that might change your sex life forever.
How do you incorporate tantric sex into your relationship?
Before you can truly reap the benefits of tantric in your relationship, you’ll have to learn a few things on your own. “Having a solo practice is the starting point of Tantra,” Wolf explains. “Even when you’re in a sexually active relationship, having your own individual practice is essential for the deepening of your connection to your own body.”
“Knowing how to cultivate a connection to self first is what increases our capacity to connect more deeply with others, and feel more present in intimacy when we have partnered experiences. Once you’ve activated your sense of sexual freedom, self-expression and inner confidence, you can then experience this in your partnership.”
What are the techniques and practices of tantric sex?
Regulate your nervous system and do breathing exercises
When you’re getting started on your own, learning how to regulate your nervous system is super important. Think things like meditation, gentle exercise and breathwork. “When we are relaxed, and our parasympathetic nervous system is activated, we feel safe to communicate,” Wolf says. “We are then able to experience what true connection really is, and enjoy mind-blowing pleasure with our partner.”
In Wolf’s words, the secret to pleasure is relaxation. That means taking the time to get off our screens and taking some much needed time out. She recommends movement practices like meditation, dancing, or even taking a walk to clear your head before sex can be really helpful. Learning to slow down your breath is great, too. Breathing in for 5 counts and out for 10 is an easy breathing exercise you can implement to come into a more relaxed state.
Self pleasure
Self pleasure is also going to be important, since this is one of the best ways you can learn about your own sexuality. “Self pleasuring quickly and unconsciously will not make you a better lover, but taking your time and treating your body like you would treat your lover will,” says Wolf.
“A simple way is to practise circulating sexual energy through your body when you self pleasure. Use your breath and visualise as you are breathing that you are drawing your sexual energy up out of your genitals with your in breath and as you breathe out, visualise it spreading throughout your body. This is deeply relaxing and energising for your system.”
Remember, before you start any kind of tantric practice with a partner, getting their full, enthusiastic consent before any sexual or intimate activity is paramount, as is communicating about how you’re both feeling throughout.
Eye gazing
One of the most common ways to start a tantric practice with your partner, once you’re ready to have them join you, is eye gazing or eye contact. Here, Wolf breaks it down step by step.
“Have your partner sit cross legged, or in another comfortable position, facing you, and make sure your posture is supported. Hold hands and keep your arms, shoulders and hands relaxed. Look into the left eye of your partner and hold a gentle yet deep gaze.” You may blink, laugh, cry, smile whilst eye gazing, but try to keep a silence. In lieu of verbal communication, establish non-verbal consent cues before you begin. “Eye gaze for at least 5 minutes or as long as you desire. You may wish to listen to some beautiful music, preferably without lyrics, and then share your experience with your partner afterwards.”
Connecting heart centres through visualisation
“Place your left hand on your partner’s heart and your right hand on their genitals. On your in breath, visualise their sexual energy drawing up through your right hand, into your heart. Use this to energise your body. When you exhale, imagine sending the love in your heart through your left hand into your partner’s heart. Continue this breath and movement energy cycle for five minutes. This is a beautiful way to meditate together that creates a deeper emotional connection, and is also highly arousing.”
Sensual massage and touch
Engaging in a full body sensual massage is another great way to practise partnered tantric, and aims to move sexual energy around the body. Gently massage your partner with intention from the chest and shoulders all the way down their body, focusing on erotic zones, all while you pay attention to your breath.
Giving up too soon
One of the most important things to know before you get started is that Tantra is not about instant gratification. Patience is required when you’re learning new way of deepening your sexual experiences. “For many people, there is a reprogramming that happens around what they’ve known sex to be about,” Wolf confirms.
“Tantra is a journey. It’s not about ‘getting it right’ straight away. While it’s extremely enlightening to educate yourself by reading, watching videos and having conversations about Tantra, the real shift happens when you do the practices.” And Wolf is confident that if you’re consistent with your practice, you’ll be surprised how quickly you’ll see and feel results.
Believing that tantra isn’t for you because no one you know does it
“Often people feel shy and don’t have the confidence to share what they’ve learnt, as they feel it’s too weird, out there and might not be accepted—but don’t assume a sexual partner won’t be interested,” Wolf encourages. “As long as someone has a willingness and openness to learn and connect with you this way, that’s all that matters. It’s a beautiful and life changing journey to introduce someone to, and you’ll often be met with gratitude.”
Tantra practice isn’t right for you because you’re not a spiritual person
Worried about the spiritual aspect of the practice? Wolf says you really don’t have to be. “Aside from Tantra having the ability to take you into ecstatic states, it’s also a very grounding somatic—somatic means of the body—practice,” she explains.
“If what you’re looking for is more meaningful connections, and a more fulfilling and enjoyable sex life at the very least, practising Tantra is for you. What I’ve found after 15 years on my Tantric Journey is that there’s never a limit to the depth you can go to with Tantra. It’s a gift that continues to give.”
— Why do some couples keep the home fires burning while for others the embers grow dim? Here’s what some romantic partners are doing right
By Nicole Pajer
You know who they are.
That couple down the block who’ve been together for 25 years and still canoodle like newlyweds. They seem to have the intimacy and magic you and your partner once shared. How do they do it?
There are plenty of obvious reasons some couples lose their intimacy mojo over time: too much stress, too much conflict, too many health issues. But there are also plenty of healthy people in otherwise healthy relationships who aren’t getting their fair share of lovin’. What’s separating the sexually successful from the carnally challenged? We took a peek under the sheets and discovered some unexpected habits that have nothing to do with your relationship and can help any couple regain their romantic mojo.
1. Sex-cessful couples use the bedroom — for sleeping
Women who sleep an extra hour at night experience more sexual desire the next day and a 14 percent increased likelihood of having sex, according to one study. Maybe it’s because their partners are better rested as well: Not getting enough sleep has been linked to erectile dysfunction and a lack of testosterone in men. “A lot of your hormones and sex hormones are actually produced during good sleep,” says Graham King, M.D., a family medicine physician with Mayo Clinic Health System. Aim for at least seven to nine hours per night; anything under six on a regular basis could be setting you up for trouble.
One key to better sleep and better sex: Don’t bring your smartphone to bed. A study conducted by tech solutions company Asurion looked at the bedroom habits of 2,000 U.S. adults and found that 35 percent of respondents said their sex life had been impacted by their or their spouse’s bedtime phone use. “The phone acts as a barrier to intimacy by distracting attention away from your partner, creating distance between you,” says Lori Beth Bisbey, a clinical psychologist and host of the A to Z of Sex podcast. “Great sex needs both people to be present and focused on each other — and little else, actually!”
2. Sex-cessful couples never crash diet
Almost every trendy approach to losing weight, from keto to intermittent fasting, involves cutting out certain food categories and thereby restricting calories. Maybe they’re fat or carb or protein calories, but the fact is that not getting proper nutrients can have an impact on your sex drive.
“We need protein, we need fats to be able to build those sex hormones and keep our different muscular systems, including our genitals, working right,” says King. Sex, he says, requires a lot of blood flow, an array of hormones, and precursors to different kinds of amino acids we need for vasodilation “and, of course, ultimately, orgasms. So if we’re malnourished, we don’t have the fuel to get there.” If you’re trying to lose weight, do it intelligently. Eat a well-balanced diet high in produce, lean meat and fish, and whole grains, with a minimum of sugar and ultra-processed foods. (AARP’s best-selling guide to 50-plus nutrition, The Whole Body Reset, is now available in paperback.)
3. Sex-cessful couples soak up the sun
You’ve no doubt heard about the importance of vitamin D, and perhaps you’ve asked your doctor to check your blood levels. If not, and if you live in the northern half of the nation, a lack of vitamin D might be interfering with your love life. Low D has been linked to decreased erectile and orgasmic function, as well as diminished sexual desire. But supplements in winter can help: Additional research has found that supplementing with vitamin D can improve sexual function and mood in women with low vitamin D levels. To get more D from your diet, prioritize vitamin D–fortified foods like milk or yogurt. If you prefer to get your vitamin D from being outdoors, remember that you also need to protect yourself: The median age of people receiving a melanoma diagnosis is 66.
4. Sex-cessful couples work their muscles
Working out increases sexual arousal in women and helps combat erectile dysfunction in men. But more important, exercise — especially vigorous exercise that stimulates our muscles — is critical to our libidos.
When we exercise, the stress on our muscles stimulates the hypothalamus to produce sex hormones, says King: “It stimulates an effect that goes through our pituitary to our adrenal glands to start building those precursors to testosterone, estrogen and progesterone.” Without that stimulation, our brains never get the signal that it’s time for lovin’.
The American Heart Association recommends at least 150 minutes of moderate exercise per week, 75 minutes of vigorous-intensity exercise or a combination of both, adding in resistance or weight training several days a week. But don’t overdo it; one study found that men who engage in intense endurance training for long periods of time had reduced libidos.
5. Sex-cessful couples avoid late-night sweets
Many of us enjoy a good after-dinner treat. But dessert is one thing — a midnight snack is something else.
“Eating sugar before bed causes insulin release and can temporarily suppress testosterone levels,” says Raevti Bole, M.D., a urologist at the Cleveland Clinic. Anyone who has felt a crash after a sugar high will understand this effect. “This can make you feel sluggish and sleepy, which can tamper with your arousal,” Bole adds. If you’re hungry before bed, opt for something less sugary, like a piece of fruit, crackers and cheese, or dark chocolate. Avoid processed treats, desserts and sugar-sweetened beverages in the hours leading up to bed.
6. Sex-cessful couples drink a lot
Not booze — water. Water makes up 75 percent of the total body weight of newborns, but as we age, that percentage drops; in older adults it can be 50 percent or lower. And that can impact our health and our sex lives.
Proper hydration is critical to the cardiovascular system, which is responsible for keeping nutrients and oxygen flowing throughout the body. Even mild dehydration can impact a man’s ability to achieve an erection, and for women, it can cause issues with vaginal lubrication and genital arousal, says Sheryl Kingsberg, division chief, Ob/Gyn Behavioral Medicine at the University Hospitals Cleveland Medical Center and codirector of the Sexual Medicine and Vulvovaginal Health Program at the UH Cleveland Medical Center.
Keep a water bottle nearby to sip on throughout the day; reduce your alcohol intake, as that can further dehydrate you; and incorporate water-rich fruits and vegetables into your meals and snacks.
7. Sex-cessful couples make their bed daily
Clutter can sneak up on you, causing stress that you might not even be aware of. One study found that cortisol levels in women with cluttered homes rose during the day and stayed high when the clutter remained; the effect was more powerful on women than on their partners.
“It is likely that this is related to the expectations that women will still be responsible for keeping the home presentable and the social approval inherent in having a lovely home,” says Bole. Chaos around us, she adds, “impacts our ability to concentrate and focus.” Another study that looked at the relationship between clutter and procrastination found that older adults with clutter problems tended to report a significant decrease in life satisfaction. Making your bed first thing in the morning gives you a sense of control that can help reduce the feeling of being a victim of chaos. Better yet, make it together.
In no particular order, here’s a list of things I’d rather do than talk about sex: accidentally like a photo of my ex-boyfriend’s new girlfriend from two years ago; play six straight hours of baby shower games; drink bath water (yes, even Jacob Elordi’s).
Though I love having sex, actually talking about it with my partner, friends, and even my therapist makes me want to curl up into a ball and hide. According to a 2023 survey from Durex, I’m not the only one: A third of the 2,000 adults surveyed reported that they feel uncomfortable talking about sex with their partners, and a fifth won’t bring up sex at all over the course of their relationships.
If these folks (myself included) get itchy having these conversations with the person who regularly sees them naked, chances are they’re probably not running out to have them with a professional, either—which is where sex therapy apps can help.
My first introduction to sex therapy apps came late one night while I was laying in bed after a not-so-great, highly-anxiety-provoking sexual experience with my long-term partner. It was a sort of a “straw that broke the camel’s back” situation that made me realize that if I continued to ignore my sexual trauma—and the hangups that came along with it—it was never going to get better. What started with a few Google searches in the realm of “what is wrong with me” took me down a rabbit hole of resources I didn’t know existed. Fifteen minutes later, I downloaded my first sex therapy app, and was almost in tears as I realized that 1) I wasn’t alone in my experience, and 2) there might actually be a solution.
While most experts will tell you that working with an actual human therapist is the best way to address intimacy issues because they’re able to take a more personal approach, apps are a great plan B, especially if you can’t afford individual therapy. There are a number of different reasons why people find themselves in need of sex therapy—Kate Levine, LMHC, a Brooklyn-based sex therapist, names desire discrepancies, shame or embarrassment around sexual preferences, and trauma as some of the most common—and considering 43 percent of women and 31 percent of men will experience some sort of sexual dysfunction (which includes lack of desire) throughout their lifetime, according to The University of Texas Southwestern, any resource that makes navigating these things more accessible is decidedly a good thing.
“For a lot of folks, talking about sex with another human being can be very overwhelming—especially initially—and it might feel easier to engage with an app, where there’s a level of separation through the screen to allow them to get more comfortable,” says Nikita Fernandes, MHC-LP, a sex therapist who specializes in queer, poly, and POC couples. “I think these apps provide a more accessible way to check into or use certain resources at someone’s own pace and time and environment.”
To begin navigating my own issues around sex, I spent six weeks testing out some of the App Store’s most popular offerings. Here’s how it went and what I learned in the process.
Pros: Solo and partnered work available, audio and written courses, stories from real couples, guided self-touch sessions, can link up with a partner’s account so you can do the work together.
Cons: Content largely focuses on cisgender sex and sexuality, no free option.
BlueheartBlueheart’s helpful articles on sexual desire and arousal. Blueheart
Blueheart was my first foray into sex apps—I downloaded it the night I realized I couldn’t “fix” my sexual issues on my own and immediately dove in.
The program starts with an assessment, which was built by psychologists and asks questions around five relationship pillars: Connection (i.e. how comfortable you are being yourself around your partner), Teamwork (how well you and your partner work through arguments), Sex and play (whether or not you feel attracted to and sexually fulfilled by your partner), Communication, and Values. From there, the app puts together a personalized program based on your needs.
The results of my assessment reaffirmed that I had significant anxiety around sex, which was impacting my libido levels, and informed me that I could benefit from learning new ways to communicate these things to my partner. The first part of my lesson plan was all about “re-sparking libido,” which consisted of 36 therapist-led audio sessions across five levels. The sessions ranged from five to 20 minutes, and each level included three guided self-touch sessions meant to help me learn how to get out of my head and focus on the pleasurable physical sensations that come with sex—which are more “guided meditation with some light nipple play” than audio erotica.
Level one began with exploring what desire is and how it works; level two was about managing stress and distractions during sex; level three focused on body image and performance anxiety; level four amped up those learnings with lessons on how to better connect to your body; and level five highlighted how to find pleasure. The final lesson, which is meant to be the last one you do on your own, teaches you how to talk about Blueheart with your partner so that you can work together moving forward.
In addition to the personalized lesson plan, Blueheart allows you to opt into other couple-friendly courses like “How To Talk About Money” and “Becoming a Better Team.” There are also a slew of expert-informed articles around body image, arousal, basic sex-ed, and more, plus stories from real couples who have found success with the program.
After spending years feeling like a freak because of my anxiety around sex, what I loved most about this app was how often it reassured me that it was totally normal—exactly what I needed to hear (especially from the soothing British woman’s voice Blueheart uses across its content). Every new session seemed to be building on the work I’d already done, which made me feel like I was making real progress. Additionally, the meditations helped me get in touch with my body, and I found myself coming back to the breathing exercises and sensory scans I learned during intimate experiences. After only two weeks of using Blueheart, I started to feel less stressed about sex, and now that I’ve finished my first full lesson, I’m excited to bring my partner into the fold to continue this work together.
Best for individuals looking to improve sexual function and desire: Rosy
Cost: $9.99/month-$74.99/month
Pros: Backed by licensed therapists and OBGYNs, offers coaching for queer and non-monogamous relationships, daily programs as short as five minutes, community-based conversation boards, live events, two virtual 30-minute coaching sessions a month with premium plan.
Cons: No free option, meant more for individual work than for couples.
RosyRosy has a slew of content types to explore, from Religion to Mental Health.RosyJust a few of Rosy’s audio erotica options.
Like Blueheart, Rosy’s sexual wellness program also begins with a quiz, but the questions are more related to your sex life over the course of the past month (think:”how often did you feel sexual desire?” and “how often did you reach climax when you had sexual stimulation?”). It also asked questions about birth control, pregnancy, and menopause (because hormones are so closely linked to sexual desire and performance), mental and gynecological health, and sexual trauma. All of this information creates your personalized wellness plan, which typically includes a daily lesson followed by a reflection in your in-app journal.
My journey started with the basics: A video in which two licensed psychotherapists explain in depth what sexual trauma actually is, which helped me better understand how these types of experiences can take different shapes. In addition to the daily tasks, the app also offers a series of “Quickies” videos where experts dive into common sexual concerns, like the orgasm gap and libido changes during menopause. Even better? It’s got an entire library of written and audio erotica (we’re talking hundreds of options), and a community discussion board where you can talk about what you’re going through with others who may be sharing the same experience.
I love how expert-led Rosy feels—certainly the closest to what I imagine IRL sex therapy feels like. The lessons gave me the opportunity to really understand how my sexual trauma was impacting me, as well as the tools I need to start overcoming it.
Pros: Designed for couples, one subscription includes two memberships (one for each partner), includes personalized therapy “journeys,” audio pleasure guides, games for couples, and sex tips. Free option offers limited access to some resources.
Cons: Not great for individuals looking to navigate sex and intimacy independently.
CoralCoral’s “Yes to Sex” sexual improv game.
Coral is designed for couples, which means that after a month of testing sex therapy apps on my own, it was time to tell my partner what I’d been up to—which was admittedly a lot less scary than it would have been prior to this experiment.
Like all of the other apps on this list, Coral opens with an assessment—but in this case, the questions focus more on your sex life as a couple rather than an individual. (A few examples, which are meant to be answered by both parties: Who initiates sex more often? Does your desire come on suddenly or gradually? Has your attraction to your partner grown or diminished over time?) Your answers will inform the “journeys” that the app recommends for you, which target your goals around things like communication, confidence, and pleasure within your relationship.
Based on the program’s assessment that my partner and I have different desire types, I got my own journeys, each consisting of both written and audio lessons meant to be worked through on your own. Beyond these structured solo paths, the app also offers a slew of “choose your own adventure”-type programs that you can do alone or with your S.O. There are audio guides for solo and partnered pleasure, games and activities couples can play together to help get in the mood (my personal favorite was “Yes to Sex,” a sexual improv game in which one partner says something like “I’d like to get naked tonight,” and the other keeps the conversation going by adding a “yes and” statement, like, “Yes, and, I’d like to give you a massage with essential oils.”), sex tips and how-to guides, and more.
Thanks to the confidence and comfort I started building using Blueheart and Rosy, I was genuinely excited to start working with my partner on Coral. Though many of the activities started off giggly and silly, they helped us have some real, honest conversations about sex—and for the first time in my life, I faced them head-on instead of sticking my fingers in my ears. It wasn’t awkward or uncomfortable. Dare I say it was kinda… fun?
Final Thoughts on Sex Therapy Apps
After six weeks of entrusting my sexual wellbeing to app-based therapy, I walked away with a better understanding of my sexuality and how to properly communicate my needs. It’s hard to pick a favorite among the three apps because each one is so different, but using them helped me realize that there are effective tools available, that I’m not alone, and that I don’t have to spend big money on an IRL sex therapist to work through my struggles—at least not for now.
Caring for your mental health is a highly personal endeavor, which is to say that what worked for me may not work for everyone. But all three of these apps will be staying on my phone—and in my life—for the long haul, because even though I’ve made strides, I’m still a work in progress. And if they can continue to make my sex life, and my attitude around it, even better? That’s well worth the monthly subscription fees, IMO.
“Based on our findings, we think it’s less ‘Happy Wife, Happy Life,’ and more ‘Happy Spouse, Happy House.”
Summary: A new study challenges popular romance myths, debunking the Five Love Languages with evidence-based research. The work, proposes a ‘balanced diet’ metaphor for expressing love, emphasizing the need for diverse and evolving expressions of affection in relationships.
The findings, including critiques of concepts like “Happy Wife, Happy Life” and the appeal of unplanned sex, underscore the importance of mutual satisfaction and novelty in maintaining desire.
The research calls into question widely held beliefs, advocating for a more nuanced understanding of relationship dynamics.
Key Facts:
Amy Muise’s research contradicts the Five Love Languages, suggesting a need for multiple expressions of love rather than one primary language.
Studies led by Muise found that both partners’ perceptions are equally important in a relationship, challenging the “Happy Wife, Happy Life” notion.
Muise’s work emphasizes the importance of planned intimacy and novel experiences in enhancing relationship satisfaction and desire.
Source: York University
From the Five Love Languages to the concept of “Happy Wife, Happy Life,” popular culture is riddled with ideas of how sex and relationships are supposed to work, but does the science back these ideas up?
According to Faculty of Health Assistant Professor and Research Chair in Relationships and SexualityAmy Muise, the answer is frequently no.
Ahead of Valentine’s Day, Muise, also director of the Sexual Health and Relationship (SHaRe) Lab, can offer alternative theories that are supported by her research and other literature in the field.
Muise’s latest research debunks the Five Love Languages, offers ‘balanced diet’ metaphor as alternative
The Five Love Languages is the invention of Gary Chapman, a one-time Baptist minister who provided marital counselling to couples in his church and wrote a book based on his experiences.
The theory goes that each of us has a primary love language – words of affirmation, quality time, receiving gifts, acts of service and physical touch – and problems arise in relationships when partners are speaking different languages.
Online dating sites encourage you to share your love language, 50 million people have taken the online test, and videos with the hashtag have half a billion views on TikTok – clearly, the concept has deeply ingrained itself in the popular imagination, but according to Muise’s latest review paper in collaboration with researchers from the University of Toronto, the theory doesn’t hold up.
“His work is based on a very religious traditional sample of monogamous, heterosexual cisgendered couples and it is all anecdotal. We were pretty skeptical of the claims made so we decided to review the existing evidence, and his idea that we all have one primary love language really isn’t supported,” says Muise.
“His measure pits the love languages against each other, but in research studies when they’ve asked people to rate each of these expressions of love independently, people tend to rate them all highly.”
Still, Muise sees why the concept has taken off. “It’s something people can really grab onto in straightforward way and communicate something about themselves to their partner. But we would suggest that love is not a language that you need to learn how to speak but it’s more akin to a nutritionally balanced diet, where partners need multiple expressions of love simultaneously, and that these needs can change over time as life and relationships evolve.”
Other research Muise has done similarly questions pop psychology concepts, exposing flaws along the way:
Happy Wife, Happy Life?
Muise and a group of international collaborators looked into the idea that it is women’s perceptions that are the barometer for the relationships, carrying more weight than men’s. In two studies looking at mixed gender couples, one examining daily diaries and the other looking at annual reports over five years, they found instead that both partners conceptions of the relationship were equally important.
“Based on our findings, we think it’s less ‘Happy Wife, Happy Life,’ and more ‘Happy Spouse, Happy House.”
Is unplanned sex hotter?
Not necessarily, says Muise. In research done last year with a York graduate student, Muise found that while many people endorsed the ideal of spontaneous sex, the researchers did not find evidence that people’s actual experience of sex was more enjoyable when not planned. If you are planning on sex this Valentine’s Day, Muise advises it might work out better to plan to have it before a big meal.
Is too much closeness bad for sexual relationships?
“In the research, we find couples who grow closer have more desire for each other, but we argue that what’s also needed for desire is otherness or distinctiveness,” she says.
“It’s important to bring new things into the relationship, find ways to see a partner in a new light. Novel experiences have been shown to increase desire in long-term relationships, so when making plans for Valentine’s day, doing something together that’s broadening or expanding can increase desire.”
About this psychology and relationships research news
Author: Emina Gamulin Source: York University Contact: Emina Gamulin – York University Image: The image is credited to Neuroscience News
Popular Psychology Through a Scientific Lens: Evaluating Love Languages From a Relationship Science Perspective
The public has something of an obsession with love languages, believing that the key to lasting love is for partners to express love in each other’s preferred language.
Despite the popularity of Chapman’s book The 5 Love Languages, there is a paucity of empirical work on love languages, and collectively, it does not provide strong empirical support for the book’s three central assumptions that (a) each person has a preferred love language, (b) there are five love languages, and (c) couples are more satisfied when partners speak one another’s preferred language.
We discuss potential reasons for the popularity of the love languages, including the fact that it enables people to identify important relationship needs, provides an intuitive metaphor that resonates with people, and offers a straightforward way to improve relationships.
We offer an alternative metaphor that we believe more accurately reflects a large body of empirical research on relationships: Love is not akin to a language one needs to learn to speak but can be more appropriately understood as a balanced diet in which people need a full range of essential nutrients to cultivate lasting love.
Ah, the early ’90s: a simpler time. It was before reality TV revolutionized the entitlement of the masses who want to get attention and money for just … existing, before 9/11 and the safety theater of the TSA, before presidential candidates in the U.S. could run on an explicit platform of ending democracy. And it was a time when “What is a butt plug?” was a common question to write into a sex-advice column.
At least that’s how Dan Savage broke down a key difference between writing his advice column then and now during a recent phone conservation from his home in Seattle. “Butt plugs have a wiki page now—I don’t have to explain butt plugs anymore,” said the writer and podcaster, whose Savage Love advice column began publishing in 1991. Now everything is about “situational ethics,” he said, as people’s conception of sex has expanded through the years, thanks in no small part to Savage himself. “And those columns are harder to write—and easier to fuck up.”
“In the mid-’90s, I would say, ‘I write a sex advice column,’ and professors, journalists, researchers wouldn’t want to play in that sandbox because it was so demeaning,” Savage recalled. He said that’s much different now, as I can also attest as the co-author of Slate’s sex advice column, How to Do It. Another change: He said he receives far fewer gay-panic-related questions now than he did when he started, as well as fewer questions that ask in so many words, “Am I normal?” That’s a question, he said, he “worked hard to make go extinct.” There was also the rise of porn tube sites in the mid-aughts, which Savage credits to expanding understanding of the range of sexual practices out there (or, as queer theorist Gayle Rubin put it, “benign sexual variation”). As a result, “you just couldn’t be in denial anymore about how infinitely varied and subjective desire, arousal, turn-ons, kinks—all of that—was, and there’s just this collective shrug where everybody went, ‘We’re all freaks,’” Savage said.
The sex-advice column is a working example of how culture operates as a feedback loop, which is informed by the same public it goes on to inform. In Confidential to America: Newspaper Advice Columns and Sexual Education, David Gudelunas writes that “the primary function of an advice columnist is not to dispense interpersonal advice to writers but rather to serve as a cultural benchmark that both identifies and helps to shift social norms pertaining to human sexuality.” The focus of Gudelunas’ book is “Dear Abby” and “Ask Ann Landers,” so he argues that this role has existed for well over half a century. Writer Tristan Taormino, who said her diaristic Village Voice column Pucker Up (which ran from 1998 to 2008) was a direct result of the paper’s aim to expand upon Savage’s early success, pointed to the term “pegging,” which Savage coined via a 2001 reader contest. “And all of a sudden, ‘pegging’ is in all the advice columns,” she said. “I feel like the audience got savvier.” Taormino has watched the discursive profile of anal sex in general grow over the years. “When my book [The Ultimate Guide to Anal Sex for Women] first came out in 1998, people did not want to talk about it. And now, quite literally, there are anal sex columns in Teen Vogue,” she said.
Taormino wrote her own advice column, The Anal Advisor, in the Hustler offshoot Taboo from 1999 to 2014. These days a lot of her advice-giving takes place when she speaks on college campuses; she said she’s seen an increase in questions about BDSM but also a consistency in subject matter over the years. “There’s a through line of basic questions, which haven’t changed since the late ’90s. And that comes out of abstinence-only sex ed,” she said. “Once they get to college, all of a sudden they have the opportunity to ask these questions.”
Audience savviness—or lack thereof—has long been a guiding force of advice columns, and not just for how it has complicated questions. In Newspaper Confessions: A History of Advice Columns in a Pre-Internet Age, Julia Golia writes of the communities that formed around newspaper advice columns of old, like The Detroit News’ Experience, which regularly featured reader input on questions, resulting in an “anonymous community in a mass-media form to ask for guidance, but also to be heard and valued.” As Golia told me, “That traditional model cannot be understood outside of the constant dialogue that happens on the internet.”
In her book, Golia draws a parallel to the subreddit Am I the Asshole?, a crowd-sourced Reddit advice column for the modern age that effectively amputates the central personality of the traditional model for something more democratic. Carolyn Hax, who has published a now-daily advice column in the Washington Post since 1998, regularly integrates reader responses to questions in her answers. She told me this was in part a product of an active online community in the comments section. Once a week, Hax sits out and her column is devoted entirely to reader responses. Hax’s column is more about general relations than sexual ones, though she does occasionally broach the topic. Previously, she was less confident about opining in an area of specialized knowledge, but now, “I’m much more comfortable with the idea of just being sex-positive,” she said. “My understanding of this has gotten so much better over the years—of what works and what doesn’t work and what comes with a with a side of shame, which complicates everything and makes it worse. That’s just time and experience.”
Feedback has been a mixed blessing for Savage. “A lot of us learn to stop reading our mentions,” he said. And yet, he’s learned and grown from being “yelled at” by readers—sometimes literally. He recalled running into writer Kate Bornstein on the streets of Seattle in the ’90s, who took him to task for something “jokey stupid” he wrote about gender-confirmation surgery. Their meeting spawned a column, which introduced the gender theorist to many of Savage’s readers. And all “because I fucked up,” Savage said. “And because I was receptive when Kate Bornstein said, ‘You fucked up.’ I didn’t tell her to fuck off. I didn’t do a Netflix special about how much I hate her.” Still, when Savage started writing in print, his archive wasn’t instantly accessible as it is today. “There was this understanding that writers and columnists were still thinking and reassessing and revising their opinions as more info or life experience came in,” he recalled. “And somehow the internet destroyed people’s ability to perceive that or allowed bad actors to argue that that’s not what you did. They will hold up the bloody shirt of something you wrote 25 years ago, and you’re like, ‘Have you read anything that I’ve written in the last 20 years about literally that?’”
As forebears to the modern advice column like Dr. Ruth Westheimer and Loveline’s Dr. Drew Pinsky did on television and radio, respectively, many of today’s self-styled dispensers of advice have expanded beyond the written word, using TikTok, YouTube, and podcasts. (Savage’s Savage Lovecast turns 18 this year.) This is another mixed blessing, according to Dr. Debby Herbenick, professor and director of Indiana University Bloomington’s Center for Sexual Health Promotion. “I think there’s a lot of upsides to video-based sex education, and sex information coming out,” said Herbenick, who has written several advice columns, including Kinsey Confidential for the Kinsey Institute from 2001 to 2018. “It can be entertaining, it can be engaging, it can get it to lots of different sources. On the other hand, there’s also not a lot of eyes on it for fact-checking. When you don’t have something that’s kind of written out there that people can parse and go through, it really does kind of become a little invisible.”
Taormino noted that the market for sex podcasts is “saturated—and we’re all vying for the same ad dollars.” She contrasted the post-Savage boom that saw the birth of her “Pucker Up” column and countless others crop up with the current censorious state of media, in which writers and sex workers are penalized for talking about sex on social media. Herbenick recalled a drug-store chain dropping an unnamed magazine she wrote for as the result of her writing about sex. “I had to fight to talk about HPV and sex toys,” she said. “And I didn’t always win those fights. And when I did, those publications were taking a risk.”
Shrinking and obliterated newsrooms only add to the difficulty of writing about sex (at least, writing about sex and getting paid for it). A certain strain of common wisdom states that “people don’t read anymore,” and so it’s only natural that a lot of the public sex discourse has poured into audio and visual media, or pithy comments on crowd-sourced advice columns like r/amitheasshole. Yet the written sex-advice column persists.
For Savage’s part, he remains just as engaged as he was 33 years ago. “I’m getting questions now from the middle-aged children of the people I gave advice to before they had kids,” he said. “If I had to write ‘What’s a butt plug?’ over and over and over again, forever, I’d probably lose my mind. The trouble that people get themselves into seems to constantly be interesting. And the situational ethics, there’s an infinite number. One genre of sex advice is, ‘What’s a butt plug?’ There’s an infinite number of ways that people can shit the bed and fuck up their life and need help or need validation or need to be told that they’re not the asshole or be told that they are the asshole. And so I think it is still interesting. And I still get questions that surprise me.”
If you’re reading this article, chances are that at some point in your life you’ve asked yourself the million dollar question: Am I gay? You might have even tried taking one of those gay quizzes online. If that’s the case, you’re not alone, and you’re in the right place.
More people are curious about their own sexualities now that queer visibility and representation have reached unprecedented heights. According to a recent study by the Cultural Currents Institute, Google searches by people questioning their sexuality and gender identity increased 1,300% from 2004 to 2023.
But even if pop culture increasingly celebrates queer people, it’s easy to forget that realizing you’re not straight can still be an anxiety-inducing and lonely experience. You might be worrying about what being gay, bi, pan, or some other non-heterosexual identity could mean for your relationships, your love life, or your wellbeing. On top of that, our more expansive understanding of sexuality and gender means even binary labels like “gay” or “lesbian” might not feel totally authentic to you.
If you’re curious, that’s a sign
First things first: the fact that you’re curious about your sexuality and asking questions is a sign itself.
Try to be honest with yourself about why you’re questioning your sexuality. You probably had an experience or a thought that triggered it; try to identify what that was and think through why you had it. “Most straight people, in my experience, take their sexuality for granted,” says Alex Jenny. “If you’re having a prolonged sense of curiosity about your sexuality, that is often a sign of something.”
Just having a singular moment of same-sex attraction or a queer sexual fantasy doesn’t necessarily mean you’re queer. Sexuality is a complicated thing, and everyone has thoughts and desires that don’t always fall into the bucket of whatever sexuality you identify with. But if you’re having prolonged, repeated thoughts and fantasies that can be called queer, it might be time to think about whether you yourself might be queer, in whatever form that might take — bi-curious, bisexual, pansexual, gay, lesbian, or otherwise.
It can also be helpful to differentiate between queer romantic feelings and queer sexual feelings. “Sexual attraction is very much like wanting to have sex with someone,” Kipling explains. “Romantic attraction is more about love and warm feelings and wanting to be around that person. It doesn’t have to include building a life with them.”
In other words, paying attention to how your body reacts physically to someone can be a good way of gauging whether you’re experiencing sexual or romantic attraction. Because our culture often conflates platonic, romantic, and sexual intimacy, you might just be experiencing an intense nonsexual crush. That doesn’t automatically rule out the possibility that you could be queer, of course, but it could be a first step towards exploring other facets of your queerness that aren’t just tied to sex.
Don’t rush to label your sexuality right away
It might feel tempting to take an online quiz or let an article like this one put a label on your sexuality. Many of us took “Am I Gay?” quizzes growing up hoping to dispel our worst fears, only to end up confirming them.
Although you should be skeptical of any “gay tests” on the internet, considering they’re extremely reductive and definitely not science-based, there are some online resources that could help you make better sense of your possibly-queer feelings. The Lesbian Masterdoc is a 30-page document that was published by then-teenager Anjeli Luz on Tumblr in 2018. It breaks down questions and feelings that lesbian-identifying people may have when questioning their sexuality. There are sections dedicated to explaining dynamics such as compulsory heterosexuality, which is the inherent assumption in society that everyone is heterosexual — an assumption that prevents people from exploring other alternatives.There’s no harm in reading documents like this, especially if you find that you identify with a lot of the material, but it’s important to keep in mind that this is only a snapshot of one queer person’s experience with their sexuality.
Finding a queer glossary could also be a good tool to get an idea of the immense spectrum of desires and identities that you might want to explore. The Gender Elephant is a flowchart by the Canadian Centre for Gender and Sexual Diversity that breaks down the difference between gender identity, romantic attraction, gender expression, and sexuality while acknowledging that all of those things exist across a spectrum.
“If these labels help you understand yourself better or help you find meaning around yourself and your identity, great,” Kipling says. “If not, also great.” You should only be using flow charts, quizzes, and other materials to the extent that they make you feel more at ease and valid in your feelings, but not if they make you feel boxed in.
Talk to queer people about what you’re experiencing
Another good place to start is to find a community, whether in a physical space like your local LGBTQ+ center or online. Talk to queer people about your thoughts and feelings, even if that feels scary or hard. They’ve likely been through some of what you’re facing, and can tell you how they themselves figured out their identity.
If you’re worried about discretion, try to find someone you can really trust with your questions, who you know won’t tell others about what you’re experiencing before you’re ready. If you can’t find someone like that in person, online communities and resources, like the Trevor Project’s TrevorSpace or the LGBT National Coming Out Support Hotline, can connect you with LGBTQ+ people who can help you make sense of what you’re feeling.
Talking to queer people is especially important because it allows you to understand that you’re not alone, and that your experiences don’t isolate you — they actually make you a part of an enormous network of people all over the world.
“You’re not going to necessarily relate to everybody’s experiences, but maybe there are little pieces of somebody else’s experience that you really resonate with,” Kipling says. On top of that, “there are people who are waiting to embrace you in the fullest sense.” When you are affirmed by others, embracing yourself gets a lot easier.
Coming out doesn’t always happen all at once
Coming to understand your identity can be an exhilarating experience, but it’s something that needs to happen at your own pace. If you do realize you’re not straight, you might begin to feel pressure to come out, but know that if coming out doesn’t feel right or safe for you, it doesn’t make you any less of a queer person.
“It’s also brave to keep yourself safe,” Jenny says. Instead of “coming out,” she prefers the term “coming in,” which gives us more agency. “‘Coming in’ is having discernment around who the people who are actually safe and want to celebrate and uplift your sexuality and my authenticity are,” she continues. “Those are the people who you can invite in.
Jenny likens sharing your sexuality to giving someone a delicate vase. You wouldn’t give something so fragile to someone who might be reckless with it, and you wouldn’t do the same with your identity.
It’s also perfectly okay to discern when and where you want to share your queerness. For example, if you decide to paint your nails at home but want to take them off to attend a family function, that’s totally fine. “When people are exploring their sexuality for the first time, they’re not immediately going to have the full queer lifestyle that they might be seeing on social media,” Jenny says.
The beautiful thing about being queer is that there are infinite ways to do so. “There are so many ways to express your authenticity, even if it’s just you alone in your room,” Jenny says. “It’s important to be okay with wherever you are in this moment.” From that authenticity grows an acceptance that you might not know or be confident in exactly who you are all the time — and that’s okay, too.
— It turns out every part of the narrative we’re taught about how desire works is not merely wrong, but wrongheaded
Young beautiful woman is kissing her boyfriend gently. Their eyes are closed. Couple is illuminated with bright multicolored lights.
By Emily Nagoski
When I first began having long(ish)-term sexual relationships during my college years I believed an old-fashioned narrative about how desire works. We’re told it’s all passion and “spark” early in a relationship, and that lasts a couple of years maybe. Then we have kids or buy a fixer-upper house or generally get busy with work and life, and the spark fizzles out, especially after 50, when apparently every hormone we ever had floats away on a sea of aging and we’re left, sexless and neutered, to hold hands at sunset.
Our options, we’re told, are either to accept the fizzling of our desire for sex or to fight against it, to invest our time, attention and even our money in “keeping the spark alive”.
Well, it turns out every part of that narrative is not merely wrong, but wrongheaded. A lot of books about sex in long-term relationships are about “keeping the spark alive”, and they too are wrongheaded. They’re so 20th century, with their rigid gender scripts and cringingly oversimplified ideas about sex and evolution.
I call this mess of wrongheadedness the desire imperative. The desire imperative says:
At the start of a sexual and/or romantic relationship, we should feel a “spark”, a spontaneous, giddy craving for sexual intimacy with our (potential) partner that might even feel obsessive.
The sparky desire we’re supposed to feel at the beginning of a relationship is the correct, best, healthy, normal kind of desire, and if we don’t have it, then we don’t have anything worth having.
If we have to put any preparation or planning into our sex lives, then we don’t want it “enough”.
If our partner doesn’t just spontaneously want us, out of the blue, without effort or preparation, on a regular basis, they don’t want us “enough”.
The desire imperative puts desire at the center of our definition of sexual well-being. It says there is only one right way to experience desire, and without that, nothing else matters. And so people worry about sexual desire. If desire changes or it seems to be missing, people worry that there’s something very wrong. It’s the most common reason couples seek sex therapy.
Here’s the irony of the desire imperative: does all that worry about “spark” make it easier to want and like sex? On the contrary, worry mainly puts sex further out of reach.
But there’s an alternative: center pleasure.
Desire is not what matters. Not “passion”, not “keeping the spark alive”.
Pleasure is what matters.
Center pleasure, because great sex over the long term is not how many orgasms you have or even how enthusiastically you anticipate sex, but how much you like the sex you are having.
Great sex over the long term is not how many orgasms you have but how much you like the sex you are having.
Spontaneous desire v responsive desire
A simple place to start changing how we think about desire and pleasure is understanding what sex researchers and therapists say about desire. They call the “spark” of the desire imperative “spontaneous desire”, and it is one of the normal ways to experience sexual desire, but it is not associated with great sex in a long-term relationship.
They also describe “responsive desire”, which is not a “spark” feeling but rather an openness to exploring pleasure and seeing where it goes. It often shows up as “scheduled” sex, where you plan ahead, prepare, groom, get a babysitter and then show up. You put your body in the bed, you let your skin touch your partner’s skin, and your body wakes up! It says: “Oh, right! I really like this! I really like this person!” Where spontaneous desire emerges in anticipation of pleasure, responsive desire emerges in response to pleasure.
Both are normal and neither is better than the other … but it’s responsive desire that is associated with great sex over the long term.
Not “passion”, not “spark”, but pleasure, trust and mutuality. That’s the fundamental empirical reason to center pleasure over spark.
Pleasure is sensation in context
Pleasure is the measure of sexual well-being – that is, whether or not you like the sex you are having.
So, what even is pleasure?
Well. Does a sensation feel good? How good? Does it feel bad? How bad?
That’s the whole thing. Pleasure is the simplest thing in the world, in the sense of declaring whether a sensation feels good or not. Next time you’re eating your very favorite food, notice what that pleasure is like – the food’s appearance, its texture, aroma and flavor. Notice what pleasure does to your body. Pleasure is simple …
But that doesn’t mean it’s always easy. We’ve been lied to about the nature of pleasure, just as we’ve been lied to about the nature of desire. We’ve been told that sexual pleasure is supposed to be easy and obvious, and if it’s not easy and obvious, then there’s something wrong. For some people, experiencing pleasure is like finding Waldo: so frustrating that you start to wonder why you’re even looking.
We’ve been told that pleasure comes from being touched in the right place, in the right way, by the right person, and if that touch, in that place, by that person, feels good some of the time but not other times, that’s a problem. These lies show up in movies and romance novels and porn, where the main characters may be running away from the villain or even just exhausted and overwhelmed by life, but Partner A touches the magic spot on Partner B’s body and it doesn’t matter what else is going on, Partner B’s knees melt and their genitals tingle.
If that’s how pleasure works for you, cool.
For the rest of us, pleasure isn’t about the right place on your body touched in the right way. It’s the right place, the right way, by the right person, at the right time, in the right external circumstances and the right internal state. In short: it’s sensation in the right context.
“Context” means both your internal state and your external circumstances.
A simple example of this is tickling. Tickling is not everyone’s favorite (though it is some people’s favorite!), but you can imagine a scenario where partners are already turned on, in a trusting, playful, erotic situation, and Partner A tickles Partner B and it feels good! But if those same partners are in the middle of an argument about, say, money, and Partner A tries to tickle Partner B, will that feel good? Or would Partner B feel more like punchin’ somebody in the nose than snuggling?
Any sensation may feel good, great, spectacular, just OK or terrible, depending on the context in which you experience it.
Pleasure is a shy animal. We can observe it from a safe distance, but if we approach too fast, it will run. If we try to capture it, it will panic. You have to build trust with your pleasure before it will allow you to observe it closely.
Pleasure happens when we feel safe enough. Trusting enough, healthy enough, welcome enough, at low-enough risk. Everyone’s threshold for “enough” is different, and it changes from situation to situation. But when we create that safe-enough context, our brains have the capacity to interpret any sensation as pleasurable.
Pleasure is not desire (though desire can be pleasurable)
Pleasure and desire are different systems in the brain. At the level of the emotional, mammalian brain, desire is known as “wanting” or “incentive salience”, and pleasure is discussed as “liking” or hedonic impact.
“Wanting”, in the brain, is a vast network of dopamine-related circuitry that mediates how motivated we are to pursue a goal. “Liking”, by contrast, is a set of smaller “hedonic hot spots” where opioids and endocannabinoids mediate how good a sensation feels.
Pleasure is stillness, savoring what’s happening in the moment. Desire is forward movement, exploring to create something that doesn’t currently exist.
Pleasure is a perception of a sensation. Desire is motivation toward a goal.
In a sense, pleasure is satisfaction and desire is dissatisfaction, because pleasure is enjoying an experience, while desire is motivation to pursue something different.
Consider the “wanting” involved in continuous, joyless scrolling on social media. You’re searching for something you can’t name, maybe for the reward of, at last, finding something that makes you feel good or that even confirms your worst fears. You want … something. But you’re not enjoying it, you’re just following the urge to keep looking. Desire without pleasure.
So far, so simple.
Where it can get muddy is in how desire feels. Pleasure, by definition, feels good. Desire per se is more or less neutral; it’s the context that makes it feel good or bad. I think people confuse desire for pleasure because desire sometimes feels good. Once we recognize that desire can also feel bad, we begin to understand both how desire and pleasure are not the same thing and why pleasure is the one that really matters.
How sexual desire feels
Anticipation, expectation, craving, longing – these are all ways of experiencing desire that can feel delightful and even ecstatic. But anticipation, expectation, craving and longing can also feel frustrating, irritating and annoying. Desire can be hope and optimism, but it can also be anxiety and fear.
Whether desire feels good or not depends on the context. All pleasure depends on the context.
If you have experienced desire, stop and recall a moment when it was pleasurable. Probably, the object of your desire, whether it was a lover or a new gadget or a tasty snack, seemed within reach, maybe you felt in control of whether or not you got what you wanted, maybe your desire was grounded in a promise someone made that filled you with anticipation.
The pleasurable version of spontaneous desire is, I think, why people get confused about the difference between pleasure and desire and why we might be convinced that “spontaneous” is the good, right, normal kind of desire. After all, it was “easy” – or at least, it happened out of nowhere – and it was fun.
But spontaneous sexual desire can feel terrible, too. Suppose you can’t figure out how to get closer to your object of desire, or the object of your desire is entirely out of reach or, worse, actively rejecting you, pushing you away. In that context, your ongoing desire can feel like a form of torture.
If you’ve wanted to want sex, you’ve experienced a different uncomfortable desire. Many people who struggle to let go of the “ideal” of spontaneous desire know how awful it feels to want something you can’t get, which is why it’s so important that we remind ourselves that it’s responsive desire, not spontaneous desire, that characterizes great sex over the long term. If you enjoy the sex you have, you’re already doing it right, and you’re allowed to stop trying to create spontaneous desire.
If we think only about the pleasurable experiences of desire, we end up using the words “pleasure” and “desire” more or less interchangeably. But they’re different; we know they’re different because of the brain science. And if pleasure always is pleasurable but desire is only sometimes pleasurable, doesn’t it make sense to center pleasure, and allow desire to emerge in contexts that maximize the chances that the desire will feel good?
Are you still worried about spontaneous desire?
If I wanted to spark controversy, I’d say there’s no such thing as a sexual desire problem, and all the news articles and think pieces and self-help books and medical research focused on a “cure” for low desire are irrelevant. The “cure” for low desire is pleasure. When we put pleasure at the center of our definition of sexual well-being, we eliminate any need to worry about desire.
But I’m not here for controversy, I’m here to make your sex life better. So I’ll just say: don’t sweat desire. If you’re worried about your partner’s low desire, ask them about pleasure. If you’re worried about your own low desire, talk to your partner about pleasure. Desire can be a fun bonus extra; it’s as important as simultaneous orgasms, which is to say, a neat party trick but not remotely necessary for a satisfying long-term sex life.
And yet. In my unscientific survey of a few hundred strangers, some people reported that what they want when they want sex is spontaneity:
“I hate talking about having sex before I have sex. Like if it can’t happen naturally, I kinda don’t want it.”
Oof, that word. “Naturally.”
If the idea of talking about sex, or making a plan before you have it, feels “unnatural”, I am here to acknowledge the reality that talking about sex might deflate spontaneous desire, but also to ask you to consider the possibility that planning sex can be part of the pleasure and that talking about sex is not just natural, it’s part of the erotic connection between you and a partner.
Pleasure happens when we feel safe enough, according to the author.
Maybe every sexual experience you’ve had in response to spontaneous desire has been better than any sex you’ve ever had in response to a plan. But did you really not plan before any of that great “spontaneous” sex? When you’re in a new or emerging relationship, do you not spend time daydreaming about a hot date, making plans for dinner or an adventure together, exchanging flirtatious texts, emails, phone calls, whispers? Hot-and-heavy, falling-in-love horniness is often accompanied by a lot of planning and preparation and, yes, even talking about sex in advance. Do you not spend time getting ready for it, grooming, dressing carefully, making sure you smell good?
Is that … “natural”?
The myth that the “natural” way to have sex is for it to be spontaneously borne of mutual horniness, without having to talk about it or make a plan? That’s the desire imperative. The desire imperative insists that without spontaneous desire, we don’t want sex “enough”. If we have to plan it, there’s a problem.
But consider what our lives are like. We schedule large portions of our days, often weeks or even months in advance. We fill our calendars with work and school and family and friends and entertainment. We fill our bodies with stress and a sense of obligation to others and to ourselves. We impose modern exigencies that don’t even create adequate opportunity for natural sleep, much less unplanned yet mutually enthusiastic sex.
I don’t expect you to believe me right away. I know you’ve been taught to worry about desire. It might even feel troubling or problematic to say that desire doesn’t matter. Maybe you’re thinking: What could you possibly mean, Emily, to not worry about not wanting it and just enjoy it instead? Are you telling me to enjoy sex I don’t want???
On the contrary! I’m saying: Imagine a world where all of us only ever have sex we enjoy. And anything we don’t enjoy, we just don’t do! We don’t do it, and – get this – we don’t worry about not doing it! When we put pleasure at the center of our definition of sexual well-being, sex we don’t like is never even on the table.
If you’ve recently gone through lifesaving breast cancer treatment, you may be looking forward to better days ahead. But as you try to get back to “normal life,” you might notice a change in your libido.
“Cancer treatment across the board can take a significant toll on the body, and breast cancer is no different,” says Gabriel Cartagena, PhD, a clinical psychologist at Smilow Cancer Hospital at Yale New Haven and an assistant professor at Yale School of Medicine in New Haven, Connecticut.
About 60 to 70 percent of breast cancer survivors report sexuality issues after treatment, according to a study published in 2019 in Breast Cancer, so if you’re having that experience, know that many other women are, too. We asked the experts and have some treatments and tips to help you fire up your sex life after breast cancer.
How Breast Cancer Affects Your Libido
So you can understand how to combat a low libido after breast cancer treatment and take back your sexuality, let’s look at the causes.
Premature Menopause
Several cancer therapies can lead to premature menopause, according to a study published in 2022 in the Journal of Clinical Medicine. Chemotherapy and radiation therapy, for example, can decrease hormone levels in your body and make your menstrual cycle slow down or stop altogether, says Mary Jane Minkin, MD, a codirector of the sexuality, intimacy, and menopause program for cancer survivors at Yale Cancer Center and Smilow Cancer Hospital. For women whose breast cancer is fueled by estrogen, treatment may include medication to block the production of estrogen, or surgical removal of the ovaries. These measures, too, can bring on premature menopause. With menopause symptoms like hot flashes, insomnia, and dry mouth, sex may be the last thing on your mind.
Emotional Distress
A breast cancer diagnosis comes with a lot of emotions. Women diagnosed with breast cancer can be at a higher risk for mental health issues like depression and anxiety, neither of which are conducive to a high libido, according to a study published in 2021.
Vaginal Dryness
When your estrogen takes a nosedive during and after treatment, your vagina can become very dry, says Dr. Minkin. Lack of lubrication in this area can make sex uncomfortable or even painful, according to the American Cancer Society (ACS).
Painful Sex
Painful sex can also arise from pelvic floor dysfunction, which means the muscles in and around your pelvis can be too tight or too loose. That’s according to the research published in the Journal of Clinical Medicine, which also found that women may experience chronic pelvic pain syndrome (unexplained pain in your pelvis) after breast cancer treatment.
Body Changes
If you have had surgery or other body changes during treatment, such as removal or reconstruction of one or both breasts, you may not feel like revealing the new you in a sexual encounter, and new or missing sensations can make it hard to get in the mood. “Many women who have lost breast tissue, particularly if they have lost nipples, may feel [less] sensation in their breasts, and many women find breast stimulation important for sex,” says Minkin.
How to Get Your Groove Back
This list may feel discouraging to read, but you shouldn’t lose hope. “The important thing is that we can help with most of these issues,” says Minkin.
Medications Minkin recommends nonhormonal (estrogen-free) medications to help with symptoms of early menopause. “An over-the-counter herbal product called Ristela can help improve pelvic blood flow and enhance libido,” Minkin says. One meta-analysis published in 2021 found that women who took Ristela and similar products that contain the amino acid L-arginine experienced more sexual arousal, better lubrication, more frequent orgasms, and less discomfort or pain. Many participants reported no side effects at all, but a few experienced an upset stomach, heavier menstrual bleeding, and headache.
“Women can also consult with their providers about using prescription nonhormonal medications called flibanserin (Addyi) or bremelanotide (Vyleesi),” Minkin says. Addyi may be less effective than other options, and can cause fatigue and drowsiness, according to a meta-analysis published in 2022 in Sexual Medicine. Vyleesi, on the other hand, has shown more promise, according to a study published in 2019, with uncommon mild side effects like nausea, flushing, and headaches.
If your low libido stems from feelings of depression or anxiety, medications, often in combination with psychotherapy, are an option you can discuss with your healthcare provider.
Vaginal moisturizers For vaginal dryness, Minkin often suggests over-the-counter nonhormonal vaginal moisturizers, like Replens and Revaree, which are inserted into the vagina with an applicator a few times a week. “[These] work very nicely for many women,” Minkin says.
Toys A vibrator or similar device could be a worthwhile investment. They can boost sensation and increase blood flow to your pelvis, says Minkin, both of which can amplify desire.
Therapy One or more sessions with a counselor can be helpful, says Minkin. Sexual health counselors often use cognitive behavioral techniques to discover the “why” behind your low libido, and help you unlock thought patterns that may be blocking your sexual drive, according to a study published in 2020. Therapy is also an effective treatment for depression and anxiety.
Vaginal hormones Hormone replacement therapy is often used to treat menopause symptoms. But if you’ve had breast cancer, it may increase the risk that it will come back, especially if your cancer is sensitive to hormones. With vaginal hormonal treatments, a cream, tablet, or ring containing low-dose estrogen is placed directly in your vagina to aid lubrication and strengthen the vaginal lining. Because much less estrogen gets into your bloodstream, this option is generally considered safe, according to the North American Menopause Society. Your healthcare provider can help you decide if hormone treatments are right for you.
Get Reacquainted With Your Body
Breast cancer treatment can leave you feeling like you’re living in a stranger’s body. “A stark change like a mastectomy can leave women feeling separated from themselves,” says Dr. Cartagena. But every woman can get to know and accept her new body.
Reintroduce Yourself Gradually
“The process to reknow your body takes time and begins in small steps,” says Cartagena, who suggests a first step could be to get dressed in the morning with the lights on. After a few days or weeks of this, you might try spending 10 seconds observing your body in the mirror.
“Exposing yourself to your body little by little can allow you to gradually grieve what is different and take notice of what is new that is still important to you,” explains Cartagena.
Reframe Your Sexual Desires
Sex after cancer may look different, and mourning lost sensations is very important, says Cartagena. Looking forward, he encourages breast cancer survivors to study what sex means to them by asking questions like, “What feels good now?”
“If penetrative sex still evokes pain, a patient can explore foreplay, different forms of stimulation, or other forms of intimacy to induce different, fulfilling sensations,” says Cartegena. Sex doesn’t have to mean one thing — it can be whatever you need or want it to be.
A decade ago, as the sex educator Emily Nagoski was researching and writing her first book, “Come as You Are” — a soon-to-be best seller exploring the science of women’s sexuality — she and her husband stopped having sex.
Nagoski began appearing everywhere, reassuring women that their sexuality was not a problem that needed to be solved or treated. She talked to the author Glennon Doyle and her wife, the soccer player Abby Wambach, about body image and shame on their podcast. She published a workbook to help women better understand their sexual temperament and sexual cues. Her TED Talks have been viewed millions of times.
But at home, she and her husband, Rich Stevens — a cartoonist whom she met on the dating site OkCupid in 2011 — were cycling in and out of monthslong sexual dry spells stemming from work stress and health problems. When I spoke to Nagoski at her cozy house in Easthampton, Mass., in the fall, and then again over the phone in January, she declined to offer specifics on just how long their droughts lasted. (She did not want people to compare themselves.) But she did not hold back about how they made her feel.
“Stressed. Depressed. Anxious. Lonely. Self-critical,” Nagoski, 46, said. “Like, how can I be an ‘expert’ — and I say that with heavy, heavy air quotes — and still be struggling in this way?”
After all, Nagoski had written the book on women and desire. She popularized the metaphor of the sexual response system as a car with an accelerator (that notices erotic stimuli) and brakes (that notice all of the reasons not to have sex. Like chores. Or a new baby. Or, just, patriarchy). When women struggle with arousal and pleasure, she explained in “Come as You Are,” it isn’t because the accelerator isn’t being stimulated; it’s usually because the brakes are being pushed too hard. Her talent was not for producing original research — this dual control model of sexual response, for instance, is not her idea — but she had a knack for sifting through the science to uncover what she believed to be most relevant to women’s day-to-day lives, and finding simple ways to describe it.
“She often reminds people that they are whole, they are not broken,” said Debby Herbenick, the director of the Center for Sexual Health Promotion at the Indiana University School of Public Health, who went to graduate school with Nagoski.
However, Nagoski’s own fractured sex life left her full of self-doubt.
“I did my best to do what I tell other people to do, which is to turn toward what was happening with kindness and compassion,” she said, recognizing how cloying that advice can sound. “I tried to give myself permission to allow these things to be true. To recognize they would not always be true. And that I would move through this spell with more ease if I did not beat myself up.”
Like a true self-proclaimed “sex nerd,” Nagoski also dug into the science of what great sex looks like in a long-term relationship and how to cope when problems arise, which became the backbone of her new book, “Come Together: The Science (and Art!) of Creating Lasting Sexual Connections,” out later this month. At nearly 300 pages, with two appendices and 22 pages of notes and scientific references, it’s the product of an academic who loves data. But Nagoski, who earned a doctorate in health behavior and a master’s degree in counseling from Indiana University, is happy to give up what she thinks are the three secrets of partners with happy sex lives in the book’s introduction: 1. They are friends. 2. They prioritize sex. 3. They ignore outside opinions about what sex should look like and do what works for them.
“When I got done,” she said, “I had this whole book’s worth of advice we used to fight our way back to each other.”
The sex educator Emily Nagoski and her husband, Rich Stevens, established new rules to help their sex life flourish. One of them: Keep the dogs out of the bedroom during intimate moments.
‘Pleasure is the measure’
Nagoski believes that most people are hung up on the wrong metrics when it comes to sex. It isn’t about novelty or orgasms, nor is it about frequency. “People always want to know: How often does a typical couple have sex?” she said, sitting on her living room couch next to Stevens, 47, while one of their two rescue dogs, Thunder, napped between them. “Which is not a question that I answer, because it’s impossible to hear a number and not compare yourself to it.” (Also, she added, people seldom talk about the quality of said sex.)
Most of us are too fixated on libido — or on wanting to want to have sex — she said, which has caused a lot of unnecessary stress and insecurity. “Desire is the No. 1 reason people of all gender combinations seek sex therapy,” she said. “Even I need to be reminded that it’s not about desire. It’s about pleasure.”
It’s a somewhat surprising take from someone who has spent a lot of the past decade helping women better understand how desire actually works, banging the drum about the difference between spontaneous desire (the feeling of wanting sex out of the blue) and responsive desire (which arises in response to erotic stimuli). In other words, there’s nothing unsexy about planning or scheduling sex.
Nagoski has been a sex educator since the mid-90s. She worked for eight years as the director of wellness education at Smith College, before making the switch to writing and speaking full time in 2016. She has also built a brand that now includes a podcast, a newsletter with more than 30,000 subscribers and a growing social media presence, where she sometimes posts with a look-alike puppet named Nagoggles.
Much of what Nagoski preaches, she said, is a transformation of how most of us have been taught sex is supposed to work — that it is always pleasurable and easy.
“Pleasure only happens under really specific circumstances, and the 21st-century, postindustrial world doesn’t naturally create those circumstances very often,” she said. “We are all overwhelmed, exhausted, stressed. Like, of course you have to put effort into transitioning out of your everyday state of mind into a sexy state of mind.”
But in “Come Together,” Nagoski is arguing that desire is almost beside the point. “Center pleasure, because great sex over the long term is not about how much you want sex,” she writes, “it’s about how much you like the sex you’re having.”
Put more succinctly: “Pleasure is the measure.”
This concept may seem obvious to some, and Nagoski isn’t saying anything sex researchers don’t know. But Rosalyn Dischiavo, president of the American Association of Sexuality Educators, Counselors and Therapists, who described Nagoski as both “delightfully geeky” and a “rock star” in the field, called it a “radical truth.”
“As sex educators, one of the most beautiful parts of our job — and one of the most frustrating parts of our job — is to ring that bell over and over and over again to wake people up and say, ‘Pleasure is good,’” she said. “‘Pleasure is healing.’”
Nagoski sometimes posts on social media using a look-alike puppet, Nagoggles
Taking her own advice
Nagoski knows that telling couples to “just access pleasure together” is easier said than done. For most people, herself included, a long list of things can hit their sexual brakes. In the past several years, she has dealt with perimenopause, a back injury, and then long Covid, which has caused severe vascular problems. For months, Nagoski could barely walk to her mailbox. And she is still healing.
In 2021, Nagoski was diagnosed with autism, after her therapist noted she was unusually relieved not to have to see or talk to others during the height of the pandemic. Around that time, she watched the Pixar short “Loop,” in which two teens, one of whom has autism and is nonverbal, learn to communicate on a canoe ride. “It’s just this six-minute, animated thing,” she said, as she teared up. Watching it, she realized, “I’m autistic.”
The diagnosis, Nagoski said, was an “enormous relief.” People on the autism spectrum are sometimes blunt and unfiltered, and the diagnosis helped to explain why she might be so good at what she does. “I think one of the reasons talking about sex is so easy for me is that I have not absorbed the same ‘shoulds’ in the same way,” she said.
“Come Together” is the first time Nagoski has publicly opened up about her sex life, a decision she initially felt ambivalent about. “Before I wrote the book, I wondered if revealing, like, ‘I, too, have struggled with desire in a long-term relationship’ would undercut my expertise.”
When asked what she and her partner did to move through their dry spells, Nagoski distilled it to this: First, she spent a lot of time talking to her therapist (whom she has seen for years) about how to speak to her husband about their issues in a way that felt loving and not accusatory. Next, before they tried initiating anything physical, the couple spent a lot of time talking about sex. Nagoski realized it was important to let Stevens be silly about their situation, she said. (Their inside jokes about his genitals can’t be repeated here.) It brought some levity to their conversations and helped them to realize how important playfulness is to their dynamic in the bedroom.
Last, she asked her husband to be more affectionate with her outside of sexual situations. Their sex life is hardly perfect now, though if she were not recovering from long Covid, Nagoski said, she would describe it as better than it has ever been.
They made small changes, too. The couple began closing the bedroom door so their dogs — who “want to be up on the bed with us,” Nagoski said — couldn’t interrupt sex. They also moved any intimate supplies they needed closer to the bed. The two were trying to eliminate every possible barrier and inconvenience.
But there are risks, Nagoski acknowledged, when couples start having conversations about what is not working in their sex lives. “None of us want to hurt our partner’s feelings,” she said. If a couple cannot navigate those talks on their own, or even bring themselves to start them, then, “yeah, therapy,” she said.
“It’s hard work,” she said of keeping sex going in a long-term relationship. “And you have to care. It isn’t necessary for survival. It’s not even necessary to have a spectacular life. I don’t require anyone on Earth to make any kind of change to their sex life if they don’t want to.”
But Nagoski said for her, “it’s a priority.” The couple now sees sex as a “project” they work on together, making time for it in their calendar.
“We talk about it more than we talk about what we’re going to have for dinner. I alter my schedule so that I don’t have anything that’s going to wipe me out so much that on our calendar day, I’m not going to have any energy left,” Nagoski said. She tries to give herself grace when it does not happen, like when she recently canceled a scheduled sex date because of a migraine.
“What matters,” she said, “is that you’re cocreating a context that makes it easy to access pleasure.”
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