The Blog Erotic at The Buehler Institute

Make Every Day Valentine's Day

I am going to paraphrase something I read about food over the holidays:  That everyone worries about what they eat between Thanksgiving and New Years, and instead should worry about what they eat the rest of the year.  It's the same with Valentine's Day:  Too much emphasis put on love and romance on one day; what about the rest of the year?

It's still early enough in 2012 to make the remaining days more fun and filled with romance.  Of course, everyone's definition of what is romantic is different; my husband and I, for example, tend to be silly.  For example, we have a running joke about (don't ask) that has gone on for at least a decade, maybe longer.  But every time we make a joke, it reminds us that our relationship is exclusive, that we love each other enough to say such things, and lets us flirt in a matter of moments.

What can you do daily in your life to make every day more like Valentine's Day?  Instead of a big box of (possibly unwanted) chocolates, when you are out and about and spot your love's favorite shop, run in and buy a piece or two of their favorite.  (I can see See's from my window in the Riverside office!)  If you see a book, hear about a concert, or read a restaurant review that makes you think your partner would enjoy that, go ahead and take the steps to procure the item or make a reservation.

Affection should be a daily occurrence.  It can be a hug, a snuggle, a kiss that's more than a peck, a massage, or a statement of love and admiration.  Verbal or silent, giving your partner a bit of love keeps your relationship alive and makes time together something to look forward to.

Beyond the more superficial ways of showing love are deeper ones, such as making a genuine effort to listen, really listen, to your partner without being defensive.  If your partner has a request, or even a complaint, if you listen in the spirit of wanting to help your partner, you will have a much more peaceful and loving connection.

What about adopting a spirit of cooperation?  When your partner has a problem, ask how you can help.  When there are tasks to be done, pitch in.  If your partner is going through a difficult time because of work or family obligations, take over their chores for awhile.  Being a help mate may not seem sexy, but consider the alternative:  Be demanding, uncooperative, or entitled, and see how far that gets you in the bedroom.

Finally, Valentine's Day isn't the only day of the year to try something novel.  There is no law that says red panties or briefs can only come out of the corner of the drawer on February 14.  Keep your partner surprised throughout the year.  Then when Valentine's Day rolls around, you won't have to dish out big bucks to appease your guilt for neglecting your lover the rest of the year!

 

Low Sexual Desire in Men: What the Heck?

"What the heck?" is what women ask me when they call wanting to know if I can help them with a husband or partner who has little or no interest in sex.  Of course, like most people, they have bought into the myth that the male partner always has more desire than the female partner, or that their partner is weird for not wanting sex.

In writing my new book for therapists on how to treat sexual problems, here is what we know about low sexual desire in men:  very little.  While pharmaceutical companies have been chasing after the magic elixir that would make women want sex, generating lots of research, interest in men with low desire has been almost non-existent. 

In my practice in Orange County, CA I have observed the following reasons for a man's lack of interest in sex:

• Undiagnosed depression
• Undiagnosed low testosterone
• Other sexual problem, like premature ejaculation or erectile dysfunction (ED)
• Aging and associated decrease in sexual activity
• Myths about sex ("A man should always feel like initiating sex")
• Medical problems and chronic pain
• Last but not least, relationship problems and poor communication

Often, there is a combination of factors, like erections not being as hard as they once were, as well as a lack of intimacy in the relationship.  Even men who are treated for low testosterone don't always get their drive back.  If their partner is hypercritical about their lack of interest, that doesn't help, either.

What to do about low sexual interest?  An assessment is the first step to creating a treatment plan.  Once a sex therapist like myself identifies the problem, there are usually several things that can be done to improve a couple's relationship when a man loses interest in sex.

Sex, Love, and and OCD on "Glee"

 

What do the television show "Glee" and my book, Sex, Love, and Mental Illness: A Couple's Guide to Staying Connected have in common?  Last night, choir director Will Schuster almost didn't go through with his marriage proposal to prissy guidance counselor Emma Pillsbury because she has obsessive compulsive disorder.  In fact, it is her parents who decline to give Will permission to marry Emma because they think that  he will tire of her mental illness and leave her.  He wonders how Emma will manage her job, marriage and, eventually, a baby with the burden of OCD.

When one member of a couple has OCD, it does create challenges.  OCD is an anxiety disorder in which a person gets stuck in a groove in which they need to perform some act to avoid a feeling of panic or dread.  A common compulsive behavior is checking locks and doors before leaving the house.  I once treated someone who took a full hour to check everything before he and his wife could leave on vacation.  Another common compulsion is to keep everything spotless. 

Can you imagine trying to have sex with someone who is so worried about whether or not they shut off everything in the kitchen that they are unable to relax?  Or with someone who is terrified of getting bodily fluids and hair on the sheets?It may sound a little silly, but when it's real, it is anything but.  When cases of OCD are extreme, marriages do get destroyed. 

In my book Sex, Love, and Mental Illness: A Couple's Guide to Staying Connected, I discuss the impact of anxiety disorders like OCD on relationships and how to overcome obstacles, including overcoming side effects of psychotropic medications used to treat them.  Minimizing stress and developing patience are part of the role of the partner.  Figuring out how to make sex sexy rather than upsetting is another goal.  This may mean scheduling sex, taking showers and brushing teeth, and creating rituals for relaxation.  In other words, don't fight the OCD, but work with it to make the partner with OCD comfortable.

Fortunately, at the end of "Glee," Will decides that his feelings for Emma and her willingness to continue treatment win out over the mental illness and he proposes to her in grand style.  When she says yes, it's a triumph of love over disease.  Let's hope that the couple can learn to live with OCD, coping in ways that make it possible to have a happily ever after life.

 

Men Sexually Abused as Children: Boy Scouts Failure to Protect

It's organizational abuse all over again.  Like the Catholic church, it appears that the Boy Scouts of America (BSA) systematically and intentionally protected molesters rather than protect the children.  A story in the Los Angeles Times on Sunday, Oct. 30 reported that the Boy Scouts knew that one of their leaders had molested boys right here in Orange County, CA but did not report the crimes to the police.

Most horrifying to me is that one of the leaders of BSA actually said that it would be troubling to let the community know that they had a sex offender as a troop leader.  What does BSA think about this decision now, when survivors are coming forward and making these mistakes public?  The one heartening part of the story is that the Scouts are working on correcting this injustice today, by carefully screening potential leaders and creating guidelines for Scout safety.

I personally have counseled several men who were molested by BSA troop leaders.  It is heartbreaking to listen to their stories.  Like the story in the Times, as boys these individuals were somewhat lost.  Their fathers were emotionally and physically unavailable and attention from a respected adult in a uniform was welcome.  But then it turned out that the attention was simply a way to gain trust so that when the molestation occurred, the boy was more apt to follow along and less apt to tell anyone what had happened.

As adults, men molested as children often suffer emotionally and sexually, but hold onto their secret tightly.  The shame of not standing up for one's self--even if as a boy they were too naive to realize that's what they needed to do--wears on them.  Sometimes their bodies responded as if they were welcoming the sexual advances, making it confusing if they didn't know that bodies just do what they do automatically.

Men hold in their rage until it can be displaced onto someone safe, like a parent or a partner.  Or they numb the rage with alcohol or drugs.  They may avoid sex because it brings up bad memories.  They become depressed and may feel like "damaged goods."

Not every man (or woman) who was molested will experience these problems, but many do.  They need to know that it is safe to come forward, either to the institution that didn't protect them.  Is there anything in the Times article that sends a signal that BSA asks that others who were molested as Scouts come forward?  Male survivors also need to know that it is safe to seek help, either from a sex therapist with a background in treating trauma, or a trauma specialist who has training in treating sexual issues if that is part of their symptoms.

I am certain that this story stirred things up for survivors.  My heart goes out to them.  I hope that the outcome of institutional abuse like this will work in a positive way to make sure that our children are properly educated about how to protect themselves or report abuse, and to keep sex offenders from taking leadership positions.

Sex Therapy for Survivors of Prostate Cancer

A new study by Leslie Schover, Ph.D., a psychologist and sex therapist, demonstrates that couples who have just a few sessions of counseling after a man has treatment for prostate cancer fare better in the bedroom than couples who don't.  In this article and interview on ABC News, a couple describes what is a very typical problem after recovery from prostate cancer, even these days when surgery is supposed to be delicate enough not to interfere with sexual function.

The problem is that medications alone like Viagra(TM) aren't always strong enough to overcome erectile dysfunction.  That can be true not just after recovery from prostate cancer, but also in men who have other illnesses such as diabetes.  Because advertising and prescribers themselves hold out the promise that the pill will solve everything, men and their partners can become confused when they don't work.

That's where counseling comes in.  In the "sad but true" department, medical doctors often don't have the time to spend educating their clients in detail.  But a psychotherapist is paid for the time, and at a less costly rate than a physician. 

Where do you find a psychotherapist who has the knowledge to help?  The first suggestion is to try the American Association of Sexuality Educators, Counselors, and Therapists, where you can click on the map to find a directory of trained professionals.  If you don't see anyone in your area, you can contact the AASECT office.  The second suggestion is to ask your physician for a recommendation.  Also, the nurse in your physician's office may have the time to sit and talk with you about treatment options and ways to improve the effects of medications.  But if you are having a rocky time in your relationship, or can't seem to reconnect the way you want to, then you'll want to see a sex therapist who is trained to treat both sexual and relationship issues.

Sex: Talk, Talk, Talk

Can you imagine a couple living together for 20 years or more but never talking about a single meal they ate, even though they sat at the table every day?  What if major purchases were never discussed, if cars and refrigerators and swimming pools just showed up?  What if the couple never talked about going on vacation but packed their bags to go, one just following the other?

For millions of couples, that's what it's like when it comes to their sex life.  They have sex, but they never talk about it.  Couples touch one another in the most intimate ways possible, then get up in the morning to eat breakfast without even a loving glance or a kiss to acknowledge their recent connection.

Perhaps there are couples out there who are so good at reading each other's nonverbal signals that they know what turns each other on without every saying a word.  But that's unlikely.  What often happens is that one or both partners are left wanting more and wishing their partner could read their mind.  Partners feel let down, resentment rises, and sexual activity wanes.

Talking about sex is a critical part of an intimate relationship.  Maybe it's unrealistic, though, to jump right in with a discussion of what would give you a better orgasm.  So you can start with baby steps.  How about asking your partner if they would like a kiss, and if so, where?  Or ask your partner to kiss you and tell them how you want to be kissed--firmly, softly, or slowly?

Agree to have a "sex talk" on the sofa before you next make love.  State three things that would turn you on and three things that turn you off.  Then listen to your partner do the same.  Agree to try one, two, or all three turn ons when you are next in bed together.  Don't talk about what happened right after you have sex.  Wait a day or two.  Then sit down on the sofa again and share some observations about what worked and what didn't.  Be gentle, you are talking to your best friend.

Can't get the words out?  Agree to exchange old-fashioned mash notes to let each other know what's in and what's out.  If you can get your courage up, you could read your sexy love notes to each other.

Talking about sex may be difficult, but it's a conversation that needs to happen if partners are going to stay excited about sex.  If things aren't working, you can't just wish for them to change.  Let your partner know it's time for the two of you to step up the intimacy and have a conversation about sex.

 

Thinking About Vacation Sex?

It's vacation time!  Couples are visiting family, couples are on trips designed around romance.  And some have expectations about sex.  Here are some things I have learned from listening to all kinds of vacation sex experiences.

1. Vacation might or might not be a great time to work on your sex life.  If your sex life has been in bad shape, sex might be awkward.  If you are a typical vacationer, you might also be eating or drinking more than usual, not exactly a recipe for love making.  You might also really need to recharge your batteries, and sex requires energy.
2. It's a good idea to talk about expectations before you head off to your vacation location.  Are you wanting to get involved in every activity you can possibly sign up for--and thus leave little time for romance?  Or do you want to make sure you schedule down time for relaxing and getting in the mood? 
3. Speaking of expectations, I cannot begin to tell you how many people come into my office just a few weeks before a big vacation to get help with their sex life so they can have a good time while they're gone!  Therapy helps--but it isn't a magic bullet.  The time to work on your sex life is as soon as you recognize there is a problem.  That way you can have a reasonable timeline for fixing your sex life.
4. Go for quality, not quantity.  It is interesting that most couples can count the exact number of times they had sex during vacation.  Once is generally considered to be terrible, twice is okay, three times is good, and four times is fantastic.  Really?  And for which partner?  If you have a really good, long session of sex, you might be pretty satisfied for a couple of days; if you have a few short quickies, you might not be satisfied much at all.  Perhaps you are looking for more of an emotional connection, or the kind of orgasm you can only have when you are fully relaxed and have time for 20 or 30 minutes of foreplay.
5. Don't forget the lube.  If you have to pack more than a carry-on bag in order to get the lube to your location, then do it, or plan to stop at a drugstore when you get to your new location.  And while you're at it, don't forget the birth control unless you want a pregnancy as a souvenir of your trip.

As always, good communication is the key for all sexual interactions.  If you have concerns about your sex life, the time to talk about them is before you take your vacation.  In fact, the time to have a conversation might be when you are planning a vacation so that you can take your couple sexual needs into account, for example, when choosing accommodations.  For example, a suite-type room might be nice if you are taking the kids along so that you can really have privacy in the evening, or asking for a quiet room away from the pool if you want don't want to listen to noise while you make love.

Vacation sex can be wonderful sex.  Doing new things together potentially creates a great, intimate energy together. 

Next post:  How to bring vacation sex back into your day-to-day life.

Bad Wiener: Stress, Anger, and Male Inability to Cope

As a sex therapist with a blog, I can't NOT weigh in on the Wiener debacle.  Today Wiener announced he is going to resign.  Really?  Didn't we all see that coming?  How could he be so stupid?

I have a somewhat different take than what I've read online thus far.   Wiener, like Wood, Clinton, and other men who have disappointed us, may have been under quite a bit of duress.  All at once, Wiener is married and about to become a father.  These are normal transitions, but when you pile on top of it one a stressful, high powered position in the public eye, you've got the potential for a crackup.

What about men who aren't in the public eye but are doing the same crummy behaviors behind their partner's back?  Same thing:  They haven't learned good ways of coping with things that bother them, from work strain to relationships.  Let's not forget, also, that health can cause stress, too.  When men don't take care of themselves physically (and as a culture we seem to be much more forgiving of an extra 20-30 lbs. on a guy), that also contributes to feeling down.

Many men have a hard time saying when they've had enough.  (Of course, there are also slacker men, but that's a different story!  They seem to be saying they've had enough before they've even gotten out of the gate.)  I've had men show up in my office with dark circles under their eyes, shoulders sagging, sitting on the edge of the seat--and telling me that everything is pretty good.  Sometimes it takes several sessions before they let their guard down and discuss what's really on their mind.

Besides stress, men generally have a tough time expressing their feelings.  Anger, rage, and frustration must be expressed somehow, though, and so it is sometimes transformed into sexual energy that is often directed at an anonymous person or someone who isn't completely aware that they are being used as an outlet.  The press has it wrong when they see acts like Wiener's as being about sex.  Wiener's behavior is not so much indicative of an "addiction," but of an inability to cope in an effective way.

The thing about sex as an outlet for stress or negative emotions is that it works so powerfully well.  Like food, cigarettes, or liquor, sex is a very rewarding activity.  Through chemicals released with orgasm, strong associations are made quickly between the maladaptive behavior and symptom relief.  "Sexting," visiting prostitutes, flings, and so forth can be a way of making oneself feel better.

What if a man is single?  Are these activities okay?  I would say that each man would need to decide for himself.  Is he really having fun, using porn or sexual adventures as an occasional release for pent-up sexual energy?  Or is there something desperate about his behavior? Is he happy or satisfied after sexual activity, or does it feel like there is something missing?  If the latter, is it a lack of resolution of negative feelings?  A sense that maybe a different kind of "medicine" is needed, such as talking it out, exercising, or simply relaxing and taking care of one's self?

The problem with the media is that "sex sells."  This isn't about sex.  It's about feeling out of control, needing to feel powerful, and failing to connect and deal with what's really going on.  It isn't Wiener's fault that he is yet another unfortunate male who is caught up in myths of what it means to demonstrate one's strength.  It occurs to me that it is rare that once men leave treatment for so-called sex addiction that they still don't really talk about their feelings to the media.  They apologize for bad behavior.  How much better it would be if they could open up and let us in just a little bit on what kinds of stress, anger, and frustration drove them to cope in such a self-destructive manner.

How Do You Know a Sex Therapist Is Real?

About every month or so I do a “vanity search” on the Internet to find out where I am ranking when people are searching for a therapist.  Fortunately, I’ve been a sex therapist for a lot longer than many other people in my area, so my website ranks high.  But lately, I’ve noticed a lot of newcomers into the field of sex therapy, and looking at their credentials has me concerned.

 

Here’s why:  Anyone in the state of California who is licensed can call him- or herself a “sex therapist.”  It is the same as calling one’s self an eating disorders or panic attack specialist; no special license is required.  So then how do you know that the person you’ve selected to help you has the right training?

 

First of all, you can see if the person is certified by the American Association of Sexuality Educators, Counselors and Therapists.  The requirements for certification are actually pretty stringent.  You have to have at least 90 hours of education in sexuality, see a good number of cases, and have your work supervised over the course of 1-2 years by a certified supervisor like myself.  Besides myself, there are two other certified sex therapists in Orange County:  Michael Smith, MFT and Francesca Cancian, MFT.  Each of us have specialty areas within sex therapy, too.  Michael Smith works with sexual compulsivity and addictions; Francesca Cancian with survivors of sexual assault and abuse, as well as sexuality for mature adults; and I see people with mental disorder diagnoses such as ADD, plus women with sexual pain disorders.  In addition, I supervise two interns working with me who are also becoming certified, one in my Newport office and one in my Riverside office.  We are all very committed to what we do.

 

Second, you can ask the person how long they’ve been licensed, and then how long they’ve been seeing sex therapy clients.  If they haven’t been in practice long, like my interns, then they should be able to tell you that they are in the process of learning sex therapy, and are taking coursework and getting supervision.

 

Third, you can find out if they are actively involved in the community of sex therapists.  There is a lot of work to be done in terms of educating the public about sex, reading research, reviewing research for journals, writing books, reading books and writing reviews, and providing continuing education to peers.

 

Just because someone comes up on a search when you are looking for a sex therapist doesn’t automatically qualify him or her to treat you.  Don’t be shy about asking.  I personally never take offense when someone asks about my credibility—but maybe that’s because I have no doubt in my ability to help someone with a problem of a sexual nature!

May Is Mental Health Month: What About Sexual Health?

My guess is that you are unaware that May is Mental Health Month, even if you or someone you know has a mental illness such as panic attacks, bipolar disorder, depression, ADD, an eating disorder, a substance use problem, etc.  That's because, let's face it, mental illness is not a sexy topic.  Not as sexy as breast cancer (which is currently much more curable than other forms of cancer, such as ovarian cancer).  Not as sexy as erectile dysfunction, for which there is more medication prescribed than almost any other malady.

Which is all the more odd because what if at least some percentage of mental illnesses can be attributed to sexual problems?  Most people think that mental disorders and sexual problems are unrelated, but in fact sexual problems can play a complex role in the formation of mental disorders.  And if our cultural were more open in how we thought about sex, we might more readily see it.

In my newly published book, Sex, Love, and Mental Illness: A Couples Guide to Staying Connected I discuss both the effect of mental health on sexuality, and the effect of sexuality on mental health.  For example:

• A man might be depressed because of years of struggling with erectile dysfunction
• A woman's normal sexual fantasies may upset her and cause anxiety; the original fantasies are forgotten, but the anxiety remains
• Another man admits he started drinking at a young age so that he could overcome his premature ejaculation and fears about his sexual performance; now he is a recovering alcoholic, fearful of "sober sex"
• Someone's Obsessive Compulsive Disorder makes it difficult to focus during sex, so that his ejaculation is delayed

I could relay countless examples where mental illness--not brain chemistry, not loss, not genetics--is the cause and / or the result of sexual problems.

The point?  Your sexual health is part of, not apart from, your mental health.  Sexual health--the ability to enjoy sexual activities and pleasure without shame or guilt--can lead to a feeling of well-being and wholeness, connection and satisfaction.  An orgasm can life one's mood, help with stress, make physical pain more bearable, and even count as an aerobic activity.  You owe it to your overall health--mind and body--to have both sound mental and sexual health.