In the field of therapy one of the common goals is to alleviate suffering and work towards increased happiness. Happiness in and of itself requires further definition. Those in the field of positive psychology define it in 3 ways, ” we work under the assumption that happiness is a scientifically unwieldy term and that its serious study involves dissolving the term into at least three distinct and better defined routes to happiness : a) positive emotion and pleasure ( the pleasurable life) ; b) engagement ( the engaged life) ; and c) meaning ( the meaningful life).

The research suggests that the happiest people are those that have all three elements in their lives. The study mentioned above goes on to say that those individuals who focus the most on creating a meaningful and engaging life are the happiest. Of course this is research, which implies certain limitations, so I might argue that the pleasurable life, positive emotion and pleasure, are equally significant in the creation of happiness.

In my work at the Center I spend a great deal of time helping women explore and create more pleasure in their lives; whether through bettering their relationships or improving their sex lives or both.  Increasing sexual pleasure for women is not always an easy thing to do. Many women with sexual dysfunction only associate sex with obligation, discomfort or pain.  One of the most fun and rewarding aspects of my job is to break those negative cycles and replace them with positive pleasurable ones.

I must admit that the popularity of 50 Shades of Grey has us scratching our heads a bit. It’s not that we don’t think the sex scenes are hot. We do. But at our last staff meeting we were discussing the fact that there is so much good and fun erotic literature for women available, we don’t understand why this particular book took off. And it can’t just be that the bondage and domination in the book is the key, since again, there is so much BDSM stuff out there and available.

Be that as it may, we know you all love 50 Shades of Grey and the Saturday Night Live skit/Amazon ad for the kindle version had us laughing out loud! So here’s a link and we hope it makes you laugh as well.

http://www.nbc.com/saturday-night-live/video/amazon-mothers-day-ad/1400037

Photo credit:  Pedrosimoes7,  via Creative Commons.   Fifth in a series based on the new book, Fifty Shades of Grey.

The questions never change

Working as a sex therapist, I have more than a passing interest in what the culture happens to be serving up about eros.

Part of it is simply curiosity about what my clients are reading.  But the greater part involves a search for conceptual tools with which to understand the erotic mind.

Fact is, sexuality remains a mystery in many ways.

Are humans inherently monogamous, or not?

To what extent are men’s and women’s sexual natures the same or different?

What’s the connection between sexuality and spirituality?

What do women want?

These questions forever haunt us.

Last year, I endeavored to review a new book, written not by sex experts but  by computer scientists, that nonetheless purported to offer insights about human sexual nature based on such things as Google porn searches and word choice in online erotic fiction.

The idea was and is a compelling one:  If you want to understand human sexuality, look at people’s actual choices.   On the internet, those choices are measurable.

By year’s end, my review of A Billion Wicked Thoughts had stretched to eleven articles, with no end in sight.  Wary of tiring my readers, I put a stop to it.

Fantasy writ large

But now with Fifty Shades of Grey it seems we’re back in the territory of mass erotic choice.

Can we learn anything about sexuality from the success of FiftyShades?   Yes, I think so.

Since the book is erotic fantasy rather than actual sex, though, we have to be careful.   We shouldn’t, for example, after reading the book presume any knowledge about the actual world of BDSM practitioners.

But when just about every woman in America is reading, has read, is about to read, or has made a conscious decision not to read this book —  well, that makes it significant.  Even if it’s just fantasy.   Sexual fantasy is where the erotic mind lives.

So what can Fifty Shades tell us about the female erotic mind in the early 21st Century?   And can it tell us anything about human sexual nature (if there is such a thing) in general?

Fifty Shades, Beatlemania, and the Justin Bieber table

In “Some Aspects of Women’s (Hetero)Sexual Desire,” I discussed how A Billion Wicked Thoughts analyzed romance novels, by far the most profitable form of fiction in the world, for clues about what turns women on.

When the article was reprinted on PsychologyToday, it drew the following response from “Anonymous” –

“It’s a proven scientific fact,” wrote Anonymous, “that women base their decisions largely on what the majority chooses. Women are social creatures.”

As the father of an 11 year old girl, I’d agree.   Looking through the teen fan magazines she leaves on the couch, and surveying the posters on her bedroom wall, I’m impressed by how much pre-teen romantic choice seems to be a team sport.

Maybe Fifty Shades is so popular for the same reason Justin Bieber is popular — simply because he’s popular.   And popularity, for many women, is a legitimate cue for attraction.

According to my daughter, in her school lunchroom there was for a brief time a Justin Bieber table — at which the subjects under discussion only marginally involved Justin Bieber.   His celebrity seemed mostly to serve as a social organizer for the 6th grade girls in their interactions with each other.

Mass erotic choice on NBC

My fellow Manhattan sex expert Logan Levkoff said pretty much the same thing about Fifty Shades in an interview on the Today Show  –  Maybe just talking about the book with other women has inherent erotic value.

This kind of thing has been around, obviously, for a long time — at least since the Beatles.  I remember my highschool girlfriend describing how she and her sisters had all decided to like the Beatles — and how they made her like George, because her older sister already liked Paul.

The fact that erotic choice can act as a social organizer makes the study of human sexuality quite tricky.    As Chris Ryan reminded us about human sexual prehistory in Sex at Dawn, human erotic life has forever been a social affair.

But can we sift through the emergent properties of social sexual choice to something more fundamental on the individual level?   Good question.

Maybe we can begin by asking, as we did in discussing Richardson’s 1740 novel Pamela, whether there are common ingredients to be found in our own culture’s favorite erotic delicacies.

I suggest we start with Twilight — and with its close cousin, Fifty Shades of Grey.

Next time.

Copyright © Stephen Snyder, MD 2012

www.sexualityresource.com New York City

Follow Dr Snyder on twitter: www.twitter.com/SexualityToday

At the Center we see women of all ages with PGAD. Sometimes the causes for older and younger women are different though the experience of coping with it is often the same. “A recent study of its prevalence in young women would suggest that as many as 1% of young women have the full blown syndrome. Recent population studies have highlighted low rates of women seeking medical or psychological help for sexual dysfunction despite reporting a high prevalence.” (Goldmeier et al. 2009) The reason that many women do not seek help is primarily due to shame and discomfort in talking about sexual issues. Many women feel afraid to discuss their condition with friends or practitioners and they become isolated. In our work with PGAD patients, we find that the ongoing support and freedom to explore different treatment options can be extremely helpful. We also offer a support group and discovered  that women need to find a safe place to discuss their experiences because the isolation can be one of the most devastating aspects of this syndrome.

Here at the Center we are always searching for the best methods of birth control with the least amount of side effects.  There is no universal answer, what works for one woman may not work for another woman.  I have already blogged about Natural Family Planning (click here to read), a form of birth control has zero side effects. However, some women find it time consuming, confusing and cumbersome.  Today, I’d like to talk about the IUD.

The IUD or Intrauterine Device is making a well-deserved comeback.  Right now, there are two kinds on the market: Mirena and Paraguard.  In the past, IUDs were only recommended for women who were done having children since IUDs were correlated with a high risk of infection as well as a risk for infertility from these infections.  For these reasons, the use of IUDs declined drastically in the 1970s and 1980s and left the IUD with a bad rap.  That particular IUD was called the Dalkon Shield, and was taken off the market. Further research has shown that in the past women were not screened for sexually transmitted infections before insertion, and the process of insertion carried infection higher into the reproductive tract which led to infertility; it was not necessarily caused by the device itself.

No method of birth control is foolproof, but the IUD is highly effective at preventing pregnancy.  The Association of Reproductive Health Professionals lists pregnancy rates among IUD users as 1 per 100 a year at most, compared with about 3 per 100 for the injection of Depo-Provera, about 8 per 100 for the pill and about 15 per 100 for the condom.

IUDs do not protect you from sexually transmitted infections. Condoms should still be used to prevent STIs if a woman is unsure if her partner has an STI or if either person has multiple sex partners.

Overall, we have seen a positive response in our patients who have stopped birth control pills and had an IUD inserted.  Both IUDs are estrogen-free.  It is known that estrogen based contraception is associated with sexual side effects, including decreased desire, arousal and increased pain.  If you are experiencing any of these side effects, I encourage you to discuss this with your ob/gyn.

I will write more about the two different types of IUDs next time…

This video is not for the faint of heart. It’s a safe sex video for seniors and hopefully it will make you smile, like it made me smile. It made me smile because it acknowledges that sex is not only for the 21 year old lithe set. And it made me smile because I think it’s time to get senior sex out of the closet.

But the message is serious, and all of you active (and happy) seniors who are following this blog should really pay attention. Being over 60 does not make you immune to STDs! You too have to have safe sex.

http://www.thedailydogooder.com/2012/04/30/safe-sex-for-seniors/

What side effects?  Low desire, decreased arousal, dryness, and even pain.  I have had numerous patients tell me they often wondered if their birth control pills could be contributing to their sexual problems but they figured that since they were never told about these potential side effects by their prescribing practitioner then it must be all in their head.

I have often sensed a feeling of betrayal on some level from my patients in this regard.  I often hear them say, “Why wouldn’t my doctor tell me?” or “I would have stopped the pill years ago when this first started if I had known that this could be a problem.”  After betrayal comes anger, sadness, and disillusionment.

So, I’m writing this blog to tell you that YES birth control pills can contribute to low desire, arousal, and pain.  If you feel like your vagina is drier than usual after you started the pill, you’re probably right…it’s definitely not in your head – it’s physiological.

I had a patient that complained about painful intercourse.  She had been on and off birth control pills since her late teens because of heavy, painful periods.  She was now in her early 20’s and every time she had intercourse, she had excruciating pain. Her treatment plan consisted of dilation to treat the vaginismus as well stopping the birth control pills.  It took a few months to advance through the dilators and she was able to have pain free intercourse.  She had stopped taking the birth control pill and used condoms to prevent pregnancy.  A couple of months went by, and I received a frantic phone call from the patient.  The pain was back.  When I asked if she had started any new medications she sheepishly admitted that she had restarted her birth control pills a month earlier.  She discontinued them immediately, once and for all.  Although she had only been on them for a month, it took another two months before she was pain free again.

We see these scenarios at the Center every day, these cause-and-effect relationships every day (and this was just one example).  If you are on this website looking at causes for your sexual problems and are on a birth control pill, stopping the pill can be a step in the right direction.  Non-hormonal birth control options like natural family planning, condoms and spermicides work well to prevent pregnancy if used correctly and consistently.  The Mirena IUD is another excellent option for preventing pregnancy as well as for women with heavy, painful periods.  Although the Mirena IUD has a hormone (progesterone) in it, we do not see it causing negative sexual side effects.  I will discuss the Mirena IUD further in my next blog.  Stay tuned…

I guess I think the real problem is the physician who doesn’t take time to get to know the patient, doesn’t deal with real issues and real people and doesn’t seem to be actively listening or engaging the patient.

However, I really do think that people also need to be more pro-active in terms of asking for what they want, arguing with their doctors and taking responsibility so that they go into their appointments armed with useful information and knowing what they want or at least what they need to ask.

Anyhow… if you want a good laugh, read this… and no… your breasts probably don’t feel like oatmeal.

http://www.xojane.com/healthy/lying-to-the-gynecologist

Fifty Shades of Grey by E L James  is really fun. The trilogy  tells the story of a recent college graduate, Anastasia Steele and her wealthy, handsome CEO boyfriend named  Christian Grey.  As their courting progresses, Mr. Grey exposes Ms. Steele to the wonders of BDSM (bondage/discipline,   dominance/submission and sadism/masochism ). For some readers this may be totally unappealing, for others it might spice up their sex lives.

What I like about 50 Shades of Grey is that it has allowed a wide audience of people to talk about sexuality in general and BDSM specifically. Though people may  feel shame or discomfort in discussing sexuality, in truth, research shows that, “BDSM is an aspect that is present in approximately 23% of the population in terms of fantasy, at least on occasion (estimates range from 12-23% for women, 20-50% for men; Kinsey et al. 1953; Arndt et al, 1985) and expressed by 10% of the population” ( Masters et al, 1994). That means that one out of 10 people are into S and M. For centuries people who were into BDSM were considered mentally ill, but in the 1980’s the American Psychiatric Association removed S and M as a category in the Diagnostic and Statistical Manual of Mental Disorders.  This was a great move forward.

Roy Baumeister, PhD., a social psychologist at Case Western University, explains BDSM in a Psychology Today article from 1999. Baumeister says that, “like alcohol abuse, binge eating and meditation, sadomasochism is a way for people to forget themselves. Masochism is a set of techniques for helping people temporarily lose their normal identity.  The Modern Western ego is an incredibly elaborate structure, with our culture placing more demands on the individual self than any other culture in history. Such high demands increase the stress associated with living up to expectations and existing as the person you want to be. The stress makes forgetting who you are an appealing escape. That is the essence of the escape theory, and one of the main reasons people turn to S and M.”
Escapism through BDSM is certainly an aspect of what appeals to both characters in the book. They also enjoy the BDSM for purely sexual reasons as well. The books description of sex seems to appeal to a wide audience, and from my perspective, that is worth a lot.  At the Center, we often hear from our patients about therapists and doctors who feel awkward discussing sex, so whenever the subject can be raised in a way that promotes discussion and makes people feel good, that’s a good thing!  BDSM is generally thought to be marginalized by the mainstream. As long as what is happening is between two consenting adults, I don’t have a problem with it. So if you are curious about BDSM or erotica, give the book a try.

As my carry-on suitcase went through the scanner, I heard the security guard call for a manual inspection. It figures. Okay… here we go. I dutifully followed my suitcase with the woman inspector to the side, where she proceeded to zip open the suitcase.

“Just to let you know” I said, “I’m a sex therapist and there are six vibrators in that suitcase. Would you like me to show you which ones have batteries?” She looked momentarily taken aback but then smiled and said, “No, that’s okay”. However, she then asked me about where these are available, where one can buy them, and seemed so tempted to ask more questions but just didn’t have enough time. I smiled and offer her my card which she happily took.

Just another day in my line of work.

On the way home I decided to try a pre-emptive strike instead. “Hi”, I said, all friendly-like to the security guard as my suitcase started its glide through the scanner… “Just wanted you to know… I’m a sex therapist and there are a bunch of vibrators in there, some with batteries”.  Again, a small flicker of surprise, a ghost of a smile and then a “no problem.” And there was none.

I say… if you’re traveling with a vibrator, go for the pre-emptive strikes. And you have my permission to become a sex therapist for the day if that makes you more comfortable!