Posts Tagged ‘sex therapy’

Book Review: Will “Sex at Dawn” influence sex therapy?

Wednesday, August 18th, 2010 by Stephen Snyder, MD

Recently, Sexuality Resource reviewed Christopher Ryan and Cacilda Jetha’s Sex at Dawn a new book drawing on a vast amount of cultural and physical anthropological scholarship to argue that for our hunter-gatherer ancestors, sexual promiscuity may have been an established way of life.  And that the development 10,000 years ago of agriculture, an ownership society, and sexual monogamy brought an end to this golden age of sexuality.

As a sex therapist in New York City (where the kind of ownership society begun 10,000 years ago has perhaps reached a pinnacle of development), I wonder about whether the ideas discussed in this book will influence my field much.

So far, it doesn’t look promising.  The dominant public reaction to the book in its first month has been that it “shows that humans are meant to be sexually promiscuous.”   This is a subtle and understandable misreading of Sex at Dawn, but a misreading nonetheless.

Let me explain why it’s a misreading — using an excerpt from Sex at Dawn that you may worry is a digression.  But trust me, it’s relevant.

Human nature?  It’s the bananas, stupid.

During Jane Goodall’s first four years studying chimpanzees in Tanzania, according to Sex at Dawn, she observed them to be remarkably peaceful creatures.  But they were difficult to observe, since they tended not to hang around her camp much.   So she tried to attract them nearer by regularly feeding them bananas.   The effect, evidently, was to make the chimpanzees more aggressive.  Fighting between them increased dramatically.

Now, which represented the chimpanzee’s true nature?   The gentle chimpanzees happily feeding far apart in the forest, not bothering each other?   Or the hoodlum chimpanzees shoving each other out of the way at the daily banana trough?

The answer, as Ryan and Jetha eloquently express, is neither.   It’s like asking whether water’s true nature is ice or liquid. It all depends on the conditions. Change the conditions, and you change which of many potential natures will be manifest.

Goodall’s observations also show the relative delicateness and vulnerability of an established primate social order.  For the chimpanzees, a peaceful society depended on abundant food supply that was dispersed, with lots of feeding spots for everyone. Stick a big box of bananas in the middle of the forest, and the whole neighborhood goes to hell.

The kind of early human social structure that encouraged sexual promiscuity was a delicate thing.  It required a small tightly-knit group of less than 150 individuals, an abundant natural food supply, and an inability to hoard resources.   As I look out my front door in New York City, I don’t detect much potential for the establishment of that kind of social order.   It’s strictly big boxes of bananas, all the way up Columbus Avenue.

Yet the popular buzz in the book’s first month seems to miss all of this.   “We’re really meant to be promiscuous,” yell the headlines.

No.  The reality is more sobering.  The material conditions that would permit a stable culture of sexual promiscuity are long since gone.

The sober reality is that, as the poet Wordsworth wrote 200 years ago, talking about something completely different but really not so different — “nothing can bring back the hour / Of splendour in the grass, of glory in the flower.”

Will Sex at Dawn influence sex therapy?  In my own practice it already has.  But in a different way than you might think.

The Wordsworth poem about “splendor in the grass” begins with the poet’s awareness that as an adult he no longer is capable of the extremes of ecstatic pleasure that he recalls from childhood.

Since reading Sex at Dawn, I’m even more conscious in my work with individuals and couples that even our best sexual experiences are probably only a dim echo of a once-ecstatic form of sexual being.  One that can no longer be adequately described in words or images, because the psychological and cultural conditions necessary for it have vanished.

This once-ecstatic form of sexual being was probably often communal, and involved an absence of shame and a deep sense of communal connection that I cannot imagine.

There is currently some talk in the sex therapy field about whether we can “change the conversation” about monogamy vs infidelity that currently dominates the American media – perhaps change it to a more European-style model, which takes sexual infidelity less seriously.

Maybe.   But I think we’d just be tinkering around the edges.

To me the message of Sex at Dawn for sex therapists is this:  Be sensitive to the fact that we’re all sexual exiles.   Be tolerant of the sexual struggles of your fellow moderns.  They’re doing the best they can under quite compromised circumstances.  Or, to quote the Wordsworth poem again,

We will grieve not, rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering.

Our sexual exile will not end anytime soon. In the meantime, we’ll do the best we can — to treat our sexual selves with kindness and understanding.

© Stephen Snyder, MD 2010    

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Tips for Selecting a Sex Therapist

Monday, August 9th, 2010 by Bat Sheva Marcus LMSW MPH PhD

At the Center we treat women who suffer from various conditions that prevent them from having satisfying sex lives.  Our goal is to uncover the physical causes of these conditions and treat them medically.

On staff at the Center are human sexuality counselors who conduct a psycho-sexual intake before a patient’s physical exam.  Through this intake, and by getting to know our patients as we treat them, we gain a better understanding of the psychological backdrop to a patient’s sexual issues.  And sometimes what we learn leads us to recommend that a patient or couple seek counseling with a sex therapist.

We, of course, have some local favorites, but often women write to us for recommendations beyond our geography and we don’t have a comprehensive list; or we just don’t have professional experience with them so we hesitate to recommend.

But we do have a strong perspective on what to look for in a sex therapist. Click here for some solid tips on choosing a sex therapist.

How long is too long: the average time for intercourse

Thursday, June 17th, 2010 by Bat Sheva Marcus LMSW MPH PhD

Okay ladies (and the men who may be looking over their shoulder.) The average time for intercourse is 3-5 minutes. So if your partner is thrusting inside of you for 25 minutes and your vagina hurts or gets sore, there is nothing wrong with your vagina. There is something wrong with your timing! Now… lets respond to all the possible women’s reactions:

 “But I LIKE intercourse for 30 minutes” Great!! You’re just not average. If you and your partner enjoy prolonged intercourse and you’re not having pain afterwards – go for it! Have fun.

 “But he needs 25-30 minutes to ejaculate” – Try exploring other stimulations for 15-20 minutes. Rubbing against your body, using your hands, using your mouth, him using his hands are all good possibilities. Then when he comes inside of you he may only need 5 minutes or so.

 “He really needs 40 minutes inside of me to ejaculate.” This is where I think you need to bring in a male sexual dysfunction specialist to have him evaluated.

 Bottom line. Don’t always blame your vagina!!

Sexual gridlock

Monday, June 7th, 2010 by Shannon Bertha, ACS, DHS

Sexual dysfunction is a complicated problem and often it isn’t one thing – or one person’s issue –  that is causing it.  If the problem goes on long enough, often it begins to affect other issues in  the relationship.  I notice that women often take on this problem as their own, “It’s my fault” or “It is my problem” or “My husband is fine, it is ME!”  At times, partners may be contributing to the problem or experiencing sexual dysfunction themselves.  At the Center, we work with our female patients to achieve optimal sexual functioning, but at times, we can only take the patient so far and may need her husband or partner to seek treatment as well.  He may be suffering from sexual dysfunctions such as difficulty achieving or maintaining his erection, low desire or ejaculation problems.  At times, men are embarrassed about getting help and therefore stop initiating lovemaking.  If  this disrupts the natural patterns in a relationship,  sexual activity may decrease in frequency and women are then left wondering what happened.   The lack of desire may become magnified, no one feels comfortable initiating sex and we have  sexual gridlock!  No on’e s moving. No one’s initiating. No one’s talking about it.  And…no one’s having sex!

Keep in mind that sexual issues are a multidimensional and it is important to investigate this from many angles. If you begin to sense gridlock in your sex life, stop the cycle, be gentle with your partner, and try to understand what’s happening between you.  If it appears to be a physical issue, there are practitioners who can help men and those who specialize in women’s sexuality.  If it doesn’t seem to be sourced in a physical problem, often some short term couples therapy can help you talk through immediate issues and get back to business!

Libido flip-flop

Friday, April 9th, 2010 by Bat Sheva Marcus LMSW MPH PhD

This entry was written recently by a patient at MCFS following six months of treatment for low desire.  Her previous entry, written after her second appointment last October, was posted on April 5th.

Last night I kissed my husband’s ear and he did not move. He wasn’t in the mood and I was!

For some people this would be frustrating. For me it was amazing! Finally, our sex life is equal. We have an equal investment in pleasuring each other.  With almost equal interest in sex – it is no longer just about his needs and my succumbing (reluctantly). The mere fact that I was interested did change his mind, and a wonderful evening ensued, but it was a pivotal moment for us.  The last few months have changed our, and my, life. God had given the world the gift of sexuality and pleasure, and it was a gift that I never received, never really understood. I now know that I was missing out on huge piece of the beauty that exists in this world and missing out on a more meaningful and spiritual connection with my husband. I am eternally grateful to the MCFS for helping me find this gift.

Why I’m Not as Crazy as I Thought

Monday, April 5th, 2010 by Bat Sheva Marcus LMSW MPH PhD

The following is a blog entry written by a patient at MCFS.  Later this week we will post another entry by the same patient, reporting on her progress.  This was written in October 2009

For about 14 years now I have been told constantly that things are in my head. Stomach cramps-must be stress, acne- must be stress, extreme exhaustion-stress, canker sores- stress, breathing issues- stress, and most recently, no interest in sex - stress and depression. 

But recentl, for the first time in my life, someone found a real reason something was going wrong.  And I could not be happier. 

My life in general is amazing. I have a loving doting husband, two beautiful children, a wonderful home, and a fine job. And yet, depression, being overweight, exhaustion and a low sex drive have plagued my life. With some strong encouragement from my husband, who is tired of feeling physically and sexually rejected, I went to the Medical Center for Female Sexuality.  And,  for the first time, someone checked my hormone levels. No one before had ever thought to stick a needle in my arm and actually see what was going on in there. They just made me pop pills and sit in front of therapists and talk and talk and talk. None of which did much except put band-aids over the problems and cause me to doubt myself more and more. With each passing day I would feel less competent, less self-confident, and more sure that I was just crazy, that many of the simple pleasures in life were out of my grasp and this was my destiny.

But yesterday that all changed.

Yesterday 2 doctors sat me down and showed me my lab results. My hormones are a mess. My thyroid is inactive and I have almost no testosterone. There is something wrong with me! I cried the whole way home for the office, grateful to God that there is an end in sight.

The journey ahead will be difficult, hormone therapy will be tough and I’m not so excited about the potential side effects. But it will all be worth it.

Apology Letter to a Vibrator

Monday, March 1st, 2010 by Shannon Bertha, ACS, DHS

Dear Vibrator,

I am so sorry.  I placed you in a drawer months ago and have not sought you out since.  Please understand, though I enjoyed you, I got nervous that this may be the only way I can orgasm.  My orgasms with you were intense and powerful and would occur like clock-work 10 minutes into vibrations.  I enjoyed them so much.  I guess I started to feel bad that I was enjoying my orgasms this much with something so artificial.  I became embarrassed.  I wouldn’t even tell my husband that I was using it; I didn’t want him knowing I was using a sex toy.  It was a shame too,  because there were so many ways I could have used you to help me orgasm during sex with him!  Again, I was embarrassed.  So now it is six months later.  It takes me much longer to orgasm using my hand and because of that I’ve kind of lost interest!  Did I really forgo all of that pleasure because of embarrassment?  Is not having orgasms a better alternative than having one with you? 

Recently, I went to the medical center for female sexuality about this orgasm issue.  The women there were very open, positive and non-judgmental.  They were very encouraging about using vibrators, especially during intercourse.  They helped me to realize this can be part of a healthy sex life and that my partner might actually like it too!  They had lots of vibrators to show me so I could touch them and see how they worked.  I couldn’t believe the variety.  So I bought one and decided to try again!

So vibrator, I am writing this to let you know I am sorry for treating you the way I did, and I promise to take you out from time to time and have you play with my husband and I.  Also, to let you know, now you have some competition!

Thank you for the good times and the times that are ahead of us.

Yours truly,

A satisfied customer.

Tiger Woods and Sex…

Saturday, January 16th, 2010 by Dr. Neil Cannon

It was only a matter of time before Tiger ended up in rehab for “sex addiction.”  I’ve been predicting this scenario publicly since November.  It appears that Tiger is now at Pine Grove Behavioral Health and Addiction Services in Mississippi, not South Africa as originally reported.  I would like to dispel a common myth among women who have been cheated on.  Men don’t cheat because of your appearance. Trust me, Tiger’s admitted “transgressions” didn’t have anything to do with Elin’s looks!  Infidelity is about unfulfilled needs, low self esteem, compulsivity, irresponsibility and a low emotional IQ.  Cheating can be about getting even and a lot of other things including narcissism which raises a lot of questions about Tiger.  If you would like to read more about the impact of “sex addiction” and infidelity, you might enjoy an article I was interviewed for by the leading women’s magazine, “She Knows”.  http://www.sheknows.com/articles/812944

The frustration of Sex Therapy.

Friday, January 15th, 2010 by Bat Sheva Marcus LMSW MPH PhD

I had a patient yesterday who has zero sex drive. Zero. She has never masturbated. She has never fantasized. She has never been turned on as far as she can tell. She is sad and frustrated and it is effecting her marriage.

She spent the last two years on sex therapy. The first year was with a sex therapist who spend the entire time having her discuss the fact that she was raised by a step father, a warm, nurturing man and the only one she ever knew as a father since he married her mother when she was pregnant. Not surprisingly this didn’t help her sex drive a whole lot.

The second sex therapist did similarly. But they also spend a great deal of time talking about a dentist who paid too much attention to her and  kissed her on the cheek when she was 15. This didn’t seem to affect her sex drive much either.

 ENOUGH.  At some point we need to get smarter about the time  (and money) we are spending  on therapy.

Consider the following possibilities:  Perhaps some problems have a physical component. Maybe some are genetic. Some problems simply cannot be helped. Spending time in sex therapy grasping at straws because the therapist needs something to address,  is not only useless but detrimental to patients. If you consider these likely possibilities and their relatively direct treatments, you will be a wise consumer and an educated patient. You know if you are being helped. If you are not, stop.

Sex Week at UMDNJ – 2010

Tuesday, January 12th, 2010 by Shannon Bertha, ACS, DHS

This past week, the University of Medicine and Dentistry of New Jersey held its 37th annual human sexuality program for second year medical students.  This program offers large group lectures, panelists, workshops and small group debriefings surrounding various issues in sexuality.  Future doctors are exposed to a variety of information on sexuality and learn how to be accepting and non-judgmental of people’s sexual practices.  Students practice giving sexual histories and learn how to be sensitive and aware of spectrums of sexuality.

This January program included many sexuality professionals with different backgrounds such as  medical doctors, sexuality counselors, sex therapists, sex educators and social workers to name a few.  For the second year in a row, the program was fortunate to have three representatives from the Medical Center to present on sexual dysfunction.  Dr. Michael Werner gave an intriguing lecture on male sexual dysfunction and Dr. Bat Sheva Marcus opened up the students’ eyes to many issues women face when dealing with sexual dysfunction.  Dr. Shannon Bertha served as the program coordinator as well as the opening lecturer on “Normative Sexual Behaviors”.

It is beneficial for students to learn from practitioners in the field using specific case histories that we encounter.  Many students expressed support for such a program, one that had a completely professional focus where they could interact with other future clinicians on the complex issues of sex and sexual dysfunction.  Many were happy to know there are clinicians in practice who focus solely on women’s sexuality including sexual health and pleasure.