Posts Tagged ‘sex therapy’

PGAD (Persistent Genital Arousal Disorder)

Tuesday, September 13th, 2011 by Bat Sheva Marcus LMSW MPH PhD

We recently had a PGAD patient in her 80’s. The PGAD (or PGAS) started a few months ago after a head trauma and a broken hip. Her symptoms were classic: constant genital engorgement (she described it as heat and a feeling of fullness) and a burning feeling that was always present and was driving her crazy. Like many PGAD patients she would need to get up and walk around to alleviate the miserable feeling which seemed to get worse when she sat too long.

Here’s the really scary piece – she had tried to commit suicide a few weeks before she came to see us.

That’s how miserable her symptoms were. One of the most heartbreaking elements of this condition is that it is so misunderstood. Most physicians haven’t heard of it, let alone seen a patient with the condition. So in good, classic medical style they tell patients “it’s in your head” (it isn’t by the way—we don’t really get it but we think it’s probably connected to pudendal nerve issues). Or, even worse, they think the patient is crazy or “hypersexualized”.  You have no idea how awful it is for a woman who is experiencing constant and severe unpleasant symptoms to be told she’s turned on. She’s not!

We don’t know an awful lot about PGAD, but we do know it’s a real and concerning medical condition that can drive perfectly normal women to the brink. We’ve had a young woman who had to drop out of school, a woman who stopped working, and now this 80 year-old who tried to commit suicide. As we learn more about the condition we will hopefully develop more effective ways to treat it. In the meantime we work with patients, trying to alleviate their symptoms and assuring them….that they are not crazy, and it is most definitely not in their heads.

Asexuality

Friday, August 12th, 2011 by Barbara Gross, LMSW

The concept of asexuality first came to my attention a few months ago when I began to see a young woman who was struggling with the fact that she felt no desire to be sexual.  As a teenager she felt ostracized from having no interest in sex of any kind.  Her girlfriends were all talking about hook-ups and sex while she had very little interest in boys.  Even when she had experiences with them, she felt it was boring.  As we began to work together it became clear that she had spent a great deal of time both worrying about her lack of desire and researching it.

She spoke at length about a web site called AVEN.  AVEN defines itself as, “the Asexual Visibility and Education Network. AVEN strives to create open, honest discussion about asexuality among sexual and asexual people alike.” AVEN is a great resource for individuals struggling with asexuality.

An asexual, as defined by AVEN is, “someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. Asexuality is just beginning to be the subject of scientific research.”

AVEN seems to have been a starting point for several women I treat,  yet it leaves many questions unanswered. It is limited in getting to the deeper issues around desire. In my practice at the Center we view desire as a multi-faceted condition; we do a thorough evaluation to uncover what might be causing a lack of desire.  It is obviously different in each person.  We do start from the assumption that most individuals want to have desire and that we can work through a process to help them discover or reclaim it, but if one feels that they have no desire and would rather embrace it, that is a fine choice too.

As a sexuality counselor, this idea of asexuality poses a unique set of questions. I see women all the time who have low libido or non-existent libido.  What makes one person asexual and another person an individual struggling with a lack of desire?  Ultimately it is personal decision and I hope that each person finds what they are seeking.  If you have no interest in sex or sexuality or in having a sexual relationship, perhaps the term asexual is a good one.  If you are someone who is struggling with a lack of desire and you would like to feel differently than you do, I would probably not use the term asexual.  Either way, you can always reach out for help to gain tools and support for what you are struggling with.  Struggling alone is what concerns me the most; with help you can come to a place of greater comfort with yourself and whatever choices you decide to make.

The Elements of Desire

Thursday, June 2nd, 2011 by Stephen Snyder, MD

(Fourth in a series of articles discussing A Billion Wicked Thoughts, a controversial new book by Ogi Ogas and Sai Gaddam that uses the internet to study human sexuality in some new and unusual ways. Photo credit:  Pedrosimoes7)

There’s an app for that

Much like your average personal computer, the human brain comes outfitted with a whole lot of cool software right out of the box.

There are programs for language acquisition.  An elaborate visual processing suite.   Apps for learning to crawl — and eventually to walk without falling down.  And a myriad other functionalities that are more than simply the sum of their neuronal parts.   All pre-set and ready to run, from the moment you plug the thing in.

Which is a good thing.  Because otherwise we’d have to learn everything from scratch.

Decades of infant research have demonstrated that babies from the moment they’re born know how to bond with their caregivers, and how to cry when their diapers need changing.   By the time a young child learns to crawl, she  already knows to fear heights — without being taught.  Later she’ll most likely automatically crave sweets and fear bugs.

The fact that all this fabulous software comes pre-installed is nothing short of astonishing — especially considering that all the instructions for building and installing it are present in a single cell at conception.

Born to learn

According to the authors of A Billion Wicked Thoughts, we’re all born with sexual desire software as well — designed to help us find suitable mates.

Early in fetal development, according to this model, human males and females start out with the beginnings of the same rudimentary sexual software.   But at certain stages of fetal life, under the influence of fetal sex hormones and other factors, certain gender-specific components are activated, never to be turned off again.  And others suppressed, never to be developed.   So by the time the boy or girl baby leaves the womb, its original unisex software has been specifically modified for male or female life.

The result is that male and female sexual software are radically different.   Much more on that later.

The software is a learning software.   Like the “mother cue” software of young geese, who will bond to anything that approximates the features of a mother goose, mental software tends to look for categories rather than specifics.   As the authors write (p. 58), “The cue is simple and general because the gosling brain doesn’t know ahead of time what its mother will look like.”

The human sexual software responds to categories rather than specifics as well.   Most heterosexual American men from the Baby Boomer generation like women to have pubic hair, whereas many if not most Millennial Generation men prefer a mate who is shaved or waxed.  Both yearnings are the result of the same software, which simply seeks vulvas.   But the software is a learning software.  It learns the ways of one’s society and one’s generation.

Flexibility within limits

Both male and female sexual software, according to this model, are highly flexible in achieving their basic aims.  A woman in a tribe of hunter-gatherers, we are told, seeks a man who is a good hunter.   Whereas a modern New York woman may look for one who can provide her with a 3-bedroom apartment.

As the authors envision it, both are responding to a piece of ordinary female software, wherein a man’s desirability is enhanced by his ability to provide material essentials.    Whether this really is an innate feature of the software, as the authors claim, or the result of other factors such as women’s historical position of dependence on men for resources, is sure to be debated.

Neither male nor female sexual software has unlimited flexibility.   There seem to be constraints.  Unlike men, most women don’t go hunting for a glimpse of a partner’s genitals.   And most men don’t get more turned on by a partner who supplies them with material resources.    Male and female aims appear to be quite different, regardless of geography or culture.

The elements of desire

Neuroscientists tell us that  perception tends to be built from just a few elements, which our minds then combine into an infinite variety of arrangements.   All colors can be produced by combining red, blue, and yellow.   All tastes by arranging combinations of salty, sweet, bitter, and a few others.   And all sexual delights, according to this theory, can be produced by the combination of basic erotic elements.

Ogas and Gaddam call these “sexual cues.”  They are the building blocks of sexual attraction.   Sexual tastes are built up of combinations of sexual cues, just as tastes in food are built up of salty, sweet, and bitter.

So OK — How well does this theory of a “software of human sexuality” fit with our ordinary experience?

From a computational neuroscience standpoint, the question may be unimportant.    How we feel about the way our minds process visual cues is irrelevant to the science of how it works.

But sexuality is different.   Most of us have strong feelings about sex.   That’s an interesting fact in itself.   Sexuality touches us deeply  - in a way that visual processing does not.

So let’s look critically at the authors’ ideas about male and female sexual cues.    Can they teach us something about our sexuality that we didn’t already know?

Before we can answer this question, we’ll need to know exactly what the authors of A Billion Wicked Thoughts think the main human male and female sexual cues are.

We’ll start next time with the major male cues.   The basic theoretical ideas we’ll master in doing so will then allow us to appreciate the female version, which is (no surprise) much more complex.  And is sure to be  much more controversial.

Copyright © Stephen Snyder, MD 2011
www.sexualityresource.com New York City

Things I Hate

Thursday, February 17th, 2011 by Bat Sheva Marcus LMSW MPH PhD

Things I Hate

Okay – I think I’m going to start a list of things I hate or that make my blood boil.
I figure one of the advantages of having a blog is being able to vent, right?
So here’s something I hate.

I hate couples therapists who are not comfortable dealing with sex!! You know, it wouldn’t be so bad if they were honest, and said to new couples coming in “you know, I’m happy to work on your other issues but I really am not trained in dealing with sexual issues.” But most of them don’t. And then, you know what happens? A couple, whose major issue might really and truly be sexual, sit and spend half a year talking about their parents, their communication, their abandonment issues… and then they quit and they are worse off than when they started because now they think they’ve already “tried the therapy route.”

It drives me crazy.

I can’t tell you how many couples I’ve seen who have said things like:

“Well I tried to raise the sexual issues but he said we work on that later.”
“Never in the 2 years we were  seeing her did she ask about our sex life.”
“She said we need to talk about our parental issues before we talk about our sex life.”
Or my  personal favorite:
“He said if we work on our communication, the sex will follow.”

NO. NO. NO. If you are going to a couples counselor and one of your issues is sexual, MAKE SURE it’s raised initially, that the therapist seems comfortable with the issue and focused on it. If the issues seems to “disappear” in therapy during the next month… pick yourself up and find yourself a new couples counselor.

Sex Therapy and Sexual Health

Sunday, October 17th, 2010 by Ilene Rosenthal, Marketing

Sex therapy is a life saver when problems in the bedroom link to problems in the relationship, a person’s comfort level with emotional intimacy and more. But issues like pain and low desire – even trouble with orgasms – often have roots in physiological imbalances (hormones, neurotransmitters, muscle spasms.) So while you’re looking into sex therapy, consider finding a doc who will evaluate you medically. If he or she tells you it’s all in your head, or a glass of Chardonnay will help, you’re seeing the wrong doc!

If seeing a sex therapist, either alone or with your partner, seems the right course of action for you, there are some resources you can tap into for guidance.  For example, Sheknowslove.com has an entry as does our own site, including guidelines for choosing a sex therapist.

Patient to Patient – A conversation about vaginismus

Wednesday, September 8th, 2010 by Bat Sheva Marcus LMSW MPH PhD

Something wonderful happened today. I saw a new vaginismus patient. Typical in many ways, she is in her 30′s, pretty and petrified of romantic relationships. She avoids relationships because she believes that there is something “wrong with her.” She feels ashamed and damaged. She really doesn’t believe she can be helped. The few relationships she has tried have left her feeling worse than when she started. She feels desperate now and is hoping maybe we can help, though she wonders (like most vaginismus patients) if she is beyond help.

 So what’s the good news?

It just so happened that immediately following her appointment was a patient who was finishing treatment for vaginismus, a magnificent and beautiful woman (inside and out) in her 40′s who 3 months ago thought she would never be “normal.” I asked if she’d be comfortable talking to the new patient and she happily agreed.  

Sitting there with the two of them almost made me cry. As I watched our “graduating” patient talk about all her fears and concerns when she came to us, and how empowered and  normal she now feels, I felt so proud of her. And watching the new patient realize that her situation is not so unique and not so hopeless — watching her light up with a new found feeling of hopefulness — made me grateful for being in this profession.

Daily I feel privileged to have the opportunity to watch our patients struggle with their worst fears and conquer them — and privileged to be a part of the solution. But in the end, they are doing it themselves. I am blessed to be able to be a part of their lives.

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, PhD

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!