Transformational Pleasure

It is still rare for doctors to consider, much less discuss, the sexual impacts of mental health diagnoses. When I giving trainings for therapists and healthcare providers, I always remind them that sexuality entwines with all aspects of health. Attention Deficit and Hyperactivity Disorder can affect an adult’s sexuality in many ways that can be addressed and often relieved. If we talk about it.

Shifting – For most adults, getting into the mindset for sex takes some conscious shifting out of the day to day distractions. For people with ADHD, shifting focus from one activity or mindset to the next can be particularly challenging. Learning to give themselves time to mentally stop what they are doing and re-adjust to a new sensual focus is important. Scheduling sex ahead of time can be helpful as it provides some structure.

Focusing – Difficulty focusing is a key feature of many people’s experience of ADHD. And sex is better with focused attention. Working with ADHD means working to reduce distractibility and refining the ability to pay attention to something, or someone, who interests you. Distractions during sex can increase the possibility of early ejaculation and erection difficulties, difficulty reaching orgasm, or feeling connected to your partners. Happily, learning to increase focus during sex will enhance the pleasure potential and make for a more intense experience.

Overstimulation – For some people with ADHD, life in general feels over-stimulating to the point of discomfort, including sex. For them, learning to relax and decrease the mental racing that can go along with high stimulation is important. Slowing down interactions and possibly taking breaks to close your eyes and breath. Being sure to focus on the present moment sensation, rather than on what to do next will also help with this. Sex is plenty stimulating; it is perfectly ok to go slow and really take it in.

Control – Sometimes ADHD can cause people to feel out of control with thoughts speeding ahead to places they don’t always choose or returning constantly to the same topic. Combined with all the sexual stimulation available, this can develop into sexual compulsivity or obsessive behavior with struggles to turn down sexual desire, even when it is creating consequences. An intense sexual drive can cause real conflicts in relationships where one partner simply can’t accommodate high levels of sexual activity. Working with the ability to re-channel thoughts, reduce anxiety, and find various balanced outlets for sexual energy can being more sense of control and empowerment.

These are just some common sexual impacts related to ADHD. Of course, relationship dynamics are affected as well which adds to the sexual dynamics. If you or someone you love is seeking support for ADHD, encourage them to find someone who will include sexuality as part of the conversation.

There is a word in the Yaghan language of Tierra Del Fuego – mamihlapinatapei. While I have no clue how to pronounce it; I really like this word, which means a look exchanged between two people who both desire to initiate something but both are unwilling to offer themselves. This may sound like a depressing thing, but I think we could stand to get more comfortable with the idea of mamihlapinatapei.

We Americans are not so great at longing. We are conditioned to focus on getting. But over the course of human history there has been a lot of longing, and there will always continue to be unrequited, unsatisfied longing. We can see this as failure, as a problem unsolved. Or we can see it as a part of the human experience and proof that the world is full and abundant – so full and abundant that we cannot HAVE it all.

There is a long literary tradition focused on long suffering yearning and unexpressed desire. I admit I found much of this irritating, too many high neck Victorian dresses, too much pining and martyrdom, too much repression. And I certainly don’t want us to return to hidden sexual drives, hidden bodies, or social structures that enforce separation and make so much loving impossible. But as I have gotten older, I have realized that there is something to learn from expressions of yearning, especially the type of yearning mamihlapinatapei speaks of – when one part of our self wants one thing and another part feels in conflict with that.

How many damaging sexual choices might be avoided if we grew up with an awareness of this concept? What if we were taught to expect moments of desire that we will not choose to act on? What if we actually enjoyed the tension of longing for something? What if the wordless exchange in a glance between two people that contained possibility but not action was considered a valuable, even beautiful, experience?

I want people to have full shameless sexual expression and satisfying sexual efficacy. I want people to get what they want. But I also want people to be so turned on by life and the world around them that they will experience some overflow, some sense of just taking it in without taking action. And I would like us to see that as potent, capable of building us up and filling us with energy of potential and private wonderings, rather than as a sign that life is passing us by. Life is here for you, with more than you can experience in one lifetime. And that is okay. Sometimes a passing look is creates a powerful memory of another version of passion manifest simply inside of you.

There is a word in the Yaghan language of Tierra Del Fuego – mamihlapinatapei. While I have no clue how to pronounce it; I really like this word, which means a look exchanged between two people who both desire to initiate something but both are unwilling to offer themselves. This may sound like a depressing thing, but I think we could stand to get more comfortable with the idea of mamihlapinatapei.

We Americans are not so great at longing. We are conditioned to focus on getting. But over the course of human history there has been a lot of longing, and there will always continue to be unrequited, unsatisfied longing. We can see this as failure, as a problem unsolved. Or we can see it as a part of the human experience and proof that the world is full and abundant – so full and abundant that we cannot HAVE it all.

There is a long literary tradition focused on long suffering yearning and unexpressed desire. I admit I found much of this irritating, too many high neck Victorian dresses, too much pining and martyrdom, too much repression. And I certainly don’t want us to return to hidden sexual drives, hidden bodies, or social structures that enforce separation and make so much loving impossible. But as I have gotten older, I have realized that there is something to learn from expressions of yearning, especially the type of yearning mamihlapinatapei speaks of – when one part of our self wants one thing and another part feels in conflict with that.

How many damaging sexual choices might be avoided if we grew up with an awareness of this concept? What if we were taught to expect moments of desire that we will not choose to act on? What if we actually enjoyed the tension of longing for something? What if the wordless exchange in a glance between two people that contained possibility but not action was considered a valuable, even beautiful, experience?

I want people to have full shameless sexual expression and satisfying sexual efficacy. I want people to get what they want. But I also want people to be so turned on by life and the world around them that they will experience some overflow, some sense of just taking it in without taking action. And I would like us to see that as potent, capable of building us up and filling us with energy of potential and private wonderings, rather than as a sign that life is passing us by. Life is here for you, with more than you can experience in one lifetime. And that is okay. Sometimes a passing look is creates a powerful memory of another version of passion manifest simply inside of you.

Here's a reprint from an article I did for YourTango.com :

More and more women are talking to each other about their sex lives. If not in open Sex and the City style confessionals over brunch, then in hushed tones over a glass of wine or huddled on the sidelines at a soccer match. Increased comfort talking about sex and desire is a good thing. But it can create advice overload, advice that just may not apply to us. Difficulty orgasming is one of those concerns for which one size solutions do not fit all. So if you have been comparing yourself to your friends and confidants and wondering why what works for them hasn’t worked for you, don’t worry. There is a solution for you; it just may be different than hers.

There are a lot of reasons why you may be having trouble with orgasm. Figuring out what is going on for you uniquely is key to getting your orgasms back, or finding them if you have not yet experienced them. A sex therapist or sex coach may be the best support in helping you assess what is impacting you, but here are a few common causes to consider. Which do you think might apply to you?

Ineffective Sex : Lack of sexual variety, skills, and experience, combined with rushed sex, are a common reason for difficulty with orgasms. Maybe you need more time for your body to get warmed up or sex that is frankly more fun for you. Since the sexual revolution of the 70s and the new focus on women’s sexual arousal , this is often the assumed problem. But I also see many couples who are having playful, arousing, exciting sexual interaction and orgasm is still missing. Go and explore new ways to be sexual but also trust yourself. Maybe there is another reason.

Your Mind is Busy Working : It may be difficult for you to turn your mind down or switch focus from the daily to-do lists to feel physical pleasure. If you are feeling stressed or anxious, it will be hard to orgasm. You could be thinking about the laundry that needs to get done for tomorrow or the deadline at work or the cellulite on your thighs. In any case, you are not thinking about how good it feels to be touched. It is important to find ways to reduce your stress, transition from the daily grind to make time for pleasure, and to learn how to train your mind to let go of things temporarily and be in the moment. Most of us can use some help with this!

Hormones Are Not There for You : We hear a fair amount about how hormones impact sexual desire and libido, but hormones also play key roles in our ability to orgasm.  Low estrogen in particular reducing blood flow to genitals which may make orgasm more difficult. If you used to have no trouble reaching orgasm and that has changed dramatically or if you feel like you have desire for sex and that the sex you are having is arousing but you never quite reach the peak of orgasm, maybe hormones are to blame. The frustration for a lot of women with this issue is that they have talked to their doctor and been dismissed. Keep in mind that most gynecologists are trained to care for your reproductive health, which is different than your sexual health or satisfaction. Seek out a doctor who specializes in sexual health or a naturopath who works with hormones.

 Low Tone or Awareness in Pelvic Floor Muscles : If you feel like you have low sensation with penetration or that you are just not feeling much, maybe you have weakness in your pelvic floor muscles which help with intensity of pleasure and orgasm. Childbirth, lack of use, and menopause can all affect the health of these muscles, but you can always train them to be stronger. You can even get to the point that you have control over contracting them which is a great way to increase sexual pleasure. You can learn about pelvic exercises called Kegels on your own and practice them. You can also find a physical therapist who specializes in pelvic floor health and get an assessment and support from them.

You Believe Orgasms are Bad, Dirty or Dangerous : There are lots of deeply held beliefs, sometimes so deep that we are only mildly aware of them, that impact our sexual pleasure. You may be able to identify the beliefs that are getting in the way; you may even want to stop having those beliefs. But changing our minds can be harder than we imagine. You can get support by reading books or seeing movies that support they way you want to see sex, talking to friends, and of course talking with a sex therapist or coach.

Sexual Pain: Sex doesn’t have to be painful and if you have been living with this, I strongly encourage you to seek help from a doctor specializing in sexual pain. Even if the pain comes and goes, the eventual anxiety about having pain will get in the way of experiencing pleasure. You are not alone in having sexual pain and you are not doomed to live with it. But you may have to do some searching to find an experienced doctor or clinician who can help.

Your trouble reaching orgasm may be related to one of these causes or several of them. You may have another reason all together. If orgasm feels important to you seek out your own solutions and support. Don’t get overwhelmed by advice overload; let your friends do what works for them. Listen to your body and you will find what works for you.

In this April’s Elle Magazine there is a commentary on new consent laws, such as those enacted in California this year, defining true sexual consent as acknowledged by verbal consent. The woman writer, Cristina Nehring, claims that asking for verbal consent is the “death of eros”. She writes a lovely narrative about her first experience of seduction and also about the sometimes exciting blurring of lines that can arise when surrender and seduction are at play. But, her resistance to verbalizing “YES” during sex is deeply concerning to me as a sex therapist and educator. And what is even more concerning is that Ms Nehring’s opinion is one that I find more than a few women quietly hold.

Ms Nehring proudly closes her article with this statement : “I would never have pursued anything in love or bed had I been asked to consent to it in advance or explicitly name it afterwards.” The implication that she doesn’t find this troubling or sad, speaks volumes about still common attitudes regarding female sexuality.

The role of the seduced, the one who is wanted rather than wanting, the reserved partner who gets overwhelmed by sexual pleasure so that she cannot say no even as she is unwilling to say yes - How many romance novels, old movies, and morality tales contain this female archetype? The woman who gets overcome by her, almost always male, partner’s passion without having to claim her own, holds a potent place in our culture’s sexual fantasies. And how convenient it is to not have to take responsibility for a sexual hunger that has been shamed and demonized. How relieving to let all that go and not have to actually admit that you want, that you feel pleasure and crave more. And indeed these can be powerfully freeing roles to enact in a BDSM scene that is carefully negotiated beforehand. But that takes communication and explicit consent. Sticking to these roles without dialogue can do a lot of damage.

Not feeling allowed to speak about desires is disempowering whether you do it to yourself or someone else imposes this limitation on you. By not getting comfortable with explicit language, we limit what we can experience and share with partners. By requiring partners to play along with unspoken roles and rules, we blur the boundaries and add to the confusion. By complaining that we should not have to respond or that it ruins the mood if our partner whispers in our ear, “Do you want this?”, we take a step farther away from honesty and intimacy. Believing that clearly communicating consent for sex is embarrassing or burdensome is an effect of a history of sexual repression, not a truth about eros.

There are many ways to consent, many of them quite compelling, and I wish for partners to try them all out together. However, being able to speak up, whether in whispers or groans, is foundational.  Being able to say, “YES!” is a gift and a right we should all celebrate. Pursue love and sex with enthusiasm and pride. Pursue them by saying you want them.

Good sex can make us feel as though the world has stopped and touch and movement and contact is all that exists in the moment. Intertwining physically, we can also feel intertwined as humans, connected like instruments in song, responding to each other’s rhythms, rising and falling together, sharing something without the effort of talking or explaining. It can feel as though veils of appropriate public behavior are lifted and there is an honesty that comes out in privacy. You can feel joined. Witnessing and being witnessed in the trance of pleasure can create a closeness that is unlike any other. It can make you feel connected and seen, basking in what you just created together.

And then we need to disentangle and go about our lives. We pull apart, literally and otherwise. It’s necessary, we cannot sustain immediate sensual connection at all times. We humans have the capacity to feel merged and connected, but also the need to function as individual beings. We cannot live on strawberries seductively inserted between our lips by an ardent partner. Nope, we have to have a cup of coffee and a bowl of cereal and get on with our day eventually.

There is an ongoing discussion out there about how to create this focused erotic trance-like connection with a sexual partner. As a sex therapist, I have plenty to say on that subject and know lots of people are yearning for those moments of intensity. But we don’t often talk about the de-escalation that comes after good sex, the necessary separation. And yet, many people struggle with these true after-the-after-glow moments. How do we experience disconnecting?

Some people feel a mild sadness or an unexplained sense of disappointment. Some people feel distrustful of their own intensity and feelings. Some may feel lonely or displaced somehow. Some people feel checked out. And, since we don’t often talk about the separation after the connection, many people may have no idea what they are feeling or why.

The ability to come together in sensual intensity requires the ability to be experience being apart. We can be apart but still allied and we can sustain ourselves through difficult times of distance by remembering the deep and earnest closeness that sex can bring. Couples who believe in the potency of that contact, even when separate, have a secret source of desire and intimacy. Remember how open and naked you can let yourself be, even as you dress yourself for your day out in the world, miles apart from those moments of skin to skin contact. Let yourself flush as you think about coming together again. How beautiful it is to be separate so that we can discover each other again and again.

Most of us have approached our dating lives with an image of sexual chemistry and desire that works like spontaneous combustion. It just suddenly hits without warning or intention and burns hard and fast, without our even trying – and can go out just as quickly. Our adult relationships may be better served by seeing sexual chemistry as a bit more complex and alchemical than that. We may not be able to create sexual chemistry anywhere with anyone, but we can actively engage with elements that build a chemical reaction we are hoping for.

Think of it like building a fire. You can sit and wait for lightening to strike and get the fire going. But this is not a great plan. It makes more sense to bring components together that will create fire. The fire will be just as hot, but you do have to put some effort and care into it.

You need fuel for the fire to burn strong and steady – Think of this as your body and your health. Are you giving your body what it needs to feel desire? Are you getting sleep, good food, exercise that is energizing not depleting, are you handling your stress? Basically, is your body ready and available to act on sexual chemistry?

The fire needs oxygen to stay alive – This relates to giving actual time and space for sexuality. You will not feel desire and chemistry while you are running from one chore to the next. Expecting to feel a lot of sexual chemistry on demand while overbooked and overworked, when you haven’t spoken to your partner in person for 3 days, when your mind is somewhere else, is like expecting lightening to strike – within a 30 minute window that is convenient for you. You need to actively create space, breathing room so to speak, for sex in your life.

Tinder will help the fire catch quicker – These are things in your life that you know make you feel more sexual, more connected or drawn to your partner, and sexier in general. Craft reminders of sensual pleasure into your day. Touch your partner as you pass by them, whisper about what you might do later in their ear. Make a point to build these things into your life so that, when the time is right, the spark can quickly catch and turn into a flame.

The Spark – Yes, the mysterious element that causes the flame to burst forth. There are many things we do that smother our natural sexual sparks and there are things we can do to encourage them, but who we desire and why remains, in large part, a mystery. There are different kinds of chemistry and there are different kinds of sex and what we want and are drawn to can change over time. One person may cause trembling in your thighs, another may cause you to feel playful and teasing, another warm and giving. Why him? Why her? Enjoy finding out…

Okay everybody, here are some myths it is time to bust …

Men like porn, women don’t. Turns out, just not true. First of all, porn or erotic art has been around since humans have been carving on walls and while the artists didn’t sign their names, it seems unlikely that this was just for men. Currently, stats tell us that in 2007 over the course of a month’s monitoring 1 in 3 visitors to the selected porn site was a woman. And plenty of women enjoy porn. A 2006 study from McGill University found that women watching porn reached physical arousal in an average of 12 minutes while for men is took 11 minutes. Visuals work for lots of people and the excitement of watching sex is probably deeply rooted in human desire maps. And the biggest problem many women report having with porn? Feeling bad about their bodies in comparison to the unrealistic expectations created in porn. Talking to men, you might hear about painful body or performance comparisons too. If only we were talking to each other about real life sex…

Oxytocin is a women’s hormone – Oxytocin, significantly released during childbirth and breast feeding, has been studied for its effect on women and often is talked about as though it is a women’s hormone exclusively and as though women have some lock on bonding because of it. But men’s bodies receive a surge of oxytocin after orgasm, and yes, it also helps them to feel trusting and bonded. It also can make all of us more relaxed and sleepy (touching on another gender sexual stereotype). Oxytocin can also be triggered through relaxed touch or hand holding, so cuddle up, it’s good for all of us.

Women have lower desire than men – Not true, not true, not true. Gosh, why is this one still hanging in there? Both men and women have desire patterns that will vary throughout a lifetime, some periods being hotter than others. And there are so many factors that affect sexual desire for everyone, from stress, relationship conflict, hormones (yes, testosterone fluctuates too), children in the house, shame, body image concerns, and on and on. A man’s desire is just as complex as a woman’s. And a woman can be full of desire at any age.

Men are the ones who cheat – Current research, and my experience as a couple’s therapist, are showing that rates of infidelity among women and men are actually pretty similar. Both men and women can struggle with monogamy and can be tempted by new sexual partners. Even with equal opportunity infidelity out there, we still hear more about men’s cheating behavior, in large part because there are still more men in power for the press to report on. Sexual stereotypes weigh heavy here and can damage relationships and trust before they even start.

Women need to feel connected to have sex, men need to have sex to feel connected – Human beings are each unique with a life’s worth of experiences, patterns, beliefs, and emotions that go into our emotional needs and sexual needs. What any one of us needs to feel connected is different. What any one of us needs to feel sexual is different too. There are lots of men who talk to me about wishing their partner would give them some focused emotional attention before expecting sex and many women who say they would like to have sex and then bask in the connectedness that creates for them. We are each different.

I had the amazing opportunity to spend 2 weeks in Rome this year which is a city of history, art, passion, and appetite. Among the many, many things Italy does well are shoes.

The best thing about shoe shopping in Italy was something that actually stunned me. They sell primarily sensible shoes. I realized that in America when I look for shoes most stores have about 70% high heels to 30% shoes the average 40 year old could comfortably walk in for a few hours (excluding trainers or athletic shoes, which are their own category). In Rome, the proportions were flipped – 70% walkable, low heel shoes, 30% high perilous heels. And the walkable shoes were stylish, meaning that all women, young to old, had cool shoes and the I-am-comfortable-moving-through-the-world attitude that went with the actually comfortable shoes.

Now sure, Rome has cobblestone streets so ladies in the high heels are taking serous risks with their ankles. But it really struck me, how far we in America have gone down this road of foot torture and high heel extremes. Searching for a “sexy shoe” will have one wading through hundreds of 4 inch heels or higher and it can seem like shoe designers consider 2 inch heels not worth the effort to make look hip in any way. Celebrities are regularly seen in 8 inch, even 11 inch heels. Well designed? Maybe. Comfortable? Doubtful. The idea that beauty or sexiness is something you have to be willing to hurt for seems to be gaining more of a hold.

I know for me that wincing while I walk or breaking into a cold sweat while trying not to think about my feet just standing still, is not sexy. I, too, am drawn in by the angle of a foot and tensed leg in a high heel. Sexy to look at. Well suited to being off your feet, which can be sexy. But limiting. It is also sexy to dance for hours, to hop on bikes and go somewhere secluded, to walk for hours and eat gelato after dark (did I mention the gelato? Oh man.) Sexy is being free to move. Sexy feels good.

Let’s say that again because I don’t think we hear it enough. Sexy feels good. Hmmm, I feel like dancing.

I have been doing a lot of radio appearances lately to promote The Conscious Sexual Self Workbook, and a question that keeps coming up is – how can we make it easier to talk about sex? Even radio hosts, who talk for a living, share with me that they start to blush and find it hard to get the words out when it comes to sex. I help people have these conversations every day. Here are some ways to set yourself up to have a better experience.

Acknowledge That This May Be Awkward – Much of our embarrassment about sex comes from an adolescent, and unrealistic, feeling that everyone else seems to have this sex thing all together and if you are not playing it completely cool, you are failing. Give yourself and your partner permission to be awkward, to stutter, to not know the answers. Maybe you even have to stop and take a break for a bit. Don’t feel that you have to play a part, be genuine, even genuinely embarrassed, it takes the pressure off.

Don’t Try to Have a Challenging Conversation Right After Having Sex – Rolling over and relaxing or critiquing what just happened – um, go with relaxing. Even if the experience wasn’t what you hoped, keep in mind that post- sex people tend to be a bit vulnerable, making it a great time to share loving words, less great for problem-solving.  Make time to have a conversation when you can feel close, awake, and can really focus on listening to each other.

Start With the Positive – Figure out what has been working for you, what do you like about sex? Asking for something you feel good about sets a tone of excitement and potential. As you start to share about something that isn’t working as well or that you would like to change, continue thinking about what you do want. What do you want more of? What would you like instead? Often people just say, “I don’t like it when you…” leaving their partner feeling like the lists of things they can do just shrunk. Certainly say if something is a clear No to you. But keep sharing your YESs too, they are equally important.

Make Contact – Touching your partner is soothing and studies have found that couples report less stress during conversations when they are holding hands. If it feels okay to do so, reach out and touch their leg or arm. Have the conversation cuddled up or while rubbing each other’s feet. Remind yourselves that you are connected by physical contact. This can also help with connection when eye contact feels too intense.

Don’t Expect to Figure it All Out at Once – Often sexual conversations open up questions, new invitations that have to be considered, edges that may take some time to approach. Pressuring yourself or a partner to come up with clear answers right away will only led to one level of growth. Embrace, “I am not sure, I need to think about that for awhile”. Then take the time to get to be curious about yourself. And then keep talking.