How to ask a partner if they have any STIs

Dear Getting smarter,
There's no A-B-C method of how to ask a partner if they have a sexually transmitted infection or STI (STI is more commonly used now than STD; however, you may see it used interchangeably). Pointers coming in a minute, but first keep this in mind: one of the most common symptoms of an STI is the absence of any symptoms, so your partner-to-be may not even be aware of infections they carry. For this reason, in addition to asking, you both may want to consider getting tested if you haven't done so recently or if you've had any exposures — ideally before getting between the sheets. Communicating about STIs before you're in bed together is also a good idea because when you're aroused, and perhaps not thinking as clearly, discussing STI infections and transmission may not be top of mind. 
Now on to some tips for your conversation. First, consider when and how comfortable you are about bringing up the STI discussion. It may be that it's something that's not discussed the first few times you have sex — you both just automatically choose to use condoms, as you described in the case with the woman who had herpes. Or it may be that you're a more verbal person and need to talk about STIs early on in a relationship. However, it's key to note that the sooner you have the discussion, the sooner you can make informed decisions about your health. Additionally, in some places, partners may be opening themselves to legal action if they knew about an STI diagnosis, didn't communicate it to their partner, and then transmitted it to them.
Whenever you talk, it can be helpful to:

•Use language that you're comfortable using.
•Be as direct as possible, knowing that it may be a little awkward (Can you find the courage to embrace and move through the awkwardness? Give it a try!).
•Be yourself.
•Stress that you care for your own and your partner's health, and you believe that these conversations are a key part of any relationship.
•Ask for details — has your partner ever been tested? How do they feel about testing?
•Pick a time and place where you won't be interrupted or disturbed and when you're not sexually engaged.
•Have some suggestions ready for how you can learn more about your sexuality and sexual choices together as a couple. Ideas include going to a bookstore to read up on sexual health books and reviewing pamphlets from a health center. You can also make an appointment together to see a health care provider to discuss your safer sex options.
Condom use as a standard safer sex practice, regardless of sexual history may be a way to reduce risk — and potentially be viewed as a way to bypass this type of discussion. But, rather than looking for ways to avoid the chat, it may be better to view it in terms of what you and your partner(s) stand to gain by having it — greater communication, more coordination of safer sex practices and risk reduction beyond condom use alone, and not least, more space for pleasure rather than worry. And this can all be gained whether the conversation is between folks in a long-term relationship or with someone you just met. However, if you're interested in developing a relationship with increased intimacy over time, it's a good idea to discuss STIs at some point. It doesn't have to be a trust issue, or a discussion of past relationships and promiscuity or prudence, but more a look at the future and caring for yourselves enough to protect each other.
Best of luck,

My mom found my contraceptives!

Dear Reader,
While you may be second-guessing yourself, rest assured that you weren't stupid to keep the backup pills. On the contrary, it was smart to hold onto them in case the first ones didn't stay down, or in case you needed them for another condom slip-up in the future. If you're certain your mom found the pills, then it's possible she already knows that you're having sex. The next step would be to choose how (or if) you'd like to broach the topic. Parents can be a wealth of advice and support in helping you navigate your relationships and even your sexual health. While it sounds like this scenario isn't what you had wanted, this may be a healthy opportunity to be open with your parents about your sexuality. However, depending on your parents’ views on sex and birth control, this may be something you choose to avoid talking about with them altogether.
Here are some suggestions for how to talk with your parents about sex, if you choose to do so.
•It can be helpful to approach your parents at a time when you can sit together calmly without interruption or set up a time where you can talk. You might say something like, "Could we talk after dinner tonight?"
•You could make a list of what you'd like to say before you meet with them, so nervous jitters won't leave your mind blank. You might also want to think ahead about questions or comments they could have. How you might respond to them effectively, keeping in mind your family’s values, culture, and communication styles?
•If the thought of talking face-to-face makes you cringe, consider starting the conversation with your parents over email or text message. You can plan out your talking points more easily, and it avoids any in-person awkwardness.
List adapted from Planned Parenthood.

While confronting the topic head on might lead to a productive dialogue, there are a multitude of reasons why this conversation may not happen at all. Parents are often just as nervous as their kids are when it comes to discussing sex. For this reason, your mom may never even bring it up, and it might just fizzle out. You also mentioned that your parents are quite conservative. In some circumstances, talking about sex with parents is more than just awkward — they may react with threats or punishment. If you think that discussing sex with your parents may negatively impact your life in a serious way, you may choose to not mention it. In this situation, if you want to talk to someone about your sex life, you may find it helpful to talk with a trusted family member, friend, or health care provider.
While you may opt to bring it up with them, there's a possibility they could still bring it up with you first. Due to this, you may want to be ready in case your mom talks to you about it. What do you feel comfortable sharing? What do you prefer to keep to yourself? If you choose not to mention it first and they initiate the conversation, you also may have less ability to steer the discussion. You may also want a plan for how you'd exit the conversation if it moves in a direction that makes you feel threatened or unsafe.
Talking about sex with parents is rarely anyone's favorite pastime, but it could be a great chance to show them how mature and responsible you are about your health and your relationships. The fact that you knew what to do after a condom broke, and that you were able to seek and obtain the pills you needed, shows that you and your boyfriend are thoughtful and knowledgeable. If you feel there is something to be gained by sharing this fact of your life with your parents, power to you! And if you feel you don't need to bring it up if they don't, carry on safely! 
Alice!

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Clitoral Unhooding (Hoodectomy) Before and After Photo Gallery

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The ins and outs of the vagina

Vaginal vs. clitoral orgasm, the G-spot, the vulva, and the clitoris: the female sex organs and their involvement in arousal and orgasm are shrouded in mystery.
In our increasingly digital world, sex and female body image are often misrepresented. Yet, sex makes people happy and plays an important role in social bonding as well as mental and physical health.
So, it’s time to demystify common misconceptions about the female sex organs and their role in sexual pleasure.
We shine a spotlight on how the vagina, vulva, and clitoris work, as well as on what is currently known about the elusive G-spot and the female orgasm.


Inside and out: The vagina and the vulva
The vagina is the muscular tube that links to the cervix, which is the lower part of the uterus.
Also called the birth canal, the vagina allows for the passage of blood and cells in menstruation, the introduction of sperm during sex, and the delivery of the baby and placenta at the end of pregnancy.
The vagina only has a limited number of nerve endings, which is thought to be important to help women cope with the pain of childbirth.
The external part of the female genitals is the vulva. It consists of the labia majora, or the outer fold, the labia minora, or the inner fold, the urethra, and the clitoris. The shape and size of the vulva is unique to every single woman.
In a study involving 32 women, Dr. Haim Krissi – from the Department of Obstetrics and Gynecology at Soroka University Medical Centre in the Ben-Gurion University of the Negev in Israel – and team found a considerable range in the length and width of the different parts of the vulva.

The clitoris: The gateway to sexual arousal
While many people think that the clitoris is a small spot just above the vaginal opening, it is, in fact, a much larger complex. The part most visible is the glans, which is 16 millimeters in length, on average. This is the part that most people will be familiar with.
The glans is covered by the prepuce, which is a skin formed from the vaginal labia. Some people liken the prepuce to foreskin. Hidden inside the pubic bone is the rest of the clitoris, and the entire complex is similar in shape to the penis, with a total length of between 9 and 11 centimeters.
The clitoris is an erectile organ and is thought to be at the heart of female sexual arousal.
In a 2015 review published in the journal Clinical Anatomy, Dr. Rachel N. Pauls – from the Divisions of Female Pelvic Floor Medicine and Reconstructive Surgery at TriHealth/Good Samaritan Hospital in Cincinnati, OH – describes the clitoris as “[…] the centre for orgasmic response.”
The clitoris is highly innervated, with the densest concentration of nerve fibres found in the glans. These nerve fibres respond to stimulation by causing swelling of the erectile tissues of the clitoris.
As Dr. Pauls explains, “It is important to note that indirect stimulation of the glans is central to female sexual arousal, but the dense innervation of the glans may lead to extreme sensitivity upon direct stimulation.”
That being said, the clitoris is not the only part of the female sex organs that can lead to arousal, according to some. The mysterious G-spot, said to be located inside the vagina, has been equally credited.

Does the G-spot exist?
The so-called Gräfenberg spot, or G-spot – which is named after the German-born physician Ernst Gräfenberg – is a topic of much contention.
While Gräfenberg has been widely credited with finding the purported spot guaranteed to produce sexual arousal, the name was in fact coined by Dr. Frank Addiego and colleagues in a 1981 paper published in the Journal of Sex Research.
The hunt for this elusive structure that promised unlimited pleasure has been on since then.
A study in An International Journal of Obstetrics and Gynaecology by Dr. Adam Ostrenski – from the Institute of Gynecology in St Petersburg, FL – and colleagues describes it as a collection of nerve bundles in the front, or anterior, wall of the vagina.
Using MRI scans, Anastasios Mpotsaris – from University Hospital of Cologne in Germany – and colleagues found
 a “distinct morphological entity” in 62 percent of study subjects in the same location.
Does this mean that the search is over? No; not all experts agree. Dr. Vincenzo Puppo – from the Centro Italiano Sessuologica in Bologna, Italy – states in an article in the journal Clinical Anatomy that there is no scientific or medical evidence that supports the existence of the G-spot.
Instead, he writes, “The G-spot has become in the centre of a multimillion dollar business: G-spot amplification, also called G-spot augmentation, G-Spotplasty, or the G-shot, is a cosmetic surgery procedure for temporarily increasing the size and sensitivity of what some believe to be the G-spot […].”
This sentiment is echoed by Dr. Pauls, who summarizes that there is no scientific or anatomical evidence that supports the existence of the G-spot.
So, the jury on the G-spot is still out. Whether by G-spot stimulation or not, the female orgasm remains a mysterious and controversial topic.

Masturbation and depression: Is there a link?

Masturbation is a healthful and enjoyable activity that has many possible health benefits. Is there any connection between masturbation and depression?
Some people believe that masturbation can cause mental health issues, but this is an outdated idea that researchers have long since disproven. On the other hand, having depression can affect how a person feels about masturbation and sex.
Read on to learn all you need to know about masturbation and depression.




Are masturbation and depression linked?

Masturbation does not cause depression. It is a natural, pleasurable activity that may boost self-esteem and help a person explore their sexuality.
That said, some people who masturbate do feel guilty or anxious about it. Historically, masturbation has been a social taboo.
The outmoded view that linked masturbation and mental health problems came about in the early 1800s.
By the 1900s, medical professionals had abandoned this view because research into psychology and sex had made it clear that the practice of masturbation was nearly universal.
Masturbation is a common, safe activity that can offer many sexual health benefits, but some religions and cultures continue to prohibit it.
Although masturbation does not cause depression, a person’s religious, cultural, or social views may cause them to feel bad about it.
A 2018 study found that 62.5 percent of male study participants with depression experience some sexual dysfunction. Myths about masturbation were also more prevalent among those with depression.
Masturbation will not have any effect on whether a person develops depression, but having depression can reduce a person’s sex drive, or libido, and may cause them to lose interest in masturbation.

How depression affects libido

Depression may make a person lose interest in activities that they usually enjoy, including sex. It is common for a person with depression to feel less interested in sex than they previously did.
Communicating this to a partner is helpful. If one or both partners are experiencing a low libido due to depression, they can find other ways to maintain intimacy, such as cuddling and giving massages.
Masturbation may also help. A person experiencing depression may find that masturbating helps them feel sexual again, but this is highly personal. Many people go through phases of masturbating more or less frequently, which may not have any effect on their mental health.
Certain medications for depression may also reduce a person’s libido. Not all treatments have this effect, so if a specific medication decreases a person’s sex drive and becomes bothersome, they should speak to a doctor about other options.
A person whose partner has depression may find that masturbating meets their own sexual needs until their partner feels like reconnecting.
As well as reducing sex drive, depression may make a person feel:
•sad
•guilty
•hopeless
•worthless
•tired
Depression may also cause physical symptoms, such as unexplained aches and pains.
Anyone experiencing the symptoms of depression should speak to their doctor, who will be able to help them access treatment.
People can use a combination of talk therapy and medication to manage depression. The lifestyle changes and stress-relieving activities below may also help:
•exercising regularly
•getting enough sleep
•eating a healthful, balanced diet
•reducing alcohol intake
•practicing yoga, mindfulness, or meditation
•journaling
•spending time with friends
The most effective mix of treatment and self-management strategies will vary from person to person.

The Many Benefits of Regular Self-Sexing

Whenever I’ve blogged about masturbation, I’ve received a few comments calling it wrong, immoral, sinful, a sign of addiction, and a waste of precious semen. Actually, making love with oneself is the foundation of great partner sex and a key element in therapy for several sex problems.
The Sin of Onan

Almost all ancient Mediterranean cultures regarded masturbation as inevitable, therefore, normal and acceptable. The lone exception was the Hebrews. Consider this story from Genesis. Judah, son of patriarch Jacob, fathered two sons, Er and Onan. Er married Tamar but died before they had children. By ancient custom, Onan was expected to marry his widowed sister-in-law and father sons who would become his brother’s surrogate heirs. Onan objected. Er was the firstborn, entitling him to a double portion of his father’s estate, two-thirds of the total, with Onan receiving one-third. With Er gone, Onan stood to inherit everything. If he fathered a son by Tamar, that boy would inherit the double portion, leaving Onan with much less. So instead of ejaculating inside his sister-in-law, he “spilled his seed on the ground.” Onan’s action infuriated God, who struck him dead. As a result, Judaism—and later Christianity and Islam—prohibited all non-procreative whoopee including self-sexing.

Why did the ancient Hebrews condemn masturbation? They were a small, struggling ethnic group surrounded by imperialistic powers constantly threatening conquest. To remain independent, they had to field as large an army as possible, which required sons. Consequently, the human authors of the Five Books of Moses had God decree that the only legitimate sex was procreative.

As if religious dictums weren’t sufficiently stifling, in 1760, Swiss physician Samuel Tissot published Onanism: A Treatise on the Diseases Produced by Masturbation. Without a shred of evidence, he claimed that masturbation not only offended God, but also depleted men’s bodies of invaluable semen, causing debility, illness, insanity, and death. Translated into many languages, the book became a best-seller and demonized masturbation throughout much of the world. We’re still living with the fallout.


Solo Sex: Beneficial
Of course, despite religious and medical condemnation, most people worldwide masturbate regularly, especially men who often stroke to Internet porn. The world’s most popular porn site, PornHub, attracts 35 billion views a year, almost 10 annually for every man on Earth. Most women also polish the pearl. Today, more than half of adult American women own vibrators, and only a small proportion use them in partner play.

Masturbation is by far the most popular type of sex on Earth. Today, there are more single Americans than ever before. Those without partners, or separated, divorced, or widowed comprise 45 percent of the adult American population, more than 100 million people. Most of them want to remain sexually active. Some single men patronize sex workers, but most singles play solo. This quote has been attributed to none other than Julius Caesar: “To the lonely, it is company, to the forsaken a friend. They that are penniless are yet rich thanks to this majestic diversion.”

In addition, masturbation is therapeutic. Sex therapists recommend it for many reasons:
•Sexual self-awareness. Masturbation is the way we explore the full range of our sexual responsiveness. Many sex therapists say: If you can’t enjoy making love with yourself, it’s difficult to enjoy it with anyone else.

•Stress management. Stress/anxiety/worry are reactions to actual or threatened change. In today’s world, things change so quickly that many people suffer chronic distress. The National Institute of Mental Health says 31 percent of Americans suffer a clinical anxiety disorder at some point in life, and virtually everyone sometimes complains of feeling stressed out. To cope, some exercise. Others drink tranquilizing herb teas (chamomile, passionflower). Some take anti-anxiety medications. And many, especially men, reach between their legs.

•Recovery from child sex abuse. This crime not only subjects children to possibly horrific violations but also destroys many victims’ ability to enjoy sex later in life. To recover sexually, they must become re-acquainted with their bodies’ ability to experience sensual pleasure from touch. A key therapeutic tool is masturbation. Therapists who treat survivors encourage them to self-sex regularly.

•Orgasm difficulties. Almost everyone can work up to orgasm solo. But during partner lovemaking, many men and women have trouble getting over the hump. As part of therapy for orgasm difficulties, many sex therapists recommend self-sexing in front of partners so they can see what gets them off. Sex therapists also recommend coaching partners’ hand jobs and oral sex to optimize chances of orgasm. Sex therapists say: Orgasm is learned. The teacher is masturbation.

•Premature ejaculation (PE). Throughout the lifespan, PE is men’s most prevalent sex problem. In every age group, one-quarter to one-third of men complain of coming before they’d like. A history of hurried masturbation often contributes to the problem. More than half of visits to PornHub last less than five minutes. Many men inadvertently train themselves to ejaculate quickly. Sex therapy for PE begins with extending self-sexing to develop reliable control—masturbating until just before the point of no return, then backing off, and repeating this until men can last as long they’d like.

•Enhanced relationship intimacy. Intimacy means self-revelation. What’s more self-revealing than showing a lover how you have sex with yourself? Many couples who masturbate for each other say it brings them closer together.
•Reduced risk of prostate cancer. Several large studies show that men who ejaculate frequently—two to four times a week—enjoy significantly reduced the risk of prostate cancer. The disease is to some extent sexually transmitted. Regular ejaculations flush out pathogens. Only a small minority of couples make love two to four times a week. Men who’d like to reduce their risk must depend largely on solo sex.

Does Masturbation Cause Erectile Dysfunction (ED)?
After solo or partner orgasms, erections subside, and men enter the recovery (“refractory”) period. They find it difficult or impossible to raise subsequent erections for a while—only minutes for some teens, but for many elderly men, twelve hours or longer. Some men are uninformed about the refractory period blame masturbation for any difficulty they have raising subsequent erections. But masturbation is not necessarily the issue. If you’re over around 40, expect your refractory period to last at least several hours, possibly up to a day. Assuming that men abstain during their refractory periods, even daily masturbation does not increase the risk of ED.

Man or woman, if you already masturbate regularly, carry on and enjoy yourself. If you don’t, your solo sex frequency is totally up to you. But you might consider upping it for stress management, to enjoy partner sex more, and as part of therapy for the problems just mentioned.

Mindful Sex Is Mind-Blowing Sex

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Are Sexual Lubricants Safe?

Previously, I’ve extolled commercial sexual lubricants as the slippery secret of sensational sex. Why the endorsement? In both women and men, lube enhances skin sensitivity to erotic touch. Many women of all ages don’t self-lubricate sufficiently for comfortable intercourse. And many post-menopausal women suffer chronic vaginal dryness. As a result, many sexologists encourage couples of all ages to use lube every time.

But now I must temper my enthusiasm. Recent research suggests that, in frequent users, sexual lubricants damage genital skin cells and may increase risk of sexually transmitted infections (STIs). I hasten to add that, for many lovers, lube benefits outweigh any risks. But the risks appear real and couples should understand them—and use lube with not just legs, but also eyes open.

Risk in High Osmolality?
Over the past 30 years, sexual lubricants have become quite popular. In the U.S. alone, they are a $200 million a year industry. A majority of couples have tried them. One-quarter of couples have used lube in the past month. And a broad consensus of women say they make intercourse more comfortable and enjoyable.

The most popular sexual lubricants—among them, Astroglide and K-Y Warming Jelly— are water-based, meaning that water is their main ingredient. In addition, these lubes contain glycerin and propylene glycol that slow the water’s evaporation and make the products slipperier than saliva.
But those other constituents also increase “osmolality,” a measure of the molecular concentration of ingredients. Most sexual lubricants have osmolalites substantially greater than the cells to which they are applied (hyperosmolality). When high-osmolality products come in contact with lower-osmolality genital or rectal cells, the cells lose water and shrivel up like grapes turning into raisins. And that may cause problems:

• Portuguese researchers exposed vaginal cells to either commercial high-osmolality lubricants or to a lubricant they formulated that had the same osmolality (iso-osmolality) as the cells. The high-osmolality lubes caused cell damage that might increase risk of STIs.
• The vagina contains a broad array of micro-organisms that help keep it healthy. University of Pittsburgh researchers found that high-osmolality lubricants kill some of these micro-organisms, possibly make the vagina more susceptible to STIs.

• Johns Hopkins researchers replicated the Portuguese study using rectal cells. The commercial lube caused greater cell damage, prompting the researchers to conclude that they might increase risk of HIV transmission.
• As part of an ongoing study, UCLA researchers surveyed adults about receptive anal intercourse (RAI) and lubricant use. Recalling the month before being surveyed, one-third of the participants reported frequent RAI and consistent use of lube.  Compared with couples who used lube infrequently or not at all, the frequent RAI-frequent lube users had three times the risk of a sexually transmitted infection—3 percent vs. 10 percent.

One of the Johns Hopkins researchers, biophysicist Richard Cone, Ph.D., advocates reducing the high-osmolality of lubricants, “Virtually all sex lubricants need to be reformulated.”
On the Other Hand
The problem with the studies just cited is that most studied cells in the laboratory, not people in the real world. Laboratory findings may be statistically significant, and therefore qualify for publication, but not really mean anything beyond the test tubes.

The one real-word study focused on couples who engaged in frequent anal intercourse, but that group represents only a small minority of the general population of lovers.
Meanwhile, Indiana University researchers gave 2,453 women one of several lubricants and asked them to keep a daily sex diary for five weeks. Compared with controls who did not use any lube, those who did reported substantially greater sexual pleasure and satisfaction with fewer genital complaints and no increased risk of STIs.

The Case for Saliva
The research to date raises questions about lube safety, but the only real-world study pointing to an increased risk of STIs involves couples who have frequent anal intercourse. For everyone else, there is no documentation of any increased risk, and some evidence of less risk. A confusing situation.

One reasonable response to the uncertainty would be to use the lube that’s closest in osmolality to genital cells. That product is Good Clean Love, available at Wallgreens and Target, or on their Web sites.
Another would be to use saliva, Nature’s own sex lubricant. Saliva is always available and it’s free. But saliva is not as slippery as commercial lubes and it dries quickly.

Meanwhile, a growing literature shows that in couple lovemaking, the key to women’s orgasms is not vaginal intercourse, but gentle, extended, cunnilingus—men providing oral sex for women. Intercourse can feel wonderful and many couples revel in its special closeness. But no matter how long intercourse lasts or how large the penis, the old in-out doesn’t provide much clitoral stimulations. As a result, among couples who equate “sex” and “intercourse,” men have orgasms around 95 percent of the time, but women’s rate is only around 50 percent.  But when men provide gentle, extended oral, women’s rates of orgasm increase to around 90 percent.

Cunnilingus automatically lubricates the vagina with saliva. So what if it isn’t as slippery as a commercial lube? During cunnlingus the man’s erection doesn’t enter the woman’s vagina, so friction and irritation are not issues. And so what if saliva dries faster than lubes? If the man provides extended cunnilingus, he’s constantly refreshing the saliva on the vulva and clitoris, so drying isn’t an issue.

Lubes may or may not do more harm than good. But lovers can easily skirt this controversy—and increase women’s likelihood of orgasm—by incorporating more cunnilingus into lovemaking.

The Odd Psychology of Goosebumps

“Skin Orgasm” might be a great name for a punk band or a body lotion, but it’s also another term for goosebumps.
Physiologically speaking, your hair stands on end when your arrectores pilorum muscles contract after your nervous system detects a stimulus like cold or fright.  For most mammals, it’s an adaptation that modifies body temperature by providing more insulation. Chimpanzees, dogs, and cats have evolved a secondary “social warning” function where the raised hair means danger is at hand (Chaplin, et al., 2014). My chocolate Lab sports mohawk hair along his spine even when the neighbor’s dainty little Bichon strolls by. Go figure.

Approximately two thirds of us regularly experience “the shivers” with art—this is the feeling that's been dubbed skin orgasm. You might be in this group if you’ve ever felt the chills while watching a dramatic movie scene or listening to an awe-inspiring piece of music. A fan of classical music might feel a tingle down his back from the opening flute lines of Mussorgsky’s Night on Bald Mountain. My personal favorite is the haunting and commanding chorus in Carmina Burana. Speaking of power, how about the brass section blasting the very first notes in the Rocky theme song? Or the hairs on the back of your neck might rise in a piloerection (from Latin pilo meaning “hair”) brought about by John Cusack’s boombox playing Peter Gabriel’s "In Your Eyes" in Cameron Crowe’s classic teen flick Say Anything.

An “aesthetic chill” can happen whenever there is a quick change in volume, key, melody, or anything else that affects the atmosphere of a song. Part of the responsibility of an artist is to create music that moves the soul and takes you on an emotional journey. There are certainly go-to tricks and intensely emotional chords employed by filmmakers and musicians, but there is no set way to manufacture this sensation on command.

However, personality plays a role. The five factors most widely used to classify personalities are conscientiousness, agreeableness, neuroticism, openness, and extroversion. Collectively, these “Big Five” factors do a nice job of capturing many of the important dimensions that make us who we are. It is not a diagnostic tool that assesses abnormality or mental illness (Obsessive-Compulsive Disorder, depression, schizophrenia, etc.), but it is able to capture many of our interesting nuances.

For example, individuals who score high on the Openness factor are prone to piloerections from emotional and dramatic events. They enjoy the frisson that comes from watching YouTube videos of hockey player Mario Lemieux taking the ice for the first time after overcoming Hodgkin’s Lymphoma. It’s similar to the shudder of emotion one gets from listening to unedited footage of Martin Luther King Jr.’s "I Have a Dream" speech.

The element of surprise is what connects the psychology of openness and the physiology of goosebumps. The first time I heard John Bonham’s bombastic drums fall from the sky on "Stairway to Heaven," I wasn’t expecting it. Aesthetic chills usually include a violation of expectations with a rapid change—in tone, volume, melody—that wasn’t anticipated. People high on the Openness factor intentionally seek out and enjoy new experiences that break from normal patterns; it’s just what they do.

Games to Cure Common Sex Problems

Too fast or too slow (or not at all!) Premature ejaculation for men and anorgasmia (no orgasm) for women are the two most common sexual problems that plague a couple’s sexual experience. Anxiety is the root cause of both problems - the majority of the time.  Ironically trying to do exactly what the problem is turns anxiety around slowing him down and speeding her up.

Premature ejaculation - Come fast!  A therapeutic intervention that works for many of my clients is the instructive to try to orgasm as fast as possible, to go for broke! 
1.Men ejaculate for two reasons – erotic stimulation and anxiety.   When a man worries that he will climax too quickly, he probably will.  His fear lowers the body’s threshold for excitement.  Trying to achieve orgasm quickly, ironically, stops him from guarding against orgasm happening too fast.  He relaxes and voila – climaxes more slowly. Reframe the issue – make it a positive.  Tell her she is so sexy you are about to burst and will probably not make it past taking her clothes off.  Tell her she’s such vixon, you can’t contain yourself! Come once, do her, and come again!
2.Most women don’t climax with intercourse – men fear disappointing their lovers and become even more anxious.  But as it turns out, the disappointment is in his disconnect over his humiliation. While you might think that too fast orgasms and not-at-all orgasms are deeply connected problems, they aren’t really. She can still climax with manual and oral stimulation (which incidentally may turn him on again) but he is apologizing and rolling over with shame.  Stay connected and stimulate her saying how much you love and enjoy her body.  She may be thrilled with this plan – she gets hers and gets more sex because he’s not avoiding it due to performance anxiety.
3.Come fast first – by yourself.  If you masturbate a bit earlier before love-making, your staying power will likely lengthen.

4.Progressive stimulation exercises work! – Reduce anxiety further by knowing there is a simple solution if this is a long-term pattern. Let’s say your partner does climax with intercourse, simply enjoys longer intercourse, or you both want to last longer – no problem. Premature ejaculation is one of the easiest fixes for sex therapy.  Many, many couples suffer when less than 6 sessions might cure the whole problem.  In short – a man needs to be stimulated shy of where he can’t control the inevitable rise of excitement to orgasm.  Alone in the privacy of their own bedroom, the couples instructions start with manual stimulation, proceeding through oral stimulation, through to vaginal containment, then to thrusting, over the course of a few months.  Stage by stage, if the point of inevitability is an 8, then a man stops the stimulation by indicating that he is at a 6.  He rests.  They start again.Lack of orgasm - Don’t come – most of the time, a woman’s lack of orgasm is situational due to her inability to relax and inadequate stimulation.  She mostly compares herself to the male pattern of easy arousal and easy orgasm and decides that she’s “taking too long.”  (Or worse – her male partner thinks the same thing!) Psychologically, telling her to take longer or to not climax (yet) refocuses her on what sensations she is feeling rather than on what she is not yet feeling.Women need the 20/20 solution – women compare themselves mostly to men whose arousal is complete in seconds and who can climax in a relatively short number of minutes.  But if women compared themselves to what other women need and if their male partners understood this need, women could relax. Most women need about 20 minutes of general whole body arousal followed by at least 20 minutes of direct genital stimulation.
5.Instruct her not to come – her mind is wandering somewhere above the bed, watching and waiting for the magical moment when she realizes it is her night.  Telling her ‘not to come’, introducing an element of control that is about “letting” her climax rather than her “making” herself get there – changes everything.
6.Most women don’t climax with intercourse – again, I repeat this to take the pressure off the male penis and to say to women – you are not dysfunctional if you don’t climax this way.  It’s normal not to.  The woman’s sexual nerve center is her clitoris not her vagina.
7.By yourself – learn to climax by yourself in different positions trying to last as long as possible before climaxing.  Many women learn to climax in childhood through self-stimulation in only one position (often on their stomachs) and have difficulty transitioning to partner sex that requires lots of variety.
8.Slow down – women patients tell me that their husbands/partners often speed up stimulation once they sense the woman is not getting there.  For her, slowing down stimulations allows her to feel without a hurry.  Rushing her, causes anxiety to countermand arousal.
9.Primary anorgasmia can easily be overcome– helping a woman who has never reached orgasm, is the other simplest sex therapy fix.  Without consistent orgasms a woman won’t have libido.  This is so elementary, it always surprises me when one or both partners assumes that sexual desire would continue when only one partner reaches climax sometimes for years on end.  Many women become orgasmic in 1-3 sessions of sexual instruction with the use manual stimulation, vibrators or masturbation.

Losing Time: Sexual Absorption and the Body

Altered states of consciousness are extreme states of absorption. These states are characterized by a loss of the usual sense of self, time, and space as a result of intense attentional focus on what is happening right now, combined with feelings of euphoria. Humans have always sought out these experiences. Excesses of Friday-night visits to the pub or trance-like club dancing under the influence of sometimes illicit drugs are testimony of the human desire to let go of the ordinary self.

Drugs are illicit and can be dangerous. Legal drugs, such as alcohol, have severe side effects — we often painfully realize that the next morning. Meditation is an extremely powerful way to lose the sense of self, as I have written before in this blog, and it is related to happiness and physical and mental health, as many scientific studies have shown. But in order to reach such levels of altered states of consciousness during meditation, long-lasting self-discipline is needed; one might have to meditate regularly for years.

There is one way to reach altered states of consciousness that is related to the heights of spiritual love. It is healthy for body and mind by all means and can be shared with a partner. I am writing about sex. Sexual desire and fulfillment can induce such an absorbed state and lead to extremely joyful altered states of consciousness. During sex with a beloved partner, one is so focused on her or him that ultimately the sense self, time, and space is lost. That is the unio mystica felt in love, being one with the other.

Rui Miguel Costa is a clinical psychologist from the William James Center for Research at the Instituto Universitário in Lisbon, Portugal. His research interests lie in the psychological and medical aspects of sexual behavior. He recently conducted a study, which was published in the journal Consciousness and Cognition, to investigate how the intensity of absorption during sex is related to sexual pleasure. We worked together, because I had developed subjective scales to assess the sense of self, time, and space in various states of consciousness, such as in meditation. Costa and his team then asked 116 heterosexual Portuguese women and men to remember their last sexual encounter and to rate how intensely they had felt their body, time, and surrounding space. In addition, we asked how much desire and satisfaction people had felt, and whether an orgasm happened.

Results show that men and women do not differ in the intensity of absorption during sex. However, there are some clear sex differences: Absorption is more closely connected to female desire, satisfaction, and orgasm than is the case for men. For women, greater satisfaction is related to more attention to the body and to an almost complete loss of the sense of time. In men, satisfaction, desire, and orgasm are less connected to absorption. For men, absorbed states do enhance the pleasure in men, but they are not as important for male orgasm as they are for women. A second part of the study was published in the International Journal of Impotence Research. The title of the journal is indicative of the importance of this type of research for clinical aspects. What Rui Miguel Costa and his team found out was that women, but not men, who are more sensitive to tactile pressure, as measured in the lab with a test of finger sensitivity, also reported more body awareness during the last sexual experience. Herein might lie a potential for enhancing sexual experience. In everyday life, one can learn to become more sensitive to bodily feelings through a hot bath, a massage, and mindful awareness of the physical self.

You Can Turn Your Own Sexy Light On: Orgasms Included!

So many women have asked me how to get their sexy on - in their own bodies. They want to know how they can turn themselves on! Do they need a partner? Can they relight their own pilot light? Raise their own sexual desire up a notch or two? They want to feel better in their own bodies. And they want to do it without sitting on a therapist couch. I get it. And I have some ideas! Of course I do! And as usual - my ideas come from my own real life experiences.

What do you know about Burlesque? Frankly, I knew just about nothing about it except that it was some kind of old fashioned stripping. I had no idea that it could be a tool of embodiment, self pleasure, and a libido lifter! Oh yeah - taking a Burlesque class can help you get your sexy on! I stumbled over it quite by accident on my Shameless book tour. I had a quiet afternoon in Seattle - and there was a inexpensive class being offered.

I don't know if it was the music, or the opportunity to take up sexual space (burlesque is all about big sexy movements) and turning on my siren energy - but I was getting hotter and hotter with every shimmy and shake. I loved "Knocking over the Tea Cups" with every swing of my hips. After the class I felt so damn sexy - and good about my body. It was amazing.

I started to go to a few Burlesque Shows while I was on the road reading and running workshops from city to city - and I got to see the fabulous Coca Lectric and Indigo Blue. I loved the costumes - and all of the body types being celebrated. Wow - I thought! How come I didn't know about this before? I couldn't believe how sexy I felt both participating in a beginner's class and watching the women on stage. It was an eye opener for me! Best of all - it was open to all. Even you!

Before I knew it - I was at S Factor in Chicago ( S Factor has studios in LA and NYC too). And another light bulb went on in my head! I toured the studios and fell in love with Sheila Kelley's concept of pole dancing to help women find their inner erotic creature! Oh my! They were talking my language! I loved that there were no mirrors in the studio - and the lights were dimmed. This was about feeling sexy from the inside out! This was about embodiment! Oh yeah - S Factor had lots of sexy clothes for sale (at reasonable prices) - but they were there to turn YOURSELF on!

How many times have I talked about dressy sexy for our own sexual engines! The staff was incredibly warm and supportive and came in all shapes and sizes! Don't let the gorgeous S Factor founder intimidate you with her amazing body - she got there from the inside out - and is making all comers feel welcome! I am ready to start pole dancing in NYC!

I know several women who are now dancing tango to turn themselves on - and a few experimenting with yoga! In fact at my upcoming Pleasure Now! workshop in Woodstock, NY - I am introducing "Shameless Yoga" with the fabulous certified yoga teacher - Lisa Rosenthal.

The fact is that we can turn ourselves on - and finding that sexy light inside of ourselves is often the best way to find true orgasmic bliss, self acceptance - and charging up our sexual core as an engine to power the rest of our lives. It's not about him ladies - it's about you!

Hating My Body, Doubting My Sexiness - Forget About Orgasms!

Most of us want to feel hot and sexy. We want earth-shattering orgasms - and to feel like those women look in those damn magazines sipping a Margarita with smoky eyes who are about to have the most incredible sex in the universe. Right? Maybe? Who knows - but I hate them.
Seeing those images can make me feel confronted with what I am not and leaves me with this feeling that I am not enough. More than that - it is this feeling that I will never have in my life what I truly want because I just don't look like that.

And what is it that I want - you may ask? It's a simple thing really....I want to be deeply desired, and feel free in my body. I want to be able to know that I am sexy from the inside out and truly believe it - all the time! I want to be able to walk around naked and not worry about my ass shaking in a bad way!

I want to get so lost in my own wanton sexiness that orgasms flow from me like a water fall.  I don't want much - I just want to dance in my own inner sexy wildness! Is that asking for so much?
Lately, I have really been confronted with my own self loathing. It is shocking that I can still go to those places of calling myself names. After all, this true confession is being spoken by a woman who has professed to the world that I have conquered body shame and self acceptance by embracing my sexual pleasure.  Am I a fraud - or am I simply real and honest? The fact is - that I have healed so much of the damage that I have walked around with for most of my life when it comes to my body image and my sexuality - but everyday as my feet touch the ground - it takes a little bit of courage to love myself just as I am. And that is the truth - to say anything else would be to over promise healing - like those 30 day miracle diets on television.

Today in the Wallstreet Journal there is a great article, Conquering Fear which is all about those nasty little voices in our heads that tell us that we are not enough - that we are fat and stupid. That our bodies are ugly - and that our boss hates us.
I know those tapes so well that I could sing a long! My book Shameless: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home in Time to Cook Dinner (Rodale January 2011) is all about my funny, sexy, unconventional path to falling in love with myself again in the most unbelievable way.... And I did.

But as I am getting closer to my book launch on January 18th - and my book tour - there are all of these promotional videos being made of me so that people can get to know me - and I get to watch them over and over again.
Every time I watch them - I get taken out of how I was "feeling" when I made those videos and I get stuck in how I believe I look. I hate my neck. My face is too round. I have a double chin in that angle. How did they shoot that angle? And I stop feeling sexy. Instead I get filled with self doubt - and worry. You see - I am a real woman. Isn't that reassuring? I am not going to give you pleasure platitudes and tell you that if you do this or that - all of your inner fears will go away completely. They don't. But it can get better.

This is what I can promise. If you work on embracing who you are - every single day just like a religious practice - things will change in your world.
In so many ways - it is like developing a healthy eating and exercising plan. There is a lot of self talk, and self encouragment that needs to happen. I have to do it too - even now.  Especially now! The voices of fear that tell us that we are not enough - or are broken in some way - don't ever really go completely away.

I hope that by showing up and being honest about how I feel and how I move through all of the hatefulness that I can throw at myself will inspire you to do it too. The fact is that most of the time these days - I feel smoking! I have a swagger to my step - and kick to my heels. I dress like a diva with a wink! And I still feel bad about my neck a lot.  You see - I still  have really big moments of self loathing. It's all a part of the process.....

Self loving is a practice. Let's practice together.

Why Partners Fake Orgasms, and What It Says About Their Relationships

My research career has primarily focused on understanding deceptive affection–that is, those times we express affection that we do not feel in the moment (or when we withhold felt affection). Most recently, we argued that pretending to orgasm was a form of deceptive affection (Horan & Booth-Butterfield, 2019) and conducted a study to better understand it (Denes, Horan, & Bennett). Before fully discussing this new study, I invite interested readers to consult a previous entry on fake orgasms or deceptive affection. 

Pretending to orgasm, colloquially referred to as faking it, is not uncommon. A 2010 study found that one-quarter of the men and one-half of the women studied had faked orgasms. In our new study, we aimed to understand how (in)authentic orgasms related to relational quality indicators (e.g., trust, closeness, and commitment), and how trait affectionate communication might explain findings.

We conducted two studies to better understand fake orgasms. In both, we instructed participants, who were in sexual relationships with another person, to complete self-reported measures within two hours of their sexual activity. Our first sample consisted of 319 participants, and our second included 139. Generally, our goal was to understand how the experience of orgasm related to relational quality indicators.

Results of our first study generally revealed that reports of relational quality indicators were higher for those who experienced an authentic orgasm compared to those who reported pretending to orgasm. Results of our second study revealed that trait affectionate communication helped explain our findings. Trait affectionate communication refers to the general tendency for someone to regularly be affectionate. As we summarize in our study:

     “… for individuals high in trait affectionate communication, pretending to orgasm is associated with higher ratings across the relational quality indicators, perhaps suggesting that such behavior is rooted in larger tendencies to show warmth and affection to others. Interestingly, the comparisons between those who pretended to orgasm and those who experienced orgasm were nearly opposite … Individuals high in trait affectionate communication who pretended to orgasm reported the highest scores for all three relational quality indicators, whereas individuals low in trait affectionate communication reported the highest scores for closeness and commitment when experiencing an authentic orgasm, and the highest scores for trust when they did not orgasm.”

Clearly, the authenticity/deception of an orgasm is a complex experience explained by a multitude of factors. Our new study adds to the conversation about this topic.
We have previously argued that pretending to orgasm is a specific form of deceptive affection. Like other forms of deceptive affection, we have argued that this tends to function as relational maintenance and/or face-saving. That said, it is likely that higher instances of regularly pretending to orgasm are indicative of underlying issues that warrant attention

Saying Yes to Female Orgasm

Among women of a certain tribal village, the  term most commonly used to describe an orgasm translates to something like, “Yes! Yes!”
It’s apparently world-wide. From James Joyce to When Harry Met Sally, something about that little word “yes” seems to connect to female orgasm in a deep way.

My guess is it’s because women have to learn in so many ways to say “no.” Cross your legs. Don’t make unnecessary eye contact. Don’t say yes on the first date.
Men don’t have that “no” thing going on so much. But for a woman to say “yes” in a whole-hearted way is a big deal.  As my Australian colleague Katherine Feeney wrote on returning from her honeymoon, in a piece entitled Saying Yes to the Female Orgasm -- 

‘In a word, the female orgasm is ‘‘yes.’’ It’s a big, gloriously large, wet, wonderful, resounding ‘‘yes’’. You cannot achieve it unless you consent, and enjoyment of it may be significantly enhanced with a throaty intonation of the word. At least once in her sex life, a woman should experience the full and frank pleasure of releasing the word “yes” as loudly and for as long as her lungs will allow.’

That same word, over and over, all around the world. The pent-up tension of a lifetime’s worth of saying “no,” all rolled into one big “yes.”
Oh My God, Yes
If you're a woman who yearns to greet orgasm with a more full-throated “yes,” then 2016 may be a very good year for you.
OMGYes, a new interactive website that calls itself “a modern, hands-on exploration of women’s sexual pleasure,” arrived with the New Year. And it’s all about that three-letter word.

The site’s founders Lydia Daniller and Rob Perkins, working with sex researchers Debby Herbenick, PhD and Brian Dodge, PhD from Indiana University's School of Public Health and the Kinsey Institute, altogether studied the masturbation techniques of over 2,000 women. Based on this extensive research, they concluded there are 12 basic elements of clitoral pleasure.

In case you’re wondering, the twelve elements are “edging,” “hinting” “consistency,” “surprise,” “rhythm,” “multiples,” “accenting,” “framing,” “layering,” “staging,” “orbiting,” and “signaling.” 
This is the first time the individual components of good clitoral technique have been presented in such an organized way.  Each element  has its own landing page, featuring interviews with several women who are keen on that element, followed by videos showing each woman performing the element on herself.


And finally, the piece de resistance:  An interactive touch-screen where you can try the element yourself on a virtual image of each woman’s vulva.
What??
Yes, you heard me right.  Your hand and her clitoris, brought together by the interactive magic of the internet. That’s the other new thing this site provides.

My fellow PT blogger Laurie Watson called OMGYes “The Khan Academy of the Cl*toris.” The Chicago Tribune’s Heidi Stevens gave it a very positive review, as did Justine Harman in Elle.
Intrigued, I took the system out for a test drive this weekend. I reported the results in an article, "Taking Female Orgasm to the Next Level," on Huffington Post. Check out the article if you want to see what it's really like to use the program.

The interactive portion of OMGYes can be disconcerting at first. Tracing your finger across the vulva of a woman you’ve just met online isn’t something most of us are used to doing.
You have to have done your homework to make the thing work. If you don’t remember what each particular woman has already told you and shown you about what she likes, you’ll get nowhere fast. 

The techniques each woman prefers are so specific and varied, that guessing will get you nowhere -- just like in real life. It's a good reminder that sometimes the best way to find out what turns a woman on is simply to ask. 
Trying it Out
So what’s the best way for a woman or couple to try out this new system? 

My recommendation would be to flip through the elements listed, and find one or two that speak to you.  For instance, if the words “hinting” and “consistency” ring a bell, then go right to those two. The program is like an encyclopedia:  too extensive to read cover to cover, but just right for zeroing in on what you need.

Resist the temptation to skip right to the interactive clitoral demonstration. Treat this like foreplay. Take your time watching the interviews at the start of each section. Then move on to the demonstration videos, before you go firing up the 2D interactive piece. You’ll find the experience richer and more rewarding if you’ve fully prepared for it.

If you find something in the program that you really like, then by all means share it with your partner. Watching your favorite sections together can be a wonderful idea. Or if you’re too shy for that, send your partner off with a list of clips you’d like them to see. 
When your partner returns eager to share everything they’ve learned, be ready to give them a live interactive demonstration. Don’t be surprised if the result is a deeper and more valuable experience together. 

As a sex therapist, will I be recommending OMGYes to couples? 
You bet.
It’s warm, wise, tasteful, and fun. I believe many couples will find this website valuable for taking their sexual communication to the next level.