Partner doesn't like doggie position

1) Dear Alice,
My partner says she does not care for the "doggie" position because it causes her pain. I, on the other hand like to experiment and want to try everything. I guess I want more than just vanilla and she says if vanilla is great, continue to go for it. I guess I'm trying to sort out facts first. First, I know that only about 8 percent of women engage in this position. I guess I want to try it occasionally because the position gives me sight sensory as well as feeling. Anyway, I tell her I'd do anything she wants, anything to satisfy her in exchange for having sex in this position. I guess it's an obsession which becomes more of an obsession when it is denied!
Back to what she says. First, is that the angle is painful. She says the position is against the normal "curve" of the penis as it would enter in missionary position. Now on to the emotional side. What happens is that she will eventually consent but then because I feel guilty I jackrabbit and I can't enjoy it! What can be done to stop the pain she says is there? Is some of it emotional?
— Barking up the wrong tree
2) Dear Alice,
I like to have sex 'doggy style' more often than I could at the moment because my wife complains that it is painful. Is that common?
doggy style

Dear Barking up the wrong tree and doggy style,
The pain your partners are experiencing could be due to a number of causes. Regardless of the percentage of people assigned female at birth who agree to have penetrative sex in the “doggie-style” position, as with all forms of sex, getting consent from your partner isn't only key, it’s necessary. Not only that, it can open up opportunities to explore new positions while also ensuring comfort for all partners. Doggy style, while this position can be exciting and pleasurable for you, it’s not uncommon for a partner who’s assigned female at birth to experience pain and discomfort. Barking up the wrong tree, it might also be worth exploring why you’re feeling guilty and why this position has become an obsession for you. Reflecting on what you and your partners want for your sex life, and how to respect each other’s choices, may provide some direction for how to move forward.  
Since your partners have stated that this position is painful, it might help to first understand some potential causes of that pain. One possibility is that there isn’t enough lubrication. Have you tried using water-based lubricant, or are you open to spending a little more time on foreplay? You may also want to ask if your partner would like you to stimulate their clitoris during sex or if more foreplay would be helpful for increasing their pleasure during the act. It’s worth noting that it can take some time for arousal (and in turn, adequate lubrication) to occur. This position could also be painful because you’re hitting the cervix with your penis. Instead of “jackrabbiting,” consider starting slow to help get things warmed up. If those causes don’t seem likely, it could simply be that you and your partner don’t fit as well in that way. The shape and size of the pleasure parts in these penetrative scenarios (e.g., penises/dildos/sex toys and vaginas) may be better suited for other positions that bring pleasure to all parties involved.

Have you tried or suggested other positions that may be more comfortable for your partner? You might take this as an opportunity to think creatively about the positions that’ll provide the stimulation you're interested in, while still finding a position that's comfortable for them. There are also variations of the doggie position that might provide more comfort, one of which entails you entering from behind while lying down next to each other on your sides, instead of attempting it on your knees. Checking in throughout while trying new positions and styles is key; it'll help you both learn a bit about what is or isn't pleasurable. Additionally, it's possible that even with these new strategies, your partner may still experience pain while in this type of position.
No matter what the cause of the pain or what position(s) you engage in, it’s critical that you and your partner both freely and willingly consent to every sexual activity. Barking up the wrong tree, you state that she "eventually consents" but a large component of consent is making space for partners to be honest and communicate about what they want to do and what they don't want to do, including different positions and sex acts, and then listening to what they've said. It must be enthusiastic and without manipulation or pressure. Could your feelings of guilt be due to the fact that your partner hasn't enthusiastically consented or hasn't consented without feeling pressured? Consent means your partner says yes not only with their words, but also with their tone and body language. If your partner doesn’t enjoy the position, it’s okay and it’s their right. Just like you have your preferences for doggie style, it’s their right to have their dislikes and sexual boundaries respected, and it's not okay to talk someone into or pressure them into a sexual position or activity that they don't like or want to do.
Another factor to consider is whether there’s something other than the physical that’s bothering them. Some people may feel as though the "doggie" position is something being done to them, as opposed to something in which they’re participating. It could also be that they feel distant from their partner when they’re not facing them. The only way to learn this is to ask and then listen to your partner's response to see how they feel. If your partner feels this way, you could offer to touch their body or wrap your arms around them to increase feelings of intimacy.
If your partner finds no relief or enjoyment in any of these changes, then it might be time to take a break from doggie style. Not forcing an issue is critical in any healthy sexual relationship and can give you both the time to relax, explore your sexuality together in other ways, and potentially come back to the doggie position at another, less stressful moment. Keep in mind that it’s possible that this isn’t a position in which your partner can participate pain-free. If this is the case, you'll need to determine how this position plays into your overall enjoyment of sex. Barking up the wrong tree, can you be in a relationship in which your partner doesn't consent to this position? Are you able to enjoy other types of sexual pleasure with this partner without this position being an obsession? In what ways can you enjoy sex without this position? If this is a sticking point for you both, you may want to reflect on the potential impact on your relationship because it's ultimately about what works for both of you.
Here's to wishing you both a happy, fulfilled, and consensual sex life.

Over-the-counter remedies for genital warts?

Dear Alice,
I found out that I have a genital wart on my penis. I went to the doctor a while back and he put some medicine on it and also gave me a prescription. After using the prescribed medicine for a few weeks, the wart went away. After a few months, the wart returned. I do not have any more of the prescription, nor do I have insurance anymore. My question with this is... can you use over-the-counter wart removal medicines on genital warts?

Dear Reader,
Wart on your finger? Wart on your penis? Although they're both warts, unfortunately, they don't have the same type of treatment. This for one very major reason: the skin tissue on other parts of your body (hands and feet, for example) is much less sensitive than genital tissue. This means that using over-the-counter (OTC) remedies designed for non-genital warts could lead to more anguish than your warts may already be causing you. Ouch! While there may not be OTC options, there may be other affordable ways to treat this wart (more on this in a bit).
Genital warts, like warts on the rest of your body, are caused by various strains of the human papillomavirus, commonly known as HPV. Strains of HPV that affect the genital area can be transmitted through any type of skin-to-skin genital contact (including anal, vaginal, or oral sex) and can stay unnoticed for long stretches of time without causing warts. HPV is one of the most common STIs (sexually transmitted infections) out there, so you’re not alone. It's possible for genital warts to flare up on occasion after treatment (as you have experienced). In case you’re wondering, STIs such as herpes or syphilis can cause sores in the genital areas that may look similar to warts. Sores caused by other STIs require different treatments, so seeking a diagnosis from a health care provider can help ensure you’re taking an appropriate course of action.

With time, genital warts may clear up on their own. Unless they're causing you distress or discomfort, the lesions themselves present little risk to you. Other strains of HPV (sometimes known as “high-risk” strains) are associated with more serious health issues, such as cancer. However, the strains that cause genital warts aren't the strains that cause cancer, so you may decide that leaving it untreated for now makes sense for you.
That said, keep in mind that the virus (though transmissible with or without visible symptoms) is more contagious during flare-ups and may be passed more easily to a sexual partner. Condoms and dental dams can help minimize the risk of spreading HPV and other STIs, but they're not 100 percent effective at doing so. Talking to partners about STIs can be awkward, but Planned Parenthood has some helpful tips for talking about HPV that might help you feel more comfortable navigating those conversations.
If finances are keeping you away from a health care provider, you may have access to some affordable options. Though it can vary from clinic to clinic, organizations such as Planned Parenthood often offer sliding scale fee structures, low cost, or free services to increase access to testing and treatment for STIs such as genital warts, even for people under age 18 (but this may vary by state). You might also contact your local health department to find out about affordable or free testing and treatment options near you.
When it comes to smoothing things over (down under), know that you have options despite your financial limitations. If you choose to wait it out and see if it heals on its own, make sure to communicate with future partners about potential risks before diving back into the sheets.

What's fisting?

Dear Just wondering,
It's understandable that you may not be up to speed on fisting. Chances are, most parents and health teachers don't cover this technique during the birds and bees talk. For now, they're excused, considering birds and bees don't have fists. Fisting is when a person puts their entire hand into another's anus or vagina. For those who enjoy this activity, it can be a highly intense and pleasurable feeling for both the receiving and giving partner. While many enjoy the sensations, there can be risks involved. Fisting can create intense pleasure, but can also cause pain and tissue damage. Throughout the experience, it's critical to keep the lines of communication open and check in frequently with partners about how they feel. The key is to go slow and talk about how it feels, and set the expectation that any partner can decide to stop at any point. It’s a sexual activity that requires trust, communication, preparation, relaxation, patience… and lots of lube.
Spontaneity can be great, but this is an activity where it’s worth spending time doing some homework before getting a fist wet. For safety's sake, it's best that fingernails on the hand that's going in be as short and smooth as possible. Next, it's time to gather safer sex materials, including a few pairs of latex or non-latex exam gloves and ample lube. Like condoms or dental dams, the gloves act as a barrier against transmission of any sexually transmitted infections, and as a bonus the material makes entry smoother. For vaginal fisting, water-based lube is a good choice since it’s generally non-irritating; silicone lube could also be used, as a thicker option. For anal play, an oil-, water-, or silicone-based lube can provide long-lasting lubrication. One disadvantage of oil-based lubes is that it can break down latex; that being said, another option can be to use nitrile gloves, which are oil-resistant. Another consideration is that oil-based lubricants can block pores and cause acne breakouts for those with sensitive skin. For more information about lube varieties, check All about lube in the Go Ask Alice! Sexual & Reproductive Health archives.

Before diving in, it might be helpful to engage in a lengthy session of foreplay to loosen up. It can be helpful to apply plenty of lube to the fisting hand, completely coating the flat parts of the hand as well as the fingers and thumb. When the receiving partner feels ready, it's good to begin by slowly inserting the fingers, one at a time, into the vagina or anus, eventually entering the body with the hand in the shape of a duckbill. When reaching further in, the fingers might curl over the thumb to make a fist. In this situation, it might be good to have the receiving partner call the shots and let their partner know what feels good or doesn’t. Once the hand is inside, the fisting partner may try gently clenching and releasing the hand as if squeezing a stress ball to "fill up" the receiving partner. Due to pressure of the vaginal wall or anus, the fisting partner may feel like their hand is being squeezed uncomfortably. If this happens, it's good to be careful not to jerk out the hand suddenly, which may hurt the receiving partner. It can be helpful to check in when it comes time to remove the fist so both partners are ready. It may be easier to remove when the receiving partner orgasms. To remove the hand, the fisting partner can gently uncurl the fist while sliding the hand out.
With patience and practice, fisting can be an incredibly fulfilling experience, but there are risks involved. If the receiving partner has any pain, fever, or bleeding afterwards, it's highly advised to seek medical care right away — these symptoms may indicate a tear in the vagina or rectum. In a couple of rare cases, fisting mishaps have led to the death of the receiving partner, which is why communication, taking it slow, and paying attention to any symptoms associated with the act are so key.
With an awareness of the risks and a commitment to care, communication, and preparation, fisting can be a deeply enjoyable experience for those who seek it out.

Will sex-ercise burn calories?

Dear Curious,
Burn, baby, burn — talk about a great workout! While you may experience some of the same physical effects during sex as you would during a vigorous workout (sweating, rapid heartbeat), you may not want to rely on sex as a main source of physical activity. Sex may not burn as many calories, but it still has a number of other benefits!
Many people believe sex burns more calories than it actually does. According to various research, it’s estimated that a person can burn about 20 calories during six minutes of sexual activity, and approximately 77 to 105 calories during a 25-minute timeframe. As with any physical activity, calorie expenditure during sex will vary depending on a person's weight, sex assigned at birth, overall fitness level, and the type of sexual activities involved, as well as the duration, intensity, if orgasm occurs, and position during sex. Research on sexual activity and the heart suggests that the maximum energy expenditure during sex occurs during orgasm but returns to its usual rate within two to three minutes after. So, while you may burn more calories during orgasm, this higher rate of metabolism isn’t sustained after orgasm has ended.

When compared with aerobic activities, sex doesn't burn nearly as many calories. For example, dancing and running may burn two to five times as many calories as sexual activity during similar timeframes. While sex may burn 77 to 105 calories in 25 minutes, doing an endurance exercise on a treadmill for 30 minutes burns approximately 250 to 555 calories, and dancing for 30 minutes is thought to burn about 90 to 266 calories. It can be helpful to remember that calculations to determine how many calories are burned are only estimates, and different studies have resulted in different estimates.
It may be helpful to check out the Go Ask Alice! Nutrition & Physical Activity archives for more information on energy expenditure and how it's calculated. Additionally, if you're interested in finding ways to burn calories or achieve a higher level of fitness, you may consider starting or maintaining a regular physical activity program. You could check out the Centers for Disease Control and Prevention for recommendations regarding physical activity and calorie-burning.
That being said, while there are estimates of calorie burn for various activities, there are numerous benefits to aerobic activity that go far beyond calorie burn. Be it stress relief, stronger muscles, or increased energy (among many other benefits), cardio activity can help to keep the body going. Besides calorie burn, other benefits of sex include a reduction in stress and anxiety and increased calmness. So, while sex-ercise may not be the most effective option for calorie burn (if that's your goal), you can still enjoy sex for the other benefits it provides!

What to know about dry orgasms

Dry orgasm, or orgasmic anejaculation, means that orgasm occurs without ejaculation, so the penis does not release semen as usual.
There are several possible causes of a dry orgasm. Some are temporary, but others may be long-lasting or even permanent.
Dry orgasms themselves are not a health concern, but the underlying issue may require treatment in some cases. Dry orgasms can take a mental toll if a person feels embarrassed to discuss the issue with a partner. They may also affect a person’s ability to have children.
Treatment is available for some causes of dry orgasm, so it is best to see a doctor for a diagnosis.
One common cause of a dry orgasm is having repeated orgasms.
Having multiple orgasms in a short period may cause a dry orgasm. It takes time for the body to replenish its semen stores, and having numerous orgasms can deplete these stores. This issue is not typically a cause for concern.
Some people regenerate semen faster than others, but the body should start producing more semen after a few hours of rest.
Genetic abnormalities
Some people do not produce enough semen to ejaculate, which may be due to a genetic abnormality.
If this is the case, there is nothing wrong with the person’s health.
Testosterone deficiency
Low testosterone levels may also contribute to reduced ejaculation, particularly as a person gets older, and their testosterone levels decline. It can also occur in people with hormonal imbalances.

Blockages

Some dry orgasm issues may also stem from blockages in the urethra or ejaculatory duct, which is the small tube through which the semen travels during ejaculation.
A cyst may grow within these ducts, or sperm may become trapped and fail to leave the body.
Nerve damage
Nerve damage may also lead to issues with ejaculation. Nerve damage may occur as a result of an accident that causes spinal injury or as a complication of another condition, such as cancer, diabetes, or multiple sclerosis.
Surgical treatment in a part of the body close to the penis may also cause dry orgasm.
A person who undergoes the removal of their prostate, bladder, or lymph nodes may no longer produce semen or ejaculate. These surgeries may affect the muscles or nerves that play a role in ejaculation.
For example, surgeries for prostate cancer that remove the prostate or seminal vesicles will result in permanent dry orgasm. As the American Cancer Society note, the testicles will still make sperm cells, but the body will reabsorb them rather than producing semen.
This reabsorption does not harm the body or lead to any complications other than dry orgasm.
Surgical procedures and other medical treatments that may affect ejaculation and lead to dry orgasm include:
cystectomy
prostatectomy
open prostatectomy
laser prostate surgery
lymph node dissection
transurethral resection of the prostate, or TURP
transurethral incision of the prostate, or TUIP
transurethral microwave therapy, or TUMT
radiation therapy

Female orgasms: What you need to know

Unlike some animals, human females can have sex any time of the month, and they do not have to orgasm to ovulate or get pregnant.
Male-dominated scientific norms mean that much about the female orgasm remains misunderstood, and many harmful myths persist.
A female orgasm can be highly pleasurable and occur during masturbation or sexual activity with one or more partners. Scientists are unsure whether it has additional benefits.
In this article, we look at why female orgasms occur and what happens during an orgasm. We also debunk some common misconceptions.
The benefits of the male orgasm are clear. Men must ejaculate to deposit sperm in the vagina, possibly leading to pregnancy. The male orgasm, therefore, serves a clear evolutionary purpose.
The purpose of the female orgasm is less clear. Researchers have suggested numerous potential benefits, but few have been rigorously tested, and no theory has conclusive scientific support.
Not everything the body does has a clear purpose, however. Scientists have not discovered the evolutionary benefits of some traits that have persisted in humans.
A 2016 study argues that the female orgasm may have no obvious evolutionary benefit and that it may be a relic of a time when the hormones associated with orgasm were necessary for a woman to ovulate.
Since there was no evolutionary need to eliminate the female orgasm, it persisted even when it was no longer necessary for fertility.
Orgasm may serve important purposes, however. The pleasure it can cause can encourage females to have sex. This may also promote bonding with a sexual partner, which does have significant evolutionary benefits.

What happens during an orgasm?
During arousal, blood flow to the genitals increases, causing them to become more sensitive.
As arousal increases, a person’s heart rate, blood pressure, and breathing rate may also increase. As orgasm approaches, the muscles may twitch or spasm. Many women experience rhythmic muscle spasms in the vagina during an orgasm.
Several researchers have proposed that sexual response follows specific stages, though their theories about these stages differ.
Still, most theories include the following stages:
excitement, during which arousal builds

plateau, during which arousal increases and levels off
orgasm, which causes intense feelings of pleasure
resolution, during which arousal diminishes
Many females are able to have another orgasm after resolution, whereas males usually require a period of rest before having another orgasm.
Health benefits
While the internet is filled with articles promising that orgasms improve skin, hair, and overall health, there is little scientific evidence that orgasms offer any specific health benefits.
Scientists have not identified any evolutionary benefits of female orgasms or found that orgasms improve health.
But orgasms are pleasurable, and pleasure can be its own benefit. Pleasurable sex may improve a person’s mood, relieve stress, boost immunity, and foster better relationships.
Women do not need to orgasm to get pregnant. However, a limited body of evidence suggests that orgasms may boost fertility.
One very small study, for example, measured whether there was better sperm retention after female orgasm. While the results confirmed this, proving that the female body retains sperm better after an orgasm will require larger studies with designs of higher quality.
People hold many misconceptions about female orgasms. Some myths include:
Women who cannot orgasm have psychological problems.
While trauma, relationship issues, and poor mental health can make it more difficult to orgasm, many people with healthy sexual attitudes and good relationships still have difficulties.
An orgasm is both a physical and psychological response, and numerous health problems can make it more difficult to enjoy sex in this way.
Some people struggle to orgasm due to inadequate lubrication. This may happen while taking hormonal birth control, or during or after pregnancy, or due to menopause.
Also, women can experience vulvodynia, which refers to unexplained pain in the vagina or around the vulva. Treating this and other medical conditions may improve sexual pleasure.
Orgasms from penetrative sex are common or the healthiest form of sexual expression.
Self-appointed experts, mostly men, have long told women that they must orgasm from heterosexual intercourse. However, many women can only orgasm from clitoral stimulation.
Sigmund Freud argued that the vaginal orgasm was the superior and more mature orgasm. No evidence supports this claim.
Women cannot have vaginal orgasms.
While vaginal orgasms are less common than those from clitoral stimulation, some women have them — with or without other stimulation.
The female orgasm can result from many types of stimulation, including vaginal, clitoral, and nipple contact.
Not everyone orgasms from the same type of stimulation.
Women need to be in love to orgasm.

Advice: The Part-time Lover

Q: My husband and I are very happy together, but he will only have sex with me every three days. When I ask him what the problem is, he tells me that it takes three days for a man's sex glands to recover, and that having sex more frequently may cause his organs permanent damage. I've never heard this before; I wonder, is he telling me the truth, or could he be hiding some other issue?
A: Here are some basic facts. The time it takes after orgasm for bodies to return to normal levels of functioning is known as the refractory period. Heart rate, breathing and blood pressure return to normal levels. It may take a few minutes for sexual responsiveness and the capacity for erection to be restored. It certainly takes time to restore the capacity for orgasm.
As men age, the refractory period generally gets longer. It can vary from a few minutes to a day or more. There is no invariable rule, as the refractory period normally varies with any one man and varies from man to man. In general, with age it takes a longer period of stimulation to produce erection and ejaculation. Direct stimulation of the penis is helpful and often necessary,
Also as men age, the amount of semen ejaculated may be reduced. Semen consists of sperm and secretions produced by the prostate and other glands.

At the very least, your husband is operating on a misconception. It would be helpful to provide him with information. There are many authoritative websites that provide information.
But he may be operating on a deliberate lie. He may be saving his sexual energy for another partner.
You can tell a lot from the sex you now have. Is your husband open to an extended period of lovemaking that satisfies you both, both emotionally and physically, and that may involve multiple orgasms, or is sex a very perfunctory event?
If you have great sex and your husband is warm and responsive for as long as you both want or need, then it sounds as if you indeed have a lot to be happy about.
But if your every-three-days sex is an act engaged in not so much to exchange affection but to release a single orgasm, then you have cause for concern.
For starters, why don’t you try approaching your husband more often in bed?

Who Says Pills Kill Sexual Thrills?

What's good for the goose isn't good for the gander, at least when it comes to sex and some types of antidepressants.
Prozac and its pharmaceutical peers—officially known as selective serotonin reuptake inhibitors, or SSRIs—have been gaining a reputation for inhibiting sexual desire. So when Lisa Piazza, M.D., of Cornell University Medical College, placed a group of 25 depressed people on SSRls, the surprise was not that the sexual functioning of the men got significantly worse—but that of the women significantly improved.


After six weeks of treatment, Piazza found that sexual desire, psychological arousal, and overall sexual functioning improved for the women, while ease of orgasm, satisfaction from orgasm, and overall sexual functioning deteriorated for the men.

Side effects from SSRI treatment may simply be less common in women, says Piazza. She also points out that the women had greater sexual impairment compared to the men at the beginning of the study, as a result of their chronic depression. Their low starting point left ample room for improvement.

Masturbation Is Sexual Health

Here we are again in May, which was dubbed as “Masturbation Month” in the 1990s by a clever purveyor of sex toys. And yet here we are in 2020 and talking about masturbation is still taboo in most of society. And that’s a shame, literally and figuratively, because masturbation is still widely considered shameful, and because for most people it’s a healthy and normal activity. There is actually a term these days for those who prefer masturbation over other forms of sex: solosexual.
Gold standard of sex
Many people have the idea that in order to call something “sex,” it must meet the “gold standard,” that is, penetration that probably ends with an orgasm. We downplay and devalue the idea that having sex with oneself is normal—even though nearly everyone does it—and is somehow shameful. We rarely talk with our children about it, and various preachers, both religious and secular, tell us that touching oneself is either a sin or something to avoid. From my point of view, we’re in need of expanding the definition of sex, not restricting it to the “gold standard.”
Couples and masturbation
Even after 35 years of being a therapist, I’m still surprised when I ask couples if they have ever talked about masturbation, and they look uncomfortable and tell me “no.” This is particularly true of mixed-sex couples, whereas I more often hear a “yes” from same-sex couples who have negotiated, talked about what is and isn’t okay, and agreed to respect those boundaries.
In therapy with mixed-sex couples, I sometimes hear, “You shouldn’t have to masturbate, you have me!” However, my sense is that most people in relationships do masturbate, whether or not they share that information with their partner. They shouldn’t assume that because their partner masturbates, it’s taking something away from them. It’s not, necessarily. We are perfectly capable of having sex with our partner and with ourselves. I would say, however, that having a candid conversation about masturbation—how often we do it, what turns us on, what type of porn that turns us on when we masturbate, and so on—is a healthy and liberating thing. I’ve had couples tell me that they had no idea about their partner’s erotic fantasies, and that it really turned them on to talk about them. 
There are definitely times where a partner prefers masturbation over partnered sex. This is normal. Masturbation is quick and easy, whereas partnered sex demands more negotiation and time. If either partner feels that their masturbatory habits do interfere with the relationship, this invites a sexual health conversation with the couple.
Understanding yourself

When I ask clients about their sex drive, inevitably someone tells me that they have a low sex drive and consequently aren’t having sex, or as much sex, with their partner, and yet are masturbating twice a day. This indicates that they have a higher sex drive than they think they do, but that having partnered sex is desired at a different frequency. This suggests a discussion around the fact that their regular masturbation indicates a higher interest in sex with themselves, or could be related to problems in the relationship. Especially in such a case, dialogue around interest in solosex in a relationship needs to be openly explored. I discourage partners from keeping it secret. That said, both partners can agree that their own masturbatory habits are private. This is an explicit contract that is agreed upon by both.
Orthodox religion has taught unorthodox ways
I’ve had deeply religious clients who were instructed to never touch themselves. But it's difficult to suppress something so deeply a part of being human. So, they’ve resorted to putting their penis between two pillows and getting off. Forbidden to touch themselves, they find a way—like rubbing up against a mattress or the floor. The problem for some of these individuals who have come to my office for help is that having masturbated in this way has made it more difficult for them to be sexual with others. As a sex therapist, I guide these clients through talk therapy on how to move to sex with partners. There is no right or wrong way to masturbate, and one is only limited by their imagination. However, if it limits you in ways you do not want to be limited, then seeking help is the right thing to do.
Solosex is healthy and okay
If you’re not in a relationship at the moment—or even if you are—don’t let anyone tell you there’s something wrong with pleasuring yourself. In fact, make it an event, a date with yourself! Light candles, pour yourself a glass of wine and crawl into a bubble bath with romantic music playing in the background. Try a new sex toy. Read an erotic story. Spend a couple of hours turning yourself on.
One client said that his spiritual teacher told his students, “If you’re feeling ungrounded or confused, lie down and touch yourself. Your body is as sacred as every other thing in this world.”  
Things to consider:
    Masturbation is sex
    Masturbation is okay
    Not masturbating is okay
    Masturbation with a partner is sex
    Self-pleasure is okay
    Masturbation without orgasm is okay
    Masturbation with orgasm is okay
    Masturbation in and of itself doesn’t take away from sex with a partner
    Masturbation can be a way to self-soothe
    Masturbation can include sexual fantasies
    Masturbation can include no sexual fantasies
    Masturbation with a Fleshlight, vibrator, or any sex toy is okay
    Masturbating while watching porn and reading erotica is okay
    Masturbation can be your entire sex life
There’s no right or wrong way to masturbate unless it begins to interfere in other ways you wish to be sexual. For example, getting used to a certain grip for males can interfere with sensation during penetration. Some women get used to a vibrator and are not sensitized to oral or manual touch exciting their clitoris. These are correctable simply by taking breaks from masturbation or using a vibrator, and changing your grip. 
Sex educator, author, and artist Bette Dodson calls masturbation “erotic meditation” and says that you are your safest sex partner. I couldn’t agree more.

Freeing Ourselves From Valentine’s Day

I don't expect to have sex on Valentine's Day. Neither should you.
It's OK if it happens, of course; I just don't expect it.
My patients have shown me over and over that expectations like that create problems. It's even worse when you don't tell your partner what you're assuming.
But say you're like many people. You look forward to sex on Valentines Day, or your birthday, anniversary, weekend away, or the day that the kids are with their uncle. You buy a bottle of champagne, or frilly underwear, or flavored condoms. Maybe you drop a few hints. Maybe your partner gets the hint, maybe not. You aren't quite sure.

You tell your best friend what you hope will happen. Maybe you say it better happen--after all, you two don't do it as much as you used to. And you get plenty of support from the usual suspects: Cosmo, Maxim, every sex advice website on the planet. They tell you to make the sex a big deal, prepare for a special night, make this the first day of the rest of your sex life.

Or let's say you don't expect (or want) sex on Valentine's Day, but you think your mate probably does. And it better be great, right--you figure that's probably what your partner's thinking. Are you up to the challenge? Can you lose 6 pounds in 3 days so you feel sexy? Are you prepared to "give" your partner the best orgasm in history, knowing that you'll be bored or self-conscious or a little sore by the time the big moment happens--if it does?

Is it possible to load more pressure on our sexuality?
Is it possible to invite more disappointment, more misunderstanding, more frustration? I don't think so.
It's bad enough that there's a special holiday on which people are supposed to drop the everyday, truly meaningful ways they expression affection (like changing the catbox when it's not your turn) in favor of made-up stuff like chocolates, flowers, and limo rides. It's worse when people imagine they "should" have sex on this day (often in the middle of the week!), disrespecting all the reasons they don't have or don't enjoy sex as much as they used to.

Sex on Valentine's Day? If you want it, let your partner know--and don't expect it. If your partner says no, don't take it personally. Just like having sex means different things to different people, so does not having sex. And if your partner wants sex but you don't, be friendly and say no thank you. Do not have sex if you don't want to. People who do that give sex a bad name.

Valentine's Day: the day of erotic pressure. Don't blame Hallmark--we do it to ourselves.
So don't!

Child.ol'.a.try

Frank and Gina* were the couple friends admired most—intellectual, funny, professors who taught on the same campus. They seemed perfectly matched. But after the birth of their first child, their sex life dropped out, they bickered incessantly, and both started taking antidepressants. Twenty years later, they're still married, with thriving careers and successful children, but privately they have been unhappy for a long time. "I used to feel that I was the light of her life, and now I feel as though she's annoyed that I'm still here," says Frank, who perpetually contemplates separating.
Close to half of today's marriages end in divorce, but that doesn't mean that couples who stay together are happy. "Even those marriages that remain intact have generally become less satisfying," says Eli Finkel, a professor of social psychology at Northwestern University.
Many couples carry on dutifully with the task of raising a family, showing a brave face to the world while secretly stuck in a mild but chronic depressive state I call "depressively married." Modern marriage, I believe, has hit a perfect storm—a collision between our biology and our contemporary values regarding marriage and child-raising.
Most unhappy marriages seem to founder on the same rocks: children. Noted marital researchers John and Julie Gottman, cofounders of the Gottman Institute in Seattle, conducted a long-term study of 130 newlywed couples. "The data shocked us," John says. Two-thirds of the new parents self-reported that they were "very unhappy after the birth of their first child."
More than a hundred studies show that marital satisfaction falls off a cliff after the birth of the first child and doesn't get much better until the last child leaves for college.
Couples have been having children since the beginning of time; why have they become such relationship-killers only now? According to Stephanie Coontz, author of Marriage, a History and professor of history at Evergreen State University, until the 19th century, marriage served the purposes of reproduction, economic security, and the creation of alliances between families. No one would have dreamed of resting such a cornerstone of society on something as fickle as love. There was little room for feelings of disappointment.
By the 1950s, people married predominantly for love, although divorce was still rare. In the Leave It to Beaver marriage, men and women had separate roles, separate sets of friends, and separate leisure activities. Children were told to go out and play (and no one felt guilty about it). As long as women performed their "marital duty" (whether they enjoyed it or not), sexual adjustment in marriage was deemed good enough. And if either partner had an affair, it seemed easier to keep the fact secret than threaten the relationship.
In the 1970s, with the sexual revolution and the birth of modern feminism, marriage underwent a second transformation: Simultaneously, the bar of our expectations was raised while the resources we gave to our relationships were diminished.
In the contemporary era, couples expect to be best friends, to have complete equality in all spheres of life, and to sustain an ongoing romance with mutual sexual satisfaction—and an exclusive relationship at that.
At the same time, modern marriage is accompanied by ever more dedication of time and resources to children.

These are Olympian expectations, but you'd have a better chance of winning the actual Olympics. The new marital ideal is, observes Coontz, "like the little girl with the curl; when it works, it's really, really good. And when it doesn't, we feel deeply betrayed."
Orgasms for All
By the 1970s, Americans had discovered the female orgasm, and sex became an equal opportunity enterprise. While the shift has expanded human potential and produced richer sex lives for men and women, it has also made postbaby adjustment a more shocking disappointment and a recipe for depressive marriage. Sexual satisfaction is one of the best predictors of overall happiness. Yet in one study, only 12 percent of couples reported not having "serious sexual problems" after having children.
It's no one's fault. The abrupt change in sexual connection between partners is hormonally influenced. Throughout the nursing years, prolactin production depresses the sex hormones estrogen and testosterone, biologically encouraging women to de-emphasize mating and focus energy on keeping their newborn alive. Further, as breastfeeding stimulates the bonding hormone oxytocin, it prompts a shift in attention toward baby and away from husband.
A sexual chasm opens between partners that wasn't there before. The Gottmans found that a full three years after childbirth, women report feeling "not very sexual" and want sex no more than "every week or every other week," while men report feeling "extremely sexual," wanting sex "every day." And when couples do have sex, there is a great discrepancy in their enjoyment of it. Men have orgasms six times more often than their partners.
Many men suddenly feel undesired and unloved. "Something inside them just breaks," says Julie Gottman. The dramatic switch in women's attention from mate to baby, guided by oxytocin, may be "evolution at its best, but it is detrimental to intimacy between the partners." What's good for reproductive success is bad for 21st-century marital success.
Some couples survive the transition to parenthood happily. Those who do, the Gottmans find, put the brakes on being child-centered. Studies show that couples who do more things alone together are happier. Yet today's parents, by substantial margins, spend less time alone together, less time entertaining friends, and less time in leisure activity than their parents did—primarily because of an increase in time spent intensively parenting their children.
Here's the paradox: We expect more from our marriages but feed them less. As Maryland attorney and divorce mediator Nancy Caplan puts it, "The end of the 'go out and play, and don't come home till dinner' era has sucked the life out of our marriages."
Perhaps it's time to consider taking a page from our parents' book on this: Take vacations without the kids and play tennis or golf—or anything—with our spouses instead of standing on the sidelines watching a pack of 8-year-olds swarm around a soccer ball.
Only in the past two decades have we developed the idea that children need an audience for their play. Are they really better off with hovering parents, or are we creating what PT Editor at Large Hara Estroff Marano calls "a nation of wimps"? Is it a coincidence that this generation of children, who have had to do almost nothing on their own, are returning home from college incapable of earning a living? Instead of blaming the economy, perhaps we adults should blame ourselves. Our overprotected children are like domesticated animals, incapable of surviving in the wild.To survive happily as couples, we need to put a higher priority on sex and erect boundaries to protect our intimacy. Parents might consider making it a ritual to lock their bedroom door after 10 p.m. so they can sleep naked without fear of exposing their children to the primal scene. The offspring of one longtime happily married couple reports, "In our family we learned that you'd better be bleeding badly before you knocked on our parents' bedroom door on the weekends. We thought it was because they needed their sleep. Only as we got older did it dawn on us, Ohhhh, they needed their sex."
If we require a more child-centered reason to attend to adult needs, consider that a happy marriage is win-win. "The love between the couple is the real cradle that holds the baby," says Julie Gottman. In the Gottmans' studies, couples who made a priority of rituals of romance and didn't focus 100 percent of their attention on the baby were happier—and so were their babies. The infants smiled more, laughed more, played more, cried less, and showed an increased capacity to self-soothe, as measured by their heart rate.
The alternative—depressive marriage—is grim for both adults and children. Children with a depressed parent are, on average, less socially competent, have lower self-esteem, are more likely to have behavioral and academic problems (even lower IQs!), and they are two to five times more likely to develop a psychological disorder.
Nobody tells you what to really expect when you're expecting. But in the 21st century, childbirth, predictably, prompts a mental health and relational crisis. On airplanes, in the event of an emergency, we are instructed to put the oxygen mask on our own faces first, and then on the children. Perhaps we need to do the same with our marriages.

The 2012 Best & Worst Sex List

Alexandra Katehakis and Center for Healthy Sex (CHS) have released their Annual Best/Worst Sex List for 2012. While there were not as many spectacular sexual implosions this year (remember 2011's Charlie Sheen, Dominique Strauss-Kahn, Herman Cain, Schwarzenegger and Weiner,) still there were significant political and social developments that will have healthy sexual implications for years to come.
Why do these stories matter, and why do we care how sexuality affects society? Because eroticism is a fundamental, connective energy that can fulfill all our most heartfelt desires. Relational sex is more than a symbol of whether we play well with others, it's literally how we relate. Most of us lack adequate sexual education, which has become politicized to the point of incompetence. We sexually develop in the shadows. So by exploring our erotic values together we transport this personal, powerful, wholehearted, carnal energy into the light.
At Center for Healthy Sex, we believe that Healthy Sex is consensual sex between adults and yields pleasure and personal growth. Everyone has the right to experience healthy sex free from trauma, abuse, violence, crime, lies, secrets, judgment, shame, guilt and regrets. Sexual rehabilitation begins with stopping problem behaviors and leads to a meaningful life of emotional and sexual intimacy over time.
With that in mind, here are the top stories of 2012, and why they matter. We hope you find these picks provocative and ideally even erotically enlightening for the 10 best sex stories, the 10 worst sex stories, and 5 honorable mentions for good measure!
THE BEST
1. Obama Wins the 2012 Election
It was a long and contentious election, but in the end the critical mass of voters' conscience tipped toward social progress preventing a major rollback of civil (sexual) rights. The Republican party profess support for less government except when it comes to definitions of rape, LGBT rights, reproductive rights and sexual healthcare - all which they'd seek to legislatively limit or deny with assuredly devastating consequences. Instead, 2012 ushered in four more years of progressive sexuality during which there will likely be all-important Supreme Court vacancies to fill that are sure to have an impact on sexual freedoms. In related news, the 2012 election gave us 20 female U.S. senators in 2013, the highest number ever. Wisconsin's Tammy Baldwin became the first openly gay person elected to the U.S. Senate. Gay rights legislation prevailed at the polls (more on that next.)
Why this matters: Perhaps an unexpected pick for best sex of the year, but the revelations and ensuing results of this election cycle caused the single greatest contribution to healthy sex for the entire world to contemplate this year. You don't see many therapists (like my colleagues and myself) sounding off on politics. We accept and honor multiple points of view to treat people of all beliefs and faiths. The two political parties in our country are increasingly polarized, and when one of those parties clearly attempts to oppress the sexual health of its people, we need to speak up.
2. U.S. President Supports Marriage Equality
Unless you were living under a rock, you have to know 2012 was a banner year for gay marriage. For the first time, a sitting president came out in support of marriage equality as Democratic leaders voted to include a gay marriage plank in the national convention's party platform, another first. Also Homeland Security set new deportation guidelines defining same-sex couples as families; voters supported marriage equality bills in Maine, Maryland, Minnesota and Washington; and DOMA was ruled unconstitutional by a federal appeals court. The Supreme Court announced the decision to weigh in on that ruling along with the constitutionality of Prop 8 in 2013. Barney Frank became the first sitting congressman in a same-sex marriage, the DADT repeal occasioned the first gay civil union ceremony on a military base, the White House hosted multiple same-sex marriage proposals, X-Men comic book characters got gay married, and Jet magazine featured their first same-sex couple. Wow, what a year!

Why this matters: The more our society moves toward acceptance of homosexuality and the less acceptable it becomes to marginalize homosexuality, the greater the opportunity for all relationships to develop a more authentic and healthy sexuality beyond social programming. Marriage equality is more than a civil right, it's an acceptance of reality. People really are homosexual. The righteousness of homosexual orientation and expression is as real whether by birth or choice (but we say "born that way.") People have many different beliefs, gods, principles, and values. Mature relational development requires accepting others for who they are, as well as for what they believe, without trying to force ideological values through harmful, prejudicial rules unfairly applied.
3. California Voters Ban Ex-Gay Therapy
California voters became the first in the nation to block caretakers from forcing minors into reparative therapy, the harmful treatments that sometimes include shock therapy in attempts to change the sexual orientation of LGBT children. In a widely contested move, California also voted to mandate condom use in porno shoots in an effort to curb the spread of HIV and STDs for both performers and viewers. Although both votes likely will be revisited by the courts, the results were historic. In another first, the California state assembly passed a bill to allow the recognition of multiple parents per child to accommodate unique family structures, which was vetoed by the governor who objected to possible implications due to poor wording and insufficient foresight.
Why this matters: There's a saying that as goes California, so goes the nation. These bills have many legal hurdles ahead of them, but the ripples they send across the country and even around the globe will surely inspire some interesting legislation to confront challenging sexual health issues in years to come. Reparative therapy in particular has never been less popular. The World Health Organization released a report this year calling reparative therapy "a serious threat to the health and well-being - even the lives - of affected people." We've known for too long that the lives of LGBT teens are at great risk, as they face bullies in their schools, neighborhoods, and community leaders. With legislation like this, California stands up to the bullies.
4. First Transgender Testimony Before Senate Committee
In June, the first openly transgender person was invited to testify before a Senate committee. Kylar Broadus, founder of the Trans People of Color Coalition, testified in support of the Employment Non-Discrimination Act (ENDA) seeking to end workplace discrimination on the basis of sexual orientation and gender identity. Gender identity protections were added to ENDA in 2007, which has been introduced in every Congress but one since 1994, but has yet to pass both the House and Senate. In related news, the U.S. Equal Employment Opportunity Commission ruled to protect transgender employees from discrimination. The APA removed Gender Identity Disorder as a mental illness diagnosis, now redefined as Gender Dysphoria, or stress attending gender identity. There were also many visible transgender personalities this year, including Matrix director Lana Wachowski who received Human Rights Campaign's Visibility Award, and beauty contestant Jenna Talackova who, after a controversial disqualification, was allowed to compete for Miss Universe.
Why this matters: Gender identity issues affect everyone from the moment we're born until our last breath. Gender expectations, good and bad, play a huge role in childhood development and adult psychological health. Many children now enjoy greater freedoms to explore and experience life beyond assigned roles thanks to progressive parents and educators; and today, transgender children have more resources and support than ever. Transgender rights are human rights, and we all personally and publicly benefit from honoring and defending the diversity of gender identity and expression.

5. Health: FDA Approves Home HIV Test
In July, the FDA approved the OraQuick In-Home HIV Test, and in October the $40 tests were available in convenience stores and online for over-the-counter purchase. OraQuick is the first rapid home HIV test - results appear in 10 minutes. The test includes a 24-hour help line and resources for dealing with a positive result. In other health news, a nasal spray to increase sexual arousal for women called the "Female Viagra" started clinical trials. The drug is called Tefina and its intended to treat Female Orgasmic Disorder (FOD.)
Why this matters: Approximately 50,000 people become infected with HIV each year, and one in five living with HIV is unaware of their infection. Like home pregnancy tests, a home HIV test will make it easier for people to privately manage their sexual health. Already there are reports of people asking partners to take these tests before becoming sexually intimate. Female sexual dysfunction also affects many women; it's estimated up to 43 percent of women suffer from some form of sexual dysfunction. These two advances are game-changers in the field of sexual health.
6. Rep. Gwen Moore Reveals Rape in House Speech
Before Republicans blocked the reauthorization of the Violence Against Women Act, Wisconsin Congresswoman Gwen Moore courageously revealed her history of being sexual assaulted as a child and raped as a young woman in a powerfully moving speech. Multiple campaigns this year raised awareness of rape including the gay/straight-themed "Men Can Stop Rape" campaign in January, the "Real Men Get Raped" campaign on London billboards in February, and the "We Believe You" campaign in March. As the year went on, there was a groundswell of public outrage over multiple unthinkable comments from Republicans like Todd "Legitimate Rape" Akin, Richard "Rape Pregnancy is a Gift from God" Mourdock, and Roger "Some Girls Rape Easy" Rivard; who, with other key "Rape-ublicans" referred to as "Team Rape," lost almost all their elections and may even have swayed the public against their party in the general election.
Why this matters: Sexual assault affects men and women of all sexualities, but still too often the victim is blamed, and the tragedy of male rape is denied. There is far too much sexual violence around the world, such as the India gang rape victim who died this week, and for any public official to politicize the issue by parsing definitions only contributes further to global resignation toward rape. Language affect Laws affect Lives. When brave people like Gwen Moore speak up about the reality of rape, or whenever real people share their personal stories of rape, it mobilizes citizens to reflect, to defend, and to act.
7. Coming Out: Orlando Cruz First Openly Gay Professional Boxer
The coming out stories keep on coming. Orlando Cruz, currently ranked as the 4th top featherweight in the world, became the first openly gay professional boxer when he came out in October. Athletes in particular had a revelatory year as former NFL player Wade Davis came out in June, and an unprecedented 23 openly gay athletes competed in the summer Olympics. LGBT allies like Minnesota Vikings punter Chris Kluwe memorably came out in support of gay marriage, and many professional sports teams joined the "It Gets Better" anti-bullying project including the San Francisco 49ers, the Pittsburgh Pirates and the Oakland A's. Other momentous coming out stories included newsman Anderson Cooper, actor Matt Bomer, chef Anne Burrell, and musician Frank Ocean who made waves as the first mainstream hip-hop artist out of the closet.
Why this matters: Quite simply, the more out and about LGBTQA personalities, the better it gets. As prominent people become empowered to stop hiding and live authentic lives in the public eye, others are empowered to join the party. Assumptions are reassessed. Stereotypes are shattered. The rapidly increasing public support for LGBT issues doesn't happen in a vacuum - it's on the backs of these courageous personalities who risk everything for truth and honor. There really needs to develop some kind of celebratory event or commemorative medal for coming out, because it always marks such a hard-won, transformational inner process. You have to wonder what fields are still left to have their first gay outings in 2013?
8. Science & Technology: Embryos Created from Two Women, One Man
This year, American scientists successfully created embryos from two women and one man for the first time. While so-called "designer babies" are as yet an impossibility, the advance of a three-way embryo finally promises a cure for certain genetic conditions, pending a complete study of potential side effects. Other interesting sex-tech advances include computerized vibrators for long-distance lovers called LovePalz, which give a whole new meaning to the term "hooking up." The vibrators come in pairs for straight, gay or lesbian mutual masturbation action -- synchronized over an Internet connection so the device mirrors your partner's actual movement. Also TrueCompanion apparently released Rocky the sex robot this year, a male counterpart to Roxxxy who was released in 2010. Rocky costs around $1500 (an extra $100 for pubic hair) and is programmed to provide indiscriminating men or women with cold, synthetic pleasure.

Why this matters: Innovation often precedes generational trends in sexual health. Science and technology find discoveries in the grey areas beyond the black and white thinking of fundamental morality, and function like sex therapy in this regard. If a person is attracted to a unique style of consensual sex, there is almost always someone willing to fulfill that need. Similarly as there is a demand for healthy embryos, or long-distance vibrators, or sex robots, then there are scientists and developers willing to fulfill these needs. Regardless of the number of people who might object to such innovation on moral grounds, it only takes one inventor to change the course of history.
9. Legal Issues: Court Settlement for Gay Sex Addict
A married father of two was awarded $255,824 in compensation after a prescribed drug turned him into a compulsive "gay sex and gambling addict." In his claim against a British pharmaceutical company, Didier Jambart of France revealed he started taking Requip to treat Parkinson's disease and within two years had developed an "uncontrollable passion" for gay sex and gambling. During this period, he attempted suicide eight times. When he discovered a website that linked the drug with hypersexuality, he stopped the medication and apparently this stopped his uncharacteristic compulsions. In other legal news, former Penn State assistant football coach Jerry Sandusky was sentenced to at least 30 years for child sex abuse. While sexual assault charges were dropped against Dominique Strauss-Kahn last year, this year he came under investigation for "aggravated pimping" and alleged involvement in a prostitution ring.
Why this matters: More and more, the terminology of sex addiction is gaining legitimacy in the courtroom. For a court to recognize gay sex addiction as a potential side effect of a medication has certain ramifications and raises many questions. To what degree does brain chemistry account for behavior? Under what circumstances might a person be absolved for their behavior? This is a core argument with sex addiction -- such as, is a sex addict responsible for sexual acting out? In treatment, the answer is usually yes, any addict must take responsibility for their behavior, and also yes, they are powerless over the addiction that drives that behavior, and require medical, therapeutic, or 12-Step intervention to recover. What do you think drives sexually compulsive behavior, what's the difference between a sex addict and a sex offender, and is any of this treatable?
10: Media: The Sessions, The New Normal, 50 Shades of Grey
Sex in the media is nothing new, but there were several important works that explored sexual issues, advanced sexual freedoms, and stimulated sexual frenzy this year. In film, The Sessions showed us naked therapy sessions between a paraplegic and a sex surrogate, drawn from a moving real life story. In television, The New Normal broke new ground for prime-time broadcast TV with a gay couple at the forefront who invite the surrogate mother of their child and her family into their home. And in books, 50 Shades of Grey presented explicit BDSM erotica between a student and a wealthy entrepreneur, while setting the record as the fastest-selling paperback of all time.
Why this matters: Many decry sex in the media as the cause of loose morals but truthfully, many people rely on entertainment as their primary source of sexual education. How else would most people learn about sex surrogacy, or show people that anyone and everyone is deserving and capable of sexual intimacy and expression as in The Sessions? We've referred clients to sex surrogates here in Los Angeles, and while the therapeutic process is more involved than presented in the film, still the scenes of careful sexual exploration captured glimpses of the healing process, albeit in Hollywood style. And where else might Middle America watch two attractive daddies kiss and cuddle in bed reciting dialogue at turns cutting, clichéd, eye-rolling, or hilarious - just like their straight counterparts - but on The New Normal? LGBT characters are steadily becoming more visible and familiar, and two male leads in bed might be the final frontier. Finally sales don't lie - many, many people are sexually curious and titillated by erotic exploration as evidenced by the popularity of 50 Shades of Grey, irrespective of the writing quality. Apparently rope sales, as well as libidos, were on the rise this year.
THE WORST
1. Resistant Strain of Gonorrhea
The World Health Organization (WHO) and the Center for Disease Control (CDC) announced early this summer that gonorrhea outside the U.S. had become resistant to all but one class of antibiotics, raising concerns of potential mutation into an untreatable "superbug." Gonorrhea is the second most commonly reported infectious disease in the U.S., infecting an estimated 700,000 Americans a year and 106 million people worldwide.
Why this matters: Could this become the epidemic of the 21st century? Men and women infected with gonorrhea often show no symptoms, and are unaware of transmitting the disease. If left untreated, gonorrhea can cause infertility and infections that spread to other areas of the body, including the brain and heart. Gonorrhea increases susceptibility to HIV infection. People can protect themselves by being monogamous and practicing safe sex using condoms for vaginal and anal intercourse, as well as for oral intercourse (the first known case of this superbug involved pharyngeal or throat gonorrhea.) If you haven't got the memo by now, condoms aren't just a precaution against pregnancy and HIV. By absolute necessity, safe sex and the awareness of personal and partner sexual health must be a way of life.

2. Boy Scouts Child Sex Abuse Scandal
The Oregon Supreme Court ordered the release of 20 years worth of secret documents kept by the Boy Scouts of America, known internally as the "perversion files." 14,5000 pages of records were opened in October revealing a widespread, systematic effort by organization officials to cover up allegations of child sexual abuse against 1,800 scout leaders. Records show that about one third of the sexual abuse cases weren't ever reported to local law enforcement. While most of the reported offenders were barred from the Boy Scouts, there were still many pedophiles to continue in their position at the request of community leaders or Scout officials. Tellingly, there's scant information about any care shown toward children molested, the primary focus in the files concerns saving the face of the Boy Scouts of America.
Why this matters: This was the year the Boy Scouts reaffirmed their gay ban blocking "open and avowed homosexuals" from membership, leadership, or employment. 300 Eagle Scouts returned their badges in protest. It seems the Boy Scouts ban doesn't apply to their secret pedophiles and enablers. First the Catholic Church, then Penn State, now the Boy Scouts. There's an increasingly evident correlation when the leaders who perpetuate institutional homophobia are the same leaders covering up sex crimes. This brings to mind the gay bully trying to ward off his own homosexual tendencies with every outward attack, but on a massive scale. It's a societal sickness, the terrible consequences from denying the integrity and inclusion of LGBT sexuality.
3. Binders Full of Women
Mitt Romney made waves when he referred to "binders of women" describing his efforts to find qualified women for posts. In another year, the casual remark may have slipped unnoticed but too many sexist cases had amassed. The Komen controversy set the tone as the world's largest breast cancer charity announced in January it would no longer fund breast cancer screenings by Planned Parenthood. Pundits and public opinion asserted Komen had bowed to political pressure in the so-called "war on women," with Planned Parenthood a key target. Komen reversed course purging many top staff, but not before permanently damaging their mission and reputation. In related news, Wisconsin governor Scott Walker repealed his state's Equal Pay Enforcement Act and signed into law a bill forcing doctors to meet three times with patients before prescribing the medical abortion pill or be subject to felony charges. Congress voted on the Blunt amendment to allow exemptions for employers to refuse contraception coverage for their female employees. The amendment was defeated, but not before Republican Congressman Darrell Issa convened a memorably stacked all-male panel to discuss female sexual health coverage, disallowing the inclusion of the sole proposed female, Sandra Fluke, a law student whom Rush Limbaugh infamously called a "slut" and "prostitute." In 2012, fierce opposition by conservative Republicans contributed to Congress' failure to renew the Violence Against Women Act of 1994.
Why this matters: We look around the world and witness so much violence against women. One in four women has experienced domestic violence in her lifetime. The human race isn't made up of men and women, we're a people. Most of us wouldn't define ourselves by genitals or chromosomes, so why the war on women? The trauma of misogyny is an inherited and inbred trait, and who knows if it first emerges from within the individual or from without via the culture. Relational dysfunction affects us all as individuals, and it's no wonder our personal relationships often lack balance and reciprocity when our leaders can be so divisive and punishing in their legislative tactics and power plays.
4. APA Rejects Hypersexual Disorder
Hypersexual Disorder was rejected this year by the American Psychiatric Association (APA) for their "bible" of mental health, the fifth version of the Diagnostic and Statistical Manual (DSM-5). The deciding board cited the inability to make uniform assessments, while critics of Hypersexual Disorder have falsely accused supporters of creating a fake condition for profit or to enforce sex-negative morality. It's hard to know what role the fierce politics played in the APA's decision, but the lack of diagnostic inclusion will have ramifications for decades. The APA is no stranger to flawed decisions -- in fact, homosexuality was listed as a mental disorder as late as 1974 when it was controversially modified to "ego dystonic homosexuality" or unwanted homosexual arousal until 1986 when the diagnosis was removed entirely. "Shell Shock," known today as PTSD, was dismissed as cowardice in 1915 and took 65 years to gain legitimacy in the DSM-3.
Why this matters: The exclusion of Hypersexual Disorder or any comparable diagnosis in the DSM-5 not only prevents insurance coverage to treat sexually compulsive behavior, but also crucial funding for further research leaving therapists without tools for improved assessments. In stark contrast, sex addiction continues to proliferate due to ever-evolving technological accessibility, while the psychological health of our culture has also evolved so that sexually addicted behaviors are no longer as emotionally tolerable to addicts and partners as times past, irrespective of morality. Certified Sex Addiction Therapy (CSAT) or Advanced Training in Problematic Sexual Behavior (ATPSB) are specialized fields, and all bona-fide sex addiction therapists could have lucrative careers at the identical pay rate as non-sex addiction therapists (as their detractors often do.) A sex addiction therapist continues to pay for education, even after certification. Unlike other therapies, sex addiction treatment is typically short term or else it's not working. The idea that financial opportunism or moralistic ideology created the field of sex addiction flies in the face of the real state of affairs, and ignores the devastating effects on those who are most suffering.
5. John Travolta Sued for Sexual Assault
Several men filed lawsuits against actor John Travolta alleging sexual assault and similar crimes. In May, separate lawsuits were filed by a masseur in Beverly Hills and a masseur in Atlanta claiming in explicit detail how he exposed himself and inappropriately touched them. According to one claim, Travolta had been banned from a Los Angeles spa for similar behavior. Both men dropped their lawsuits later that month. In June, a third man filed an assault-and-battery claim against the actor for a 2009 alleged incident on a cruise ship where Travolta purportedly dropped his bathrobe, propositioned the man, and rubbed up against him. A masseur in New York and a gym employee made similar claims to the press. And in December, his former personal pilot filed a lawsuit claiming he was threatened by John Travolta's representatives after disclosing details in August of an alleged 6-year romantic relationship with the actor. Travolta's attorney dismissed every single one of these claims as opportunistic attempts "to get 15 minutes of fame."
Why this matters: Who can know the truth behind closed doors in Hollywood? Exhibitionism is certainly not a victimless crime. Sex addiction is a progressive disease, which many times involves greater and greater risk-taking that may bring shame and ruin on the individual and their family. People in power too often use sexuality as a form of intimidation, perhaps as an unconscious method to process their own feelings of debilitation. The all-too-common desperation of almost getting caught and covering up sexual compulsion prevents recovery for a very treatable condition, and can even become a ritualized aspect of the addictive cycle.
6. Woman Suffering from 100 Orgasms per day Commits Suicide
Tragically the day after the Tampa Bay Times published Gretchen Molannen's personal account of living with Persistent Genital Arousal Disorder (PGAD), she committed suicide. Multiple stories broke this year about women who suffer from PGAD, which can result in hundreds of orgasms each day caused by the slightest friction. In August, Kim Ramsey from New Jersey spoke out to The Sun about her condition. The documentary 100 Orgasms a Day aired in the UK in September, featuring Rachel from Atlanta who revealed at times experiencing orgasms every 30 seconds for up to eight hours.

Why this matters: Thousands of women are estimated to suffer from this condition, an offshoot of Vulvodynia or chronic pelvic pain. Chronic sexual pain affects men and women of all sexualities and backgrounds. Like many sexual afflictions, PGAD is not recognized currently as an official condition by the medical community, but should be included in the DSM-5 (see above.) Any sexual dysfunction, disorder or condition has real physical or psychological causes that can be treatable but many people lack comprehensive healthcare or are too fearful, embarrassed, or repressed to seek out professional help, and so suffer the sometimes uncomfortable, sometimes heartbreaking, sometimes deadly consequences.
7. Germany's Animal Brothels Prompt Bestiality Laws
In December, Germany's lower court passed a ban on bestiality - making sex with animals, the "pimping" of animals, or training animals for sex with humans a punishable crime with a $31,000 fine. Why would this even be necessary? Apparently since the Animal Welfare Act of 1969, bestiality laws have been off the books and recently so-called "erotic zoos" or "animal brothels" have been setting up shop where "people can visit to abuse animals ranging from llamas to goats" according to The Daily Telegraph. A bestiality group called Zoophile Engagement for Tolerance and Information (ZETA) announced plans to mount a legal challenge. According to the group Veterinarians Against Zoophilia, thousands of Germans exchange information online about sex with animals.
Why this matters: People who have sex with animals are psychologically disturbed individuals. Typically attachment disorders or relational trauma are involved, the arousal template may involve replaying the emotions of traumatic events at crucial stages in sexual development. Like pedophilia, bestiality (or "zoophilia") is always non-consensual because a child or an animal does not have the comprehension, capacity, or foresight to make informed choices involving sexual activity. That various conservatives compare homosexuality to pedophilia or bestiality indicates they do not have a moral or legal concept of a "consensual relationship," which must be somewhat unsettling on some level for their companions.
8. Political Sex Scandals: Hypocrisy of a Pro-Life Congressman
In political sex scandals, Tennessee Republican Congressman Scott DesJarlais was re-elected this year on a pro-life and "traditional marriage" platform, despite a woman's claims that he pressured her into having an abortion as the result of an extramarital affair. The week after his victory, a judge ordered the release of his divorce transcript revealing the fact that he had multiple affairs with patients and co-workers at his medical practice, as well, he supported his wife to have two abortions. In a recent radio interview, DesJarlais disclosed that "God has forgiven me." This was the year of the Secret Service scandal involving prostitutes in Colombia, multiple sex scandals in China, and the Jimmy Savile scandal in the UK involving a vast conspiracy from government officials (allegedly including a former prime minister) to BBC network execs who covered up possibly hundreds of cases of child sexual abuse committed by the popular children's entertainer who died in 2011. The Petreaus scandal, which dominated the airwaves in November and effected the resignation of the CIA director after the revelation of an extra-marital affair, seemed tame by comparison.
Why this matters: There are always political sex scandals. These sex scandals too often involve conservative politicians acting against professed values, sometimes directly counter to their political platform. For whatever reason, it seems liberal politicians are forced from office, while conservative politicians find "forgiveness from God" and continue to enforce policies that belie their increasingly hypocritical positions. Hypocrisy is a societal affliction that begins as a familial complex. When caretakers practice double standards ("do as I say not as I do") this creates confusion and resentment in children, who often struggle to reconcile the rules with the reality. In extreme case, these children will grow up to either perpetrate or tolerate extreme acts of hypocrisy.
9. Smalltown Scandals: Gay Deportation Threats in Arizona
In small-town sex scandals, Paul Babue is the conservative, anti-immigrant Republican Sheriff of Pinal County, Arizona. He's the youngest sheriff in Arizona, and last year was named the National Sheriff of the Year by the National Sheriff's Association. In 2011, he formed an exploratory committee to run for Congress, but those plans were dashed when his undocumented Mexican immigrant boyfriend of ten years publicly outed him during a bad breakup, accusing Babeu of threatening him with deportation. This November, he was re-elected Sheriff for a second term. In another small-town scandal, the City Commissioner of Boynton Beach, Florida, a Democrat named Marlene Ross, resigned from office when an investigation became public after she alleged a lobbyist had blackmailed her to change her votes or he'd reveal her sexual relationship with a first cousin, a convicted felon.
Why this matters: The issues that play out in small towns are the same issues that plague the national stage. Most of us will never know what it's like to be embroiled in public controversy, but we all have work to do around defining and living up to our true values. There's a common saying in recovery that "if you spot it, you got it." From the outside, these stories seem so unthinkably corrupt, almost clichéd. A leading anti-immigration sheriff is having a gay affair with an undocumented immigrant? Wha- ? Rather than pointing fingers, these examples are opportunities to recognize the way we all play by different rules and make exceptions that may compromise our professed values in order to get what we want. Personal sexual health doesn't involve wagging fingers to shame others. The more we identify with others in thoughtful empathy, the more we will heal what's blocked in our own sexual energy.

10. Sex Expert's Son Arrested for Public Indecency
William H. Masters III, the son of famous sex researcher Dr. William H. Masters of Masters & Johnson, in May was arrested for masturbating in Central Park, and again for indecent exposure in September. His neighbors described him as a "warm, sensitive, compassionate person." In similar news, Jason Russell of Invisible Children and KONY 2012 was arrested for public indecency in March, actor Fred Willard was arrested for masturbating in an adult theater in July, and actor Nick Stahl was arrested for investigation of lewd conduct in a private booth at a porno store this past week. Less-prominent cases included a man arrested for breaking and entering in order to masturbate to online porn, a woman arrested for masturbating at a Starbucks, and a man arrested after caught hiding beneath a trailer for a week masturbating while secretly videotaping a mother and her children as they undressed. Of course, there are many stories of this nature every year.
Why this matters: These sexual perpetrators include well-known, well-liked personalities -- the son of one of the top sex experts in history! If convicted, most crimes of this nature require registering as a sex offender for life. Why do these people risk their livelihood, families and reputations for sexual gratification, and not exactly erotic-sounding sexual gratification at that? How do we help anyone recover from clear signs of sexual addiction, when there is so much denial that it even exists?
HONORABLE MENTION
1. Genital Feast
In April, Mao Sugiyama auctioned off his severed genitals, which he cooked and served at a banquet for $250 a plate in Tokyo. A self-described "asexual," Sugiyama underwent elective genital-removal surgery in March and kept the body parts on ice. He announced the auction in a tweet: "... I am offering my male genitals (full penis, testes, scrotum) as a meal for 100,000 yen ...Will prepare and cook as the buyer requests, at his chosen location." Although Sugiyama carefully followed all laws, there was even a licensed food preparer in the kitchen, he has been charged by authorities with indecent exposure.
Why this matters: Many people identify as asexual or agender (respectively the lack of sexual interest/orientation or gender identity.) Although perfectly valid, this is not a sexual realm that is easily understood, and it's possible this feast of amputated sex organs plays into a certain shock and horror about the sexuality. Sugiyama has referred to his event as a performance intended to raise awareness about "sexual minorities, x-gender, asexual people." But many people might not see past the cannibalism.
2. Sexual Worth
A Hong Kong tycoon offered $65 million to the man who could successfully woo and marry his daughter. Sounds almost like a common fairy tale plot, right? Except that his daughter, a lesbian, already eloped with her wife to France this year. In a similar story of financial exploitation, a documentary filmmaker paid over $20,000 to two young adults to auction off their virginity online. The first, a Brazilian 20-year-old woman, sold her viriginity for $780,000, while her 23-year-old male counterpart from Russia sold his virginity for $3000.
Why this matters: To objectify and sexualize people, particularly women or young adults, cannot help but result in relational disconnection. Although Gigi Chao, the lesbian bride, publicly supported her father's actions referring to them as "sweet," the outdated offer of a marriage dowry comes with complications, especially as a manipulative attempt to change a daughter's sexual orientation. Marriage bounties are a widespread problem in many countries where women have little rights or recourse. The dream of amassing money in exchange for something as simple as sex, love or marriage reveals how little value sex, love or marriage have to offer many people whose early models may have thwarted worthy ideals.
3. CreepShots
So there are people who post so-called "creepshots" to the Internet as a hobby. They take voyeurisitic photos, mostly of women unaware. There was a forum on Reddit called CreepShots devoted to images of women uploaded without their knowledge or consent. Reddit has banned CreepShots and similar subReddits called CreepyShots and CreepSquad. On Tumblr, a blog called Predditors was created that started posting personal information about CreepShot contributors. As a result, a financial services employee was fired from his job within 24 hours after being exposed as a CreepShot troll. A teacher was fired from his job for posting CreepShots of his underage students.
Why this matters: According to the FBI, voyeurs are likely to demonstrate some characteristics that are common among serious sexual offenders. Certain voyeuristic fantasies, urges and behaviors are listed in the Diagnostic and Statistical Manual of Mental Disorders as a paraphilia. Like exhibitionism, voyeurism isn't a victimless crime. In the U.S., voyeurism laws are related to invasion of privacy laws, but can be difficult to prosecute. Video voyeurism, secretly filming sexual acts or nudity with a hidden camera, is an offense in nine states and may require the convicted person to register as a sex offender. It's possible a correlation exists between the availability of hardcore online porn and the increase in voyeuristic activities that objectify women.
4. Notable Breakups
Hollywood couples who called it splitsville in 2012 included Kristen Stewart and Robert Pattinson, Rhea Perlman and Danny DeVito, Will Arnett and Amy Poehler, Heidi Klum and Seal, Katy Perry and Russel Brand, and Glee's fictional gay couple Klaine, which sent tweens spinning.
Why this matters: Relationships are challenging. They require work, attention, and care. But all the right action in the world is no guarantee for matrimonial bliss. Of these notable breakups, the reaction of Twilight star Kristen Stewart was most remarkable. US Weekly photographed the 26-year-old actress in a secret rendezvous with a 41-year-old married man, her Snow White and the Huntsman director. Within hours Steward issued a public apology confessing to the affair, causing a predictable media frenzy. According to current statistics, 60 percent of men and 40 percent of women become involved in extra marital affairs. Healthy intimacy requires transparency. In this age of denial patterns playing out with every scandal, it's a little surprising to witness anyone on the public stage accept responsibility for their actions.
5. Public Nudity
The so-called "Buff Stop" park in the Castro District of San Francisco started attracting public nudity activists soon after its creation in 2010, becoming the first non-beach, urban clothing optional park in America. As a result of increased complaints, the city's Board of Supervisors voted for a city-wide public nudity ban (prompting a "nude-in" as demonstrators stripped in the board chambers at City Hall.) The mayor is expected to sign the ordinance, which doesn't apply to street fairs, parades or other permitted public events. In somewhat related news, grainy snaps surfaced of a naked Prince Harry playing strip billiards in Las Vegas, soon followed by topless photos of Kate Middleton sunbathing at a French chateau. Royal controversies ensued.
Why this matters: Nudity is a most basic attribute. We love our bodies, we hate our bodies. We adorn, expose, bind, flaunt, and hide our naked bodies. It might seem impossible to separate nudity with sexuality, but they are different aspects of our humanity worth exploring. It's true, the immature attitude toward nudity in our culture is easily evidenced. And it's understandable not everyone wants to share a subway seat with a sweaty ass. What's your own nude 'tude?

 
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Dr. Oz, Orgasms, and Health

Somehow I wound up in a dispute with Dr. Oz. And about orgasms and health, of all things. So, this needs clarification.
Dr. Mehmet Oz, in case you do not know, is a sometime surgeon and a media empire, with a TV show, a radio show, best-selling books, and much more. His shows are criticized by some as being sensational and going beyond the evidence, but I think it is a good idea to bring a focus on health and well-being to a mass market. Let’s face it, his viewers would not be reading The New England Journal of Medicine if the Oz shows went off the airwaves.
One of the Dr. Oz recommendations that has drawn a lot of attention is to have plenty of orgasms to stay healthy. I was drawn into talking about this issue because of a finding on this matter in our research on The Longevity Project.  In our work on the Longevity Project, we have been studying over 1,500 bright American men and women who were first examined as children in the 1920s. They were followed for their whole lives, and we have evaluated how well they aged and how long they lived. We ask: who lives long, healthy, and thriving lives, and why? Many of the participants do indeed live very long, happy, healthy lives. One really intriguing finding concerns the women’s frequency of orgasm during sex.
“Patricia” was so sensible and conscientious throughout her life that we nicknamed her Prudent Pat. In 1941, Patricia and the others answered questions about their sex lives. Patricia was prudent but not prudish. When asked, “How well mated are you and your husband, from the strictly sexual point of view?” Patricia’s response was that she was extremely well-mated. She and the other women also reported frequency of orgasm during intercourse, on a scale from “never” to “always.” The average was above the midpoint, revealing a generally good but not outstanding sexual satisfaction. But Patricia was again near the top.

The answers allowed us to create a predictor measuring what the originator of the study, Dr. Terman, called orgasm adequacy. We also spent many years tracking down and gathering the death certificates of the participants, so we would know exactly how long each one lived. Finally, we looked to see if sexual satisfaction would be related to a longer life, even after taking the women’s personalities into account. The startling result was very clear: Women who had a higher frequency of achieving orgasm during intercourse tended to live longer than their less fulfilled peers.
Many women (and men) wish we knew precisely why. The limited sexual information available from several other studies does also suggest an association between sexual activity and health, in both men and women, but the links are hazy. This is not really so surprising when one imagines trying to do a controlled study in which half of the people are randomly assigned to have more sex (or better sex). Not possible. Nevertheless, although it is true that correlation does not mean causation, it is dumb to ignore sets of correlations, that is, pieces of the puzzle, that bear on this issue.

Here’s what we do know. Sexual satisfaction tends to play a role in a happier marriage, and happier marriages play a role in greater sexual satisfaction. And we know that people in stable, fulfilling marriages tend to be healthier and live longer. Further, good health allows more sexual activity, and good sexual activity encourages many people in satisfying relationships to stay in shape and maintain their health. What is causing what? We won’t know until the completion of many other long-term studies of intimacy, personality, behavior, and health. At the moment, we can simply say that a sexually satisfying and happy marriage is one of the good predictors of future health and long life.
In our book on The Longevity Project, Dr. Leslie Martin and I advise readers to “throw away your lists.” This means that there is no single element that is a key to happiness, thriving, health, and long life. There are clusters of behaviors and healthy life patterns that are markers of thriving for most people. There are likely underlying biological predispositions in common toward good health, intimacy, and sexual activity, and also feedback loops toward better biological homeostasis. But there are also many, many bacteria and viruses that are easily transmitted through sexual intimacy and cause diseases ranging from herpes and hepatitis to syphilis and AIDS. And there are also numerous well-documented destructive psychosexual disorders, including hypersexuality (sexual addition).
So, getting back to Dr. Oz, I have been recently quoted in the news as taking issue with Oz’s recommendations to have lots of sex to stay young. But that is not really my gripe at all. Rather, the results of our years of research on well-being and health clearly document that it is your long-term patterns of health behaviors, activities, and social relations that matter most. We do not recommend obsessing about whether this week has brought you a cup of blueberries, two servings of fish, 8.5 hours of daily sleep, 10,000 steps, two hours of yoga, and the Oz-recommended number of orgasms.
 If you are interested, The Longevity Project, which explains the long-term pathways to thriving, was published in paperback edition by Plume (see http://www.howardsfriedman.com/longevityproject/ ) and is also available on Kindle and Nook. The book also contains self-assessment quizzes to help you figure your current trajectory.
Photo of Dr. Oz at the Time 100 Gala by David Shankbone; creative commons licenses-2.0), via Wikimedia Commons
Copyright © 2014 Howard S. Friedman, all rights reserved.