Sex and Self-Esteem


If you think it’s mainly sexually unconventional or differently wired people – gays, lesbians, queers, kinksters – who naturally will be the most ashamed of their sexual desires, you’re wrong.

How we feel, personally, about sex acts is certainly impacted by the religious and social norms, of course. We can see the brutal evidence of that in the high rates of suicide among gay and transgendered youth, for example, who feel emotionally overwhelmed by the negative social messages they get about their identities. The pain people experience by feeling socially outcast, rejected or mocked by peers, treated as sinners or mentally ill people, and denied their human rights on the basis of their sexual identity, is enough to destroy anyone’s self-esteem.

But, interestingly, it’s equally, if not more strongly, influenced by how we feel about ourselves. People with fundamentally positive views of themselves tend to be self-accepting, no matter how quirky, edgy, or sexually radical they are. They tend not only to ask for what they want, but they expect to get it and on the whole get more of what they want out of sex than other people. They don’t believe their sexual interests make them a flawed person or less than others; indeed, it may make them feel more creative and adventurous than others. In other words, people with good self-esteem feel entitled to sexual pleasure in bed and seek it out on their own terms.

People with a negative sexual self image tend to feel anxious and inadequate. They find it hard to articulate what they want, and harder to ask for satisfaction. They may be their own worst enemies – censoring their fantasies, sublimating all their urges, and sacrificing their needs to please their partners or their parents. They may struggle with shame for wanting what they want, or wish they were more like other people, who they imagine are having better sex lives. In the end, they never get as much sex, or the kind of sex, they need to feel complete.

Resolving sex issues in relationships isn’t as hard as people believe it to be. I think people are scared that sex will turn out to be too embarrassing or mysterious for them to handle. They’re afraid that opening up about their sexual needs and fantasies to their partners will hurt their relationship. My clinical experience has been the opposite: secrets destroy otherwise supportive, respectful, loving relationships.

BARBARA was a bio-engineer in her late 40s and married to her high school sweetheart, Jim. She heard me on a Playboy radio show talking about swinging and bisexuality, and wanted my opinion on her marriage. About a year ago, she learned that Jim had been cheating on her for the past 12 years. It was ugly at first. They fought and cried over it, and finally, they reached a place of peace and forgiveness. They still loved each other. They didn’t want to divorce.

She accepted responsibility for her piece of it: she lost her desire for him about seven years into their marriage. She’d had some infections and had to avoid sex on doctor’s orders for a year. After that, her desire never really returned. First it slumped to once a month, then once every few months and now it had been almost 15 years since they’d had regular intercourse. When he finally confessed about cheating on her, it hurt like hell but it wasn’t a total surprise.

When Jim told her that he’d been dipping his toes into the world of swinging and group sex, Barbara said her ears perked up. She’d always been curious about it. She made him give her all the details on his experiences. Instead of feeling angry, she felt envious, even turned on by the thought of group sex. She looked at Jim through fresh eyes: it made him seem sexier now that she knew that other, younger women had found him attractive.

They started making love again and that, too, seemed more exciting to her than she remembered. After thinking about it for a few weeks, she asked Jim how he’d feel about exploring the swinger lifestyle as a couple. She’d always had bisexual fantasies and wished she had the nerve to try visiting a sex club. Jim was amazed and, of course, enthused, and they began looking for an event they could attend.

On a whim, Barbara visited a psychologist to hear what a professional thought about her situation. Was she crazy for feeling the way she did? The psychologist seemed to think so. She was alarmed by Barbara’s story and felt that Barbara’s sudden interest in swinging must be a symptom of her grief. Or maybe Jim had secretly coerced his wife into enabling his own sex addiction. She urged Barbara to give herself a year, perhaps two, to slowly heal from her husband’s betrayal and come in for weekly counseling to work on her dependency issues. Barbara left that session feeling completely rattled.

The possibility of an open marriage – something they’d never considered before – was actually exciting to her. She saw it as a way of not just getting back her sex life with her husband, but having a sex life that would never bore her. Was she wrong to want that? Did I agree with the psychologist that she needed to spend more time grieving?

I understood the psychologist’s concern about the betrayal. In general, yes, people need time to process grief and betrayal. For some, the shock of the betrayal is so overwhelming they end the relationship there and then. Even when partners negotiate a truce, they may still feel hurt and unable to resume intimacy until trust is restored. Sadly, there’s no guarantee trust can be restored after betrayal: that depends on a wide range of factors, from someone’s capacity for forgiveness to his or her attitudes about sex. So when you work with individuals, you have to figure out whether they fit the general pattern or whether they break the mold.

Barbara and her husband were definitely mold-breakers. Their commitment to their marriage was unshakeable and their attitudes about sex were liberal. Barbara was hurt at first but, practical minded, she did not view sex outside of marriage as a deal-breaker. Her husband was genuinely repentant. They had already come through the worst of it and seemed more solid as a couple than before. All those factors worked in their favor. They only needed one rigid boundary: no more lies. Jim promised Barbara and Barbara chose to believe him.

I don’t condone lying to your partner. I think it invariably creates rifts and heartaches. But I could sympathize with Jim’s misery. Barbara rejected and ignored his sexual being for years. That’s a wretched thing to do to someone you love. I can understand when someone wakes up one day and realizes they can’t live another day without the comforts of sexual intimacy. That’s very human.

Ideally, Jim would have reminded Barbara that it was absurd to expect a virile man to live like a eunuch. They could have either consulted a professional or worked out a more satisfying compromise on their own. They both would be grounded in the basic understanding that sex is a vital part of every life. But in a less than ideal world, many adults are unable to have genuinely mature conversations about sex. If a partner has sexual inhibitions or low self-esteem, even raising the subject of sexual problems with them may make them tight-lipped or angry.

What impressed me about Barbara and Jim was that, when the chips were down, they rallied together and finally had their first serious, mature conversation about their sex life. Barbara accepted her responsibility in the mess: she’d settled into the same kind of sexless marriage her parents had. When she first wed Jim, she had vowed to herself she would never let that happen and yet she did.

Barbara and Jim were done grieving. What they needed at this point was someone to reassure them that it was safe to resume their sex life. So I did. I explained that sex itself can be nature’s best healing medicine. The intimacy would revive and reconnect their sexual brain chemistry (or what some folks call “sexual energy”). And if swinging was something that made their blood pump right now, and offered them a hotter way to have sex, then good for them. Maybe they had found THEIR key, that thing which could make them happier than they’d ever been.

I speculated that perhaps the reason their old sex life failed was precisely because they both had always craved greater variety. Barbara admitted she’d always had bisexual fantasies. I found that interesting because I believe the need for a high degree of sexual variety (such as swinging) may be wired into some people’s sexual identity (as I’ll explain in depth in the next section), much as I believe that homosexuality, BDSM, transgenderism, and other so-called sexual perversions are, in fact, normal biological differentials that travel with us from the womb to the grave. On this theory, it was not impossible that Barbara and Jim were always wired to be swingers. It certainly seemed that Jim was, judging by his choice of sexual diversions.

From my point of view, the psychologist hadn’t really listened to Barbara. She categorized her as “betrayed wife” and treated her accordingly. The treatment was typical yet completely wrong-headed because there is no monolithic model for a betrayed partner. I have worked with women and men who grieve over their partner’s betrayals for years on end; and women and men who shrugged and moved on with their lives. If Barbara had low self-esteem, it’s more than possible that Jim’s adultery could have driven her to act out in self-destructive ways or might have destabilized her emotionally. If she’d been inhibited, his sexual adventures likely would have been frightening, perhaps even disgusting, to her. If she hadn’t been sexually aware, she might have stewed with rage over his experiences instead of noticing that they were turning her on. But Barbara had her stuff together. She was strong and self-aware. I saw no reason for her to stop looking for the swing party of their mutual dreams.

The psychologist also took the draconian but common point of view that swinging itself is weird and may therefore be a symptom of a psychological problem. I assured Barbara and Jim that this was a long-outdated way of looking at sexual variations. The urge to swing isn’t symptomatic of anything except an urge to swing. But whether or not they chose to take their marriage in that direction, Barbara had learned the hard way that a sex-negative life is not a natural, healthy way for anyone to live. She will never make the mistake of letting her sex life with Jim go dead again.

But what happens when you do have low self-esteem?

LLOYD, an engineer in his late 30s, was one of the most stressed out fetishists I’d ever worked with. He knew he was different, he said, even when he was five or six. While other kids played with toys, he loved playing with shoes. By the time he was in high school, he was as excited by girls as any normal boy, but also extremely ashamed of himself. Other boys talked about girls’ breasts, but Lloyd was much more interested in their feet. His biggest fear was that a girl would notice him staring at her feet and call him out as a pervert.

He was financially successful and didn’t have trouble meeting women but he felt it would be wrong to inflict his disturbing fetish on a decent, regular woman. When the fetish itch needed scratching, he visited professional dominatrices. He loved to watch them model exotic footwear, and always felt grateful when one of them allowed him to masturbate to orgasm while kissing their feet, a rare but much appreciated indulgence.

Until a few years ago, this had been enough for him. But now he seemed to be losing all interest in sex. He couldn’t maintain an erection long enough, or find a fantasy sufficiently thrilling enough, to get him over the top during intercourse. He tried Viagra and although it kept him physically hard, it felt like he was just pushing a sausage into a soggy sleeve. It felt numb. The only thing that turned him on now was his play-time with professionals. He felt doomed: all his dreams and ambitions to have a family, and a normal life with a woman who loved him, were now completely impossible.

Since I specialize in kink and fetish in my practice (and my life), I knew something Lloyd did not: that he was normal for a fetishist. Some clients laugh in delight and others squirm in discomfort when I tell them that, but it is true.

Virtually all fetishists experience a similar sexual arch in their lives. As children, they are either openly or secretly fascinated by something that, at the time, is merely intriguing because their minds are not yet mature enough to perceive a “mating opportunity.” In puberty, that fascination becomes more consciously connected as hormones flood the body and change internal reproductive biology. When they begin masturbating, and throughout their teens, their early fascinations take a central place in their masturbatory fantasies, and by early adulthood they begin experimenting with partners when possible.

Adulthood is where innumerable variables change that arch, particularly the life choices that people make. Some people follow through on their sexual needs and form relationships with people who accept them as they are. Others (the majority, in my experience) don’t accept their quirks and form relationships with people in hopes they will “get over it” and be able to live according to the culturally idealized model.

But the overall pattern is pretty similar: by adulthood, a fetishist finds it increasingly hard to feel fully satisfied unless there is some fetish activity in their intimacy. As noted above, it’s common for all people to lose interest in sex when the kind of sex they have is not giving them the kind of fulfillment their brains crave. For men, this may also lead to impotence, difficulty maintaining erections, and the kind of penile dissociation that afflicted Lloyd and made his genitals feel alien to him.

From clinical experience, it seems to me that the more self-hating the fetishist, the more it’s likely they partner with someone who is sexually conservative, even rigid, about maintaining the social model of normality in their bedroom. I’ve often wondered if they subconsciously choose the last person in the world to accept their fetish precisely as a way to police themselves and prevent themselves from yielding to temptation. When and if the fetishist finally reveals that they like to wear panties or want their partner to wear boots to bed, their conservative partner is usually appalled, angry, shocked, betrayed, disgusted or all of the above. It’s a sad dynamic I’ve seen played out hundreds of times in hundreds of ways.

Lloyd was in a very bad, sad place. The picture I got was of a man who had never once in his life known the complete fulfillment of good sex. Since he never told a woman what he really needed and wanted, the real women in his life were never even given the chance to turn him on. By confining himself to a fantasy world of cruel women always dressed in latex and ready for fetish play, he had missed real-life opportunities to bond with women who both accepted him sexually and might want to form a permanent commitment with him too.

He was sabotaging himself from getting what everyone needs: that combination of thrilling sex AND bonded intimacy that can only come with being in the arms of someone you really want to be with and who really wants to be with you. Sex-workers provide many services but seldom trigger the intense brain chemistry that flows when partners are joined together uniquely by mutual lust. Wondrous but true: studies on the human brain and endocrine system suggest that we get the biggest chemical benefits from sex when we and our partner are both totally into it. It doesn’t require marriage; it doesn’t require that you know the person; the sex doesn’t have to be technically great; you just both really have to want it to happen and enjoy the way you do it together. Our brains reward sexual enthusiasm.

Unfortunately, that means it punishes pessimism. Lloyd was so ashamed of his fetish – which was really mild and completely harmless – that he’d convinced himself no woman would ever love him if she knew everything about him. It wasn’t the fetish itself that stood between him and a happy sex life. It was his self-hatred that had rendered him literally impotent. I want to contrast Lloyd with Harry.

HARRY was a cute guy in his mid-30s with lots of positive energy, one of those people who greet you with a big smile and warm hello. I wasn’t sure if he was just turning the charm on to impress a therapist at first but, no, Harry was just a through-and-through sweetheart, easy-going and honest to the core. He brimmed with self-confidence as he flashed some great gadgets and talked about the Internet company he started and how well it was doing.

When it came to sex, Harry was just as upbeat. Harry loved masturbation. He jerked off at least two or three times a day, more when he had the time for it. He was an unapologetic consumer of porn, and didn’t mind spending money at strip clubs either. His girlfriends always played along with his fondness for masturbation. Some of his best experiences had been himself and a girl secretly giving each other handjobs in clubs and dark bars when no one was looking.

If a woman criticized him for it, he didn’t remember. He certainly never dated her again. All the ones that stuck around were “free spirits,” who embraced his sensuality and admired his ability to get hard again and again. He felt that his skill at manipulating his cock and balls had turned him into a super-lover, with exceptionally good control over his own orgasms. Apparently, women agreed because he was very popular.

The only reason he was seeing me was because he’d been dating a submissive woman who he really cared about. He thought she could be “the one.” She had been so giving and playful about his masturbatory obsession that he wanted to fulfill all her fetishes and fantasies. He loved the idea of being dominant with her but didn’t want to make any big mistakes. So he was talking to me in hopes I could give him some insights and tips to help him become as good at BDSM as he already felt he was at straight sex.

As I said, Harry was a sweetheart. At no time did he express the least bit of shame over his interests. He expected that a woman who really cared about him would accept his sexuality as it was. He was aware that some people might judge him but he frankly didn’t care. He never lacked for girlfriends and the ones he picked liked him for himself, as he was, and didn’t need him to change. Similarly, he didn’t blink when he found out his girlfriend was kinky. Well, maybe he blinked but it didn’t bother him. It just sounded like a new arena for erotic adventure to him. I guess he already knew that we are all created equal but different, and it is OK to pursue sexual pleasure on your own terms. I wish everyone was as wise as him.

Sometimes my clients are so naïve I wish I could have been their mother so I could have spared them years of unnecessary heartache and confusion.

LISA, a part-time realtor and full-time mother of three, had lost all interest in sex with her husband, Tim. She blushingly explained, through stammers and pauses, that while she loved him, she never liked sex as much as he did. She had talked to some of her girlfriends and her mom, so she knew it was normal to lose interest and that sex was really more for the man. She had tried hormone treatments and herbal remedies. Nothing worked.

She blamed it on the kids. Since the last one, her drive never came back. She felt bad for Tim. She hated disappointing him all the time. It made her feel broken. If not for Tim, she would give up sex altogether. The whole thing was just too much stress.

I listened carefully to her. When I hear a wife tell me that sex is “for the man,” I know it’s going to be a long haul. I know that before I can help her work on her sex life with her partner, I have to work with her on her personal relationship with her own sexuality.

There is NO evidence to suggest females don’t “need” sex. Quite the contrary: orgasms are our friends. They are beneficial to the human organism (heart, brain, circulatory system, skin, reproductive organs), regardless of biological sex. That full-body flush – the increased circulation, the cocktail of beneficial and calming brain chemicals, the relief of the pressure which builds in the lower anatomy – is an organically healthful experience for humans, as any honest medical doctor can tell you. Remaining sexually active is essential for women who want to be able to have sex in old age too. Regular orgasms are a natural way to ward off the effects of aging on female genitals – your doctor may not tell you this, but the science says that exercising your pelvic floor muscles and encouraging blood flow to the region helps women prevent the post-menopausal risks of vaginal atrophy and inorgasmia.

Similarly, while we don’t know nearly as much about estrogen yet as we do about testosterone, we know enough to understand that it too is a powerful natural chemical which makes women either seem wildly horny or viciously disinterested in sex or strangely emotional about sex (among many other alternating moods which may occur during ovulation, PMS, pregnancy, perimenopause, and any other significant hormone swings which naturally occur in women’s lives).

The theory that women are less sexual by nature than men is a myth that has haunted our culture for thousands of years. It’s based on religious teachings which presume that men are closer to the divine, and therefore superior in all ways to women. It is the male seed which must be carried on, and woman’s function is to be his lesser vessel. Her needs don’t matter because she doesn’t really matter, at least not until she proves her worth by producing children, and demonstrating that she is a worthy vessel.

That, in an alarmingly magical nutshell, is how most western religions have continued to view the difference between male and female for thousands of years. Moreover, that mythology was accepted, whole cloth, without questioning, by the great Victorian scientists who first essayed to organize and define human sexual behaviors. And it may be how most of the people around you understand sex, more or less: that it is mainly men who get horny, while women are more ethereal. At least the decent women are. Those others, the ones who are all sexed up, are something else entirely. (Which is to say, a little scary to a lot of people.)

It may seem innocent enough on the surface but really it is poisonous. Our cultural assumptions about female sexuality are largely rooted in patriarchal Catholic dogma that has long since ceased to be relevant to western cultures and religions, including to the post-Vatican II Catholic church itself.

From a sexological point of view, it’s a form of ignorance which causes social harm by rationalizing sex crimes against women. Example: I think it’s one of the underlying assumptions of the date rapist’s mentality that women never really “want” sex and therefore it’s a man’s right to coerce her. Rapists feel justified in taking what they want from women because, to them, women are sexually inferior and created for their pleasure.

This isn’t just something we can blame on religion. It’s also in line with the way medicine and psychiatry have traditionally treated female sexuality, as I detailed in Sex and the Self. Much of 20th century psychiatric theory still depended on the early theories of Sigmund Freud who, by the 1960s, had become something of a cult-figure in the United States, and assailed as the person who definitively had plumbed the depths of the human sexual psyche. If you’re old enough, you may remember that “Oedipus Complex” and “penis envy” were as much a part of popular language as Gangnam style is today.

Ah, Sigmund, the sex genius who could never figure out what women really wanted because he never could wrap his giant mind around the fact that women wanted sex. He and his colleagues knew that orgasms relieved women: many doctors offered the service of pelvic massages (i.e., masturbation) to “cure hysteria” and “alleviate female neuroses,” which is what we today would call “needing it bad.” Time and again, physicians from the late 19th century to the late 20th century did not accept that women’s needs and desires were as strong as men’s and that those desires were just as likely to be varied too. They refused to acknowledge that women grew depressed and dysfunctional when they were forced to stifle their own sexual identity and live up to a false, non-sexual model. Instead, they diagnosed women as neurotic and masochistic and frigid when they didn’t act as obedient vessels should.

The irrational idea that men are sexual and women are not has done more to fuck people up over what sex is than any other ideology in human history. It has also impacted the public health and well-being of adults. Big drug companies who spend billions studying testosterone and how to restore erections have barely studied female libido or how to improve female function. Male reproductive medicine is very advanced. We understand a lot about how the penis works, what makes male orgasm happen, and between the range of services offered by sex therapists and sexual medical doctors, we can restore erectile function in more men than ever before in history. No such progress for women. As some female science bloggers have dourly noted, the sexual function of pussies has been radically understudied and ignored by medicine.

Science just doesn’t like to think about the vagina, at least not as a beautiful, fully alive, sexual organ. Science prefers to see it, when it sees it at all, as a baby hole. All the ingrained cultural vagina-negativity, all the undermining and mockery of female libido by society, has infected women as much as, sometimes even more, than men. It makes women ashamed of their own vaginas and that shame is the root cause of a lot of bad sex lives, reproductive diseases, and rotten quality of life.

But to get back to Lisa: even though she had made some bad assumptions about her own capacity to be a more sensual and sexual person, it occurred to me that it was possible that hers might just be a sticky case of incompatible libidos. I’ve worked with some disappointed partners who only realized after falling in love with someone that their sweetheart doesn’t want as much sex as they do. There is not a lot one can do to help people who have incompatible libidos. It is not a disease to have either a high libido or a low libido. Some people need to have a lot of sex to feel really great and some people feel contented to go without for stretches.

My own rule of thumb for “normal” for any couple is first to take a look at their baseline sexual pattern. That means the basic frequency of their sexual activity. There may be weeks or months or even a year when they have a lot more sex or a lot less sex, because of life stresses or circumstances, but overall, I want to know how many times per week or month they are likely to have sex.

If the pattern seems stable, and all involved are content with it, I consider it a normal sex life. BUT if there’s a lot of change and instability in their sex lives (most commonly, a ton of sex at the beginning that dwindles to nothing over time) or if one partner complains of frustration or the other complains of feeling oppressed by demands for sex, that signals to me that there’s a good chance their libidos may not match. When you have two people with different levels of desire for sex, and they commit to a monogamous relationship, the only way they can both get what they need is to negotiate a compromise that keeps the horny one happy while giving the less-horny one more emotional rewards.

Lisa found it so difficult to talk about sex, getting information from her was a long and arduous process. She herself had never realized there were so many dimensions to sex, and her amazement more than anything, I think, kept her coming back for sessions. I thought she was brave! I was determined to figure it out for her, so I kept poking.

Were there any big stresses – major illnesses, job insecurity – in the background? Was there anger or resentment in the household? Were the kids doing okay? Did Lisa feel good about being a full-time mom or did she resent Tim’s busy professional life? Was she withholding intimacy as a punishment? Any and every life problem can creep into a couple’s bedroom. When the impulse to have sex comes on, people with low libido may find it impossible to feel aroused or remain focused on sex because their conscious mind is worrying about other things. But Lisa was happy with her life, adored her children, and thought her husband was wonderful. She just didn’t want to sleep with him.

So I turned to Lisa’s claim that things changed for her after giving birth to her last child. While most women return to their former pattern of sex after giving birth, some take a while to rekindle their passions, and others will never feel quite the same, physically or psychologically, once they become mothers. Inside the brain, the same multitudes of tiny differentials that make some women experience post-partum depression while others glow with joy at the achievement, will also influence how women feel about sex after giving birth. For some women, the responsibilities and the brain chemistry of motherhood may overwhelm their sense of themselves as sex partners, and push sexual activity to the bottom of the emotional priority list.

Meanwhile, the physical health of the mother and of her vagina will also play a key role in when and whether her desire for sex fully rebounds. In France, where new mothers receive routine medical treatment to help them restore their vaginal muscle strength after birth, recovery is somewhat predictable. In the United States, where people are too freaked out even to discuss the subject openly, not only is recovery unpredictable, but some women never get back to complete vaginal function.

So when it comes to motherhood and libido, there are an array of variables that influence when and how much a woman will desire sex. A good bit of it depends on the woman’s own attitude towards sex and her eagerness to resume vaginal sex with her partner, but some of it is a matter of biological differentials – different brain chemistry, different hormone levels, different recovery rates, different body types, and so on.

Despite Lisa’s claim that things had changed after the last birth, when I made her reconstruct her sex life with her husband after the other births, she realized that things had actually begun to change significantly earlier than that. She thought it changed when she gave birth the first time. Then she realized things had actually started changing in her first pregnancy. She confessed, for the first time, that she exaggerated her symptoms sometimes to get out of having sex with him, complaining of migraines or back pains she didn’t really have. After further probing, Lisa was finally able to dredge up the awful truth she’d buried long ago: actually, she always kind of tried to avoid sex with Tim, from the day they got back from their honeymoon.

I think she was more surprised by her revelation than I was. From my perspective, when people reach the point in a relationship where they avoid sex with their partner, more often than not it’s one of two things: either that they have fallen out of love with their partner or the type of sex they are having is awkward and dissatisfying. Since Lisa was very much in love with Tim I had an immediate intuition that their honeymoon must have completely turned her off and that, while she started out eager enough, something happened that made her retreat into a shell she still hadn’t poked out of yet. That made me question her intensely until she finally – with eyes half-closed – finally told me how they actually did IT.

She told me they did it the same way every time and had developed a routine. Maybe once or twice a week, usually on the weekend, Tim would reach for her breast in bed. If she wasn’t in the mood, she’d push his hand away or say no. If she was in the mood, she’d curl up to him and they’d kiss. He would then strip off his shorts and climb on top of her. He then put it in her and pumped until he was done. He made love to her until he was done and then went to the bathroom to wash up immediately afterwards.

It was dull but nothing I hadn’t heard before: two painfully shy, inexperienced people who develop a quick and silent way of making love, so they don’t have to actually talk about sex or become too familiar with their partner’s body. If Lisa had been the exact same kind of person as Tim, someone who could be instantly aroused at the thought of making love, and satisfied by a few minutes of penetration, she would not have needed to talk to a sex therapist. They could have continued to have a sex life that I found dull but which worked perfectly well for them because there is no rule book which says everyone must be creative in bed. The only rule for sex should be that the adults having it are good to each other and have a wonderful time together. If mutual pleasure can be achieved in a few wordless minutes of penetrative bliss for a couple, that’s awesome. For them.

Unfortunately, Lisa was more typical than atypical and I was beginning to wonder if the real reason she didn’t like sex was she didn’t like the way they were having it. If her brain was saying “I don’t think so,” her vagina was not going to long for him. For most adults, mind and body must both be fully engaged for sex to be great. If our minds are not on the right page, our genitals won’t be writing anything today.

A basic, healthy model of female sexuality is that sex needs to begin (emotionally, psychologically) before penetration. The wisdom is a woman needs “romance,” and I guess that’s one word for it. A more accurate way to see it is that adults, and women in particular, need warming up: their sexual brain chemistry has to be stoked. A healthy, organic model of female orgasmic function begins in the mind (she has to feel receptive to her partner). Biologically speaking, female genitals take longer to reach full arousal than male genitals, so encouraging blood flow by touching is essential for most females. Stimulation to erogenous zones (breasts, thighs, ass, vagina) accelerates female arousal and leads to lubrication (along with swelling in the labia, a primary signal that a woman is on the right path to orgasm). And while penetration is important to some women, even those who love it the most still want to feel held, kissed, and handled during the sex act, and not just penetrated. Cuddling with an appreciative partner afterwards is the best way to complete a sexual experience: not running off to the bathroom as if you’ve been contaminated by toxic waste.

It sounded like Lisa had fallen into a sex-negative rut. Slowly and unknowingly, couples can create their own negative feedback loops by repeating frustrating or disheartening sexual experiences over and over again, until they just can’t stand having sex anymore. Instead of accepting that they need to make changes or perhaps learn to have sex in new and better ways, they live with the secret pain and reassure themselves that sex doesn’t really matter.

And that’s when Lisa dropped a bombshell.

Lisa had never touched her husband’s penis. She had grazed it with her hand a few times, and sort of fumbled at it, but she had never actually held his pulsing erection (or his soft cock) in her hand for more than a few seconds. It was too embarrassing. She had never let him touch her vagina either. He was usually hard by the time he got to bed, so he always tried to steer his penis into her without ever having to touch her.

So never mind about what may or may not be a normal libido for Lisa, whether or not everything’s perfect in the home, and never mind that sex hasn’t been as exciting since delivery. They’d never caressed each other or had oral sex. Ever!

The simple fact is that no matter how many times you have sex with your partner, you cannot have a good sex life if are afraid to touch your partner’s genitals.

After enduring an entire marriage of mind-bogglingly bad sex, the “fix” was getting her and her husband to learn the fundamentals of touching each other. I suggested they build body comfort and intimacy by spending time together naked with the lights on, until they were fully comfortable being naked together. As usual, they hemmed and hawed at the beginning but once they did their homework in earnest, it did not take very long for them to make significant changes in their sexual interaction. Lisa learned how much fun sex could actually be for a woman when she gets foreplay, kisses, oral sex, and orgasms. It’s a whole different world then. She felt like a newlywed again.

The Urge to Merge and Consensuality

In the first volume of this trilogy, Sex and the Self, I talked in detail about the difficulties in defining sex. The word itself means different things to different people, depending on their own moral codes and views about intimacy. The best approach, therapeutically, is to let couples define what sex means to them, and to work from there. But I’m going to offer a single definition in this section, for the purposes of understanding why and how sex may go wrong for people.

Sex is the drive to make an erotic connection with something outside ourselves and to mitigate that urge.

In other words, sex is a combination of two things: 1) your biological drive to form an erotic bond with a partner and 2) you relieving your craving for that erotic bond.

The exact ways people choose to relieve their cravings at any given time are so multitudinous and varied as literally to be undocumented. They range from masturbation to baroque scenarios. Variations in themselves never indicate a problem, no matter how weird or unappealing they may sound to people who don’t find them arousing.

The old way of thinking about sex, the way Victorians and psychiatrists in the past and plenty of sex-negative ignorami in the present think about it still, is to assume that a variation was an anomaly or abnormality. Variations were viewed as the root causes of sexual dysfunction, marital unhappiness and relationship woes. Example: psychiatrists assumed that masturbation was symptomatic of a mental disorder until the early 1960s, so if a husband or wife was found to enjoy self-pleasure, they might be diagnosed as neurotic perverts. Homosexuality and lesbianism were assumed to be mental disorders in themselves (for no valid scientific reasons whatsoever, by the way), along with a wide range of sexual behaviors people in the 21st century generally consider acceptable.

Today, we know that the correct way to assess the well-being and functionality of a sexual relationship is by examining how well the partners function together as a unit. We can evaluate it according to a simple standard of intentionality. It is the intentionality of an act – not the act itself – which ultimately determines whether a sexual experience is affirmative or destructive.

Take the act of sexual intercourse between man and woman, for example. Among well-intentioned people who are eager for the experience and do their best to give as much pleasure as they get, intercourse can be one of the most sacred and blissful pleasures imaginable. But in a couple where a partner is aggressive or emotionally cold, or conversely feels manipulated or intimidated into sex, the same act can be damaging and brutal. It is, of course, one of the toughest things for victims of domestic violence to explain in court – that even though they technically consented to sex, psychologically they felt raped and were left with the same emotional scars as the victim who can provide forensic proof of violence.

Non-consensual sex is, by this definition, sick, perverse, and damaging. It goes against our brain chemistry, which is designed to encourage affirmation and joy through sexual bonding. Because non-consensual sex is so contrary to human biology, it triggers fear and stress responses that can distort how we see ourselves, our opportunities and even our entitlements in life. It makes some people literally feel like damaged goods and invariably diminishes their sexual function. In light of our growing understanding of the brain, it is more than likely that a painful, frightening sexual experience actually changes something in its structure. Victims of sexual abuse or violence share a wide range of post-traumatic symptoms, including chronic depression, higher risks for suicide and substance abuse, stress disorders, and stress-related diseases. It is probable that one day, brain scientists will be able to detect how their brains were altered by their experience of sexual trauma.

That’s why I believe that everyone who manifests sex drive in anti-social and deliberately harmful ways needs intensive counseling at the least and permanent separation from society at the worst. Conversely, I think it’s a maddeningly irrational social injustice to criminalize any form of consensual sex between adults – and, in this category, I include everything from swinging and spanking to sex-work and adult porn consumption.

Again, it’s about intentionality. The image of someone tied up during sex, for example, bothers a lot of people. They associate bondage with images of people held captive against their will (such as hostages) and imagine the person doing it as unfeeling or vicious and the person tied up as self-hating. But bondage people do bondage for all the same reasons straight people do straight things: it gets their blood flowing, it makes their hearts pound, it fills them with excitement, gets them aroused, and makes them feel intensely bonded with the person they’re doing it with.

Consensual sex, no matter its expression, provides the body and mind with that unfathomable, seemingly divine cocktail of natural chemicals that make us feel more alive. As I see it, we’re all looking for happiness – we just take different paths to get there. What we do share is the primal joy of having great sex: it feels like sunshine in the human soul. So, does it matter to me if one person has to wear a diaper to feel it, while another must be plunged deep in his boyfriend’s ass, and another finds ultimate pleasure in being vaginally penetrated by her one and only true love? No. All of us are looking for happiness through sex: we just take different paths in our individual journeys to get there.

Clinical experience has shown me that when clients with negative patterns of sexual behavior start having positive experiences, it quickly begins to improve the quality of their inner emotional lives. With abuse victims and, really, anyone who is unhappy with their sexual relationship, the first step is building a positive new sexual feedback loop that makes the connection between sex and joy. The more positive experiences they have, the more confidence they build about their ability to perform well in bed. The more success they have in the bedroom, the more optimistic they feel about other realms of life. While the science isn’t there yet, in my clinical experiences, repeated experience of happy sex balances and heals the mind.