Until recently, many doctors dismissed women’s genital pain (dyspareunia or vulvodynia) as “neurotic,” which left them doubly wounded—in pain and put down. Some men don’t believe women’s complaints of sexual pain. A few even believe that sex should hurt women. Wrong.

Pain is a mind-body experience with physical and emotional components. Stress, anxiety, and depression aggravate pain. It’s important to identify both the physical and psychological components because each responds to different treatments. If one component resists treatment, it may help to treat the other.

Sex Should Never Hurt

Attention, men: Except for consensual BDSM, sex should never hurt. Some men feel so eager to plunge into intercourse that they dismiss women’s complaints of pain. Big mistake. If sex hurts her, she can’t become aroused, which means lousy sex for both of you.

Most Sexual Pain Can Be Cured

In a two-year study, two-thirds of women with sexual pain reported significant improvement. The many causes include:

Lack of Lubrication

Poorly lubricated intercourse is a major cause of women’s pain. Many perfectly normal women don’t produce much vaginal lubrication. After 40, as women become menopausal, lubrication problems become even more prevalent. Cunnilingus can supplement women’s natural vaginal lubrication. But if the woman reports pain, use a commercial lubricant—lots of it.

Nonsensual Lovemaking

Before they can enjoy intercourse comfortably, most women need considerable warm-up time, 30 to 45 minutes. If men push in before women feel receptive, they experience pain. Pain-free lovemaking is based on leisurely, playful, whole-body massage. Men should slow down, then slow down some more. Intercourse can wait. Give women all the time they need to become relaxed, aroused, and receptive. Sex therapists recommend at least 30 minutes of kissing, cuddling, mutual whole-body massage, and oral sex before intercourse.

Inserting Too Quickly Or Deeply

Even if women are lubricated and feel highly aroused, they may experience pain if men push in too forcefully. Don’t imitate porn. The vagina is not a hollow space. It’s comprised of folded muscular tissue that yields most comfortably when the penis enters slowly.

Deep insertion may also cause pain, especially during rear-entry (doggie style). To enjoy this position without pain, the man should remain still and allow the woman to back onto the penis at her own pace. This way, women can let men know how deeply they can comfortably insert. And in the woman-on-top position, again, the man should remain still so the woman can sit down on him, controlling the speed and depth of insertion.

Relationship Issues

If relationships cause women emotional pain, they may experience physical pain during sex. For relationship issues, consult a couples counselor or sex therapist.

Birth Control Pills

Andrew Goldstein, M.D., editor of Female Sexual Pain Disorders, says today’s birth control pills are “a leading causes of women’s sexual pain.” The Pill causes overproduction of sex hormone-binding globulin, which binds to vulvar tissue, and causes biochemical changes that produce pain. Goldstein says that women with sexual pain should switch contraceptives and take supplemental estrogen and androgens to normalize their levels. With this treatment, he says most women with Pill-related pain are cured in six months.

Vulvar Skin Conditions

Women’s external genital skin is sensitive to irritation from douching, pubic shaving, sunburn, latex allergy from condoms, or contact dermatitis from harsh or perfumed soaps, feminine hygiene products, or underwear made from synthetic fabrics. If the vulva appears red or irritated, consult a physician.

Sexually Transmitted Infections

Chlamydia, genital warts, and pelvic inflammatory disease may cause pain on intercourse. If pain persists despite increased sensuality and lubrication, see a doctor for screening.

Other Vaginal Infections

Vaginal yeast or bacterial infection (vaginosis) may cause sexual pain, which may feel worse the day after lovemaking. Women in pain should be tested.

Emotional and Sexual Trauma

It may take many years for early life trauma to manifest as pain. Sex therapy can help. So can the excellent book, Healing Sex: A Mind-Body Approach to Healing Sexual Trauma by Staci Haines (Cleis Press).

Oxalate Irritation

Some foods contain oxalates. Women sensitive to them may develop urethral irritation, which can cause pain. High-oxalates foods include: celery, coffee, chocolate, rhubarb, spinach, and strawberries. The Vulvar Pain Foundation publishes a more extensive list.  It can take three to six months on a low-oxalate diet to experience improvement. Oxalate irritation may also improve with a calcium citrate supplement (Citracal).

Vaginismus

Vaginismus causes pelvic muscle spasm, which closes the vagina. In mild cases, intercourse causes discomfort. In severe cases, insertion is impossible and attempts cause sharp pain. Ask your doctor to check for vaginismus. It’s best treated by a physician-sex therapist team. Therapy includes Kegel exercises, biofeedback, and insertion of graduated dilator rods that gradually coax the vagina open.

Vulvar Vestibulitis (VV)

This poorly understood condition involves inflammation of the tiny vestibular glands inside the vagina. Testing for VV, involves pressing a Q-tip into this tissue. In women with VV, Q-tip pressure causes sharp pain. Some VV clears up with time and lubrication. Other treatments include: biofeedback, Kegel exercises, a low-oxalate diet, a support group, and surgery to remove the glands (vestibulectomy).

Other Conditions

Women’s sexual pain may also be caused by: uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome, and gynecological cancers. A work-up should investigate all of them.

For more on genital/sexual pain, contact: the International Pelvic Pain Society ,  the National Vulvodynia Association, or the Vulvar Pain Foundation. Or consult a sex therapist by visiting the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Message to Men

If women complain of genital/sexual pain, don’t criticize them for sabotaging sex. Instead, slow things down, use lubricant, embrace whole-body caressing, and urge her to consult a physician. If that doesn’t resolve the problem, as a couple, consult a sex therapist. Remember, for great sex, intercourse is not necessary. You can enjoy mutual pleasure using your hands, tongues, and toys. Women appreciate men who take their pain seriously, men who are patient and supportive during its evaluation and treatment.

References:

Bergeron, S et al. “A Randomized Comparison of Group Cognitive-Behavioral Therapy, Biofeedback, and Vestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis,” Pain (2001) 91:297.

Binik, Y.M. et al. “Female Sexual Pain Disorders: Genital Pain or Sexual Dysfunction?” Archives of Sexual Behavior (2002) 31:425.

Dunn, K.M. et al. “Systematic Review of Sexual Problems: Epidemiology and Methodology,” Journal of Sex and Marital Therapy (2002) 28:399.

Graziottin, A. “Clinical Approach to Dyspareunia,” Journal of Sex and Marital Therapy (2001) 27:489-501.

Graziottin, A. et al. “Vulvodynia: The Challenge of Unexplained Genital Pain,” Journal of Sex and Marital Therapy (2001) 27:503-512.

Graziottin, A and L.A. Brotto. “Vulvar Vestibulitis: A Clinical Approach,” Journal of Sex and Marital Therapy (2004) 30:125.

Heiman, J.R. “Sexual Dysfunction: Overview of Prevalence, Etiological Factors, and Treatments,” Journal of Sex Research (2002) 39:73.

Lamont, John, et al. “Psychosexual and Social Profiles of Women with Vulvodynia,” Journal of Sex and Marital Therapy (2001) 27:551-555.

MacReady, N. “Biofeedback, Kegels Can Ease Pain in Vestibulitis,” Family Practice News 9-1-2003.

Metts, JF. “Vulvodynia and Vuylvar Vestibulitis: Challenges in Diagnosis and Management,” American Family Physician 3-15-1999. 59:1547.

Reissing, E.D. et al. “Vaginal Spasm, Pain, and Behavior: An Empirical Investigation of the Diagnosis of Vaginismus,” Archives of Sexual Behavior (2004) 33:5.

Simons, J.S. and M.P,. Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Research,” Archives of Sexual Behavior (2001) 30:177.

Who wants sex more?  If you’re thinking the man, you’re almost right. According to sex therapists, the man has more libido in two-thirds of cases, but surprisingly, in one-third, it’s the woman. When the man has more desire, it causes stress, but “everyone knows” that men are horny, so people expect this, it’s culturally normal. However, when the woman wants sex more, it’s culturally unexpected, more stressful for the couple, and may lead to name-calling. “Nymphomaniac!”

One largely unmentioned aspect of desire differences is that they eliminate nonsexual affection. Those with greater desire eagerly initiate hugging, cuddling, and kissing in part because it’s emotionally nourishing, but also in hopes of getting lucky. Meanwhile, those with less interest withdraw from kissing and hugging for fear that it might be misinterpreted as a sexual invitation.

Today, desire differences are a leading reason why couples consult sex therapists. Therapists typically ask, “In your relationship, who controls the sex?” Each points to the other—and both are astonished that their partner thinks they are in control when each of them feels powerless. The one with more libido feels eviscerated by every cruel “no.” And the one with less feels emotionally battered from constantly fending off advances.

Fortunately, desire differences CAN be resolved. Here are the steps sex therapists recommend:

• What do you really want? Is it sex? Or other needs: more fun together, nonsexual affection, or proof of your partner’s love. Despite desire differences, couples usually feel closer when they cuddle more, make social plans, and treat each other compassionately.

• Negotiate a compromise frequency. If one wants sex twice a week while the other prefers once a month, their average is four or five times a month. But averages don’t matter. The challenge is to is find a frequency you can both tolerate. Note: While couples over 50 have frequencies ranging from daily to never, surveys show that older lovers’ most typical frequency is two to three times a month.

• Schedule sex dates in advance. This is critical. Scheduled sex dates reassure higher-desire partners that lovemaking will actually happen, and they reassure lower-desire partners that it will happen only when scheduled.

The moment couples schedule sex dates, relationship tensions subside.

• “But suppose we have a date, and I’m not in the mood?” Lower-desire partners always ask this question. But in practice, the issue is usually less problematic than they fear. As scheduling reduces tension over sex, the relationship improves, and lower-desire partners can typically psyche themselves up for sex.

Of course, no sex schedule is carved in stone. Sex therapists advise trying scheduling for six months. If it’s not working, re-negotiate.

But usually, scheduling is a breath of fresh air. Higher-desire partners hate to grovel and lower-desire partners hate feeling besieged. Scheduling is usually a relief.

• Embrace your schedule in good faith. Don’t bicker about your compromise schedule. Higher-desire folks must not whine for more sex, and lower-desire partners must not cancel sex dates, or unreasonably postpone them.

• Cuddle more. When couples embrace their schedules in good faith, nonsexual affection returns to the relationship. Both people can initiate hugging, kissing, and cuddling without fear of misinterpretation because both know their schedule. Couples who have resolved desire differences often feel surprised by how much they’ve missed nonsexual affection, and astonished at how important it is to the relationship and their own well-being.

• Consider sex therapy. If you need help negotiating a schedule, or if a chronic desire difference has poisoned your relationship to the extent that you can’t discuss the issue, consult a sex therapist. To find one near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology. Figure four to six months of weekly hour-long sessions.

The idea that desire follows good sex turns conventional notions of libido upside down. But Basson’s insight also provides perspectives that can help men and women better understand each other and enjoy greater sexual satisfaction.

Most Women Really Need Extended Warm-Up Time

Many supplements claim to boost women’s libido, and since Viagra, drug companies have been hot to develop drugs that pique women’s desire. But if Basson is correct—and  the many sexologists I’ve interviewed on the subject agree that she is—then drugs and supplements may be putting the erotic cart before the horse.

The question is not: What provokes women’s desire? The real question becomes: What kind of lovemaking allows women to feel relaxed, protected, and cherished enough to enjoy lovemaking and eventually experience desire?

That’s easy. In dozens of sex surveys over the past 40 years, women say they prefer leisurely, playful, sensual lovemaking based on whole-body mutual massage that eventually (after 30 to 45 minutes) leads to genital caresses. One of women’s top erotic complaint is that men are too rushed and too focused on female breasts and genitals, that men are all finished before women have even become interested. Viewed through the lens of Basson’s work, this makes perfect sense. The classic, porn-inspired male “wham, bam” style of sex doesn’t allow women the warm-up time they need to feel sufficiently relaxed and valued so they can experience desire.

So, ladies, if you feel sexually neutral as an erotic interlude begins, you’re normal. If you’re “slow” to become aroused, you’re normal. If you like lots of kissing and cuddling and massage before things progress to genital sex, you’re normal.

And gentlemen, if you want her to feel turned on, if you want her to want you, then slow down, then slow down more. Kiss her, hold her close, and gently caress every square inch of her body from her scalp to her feet for at least 30 minutes before you touch her breasts or genitals.

“I’m Not In the Mood”

Basson’s discovery also sheds light on desire differences. After relationships’ initial hot-and-heavy period (six months to a year), desire cools, and one person—usually, but not always, the man—wants sex more than the other. Desire differences are virtually inevitable in long-term relationships, and often become festering sores. This joke always gets a grim rise out of men: What’s foreplay to a man married 10 years? An hour of pleading. Today, desire differences are a leading reason why couples consult sex therapists.

Therapy is a good choice. Sex therapists have developed a deceptively simple yet remarkably effective program for resolving desire differences: Negotiate how often you’d like to make love, then pull out your calendars and schedule it in advance.

Of course, this opens a can of worms. Many people have strong feelings about sexual frequency, and many lower-desire folks cringe at scheduling, saying, “What if the date rolls around and I’m not in the mood?”

There’s no “normal” sexual frequency, but for the record, the University of Chicago’s landmark “Sex in America” survey showed that from age 20 to 60, most couples make love from twice a week to twice a month, with lovers under 40 typically reporting four to six times a month and those over 40 doing it on average three times a month.

As for reluctance to schedule sex, women who feel that way are probably in the large group Basson has identified, those who don’t experience desire until they’re well into good sex. Sex therapists urge lower-desire lovers to temporarily shelve their doubts and try scheduling for a few months. If they don’t like it, they’re free to stop. But typically, initial reluctance yields to a pleasantly surprised admission that scheduling works quite well. It also improves things out of bed. It reduces resentments and contributes to a happier relationship.

Basson’s research focuses only on women. But therapists say that in serious desire differences, about one-third of the time, the lower-desire partner is the man. It’s possible that these men are like so many women, not very interested in sex until things heat up.

If you want to resolve a long-term desire difference, start by reading my article, “’You’re Insatiable!’ ‘You Never Want To!’ The Sex Therapy Program That Treats Desire Differences.”

If the article does not provide sufficient resolution, I’d urge a few months of sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Basson, R. “The Female Sexual Response: A Different Model,” Journal of Sex and Marital Therapy (2000) 26:51.

Michael. R.T. et al. Sex in America: A Definitive Survey. Little Brown, Boston, 1994.

At the beach, the gym, or socially, many people occasionally enjoy wearing tight, form-fitting, or revealing clothing to show off some aspect of their bodies. There’s a little bit of exhibitionist in most of us, too.

But how many people are really deeply into watching sex or exposing themselves in public? That’s been a mystery but a Swedish study has investigated the issue, providing what, as far as I know, is the only real data on the subject.

Researchers at the Karolinska Institute (the university that awards Nobel Prizes) surveyed a random sample of 2,450 Swedes age 18 to 60.  Seventy-six (3.1 percent) reported at least one incident of feeling sexually aroused by exposing their genitals to a stranger. Men were more exhibitionistic than women (4.1 percent vs. 2.1 percent).

One hundred ninety-one (7.7 percent) reported at least one incident of being sexually aroused by spying on others having sex. Again men were move voyeuristic (11.5 percent vs. 3.9 percent).

It’s no surprise that men are more voyeuristic than women. Voyeurs are called peeping Toms, not peeping Tinas. The audience for pornography is clearly voyeuristic, and according to porn industry estimates, 80 percent of pornography is viewed by men solo. In the study, the single best predictor of voyeurism was frequent use of porn.

Compared with the population as a whole, voyeurs and exhibitionists are more sexually active. According to the study, they are more easily aroused, masturbate more often, and have intercourse more frequently. They’re more sexual in general, so they’re apparently more interested in exploring the fringes of sexual expression.

It’s risky to be an exhibitionist and/or voyeur. In most places, it’s illegal. But in some places, voyeurism and exhibitionism are not only legal, but encouraged—nude beaches, sex clubs, swing clubs, Mardi Gras in New Orleans, Nudes-a-Poppin’ in Indiana, and Fantasy Fest in Key West are the ones I’m familiar with. There must be others. Anyone know of any?

Nude beaches, Mardi Gras, Nudes-a-Poppin’, and Fantasy Fest are all about exhibitionism, with topless or naked women (and some men) enthusiastically flaunting it for eager men and their cameras. But these venues do not involve true voyeurism because voyeurism involves more than gazing at nudity, it means watching people having sex.  For that, you have to visit sex clubs or swing clubs.

As far as I know, there are swing clubs and sex clubs in virtually every major metropolitan area. Swing clubs typically admit only couples, and many sex clubs have one night a week reserved for couples. But most sex clubs admit singles and make their money from single men. Where I live, in San Francisco, a major sex club is the Power Exchange, which began as a BDSM club and still maintains a play dungeon in the basement, but it also has two other floors full of couches, beds, and little rooms and nooks where nookie is encouraged and can be observed.

The night I visited the Power Exchange—as part of a “field trip” during a sexology meeting—there were maybe a half-dozen couples in various stages of getting it on, being watched by dozens of men, many of whom were opening masturbating. Admission to the Power Exchange costs HOW MUCH for couples and single women, and $60 for single men. Bowls of condoms are everywhere, and monitors circulate to make sure no one feels harassed. According to the staff, many patrons, both couples and single men, are out-of-towners, tourists attending conventions who want to play or watch people playing far from home where they’re unlikely to run into anyone they know.

It’s not clear if the Swedish results reflect the prevalence of voyeurism and exhibitionism in the U.S., but I suspect they do. Everyone who has ever seen an R-rated movie is at least a little voyeuristic, and sex clubs couldn’t survive without a steady stream of exhibitionists to attract the crowds of high-paying single voyeuristic men.

The study: Langstrom, N. and M.C. Seto. “Exhibitionistic and Voyeuristic Behavior in a Swedish National Population Survey” Archives of Sexual Behavior (2006) 35:427.

Non-ejaculation is men’s secret sex problem. It can develop at any age, teens to elderly. According to the “Sex In America” surveys (1999 and 2008), It affects 28 percent of men under 50, 16 percent of those in their early sixties, 23 percent from age 65 to 74, and 33 percent of men 75 and older. Fortunately, E/O problems can usually be resolved with self-help and/or sex therapy.

Many Possible Causes

Masturbation style. Some men self-stimulate in a particular way and train themselves to trigger E/O in that way only. Without knowing the man’s erotic idiosyncrasies, a lover may not be able to help him get there. Palo Alto, California, sex therapist Marty Klein Ph.D., says “I’ve counseled guys who yank their penises harder than any woman ever would.”

Stress. Sex therapists say that several emotional stressors may be associated with E/O difficulties: anger at one’s lover, fear of pregnancy or sexual infections, or a fundamentalist religious upbringing. “I’ve seen ejaculatory problems linked to strict Catholic, Protestant, and Jewish upbringing,” says Fair Oaks, California sex therapist Louanne Weston, Ph.D. “It’s not the religion. It’s fundamentalism’s sex-negativity.”

“Delivery boy” attitude. Lovemaking involves giving pleasure and receiving it, but some men believe their only job is to give it. “When a man pays too much attention to his partner’s experience, and not enough to his own,” Klein explains, “he loses erotic focus, which can interfere with ejaculation and orgasm.”

Drugs. Antidepressants are notorious for impairing E/O. Alcohol is usually associated with ED, but in some men, it causes E/O problems. Many other drugs may also cause E/O impairment: pain relievers (Aleve, Naprosyn) and blood pressure medications (many), anti-anxiety drugs (Xanax, Valium), and psychiatric medications (many), among others.

Aging. “As men age,” says Bloomfield Hills, Michigan, sex therapist Dennis Sugrue, Ph.D., “they notice that their penises need more stimulation, sometimes, a lot more, to trigger ejaculation. This is normal, but often disconcerting.”

Weak pelvic floor muscles. Aging also weakens the muscles involved in E/O. When this happens, semen doesn’t spurt, it dribbles, and orgasms may provide little pleasure.

Medical conditions. Neurological conditions (diabetes, paraplegia, multiple sclerosis) might damage the nerves that control O/E. Surgery for benign prostate enlargement has no effect on orgasm, but it eliminates ejaculation.

Resolving E/O Problems

First, consult your doctor. Your physician should investigate possible infections, drug issues, or pain or neurological problems. For antidepressant-induced E/O problems, ask if you can to switch to Wellbutrin. It’s as effective as other antidepressants but less likely to cause this problem.

Practice Kegel exercises. These simple, discreet exercises tone the pelvic floor muscles, intensifying orgasm and strengthening ejaculation. To learn Kegels, visit GreatSexAfter40.com and read the article.

Value your erotic context. The myth is that can function sexually under almost any circumstances, while women can enjoy sex only under a number of pre-conditions—a nice dinner, flowers, clean sheets, and a man actually interested in what they have to say. But men also have pre-conditions for satisfying sex, and as men age, the context becomes increasingly important. To trigger E/O, you may need particular conditions. Identify yours and work with your partner to provide them.

Value your own pleasure. You’re more than a delivery boy. You, too, deserve erotic satisfaction and have every right to ask for the stimulation that produces it.  If you engage in vaginal intercourse, it may not provide enough stimulation for E/O. “You may need very vigorous manual or oral stimulation,” Klein says. “If so, ask for it.”

Coach your partner. Most men with E/O problems can masturbate to orgasm. Show your partner exactly what works for you, and coach her to provide it. You may feel bashful about masturbating in front of her, going puboic something that’s usually private. But it not only teaches your lover what you need, it also involves self-revelation, which deepens the intimacy in your relationship.

Breathe deeply. It relaxes the nervous system so that erotic stimulation can trigger E/O

Heat up your fantasies. Recall the fantasies that have helped you with E/O in the past. Elaborate on them. (They need not include your lover.) They just need to arouse you. Or try X-rated videos.

Use lubricant. Sexual lubricants make the genitals more sensitive to touch, and often help resolve E/O problems.

Read a book. The one most often recommended is Becoming Orgasmic: A Sexual and Personal Growth Program for Women by sex therapists Julia Heiman, Ph.D., and Joseph LoPicollo, Ph.D. Though aimed at young women, the program also works for men of all ages. Its message is that each of us is responsible for our own sexual satisfaction. A lover can create an erotic context that allows E/O. But no one “gives” anyone else an orgasm. Orgasms emerge only when we let them.

Consult a sex therapist. If self-help doesn’t provide sufficient relief, sex therapy can usually resolve E/O issues. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

If men made love the way most women prefer, women would receive the leisurely, playful, massage-inspired, whole-body sensuality every sex survey shows they value for erotic enjoyment.

Meanwhile, if men made love the way most women prefer, men would enjoy more aroused, more enthusiastic lovers, and more reliable erections and better ejaculatory control.

All men have to do is let go of the idea that sex should proceed like it does in pornography.

Women’s Biggest Complaint About Men As Lovers

In survey after survey, women, especially young women, complain that men, especially young men, are too rushed, too mechanical, and too narrowly focused on women’s breasts and genitals.  In many women’s experience, too many men view sex as a headlong plunge into intercourse. That’s porn-style sex. It can be summed up by the phrase, “wham, bam, thank you, ma’am.”

The breasts and genitals should certainly be included in lovemaking, but every major sex survey agrees that most women prefer a shift away from genital preoccupation toward slow, playful, whole-body massage.  Most women consider the entire body, every square inch, one big erogenous zone, and can’t understand why so many men explore only a few corners of it. Many women resent men for rushing through sex, and as a result, get turned off to lovemaking.

Men’s Biggest Complaint About the Way Women Make Love

Meanwhile, men’s biggest complaint about the female lovestyle is that many women simply aren’t interested.  They need to be wined, dined, and coaxed into bed, and when they get there, they take little or no initiative, and fight men’s advances, which men resent.

Many men also feel deep sexual self-doubt.  The women on TV, in the movies, and certainly in pornography are all very interested in sex and enthusiastic participants in it.  Men think: If the woman in my life isn’t interested, there must be something wrong with me.  But instead of asking women what’s wrong, men often internalize what they’ve experienced from the sex media: Their penises are “too small” to provide women adequate pleasure.  Surveys show that most men are convinced this is true.  Many men also worry about coming too soon, or erection problems, or not coming at all.

A Truce in the Battle of the Sexes

Since the mid-1960s when research by William Masters, M.D., and Virginia Johnson led to the development of modern sex therapy, it has become abundantly clear why so many couples’ love lives are agony instead of ecstasy.  The rushed, mechanical, all-genital lovestyle most men learn at the curbside, in the locker room, and from pornography ignores women’s needs and contributes significantly to men’s sex problems. Men learn that except for a few quick swipes at women’s breasts, the only part of the body that counts is between her legs.  They should listen to women: The whole body is one big erogenous zone.

In fact, leisurely, playful, whole-body, massage-inspired caressing is the single most important ingredient of high-quality lovemaking. Sure, genital fondling and oral sex are part of great sex.  But so are foot massage, back rubs, finger and earlobe sucking, scalp, face, and back-of-the-knee caresses, and gently kneading the flesh from head to toe. In addition, the wham-bam approach not only confounds women, it also hurts men. It’s a major contributor to erection problems, premature ejaculation, and difficulty ejaculating and enjoying orgasm.

Men’s sexual miseducation is not their fault. Young men feel tremendous pressure to know the ins and outs of sex, as it were, so they’ll be able to lead their presumably sexually naive girlfriends in intimate explorations.  Few parents discuss sex the details of erotic technique with their sons.   School-based sex education is all about sperm, eggs, sexually transmitted diseases, and (occasionally) contraception. But even the best school-based sex-ed programs communicate not one iota of information about the critical importance of whole-body sensual caressing.  So young men fall back on the only resources available to them—other clueless young men, and the sex media, which largely ignore sensuality, and instead, feature men with elephantine penises (the main reason why just about every many is convinced his is too small) pounding away like a piston in overdrive. It’s a classic case of the blind leading the blind.

The Key to Great Sex

It’s also why sex therapists need not fear unemployment. Sexological research has made many startling discoveries, but none more important than this: The key to great sex is leisurely, playful, whole-body caressing.  How leisurely?  Very.  Song lyrics endlessly gush about making it last “all night long,” but for many men, all sex is a “quickie.” Sex therapists spend a good deal of their time urging men to slow down, then slow down more, and learn that the best sex as an extension of whole-body mutual massage.  Singer-songwriter Michelle Shocked put it well: “If love is a train, I think I’ll ride me a slow one.  Let’s ride all through the night making every stop.”

When men drop the wham-bam attitude and begin to appreciate the pleasure potential of such secret pleasure spots as their calves, shoulders, chests, and ears—along with everyplace else—some amazing things begin to happen.  Women start to enjoy lovemaking because they’re getting what they wanted all along—creative, non-mechanical, whole-body intimate sharing.  And because lovemaking unfolds more slowly, there’s plenty of time for women to become truly aroused and take some sexual initiative.

A more sensual style of lovemaking is also a major ingredient in sex therapy for many male sex problems.  When men adopt the sensual lovemaking style most women prefer, they find it much easier to learn voluntary control over ejaculation.  Many erection problems clear up.  And those who have difficulty ejaculating are more likely to enjoy release.

Dude, when it comes to sex, women know best. They want you to slow down, so slow the f*** down already.  Forget genital preoccupation, and learn to appreciate whole-body caressing and massage.

When men make love the way women prefer, men have fewer sex problems, women enjoy sex more, and both men and women feel more loving toward one another and more erotically fulfilled.

Selected references:

Miller, AS and ES Byers. “Actual and Desired Duration of Foreplay and Intercourse: Discordance and Misperceptions in Heterosexual Couples,” Journal of Sex Research (2004) 41:301.

Mohn, T. “The Spa Experience as Tuneup: Reports Discover That Men and Women See Massage Differently,” New York Times, 5-31-2005.

NewScientist.com. “Scientists Reveal the Secret of Cuddles.” 7-28-2002.

But men faking orgasm? That’s unheard of. Well, no, not exactly. Many sex therapists offer anecdotal reports, and a 1981 study of 280 college students (185 women and 95 men) showed the familiar rate among women (60 percent)—and faking by 36 percent of the men. But that was the only real study of male faking, until recently.

In 2010, researchers at the University of Kansas asked 281 undergraduates (180 men and 101 women) to complete an anonymous sex survey that included questions about faking orgasm. Consistent with previous findings, two-thirds of the women (67 percent) said they’d pretended at least once—and 28 percent of the men said the same.

While not a nationally representative sample, the participants included a reasonable demographic cross-section of college students: largely white, but some Asian, Hispanic, and African American, and largely heterosexual, but some gay/lesbian or bi. Pretenders and non-pretenders reported generally similar sexual experience, but the fakers were more experienced, so they’d had more opportunities to pretend. Fakers were also sexually more adventurous, reporting more masturbation, oral sex, and anal play.

Most faking took place in established relationships (78 percent of the women, 53 percent of the men), but it also occurred among dating couples (2 percent of women, 16 percent of men, friends with benefits (10 percent and 9 percent), and casual hook-ups (10 percent, 16 percent).

No women faked it with men they’d just met, but 7 percent of the men did with women they’d just met.

Most faking took place during vaginal intercourse (55 percent of the women, 80 percent of the men), but some occurred during oral sex (8 percent, 11 percent), or other unspecified sexual play (37 percent, 8 percent).

Women’s pretending was rarely linked to alcohol, but men’s was. Two percent of the women had some alcohol before faking orgasm and 6 percent said they were drunk. Meanwhile, 11 percent of the men had been drinking and 24 percent claimed they were drunk.

Faked orgasms typically involved acting—moaning, hip thrusting, and thrashing about in an effort to fool the partner. Young women’s acting often tricks young men because guys with limited sexual experience may not recognize the pelvic muscle contractions of real female orgasms.

But men’s orgasms produce visible evidence, semen, so how can men fake it? Condoms and lubricant are often the keys. Men thrust and moan, and then deftly discard the condom before the women notice there’s nothing in it. Or they spit into the condom before donning it. Or they use lots of lube and the woman’s vagina is so wet that it feels like semen. Or some college-age women are as clueless about men’s orgasms as men can be about women’s. As one man recalled about faking it: “She was like, well, did you get off? And I was like, yeah.”

Men and women fake orgasms for similar reasons:

Orgasm was taking too long or wasn’t going to happen: women, 71 percent; men, 84 percent.

They wanted the sex to end: women, 61 percent; men, 82 percent.

They wanted to avoid hurting the partner’s feelings: women, 69 percent; men, 47 percent.

They felt bored, or tired, or sleepy, or no longer in the mood for sex: women, 56 percent; men, 72 percent.

This study confirms the previous research that a majority of women have faked orgasm at least once, and it corroborates the one previous study that men also fake it. Based on these two studies, it seems somewhere between one-quarter and one-third of men have faked it, meaning that men pretend to have orgasms about half as much as women.

Have YOU ever faked orgasm? I’m especially hoping for comments from men. Why? And how did you explain the lack of semen? Or did you?

The study: Muehlenhard, C. and S.K. Shippee. “Men’s and Women’s Reports of Pretending Orgasm,” Journal of Sex Research (2010) 47:552.

Quite often because one or both lovers ignore a key ingredient of great sex—leisurely, playful, massage-style caresses of the whole body, from the scalp to the soles of the feet and everything in between.

Novice lovers typically focus on a few places—the genitals and women’s breasts. Advanced lovers know that every square inch of the body is a sensual playground, that the entire skin surface can revel in sensual touch, and that when lovers postpone genital sex and caress each other all over for an extended period (30 minutes), subsequent genital play feels more arousing and orgasms feel more intense and pleasurable.

Most women understand this intuitively. Compared with men, women are more tactile and instinctively appreciate sensual touch and massage. Unfortunately, many men focus on only a few corners of the body and largely ignore everything else. But believe me, guys, if you embrace leisurely, playful, massage-based, whole-body sensuality, you’ll enjoy sex more—and your lover will be much more responsive and enthusiastic.

Touch is the Only Sense We Can’t Live Without

The skin is the body’s largest organ. When massage-style caresses excite it—all of it—anxiety melts away, mood improves, and pain subsides, all of which enhance sex. Sensual massage from head to toe is critical to women’s sexual responsiveness. Without extended, whole-body massage, many women find it difficult or impossible to become sexually aroused, let alone have orgasms. In addition, leisurely, playful, whole-body massage helps prevent and treat men’s sex problems, notably rapid ejaculation and erection difficulties.

Human beings can live without sight, hearing, taste, or smell. But deprive infants of loving touch and they die. That’s what happened at the close of the 19th century when some leading infant-care experts insisted that cuddling babies was “primitive.” Hands-off infant care was embraced by many educated, wealthy Americans determined to greet the new 20^th century with the latest scientific wisdom. The staff of many orphanages also stopped cuddling infants on the advice of these so-called experts. However, this message did not trickle down to poor, less educated women, who continued to hold and hug their infants.

By 1910, pediatricians were reporting a strange new disease, failure to thrive, that caused healthy infants to lose weight and die. It was epidemic in orphanages, and also struck infants in affluent families. But poor families were unaffected. Eventually, physicians identified its cause—lack of cuddling. When parents and orphanages returned to “primitive” infant care, the kids thrived. Today, child development experts agree that infants cannot be held and cuddled too much.

Failure to thrive has never been documented after infancy. But the fact that lack of touch can lead to death for even a brief period shows how important it is. Think of touch as an essential nutrient transmitted through the skin.  Cuddling and massage are deeply nurturing and relaxing. They are also fundamental to fulfilling sex.

 The skin contains two types of touch-sensitive nerves. Pain is transmitted through nerve fibers that trigger release of stress hormones. But the skin also contains C-tactile fibers that respond to pleasing touch and stimulate release of other hormones that produce feelings of relaxation and well-being. Gentle massage stimulates release of oxytocin, a hormone linked to attachment and to sexual arousal, pleasure, and orgasm.

Why Many Men Resist Massage-Based Sex

Unfortunately, many men feel skeptical about the role that whole-body massage plays in great sex. Their doubts stem, in part, from the fact that as they leave childhood, many men “lose touch” with touch. Men slap each other’s backs, but they don’t share gentle, affectionate touch the way women do.

Another reason has to do with the single most compelling source of male sex education, pornography. The sex in porn is 95 percent genital. Now, there’s nothing wrong with enthusiastic genital sex. But what men learn from porn—and it’s one of the top destinations on the Internet, some 15 billion pages—is that sex is all about the genitals and only the genitals.

Finally, we have the unfortunate term, “foreplay,” which implies something done before the main event, intercourse. Many men engage in perfunctory foreplay and then rush into intercourse.

Rushed foreplay represents a fundamental misunderstanding of how women—and men—respond sexually. Most women prefer extended, playful, whole-body massage that includes their breasts and genitals—but is not fixated on them. In fact, to experience sexual arousal, most women absolutely need extended, whole-body caressing.

Rushed foreplay is also a one-way ticket to men’s sex problems, notably premature ejaculation. Many songs rhapsodize about doing it “all night long.” But with rushed foreplay, many men don’t last two minutes. The reason is that the penis works best in the context of whole-body massage. If all the erotic attention is focused on the penis, the little guy can’t take the pressure, and ejaculation happens quickly. Extended, whole-body caresses distribute sexual arousal around the entire body, which takes the pressure off the penis. It still becomes highly aroused—in fact, more aroused—but because men are aroused from head to toe, the penis is under less pressure, which helps men last longer. (For more on curing premature ejaculation, see my article.)

Men skeptical of whole-body touch might change their minds after a professional massage—not what’s offered at massage parlors, but a nonsexual, 60- to 90-minute massage by a certified massage therapist. Professional massages can introduce men to slow-paced sensual pleasure. My advice to skeptical men: Make love shortly after a professional massage. I bet your penis behaves better, and your lover becomes more aroused and responsive. My advice to women: Give your man a gift certificate for a professional massage with the promise of something even better afterwards.

Replacing rushed foreplay with leisurely, playful, whole-body caresses is probably the single most woman-pleasing change men can make in their lovemaking. And once men get used to it, they usually find that extended sensuality—30 minutes of gentle touch before you reach between her legs—also enhances their own sexual pleasure.

Not “Foreplay,” Loveplay

Now, back to “foreplay.” Forget it. Instead, think of every moment of sex as “loveplay.” Foreplay implies linear lovemaking, first kissing, then the man’s hands on her breasts and between her legs, then intercourse, then it’s over.

In contrast, loveplay is more creative. You might light some scented candles, and have a glass of wine, listen to music, or watch an erotic video while, gently holding each other, kissing, and stroking each other’s faces and arms. Next you might feed each other little snacks as you undress, caressing each other some more. Then you might shower together, and dry each other. After that, you might repair to bed, turn on some music, and lie face-to-face, kissing, lightly caressing each other. Then, you might suckle each other’s nipples for a while. Next, you might trade foot massages, and after that, fondle each other’s genitals for a time, and then treat each other to oral sex. After a while, you might have intercourse, then uncouple and feed each other some more snacks, while continuing to kiss and caress one another. Next, you might return to oral sex or play with a vibrator or return to intercourse, but in s different position. And on and on…. None of this is “foreplay.” None of it comes before anything else. It’s all lovemaking. It’s all loveplay.

Many women wish men would learn that sex is best when it involves the whole body. The genitals are certainly important, but so is everything else. The entire body is a sensual playground. Great sex excites every square inch of it.

• A healthy nervous system to feel erotic pleasure.
• A healthy heart and blood vessels (cardiovascular system) so sufficient blood flows into the genitals for erection or vaginal lubrication.
• Deep relaxation so the nervous and cardiovascular systems function at their best.

How can you gain these benefits? By following standard health advice:

• Exercise daily.
• Eat at least five daily servings of fruits and vegetables, and limit meats, cheese, fast foods, and junk foods.
• Maintain recommended weight.
• Manage stress.
• Don’t smoke.
• Limit alcohol.
• Sleep soundly.

Exercise Daily

Massachusetts researchers surveyed 1,709 men over 40. As exercise increased, sex problems decreased. Women also report improved sex with regular exercise.

Exercise increases blood flow into the genitals. It boosts testosterone, which fuels libido in both genders. It also elevates mood, reduces insomnia, helps control weight, promotes deep relaxation, minimizes menopausal discomforts, and contributes to self-esteem, all of which enhance libido and sexual satisfaction.

How you exercise doesn’t matter. Do anything you enjoy: walking, swimming, yoga, dancing, golf, gardening—whatever. Just do it at least 30 minutes a day.

Regularity is more important than intensity. It’s better for health and sex to take 45-minute walks daily than to hike five miles twice a month.

Eat More Fruits and Vegetables

Want to do it like a rabbit? Then eat carrots like Bugs Bunny.

Fruits and vegetables are rich in antioxidant nutrients that contribute to cardiovascular and neurological health. In contrast, meats, cheese, fast foods, junk foods, and whole-milk dairy products are low in antioxidants and high in cholesterol and saturated fat that narrow the arteries, limiting blood flow into the genitals. University of South Carolina researchers checked the cholesterol levels of 3,250 men, and then surveyed their sex lives. As their cholesterol increased, so did their reports of sex problems.

Include fruit with breakfast. Eat at least one salad a day. Snack on fruit. And one night a week, dine on vegetable soup. Make a big pot and you also get a few lunches.

Maintain Recommended Weight

Many overweight adults enjoy sex. But the research is clear: Weight loss improves sexual pleasure.

Duke researchers surveyed the sexual impact of weight loss among obese adults. Moderate loss—10 to 30 pounds—boosted their libidos, sexual function, and erotic satisfaction.  Brown researchers surveyed 32 seriously overweight adults starting a weight-loss program. After losing an average of 56 pounds, most reported more sex and greater erotic satisfaction.

It’s tough to lose weight, but guess what helps? Daily exercise and a diet full of fruits and veggies. Exercise burns calories, and plant foods are filling but low in fat and calories.

Avoid crash diets. Instead, embrace modest changes for life, for example, daily walks, fruit with breakfast, and once a week, vegetable soup for dinner. A reasonable goal is two pounds a month, which means 24 pounds in a year.

Manage Stress

Stress often contributes to sex problems. It reduces blood flow into the genitals, and releases hormones that depress testosterone. It contributes to cardiovascular disease, and raises risk of anxiety and depression, all sex killers.

Proven stress relievers include: exercise, pets, massage, laughter, meditation, hot baths, gardening, music (playing or listening), and time with loved ones. Ideally, combine them: Exercise with friends. Garden with your spouse.

Quit Smoking

Many studies show that as smoking increases, sexual satisfaction decreases. Smoking accelerates growth of the artery-narrowing deposits that reduce genital blood flow. If you smoke, your doctor can help you quit.

Limit Alcohol

Alcohol is the leading drug cause of sexual impairment. As Shakespeare wrote in Macbeth, it “provokes the desire, but takes away the performance.” Health authorities advise limiting alcohol to no more than two drinks a day. A “drink” is one 12-ounce beer, one shot of 80-proof spirits, or five ounces of wine, a standard wine glass half full.

Sleep Soundly        

Sleep problems reduce sexual energy and depresses libido and testosterone. Half of adults experience occasional insomnia, and millions suffer chronic sleep problems. Sleep problems typically increase with age.

Sleep needs vary, but experts agree that to function optimally, most adults need at least seven hours a night. Regular exercise improves sleeps. Quitting smoking also helps—nicotine is a stimulant. Limiting alcohol helps, too—alcohol disrupts sleep.

Of course, a healthy lifestyle doesn’t guarantee great sex, but it definitely helps­—and it contributes to longevity so you’re likely to enjoy better sex for more years.

Since the late-1990s when the Internet took off, porn sites have become one of men’s top destinations. Today, more than 25 billion Web pages present every type of X-rated fare imaginable (and some you probably never imagined) for free 24-7-365 on everything from desktop computers to smart phones. And today, many people (mostly women) consider “porn addiction” a major problem.

Is it? In my opinion, no. A small fraction of men watch so much so compulsively that it is a problem. They need therapy. But the vast majority of porn viewers are regular, normal, decent guys who enjoy a little X-rated action to add some zing to masturbation. Is this “addiction”? A public health problem? Not as far as I’m concerned.

The Audience: Men Solo

Who views porn? Overwhelmingly, men solo. According to Adult Video News, the pornography trade magazine, 71 percent of X-rated media is viewed by men solo, 19 percent by heterosexual couples, 7 percent by gay male couples, and 2 percent by women, either solo or lesbian couples. Men who use porn solo account for almost three times as much as all other users combined.

No surprise there. Men become aroused visually, while women become aroused by sensual touch. That’s why men love women in skimpy outfits and lingerie (they view it) while women love bubble baths and spa treatments, and silk (they feel it).

In addition, pornography celebrates men’s erotic fantasies, a world where women are perpetually horny, available, enthusiastic, and happy to service men endlessly while ignoring courtship, intimacy, marriage, birth control, infection prevention, and their own sexual satisfaction.

Critics charge that porn causes rape. It doesn’t. As Internet porn has become ubiquitous, the sexual assault rate has declined. Porn causes primarily one thing—masturbation. Generating erotic fantasies takes effort. Men figure: Why expend the energy creating my own when porn provides more than I could ever want?

All the research on porn and my own interviews of sex therapists concur that men who use porn don’t consider it a betrayal of their relationships. They don’t love their spouses or girlfriends any less because of it, nor do they judge their lovers harshly compared with the women they see on screen. And except for the small group of compulsive porn consumers, the vast majority of men don’t consider it a substitute for their lovers.

Women’s Fears

Many women feel much differently. Illinois State University researchers visited Internet relationship sites and collected 100 posts by wives and girlfriends who had discovered that their men viewed Internet porn. They did not consider it an innocent masturbation aid. Quite the contrary, they felt traumatized and confused, and considered it incomprehensible that their lovers would spend time this way. They equated porn with infidelity, proof that their lovers no longer desired them. They also experienced deep feelings of loss—of the man’s affection, his sexual interest, and intimacy and trust in the relationship. They often described themselves as feeling old, fat, ugly, and worthless because of their lovers’ Internet porn habits. Women who were more accepting called their men “sick” and hoped they could be “cured.” Those who were less tolerant called them “perverts, degenerates, or sex addicts” and questioned whether the relationship could endure.

Clearly men and women differ about the meaning of pornography. For most men, porn represents a form a self-soothing, a way to take a little break from daily hassles by masturbating. Women often self-soothe by taking hot baths or shopping. The shopping analogy is apt. Women’s horror at the time many men spend viewing porn resembles men’s incredulity at the time many women spend shopping. “Another pair of shoes? You already have a million!” “I just like to know what’s out there, and these were so cute.”

Women’s Insecurities

One reason women recoil from porn, Fair Oaks, California sex therapist Louanne Weston, Ph.D., explains, “is that so many women feel so insecure about their bodies, especially compared with the women in porn.” Since the Internet, porn bodies have become more diverse than they were back when men in trench coats sat in those seedy theaters. Today, porn boasts every imaginable example of womanhood—every age, race, ethnicity, weight, and breast size. If you want to see wrinkled, gray-haired, 75-year old women with flat chests and sagging rumps give head, believe me, it’s out there. But this new diversity doesn’t change women’s self-consciousness. The women in porn flaunt it, shake it, and crave sex. Few real women are like that.

Women may also feel distressed about porn because they think they should be able to fulfill all of their man’s  sexual needs. But they can’t fulfill his needs around masturbation, which, by definition, happens solo. “Too many women,” Weston says, “think a marriage license is a license to run their man’s sex life. They believe that once men say, ‘I do,’ they should no longer want to masturbate. That’s naïve.”

“Men like porn,” says Palo Alto sex therapist Marty Klein, Ph.D. “because it appeals to their fantasies of unlimited sex without responsibility. But women feel threatened because they fear men think they’re fat and ugly.”

“The men I counsel have no desire to toss their partners aside for women in pornography,” says Bloomfield Hills, Michigan sex therapist Denny Sugrue, Ph.D. “But they like porn for fantasy while masturbating. They don’t reject their lovers’ bodies, and they don’t see viewing as cheating or a sign of relationship dissatisfaction.”

Do Men in Relationships Have a Right to Masturbate?

Some of women’s disgust with porn has to do with objections to their men masturbating. But masturbation is our original sexuality. The vast majority of men were masturbating enthusiastically and frequently long before they met their spouses. Why deny yourself apple pie once you’ve discovered peach?

Some women whose posts the Illinois researchers collected had spouses who viewed pornography daily for hours, refusing real sex, and sometimes losing their jobs. When anything sexual interferes with one’s ability to work and love, that’s not healthy. Men who can’t control their porn consumption should consult a sex therapist. Here’s a key red flag: Planning to watch for five minutes then two hours later wondering what happened to the evening. Men interested in weaning themselves from porn can do it with the help of sex therapy. To find a therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

But as far as I’m concerned, there’s nothing wrong with otherwise well-adjusted men casually consuming porn while masturbating.

References:

Bergner, R.M and A. Bridges. “The Significance of Heavy Pornography Involvement for Romantic Partners: Research and Clinical Implications,” Journal of Sex and Marital Therapy (2002) 28:193.

Bridges, A.J. et al. “Romantic Partners’ Use of Pornography: Its Significance for Women,” Journal of Sex and Marital Therapy (2003) 29:1.

When desire differences emerge, who wants sex more? That’s a no-brainer, right? The man. Perhaps you’ve heard the old joke: What’s foreplay to a man married for 10 years? An hour of pleading.

There are plausible biological reasons why, in general, men would want more sex than women. Male sex hormones (testosterone in men and a slightly different hormone in women) fuel libido in both genders, and men have much higher levels. Studies of transsexuals show that when men become women and take female sex hormones, they typically report a mellowing of sexual desire, but when women become men and take testosterone, they usually say, “As a woman, I liked sex but didn’t feel driven to it. Now I do.”

An evolutionary argument corroborates this. The biological purpose of life is to reproduce life, to send one’s genes into future generations. Women are most likely to do this by having a few children and nurturing them until they, too, reproduce. That works for men, too, but men can also pursue another strategy—wanton sex to impregnate as many women as possible.

These explanations sound neat and compelling, but if they truly explained desire differences between the genders, we would expect the overwhelming majority of men to want sex more often than the overwhelming majority of women. That does not appear to be the case.

Over the past 20 years, I’ve informally polled dozens of sex therapists asking about the gender break-down of desire differences. I don’t pretend that my findings represent anything beyond a seat-of-the-pants inquiry, but therapists’ replies have been remarkably consistent: Two-thirds of the time, the man wants sex more, but in one-third of cases, it’s the woman. Now, this is a two-to-one margin, so partisans of the conventional wisdom can say, “See? Men clearly want sex more than women.” All right. But if that’s the case, why do somewhere around one-third of women want it more than men?

A fascinating recent book, Sex At Dawn: The Prehistoric Origins of Modern Sexuality takes a stab at an explanation. Co-authors Christopher Ryan and Cacilda Jetha marshall a great deal of psychological and anthropological research to support their view that if we remove the shackles of so-called civilization, women are just as libidinous as men and maybe more so. But for better or worse, we live in the world we inhabit, and the apparent enthusiastic promiscuity of prehistoric women doesn’t alter our sexual norms today.

Any chronic desire difference can drive people crazy. But in our culture, when the woman wants sex more, the couple descends into a special circle of hell, the place reserved for those caught in culturally unexpected circumstances. It’s bad enough to have a chronic desire difference, but when the situation contradicts the highly prevelant assumption that women–all women!–are erotically coy, while men–all men!–are insatiable horn dogs who can never get enough, desire differences feel even more distressing.

I sympathize, and I’m here to say that if, in your relationship, the woman is more libinous than the man, you’re by no means alone. Whatever the reason, if women want sex more in one-third of couples who consult sex therapists, then after men say “good-night,” the number of women who grit their teeth, or cry, or reach for a vibrator has to be in the millions.

Ladies, don’t let the weirdness of wanting sex more than your man deter you from working to change things. The sex therapy program that resolves desire differences is remarkably effective, and it works no matter who wants sex more. To implement the program, read: “You’re Insatiable!” You Never Want To!” The Sex Therapy Program for Resolving Desire Differences. And if my summary doesn’t provide sufficient relief, consider finding a sex therapists near you by visiting the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Mayo Clinic researchers have shown that in men, snoring is associated with reduced sexual satisfaction. It’s the first study to show this, so one might dismiss the finding as a fluke, especially because the men’s sexual function (libido, erection, and ejaculation) remained unaffected. But the association was strong. It appears that men’s snoring irritates the women in their beds, disturbing their sleep and reducing women’s sexual energy to the point that men report normal sexual functioning but less satisfaction.

In the study, the Rochester, Minnesota, researchers asked 827 men in ongoing relationships, age range 51 to 90, to complete surveys of their sex lives and sleep habits. As snoring increased, sexual satisfaction declined. Compared with non-snorers, heavy snorers were twice as likely to report low sexual satisfaction—even though the heavy snorers reported no more problems with libido, erections, or ejaculation.

It’s possible that the snoring-sexual satisfaction association is an artifact, a finding better explained in another way. In addition to suffering in the sack, the heavy snorers also reported less robust health: more diabetes, strokes, heart attacks, and congestive heart failure. All of these conditions can sap sexual energy and interfere with sexual functioning and satisfaction.

But when chronic medical conditions reduce sexual satisfaction, they also always impair sexual function, reducing libido, and increasing risk of erectile dysfunction and other sex problems. In this study, snoring reduced sexual satisfaction—without at all interfering with sexual function. So what gives? A message that’s usually delivered by a sharp elbow in the wee hours. Don’t annoy the woman you sleep with.

Anyone can snore, but “sleeping out loud” is considerably more common in men than women. No matter who snores, that person’s bedmate typically responds with a swift kick to coax the offender to roll from a supine position, which promotes snoring, to side-sleeping, which is less likely to trigger it.

Snoring is caused by a loss of muscle tone in throat tissue, which sags. As you breathe, the air makes this loose tissues vibrate audibly.

If you snore, you can boost your sexual satisfaction, by working to stop snoring:

Get your partner earplugs. Cheap ones are available at pharmacies. Custom plugs cost more but work better. Ask your physician.

Get out your sewing kit. Sew a golf or tennis ball into a closed pocket on the back of your pajamas. This prevents supine sleeping—and the snoring associated with it.

Lose weight. The less fat tissue in the throat, the less likely you are to snore.

Treat your allergies. Hay fever makes throat tissue swell.

Stop alcohol within four hours of retiring.  Alcohol relaxes the throat muscles, loosening throat tissue, and promoting snoring.

Avoid sedatives. Sedatives have effects similar to alcohol. If you have insomnia, get more regular exercise, discuss non-drug alternatives with your physician, or consult an acupuncturist, hypnotherapist, naturopath, or massage therapist.

Don’t smoke. Smokers have chronically swollen throat tissue, which increases snoring.

Raise your head. Elevating your head often reduces snoring. Use an extra pillow. Or raise the head of your bed with bricks or wood blocks.

Try an AveoTSD. TSD means tongue stabilizing device. This odd-looking plastic gizmo extends the tip of the tongue so you sleep as if sticking your tongue out. This repositioning opens the airway and minimizes snoring. When it works, it works very well. For more, visit getaveo.com

Consider minor surgery. Some otolaryngologists claim good success implanting small, flexible bands in the throat, like the stays sewn into some shirt collars. Cost: Around $4,000, usually out of pocket.

Sleep separately. It’s the last resort, but if you sleep somewhere else, that other thing you do in bed is likely to become more enjoyable.

The study: Hanak, V. et al. “Snoring as a Risk Factor for Sexual Dysfunction in Community Men,” Journal of Sexual Medicine (2008) 5:898.

• Close your mouth and dry your lips.
• Run a finger lightly over them, paying attention to how this feels.
• Now, lick your lips.
• Run a finger lightly over your moistened lips.
• Notice any difference?

If you found that caressing moist lips felt more sensual, sexual lubricants can help you enjoy more pleasurable lovemaking—immediately.

Don’t take my word for it. In a recent study, researchers at Indiana University’s Kinsey Institute asked 2,500 women to rate their lovemaking with and without a lubricant. The women rated lubricated sex substantially more enjoyable.

In the finger-on-lips exercise, the lubricant was saliva, the world’s most popular sexual lube. It’s effective, always available, and free. But saliva is more watery than slippery, and it dries quickly. To enhance sexual pleasure, most people find that commercial lubricants work better.

Sex guides often overlook lubricants, mentioning them only in passing for older women experiencing menopausal vaginal dryness. But in the Indiana study, lubricants enhanced lovemaking for women of all ages.

Lubricants also help men. They enhance masturbation, and before donning a condom, if you place a drop on the head of the penis, you may well notice more enjoyable intercourse. But if you try this, be sure someone holds onto the base of the condom during intercourse. Having lube under condoms boosts pleasure, but it also increases risk of slip-offs.

Most sex researchers have also ignored lubricants. In their landmark “Sex in America” survey, University of Chicago researchers asked nothing about them. However, the survey asked women if they’d suffered vaginal lubrication problems during the previous year. Almost 20 percent said yes. This suggests that millions of Americans are unaware of lubricants, which, in seconds, often eliminate this problem.

In the 1960’s, pioneering sex researchers William Masters, M.D., and Virginia Johnson described vaginal lubrication as the hallmark of initial arousal in women, paralleling erection in men. They maintained that the vagina produces lubrication fairly quickly as women become aroused.

While this is often true, many perfectly normal young women are slow to produce natural lubrication, and when they do, they don’t produce much. Then, starting as early as 40, menopausal vaginal dryness begins to become an issue. Meanwhile, porn stories typically imply that every woman’s vagina overflows at the wink of an attractive man’s eye. “When he kissed me, I soaked my undies!” Actually, it’s just as likely for women to feel erotically aroused and not produce much lubrication. Possible reasons include: individual differences, aging, the menstrual cycle, stress, jet lag, extended lovemaking, and drugs, among them: alcohol, cigarettes, antihistamines, cold formulas, birth control pills, marijuana, antidepressants, and anything that causes dry mouth.

Four types of lubricants are available over-the-counter at pharmacies: water-based, oil-based, petroleum-based, and silicone-based. Each has advantages and disadvantages.

Most lubricants are water-based. They’re widely available, inexpensive, safe to use with latex contraceptives, don’t stain bed linen, and during oral sex, it’s safe to ingest small amounts. But they don’t work as whole-body massage lotions, and during extended lovemaking, water-based lubricants may dry out. Either apply more, or refresh them with water or saliva. They rinse off easily with just water.

Oil-based lubricants include: vegetable and nut oils, and Crisco. The former can be used on the genitals and as massage lotions. Crisco is a popular lube for anal play. Oil-based lubes are safe to ingest and safe to use with latex contraceptives. However, they may feel greasy and may stain bed linens and clothing. They require soap and water to wash off.

Petroleum-based lubes include: Vaseline and baby oil. These lubricants destroy latex and should never be used with condoms, diaphragms, or cervical caps. Don’t use petroleum lubricants inside the vagina. They are difficult to wash out, may cause irritation, and change vaginal chemistry, increasing risk of infection. They should not be ingested, and they may stain bed linens.

Silicone lubricants were introduced in the 1990s, a personal adaptation of the industrial lubricant, WD-40. They feel silky and are not messy. They retain their slickness longer than water-based lubes. They don’t damage latex and are safe for use on the vulva, clitoris, and penis, and in the vagina and anus. They do not stain bed linen or clothing. It’s not clear how safe they are to ingest, so it’s prudent not to.

Don’t apply lubricants directly on your lover’s genitals. Right out of the container, they may feel cold and jarring. Apply a small amount to your hand, rub it between your fingers to warm it, and then caress your lover with lubricated fingers.

If you use condoms, be careful with lubricants. They increase risk of slip-offs. Have intercourse gently and when the man withdraws, one lover should hold the condom onto the base of the penis.

Wetter is better. Many sex therapists recommend lubricants every time, whether or not they’re necessary to prevent discomfort. As the new study shows, lubricants make lovemaking more enjoyable—in about 10 seconds.

Hebernick, D. et al. “Association of Lubricant Use with Women’s Sexual Pleasure, Satisfaction, and Genital Symptoms,” Journal of Sexual Medicine (2010) epub ahead of print.

ED means no erections from masturbation. According to the American Urological Association, erectile dysfunction (ED) is “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” Huh? That’s absurdly vague. If you define “an erection” as what you see in porn, and “satisfactory sexual performance” as porn sex—instant, hard-as-rock erections that last forever with climaxes always on cue—then just about every guy has ED. What is it, really? For practical purposes, ED means that a man who’s sober (no alcohol or other erection-impairing drugs) cannot raise an erection during extended masturbation.

ED is not inevitable. According to landmark studies by University of Chicago researchers, among men aged 50 to 64, about one-third suffer ED. From age 65 to 85, the figure is approximately 44 percent. While ED is quite common in older men, more than half never develop it.

Most older men suffer not ED but erection dissatisfaction. Starting around age 50 (often earlier for smokers and/or diabetics), erections change, in some men gradually, in others more quickly. Men lose the ability to raise erections solely from sexual fantasies. Direct fondling becomes necessary. When erections appear, they rise more slowly and do not become as firm as they were during men’s thirties and forties. And minor distractions—an ambulance siren on the street—may cause wilting. These changes alarm many men, who jump to the conclusion that they must have ED. If you can still raise erection during masturbation, you don’t. You have erection dissatisfaction.

Post-50 erection changes are normal and inevitable. But some lifestyle factors can postpone or even temporarily reverse them: falling madly in love, getting in shape (see below), and making love earlier in the day when you have more energy.

Unfortunately, other factors exacerbate erection dissatisfaction: anxiety, alcohol, many other drugs, relationship problems, and making love when fatigued, i.e., late at night after a long day and a big dinner with wine.

Anxiety is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It’s normal. And if you become anxious, erections become less likely.

Good ways to minimize anxiety: a hot shower before sex, and during lovemaking, deep meditative breathing, a slow pace, and lots of sensual touch all over.

Erection dissatisfaction can actually enhance lovemaking. The dark cloud of erection changes has a silver lining. Young couples often have problems because young men become aroused faster than young women. Young men are often all finished before young women have even become aroused. Post-50 erection changes slow men’s arousal so their erotic pace more closely matches women’s. A slower pace allows plenty time for kissing, cuddling, and whole-body massage, all essential to most women’s enjoyment of sex. Seen in this light, for many older couples, erection dissatisfaction can be a gift.

Healthy lifestyle minimizes risk of ED. Erection depends on blood flow through the penis. Anything that impairs it increases ED risk: smoking, diabetes, high cholesterol, high blood pressure, heart disease, being overweight, little regular exercise, more than two alcoholic drinks a day, and fewer than five daily servings of fruits and vegetables. Avoiding these risk factors does not prevent post-50 erection changes, but it preserves erection function and helps prevent ED.

The drugs are worth trying, but don’t expect miracles. Everyone has heard of Viagra, but Cialis is actually more popular because it’s effective longer—24 to 36 hours instead of three to five. Erection drugs improve erections in around two-thirds of men. They don’t work for about one-third. They do not produce porn-star erections. Over time, many men need larger doses. But as dosage increases, side effects become more likely, notably, headache and nasal congestion. Finally, the drugs have no effect on arousal, so men may raise erections but do not feel particularly interested in sex. Many men feel disappointed with the drugs. Fewer than half refill their prescriptions.

If you’re no longer having intercourse, you don’t need erections. Most men assume that erections are necessary for sex. No. Couples can have great sex without them. Intercourse becomes problematic for older couples. Men have erection issues and post-menopausal women develop vaginal dryness and atrophy that can make intercourse uncomfortable (or worse) even with lubricants. Many older couples jettison intercourse in favor of mutual massage, oral sex, and sex toys—and still enjoy hot sex.

Men can have orgasms without erections. That’s right, you don’t need an erection to have an orgasm. In an erotic context filled with kissing, cuddling, fondling, massage, oral, and sex toys, a man with a semi-erect or even flaccid penis can enjoy orgasms as intense as any he ever experienced during intercourse.

The drugs work best in combination with sex therapy. Several studies have shown this. There’s more to satisfying sex than an erection. Relationship issues are crucial, especially if sex has been a sore point or if the couple hasn’t had much for a while. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Erection changes can mark the end of sex or a new erotic beginning.  When erection dissatisfaction develops, some men decide that’s it, sex is over. Others accommodate and continue to enjoy lovemaking as long as they live. The choice is yours.

On the one hand, the wish to “give” great orgasms is laudable, especially for men who hope to give them to women. In the Western world, until well into the 20^th century, sex was something for men to enjoy, and for women to endure. Men “took” sex from women, who were considered merely fleshy receptacles for men’s lust. Many people believed that women were unable to experience sexual pleasure, so men had no responsibility to provide it.

Today, we know that men and women are equally capable of sexual pleasure, and that satisfying lovemaking involves both lovers taking turns giving and receiving sensual caresses. Compared with how men felt a century ago, the wish to “give” women orgasms represents progress. But no one “gives” anyone else an orgasm.

Orgasms Are Like Laughter

Orgasms emerge from deep inside us when conditions are right. Comedians can tickle our funny bones, but they don’t “make” us laugh. They allow us to. They create the conditions that encourage us to produce laughter from deep within ourselves.

Orgasms are similar. They, too, emerge from deep within when conditions are favorable. For most people, those conditions include: trust, comfort, relaxation, love, understanding, and whole-body massage that eventually focuses on tender genital caresses.

Lovers create the physical and emotional context the allow orgasms to happen. A lover can be trustworthy and help you deeply relax. A lover can caress you the way(s) you enjoy, the way(s) that allow you to dive deep enough into your own pleasure and sexual fantasies to produce your own orgasms.

A lover can also destroy the conditions that allow orgasm by being untrustworthy and causing grief instead of relaxation and comfort. But lovers don’t “give” each other orgasms. Each of us is responsible for our own orgasms. We produce them ourselves.

That’s why it’s so important for lovers to tell one another what they enjoy, what turns them on. Of course, this is often not easy. Here are some suggestions:

No one can read minds. Forget all the romantic Hollywood nonsense about knowing instinctively which erotic moves your lover wants. Being in love doesn’t confer magical powers that allow the two of you to read each other’s sensual minds. Unless you signal your likes and dislikes, your lover doesn’t know what turns you on—and what turns you off.

No need to be didactic. You don’t have to provide an instruction manual with detailed explanations of what you enjoy. Instead, when your lover does something you like (or close it), just say “yes” or  “ahhh.” When your lover’s moves don’t thrill you, remain silent. Most lovers quickly provide more of what elicits an “ahhh” and less of what greets them with silence. Over time—usually a month or two—you can get a lot more of what you want, and less of what you don’t, simply by saying “yes” and “ahhh.

Review things afterwards. Even when you say, “yes” or “ahh,” it still might be difficult to direct a lover’s moves while you’re in the middle of things. But afterwards, when you feel content and close, it’s often easier to comment. Begin with compliments. Highlight what you enjoyed, and ask for more of it. For example: “Remember when you were giving me oral and you circled my clit with your tongue? That was great. I’d love that every time.”

Be positive about negatives. If a lover does anything you really can’t stand, feel free to say so, but give it a loving spin. List a few moves you enjoy, then criticize the one you don’t. For example: “I really love the way you stroke my penis and suck me, but when you suck on my balls, it kinda hurts. Can we leave that out from now on?”

Cultivate experimentation. As marvelous as sex can be, after a while, the same old moves get boring. You might try new accouterments—candles, music, sex toys. Or a different time of day. Or a new place—a different room of the house or a romantic weekend getaway. Use your imagination.

Be patient. It takes some people—both men and women—quite a while to work up to orgasm. Sometimes, it’s situational. If you’re under the weather, it may take longer than usual. But some people always take quite a while. That’s just who they are—and that’s fine. If your lover takes what you consider a long time, or if you’ve ever received apologies for “taking so long,” reassure the person that you’re there for their pleasure, no matter how long it takes. Invite them to relax and focus on their own erotic feelings, not on how impatient they imagine you to be. The anxiety people feel about thinking that they take too long actually interferes with orgasm. So be patient, and tell your lover you’re happy to be patient. That should help them relax enough to have orgasms. Or consider a vibrator. Vibrators often help women have orgasms more quickly, and vibrating penis sleeves often help men.

If you implement these suggestions, your lover should feel comfortable, relaxed, trusting, accepted, and loved enough to have orgasms. But remember, you don’t “give” them. You’re the catalyst. You help create the conditions that allow your lover to release them.

The question is not: How can lovers give each other wonderful orgasms? The question is: What can lovers to help each other relax and feel accepted, trusting, and loved enough to reach deep inside themselves to release their own orgasms?

Vaginal Tightness

Imagine a hand towel stuffed inside a thick sock squeezed by two hands. The sock is the vagina. The towel is the folded muscle tissue of the vaginal wall. And the hands are the pelvic floor muscles that surround the vagina.

The vagina’s tightly folded muscle tissue is very elastic, like an accordion or the mouth. Try this: Pull the corners of your mouth out toward your ears then let go. What happens? The mouth immediately snaps back to its pre-stretched state because the tissue is elastic. Do it 100 times. There’s no permanent stretching. The mouth quickly returns to its pre-stretched state and no one would ever know you’d stretched it.

The same goes for the vagina, with two exceptions I’ll discuss shortly.  When it’s at rest—all the time except sexual arousal and childbirth—the vagina’s muscle tissue remains tightly folded like a closed accordion. Anxiety makes the vaginal musculature clench even tighter. That’s why young girls sometimes have problems inserting tampons. Their vaginal muscle tissue is tight and contracted to begin with, and many girls feel anxious about touching themselves and inserting anything, so the muscles contract even tighter.

As women become sexually aroused, vaginal muscle tissue relaxes somewhat. Biologically, this makes perfect sense. Evolution is all about facilitating reproduction. A tight vagina would impede intercourse and reproduction, so women evolved to have sexual arousal relax the vaginal muscles, allowing easier insertion of erections—and greater chance of pregnancy.

However, arousal-related vaginal loosening does NOT produce a big open cavity like the inside of a sock. Rather, the vaginal interior changes from resembling a tight fist to a fist loose enough to insert a finger or two.

If the vagina feels “too tight” during lovemaking, the woman is either (1) not interested in sex, or (2) she has not had enough warm-up time to allow her vaginal musculature to relax enough for comfortable insertion.

A man who attempts intercourse before the woman is fully aroused—before her vagina has relaxed and become well lubricated—is either sexually unsophisticated or a boor. Most women require at least 30 minutes of sensuality—kissing, hugging, and mutual massage—for their vaginas to relax enough to allow the penis to slide in comfortably. That’s why leisurely, playful, whole-body lovemaking is so important. It gives women (and men) the warm-up time they need. In addition, it also allows the vagina to relax, and, in most women, produce enough natural lubrication for comfortable intercourse. In other words, the solution to vaginal tightness is extended foreplay. It you need more lubrication, try a commercial lubricant.

One final note: If a woman experiences pain and/or great difficulty inserting a tampon or accepting an erection, the cause may be vaginismus, unusual clenching of the vaginal muscles. For suspected vaginismus, consult a physician.

Vaginal Looseness

After relaxing during sex, vaginal muscle tissue naturally contracts—tightens—again. Intercourse does NOT permanently stretch the vagina. This process—loosening during arousal and tightening afterward—happens no matter how often the woman has sex.

The vagina stretches a great deal during childbirth, like an accordion opened all the way. Post-partum does it re-tighten completely? Usually, at least in young women, that is, women in their late teens and early twenties. Within six months after delivery, the typical young woman’s vagina feels pretty much how it was before she gave birth.

Now for the two exceptions. If you stretch elastic a great deal, over time, it fatigues and no longer snaps back entirely. That can happen to the vaginas of young women after multiple births. Their vaginal muscles can fatigue and not fully contract. In addition, aging fatigues vaginal muscle tissue. Whether or not women have given birth, as they grow older, they may complain of looseness.

Today, many woman delay childbearing until after 30, and some have children after 40. Combine the rigors of older childbearing with the effects of aging on the vaginal muscles, and many women complain of looseness. Women who give birth after around 30 may notice persistent looseness after delivering only one child. (Individual differences account for the fact that birth- and age-related looseness happens to some women and not others.)

Here’s a quick fix for vaginal looseness. Have intercourse in the man-on-top position. Once he inserts, he lifts himself up and the woman closes her legs. Her thighs squeeze his penis and make her feel tighter.

The tightening approach most often recommended by sex therapists is Kegel exercises. Kegels, named for the doctor who popularized them, involve contracting the muscles used to interrupt urine flow or squeeze out the last few drops.

Kegels do, indeed, tighten the vagina, but ironically, they have nothing to do with the vaginal muscles. They strengthen the pelvic floor muscles that surround the vagina, the hands that hold the stuffed sock. Age and childbirth fatigue these muscles. The hands don’t grip the sock as tightly and the towel feels loose. Kegels tighten the pelvic floor muscles. The hands squeeze the sock more tightly, which clamps down on the towel, and the vagina feels tighter.

Kegels are totally private. They can be practiced anytime anywhere. Start slowly and over several weeks, work up to a half-dozen sets of 10 contractions several times a day. In a few months, you should feel tighter. You should also enjoy more intense orgasms. The pelvic floor muscles contract during orgasm. As they become stronger, so do orgasms.

If several months of daily Kegels don’t produce the tight feeling you want, try ben-wa balls or vaginal cones. Ben-wa balls are sold as sex toys. Insert them, then walk around the house trying to keep them from falling out. When the pelvic floor muscles are weak, the balls drop out quickly, but as the muscles grow stronger, women can hold the balls inside longer. Vaginal cones are similar, except they’re prescribed by physicians. (To obtain ben-wa balls, visit MyPleasure.com.

If vaginal cones don’t work, electrical stimulation of the vaginal muscles is your last resort. A nurse inserts a probe similar to a tampon and a mild electrical current causes muscle contractions that make the vagina feel tighter. Treatments happen in a urologist’s office during 20- to 30-minute sessions usually twice a week for about eight weeks.

Unfortunately, the mythology of vaginal tightness and looseness is deeply ingrained. I’ll probably get nay-saying comments from women who swear that losing their virginity caused permanent loosening. I’m not about to argue with anyone’s experience. I’m just pointing out the physiology of tight and loose vagina. Do you think it makes sense?

What is anal sex? If you think it’s penis-anus intercourse, think again. That’s the least popular form of anal play. Most lovers limit things to sphincter massage and gentle fingering that doesn’t go very deep.

Anal is much more popular in porn than in real sex. In the landmark “Sex in America” survey (1999), 26 percent of men and 20 percent of women said they’d tried it—but only 2 percent and 1 percent respectfully said they’d included anal the last time they’d had sex.

Nonetheless, many people are curious about anal, and some are quite enthusiastic. Aficionados say it deepens intimacy, with the recipient, in effect, saying: “No part of me is off limits to you,” and a the inserter saying: “All of you turns me on.”

Unfortunately, many women have suffered pain from anal. The anus is much less receptive than the vagina or mouth, so many men have had difficulty entering it, and when they do, many women experience sharp pain, which typically ends things, often forever.

Misconceptions also abound, for example, that anal is dirty, that it must hurt women, that men who enjoy receiving must be gay, and that it spreads HIV.

In fact, anal sex need not cause pain. With good hygiene, it’s clean, and free from fecal contact. Many 100 percent heterosexual men enjoy receptive anal. And with condoms, anal intercourse is as safe as any other type of safe sex.

Anatomy Surprise

The anus contains not one, but two sphincters, one visible, the other not because it’s slightly inside. The external sphincter is easier to relax. But if you want to relax your internal sphincter and enjoy receptive anal play, over time, you probably can.

Inside the internal sphincter, the narrow anal canal extends an inch or two. The sphincters and anal canal are highly sensitive to touch, the reason anal play feels erotic. The anus is also surrounded by muscles that contract during orgasm. Anal stimulation can excite these muscles and intensify orgasm.

Beyond the anal canal lies the rectum, a wide, five-inch cylinder with curves that vary from person to person. Anything inserted into the rectum must negotiate these curves, which is why anal insertion of anything should proceed very slowly, with lots of lubrication, and the recipient always in control of the speed and depth of insertion.

The rectum and anal canal usually contain only traces of stool. Most fecal material is stored just above the rectum, but traces of stool may remain on anything that enters the anus.

Unlike the vagina and mouth, the anus and rectum are not self-lubricating. For pain-free anal, you must use plenty of lubricant. Even with good lubrication, anal play may cause minor bleeding, especially if the recipient has hemorrhoids.

Minor bleeding is no cause for concern—unless an inserted erection is HIV-positive. If HIV-contaminated semen contact blood, the recipient risks infection. Unless you’re confident that your lover has no sexually transmitted infections, use condoms.

Hygiene

Anal play is a minority pleasure because our culture views the anus as dirty and disgusting. Overcoming this taboo takes time. Take all the time you need.

Cleanliness is crucial. Wash, bathe, or shower beforehand. Clean the area with a soapy finger. Some people also rinse internally with enemas. Disposable enemas are available at pharmacies. Anal rinsing helps lovers relax, and if the recipient washes well beforehand, anal play—including oral-anal “rimming”—is clean and safe. But nothing that touches the anal area should contact the vagina. Anal bacteria may cause a urinary tract infection.

Recipients, Start Solo

If you’re interested in receiving, begin by fingering yourself. Lubricate the opening, then, while breathing deeply, slowly press one finger through the external sphincter. Once you’re comfortable, press through the internal sphincter. Recipients should feel comfortable with solo play before complicating things with anyone else.

Use plenty of lubricant. Popular water-based lubes may not work for anal play. Try thicker jellies, vegetable oil, or Crisco.

Most lovers stop at fingering, but you might try a string of anal beads or a small butt plug. Plugs have flared bases keeps them from getting lost inside.

It Should NEVER Hurt

Fumbling attempts at anal can really hurt. Any pain means the recipient is not sufficiently lubricated and/or relaxed, and/or the inserter is being insensitive.

Couples interested in anal should cultivate whole-body relaxation. Take a hot bath or shower together. Enjoy mutual whole-body massage, and other sex play. Anal feels most enjoyable when lovers feel highly aroused. Then proceed to well-lubricated external sphincter massage. If the recipient allows, try very gentle, shallow fingering. Most people stop there.

If you’re interested in going further, the recipient should ALWAYS be in charge. The inserter should remain still—no pushing inside, and no thrusting until the recipient invites it, and if so, slow, gentle, well-lubed movements. With the inserter still, the recipient should move onto the penis or toy. This recipient should always control the speed and depth of insertion. Good positions include: recipient-on-top, spooning, or standing bent over with the inserter behind.

Some recipients enjoy being fingered or wearing plugs as their lovers brings them to orgasm by hand, mouth, or vibrator.  But many recipients prefer not to have orgasms with anything inside the back door. Discuss this. It’s the recipient’s call.

If Only One Wants It

While there’s nothing wrong, unnatural, or perverted about anal play, it’s insensitive and wrong to pressure anyone into it. If you’re eager and your lover is reluctant, never force it, and don’t nag. Explore your partner’s reluctance. What exactly is off-putting? Listen carefully. Address the person’s concerns. Ask if there is any way your partner might feel comfortable with anal play, for example, gentle sphincter massage. Remember, most people stop there or engage in gentle fingering. Do only what’s mutually agreed. If your partner says stop, stop immediately. Always respect limits.

No Damage

Some worry that once stretched sexually, the anus won’t return to normal, resulting in soiled underwear. No. The anal sphincters open and close throughout life. Assuming yours close normally after defecation, they’ll do the same after anal sex.

Are Recipient Men Gay?

Straight, bi, or gay, sexual preference has everything to do with your fantasies and your sex partners’ gender(s). It has nothing to do with sexual activities. Gay men kiss, hug, and enjoy oral sex. Are kissing, hugging, and oral gay? No, and neither is recipient anal.

Deeper Intimacy

If anal sex repels you, don’t play that way. But compared with other types of lovemaking, anal requires more communication and trust, which deepen intimacy and bring couples closer. In the end, as it were, anal is just another sexual variation that some people enjoy.

For more information, read Anal Pleasure and Health: A Guide for Men and Women by Jack Morin, Ph.D.. or The Ultimate Guide to Anal Sex for Women by Tristan Taormino.

Fortunately, erotic heat can be re-ignited in many ways. Authors Barbara and Michael Jonas have compiled hundreds of ideas from real couples in The Book of Love, Laughter, and Romance (www.TimeForTwo.com). The Jonases themselves do this with “surprise dates.” However, before I describe surprise dates, I must discuss dopamine.

Dopamine is a neurotransmitter, a compound involved in communication among brain cells, especially in the realm of emotions. When people fall in love, dopamine levels soar. High levels of dopamine make people feel energized, exhilarated, and obsessed. They have difficulty sleeping and lose their appetites—all attributes of falling madly in love. In addition, as dopamine rises, so does testosterone, the hormone that fuels sexual desire in both men and women. Heightened libido is, of course, a hallmark of mad love.

But that feeling doesn’t last long. Brain scans tracking people in relationships from newly in love to old married couples show that dopamine levels stay high for an average of seven months, then decline, marking the end of the hot-and-heavy period. But as this happens, levels of two hormones rise, oxytocin and vasopressin, which are associated with attachment, affection, security, trust, and contentment with a long-term partner.

Long-term attachment can feel wonderful, but if you miss erotic heat, you can re-create it by raising dopamine. How? By focusing on each other, by cultivating novelty in your relationship, and by doing new and exciting things together.

Which brings me back to surprise dates. They begin when you schedule one day together, or at least, a major part of the day. Surprise dates include three elements: togetherness, fun, and at some point, sex. One person takes responsibility for planning the date, and tells the other when to meet and what to wear. The activity is something both enjoy, or something new that the planner would like to try and thinks the other would like. The other person commits to participating with an open mind. That’s all there is to it.

Surprise dates recreate the early days of a relationship when couples focus intently on each other and do things that say, “You’re very special to me.” That raises dopamine. Having fun together, and especially trying new activities, also raises dopamine. And as surprise dates approach, the non-planner anticipates them and wonders what they’ll involve, which also tweaks dopamine. Finally, as surprise dates unfold, the erotic temperature rises, and by the time the couple repairs to their bedroom (or to a hotel or some other place), they’re ready to have some horizontal fun.

Schedule surprise dates to fit into your lives, say, one or two a month. Take turns planning them. Scheduling in advance is crucial. In new relationships, high dopamine levels make people focus intently on each other, as in, “All I think about is you.” But as dopamine levels decline, that obsessive focus tends to evaporate, and if couples value special time together, they must schedule it.

It’s also crucial for one person to take responsibility for each surprise date. The planner invests creative energy in the relationship, focusing on what the other might enjoy. As the date unfolds, the planner shows the other “you’re special to me.” Meanwhile, the non-planner gets to anticipate the fun…while thinking of the next surprise date, which is that person’s responsibility. Lavishing attention on each other and having fun together create the mood for love, so making love fits right into the picture.

Surprise dates are not new. They’re a standard element of couple counseling. Therapists often urge couples to make time for each other, and enjoy new experiences together, for example, romantic get-aways—approaches very similar to surprise dates. Therapists may not explain the role of dopamine, but creative novelty boosts it, and coaxes the erotic embers into flame.  Maybe that’s why, when people fall in love, they often say, “We have great chemistry.”

Why does erotic heat cool? Psychologists, poets, and lyricists have suggested a myriad of answers, but for couples interested in rekindling erotic passion, the key player is dopamine, the brain chemical (neurotransmitter) that both lights sexual fire and throws water on it.

When people fall madly in love, their dopamine levels soar. High dopamine causes a number of reactions, among them: exhilaration and difficulty concentrating and sleeping. Your heart pounds. You lose your appetite. And you become obsessed with your object of desire—all elements of falling head-over-heels in love. In addition, as dopamine rises, so does testosterone, the hormone that fuels sexual desire in both men and women. But over time, dopamine levels return to normal and Fourth of July’s fireworks morph into Thanksgiving’s cozy affection. But if you tweak your dopamine, longtime couples can enjoy the erotic heat of second honeymoons.

How do you boost dopamine? In a word, novelty. Doing new things together elevates it. In one experiment, psychologists gave 28 couples questionnaires that explored their feelings for each other. Then half the couples completed a tedious task, while the others engaged in a new and exhilarating activity. Afterwards, everyone completed the questionnaire again. The couples involved in the exciting activity reported greater relationship satisfaction, and said they felt more passionately in love. Credit their novelty-induced spike in dopamine. Here are four effective ways boost your dopamine and break out of sexual ruts:

Do exciting new things together. This is standard relationship-enhancement advice. It’s no coincidence that weekends away are often called “romantic getaways,” or that sex often feels more passionate in hotel rooms. You’re in new and different surroundings. That’s exciting and romantic—and it spurs the libido.  Of course, there are different grades of “new,” from a new restaurant around the corner to a month in China. The more “new” the activity, the greater the increase in dopamine. But any shared new experience can echo in the bedroom.

Laugh. Humor is funny because the punch line is a surprise—in other words, something new and unexpected. Like other novel activities, humor raises dopamine levels. Ask couples how their relationships have endured, and many credit a shared sense of humor. When humor dies, the relationship is in trouble. Maybe that’s why we call relationship movies with happy endings “romantic comedies.” See or rent some, or attend a comic play or stand-up comedy.

Keep ’em guessing. Oscar Wilde once said, “The essence of romance is uncertainty.” An age-old strategy for winning a love is to play hard-to-get, which spurs yearning and anticipation, but delays the reward. Guess what surprises, uncertainty, and delayed gratification trigger in the brain? A surge of dopamine. Romance experts Barbara and Michael Jonas, coauthors of The Book of Love, Laughter, and Romance, urge couples to schedule regular “surprise dates.” One plans an afternoon or evening outing, but keeps it secret, telling the other only what to wear and what time to be ready. “The anticipation makes surprise dates very romantic and enriching,” Barbara says, “and each person sees the other expending effort to please them, which is flattering—and arousing.”

Make love. The skin-to-skin contact of lovemaking and especially orgasm trigger release of testosterone in men and closely related hormones in women (androgens). These, in turn, raise dopamine. To make sex more exciting and to inject an element of playful surprise, try something new on the way to bed or between the sheets. Make love in a different place, at a different time, and with different accoutrements: candle light, music, lubricant, lingerie, sex toys, or professional massages beforehand.

Of course, love is a mystery, but on some level, everyone seems to appreciate its biochemical basis. Perhaps that’s why, when two people fall in love, they say: “We have great chemistry.”

Their findings suggest that older woman continue to care about emotional closeness, but that the physical aspects of sex—its frequency, duration, and women’s regularity of orgasm—become increasingly important to them. Meanwhile, men continue to value the physical joys of sex, but relationship quality—feeling emotionally close to the woman—becomes increasingly important.

A New Focus on Sex During Midlife and Beyond

Until Viagra’s release in 1998, sex researchers virtually ignored the sexuality of post-menopausal women and older men. But during the 14 years since the drug’s approval, many studies have explored the physical, relationship, and cultural factors that affect sexual satisfaction after 50.

Among physical factors, health is paramount. Good health is strongly associated with sexual satisfaction at every age. But after 50, aging-related illnesses take an increasing toll: diabetes, heart disease, cancer, stroke, high blood pressure, arthritis, depression, and others. Adding insult to injury, many of the drugs used to treat these conditions cause sex problems, notably antidepressants and blood pressure medication.

In addition, after 50, sex changes. In both genders, desire tends to decline (but not disappear), arousal becomes increasingly problematic, and unless older adults perform Kegel exercises, orgasms often become less intense because of diminishing pelvic muscle tone. In addition, in women, decreased vaginal lubrication and thinning of the vaginal lining (vaginal atrophy) make intercourse less comfortable and often painful. In men, erection difficulties become common and many men experience a resurgence of ejaculatory control problems, typically linked to their erection issues.

Relationship factors affect sexual satisfaction at every age. But after 50, compared with those who rate their relationships as “generally unhappy,” those who rate them “generally happy” enjoy significantly greater sexual satisfaction.

Finally, cultural attitudes often persuade people over 50 to withdraw from sex. American culture views sex as the province of the young. Our culture considers older adults “in decline” and “not sexy.” Many older adults internalize this and retire from lovemaking.

Surprise: Physical Women, Emotional Men

The recent study confirms one previous observation about sex after 50. Sexual satisfaction is strongly associated with the couple’s health. When one spouse suffers a chronic condition, sexual satisfaction plummets for both.

But this study suggests that older women become less preoccupied with relationship quality and more concerned with the sex itself. Independent of how they feel about the relationship, older women say they feel sexually satisfied if they have sex regularly, if it lasts longer than 30 minutes, and if they are regularly orgasmic.

Meanwhile, men in this survey said they derive as much satisfaction from the physical elements of sex as they did when younger, but that after 50, they value emotional closeness more than ever.

In other words, after 50, the gender gap in relationship and sexual satisfaction narrows. Women become more focused on the sex—and presumably more assertive about asking for the erotic moves they want. Men become more focused on the relationship—and hopefully on giving women the kind of sexual experiences they want.

Many aspects of aging are problematic—more aches and pains, more chronic medical conditions, and more drugs that may have sex-impairing side effects. But aging also offers older lovers some compensations—a convergence in men’s and women’s values about sex and relationships. The implication is that, assuming good health, older men and women might get along better and feel more sexually compatible than ever.

The study: Carpenter, L.M. et al. “Physical Women, Emotional Men: Gender and Sexual Satisfaction in Midlife,” Archives of Sexual Behavior (2009) 38:87.