These behaviors lead to the common complaint of being too tired for sex.  But I sometimes wonder if it isn’t the other way around:  there may be sex and relationship problems which lead to health and sleep problems.  If you have a good sex life and your marriage and relationship are satisfying, chances are you are sleeping well.  If you had a loving, intimate relationship with your partner, your perspective on the problems of living might change.  You might be less troubled, less anxious, and more resilient if you had a better intimate life, in and out of the bedroom.

By coincidence, the next day I received an article in my inbox from the journal “Canadian Psychology” that discusses therapy for insomnia.  Did you know that 30% of adults report insomnia occasionally, and 10% report frequently enough that it is considered a chronic disorder?  Insomnia is associated with several mental disorders, and it is also a cause of depression and dependence on sleep medications.

Insomnia can also interfere with sexual functioning, so it’s a good idea to look at your sleep habits if you have decreased sexual desire or other issues.  How do you improve sleep?  By establishing a regular sleep routine, i.e., going to sleep and waking up the same time each day; avoiding alcoholic beverages in the evening; keeping your bedroom dark and cool; and sleeping on a comfortable mattress and pillow.  Also, use the bedroom only for sleep and sex; don’t work or argue in the bedroom.

How you think about sleep also influences how well you sleep.  If you think of not having sleep as a disaster, you’re going to be very anxious about getting enough sleep.  If you do have a difficult time sleeping one or two nights, don’t make it into a catastrophe.  Just tell yourself that it’s normal to have sleep problems and that you are going to get a good night’s sleep.

Sex and sleep are connected.  When both are good, you’re happier and more resilient to stress, and in better overall health.

Really?  That’s not what I see.  When a so-called sex addict comes into my practice, I usually have before me a man who:

• Was exposed to pornography at a young age

• Learned to cope with many adolescent challenges by looking at porn
• Used porn to “self-medicate” stress, anxiety, and depression
• Has difficulty sustaining an intimate connection with his partner
• Doesn’t readily share what will turn him on
• If not yet partnered, may have social anxiety or feel unlovable
• Has a partner that doesn’t understand his sexual needs
• May have been sexually abused and is now trying to figure out how sex is supposed to work
• Is confused by his own secretive nature about sex
• May use porn to satisfy a need for sexual arousal that his partner doesn’t understand

My preferred label, if one must used, is “problematic sexual behavior.”  Usually, what makes the sexual behavior a problem is that it interferes with a person’s relationships or ability to function in other ways.

A man that pays a prostitute instead of talking to his partner about his real sexual needs is avoiding conflict or embarrassment.  If the secret behavior is revealed, the focus is on the fact that he had sex with another woman, and not on other, perhaps deeper problems that may exist.  A man that works at home and misses calls while looking on the computer may be underachieving at work; why is that?  A man that never dates despite his desire for companionship and hides behind his computer screen has another type of problem.

As a psychologist and AASECT-certified sex therapisty approach to treating problematic sexual behavior is unique to each individual.  I don’t sell a fancy program or follow a set course of therapy.  I want to work with someone to understand what function pornography or other types of sexual behavior serve in their life.  When do they look at porn?  What is the trigger?  What do they gain?  Lose?  If they weren’t looking at porn, what might they be doing instead that would make them feel better about themselves?  How is affecting their relationship, if they are in one?  If not in one, is using pornography holding them back?  If so, how?

Who comes in for help with problematic sexual behaviors?  All kinds of people, from high-powered executives to students, from newly weds to men in their 70s, from atheists to pastors.  Often they come in alone, forced by their partner.   For all of them, my goal is a better understanding of one’s sexual behaviors, one’s intimate needs, one’s relationships, and one’s choices when it comes to pursuing pleasure of all types.  If possible, I want to meet with the partner so that they can be part of the process of learning about sexual health, as well as help them process any feelings of anger, hurt, or betrayal.

If you have given yourself the label of “sex addict,” I’d ask you to look behind those words and give yourself the opportunity to learn how to get more of what you really need to be happy, without hurting yourself or your partner in the process.

There are so many stereotypes when it comes to sex and the mature adult.  I always remember a man in his 30s telling me, “My wife and I need to hurry up and start having a lot of sex, because we’ll be done by the time we’re in our forties!”

You’ve gotta be kidding.

Just because you don’t move as quickly or forget your glasses are on top of your head occasionally doesn’t mean that you aren’t spry enough to have sex.  The body may not be as beautiful, but feelings of love and desire may grow even stronger with a couple that has been bonded for years.  And for couples experiencing romance in their later years, the sparks can still fly pretty high.

Enjoy the article, and let me know what you think!

In my newsletter this month (you are signed up, aren’t you?) I included a Valentine’s Day sex life check-up that included items like the following that you can discuss together:

1. What was the best part of our relationship last year?
2. How did you feel supported by me?
3. Did I do anything particularly loving over the past year that you’d like me to repeat this year?
4. What was the least helpful thing that I did?  What would you like me to do instead?
5. What does our relationship mean to you at this point in time?  (Companionship, co-parenting, a sexual partner, a major support in times of stress, etc.)
6. What are your thoughts about our sex life?  Is it fine as is, or could it be improved?
7. What do you see as challenges for our relationship over the coming year?
8. What would you like us to do differently this year?
9. What would you like to keep the same?
10. What can I do to make you feel loved and cherished?

After all, people check-up on their physical health, their financial health, even the health of their garden.  Why not do a check-up on your sex life?  Part of the joy of being in a long-term relationship or marriage is that you have a safe place and a safe partner with whom to explore your sexuality.  You change, your partner changes; why not take a moment to learn a bit more about yourself and each other?

May you have a sweet Valentine’s Day celebration!

Sometimes marriages naturally go through dry spells.  A partner might be sick, be pulled by care-giving demands, or absent due to military or other job obligations.   But when couples go for a year or longer without connecting in the bedroom, there’s a problem.

What causes a sexless marriage?  Many couples stop having sex during the last part of pregnancy and during the first months they have a newborn.  They struggle with finding time, but also with feeling sexy when there’s an infant in the house with all the demands of parenting.  Other couples struggle with sex from the beginning.  One partner may have been raised in a very strict religious home and can’t let enjoy sex, even though they’re married.

There can be serious issues that get in the way of a couple having regular sex.  If one member of the couple has been sexually abused or assaulted, then they may avoid sex because it triggers bad memories.  Other problems, like depression or substance abuse, can get in the way of sexual pleasure.

What can you do about a sexless marriage?  First, it’s important that you and your partner acknowledge there is a problem.  Try to talk it out together to figure out what the root cause is.  When you do try to restart your sex life, be realistic.  Though it may not seem romantic, you may need to schedule times for making love.

Many people are unaware that there is a type of professional called a sex therapist that is available to help couples that have a sexless marriage.  A sex therapist is a psychotherapist that specializes in sexual problems.  It is talk therapy.  If you do decide to see a sex therapist, check with your state’s licensing board online to ensure that they are licensed to help you.

Sometimes couples disappoint each other in the bedroom and have trouble with forgiveness.  A man’s female partner can’t have an orgasm and he berates her for being unresponsive.  A woman’s male partner ejaculates too quickly and she becomes caustic and critical.  The couple may just have different expectations about their sex life, but be unable to discuss it; they may quietly suffer for years.  The angry partner may also become critical, sometimes, in other parts of the couple’s relationship; at other times, the couple may put a lot of energy into putting up a front to the world that their relationship is really much better than it is.

Can you forgive your partner for their sexual shortcomings, be a good friend, and support them toward change?  Can you let go of your resentment and become compassionate, realize that your partner may be hurting, too?  Sexual forgiveness takes maturity, too.  Your partner perhaps didn’t learn how to be a long-term sexual mate.  You can learn together.  If mistakes or missteps have been made, be patient and above all be forgiving.

But foreplay isn’t just about orgasms.  It is also a way to connect with your partner.  You can take turns giving one another pleasure.  You can choose to be passive and let your partner give to you, or to be active and please your partner.  Or, you can have mutual foreplay, both giving and receiving pleasure at the same time.  It’s more about sharing an intimate, fun experience than about preparation for intercourse.

If foreplay is imaginative, there may be no need for intercourse; orgasms may be experienced in other ways.  Foreplay can also allow you to explore one another’s bodies, to understand what is erotic for each of you.  It is a time to free yourself and be creative, to try out scenarios that turn you on.  You may find out that you enjoy some of the same things, or that you need to make adjustments so that your fantasy is fun for both of you.

Foreplay builds a sense of connection and intimacy.  When someone doesn’t want foreplay, for me as a therapist, I am always curious about whether they are able to be truly intimate with a partner, to let a partner get into what they are really about in the bedroom and to get into their partner’s thoughts and feelings.  Foreplay is one of life’s great free experiences, right there in the privacy of your own home.

Women’s sexual desire is more complex than a man’s.  Especially for women in long term relationships, sexual desire is less driven by hormones, though they do play a role.  What seems to be more important is the quality of the relationship between a woman and her partner; her mood, energy, and stress level; her feelings about herself and her body; and her overall enjoyment of sexual activity.

Also, while men feel horny and then want sex, women in long terms relationships often need some loving before they feel horny.  If a man approaches his wife or partner with his motor on “idle” and gives her some time to warm up without pressure, letting her tune in to her own needs to see if a “no” might become a “yes.”

Another way to help a woman enjoy sex more is to take the time to find out what she enjoys.  If she can’t communicate it verbally, ask if she can show you by guiding your hand with her own.  Encourage her to explore her own body so that she can share what she has discovered with you.

If your wife complains that she doesn’t have any energy, help her out.  If you are feeling amorous, take over a few chores so that she can put her feet up or take a warm bath.  Try doing this regularly, whether or not you are looking for an opportunity for sex.  It’s a fact:  Men that help out have sex more frequently.

There are some rather serious reasons that women may lack desire.  One is that they experience sexual trauma.  Another is that intercourse is painful.  A third would be medical problems, both gynecological and non-gynecological; a woman that has no drive should definitely seek a medical examination.  Problems with depression and anxiety can also interfere with drive.  Finally, changes such as the birth of a child or menopause can have an effect on libido.  These experiences are real and need to be addressed; they just don’t go away on their own.

There is nearly always a reason a woman’s drive goes missing.  Invite your wife to do some detective work with you and then work on the problem together.  If you solve it, great.  If not, perhaps you are both too close to the problem or haven’t considered some of the other many reasons this happens; try using the services of a AASECT certified sex therapist to help you.

It isn’t just men that feel sex is only about intercourse and resulting orgasm.  Women often say that it’s the only part of sex they enjoy.  Perhaps it’s because it’s the only part of sex that has an official stamp of approval as being sex.  After all, most people are taught that “Sex is for after you get married
because it can result in pregnancy.  Since pregnancy nearly always occurs as the result of intercourse, it only makes sense that sex means such an act has occurred.

Of course, there’s nothing wrong with intercourse.  It’s just that it’s very limited.  It requires that both partners be aroused, that the genitals are in good working condition, that the participants have the strength and stamina to follow through with the act.  That is, I think, part of the reason that people think of “sex” as being for young people.

If sex included every act of pleasure, people–both individuals and couples–would be much better off.  Including self-, oral, and manual stimulation would take the pressure off of having intercourse.  It would decrease unwanted pregnancy and disease.  It would make it easier to imagine having sex as one ages, or sex if one is alone.  And if a woman had discomfort with intercourse or a man struggled with erectile dysfunction as the result of temporary illness or stress, then they could still be affectionate and comforting with one another.

If you are someone that balks at the idea of venturing beyond sex = intercourse, it might be interesting to think about why that is.  Is it due to stereotype?  Inhibitions about other types of sexual activities?  A belief that sex is only for procreation, so if one is going to have sex for recreation, it had better be a reasonable facsimile?  If going outside your sex = intercourse comfort zone is truly distasteful, well, so be it.  But it could be that you realize you are holding back from exploring all types of sex, starting with cuddling and kissing.  And then what would be the harm of exploring your sexual potential?

Horse rubbish.  I am a proud possessor of a Psy.D., the only drawback of which is that Ph.D.’s like to take pot shots at my degree.  In fact, when I was in grad school I remember dreaming that a fellow Ph.D. student parked her Cadillac on my then rather sad-looking front lawn; talk about an inferiority complex.  I’ve gotten over that, though–and my lawn has been replaced with water thrifty plants, to boot.

What the heck is a Psy.D., you might be asking yourself.  Well, it is based on the so-called “Boulder model” of training, which came out of the University of Colorado at Boulder.  The idea was that those psychologists that wanted to practice psychotherapy needed to have more clinical training and supervision.  In order to provide top notch services, the Psy.D. needs to be able to evaluate research and implement it in the clinical setting.  To that end, the Psy.D. writes an extensive review of an area of research literature for a dissertation, as opposed to doing a piece of original research.

For my doctorate, I attended weekly supervision of my clinical work not only at my training setting, but with my dissertation chair, doubling the amount of supervision of Ph.D. students (and MFT therapists as well).  Instead of a year of courses on research methods, I took a year of courses on reading and evaluating published papers, which naturally requires a grasp of research methods as well as good critical thinking.

In my current practice as a Psy.D., I am constantly reading research, not just on topics related to sex therapy, but on a broad range from stress combat to mood disorders to health psychology.  If you’ve been a patient of mine, you know that I often quote research in sessions.  I think it helps to know a thing, rather than just speculate.  If you’re a reader of my blog, you know that I am quick to evaluate a study that is stirring up public interest.

If you are choosing a psychologist, the type of degree–Ph.D. or Psy.D.–isn’t as important as whether or not they keep their practice based in science, and not just on their personal experience.  This latter type of approach is one I call, “The World According to . . . “  You can fill in the blank with the name of the therapist.  It isn’t that personal experience can’t be valuable–I’ve been married nearly 25 years, so I bring in some of my own observations and experiences into the treatment room–but it shouldn’t be the basis for psychotherapy.

Just to add to the confusion, there are plenty of people with doctorates that aren’t psychologists.  It’s always a good idea to check up to see if someone you are considering as a therapist is, indeed, licensed.  In California, you can verify a psychologist’s license here, and a Marriage & Family Therapist (MFT) or Licensed Clinical Social Worker (LCSW) here.

Just what the heck is a Psy.D.?  It’s a tremendously useful degree for any psychologist interested in using the best that research has to offer and combining it with natural intuition.  I wouldn’t change my doctorate for any other.