Showing posts with label Sexual Dysfunction. Show all posts
Showing posts with label Sexual Dysfunction. Show all posts

Saturday, October 13, 2012

Robert Augustus Masters - Bringing Sex out of the Closet (Integral Post)


This Integral Post from Robert Augustus Masters is an excerpt from his recently updated and re-issued book, Transformation through Intimacy, Revised Edition: The Journey toward Awakened Monogamy. It is one of the three most important relationship books I have read (the other two being David Schnarch's Passionate Marriage: Keeping Love and Intimacy Alive in Committed Relationships and John Welwood's Perfect Love, Imperfect Relationships: Healing the Wound of the Heart).

The message of enlightened monogamy and relationship as a spiritual path is one too often missing in the integral world, especially when it's "leaders" espouse their "right" as "second tier" and "post-conventional" to have sex with anyone and any number of people they deem suitable - and we should not dare to question their obviously egocentric sex drives (addictions?) because they are so much "more enlightened" than the rest of us. After all, they are the "leaders" in the integral community. [Please note that the quotation marks are meant to impart cynicism.]

Masters' work calls bullshit on all of that, which is why his entry into the integral world (which coincidentally coincided with Gafni's leaving) is such an important step forward.


Bringing Sex out of the Closet


July 2nd, 2012



Sex is arguably still in the closet.

Yes, it’s wearing a lot less and showing a lot more than was the case forty or fifty years ago, but it’s still not truly out in the open, except in mostly superficial ways. Its ubiquitous exposure, highlighting, and pornification simply camouflage it. However brazenly explicit sex now is, it nonetheless remains largely hidden, its depths mostly untouched, its heartland still largely unknown, obscured by the tasks to which we commonly assign it, especially that of making us feel better.


Just as getting openly and passionately angry does not necessarily bring us any closer to truly knowing our anger, being frequently expressive of and/or pervaded by things sexual does not necessarily bring us any closer to truly knowing—or being intimate with—our sexuality.


How-to books and courses on sex abound, pointing out various ways to get turned on or more turned on in a relationship, with little or no attention given to actually exploring the very turned-off-ness that seemingly necessitates finding out how to get turned on. Judging from the sheer volume of such books and courses, plus an immense amount of personal testimony from all quarters (for example, the great number of American women who admit that they don’t enjoy sex with their husband), it appears that there’s an abundance of sexual dysfunction and dissatisfaction within relationships.
There is plenty of focus on this, accompanied by all kinds of remedies, but not nearly so much focus on how dysfunction and dissatisfaction in the nonsexual areas of relationship might be affecting one’s sexuality.

We are usually quite reluctant to cast (or even to permit the casting of) a clear light on what is actually happening during our sexual times with our partner—other than biologically—but without this, we are simply left in the dark, pinning too much on what we hope sex will do for us.

And there is so much that we expect sex to do for us! More often than we might like to admit, we assign it to stress release, security enhancement, spousal pacification, egoic gratification, pleasure production, and other such tasks. We may use it as a super sleeping pill, a rapid-action pick-me-up, an agent of consolation, a haven or hideout, a control tactic, a proof that we’re not that old or cold. We may also employ it as a psychological garbage disposal, a handy somatic terminal for discharging the energies of various unwanted states, like loneliness or rage or desperation. Mostly, though, we just tend to want sex to make us feel better, and we use it accordingly, whether in mundane, dark, or spiritual contexts.

Not only do we hear more and more about “sexual addiction,” our culture itself is so ubiquitously sexualized that it could be described as sex-addicted. But sexual addiction is not primarily about sex but about that for which sex is a “solution.” It is so easy to think that our sexual charge with a particular person or situation is no more than an expression of our natural sexuality, when in fact it may actually be an eroticizing of our conditioning or of some need we have. (For example, arousal in a certain pornographic fantasy may be secondarily sexual, its primary impetus being rooted in one’s longing to be unconditionally seen, loved, and wanted.)

There won’t, however, be any real freedom here until we release sex (and everything else!) from the obligation to make us feel better. So long as we keep assigning sex to such labor—slave labor—we will remain trapped in the very circumstances for which sexual release is an apparent “solution.” Increased stress means an increased desire to get rid of stress, and if we attempt to do so through sexual means (which does not really get rid of stress, except in the most superficial sense), we simply reinforce the roots of that stress. In addicting or over-attaching ourselves to erotically pleasing release, we also frequently addict ourselves to the very tension that seemingly necessitates and sometimes even legitimizes such release.

The abuse of sex, particularly through the expectations with which we commonly burden it, is so culturally pervasive and deeply ingrained as to go largely unnoticed, except in its more lurid, obviously dysfunctional, or perverse extremes. Even more removed from any telling awareness is our aversion to truly exploring and illuminating the whole matter of human sexuality, not clinically nor in any other kind of isolation, but rather in the context of our entire being, our totality, our inherent wholeness.

That is, sex does not need to be—and in fact cannot be—crystallized out and set apart from the rest of our experience (as those overly focused on the mechanics of sexuality often try to do). Rather, it needs to be seen, felt, known, and lived in open-eyed resonance—and relationship—with everything that we do and are, so that it is, as much as possible, not just an act of specialized function nor an act bound to the chore of making us feel better or more secure, but rather an unfettered, full-blooded expression of already present, already loving, already unstressed wholeness.


To embody such wholeness requires a thorough investigation of the labor to which we have assigned—or sentenced—our sexuality.


That labor and its underpinnings are eloquently revealed through the stark slang of sex. Many of the words and phrases regarding our sexual functioning bluntly illustrate the frequently confused, disrespectful, and exploitive attitude commonly brought to one’s own sexuality and sexuality in general. Consider, for example, the notorious and enormously popular “f” word, for which there is an incredible number of non-copulatory meanings, a fucking incredible number, all pointedly and colorfully describing what we may actually be up to when we are busy being sexual or erotically engaged.

Here’s a partial list, the majority of which overlap in meaning: ignorance (“Fucked if I know”); indifference (“I don’t give a fuck”); degradation (“You stupid fuck”); aggression (“Don’t fuck with me!”); disappointment (“This is really fucked”); rejection (“Get the fuck out of here!” or “Fuck off!”); manipulation (“You’re fucking with my head”); disgust (“Go fuck yourself”); vexation (“What the fuck are you doing?”); exaggeration (“It was so fucking good!”); rage (“Fuck you!”); and, perhaps most pithily revealing of all, exploitation (“I got fucked”).

Throw together the various meanings of “fuck,” plus the “higher” or more socially acceptable terms for sexual intercourse—including the vague “having a relationship” and the unwittingly precise “sleeping together”—and mix in some insight, and what emerges is a collage composed of (1) the dysfunctional labor to which we have sentenced our sexual capacity; and (2) the expectations (like “Make me feel wanted” or “Make me feel better”) with which we have saddled and burdened it.
When we primarily assign our sexuality to stress release, security reinforcement, egoic reassurance, the fueling of romantic delusion, and other such chores—thereby burdening it with the obligation to make us feel better—we are doing little more than screwing ourselves, dissipating much of the very energy that we need for facing and healing our woundedness, the woundedness that, ironically, we seek escape or relief from through the pleasuring and various sedating options provided by our sexuality.

This is not to say that we should never use our sexuality for purposes such as stress release, for there are times when doing so may be entirely appropriate, but such usage needs to be more the exception than the rule.

We are living in a pervasively sexualized culture—“sexy” as an adjective has infiltrated just about every dimension of life. There’s much more openness regarding sex than there was fifty or sixty years ago, but much of that openness has more to do with breadth than depth. We have more permission to experiment with sex and to talk graphically about it, but we nevertheless don’t talk about it in real depth very often—exploring, for example, the nonsexual or presexual dynamics that may be in play during sex—for to do so would put us in a position of real vulnerability and transparency, not so able to hang on to a semblance of “having it together.” Seeing what we are actually doing in nonsexual contexts while we’re busy being sexual may not be very high on our list of priorities!

And this is the era of informed consent, centered by the myth—yes, myth—of consenting adults. In sexual circumstances, many of us may not be clearly considering what is really going on and what is at stake, instead making choices from a desire (largely rooted in childhood) to get approval, affection, connection, love, or security, or to be distracted from our suffering. At such times, we are operating not so much as consenting adults as adult-erated children (and/or adolescents) whose “consent”—however “informed”—is largely an eroticized expression of unresolved woundedness or unmet nonsexual needs.

The deepest sex, sex requiring no fantasies (inner or outer) or turn-on strategies or rituals of arousal, but rather only the love, openness, and safety of awakened intimacy, cannot be significantly accessed without a corresponding depth in the rest of our relationship with our partner. Without such mutual maturity, it doesn’t matter how hot or juicy or innovative our sexual life may be, even if we have many orgasms, big orgasms, together.

In fact, when we make coming together a goal, we simply come apart, separating and losing ourselves in our quest for maximally pleasurable sensations. “Sensational” sex is precisely that: sex that is centered and defined by an abundance of erotically engorged sensations. The romanticized presence of these sensations is often misrepresented as actual intimacy, at least until the rude pricks of reality do their vastly underappreciated job.

Most couples we see are not really all that happy with their sex life. Some of them have gone flat sexually, having had little or no sex for a long time. (Not surprisingly, the rest of their relationship is also usually flat, emotionally depressed, low in passion, unnaturally peaceful.) Other couples are more openly frustrated, wanting more than they are getting (such a quantitative focus being mostly a male complaint), or wanting more connection before sex (such a qualitative focus being mostly a female complaint). And others initially act as if they are doing fine sexually, being reluctant to reveal their discomfort with the direction that their sex life may be taking (like tolerating a partner who prefers porn to them). And so on.

The good news is that such dissatisfaction, if allowed to surface in its fullness, will often goad a couple into doing work that they would otherwise avoid or postpone.

As a couple explores their sexuality, and explores it deeply, they will discover that what’s not working in their relationship usually shows up in their sexuality, often in exaggerated form. And conversely, as they ripen into more mature ways of relating, they will find that this revitalizes and deepens their sexuality. No sex manuals or tantric rituals are needed, nor any fantasies or other turn-on tactics—their increased intimacy and trust in each other are more than sufficient, creating an atmosphere within which love-centered, awareness-infused sexual desire can naturally arise and flow, carrying the lovers along into the sweet dynamite and ever-fresh wonder and ecstasy of what sex can be when it has deep intimacy’s green light.

DON'T MISS: Monogamy as a Path to Awakening

Robert Augustus Masters, Diane Bardwell Masters, and Ken Wilber
In this extraordinary discussion, Robert and Diane talk to Ken about the next evolution of intimate relationships: monogamy as a spiritual path, a crucible for awakening, and a vessel for enlightenment in the 21st century.


About TRANSFORMATION THROUGH INTIMACY: THE JOURNEY TOWARD MATURE MONOGAMY

Intimate relationship has long been viewed and lived as a lesser alternative to spiritual life. More recently, the need to integrate our spiritual and intimate lives, rather than maintaining separate spheres and relationships on autopilot, has become increasingly apparent. Given the high rates of infidelity and divorce, it would seem that the possibilities of freedom through intimacy have not been explored in much depth. Too often we pull away when relationships become difficult, missing out on the rewards of connecting more profoundly.

The passage from immature to mature monogamy is not only a journey of ripening intimacy with a partner, but also a journey into and through zones of ourselves that may be very difficult to accept and integrate with the rest of our being. Transformation through Intimacy explores intimate relationships through a four-stage lens: me-centered, we-centered codependent, we-centered coindependent, and being-centered. Bringing his many years of experience as a psychotherapist and spiritual practitioner to the subject, Masters shows readers not only how to navigate the thickets of reactivity, conflict, shame, anger, fear, and doubt, but how to understand them in a new light so that a deeper level of relating to oneself and one's partner becomes possible, opening new levels of trust, commitment, and love.

"This is an important and tremendously useful book, packed with wisdom and insight. Highly recommended!" –Ken Wilber, author of Integral Spirituality

Friday, May 11, 2012

Documentary - The Erectionman


One of the most successful drugs of all time is the infamous little blue pill - Viagra. This less than serious documentary takes a look at The Erectionman, the supplier of erections for flaccid men everywhere. And they also look at what Viagra says about male sexuality and anxiety - Viagra is essential to the belief that men must be "ready" on demand.





The Erectionman Synopsis

This movie tracks the history of a little pill that popped on to the market ten years ago, and turned the world upside down. These tiny blue diamonds are also known as Viagra. Nosy and armed with a healthy dose of humor, the director discovers a tale about virility, anxiety and the state of our modern-day man. How one little pill changed the course of sexual evolution.

Film Credits

Starring

  1. Irwin Goldstein
  2. Michael Schaap
  3. Chip Rowe

Director

  1. Michael Schaap

Producers

  1. Bruno Felix
  2. Femke Wolting

Writer

  1. Michael Schaap

Monday, March 12, 2012

Sexual Dysfunction Is in Your Head - Relationship Styles Offer Insights


A new research project being run at Deakin University (Australia) is looking at relationship styles and their links to sexual dysfunctions. It's about time we move away from the magic pill solution and get to the real issues that keep people from being happy.

This brief press release offers some preliminary results.

Study finds link between relationship style and sexual dysfunction

Deakin University research has shown that being too needy or not needy enough in a relationship can result in sexual issues.

Christina Stefanou is conducting her doctoral research with Deakin’s School of Psychology under the supervision of Professor Marita McCabe and is looking at the connection between relationship style and sexual functioning.

Preliminary results from the experiences of the 127 people who have taken part in the study so far demonstrate the strong links between relationship style and sexual dysfunction in both men and women.

“The preliminary analysis showed that individuals who fear rejection or abandonment and value intimacy to such an extent that they become overly dependent on their partner, had higher levels of sexual dysfunction (i.e., with sexual arousal, lubrication, orgasm, and sexual satisfaction in women, and erectile function, orgasm, intercourse satisfaction, and overall sexual satisfaction in men),” Ms Stefanou said.

“Similarly, individuals who experience discomfort with closeness and find it difficult to depend on their partner also had higher levels of sexual dysfunction (i.e., with sexual desire, arousal, lubrication, orgasm, pain, and sexual satisfaction in women, although no relationships were found with dysfunction in men).

“These findings suggest that rather than simply treating the symptoms of sexual dysfunction, treatment strategies may be more effective if they considered the psychological characteristics that impact on sexual behaviour within relationships.”

Ms Stefanou’s study is ongoing and if you would like to complete the questionnaire, please visit www.relationshipsandsex.com.au

Monday, November 28, 2011

Testosterone Boosts Sexual Function in Men on SSRIs

One of the issues for men (and women) on SSRI antidepressants is the loss of sexual desire and function. But new research suggests that for men at least, testosterone treatments can restore some sexual function. Good news for men who need the medications and still want to enjoy an active sex life.

Worth noting is that the men in the study had to have a morning total testosterone level of 350 ng/dl or less, which is clinically low to begin with. The study establishes no connection between SSRI meds and low testosterone.

This was posted at Brain Posts.

Testosterone Boosts Sexual Function in Men on SSRIs

Selective serotonin reuptake inhibitor antidepressants (SSRIs) such as fluoxetine (Prozac) continue to be a common first-line treatment for major depression and a variety of anxiety disorders.  Although generally well tolerated, sexual side effects are common in both men and women taking SSRIs.

There are a variety of options for managing sexual side effects.  These can include reducing the dose of the SSRI, switching (or augmenting) with antidepressants without sexual side effects or in men considering a trial of an erectile dysfunction drug such as sildenafil (Viagra).

Now a small clinical trial suggests that testosterone gel may be another option for men with SSRI-related sexual dysfunction.

A team of researchers from Israel and the United States combined to perform a randomized placebo-controlled trial of testosterone gel in men with low or low-normal serum testosterone levels.  The key elements of this randomized trial published in The Journal of Sex and Marital Therapy include:
  • Male subjects with DSM-IV major depression currently or within last year
  • Taking one of eight SSRI drugs
  • Current HAM-D depression severity rating scale of twelve or greater
  • Morning total testosterone levels less than or equal to 350 ng/dl
  • Randomized to receive testosterone gel (5 gram/day) versus placebo gel
  • Primary sexual function outcome measured by the International Index of Erectile Function (IIEF)
It should be noted this present study was a secondary analysis from data collected to determine if testosterone augmentation would improve depression in men partially responsive to SSRI treatment.  This explains the requirement that at least moderate depressive symptoms were required for participation in the study.  The second reference below is the results manuscript for the testosterone augmentation in depression study.  This study found limited support for testosterone augmentation in depression.

The testosterone augmentation group showed an improvement in IIEF scores in a variety of domains compared to the placebo group.  This included improvement in subscales in the domains of sexual desire, erectile function and orgasmic function.

The authors were unable to demonstrate a correlation between testosterone levels and improved sexual functioning ratings.  Of note, some of the participants with low screening testosterone on more accurate testing later on admission samples showed normal testosterone levels.  These individuals appeared to have as much improvement in sexual function measures as men with low serum testosterone levels.

The authors note they were unable to distinguish whether impaired sexual function in this sample of subjects was due to SSRI treatment, major depression or a pre-existing hypothalamic-pituitary-gonadal functioning.  Nevertheless, they note their study supports "the need for systematic clinical research to determine the therapeutic utility--including the effect on sexual function--of androgen replacement in depressed men, and the proper sequence of treatment".

It should be noted that although testosterone gel is approved for use in hypogonadism in men, it is not approved for sexual dysfunction in men with normal serum testosterone levels.  Testosterone therapy poses significant risk and should only be considered in the context of a medical evaluation by a physician.  Testosterone supplementation may increase risk for prostate cancer.  Subjects in the study described here were required to have normal prostate specific antigen levels (PSA less than 4.0 ng/ml) to participate in the study.

Photo of green sea turtle from Loggerhead Marinelife Center of Juno Beach, Florida from author's personal file.

Amiaz R, Pope HG Jr, Mahne T, Kelly JF, Brennan BP, Kanayama G, Weiser M, Hudson JI, & Seidman SN (2011). Testosterone gel replacement improves sexual function in depressed men taking serotonergic antidepressants: a randomized, placebo-controlled clinical trial. Journal of sex & marital therapy, 37 (4), 243-54 PMID: 21707327

Pope HG Jr, Amiaz R, Brennan BP, Orr G, Weiser M, Kelly JF, Kanayama G, Siegel A, Hudson JI, & Seidman SN (2010). Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. Journal of clinical psychopharmacology, 30 (2), 126-34 PMID: 20520285

Sunday, October 23, 2011

Consuming Internet Porn Inhibits Male Performance and Rewires the Brain

Transsexual model Karis

New research suggests that men who consume internet porn perform poorly when with a real flesh-and-feelings woman. This seems to especially be a problem for guys under 25 years of age - they have grown up with internet porn the ways guys in my generation grew up with Playboy. The problem for them is that the internet does different things to the brain when sex is concerned.
Lots of guys, 20s or so, can't get it up anymore with a real girl, and they all relate having a serious porn/masturbation habit. Guys will never openly discuss this with friends or co-workers, for fear of getting laughed out of town. But when someone tells their story on a health forum, and there are 50-100 replies from other guys who struggle with the same thing. This is for real.
According to the new study:
[E]rectile dysfunction due to excessive Web porn begins for many men in their teens. 70 percent of those young men who came to seek help for performance issues said they were Web porn habitues.


The weary and wise might offer that this problem must be psychological. Yet the researchers declare: "Hold on there, big brains."


For their belief is that Web porn simply numbs men's pleasure receptacles, desensitizing responses to the neurochemical dopamine. This is a chemical associated with reward and, in young men, researchers believe that gorging on Internet porn simply shuts down the physiological sense of reward from sex.
But it goes in a much different direction from here.

Men who look at a lot of internet porn find themselves becoming habituated, just like a cocaine user who needs more and more to get the familiar high that they crave. In the world of porn, this is reflected in men who start with pictures of of young women and then, from there, it escalates in directions they would never have imagined before they began consuming porn.

One young man said:
Anthony: I started looking at porn, on a regular basis, about five years ago. First there were the beautiful women, then the hardcore porn, then the weird insertions, then the transvestites, then critters, then the hermaphrodites, then the teen porn, then the younger models and now prison (soon to go). As the years passed I became less and less interested in masturbating and more and more interested in "novelty" searching. Looking back, I just don't see how I failed to recognize that I had a problem.
One of the best explanations for this phenomenon comes from Norman Doidge's The Brain that Rewires Itself. In this Psychology Today article, they quote his book:
What if the porn to which you once happily fapped no longer does the job? Could this be why viewers who would never harm others are viewing violent porn? Why gay porn viewers are feeling baffled by their tastes for straight rape porn or lesbian porn? Why straight men are bewildered by their tastes for transsexual or gay porn?


Psychiatrist Norman Doidge explained in The Brain That Changes Itself:
The content of what [patients] found exciting changed as the Web sites introduced themes and scripts that altered their brains without their awareness. Because plasticity is competitive, the brain maps for new, exciting images increased at the expense of what had previously attracted them. (p.109)
Do a viewer's most recent porn tastes reveal his "deepest urges and most uninhibited thoughts," as Ogas and Gaddam claim? Does his sexual orientation change along with what he views? Or does cyberporn manufacture superficial tastes, sometimes unrelated to sexual orientation? Most likely, the latter.
I am not so sure about the claim at the end of that paragraph. In the sex addicts I have seen, there is more fluidity in their sexual preference than in non-addicts who use porn to self-medicate (for escape, to relieve stress, etc.).

One of the outcomes of these brain changes is desensitization:
Over time, a user's brain can physically change. Signs of fundamental brain alterations (as contrasted with short-lived habituation) may include: chronic weakened impulse control, craving spikes in response to cues he associates with porn use, and decreased sexual responsiveness. He's no longer registering pleasure normally; his desensitized brain is desperate for the dopamine hits from stimulation. To climax, he needs to watch for longer or move to new genres of porn.
One of the outcomes of this is that straight men start looking at gay porn, or violent porn, and eventually transsexual porn (the operator of one site claims in that Psychology Today article that ALL of the visitors to his site are straight guys).

But if a brain's wiring can be changed in this way, as Doidge illustrates, it can - fortunately - be changed back with time and some serious dedication to not viewing porn and not masturbating.
Unwiring plastic changes


As a porn user's addiction progresses, masturbation habits may tell him very little about his actual orientation. However, guys on our forum have discovered that if they (1) give their brains a rest from porn, porn fantasy (and ideally masturbation and orgasm), and (2) replace their former habits with socializing, exercise, meditation and other comforting activities, they can start to see changes in their sexual tastes surprisingly quickly. Here's Ryan's report after only a month:
I spent the last year of high school jacking off to Internet porn compulsively, and escalated to gay porn several months ago. I found it disturbing to watch; it fueled my OCD and subsequent depression.


Now I'm feeling almost like a new person. I've been through nearly 4 weeks of hell, and had to get my antidepressants adjusted. I've been biking daily and interacting with others at college. But I do not get aroused at gay porn anymore. It's like I have gotten rid of those circuits. The thought of lesbian porn is once again arousing. I am also slowly starting to get my libido back. It's not over yet, but I have conquered part of it.
You can read the whole Psychology Today article here.

Reflection in sunglasses of porn viewer

In another Psychology Today article from September, they reviewed the new definition of addiction (it's about the brain, not about behaviors) and show how sex and porn can produce addiction in compulsive users (the key word being compulsive).
If you view porn, are you an addict or merely a user?


This question used to be a silly one for most porn users. Prior to the Internet, porn use (if any) bore some relation to authentic libido. When one had had enough, the magazine went back under the mattress. Internet porn, however, has the power to override natural satiety mechanisms in many brains. This increases the risk of the addiction-related brain changes ASAM addressed.  


With respect to porn, it's not time spent viewing or what you're looking at that determines whether your brain has changed. Instead, watch for these signs:
Curious how these telltale symptoms might show up in today's porn users? We've culled the following questions from actual reports of self-identified porn addicts. Many users do not make the connection between their symptoms and their porn use until they abstain from porn for weeks, but these questions, and the remarks below them, may help you determine whether you need to seek help to reverse unwanted changes and restore your brain to balance.
  • Have you tried to stop using porn and failed? Did you noticewithdrawal symptoms?
  • Do you experience intense cravings when you have no access to porn for several days?
  • When you use again do you notice rapid escalation to more extreme material?
  • Have you noticed changes in your sexual tastes?
    • Have you explored new types of porn in order to attain earlier levels of excitement?
    • Are you viewing things that never turned you on?
    • Are you using porn that does not match your sexual orientation?
  • Is porn viewing the most exciting thing in your life? Does life seem dull otherwise?
  • Do you feel powerless to stop yourself from using porn if you see or experience something you associate with porn use, such as:
    • being alone in the house,
    • seeing a TV show with your favorite fetish hinted at or portrayed,
    • seeing news about a favorite porn star?
  • Do you see potential mates differently—more as body parts than as people?
  • Since using Internet porn, do you feel more tongue-tied, unsafe, awkward or anxious around other people—especially potential mates?
  • Is it harder to connect with others? Do you feel lonelier? Are you more worried about what others think about you?
  • Have you (or those who care about you) noticed you:
    • procrastinate more than before using, have lower motivation(don't care), chronic fatigue, brain-fog, or difficulty concentrating or remembering things?
    • have become more anxious, restless, impulsive, stressed, irritable, unhappy, pessimistic, emotionally numb, or depressed?
    • have become more secretive, or isolate more?
  • Have you noticed declines in your sexual function during sex: more rapid ejaculation (PE), inability to maintain an erection without self-stimulation, porn or porn fantasy (even if you can get rock-hard to porn), delayed ejaculation (or inability to orgasm), less satisfying orgasm, need the lights on during sex to get aroused, not turned on by attractive partner, no desire for sex?
  • Have you noticed declines in your sexual function duringmasturbation: unable to masturbate without porn or porn fantasy, need for more vigorous masturbation ("death grip," faster strokes), weaker (or rapidly fading) erections, climaxing with a semi-erection, more frequent urination?
  • Since using Internet porn, do you feel like you've lost your "mojo," or sex appeal? Do you doubt your attractiveness or feel more anxious about the dimensions/appearance of your genitals?
  • Does your voice feel more nervous, shallow, tight, or unnaturally high? Shallow breathing?
  • Have you masturbated to the point of abrasions or other physical damage?
  • Can you fall asleep without using porn? Do you have more troublesleeping soundly through the night?
  • When under stress do you use more porn?
  • Do you have intrusive porn flashbacks?
  • Are you risking your job, education or relationship to watch porn, or spending too much money on it?
  • Have you lost a relationship or job, or dropped out of school due to your porn use (or symptoms related to it)?
  • After climaxing, do you notice more intense mood swings (irritability,depression, anxiety)?

Thursday, November 4, 2010

Hypoactive sexual desire disorder in men: Biopsychosocial approaches

What follows is a short research paper I wrote for my sexuality and psychotherapy class - I thought I'd post it here because so many men have internalized the belief that men are always ready, willing and able to have sex - and want sex more than anything else.

The reality is that men and women are not that far apart in their levels of desire, especially if we strip away the cultural beliefs and training around this topic.
____

Hypoactive sexual desire disorder in men: Biopsychosocial approaches

The cultural myth is that men think about sex every seven seconds (Ahuja, 2006). Furthermore, men are always ready, willing, and able to have sex (Brizendine, 2006, p. 91; Meuleman & Van Lankveld, 2004, p. 293; Pleck, Sonenstein & Ku, 1993, p. 21). The reality is that many men think about sex once a day or less:
According to the Kinsey Report (Sexual Behavior in the Human Male), 54 percent of men think about sex every day or several times a day, 43 percent a few times a week or a few times a month, and 4 percent less than once a month. (Dixit, 2007)
On the other hand, it is assumed and widely verified that sexual desire occurs less frequently in women and that arousal is much more complicated. One could argue the etiology of this fact, whether it is that women possess lower endogenous testosterone or that female children are socialized to be and feel less sexual, but that is another topic. What is true, however, is that women suffer from desire disorders more than men, most commonly hypoactive sexual desire disorder (HSDD) (Goldstein et al., 2006; Laumann, et al, 1994, p. 370 & 371). To be precise, the prevalence among men versus women is about 15% versus 35%, respectively (Levine, 2010, p. 40).

The Diagnostic and Statistics Manual of Mental Disorders, 4th edition, text-revision (DSM-IV-TR, American Psychiatric Association, 2000) defines hypoactive sexual desire disorder as, in summary, “Persistently or recurrently deficient (or absent) sexual fantasies and desires for sexual activity” that causes personal and relational stress, and that cannot be accounted for by Axis I disorders, substance use (including medications), or other medical conditions (p. 541). The disorder is further defined through lifelong versus acquired, generalized versus situational, and psychological versus combined factors (p. 541). There are many chemical factors that can lead to HSDD in men, most commonly anti-depressant medications (specifically, selective serotonin reuptake inhibitors and anti-hypertensive medications) as well as hormonal issues (hypogonadism or endocrine dysfunction as a result of environmental xenoestrogens) and psychological issues (anxiety, depression, and other Axis disorders) (Levine, 2010, p. 40). All of this makes a differential diagnosis more challenging.

Once ruling out medications, mood disorders, and hormonal issues, it becomes important to identify whether the situation is lifelong or acquired and situational or generalized. Further, men will often report erectile dysfunction rather than low sexual desire, further complicating diagnostic efforts (Levine, 2010, p. 41). This tendency to underreport desire disorders can likely be traced back to the cultural myths about male sexuality—a mechanical problem is bad enough, but male socialization conveys that not wanting sex is simply not masculine (Fracher & Kimmel, 1992). When clients find it difficult to discuss sexuality or sexual desire issues, The Sexual Desire Inventory (Spector, Carey & Steinberg, 1996) can be a useful tool for acquiring information in a way that allows more openness for the client (Meuleman & Van Lankveld, 2004, p. 291).

For those clients who profess they always have experienced low desire (lifelong variety), and who also believes that the low desire is ego syntonic, continued treatment may not be desirable unless the client is dissatisfied with the situation. For example, 27.4% of men aged 18 to 59 who were living with a partner had sex three times or less in the last year (10% had zero sex) and two-thirds of the men who had no sex were not troubled by it (Laumann, et al, 1994). For these men, lack of sex drive may be a character trait or an aspect of temperament with which they were born.

However, as Levine suggests, the situation is seldom as simple as innate low desire and no feelings about that loss of intimacy:
Lifelong HSDD usually reflects the constitutional endowment of sexual drive, although the internalization of antisexual values and experiences of abuse or neglect may produce a lifelong low sexual interest level. (2010, p. 41)
Levine goes on to suggest that attachment issues, which can inhibit adolescent sexual development can sometimes be at the root of low desire. In women, low desire or frequency of sexual behavior is associated with avoidant attachment, but in males it is associated with ambivalent attachment patterns (Feeney, 1999, p. 371). However, this is only one opinion—a study by Hazan, Zeifman, and Middleton (1994) found that avoidant men and women report low enjoyment of sexuality whereas ambivalent subjects of both sexes enjoy cuddling but not overt sexuality (cited in Feeney, p. 371)—there are very few studies that look at attachment issues and male hypoactive sexual desire.

Most often, HSDD manifests later in a relationship after a time of relatively normal sexual function and behavior (acquired variety). The reasons for this loss of desire can be physical, especially low androgen levels, as noted by many researchers (Knussmann, Christiansen & Couwenbergs, 1986; Mantzoros, Georgiadis & Trichopoulos, 1995; Nilsson, Moller & Solstad, 1995). There also can be other physical issues to rule out, including “various combinations of direct illness effects: treatment effects from medication, radiation, or surgery; psychological reactions to being ill; spousal reactions to the ill partner” (Levine, p. 41).

After ruling out all other issues (these are commonly seen as acquired generalized causes), the next step is to examine acquired situational issues. According to Levine, these tend to occur shortly after marriage. One variation, the Don Juan “casualty,” typically values the seduction more than conquest, and once he has “won” the women whom he often sees as a wonderful person, the sexual impulse is gone. In another variation, the pornography “casualty,” the man has been shaped and has shaped his sexual scripts through pornography. For him, an actual woman is too complex and intimidating for him to feel sexual toward. Finally, the “practical marriage casualty” results when a man chooses a wife for status and social benefits without really feeling any romantic interest. Each of these assumes a somewhat normal sexual fantasy life but a sexless relationship.

The therapist should also examine more complex, relationship-based issues. Among the variety of reasons a man may feel no sexual chemistry or desire for his wife include the following: he is having an affair, he no longer finds her sexually attractive, he finds her complaints about his sexual functioning overwhelming, her new status as a mother has rendered her asexual in his eyes, and perhaps the most irrevocable issue, he is a closeted homosexual and can no longer pretend to feel attraction for his wife even though he cannot face his sexuality. The job of the therapist is gently to explore these possibilities with the client while always keeping in mind that, “For men, sexual behavior is the ultimate expression of their manhood; beyond manhood—their personhood” (Gaylin, 1992, p. 117).

Levine argues that there are no physiological treatments (magic pills) for low sex drive (p. 42) and that there does not seem to be anything resembling a Viagra for low desire. However, he also states that none of the most common psychotherapies—cognitive-behavioral, psychodynamic, sex therapy, Psychodrama—have proven useful in treating HSDD (p. 42). Therapy can involve the man by himself, the man with his partner, or placement into a group with other men who experience similarly limited interest in their partners. While the group work may not do much to repair or save the relationship, it can help the man better understand his avoidance or motivations.

In lifelong/generalized HSDD, successful therapy may simply entail helping the couple develop strategies to maintain intimacy and a sexual common ground. With situational/acquired HSDD, successful therapy may include exploring relationship issues, physical attraction issues, family of origin issues, and a variety of other factors. Finally, it is also possible that the man developed a part—a subpersonality—whose role it is to suppress sexual desire, generally as a result of some shame-related experience (Schwartz, 1995). If that part’s “burden” can be identified and removed through therapeutic intervention (often a form of active imagination), then therapy can focus on trust-building and the creation of intimacy within the couple, but without sexual contact, until physical desire returns. However, it is handled, sensitivity to the importance men generally place on their sexuality as a major construct of their personal identity is crucial.


References
Ahuja, A. (2006, February 1). Every 7 seconds? That’s a fantasy. The Times (UK). Retrieved from http://www.timesonline.co.uk/tol/life_and_style/article723673.ece

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Text Revision ed.). Washington, DC: APA.

Brizendine, L. (2006). The female brain. New York: Broadway Books.

Dixit, J. (2007, June 4). Five shocking stats about men and sex. Psychology Today. Retrieved from http://www.psychologytoday.com/articles/200706/five-shocking-stats-about-men-and-sex

Feeney, J. A. (1999). Adult romantic attachment and couple relationships. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 355-377). New York: Guilford Press.

Fracher, J., & Kimmel, M. S. (1992). Hard issues and soft spots: Counseling men about sexuality. In M. S. Kimmel & M. A. Messner (Eds.), Men’s lives (2nd edition), (pp. 438-450). New York: Macmillan Publishing Company.

Gaylin, W. (1992). The male ego. New York: Penguin Books.

Goldstein, I., Meston, C., Davis, S., & Traish, A. (Eds.). (2006). Female sexual dysfunction. New York: Parthenon.

Knussmann, R., Christiansen, K., & Couwenbergs, C. (1986). Relations between sex hormone levels and sexual behaviour in men. Archive of Sexual Behavior, 15, 429-445.

Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

Levine, S. (2010, June). Hypoactive sexual desire disorder in men: Basic types, causes, and treatment. Psychiatric Times, 40-43.

Mantzoros, C. S., Georgiadis, E. L., & Trichopoulos, D. (1995). Contribution of dihydrotestosterone to male sexual behaviour. British Medical Journal, 310, 1289-1291.

Meuleman, E. J., & Van Lankveld, J. J. (2004, July 12). Hypoactive sexual desire disorder: An underestimated condition in men. BJU International, 95, 2 9 1 – 2 9 6. DOI: 10.1111/j.1464-410X.2005.05285.x

Nilsson, P., Moller, L., & Solstad, K. (1995). Adverse effects of psychosocial stress on gonadal function and insulin levels in middle-aged males. Journal of Internal Medicine, 237, 479-486.

Pleck, J. H., Sonenstein, F. L., & Ku, L. C. (1993). Masculinity ideology: Its impact on adolescent males’ heterosexual relationships. Journal of Social Issues, 49(3), 11-29. Retrieved from SocINDEX with Full Text database.

Schwartz, R. C. (1995). Internal family systems therapy. New York: Guilford Press.

Spector, I. P., Carey, M. P., & Steinberg, L. (1996). The Sexual Desire Inventory: Development, factor structure, and evidence of reliability. Journal of Sexual and Marital Therapy, 22, 175–90.

Saturday, May 29, 2010

Michael Castleman - Premature Ejaculation: The Two Causes of Men's #1 Sex Problem

http://increasesexualstaminatoday.com/wp-content/uploads/2010/02/increase-sexual-stamina.jpg

Michael Castleman blogs for Psychology Today at All about Sex. In this post he reveals that PE is much more common than ED, but gets no press. He also suggests that the two biggest causes of PE are youth (kids are so damn excitable - but it often becomes a conditioned reflex) and pornography.

Premature Ejaculation: The Two Causes of Men's #1 Sex Problem

Premature ejaculation is men's most prevalent sex problem.

Ever since Viagra's 1998 approval, erectile dysfunction (ED) has dominated media coverage of men's sex problems. But ED is actually less prevalent than rapid, involuntary "premature" ejaculation (PE).

University of Chicago researchers have conducted the most widely cited research into American sex problems. Their two studies (cited at the end) are based on a representative sample of 2,865 men, 18 to 85. They show that from 18 to 59, PE is much more prevalent than ED, and that among men 60 and older, one-quarter of men continue to experience it. As a result, sexologists consider PE men's #1 sex problem. The numbers:

Erection problems*
(% reporting any during previous year)
18-29: 7
30-39: 9
40-49: 11
50-59: 18
57-64: 31
65-74: 45
75-85: 43

Premature Ejaculation*
(same criterion)
18-29: 30
30-39: 32
40-49: 28
50-59: 31
57-64: 30
65-74: 28
75-85: 22

(*One study tracked ages 18-59, the other, 57 to 85)

PE has a convoluted history. The 4th century Kama Sutra chided PE sufferers for frustrating women. However, during the Victorian era in England and America, women were not considered sexual, but merely passive receptacles for men's lust. Because women's pleasure was not an issue, neither was PE. In fact, Darwinians considered rapid ejaculation a sign of virility. Those men, they argued, were more likely to father children and pass their genes, including presumably those for PE, to future generations.

However, by the 20th century, PE was again problematic. Psychoanalytic theory blamed it on neurotic ambivalence toward women. But during the 1960s, Masters and Johnson conclusively showed that a simple self-help program could teach more than 90 percent of men to last as long as they wanted within a few months. Their success launched contemporary sex therapy.

PE has two major causes: youth and pornography. Young men have very excitable nervous systems. They're primed to ejaculate and don't even need sex to do it (wet dreams). In addition, in our culture, men are supposed to orchestrate sex, but few young men know much about lovemaking. This causes anxiety, which makes the nervous system more excitable and more prone to PE, which often becomes a conditioned reflex that can last a lifetime.

Meanwhile, pornography has become the leading sex educator of men. Internet porn is available for free 24-7. In a previous blog, I argued that porn does not cause rape (read more). But porn causes sexual harm. It teaches sex all wrong, deluding men about what good sex is. No wonder so many women complain that men are erotically clueless. Here's the deal, guys: Porn is almost entirely genital. Boy meets girl, and faster than dropping a zipper, they're deep into oral sex and intercourse. Porn-style all-genital sex puts tremendous pressure on the penis, which reacts by ejaculating quickly. Porn-style sex cements PE.

Fortunately, in just a few months, the vast majority of men can break the PE habit and learn to last as long as they'd like. The cure combines deep breathing and relaxation with doing the opposite of what you see in porn, namely embracing leisurely, playful, massage-based, whole-body sensuality that spreads erotic arousal from just the penis to every square inch of the body, taking pressure off the penis.

Many surveys show that women prefer lovemaking based on leisurely, playful, whole-body sensuality. Of course, this lovemaking style includes the genitals, but unlike porn, is not fixated on them. Men who embrace the self-help PE cure gain not only ejaculatory control, but also happier lovers. Ironically, women become happier not just because the man lasts longer--only 25 percent of women are consistently orgasmic during intercourse no matter how long it lasts (read more)--but because the program that cures PE teaches men to make love the way women prefer, with the emphasis on whole-body sensually.

Anyone interested in the self-help cure for PE can visit my site, GreatSexAfter40.com, and read the article on the self-help cure for premature ejaculation.

Studies cited:
Laumann, E.O. et al. "Sexual Dysfunction in the United States: Prevalence and Predictors (Age 18-59)," Journal of the American Medical Association (1999) 281:537.

Laumann, E.O. et al. "Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age," Journal of Sexual Medicine (2008) 5:2300.

His "cure" for PE costs $1.99 for a PDF download - payed through PayPal.

My opinion is the changing the focus from intercourse to intimacy - emotional and physical - goes a long way toward improving the love-making experience for both partners, whether PE is an issue or not. Just being naked together, enjoying each other's sensuality, scent, appearance, taste, and so can be very rewarding, no intercourse required. My guess is that this is part of most PE treatments these days - a form of desensitization to reduce arousal and/or anxiety. My guess also is that most women would love this experience, especially if intercourse isn't on the agenda.

OK, that said, here is WebMD's solution for PE.
Faced with premature ejaculation, most men try to distract themselves during intercourse, believing that by thinking about other things, they can trick themselves into lasting longer. Usually, that only makes things worse.

Don't tune out your body. TUNE INTO IT. You need to become more familiar with your different levels of sexual arousal. You also need to recognize how you feel as you approach your point of ejaculatory inevitability, the "point of no return." Once you recognize how you feel close to your point of no return, it's not difficult to make small sexual adjustments that allow you to remain highly aroused without ejaculating.

Sexual arousal is a four-phase process. In the Excitement Phase, breathing deepens and erection begins. In the Plateau Stage, erection becomes full and you feel highly aroused. When arousal builds to a certain point, the next phase occurs, Orgasm with Ejaculation. Then during the Resolution Phase, breathing returns to normal and erection subsides. The key to ejaculatory control is to extend the Plateau Phase, to maintain arousal without triggering Orgasm and Ejaculation.

To learn ejaculatory control:
  • Don't use drugs or alcohol. They're distracting and they interfere with the self-awareness crucial to learning ejaculatory control.
  • Appreciate whole-body sensuality. Men often think sex happens only in the penis and only during intercourse. That view is a one-way ticket to premature ejaculation (not to mention erection problems, and women with those proverbial headaches). The best sex involves head-to-toe arousal. Men learning how to approach -- but not arrive at -- their point of no return, need to appreciate whole-body sensuality, the pleasure potential in every square inch of the body. Whole-body sensuality releases tension. Tense bodies that have no other outlet often find release through involuntary ejaculation. But as you learn to appreciate sensual pleasure from head to toe, whole-body arousal takes the pressure off your penis, and you last longer.
  • Whole-body sensuality means relaxation, but the "relaxation" involved in great sex is not the kind that includes an easy chair, a six pack, and Monday Night Football. It's the kind you feel after a hot bath or a good massage. In fact, bathing or showering together before lovemaking can help men relax and appreciate whole-body sensuality -- and last longer.
  • Breathe deeply. One very easy way to stay relaxed while making love is to breathe deeply. The body has a natural tendency to breathe deeply during sex. But many men fight it. They think they should stay in control by not breathing deeply and making the little love-moan sounds that go along with it. But when men work to control their breathing, they often sacrifice ejaculatory control. Try breathing deeply. Let your breath go. Many men are amazed how much this one little change improves their premature ejaculation.
  • Start with masturbation with a dry hand. By varying how you caress your penis, you can learn to stay highly aroused for quite a while without coming. When you feel yourself approaching your point of no return, simply back off a bit, stroke yourself more gently or not at all, and stay aroused without ejaculating. Then as you feel yourself getting a little distance from your point of no return, return to more vigorous self-stimulation. Repeat this several times over several sessions. Approach your point of no return, then back off. For most men, it doesn't take long to develop good ejaculatory control while alone.
    Then move on to masturbation with a lubricated hand. Use saliva, vegetable oil, or a commercial sexual lubricant. For most people, lubricants increase the sensual intensity of erotic fondling. Follow the same program: Masturbate until you approach your point of no return, then back off. Repeat this several times over several sessions.
  • Once you have good control during masturbation, and appreciate whole-body sensuality, and feel comfortable breathing deeply during lovemaking, then you're ready for the couples program -- if you're in a couple. The couple approach is called the "Stop-Start Technique." First, arrange "stop" and "start" signals with your lover, for example, a light pinch or tap, or a tug on an ear.
    Then, your lover strokes your penis by hand as you lie still. When you approach your point of no return, give the "stop" signal. Your lover immediately stops stroking you and simply holds your penis gently, as you continue to breathe deeply and pays close attention to the sensations you're feeling. When you no longer feels close to ejaculation, gives the "start" signal, and your lover begins stroking you again. How many stops and starts should you do? A half-dozen over a 15-minute period works well for most couples. Do what feels comfortable for you.

    With stop-start, the focus is on the man. He's the one learning the new skill. But don't forget the woman's sensual needs. As part of each practice session, she might guide your hand over her to show you what she likes.

    Once you've gained good ejaculatory control with your lover's hand, try the same stop-start procedure with oral caresses. Again, you begin by lying still.

    Once you've gained good control orally, feel free to start moving. You're making love again -- but now you have ejaculatory control. Congratulations.

Here are some other suggestions for lasting longer:

  • The man-on-top (missionary) position can be fun, but it's harder for most men to control their ejaculatory timing, because they have to hold themselves up. Try making love with the woman on top. This position is more relaxing for men, and it often helps ejaculatory control.
  • Make some noise. Love moans help men (and women) relax, and they often help men last longer.
  • It's important to understand that learning ejaculatory control takes time and practice. You may feel a little awkward along the way. Try to maintain a sense of humor about any accidental spills.
  • Some penile skin creams advertise that they help a man last longer. These products contain topical anesthetics that dull sensation in the penis. If you like to play with penile sensation, there's no harm in using them. But they're not a good idea for learning to last longer. They dull sensation. But the key to lasting longer is for the man to become more familiar with what he feels so he can back off from his point of no return while still remaining highly aroused.
  • Finally, the program we recommend for learning ejaculatory control is very likely to provide your lover with greater sexual enjoyment -- but not just because you last longer. Women generally prefer leisurely, playful, whole-body, massage-oriented sensuality that includes the genitals but is not limited to them. Women's main complaints about men's sexual style are that it's too rushed, too mechanical, too eager for intercourse, and that it focuses only on the breasts and genitals. Women generally feel that the whole body is a sensual playground and can't understand why so many men explore only a few corners of it. Like women, penises generally prefer leisurely, playful, whole-body, massage-oriented lovemaking. The rushed, penis-centered, intercourse-fixated sex style puts a lot of pressure on the penis, and leads to premature ejaculation. But when men make love the way women prefer, whole-body arousal takes the pressure off your penis and you last longer. Basically, if men would make love the way women prefer, women would have fewer complaints, and men would have fewer sex problems.

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