Morgan Flores, M.S.
Maybe this sounds weird, but I am super passionate about talking about sex with patients because it is such a significant part of life for many people and it is such a hush-hush topic! Well, actually society brings up sex all the time, but not usually in the most flattering, informative, or helpful ways. Real talk about sex is needed as there are so many people out there who have genuine questions that there are legitimate answers to. If you could have a non-judgmental conversation about sex where you could express concerns, ask questions, and get feedback based on research today, would you? If even one question or concern comes to mind for you, here are some ideas of who you could talk to and what information is already at your fingertips:
Talk about it with your doctor
Influence of medical diagnosis or medications. The first thing to consider with any kind of sex concerns or performance issues is whether or not there is a medical situation at play. Before considering any other options, it is important to rule this out a medical diagnosis or medication interaction or work on a solution with your doctor if applicable. While this might not feel like the most natural conversation to start with your provider, just remember that it is not an uncomfortable conversation for them. If it makes you feel better, write out a bulleted list of your concerns so you don't get nervous at the moment and forget something you want to talk about.
Anatomy and sex. Whether you are struggling with a sex issue or not, there is some information from the medical field that everyone can glean from; an educated perspective of sexual anatomy. You might brush over this thinking, "I already know what I need to know", but an in-depth understanding of anatomy and the rhythms of climax and release in sex for both genders can boost your experience overnight. There are several books published on this topic that you can read in the comfort of your own home. I recommend A Celebration of Sex for Newlyweds by Dr. Douglas E. Rosenau. Even if you are not newly-wed, this is a concise and clear book with a lot of practical information, illustrations and everything included (note this author discusses sex from a Christian perspective; if this is not for you, reach out and we can make alternative suggestions!).
Talk about it with your therapist
Neurological components of sex and sex habits. Sex is not just a physical act, it affects us psychologically and emotionally in very profound and lasting ways. Without getting too nerdy on you, when you have sex your brain releases neurotransmitters that are significant to be familiar with and understand how they influence sexual behavior:
Dopamine- also known as the reward signal. Dopamine urges you to repeat whatever behavior gives you pleasure but the more you do that activity, your brain becomes tolerant of that level of dopamine so it urges you to increase the intensity of the behavior to get the same "good feeling" experience. Dopamine is present in a lot of different behaviors, but sex is one of the most dopamine-rewarding activities someone can do. Dopamine plays an important role in minimizing a sense of risk for productive behaviors that might otherwise be hard to do (e.g., going for a better job, committing to marriage, having children, etc.). It can also serve to make people more immune to warning signs of more destructive behavior, or at least minimize their worry regarding consequences (e.g., substance addictions, casual sex, etc.).
Oxytocin- is active in men and women but is primarily active in females. For women, oxytocin encourages bonding with newborns (encouraging their derive to care for the infant even though it is very demanding) and it also connects her to her partner (encouraging the prospect that a newborn will have a better chance of survival and well-being in a two-parent home). Research has discovered that oxytocin is released in a woman's brain when she engages with a partner physically, from a 20-second hug to the intensity of oxytocin release when engaged in sex. The effects are that this neurotransmitter neurologically increases her desire for more closeness, and initiates the development of increased trust in the man she is in contact with (regardless of whether he is trustworthy in fact or not). This explains why women can find themselves going back to a harmful relationship even when they might acknowledge it is not the most healthy. It is not just an emotional feeling but a brain molding that is subconscious and is difficult to break without emotional pain. It also has implications for the brain's ability to form healthy bonds with future sex partners, including one's spouse when a stable relationship is introduced.
Vasopressin - known as the "monogamy molecule" has a similar function in men as oxytocin does in women. It contributes to the attachment to who he is intimate with and their offspring if applicable. In the context of a committed relationship, it encourages family development and longevity in a committed relationship. Outside of this context, men find themselves going back to unhealthy relationships or having sex with multiple women, bonding with each of them, to the extent their brain is modeled to normalize their experience and the result is a neuronal interference with the brain circuits needed for long-term connection in a stable relationship. In other words, they can find themselves limited to the dopamine rush of sex and the vasopressin no longer serves to facilitate bondedness when a man wants to enter into a committed relationship because the brain has molded to normalize casual sex. The result is a neuronal subconscious continuation of promiscuous behavior based on brain molding that impacts a man’s relationship well beyond the moment of casual sex.
Translated into English. The impact of these neurotransmitters is amazing when you think about how consistent sex in the context of a committed relationship, like marriage, can bring you closer together, feeling more bonded and more patient, and even more passionate about sex with one another where each partner is encouraged neurologically to have sex with each other again and again! It is very important to note, however, that the neurotransmitters involved in sex are values neutral, so they are engaged in sex no matter the context. For the very same reason, casual sex can be confusing and potentially harmful psychologically because the same chemicals are released but the stability of the relationship is not there to facilitate the purpose the hormones are supposed to have. The effect is a pattern of devastating breakups and difficulty experiencing the positive effects of sex in a committed relationship once you get to that point because your brain has trained itself to function in the dysfunction so that its original purpose is now foreign and uncomfortable. For this reason, neurologically-based research suggests that sex is best experienced in the context of a committed relationship for the best mental health and relational health (Mcilhaney & Bush, 2019). To read more on this matter, I recommend the book Hooked: The brain science on how casual sex affects human development by Mcilhaney & Bush. But wait, if you find yourself way past that line, don't stop reading, this next part is just for you!
Neuroplasticity! If you know what that word means, you are probably just as excited as I am! For those who are not familiar with that term yet, let me introduce the concept. That is my favorite thing about being a therapist is that it is not just wishful thinking; our brains were designed for growth and we can be intentional to see that work in our favor. The brain was created with the capacity to "change in response to the environment" (Okuno, 2016). Translated to the topic of sex, that means that, no matter how bad your past experiences or current dysfunction, research also shows that our brains can change and heal! Therapy can be a great resource to give you tools to make that happen for you!
Anxiety around sex. People can be anxious about sex for a variety of reasons like, a lack of knowledge, bad previous experiences, sexual trauma, the belief that sex is bad or wrong, and the list goes on. All these things are great topics for therapy! Your clinician can work with you to develop an individualized plan based on your concerns and your goals. Sometimes insight and research-based perspective alone do wonders, but there are also practical things you can learn in therapy to eliminate roadblocks in your sex life. The beauty of therapy is it is specific to you and there are a variety of interventions available. Resources can include research-driven information on sex; specific tools to help reduce anxiety around sex; trauma interventions; sex disorder interventions; mediation of marital conversations about sex; etc.
Becoming a sexy person. It is also important to remember that part of having good sex, is becoming a mature and sexy person. By that, I am not referring to how you look, although taking care of your body and being healthy is a loving and selfless act of care for your partner. I am referring to mental, emotional, and spiritual maturity that is reflected in character and the selflessness in love that makes for a better foundation in a relationship, including sexual intimacy. I note this here because therapy can be one practical way to be intentional about growth in different areas of life that will have a ripple effect to impact relationship intimacy, including sex.
Talk about it with your partner or spouse
Spoonfeed each other. I once heard an analogy of marriage that stuck with me and I think it applies to a healthy attitude when approaching sex. If you can imagine with me, you and your partner sit down to eat and each of you has a spoon, but both of your spoons are so long it would be impossible to bring it to your own mouths. The only way either of you would be able to eat would be to feed one another. Truly satisfying sex happens when both parties go into it with the expectation to please their partner; then it is a win-win situation where both individuals' needs are met in a way that encourages connection. Put another way, you are the only one who can sexually satisfy your partner and that is both a huge honor and a legitimate responsibility. If you and your partner both think of it this way and seek to serve each other first, the result will be that both of your needs will be met.
Discover what you find enjoyable and talk about it. Your engagement in sex will make it more enjoyable for you and your partner. It is important to express your needs, not as demands but as a boost to your long-term relationship where you can both be honest and seek to mutually satisfy one another. When the gift of sex is given out of love, the most enjoyable part can be seeing your partner experience pleasure. It is not just, "ok, do it and get it over with" or because that kills half your partner's fun of seeing you enjoy the moment with them.
Discover what you don't like and talk about it. Boundaries in sex help you both feel safe and the vulnerability of sex will not feel as daunting. In reality, some things either are not safe or that one of you is not comfortable with that might be counterproductive if the main goal of sex is serving one another and growing in intimacy. On the other hand, some things are just preferences; which are fine to have and to acknowledge. If one partner likes a certain position or type of foreplay and the other doesn't, you might not do it every time but, when you do, it can be a special opportunity for them to communicate care on a selfless level. Your preferences can also change. Women, in particular, can feel like doing something one night and then feel like the same thing is a turn-off the next (or even in the same sex session). That is not a bad thing; it is actually what can drive a lot of fun creativity, but it certainly requires communication. This includes talking about your desires, hopes, and expectations in advance as well as in the moment to help you both get on the same page and serve each other best!
Sex is not a dirty word. It is a gift in the context of a committed relationship that grows in intimacy and pleasure. Cultivating a good sex life takes intentionality, which includes talking about it! You could be a few conversations away from improving this area of your life in a meaningful way! What is the next conversation you want to have? If it is with a therapist, I would consider it an honor to meet with you to have this conversation as an individual, or as a couple. Let this be your invitation; it's not weird, and, for a lot of people, it's well worth it!
Morgan is accepting new patients; reach out to our office to inquire about services!
References
Mcilhaney, J. S., & Bush, F. M. (2019). Hooked: The brain science on how casual sex affects human development. Northfield Publishing.
Rosenau, D. (2002). A celebration of sex for newlyweds. Thomas Nelson Pub.
Okuno, H. (2016). Neuroplasticity. In D. Boison & S. A. Masino (Eds.), Homeostatic control of brain function (pp. 175–186). Oxford University Press.