My View of Safer Sex

For many years, safe sex and safer sex have been terms intended to minimize sexual risks such as unwanted pregnancies and sexually transmitted infections (STIs). There have been government guidelines and health, education and other organizations which have promulgated their own rules and guidelines.

Most of the rules have focused on using condoms consistently and carefully. It is known that using condoms lowers the risk of unwanted pregnancies and STIs, but it is also known that condoms can break or come off, which increases risks.

Condoms do not totally protect against herpes transmission if the shedding of the virus is not fully covered with a condom. Since herpes can shed without sores, condom use is a good idea to lower the risk of herpes transmission.

When I discuss safer sex with clients or with an audience, I focus on condom use unless both people test negative for STIs such as HIV, HPV (genital warts may result from HPV), chlamydia, hepatitis B, gonorrhea and syphilis, and they are sure that their relationship is monogamous, or that they at least are using condoms with others. The tests for herpes may not be fully informative, in that you may find out that a person has been exposed to the virus, including a cold sore, but you cannot be sure the person is transmitting herpes, or specifically, genital herpes.

I also focus on conducting a Pre-Sex Discussion (PSD) as part of safer sex. In such a disucssion, you each ask questions about any history of STIs, and you ascertain whether effective birth control is to be used (see my book, The Naked Truth About Sex, for a thorough discussion of a PSD). It is smart to use more than one method of birth control. Condoms can break. Using an IUD, the pill or another method is appropriate.

We must balance sexual risks with the benefit of sexual pleasure. It would not be pleasurable to have a problem such as an STI or unwanted pregnancy because the lovers did not use condoms when they were not reasonably certain of the sexual risks going in. I always caution clients to use commonsense about safer sex. I explain risks and ways to minimize them. In the end, each person must calculate their own sexual risks with their lovers, and decide together about precautions they will take. We are all responsible for our own sexual behavior, but we must be honest in our discussions of potential and actual sexual risks.  

How to Solve Sexual Problems

While it is true that some minor sexual problems can be solved by reading a book, most problems require a board certified sex therapist who works with appropriate doctors.

Every sexual problem involves mental issues–changing thoughts to fix them–and many problems also include physical/medical causes. In addition, relationship issues are often critical to address. Every case is a puzzle to solve, with mental, physical, medical and relationship pieces. 

When a man has E.D., there are typically both physical/health pieces, and mental pieces in the puzzle. His performance anxiety may be caused in part from poor health habits such as lack of regular exercise, poor diet and limited sleep. He may also be on medications that adversely affect erections. There may be relationship issues such as poor communication, anger, conflict and hurt feelings, to name just few. He may be overly anxious or depressed. Such mood states can affect his libido and his erections. To solve his E.D., all of these issues must be properly addressed by a board certified sex therapist in conjuction with a urologist, G.P. or another doctor with a grasp of sexual medicine.

Similarly, when a woman has low desire, limited arousal or lack of orgasm, she needs a complete treatment plan (which is not merely “how do you feel?!”) developed by a sex therapist and a gynecologist or another doctor. When there is a couple, a sex therapist usually sees both partners separately, and then together. It is common to discover that both partners have sexual problems, even though one problem may have brought them to the sex therapist.

There are sex therapists who contend that all sexual problems are mental and relationship based, but I am not one of them! When there is a physical problem, it affects a person mentally, and the relationship is also affected. Similarly, some M.D.s think that sexual problems are entirely medical, but many are astute enough to realize there are mental and relationship issues too.

When there is a couple, couples therapy with a sex therapist is appropriate. A marriage counselor usually lacks the background to deal well with sexual problems, and no one should need BOTH a marriage counselor and a sex therapist to solve a sexual problem! Most sex therapists do couples therapy. It would be difficult to solve a sexual problem by seeing one person in a relationship. If a person does not have a lover, working with the individual is important to prepare that person for a satisfying sexual relationship.

It is not uncommon for some to conclude that there is one cause–such as a physical problem–for every issue. This is just plain wrong. Sexuality is complicated. This is why the team approach to solving sexual problems is the most effective. It is also too common for some to seek help, and to drop out of therapy when some progress is made, wrongly concluding that they can solve the rest themselves. It is a mistake to try to save money or time at the expense of a full solution to a problem. This is part of valuing a relationship enough to properly solve the problem(s)!

Dating Around or Dating One Person?

Starting in Junior High School, the dominant dating script is to limit dating to one person. Why? I see middle aged people who are newly divorced who feel pressure to date one person, and not to feel free to date others. This is an extension of the Junior High script. Again, why?

Dating is supposed to be a fun way to casually get to know others. If dating is always mate selection, there is little wonder why so many prematurely commit to one person, and then discover they were too hasty in their decision. The monogamous script says that we can only date one person, especially if it is sexual. Again, why?

There are different motives and meanings for sex. Dating need not be limited to the “one and only forever” script. Why are people so insecure and possessive? There is a tendency to view being serious as a normal and good thing, when in many cases it is far from good or normal.

I have had clients who worry that anyone they choose to date will think they are serious and want to be exclusive. They fret over wht they feel is pressure to commit to each person they date, when they are not emotionally available to be exclusive. They are thinking with all the “shoulds”–tht they “should” cave to another person’s desires to be exclusive, even if they have no desire to do so.

Sex does not always mean exclusivity or being in love. Sometimes it is fun, a friend with benefits, or hooking up. Why must sex alwys mean you are headed toward exclusivity? Why can’t sex be fun and enjoyable without a definite commitment to a future together?

When a high school graduate goes to college, she or he may still date a high school boyfriend or girlfriend. In most of these caes, the high school student expects their college lover to be exclusive even if they are not seeing them often. Most of these relationships end, in part because of the all or nothing expectation of exclusivity.

For those who conduct pre-sex discussions (see my blog on this) and are careful about STDs, the only safe sex is not monogamy. There is a moralistic veneer under these expectations, where STDs are a ruse for a person’s insecurity about sharing a lover with others.

We have competing sexual scripts. The conventional script says you must be exclusive if you dat and/or have sex. Other scripts say it is fine to date several, or to have sex with more than one. Each of these scripts should be discussed with potential and ongoing lovers.

Any date is potentially a sexual experience. Each person has to think through competing scripts to find one that best fits their needs at that point in their life. This is why pre-se and after-sex discussions are important. You want to be on the same page to avoid hurt feelings and other problems.

Our puritan culture dictates that we must all be alike to be normal and accepted by others. It is time to be critical thinkers rather than succumb to convention. We must question any advice that says we must all be one way. We are all unique and we should find our way through this morass of competing scripts.

Possessing another in the name of love is not love at all. It is a desperate need to control another in the name of love. If possession is the norm, does this make it normal? No! It is time to move beyond the shackles of traditions that never were much fun, or very functional, for many people. Why not view dating as a recreational activity that allows us to get to know and savor our dates without committing our entire lives to them?

A famous sociologist, Bernard Farber, argued in the 1960′s that we are all permanently available to each other. This is because of the power of attraction, sexual chemistry and the reality that we flirt, notice and engage many people throughout our lives. This is why we don’t truly live in a monogamous society. Some are happily monogamous, but this does not mean all people must make this choice to feel joyous and intimate.

Part Two: Who is a REAL Sex Therapist?

Over a year ago, my first blog explored board certifications and training to legitimately allow a therapist to call her or himself a sex therapist. Since then, an increasing number of counselors and therapists have claimed to be sex therapists on a variety of websites, with little to no basis in reality. This is highly questionable ethically. Unfortunately, the person with a problem has to spend time checking each therapist’s credentials to see if that therapist is in fact a sex therapist.

I recently discussed this problem in my keynote presentation at the Washington Mental Health Counselor annual meeting. Some counselors seemed unaware that a sex therapist needs a board certification to be a REAL sex therapist. Others affirmatively nodded to my point that no one should call themselves a sex  therapist unless they are certified by one or more national clinical sexology or sex therapy boards. Fortunately, most therapists are ethical and do not mislabel their training, certification and scope of practice. It is the remainder who need to be scrutinized and sanctioned, when appropriate.

The four national boards include The American Association of Sex Educators, Counselors and Therapists (AASECT), The American Board of Sexology, The American Academy of Clinical Sexologists, and The American College of Sexology. The gold standard for certification is AASECT–this association requires the most training and the highest standards to be a sex therapist. I am certified by all four boards. Beware of those who claim to be sex therapists or clinical sexologists, but fail to list where their certifications come from (the only four credentialing organizations are in this blog), and also beware of those who use membership in AASECT as a credential to be a sex therapist. Unless the therapist is board certified by AASECT, they cannot use AASECT to claim they are a sex therapist.

As I stated in Part One (my first blog, August, 2011), those seeking a sex therapist should not be fooled by listings on Psychology Today, Google, Google AdWords, Bing and other therapist websites. In the past year, I have noticed counselors who have a license who have absolutely no credentials as a sex therapist who falsely claim to be sex therapists, or to do sex therapy, or who imply they are sex experts because they offer real help for all sexual lissues. Other examples are counselors who say they specialize in sex therapy, or claim to be sex therapists because they deal with sexual abuse. Sexual abuse is one issue for a sex therapist, but a practice limited to abuse does not qualify the therapist as a sex therapist.

Sex coaches help fine-tune sex (with good to no real credentials), but they are not sex therapists. When you check some of their websites, some appear to be trained, but it is rather apparent that others are essentially doing sex therapy without a license or certification. Another misnomer is that those who claim to do “Christian Sex Therapy” are necessarily sex therapists at all. Again, unless they have a board certification, they are not leglitimate sex therapists.

Others are working on a license and/or a board certification as a sex therapist, and yet they claim to be sex therapists before they are fully licensed or board certified. All of these therapists have to list their current credentials in their disclosure statements, but their website home pages often make it appear they are already credentialed as sex therapists, when they are not. Some who are not yet board certified or fully licensed have attractive websites that make it appear they are more credentialed than they are. Some in the process of becoming board certified charge more than some who already have board certifications and full licenses! We all have to start somewhere, but there should be truth in advertising–not just in a disclosure statement.

I called Psychology Today to voice my displeasure with their policy to accept whatever a counselor says they are qualified to do, and they said they had no way to check out counselors. Really? But they are making more money listing more and more counselors and giving them their meaningless green arrows, implying they are certified by Psychology Today!

Similarly, those who state they are “sex addiction” counselors are not sex therapists unless they are board certified as sex therapists. (See my blogs on the semantically incorrect concept, “Sexual Addiction”). Lacking honesty, it is left to the consumer to do her or his research on each therapist’s credentials. If a therapist does not list their license and their board certifications, ask them to verify them.

Finally, Florida is currently the only state that legally requires that a sex therapist be properly trained and certified so they qualify for a license as a sex therapist. Sex therapists in Florida cannot practice without this license. I predict that more state legislatures will eventually follow suit, but this will take a long time. In the meantime, buyer beware!

Conducting a Pre-Sex Discussion: Are You on the Same Pleasure Team?

This blog is for singles and others who are free to pursue new lovers. You should never have sex (oral, intercourse, etc.) without a proper Pre-Sex Discussion (PSD). You should always interview each other to make sure you are on the same page as far as what any sex would mean, if you were to have sex (sounds like a meal–I hope gourmet!). What would be desired and expected?

Tearing each other’s clothes off and having sex without any discussion is a possible recipe for disaster. Unwanted pregnancy, sexually transmitted diseases (STDs) or emotional problems can stave off undesirable consequences of erotic pleasure.

You need to be certain that you are on the same Pleasure Team by conversing about what you are doing, or about to do, and why. This is far better than manipulating each other while running out of breath from escalating arousal without common goals and meanings.

Don’t decide whether to continue sex play while in the heat of lust. The agreement should be clear by the time you eargerly unsnap bras and unzip zippers! Why complicate your lives by not being clear about any agreement about what and why you would mutually choose to be sexual? You might decide NOT to be sexual, or to be sexual with some guidelines. When in doubt, don’t!

If one potential lover prefers a friend with benefits (FWB) or a casual hook up or a booty call, and the other wants an exclusive, serious relationship, a mutually satisfying experience is unlikely. A PSD is more than “do you have a condom?” A PSD minimizes dangers and maximizes pleasures. A PSD encourages mutual honesty.

When you are sexual, sometimes you share your hearts. Sex should not be expressed in a way that hurts yourself or other(s). A PSD lessens the chance you will be hurt or exploited, but it is not foolproof. Any sexual adventure entails some risk, but what is life without risk?

You can’t escape flirtation and sexual overtures. The only alternative to a PSD is to fumble your way through uncomfortable and often risky seduction games. An unhealthy emphasis on danger doesn’t usually stop you from indulging in sex, but it may make you anxious when you do.

A PSD should include questions, answers and conversation from both prospective lovers. Starting a PSD should be fun and enlightening–it makes you look sophisticated and full of common sense. Your rule should be no sex until we talk, and then we’ll see how we both feel, and we’ll make an intelligent decision together.

When there is powerful sexual chemistry, it’s not too early to suggest a PSD! This doesn’t mean you’ll necessarily agree to be sexual after your first discussion. A mutual agreement is consent to be sexual, or to choose not to be sexual at that time. Mutual consent without mutual candor is worthless. A PSD is the first step toward caring and responsible sex. I recommend that lovers continue their dialogue about their sexual experiences after having sex the first time.

How Important is your Intimate Relationship?

I am often confronted with potential and actual clients who find excuses not to start or complete couples or individual therapy. They may prioritize sports events, parties, work and children, and other supposedly pressing needs and events. In the process, they may neglect doing their homework from therapy, or terminate therapy after making partial progress.

To solve a sexual or relationship problem, clients must be committed to their healing, and they must do some work between sessions. When the going gets tough, couples either find strength from mutual healing, or they abandon therapy, and perhaps each other. Is a spontaneous invite to a social event or a trip to Idaho more pressing than fixing a serious problem? Somes it is. If a client decides to reschedule our sessions over and over because of other priorities, I am concerned that they are not fully committed to therapy.

Although I will never know how many couples and individuals who stop coming eventually solve their problems, I believe that many of them did not find a real solution, even if they made partial progress. There is a tendency for some to think they can solve their own problem after some progress, but some of these clients come back after a few months because their unsolved problem got worse.

Even though I always caution clients to complete their homework and home play, and to stay with therapy, this does not always happen. Sometimes they claim to be too busy, or they want to save money, which makes me question whether their relationship health and emotional wellness are really important.

Some problems do not require many sessions, while others are so complicated that more sessions are necessary. I work as quickly as I can. Sometimes one person wants to complete therapy, while the other does not–perhaps because change is uncomfortable and stressful. I know that some of these relationships eventually end in a divorce or similar break up.

If a couple is really committed to therapy, the results are typically good. But it takes two people who follow through with the work and sessions to achieve a positive result. I do not just do therapy to make a living. I do it to help people.

Sometimes one person wants to see an individual therapist. I encourage this and refer out when appropriate. However, it is a myth to think that people must seek individual work prior to doing couples work. The relationship may go by the way in the meantime. If individual work is needed, my recommendation is to do individual and couples work simultaneously. No amount of individual therapy solves a relationship problem. It takes couples work to resolve a relationship concern. Some clients attempt to craft their own treatment plan by failing to see this.

If I am doing couples therapy and one or both people are also seeing an individual therapist, I prefer to coordinate my work with the individual counselor(s). Otherwise, the head does not know what the tail is doing, and progress is slower. Clients need to go to therapists they trust and feel comfortable with. I am direct and I use humor to provide a balanced perspective. I believe this helps clients feel assured that they can improve their thoughts, emotions, behavior and communication with clarity and compassion.

Who is Too Young or Too Old to Make Love?

It is not unexpected that delicious desire, undulating arousal and stupendous orgasms are not reserved for a specific age group, gender, marital status, sexual orientation or another social category or group. Or are they? If we take a brief look at the politics of sex and sexual behavior, a variety of social and religious groups are hell-bent on limiting erotic pleasure and fantasies for someone.

In my book for teenagers, The Naked Truth About Sex (2006), I observe that some parents contend that teenagers are too young to have sex (usually they include intercourse, oral sex and more). Although most teenagers would be smart to learn about sex before they have intercourse, most of them aren’t waiting very long.

Perhaps in retaliation, some teenagers say their parents and other adults are too old to have sex. These teenagers believe that sex is just for the young, and that anyone older than age thirty is beyond their sexual prime.

To make matters worse, the same parents who disapprove of teenagers being sexual often think their parents are too old to enjoy sex. I call this the tyranny of middle-age. Middle-aged people often think they are the only group who should be having sex. The irony of the middle age group is that many of them are too stressed from work and children to have much sex, or at least much quality sex.

So who is too young, and who is too old for sex? Infants have been observed having orgasm. Some in their 80′s and 90′s still have some sex, including oral sex and intercourse. Still others masturbate whehter they have a lover or not.

Age discrepancy between lovers is another common turn-on or complaint, depending on the values of those making observations. Age differences matter more for the very young when emotional maturity is an issue, than for those who are not teenagers. If sex is consensual, what is the problem? Our society likes to make sex a problem one way or another. Sex doesn’t have to be a problem!

With the graying of America, older people are active socially and sexually. With proper health habits, sex, like wine, can improve with age. And yet our society negatively labels the aged as nonsexual or inappropriately sexual. There are no commercials for Viagra for those in their eighties and nineties. This is because the medical profession and nursing homes often treat the aged as sexless while failing to offer older people credit and compassion for their sexual capabilities and concerns.

Older people often rightly do not buy the age bias when it comes to reveling in sexual pleasure. It is not surprising that the natural, concentrated health capsule Reservatrol intended to extend life coexists with a variety of medications and herbal formulats with horny goat weed, damiana, Tongkat ali and other herbs designed to enhance sexual desire, arousal and orgasm.

All people–whether heterosexual or not, married or not, and young or old–have a sexual right to healthy erotic pleasure. No one has the right to censor or restrict consensual, responsible, non-exploitive sexual expression (which includes masturbation) for any age group. Despite rigid religious edits (Wilhelm Reich, a famous twentieth century Austrian American sexologist observed that rigid religion and sex are arch enemies), human beings will prevail in their normal and natural quest for intimate pleasures.