Say Yes to Sex!

A couple of months ago I read an article reminding professionals to ask about sex during assessments for bipolar disorder, which I do routinely. In my book I shared a few quotes about sex and my experience of discussing it with clients. But in the big scheme of things, people have a hard time discussing it. So yes, I'm talking about sex today.

First of all, it's difficult for me to understand how sex became something dirty and a taboo topic in some cultures (I'm being facetious, but this blog would be too long if I went there LOL). The reality from a biological standpoint: our bodies were made to have sex, it's how we reproduce. Our "private" parts have extra nerve endings so we can experience intensely pleasurable sensations. ORGASMS ARE AMAZING! Yes, sex is supposed to be enjoyable. And everything ain't for everybody. There are different strokes for different folks. A variety of things turn people on: hair color, body type, hot wax, whips and chains, fetishes, different positions, and so on.  Too often people are called freaks, perverts, nasty, or sick(although in some cases they are) because others view the world rigidly using their moral compass. Now we have a culture where people don't talk about sex enough; even with media being saturated with sexual images and content. Sadly many people still think their belief that children shouldn't be having sex is justification for not talking to them about it. As if just saying no was ever an effective tactic (did red ribbon week stop the crack epidemic?). Not talking about it can result in unwanted pregnancies, sexually transmitted infections (including HIV), and risky behaviors (for example thinking that anal sex is better than vaginal sex because it maintains virginity and or prevents pregnancy). They're going to do it anyway, they may as well be informed; might have to inform yourself in the process. Young people need to feel comfortable and safe talking to trusted adults about sexual situations. And please give them unbiased and accurate information about birth control and options for terminating pregnancies. Having an abortion will not damage the uterus (I'm annoyed when I hear that). "My mama said....." is often part of the explanation I hear when someone explains why they made certain decisions about pregnancy.

Sex is part of intimate relationships. During a conversation with a friend, he shared that men sometimes feel uncomfortable talking to women about sex and think that there's no need to ask about what she likes; does she like what he's doing? He went on to explain that a common perception is that a woman's willingness to repeatedly have sex means that everything's cool.  Now let's look at the other side of the story. Women are made to believe that it's shameful for us to be comfortable with our sexuality. Some don't feel that they can say what they like without being judged. A patient once told me that she didn't feel like she could tell her boyfriend to use a condom because she thought it would upset him. Lack of satisfaction has ruined many partnerships, but simple conversations may have saved them. One never knows, trying something different may be fun. A conversation can take the anxiety out of a sexual encounter. If you know that your body works differently and talk to your partner ahead of time, it can prevent them from thinking that they're doing something wrong. Sadly, I've encountered sexually active women who have never experienced an orgasm. Beyond that, some don't even have a real understanding of how their reproductive system works. That being said, they don't know how to let someone know when things aren't right. Which leads me to sexual dysfunctions.

Ladies and gentlemen. If it doesn't work right please speak up. Talk to your partner and or a healthcare provider. There are soooo many different things that cause problems, but there are solutions for most of them: difficulty becoming aroused, difficulty staying aroused, aroused but can't have an orgasm,  performance anxiety, painful sex, and the list goes on... One of the most interesting diagnoses I've seen is Headache Associated with Sexual Activity. What's more embarrassing having equipment that doesn't work, or talking to someone and getting some help? All treatments are not medications. Sometimes we recommend different techniques, therapies, devices, lubricants, masturbation (does it work alone and just not with others?), condoms, and exercises. Sometimes issues are a side effect of medication or related to a physical health issue (diabetes, high blood pressure). So at the end of your visit when you're asked if there's anything else that you'd like to discuss say yes, and talk about sex.