The first time I ever witnessed a good impression of a fake orgasm was a movie called, “When Harry met Sally.” Most of us saw it, and most of us remember our reaction. We may have blushed especially if we were a woman, because most women watching it have faked an orgasm. The interesting part to me was men didn’t seem alarmed. They really were convinced it was the real deal, didn’t really react to the exaggerated “YES” in the movie, and no doubt had been or were currently being faked by a lover of their own. I talk to men and women about their intimacy and sex every day. I have yet to hear a man ever say he faked an orgasm. Why? There are many reasons. For one thing, most women don’t care if he has an orgasm or not. It doesn’t say anything about his technique if he does or doesn’t. However, if his woman doesn’t orgasm, the man tells himself that he is doing something incorrectly.

If a woman doesn’t orgasm, it is a reflection on her lover (sometimes). I don’t think women necessarily blame their partner, but their partners often blame themselves. Women fake orgasms because they want their partner to stop, or they may be frustrated with their partner’s skill, or they may not be in the mood to orgasm, or they may need a different type of stimulation, or they may not be able to create the right fantasy in their head (due to something their partner is doing or saying that distracts them).  Or it’s thinking of your to do list sex.  They may feel fat that day, they may not like how their partner smells, or they may be angry at their partner and hurt.  It may be pity sex, they may be with a talker of nonsense which totally turns them off, they may be bored with the way their partner mounts them, or they may be bored with the music to which their partner insists on listening, or they may be tired. The list goes on and on why women feel the need to fake an orgasm. It isn’t honest, and it prevents a couple from improving their sex life when one of the partners fakes anything, so in my line of work I discourage faking.

When a couple who has had many fake orgasms begin not having them at all, it is like an alcoholic not relying on vino anymore…it can be scary. It means you have to be willing to talk about how you feel. Talking about how you feel about the kids or the in-laws is one thing, but talking about what you like in bed, where you like to be touched, and what sort of friction feels best is awkward. It doesn’t matter if you’ve been together five or thirty years.  You may be able to write each other’s obituary, but talking about what you like sexually can make you feel like a clumsy fifteen year old.

Men are so connected with their sexuality that when they find out their partner has been faking orgasms, even if it was done to protect his feelings, he feels a sense of betrayal. He will even say, “You’ve been faking all these years?” “What else have you faked or lied about?” Who can blame him? Sex is his main way of connecting, emotionally and physically. It would be the same if a man told a woman that, “He loved only her,” but yet had a girlfriend on the side. She would no doubt feel betrayed if she found out, but is that any worse than betraying your lover by acting as if he is pleasing you when he is not? If women say, “I want my relationship to be transparent and real,” then women’s sex lives should demonstrate that as well.

When women claim their sexuality, and become an equal partner with love making, sex becomes a more intimate relationship. Women who know what they like can help set up that atmosphere. They can teach their husbands or boyfriends what feels good for them so the sexual pleasure is experienced by both. Women who have sex are healthier and more emotionally balanced than women who don’t. Women want men to engage with them emotionally, but they forget intimacy is perhaps the best way to enhance connectedness and a sense of well-being.  If you have been faking way too long, and you want a richer, deeper intimacy with your partner, these tips will help. The first step is the toughest, because there is no such thing as a little faking. You either fake….or you don’t.

1. Tell your partner you want to become a more engaged partner in your love making. You needn’t tell them you have been faking orgasms, although it may help to tell them you aren’t sure what pleases you.
2. Try new things. Couples who are open to trying new places, music, smells, and/or positions seem to anticipate their time alone much more.
3. Make time. If you get careless and don’t make love making a priority, it will become quickies every day. Quickies are highly correlated with fakers. This is mostly a time problem. Women take longer.  If you block out two hours (reserve an hour and a half for a bath, dancing, and/or being close with soft talking), you will have more success at achieving a real orgasm.
4. The body has an incredible ability to learn. Once you have a real orgasm, the likelihood of you having another one is high.
5. When your partner does something RIGHT…always let them know you are delighted. 

So many women in their thirties and forties tell me they have never had an orgasm. Their partners, on the other hand, are telling me how much sex they have and how much their partner enjoys their orgasms. Faking an orgasm is, not only a type of deceit to your partner, it is a disrespect of your own sexual needs. Your body has an incredible ability to help you release stress, minimize moodiness, and attain a physical/emotional connection to another. Why would anyone want to fake something so beneficial to their health? –Mary Jo Rapini

In an interesting interview with Meg Ryan, who faked the famous orgasm in “When Harry met Sally,” she said she did it by pretending she was on a roller coaster in the dropping phase. No woman hearing that interview was surprised that the fake orgasm had nothing to do with sex…..every man was surprised because as they watched it, they “knew” that’s how they made their wife feel with her orgasms. The brain, not the genitals, is the biggest sex organ.

Last week I went to a healthy happy hour with a couple of my closest friends. We began visiting about life, relationships and our work. One of the women was talking about her elderly mom who lives on the east coast. This dilemma of having an elderly parent far away and worrying about them is a common issue right now amongst many. My friend’s mom is there all alone, and my friend and her family and support people are here. Of course mom doesn’t want to move, but is too elderly to live alone. My friend offered several options for her mom. She could find an elderly gated community that offered medical necessity care and social activities, move to an assisted living home, have someone come into her home to help with caring for her, or move in with her daughter down here.

I have never met my friend’s mom, but I believe I would like her. For an eighty-eight year old woman she is sharp as a tack. She very rationally told my friend why she did not want any of the options offered. They were well thought out answers and made a lot of sense. When I am eighty-eight, I hope I can reason as well. Her reason for not wanting to come and live with her daughter was my personal favorite. She told my friend, “I love your husband too much, and if I move in, you will never have sex with him again.” My friend turned red; the thought of her eighty eight year old mother saying such a thing embarrassed her. My friend also admitted that part of the embarrassment had been that her mother is able to look through her, and knew the truth about her. My friend would not have sex again if mom moved in. In fact, my friend isn’t alone. Most women cannot have sex if parents are in the vicinity. This goes back to the fact that women don’t have sex when they are stressed. By contrast, men need sex when they are stressed, because sex helps relieve their stress.

When parents move back in with their kids as they become older, it places stress on the child and spouse. This happens even if the child wants to care for mom and/or dad. There are all kinds of reasons why this happens. Mom and dad are more fragile in old age, and the child is forced to worry about them, but there is still the conflict that mom and dad are still the authority. It’s difficult to take that away, to take over managing their life. Many of my baby boomer couples haven’t had sex in months due to the stress of having to take away a parent’s car keys due to their limited eyesight and immobility. When a daughter’s elderly parents are underfoot in their home, they no longer are their husband’s lover, they are a care taker. The thought of making noise while having an orgasm where mom or dad may hear is something most female boomers will blush about, even if the TV is so loud your neighbors can hear it. Women need an atmosphere conducive for enjoying sex, and home isn’t it anymore once the parents move in.

My upbringing taught me it is an honor to have one’s parents live with you when they grow older and feebler. I am a relationship therapist and an advocate for marriage, so I also believe the couple’s marriage must take priority. If you have the privilege to care for your older parents and you don’t want to harm your marriage (sex is the glue of a healthy marriage), there are things you can do that will help. Here are a few that I advise, but your parent’s health care facility social worker may be able to offer many more.

1. If at all possible, give mom and dad as much independence as possible. An apartment in the backyard or a small room away from the rest of the family will help maintain your privacy as well as theirs.
2. Scheduling sex means sex will happen, and so schedule it during your parent’s favorite program, radio show, or nap.
3. Contact senior services in your area. Many times they will have a shuttle bus that comes around and picks up seniors and takes them to activities especially relevant to their social needs.
4. Talk to your spouse about getting away more often. There are many people who sit with elderly clients so caretakers can get out of the house. There has never been a more necessary time to get away with your spouse. Caring for elderly parents can be exhausting and emotionally painful.
5. Keep it simple. As people grow older, their world becomes narrower. This is not a bad thing. The older we get, the more we pay attention to the birds, squirrels, and nature. Telling mom and dad that you and your spouse are going to spend the evening alone in the bedroom is wise. They will get the hint, and you have communicated like the adult they always hoped you’d grow up to become.

I frequently get requests for marital therapy where the woman will say, “My husband has become an animal.” I inquire asking her, “Has anything changed in the marriage?” Frequently she will say, “Not really, my parents moved in, but they are in an apartment in the back of the house, so it really doesn’t affect us.” I will then ask, “Are you as active sexually as you use to be?” Her response may bring a faint smile to your face, she says, “No, I’m stressed out, my mom is here all the time.” Take care of your marriage, and prioritize your time together. Part of your mom and dad’s happiness stems from them knowing they raised a child who is happily married.

*Single people caring for a parent may find the load of caring for their elderly parent overwhelming. Remember, you need to take time for yourself more frequently than if you were married, because there is no one to share the load.

I am working toward a national TV show that teaches people what healthy marriages look like. My goal is to teach or have the show mentor how to build a strong marriage, the sorts of issues that arise and the healthiest way to resolve conflicts. Current television programs as well as magazine articles, movies and music don’t represent marriage very well. The area they do the worst job covering is married sex.  In many ways, even though most of the single people I know want to get married, the marriage rate has gone down (especially among the uneducated). Couples who believed that cohabitating would keep their sex hot have been disillusioned and disappointed when they found that what keeps sex hot is the security and commitment to one another. Moving in together without a commitment to one another may have made the sex better at first, but once the couple began leaning more on one another and having expectations of one another, the sex dwindled just as it does in a marriage that isn’t working.

No matter how perfect you are for one another or how great your marriage is, you will get bored with one another from time to time. It is fascinating to talk with a couple that has been married for twenty years and try to imagine what they still see in each other. How can anything be novel or exciting, and how do they beat the boredom? What you must remember is, no one is the same person each day, each month or each year. A healthy marriage helps each person grow and evolve. I think it’s fair to say that the healthier the marriage the more you can embrace and expect each person to grow and change. The way they communicate their love changes too. My husband says things and touches me now in a way that is much deeper than when we first married. When we call each other from another city, our way of communicating is different than it was when we first married. I get him, and he gets me. Couples who have been happily married for a long time understand the concept of feeling “freer” with marriage than they were being single. A healthy marriage supports both people’s ability to become the people they want to become. 

Great sex is highly correlated with understanding your partner. For women, the more secure and comfortable they are with their partner, the more unconventional and open to new things they will be. This affects their partner and is what makes their partner love sex with them. Men’s need for visual variety is much higher than women’s. Men may use this as an excuse for why they visit men’s clubs or invest in pornography, when in truth; this is a rote, “in the box thinking,” excuse. If couples talk about this need, they can both do things that will help provide variety and not lead to the potential problems that men’s clubs and watching pornography may cause. When a married couple is struggling with their sex life, the biggest obstacle is convincing the couple that they must keep talking about their sex life. One of the assignments I give each of my married couples who are unhappy with their marital sex life is to talk about their sex life for 10 minutes, four days a week. This proves excruciatingly painful for them, especially the women. Couples can go on “date night” and talk about their kids all night, but if one of them interjects, “Oh wait, we have to talk about our sex life now,” you would most likely hear silence at best, a groan at worst.

Some of women’s views about their sexuality are directly related to the way society affords more social accolades for being a good mom than they do for being a wonderful, intimate partner to their husbands (the media also projects husbands as being another child for the wife to look after). The fact that it is not valued by society contributes to women not valuing intimacy or sex as much as they do their children and their numerous other chores. Women don’t use sex as a stress reliever as men do, because it isn’t a stress reliever. It becomes a chore when a woman feels as if she has numerous jobs to do, and lists pleasing her husband as another one of those jobs. Many women don’t understand the importance of their sexual health and how important sex is to a healthy marriage. It isn’t uncommon for me to counsel a forty year old woman who has been married for years but has never had an orgasm and has no idea how to achieve one. For this woman sex is a stressor and a chore.   It takes understanding on both sides; the wife needs to understand that sex is a stress reliever for her husband, and her husband needs to understand that sex may be an additional stressor to his wife. If a husband can help alleviate some of her other tasks, and she can do little things such as touching and embracing him more, it may help alleviate some of his stress without adding to hers. Many women will tell me the reason they don’t hug or touch their husband more is because the husband’s mind goes directly to the goal of having sex, and she feels “too tired to get into all of that.”

If we are going to build healthier families, we must begin with building healthier marriages. If we are going to build healthier marriages, we must build healthier communication. If we are going to build healthier communication among married couples, we must be able to talk about our sexual feelings with our spouses. If you are going to talk about your feelings toward sex, you have to become aware of your sexual/sensual self as a person. Below are a few suggestions to help you get started.

1. The brain is the largest sex organ. You have to start here to feel good about sex. If you are angry or anxious about a partner, you have to deal with the brain first. Anger that is held in does not create good sex nor does it help you feel sexy.
2. Your attitude. Embrace yourself—you don’t need to be a perfect size. If you have curves and hips, embrace them. This is one of the most beautiful aspects of women. Most of us have flaws, cellulite, acne, wrinkles. These “flaws” will not distract from a beautiful smile or a warm embrace. Take a lesson from your man. Men are much better at embracing and not seeing their flaws than women are.
3. Fantasize. The more you think about sex, the more you will want it, so be sure to take time to think about it. Read romance novels, listen to music, and watch movies. I caution couples not to share their fantasies unless they involve one another.
4. Get to know your body. Touch yourself so you know the sensitive areas of your body. Where does it make you feel good to touch? Do you get goose bumps when you touch a place on your neck or tummy? This knowledge is very important and helpful to the person loving you. Your partner cannot read your mind so let them know what feels good.
5. Foreplay. The name tells you what it is for. Healthy marriage foreplay starts first thing in the morning and lasts all day. If sex relieves men’s stress, talking relieves women’s. Guys, make sure you call or text your lady during the day, as this will help alleviate her stress and she may be more receptive to helping you relieve yours at night. Note to remember: Women have less stress when they are emotionally connected. Guys have decreased stress when they are physically connected. (Guys, talking and listening to your lady decreases her stress. Sex happens when women are NOT stressed). These rules do not apply to dating, but usually someone isn’t being authentic.

It would be short sighted for couples to get married and talk about “till death do us part” if they didn’t consider what they were going to do to keep their sex life interesting. Yet, that is what happens to most couples who wed. Couples talk about their new place settings, TVs, and bedrooms sets, but are naïve about the issues that will have a huge impact on their ability to keep their marriage healthy. Married sex has the capacity to be the best sex, but only if the couple values its importance. In the end, it’s not the lifestyle of marriage that sets the snore factor. It’s the couple who sets it and snores.

My brand is empowering women and the men who love them, so I was naturally drawn to a study published in the Journal of Sex that suggested empowered women have less sex than women who are dominated by men. The study was done at Johns Hopkins University, which is a school that has an outstanding academic record for students and faculty alike. With all studies, it depends where they are done, and in this case the subjects were in Africa. Researchers surveyed women from six African countries and the results showed the more dominant the women (in Africa dominant means they can choose their own shampoo, toothpaste, and shoes), the less physical intimacy they shared with their partners. The study was really testing the decisions that a woman could make on her own instead of asking her husband. The findings showed that more dominant and assertive women had approximately 100 times less sex.

Some women may be discouraged with this news, but I am elated! Research has shown that the more empowered women become, the more cautious they are with engaging in sex.  Men, on the other hand, take more chances and engage in riskier sexual encounters when they feel better about themselves.  In Africa, for women to have sex frequently and submissively is a death sentence. It makes sense that if women feel good about themselves, they will be pickier and decide to use appropriate protection. The HIV prevalence rate in these countries is anywhere from 5% to 14%. In some African nations, it is more likely a woman will have an increased chance of getting HIV after marriage. This is not true in the United States.

Do empowered women have less sex with their husbands in the United States? Like all things, we have to define “empowered.” I describe empowered as being educated, aware, and knowledgeable about your body, emotions, and sexuality. I believe the more that girls/women focus on their interests instead of gaining the security of a boy/man, the more likely they will be able to be a loving, equal partner who can co-lead a family and offer stability within the marriage. Raising children and working at a healthy marriage takes two people. Women who are unsatisfied with their role make their partner’s life miserable. Blaming your partner because you aren’t knowledgeable about your body and what makes it feel good is unfair and irresponsible. Women who feel good about their bodies have better (frequency is not measure of better) sex in their marriage because they feel equal to their partner and understand the health benefits of sex.

Children who grow up with a strong mom who is gentle but also firm, knowledgeable about her body, open to teaching them about theirs, and direct with her expression of feeling (without being insensitive to theirs) grow up respecting women and understanding their value. Many families are lacking these empowered women mentors though, so  how do we teach girls/women to be assertive without being insensitive to others feelings? How do we teach them that they don’t need a boyfriend, but an interest to pursue in life? How do we teach them to understand and know their body so magazine ads and other media sources cannot turn them into women who hate their bodies and feel totally disconnected from them? It begins with teaching them to honor themselves enough and to explore their options. Here are a few other suggestions to help empower women so they can make wise choices with sexual partners.

1.     Quit focusing on abstinence and instead focus on helping girls decide what they want to do with their lives. Empowered girls who feel better about themselves make better choices with securing a partner.

2.     The focus should be on being your best self, not a magazine photo of an airbrushed beauty. I recently did a story on HLN that depicted moms of beauty pageant toddlers now giving their young toddlers “pixie sticks” to eat so they would behave perkier. This is not empowerment, no matter what the moms say.

3.     Focus on how you talk to your daughter’s other parent. Are you disrespectful of him? Moms teach daughters (and sons) how to talk to their dad (and future men). Respect your child’s other parent because empowered women respect men.

4.     Never tell your daughter that she shouldn’t feel the way she does. A feeling is never right or wrong; it just is. Validate her feelings even if you don’t agree…she has a right to how she feels.

Empowering women, daughters, or anyone doesn’t mean you become their best friend. No gender is more or less than the other, as we need both men and women. Empowering women doesn’t mean “de-powering” men.  When you are someone who empowers others, you believe in encouraging, educating, and being a mentor. Empowerment like most things begins at home.

The biggest discrepancy between men and women is the way they look at relationships. Women need a relationship to have sex. Guys need sex to have a relationship. That says everything. Guys could do without the relationship if they just had sex, most of the time. Women think they could do without the sex if they had a great relationship. But…they can’t, nor should they. Women’s ambiguous feelings toward sex and relationships tend to initiate most of the conflict within the relationship and marriage. It’s not that women don’t want sex; it’s simply that they want the relationship more. Guys cannot understand this, and they go to great lengths to try and “trick” the system, but the system is set in place, and the only one who gets tricked is the guy and whoever he is in a relationship with.

Typically, when men marry they feel a sense of accomplishment. They found someone to share their life with, help them face their battles and be their sexual companion. They may want kids, and trust this woman to help raise the children to grow up to be responsible adults. Women want all of this, and more. They want a relationship. They want to share their lives with their partner and feel connected. Women achieve this connection by talking in an intimate setting.

Men talk about this need to talk, and may joke about it, but they really don’t understand the importance of it until they are in their mid forties. Up until that time, it seems unnecessary to many men, and they draw no correlation between their ability to communicate with their wives and the frequency of sex they engage in. They should. Men are making a huge mistake if they tease or belittle this need for closeness that women have. Women cannot fight the need, and the majority of affairs women have are due to their finding another partner who addresses their need for verbal closeness. It’s not right, but it happens, and it happens much more frequently than the men to whom they are married could ever imagine. When men find out their spouse has cheated they are justifiably angry and tell her, “How could you do this to me?” “I gave you everything.” “Anything you wanted, I did for you.” “Why?”

He may have done a lot, given a lot, but he assumed his wife loved him the way he loved her. She didn’t. She wanted a relationship and that was the one thing he could not/did not give her.

Cheating is never an acceptable solution to any problem, but not understanding why cheating occurred makes you more vulnerable to it happening again. If you are a guy, don’t assume that once you marry your emotional work is done. If you are a woman, talk to your partner and tell them directly what you need. They cannot guess, nor should they. If you can’t admit to what you need to feel sexual with them, or connected with them, then seek counseling.  Marriages that express more anger are marriages where sex has been limited or used as a weapon. If you use sex as a way of getting back or hurting your partner, it will backfire on you when you least expect it. How do couples make sure they emotionally connect in a world where both people are working, traveling or have kids to take care of? It’s not that difficult, but the need for an emotional as well as a sexual connection has to be valued. These suggestions will help bring more intimacy into your new year:

1.     Couples who talk about their sex life have a more intimate closeness and engage in sex more frequently. Set aside ten minutes each day to be together, hold hands and talk. One of the biggest problems with sex is talking about it. Suffering in silence is not recommended, nor is blaming or shaming.

2.     If you feel “dead” or “numb” when you make love, that is a problem. Go to your physician and ask for a referral to an Urologist who specializes in sexual dysfunction. If the feelings are more due to conflict in your relationship, begin with a counselor.

3.     When you notice distance in your relationship, confront it directly. Passively waiting for it to “blow over” is being neglectful of the most important relationship in your life.

4.     No relationship or marriage just ends. There are warning signs. A fever means you are getting sick; withdrawal means someone is unhappy in the relationship.

5.     Frequency of intercourse is a matter of personal preference. As a general rule, once a week is a good place to begin. Many of my patients have gone for a year without sex; this is too long. It isn’t healthy physically or emotionally for either partner. Intercourse is only one type of intimacy; there are unlimited ways to show physical and emotional intimacy.

Many influences in our lives dictate our comfort with our sexuality. Talking about these influences and encouraging your partner to trust you with their feelings are integral parts of a healthy marriage. Feeling ashamed or embarrassed about your sexuality and blaming your partner because they enjoy their sexuality is self righteous and demeaning. When one partner is unhappy with the frequency of sex in their marriage, the worst thing you can say is, “I’m going to leave and find it elsewhere.” The best thing you can do as a couple is to address the issue together. Go to the physician and counselor together. Intimacy and sex is the glue that holds a healthy marriage together, but it must include a verbal/emotional connection to enhance the symbolism. After all, meaningless sex is everywhere, hence its name. 

“A good way to change someone’s attitude is to change your own, because the same sun that melts butter hardens clay.” – Unknown

The New Year is a time of transformation in your relationship. You know what didn’t work, and you know what sometimes worked, so it’s time to prepare to get your relationship back on track. We spend a lot of money and time buying our gym memberships and cookbooks to get our body in shape, but we forget our relationship needs a plan too. Your relationship can be neglected in all types of ways. Letting your body go, using food, cigarettes, alcohol or drugs to manage chronic stress all affect how we relate to ourselves as well as our partner. We get bombarded with losing weight ads, new healthy foods to try, as well as new exercise workouts. The best workout for your relationship and the quickest way to feel connected and encouraged in your relationship is to have sex with your partner. Not only that, every cell in your body responds in a positive way when you have sex in a committed, healthy relationship. Couples who have sex are healthier, more connected and less depressed. What drug could offer you all of that and more?

Many women are reluctant to engage in this new “workout” of adding frequent sex to their marriage. The kids, the chores, their busy schedule, as well as their partners has them feeling frazzled and beat down. They no longer feel sexual, or perhaps they feel it is too much work. Statistics support that up to 40% of women lose their libido or struggle with feeling sexual toward their partner. There may be medical as well as self esteem issues causing this problem, but research also suggests that engaging in the act of love making itself can begin to help women feel more sexual and alleviate depression and anxiety. A big part of this issue is marital discord.

 When women no longer feel close to their partner, it is difficult for them to want to have sex, and many times this loss of connection fuels the feelings of depression and anxiety that sex would help alleviate. A vicious cycle is difficult to break, unless women begin to understand they aren’t having sex for anyone but themselves and their health. When women can begin to see sex as a way of promoting their own health, they won’t use it as a form of punishment when they are not connected with their spouse. Sex should never be used as a bribe or a reward anymore than eating healthy or exercising should be. Sex is an expression of love, connection, and a form of taking care of yourself. One should eat healthy because your body needs good food to function well, and you should exercise to help alleviate stress and keep your body in good shape. Sex, eating well and exercise are all cheaper and healthier than a psychotherapist, physician, or medications.

The loss of connection is no little thing, and many times it underlies depression, which compromises ones’ ability to enjoy life. However, using this loss of connection as an excuse for not exercising, not eating healthy, or not engaging in sex is being irresponsible. This new year, step up to the plate. Confront the real issues, but keep them separate from taking care of yourself. If you have problems with low libido, there are many medical/emotional reasons that can cause you to feel dead inside. Below are suggestions of where you and your partner should begin.

1.     Make an appointment with your physician and tell them you would like to be referred to an urologist who specializes in sexual dysfunction. No matter if you are a man or a woman, this should be addressed for your health and the health of your marriage.

2.     There is a wonderful website for couples called www.middlesexmd.com. I am an expert for this group, as well as several other professionals. It is run by a physician who specializes in sexual issues. Go to the site as a couple, read the articles and talk about them as a couple.

3.     If you grew up thinking sex was dirty, you have to make “new tapes” in your head. Religion can be wonderful to inspire and encourage people, but it can also make people feel shamed or inhibited about their sexual health. You are an adult; it’s time to reassess what those old tapes are telling you.

4.     Couples deal with a sexual issue better than you can deal with it on your own. Talk to your partner about your feelings. Guys, you need to take time, and sit with your partner and LISTEN. Don’t tell her she’s crazy or you don’t understand. Tell her you love her and you are sure your love can see her through this. If guys have the low libido, ladies, be as loving and supportive as I have suggested (1/3 of all men deal with erectile dysfunction).

When I first began as a psychotherapist, I was trained to do marital therapy only. After two months I quickly realized I needed additional sexual training. Almost every marriage that is struggling has a sexual component. When sex stops, one person is feeling rejected, and most likely they use sex to project that feeling on to their partner. Let’s stop this cycle in the New Year. Ladies, become the initiator in love making for a healthier and happier 2012.

One of the main complaints that bring couples to sex counseling is the lack of sex. There are many reasons couples don’t enjoy sex anymore. Marital conflict, depression, and stress all affect libido. One of the reasons rarely talked about, but perhaps one of the main reasons is “painful sex.” When a woman talks about painful sex, the first thing a health care worker will think of is prescribing lubricants. This may alleviate the pain, and may cure the problem, but there are many things that cause painful sex besides dryness.  The main hurdle to overcome is encouraging the couple to address the issue and talk to their health care professional about the problem. So many times, women believe painful sex is part of sex, and they either avoid sex entirely or endure the pain. This is unfortunate as sex is so healthy for women and men’s immune systems as well as cardiovascular health, that to avoid it or endure it is not practicing a healthy lifestyle.

The medical name for painful sex is dyspareunia. It is experienced right before sex, during, or after intercourse. It can happen in both men and women, but we seem to hear more about it happening with women.  There a several common reasons which include: rapid intercourse, an inflamed bladder, dryness, scar tissue, positioning, nerve inflammation, STDs, and sometimes spermicides.

Men may specifically suffer more pain with conditions such as Peyronie’s disease (a curvature of the penis caused by scar tissue build up), and inflammation of the urethra or prostate. Women more specifically suffer when there is a lack of moisture in the vagina, fibroids, yeast infections, hormonal deficiencies, and genital fit with their partner’s penis.

What can be done depends on the cause. Research in this area has suggested that as many as 80% of people who suffer from painful sex learn to live with the symptoms. One in three endured painful sex weekly. Half of those surveyed never discussed the problem with their health care provider. If you suffer from painful sex, the suggestions I recommend below can help you get started in resolving them.

1.     Begin by talking to your partner and make an appointment together (if comfortable) to see your health care provider.

2.     Ask your health care provider for a referral to a counselor who works with couples’ sexual issues.

3.     Reassure one another by exploring other options of expressing intimacy. Couples become more frustrated if their options of sexual expression no longer work. Exploring what feels good, and what you are willing to try often solves the problem.

Sex is one aspect of a healthy relationship. It is powerful and when working well is only 5% to 10% of the relationship. When it is not working well it becomes 90% of the focus. A healthy lifestyle includes pain-free enjoyable sex.

“It takes a really big man to love a really big scar” –Carly Simon

I worked for nine years in Lubbock, Texas as an intimacy and sex counselor for cancer patients. They taught me more than any textbook or class. I celebrated their success with them, prayed for their healing with them, and sat by their bedside with their loved one when they took their last breaths. Many people would call that a depressing job, but I never lived as fully as when I worked with this population.

One of the many things I learned was that when you have a chronic illness such as cancer, MS or depression your relationships have to change. Intimacy and sex with your partner have to be discussed openly along with emotions such as fear, anger, guilt, and confusion. Sharing these feelings and concerns with your partner can actually make you closer to your partner than ever before. Infertility, impotence, a colostomy bag, the loss of a breast and not being able to feel or move your legs will contribute to feelings of being only half a person. The scars of the disease on the outside are many times minor compared to the scars left inside. It takes a loving partner to understand that illness is a temporary detour where adjustments need to be made in the way you express your love. Completely withdrawing love or affection can lead to depression or feelings of hopelessness.

Couples need to be more educated on how to express their intimacy and love when their partner becomes ill. Sex is never something that should be avoided among couples, healthy or not. All humans enjoy and need intimacy to feel healthy and loved. These feelings help overcome the obstacles that chronic illness often inflicts. Below are suggestions for couples who suffer from chronic illness in their relationship. My intention is to help you get started. As you become more confident in your ability to express your feelings of love to your partner, I encourage you to seek continued counseling with a therapist of your choice.

1.     Share the diagnosis.  This simply means that you talk to your spouse and tell them that you are a team. Anything that affects their wellbeing will affect yours. This makes the “patient” (your spouse) feel loved and more confident with being able to endure their illness. It also provides an opportunity for you to help with routine care that may be necessary during this time.  

2.     Intimacy takes only minutes. Rather than thinking about a vacation or getaway, take advantage of “mini vacations.” These are moments that you can be close by holding hands, watching a funny movie, cuddling on the sofa, listening to old songs together or talking to one another. Many times, these are “miracle moments” that life’s busy pace robbed from you prior to the illness.

3.     Rediscover the joys of “petting.” With chronic illness, skin sensations change. Chemotherapy, for example, can heighten sensitivity of the skin, whereas M.S. can deaden it. Learning to touch one another again without a goal and talking about how that feels can make you feel like a kid again. In a sense, chronic illness makes anyone who endures it an unfamiliar person. Take time to rediscover and allow your partner to set the pace.

4.     Start in the tub or shower. Most of us are comfortable in warm water as it relaxes us and takes some of our pain away. Sitting in the tub with the one you love is an opportunity to relax, look at each other’s face, and talk. Washing each other’s back or feet is also a wonderful way to express your love and intimacy to your partner. Many times, it is the intimate setting of a bath where partners are permitted to see and touch the scar. Your reaction will mean everything, and the best reaction is to thank your partner for showing you and reassure them that their scar makes you love them more.

5.     Medicate before having sex.  When couples want to share intimacy and sex, it is important that it is planned. This is necessary because pain is often part of a chronic illness. No one feels sexy when they are in pain so planning your medication at least one hour prior to engaging in sex, will help to insure your comfort and ability to enjoy the expression of intimacy.

The loss of a breast, body part, or one’s mobility is symbolic of a loss of their independence and sometimes their identity. The partner has so much influence at this time. In fact, the partner is often the one who is able to influence how their spouse handles their chronic illness the most. No one wants their partner to suffer from chronic illness, but if they do, remind yourself that you and you alone may provide the emotional healing your partner needs to reclaim their sexual and intimate self.   

There was a lot of talk several years ago that a single woman over 40 years of age had a better chance of being blown up in a terrorist attack than finding a healthy marriage partner. Times have changed, and 40 year-old women no longer look 40 and terrorist attacks are more frequent. The saying has lost its “punch” and you seldom hear this phrase anymore. I have gone to more weddings where the bride and groom are both over 40 years of age, and/or one of them is over 40 and the other is 39 and holding.

The new phrase is, “You get what you envision and believe.” People who are optimistic and see their partner as being the best and visualize their lives as being sexually active usually end up with great partners and sexually active lives. The practice of optimism has never been as correlated to positive outcomes as it is with sexuality. Joel Black, Ph.D. has written numerous articles about sex lives over 50 years of age. He reports that when couples engage in the habit of optimism they suffer fewer problems with age-related effects of aging on their sexuality, and when or if there are problems, their optimistic habits help them work around the issues in a healthy way. This makes so much sense in working with couples. By the time I see the couple, one or both of them are depleted of optimism. In fact, many times it is not the relationship that is the issue, but the couple’s viewpoint that it is terrible and there is no hope of fixing it. Couples come in ready to give up on having a healthy sex life because they haven’t been successful at having sex for months or years. When I ask them how they can give up such a vital area of their relationship, they will say often times with disdain, “It was never good anyway, and she/he doesn’t really care about sex.” Very rarely is this the case. The partner has given up, because the person stating this has become so negative that being involved with them sexually is more painful than becoming celibate in the marriage.

Pessimism towards one’s sex life doesn’t happen overnight; it is a pattern developed relatively early in the relationship/marriage and it continues to get worse as the years go on. Pessimism is a habit just as optimism is. When you date, you know right away if the person you are out with is a pessimist by trait or an optimist. Usually, pessimists attract optimists much like a magnet attracts metal, and if you are a full-blooded optimist it is highly likely the person sharing your pillow is a pessimist. When couples are newlywed, they may find this match humorous. However, when you grow as a couple and your pessimistic partner is getting older, complaining about the effects of aging, and the lack of vigor, the humor you may have enjoyed in your youth with this person becomes dulled. The optimistic partner becomes overwhelmed with trying to appease the pessimistic spouse, and this is where touching, talking, and enjoying intimacy hits the wall. Many times this is where they enter my office, both of them looking very pessimistic regarding their non-existent sex lives.

Learning how to become an optimist regarding your intimacy and sex life is not easy, but it is possible. Choosing to see things in a positive light is as easy as choosing to see it negatively, but like the development of any habit you have to practice. Choosing pessimism may be ingrained if you grew up with it in your own family of origin. In this case, what you grew up with has to be re-taped or taped over with positive thinking. Joel Black, Ph.D. has these suggestions for re-taping pessimistic tapes into optimistic sexually healthy tapes.

1.    Understand that temporary conditions aren’t permanent or indicative of what is to come.  A pessimist says, “I can’t get an erection; I must be impotent,” while an optimist says, “I can’t get an erection because I’m tired and ate and drank too much tonight; I’ll try in the morning.”

2.    Be specific.  A pessimist may say, “Sam didn’t call after our first date; I’m a loser,” while an optimist says, “Sam may not be interested in a relationship with me, but there are plenty of other men.”

3.    Don’t assume everything that happens is because of you. A pessimist says, “Jill didn’t like me,” while an optimist says, “Jill may not be ready for a relationship.”

Couples who have the healthiest relationships are those that embrace each other and what life offers. To think your sex life doesn’t require change and learning to get better with age is shortsighted. Optimists not only have better sex lives, but they are more successful in parenting, business, and being healthier. Anyone can become an optimist at any age or stage in life. If you find yourself looking pessimistically at your partner, “re-taping” some of those messages you are hearing and verbalizing may help to restore your sex life.

I work as an intimacy and relationship counselor with urologists and internists, who often see patients due to erectile dysfunction. Frequently, I see couples who worry about erectile dysfunction when the changes they are experiencing are completely normal. Aging, stress, and intimacy conflicts can all hinder achieving an erection. Erectile drugs, such as Viagra and Cialis, have made it easy to achieve an erection; however, medications may mask a problem that shouldn’t be ignored.

Many people medicate a symptom, such as an inability to achieve an erection, before understanding the underlying problem. Medical illnesses, such as diabetes, vascular disease, or urological and neurological conditions, can also cause erectile dysfunction. Heavy smokers and drinkers may suffer extensive damage to the small blood vessels, which include those in the penis. For many men, erectile dysfunction includes a combination of physical and psychological factors. If you address your diabetes, but don’t get help with the resentment you feel toward your partner, the penis is not going to perform to your satisfaction no matter what medication you use.  Men are dating later in life and, with dating, there is pressure on performance. Sometimes it is easy to become panicked or anxious when the penis doesn’t perform up to par. Below are common worries that men have, that may be signs of aging, anxiety, stress, and intimacy conflict rather than actual erectile dysfunction.

1. You no longer get an erection just from thinking about sex or seeing your partner in a seductive pose. For men over 40, this is quite common from time to time.
2. You need direct stimulation to get erect.
3. It takes longer for you to achieve an erection (this may be more pleasing to your partner).
4. Your erection is not as hard as it was when you were a teen or in your early twenties.
5. You need more recovery time after ejaculation (this changes with each passing year), and after ejaculation your erection subsides much quicker than it did when you were younger.

The partner plays a large role for the man who worries about erectile dysfunction. Reminding him that you love him and still enjoy intimacy together helps reassure him that he is still your lover and able to please you. Complaining that “all he thinks about is sex” is not only thoughtless, but sends him the direct message that he is being silly or superficial to be so concerned about his ability to feel like a man. If your man struggles with erectile dysfunction, these three tips may help improve the situation and reassure him of your love and desire for him:

1. Encourage him to make an appointment with an urologist and offer to go with him. Sometimes men want to do this on their own and, as their partner, you should honor that.
2. Make sure you save time each day to talk with him, and begin talking about exploring new options. The fact that most couples only know how to have sex one or two ways puts more pressure on the man. If he knows there are many ways to please you and if you remain open to new ideas, it will help both of you and your relationship.
3. Stress is highly correlated with erectile dysfunction, as is obesity. Movement every day can help alleviate both of these. Begin a walking program where you walk one to two miles each day. This is also a wonderful way to converse and enjoy each other’s company.

Erectile dysfunction is a real condition, but so are aging, stress, conflict, and anxiety. A medication may help relieve the symptoms of ED, but addressing the issues behind the condition may help cure it. Sex is important; it’s healthy and it is good for the marriage. Reassuring your partner that you are a team and will work with them is part of the cure.