Responding to ‘Playing Doctor’

Responding to ‘Playing Doctor’

playing doctor

It’s common for our children to surprise us with how fast they are growing. As a child I always looked forward to the packages that arrived seasonally from my year-older cousins, full of wonderful clothes just ready for me. My mother packed up similar boxes for my younger cousins, greeted with equal enthusiasm, I’m sure.

Our kids slip through sexual development stages, too, not so easily marked by tight shoes and tee shirts that no longer cover our tummies. We sometimes miss them, too, because we ignore them, embarrassed by the topic of sexuality in general and particularly by the subject of our children’s sexuality. Understandable enough, but this can leave us caught off guard and unprepared for the inevitable situations when we must respond to our kids growing up.

Just the other day I got a call from Jane, a young mother of two unsure of how to deal with something that had just happened.  A couple of neighbourhood children were over for a play date, and while the six-year-olds played in the rec room and the baby napped, she was preparing snacks.

When she heard the baby fussing, she went to attend to him and passed the rec room door. She thought she saw her six-year-old hopping off a table and rearranging her clothes, but she wasn’t sure. Jane was ripping down the hallway to a crying baby and hadn’t really been paying attention. What had she really seen?

When she had gotten the baby, she entered the rec room. The kids were playing house as usual and nothing seemed out of the ordinary. Still…

Jane called me immediately.

“They’re only six!,” she cried. “I didn’t punish them because I wasn’t sure, but surely I should do something. Should I forbid those children from coming over again? What should I say to my daughter?”

Jane’s reaction was typical. She was surprised to find her youngster expressing sexual curiosity and suspected that this exploration should be stifled.

I asked Jane what happened when she was caught playing doctor as a child. She asked how I knew that had happened and I chuckled, responding that almost everyone plays that game, and most are caught. I went on to explain that at around five or six, children reach a maturational age when they become intensely curious about all sorts of scientific things, their bodies included. They are at this stage aware of the differences between males and females, but are mightily confused about those differences. And they want to know!

If your children live in a home where nudity is not the norm, or where they lack the opportunity to interact with opposite gender siblings during bath time and dressing, they will find ways to satisfy their curiosity about how boys’ and girls’ bodies differ. “I’ll show you mine if you show me yours” is one effective method of getting an answer. Playing doctor is another.

These kids are not perverse—they’re curious. Their motivation in what we consider their sex play is not sexual in adult terms. They want to see and possibly touch, but their aim is to learn the similarities and differences in their anatomies. They may well have discovered the pleasure of masturbation—and wonder how good someone else’s body feels—but their behaviours are fueled by curiosity rather than the emotional crushes that blossom years later.

How should you handle the situation?

Not by punishing, not by isolating. If you happen into a room with a group of children playing doctor, be assured that the activity will stop immediately of its own accord. Be graceful. Apologize for interrupting and back out swiftly, as though you had seen nothing. Those kids will want to believe you missed it.

But that’s not all. Your job has just begun. This is your cue that your child (and the other children) has reached the maturational threshold to want and need accurate information about how their bodies are constructed and changing. Let the other parents know what happened in a positive, matter-of-fact way.

Inform yourself and then inform your child. Get books geared to their level and teach them respect and pride in their bodies. Yes, you may be a little embarrassed at first. It passes.

If for no other reason, do this to abuse-proof your kids. That’s right, children who know proper names for their body parts, and who feel pride and ownership over their bodies, are poor targets for predators. If your children know they can talk to you about sex from early on, they will.

“I’m glad I called,” sighed Jane. “This feels much better than how I might have handled this.”

“Don’t lose my number,” I laughed, “There are lots more stages ahead!”


Little Lust at the Lusty Lady

In an effort to stay current and informed, I attend a number of conferences each year, some better than others. I recently returned from one in Seattle that left me thinking long after the handouts and business cards had been filed. I’m speaking of FtM: 2006, A Gender Odyssey, three-days of information and thought-provoking workshops about gender and relationships punctuated by a bonus film festival.

This month’s Hot Topic is not about that valuable conference, but about a field trip I took during my weekend there. During my graduate studies in San Francisco, I learned that The Lusty Lady peep show there was the only union-run shop in the country (Seattle’s, sadly, is not). I had cheered Carol Queen’s sensitive and hilarious performance piece about working there. Still, I had never seen it for myself and here was my chance. After a testosterone soaked day at the FtM conference, I sought balance in an estrogen-dipped experience at The Lusty Lady, Seattle style.

I was excited. Dressed in a low-cut top and high-heeled shoes, my cleavage was padded with money to spend. I didn’t know what to expect, although I had previously enjoyed strip shows and exotic cabarets. I trotted in, trying to look comfortable and worldly.

The receptionist eyed me, sighed, and gently asked, “Want me to explain how it works here?” I had fooled nobody! I bought twenty dollars’ worth of ones (which quite impressed the fella behind me), listened to my options and headed inside, hopeful for an evening of entertainment.

Beyond the doors lay a different environment. No more eye contact, bright lighting, and quick smiles–here it was dark, hushed, and cold. One long corridor of doors led off another, and each door reached only to the knees, below which stood rumpled trousers above still shoes. Nothing moved. There was no floorshow. The entertainment here was clearly solitary.

For a moment I considered turning on my heel and retreating, pretending I’d simply walked into the wrong theatre. This was not at all what I was expecting. But my curiosity propelled me forward.

I found a legless door and slipped inside a dark claustrophobic cubicle with a little box for whisking in dollar bills. All right! I had a brafull of those. Immediately one wall of the booth snapped skyward to reveal a brilliantly lit, fluorescent pink Astroturf- and mirror-covered room occupied by three very young, very bored, very bare women in impossibly high heels touching themselves like the models on late night TV. I quickly realized they couldn’t see or hear me—I could not interact with them. The only role available to me was that of voyeur. The curtain snapped shut.

I fed in another dollar.

I tried to turn this scene into fantasy but was overwhelmed with what felt like loneliness. I moved closer to the window to feel less isolated only to hear one of the dancers squeal “We got a girl over here.” They could see me through the screen! How rare it must be for them to see another female face in those windows. I retreated into the darkness of the booth, unsure of my role. They quickly forgot me.

I learned a lot about sex that night at The Lusty Lady, especially about how men can access non-personal sex more easily than I as a woman could. I understand now how important it can be for a woman to wear sexy lingerie for a man, because that connection is powerful and immediate for him and by being part of the action, she gets to participate in it.

It seems men can translate a visual image to a mental erotic state, bypassing the emotional stations that women visit on the way to arousal. Women lament that men don’t indulge them in the romance they need to feel sexy. I see now that women don’t pander to men’s need for that direct link between their eyes and their cocks either. My visit to The Lusty Lady showed me how different our pathways can be. I see now that, with that understanding, we can make sure that each gender gives the other what they need so that the fires are kept mutually burning.

Yes, my weekend in Seattle taught me valuable sexological lessons. I hope that sharing my experiences with you enriches your understanding of how complex and magnificent our erotic lives can be. Gals, climb into something sexy. Guys, reward her with whispered sweet nuthins. We all win.

Talking to Youth About Sex: What’s Enough? What’s Too Much?

– Originally published on

North Americans embrace the ideal of providing children with carefree childhoods ripe with opportunities for growth and expression. Fortunate to hold much of the world’s wealth and natural resources, we are commonly able to meet this laudable goal. We promote education and enforce laws against child labour. We enrich our children’s lives with car pool service, birthday parties, and extracurricular activities. We encourage our leaders of tomorrow, supporting their growth into adulthood untarnished by the harsher realities of the world. Few would argue the wisdom of such a philosophy. We know that children raised in an environment of safety, security, and happiness grow into well-balanced, self-actualizing adults. We are richer personally and culturally for providing fertile earth in which to grow our children to adulthood.

We ensure this unworried childhood by shielding our young from the cares and responsibilities of the adult domain. David Steinberg, editor of The Erotic Impulse, uses the term “designated innocents” to refer to this protected class of junior citizens. The problem with remaining innocent, he argues, is that innocence can become confused with ignorance. Knowledge equates with power, so we must strike a balance between protection and education.

This dilemma is enacted in our approach to imparting sexual information. Hoping to spare our adolescent population the responsibilities of unintended parenting, we filter the knowledge afforded them. We warn them of the consequences of intercourse, and the admonitions usually broaden to include all sexual behaviour. Our protection is well intended, but poorly aimed. It is with comprehensive understanding that we are best prepared to make personally enriching decisions, not by remaining fearful and ignorant. Our alarming teen pregnancy rate is one indication that lack of information does not serve our common good, another is the epidemic of sexually transmitted diseases among our youth.

How can we balance the twin goals of innocence and enlightenment? We can begin by demystifying the subject of sexuality. If we encourage our toddlers to feel pride and delight in their bodies, they will be less likely to tolerate inappropriate touching. If we provide accurate, non-judgemental information to our preteens about their maturing bodies, they will better understand the confusing and overwhelming emotions that accompany the physical changes of adolescence. They will have learned that adults tell the truth and provide protection, and thus will turn to their elders for guidance through the turbulence of sexual awakening. Armed with knowledge about the workings of their bodies and faith in their parents’ good intentions, they are better able to weigh Nature’s urgent invitations against the potential consequences.

One of the problems with consequence-only information is that teens soon realize how good sex feels. If they have been warned about the “badness” of sex, they feel duped when they discover the delights of arousal,
inclusion, and intimacy. It is especially now that they need education about the rapturous and bonding emotional aspects of sexuality. Without this knowledge, they are left hormone-driven and bereft of social skills, believing that sex equals intercourse. By telling them “no” rather than “how”, we deny them the very information they need to explore their bodies and their awkward interpersonal relationships in a safer manner. They need to know about caressing and kissing and fondling. We owe them information about how to negotiate, how to judge the difference between what we want and what we need, how to establish and maintain respectful, enduring relationships. We need to be expansive in teaching our children about sex so that they are prepared to meet challenges and opportunities with a strong sense of self and respect for others.

This is, surely, a tall order. We must first address our own ignorance, bashfulness, and shame about sexuality. It would be helpful, too, if we were part of an enriched and enriching union (and society!) that supports respect, intimacy, and honest communication. And of course we must learn to establish the kind of truthful relationship with our children that fosters dialogue. Utopian? Not at all. Difficult? You bet. Worthwhile? Indeed.

Penis Size

Dear Subscribers,

The following letter came to me via my website. It reflects such a common issue that I’m sure it will resonate with many of you. Here’s your chance to ‘listen in’ and examine a sexual issue. Feel free to send me your own questions. Even if your letter doesn’t make the Hot Topics column, you will get a personal response.

Please Note: All identifying information in this, and all other, articles has been modified to preserve confidentiality. You can always count on this.


Dear Dr. Ren,

I am totally embarrassed by this question.

My wife and I have been married for 10 years. We are both relatively fit and able-bodied. The marriage is great and we have 2 wonderful children; it’s just that most of the time we only have time for quickies (dodging the kids) and I would rather use my penis. I can really only pleasure her orally or with different types of devices because my penis very small fully erect. The width of it, along with the length just isn’t enough, I guess, to me more personally than my wife. Although there is no problem with my erections, my wife gets no pleasure when I’m inserted. It would be great if I could finish the job with just my penis, so I got some electric penis pumps.

We have tried many different positions and have bought many books showing other sexual methods. I have never tried any product I see advertised. Is there really anything out there that enhances the penis?


Let me begin by assuring you that anything over about two inches in penis length is wasted as far as vaginas go, however, you first you can buy a penis pump from Spank The Monkey to make it bigger.

You see, women don’t have nerve endings except in the outer third of the vagina (it’s why we aren’t aware of tampons). The pleasurable sensations we experience from deep penetration are from pressure on the cervix, which can be accomplished quite well with fingers and dildos. I suspect your wife’s lack of pleasure is far more psychological than physical…we are sold such a bill of goods (women as well as men) regarding the ‘bigger is better’ myth, but you can also try checking the  Atlant Gel opiniones, it says it is great for penis enlargement and to increase the sex drive and sexual pleasure, this can also help you with your confidence, remember that the psychological part is really important to pay attention to it.

You are correct that girth is more important than length. And your comment “to me more personally than my wife” reveals much insight, too. If she is dissatisfied, experiment with positions, toys, vacuum penis pump, different touching techniques, etc, and above all, keep talking and listening. And try to believe her when she tells you she wouldn’t trade you in for anything in the world. As to wanting to “finish the job with just my penis”, you may be looking at an ego issue rather than a sexual issue…and that’s a good thing because you can control that. Please believe me when I tell you women are far more satisfied with a caring, attentive lover with a small dick than an insensitive lout with a big one.

I see from your letter that you are comfortable using toys (and, I presume, your hands), since there are many options that you can try, for example I went to this site online where I read a Fleshlight review and decide to give it a try. I suggest you continue to intersperse intercourse (which, again I’m presuming, YOU enjoy) with oral sex, penetration with dildos for that full feeling your wife likes, and digital manipulation.

As to your question about whether there is actually anything that will extend penis length, yes, there is, but they are imperfect. Check with your local sex store, or contact Good Vibrations. They carry a condom-like sheath that has an extension included, providing extra length. It might be just what you are looking for.

As for creams, lotions, etc…it’s all snake oil. There are penile extension surgeries, but they are very high risk and many men rue the day their egos convinced them to agree to them. There is also a technique (much less dangerous) in which the suspensory ligaments are severed so the penis hangs lower from the body, giving the effect of being longer. Problem? The suspensory ligaments anchor the organ…cut them, and you have no control of the penis, so you must hold it in place during sex or you keep missing your target while thrusting. What a bother.

The fact that you usually have time only for quickies is certainly as much of your problem as the size of your penis. My bet is that if you and your wife set aside time each week for nothing other than creating a safe and comfortable environment in which sex and intimacy can happen, you will both be far more satisfied. I do understand how ‘quickies’ become the norm in a busy household, but your letter cues me that this may well not be affording you what you are seeking. Have a look at my article ‘Mate Dates’, and call the babysitter.

I hope this helps. If you are enjoying a good marriage after ten years, you’re doing something right! Apparently, you and your wife are communicating and problem solving together. The enjoyment of sex is much more between our ears than between our legs. Still, I hear your anguish and hope that these suggestions will bring you some welcome relief from concern.

If you need more information, just ask.

Playing Doctor: Curiosity or Danger?

Remember the song we taught our toddlers in day care: “Head and shoulders, knees and toes, knees and toes….eyes and ears and mouth and nose….head and shoulders, knees and toes”? A generation ago we believed it important that our children know the names of their body parts. It was even politically correct to teach them ‘vagina’ and ‘penis’. We empowered kids with programs that taught them to “just say No”. We encouraged our children to distinguish between ‘bad touch’ and ‘good touch’. We got more realistic about abuse and response.

Fast forward to present. America’s accelerated antisexual fervor has changed our societal approach to sex and sex education. I recently watched a daytime talk show on which an actor related how proud she was of her bright young son’s curiosity. That is, until he asked her during a diaper change what “that” was. She panicked, summoned her husband, and fled while her mate handled this delicate question. She asked later what he’d told the lad. Her husband proudly announced, “I told him that was his pee-pee.” The actor and her interviewers laughed in accord with the seeming impossibility of grace with this topic. Dismayed at this role model’s discomfort about a child’s honest question about his body, I shook my head and switched off the program.

Among the important learning milestones of childhood is something called organ constancy, the feeling of ownership of our own body. The timing of this process begins at about six months and continues until the age of about four, and is heavily dependent upon gender. Boys, with their external genitals and frequent touching of their penises during urination, achieve organ constancy as much as three years before their sisters, who are unable to see and are discouraged from touching, their own genitalia. When the girls catch up, they become curious about this newly-perceived distinction and the stage is set for play that informs the toddlers about the differences in their bodies.

Until or unless we are caught at it, we retain little memory of these pleasant experiences. Depending on the adults’ response to their discovery of our innocent behaviour, this milestone either passes unnoticed or becomes our first experience of sexual shame. Today’s parents fret about what we used to call playing doctor. They now label it as sexually inappropriate and/or abusive behaviour. Troubled mothers worry that their sons will become perverts or their daughters victims. Sex is now so villainized that we have forgotten how benign and important our early sex play was. We are now vigilant about protecting our children from the dangers of sex, and danger seems to be everywhere.

However, there is no danger in peer-aged children exploring their own and each other’s bodies. Indeed, such play defines differences between male and female and helps children form strong organ constancy.

This in turn protects children from abuse, for when they feel entitled to their own bodies, they can better differentiate between good and bad touching. If they know the names of their body parts and feel comfortable speaking about them, they are more likely to report unpleasant situations. They will be their own first line of defense against abuse.

On a deeper level, early introductions to organ constancy carry pleasurable physical responses. If shame is not layered on those early memories, we grow up comfortable with our bodies and with our bodies’ responses to arousal. We have a better chance of developing a positive body image, despite the constant media blitz of unattainable perfection. We will enjoy our own bodies and those of others. Early curiosity becomes fused with adult desire resulting in fearless intimacy and sexual abandon. Isn’t that what we all want?

So, parents, please be gentle with your young sons and daughters. Help them to accept and honour their bodies and to welcome pleasure. Without the hormones of puberty, they lack the capacity for lust. Their curiosity is innocent and important. It is also easily addressed. The playing doctor stage is brief if left alone. Take this opportunity to share some introductory sex education books with your tots. They’ll learn what they need to know and move on to their next developmental stage.

Sometimes we make things far more complicated than they need to be. Until we teach them differently, kids are neutral about their body parts. Our job is to foster their healthy acceptance of their bodies. We’d all do well to relax and enjoy.

Women’s Unpredictable Orgasms

I find myself explaining to clients the difference in men’s and women’s orgasmic patterns so often that it seems right to devote a Hot Topic to this essential information. It is true that all human bodies respond physiologically almost identically, but the stimulation we require to achieve orgasm varies considerably. The more we know about our own pleasure paths and those of our partners, the more fun we can have sexually.

The difference revolves around the point of inevitability of orgasm. That is the moment when you know—really know—that you are about to come. What happens for men at this moment is invariable – they come. It doesn’t matter if their mother-in-law walks in the room (or the kids, or the cops, for that matter), they’re gonna come. It doesn’t matter if stimulation continues, stops, or changes. Once a male reaches the point of inevitability, orgasm follows.

Not so for women. During the arousal phases, the physiological signs (muscle tightening, skin flushing, breathing changes) are identical to men’s, but when your girlfriend is shouting “yes, yes, yes” while you are circling her clit with your thumb in rotations of one per second and you figure that if she loves this pace then two per second will be twice as good….well, trust me, you’d be wrong. Any change in stimulation at the point of inevitability and the moment will be lost. The connection is far more fragile for women than it is for men. It is one of the few sexual differences between men and women.

It is not only during partnered sex that women experience this tenuous connection. Sometimes women report that even while masturbating in their usual manner they will sometimes experience an orgasm that ‘gets away.’ Almost at orgasm, the most subtle of shifts will prevent the explosion and they are left to start again. It can be a very frustrating experience.

Women who do not understand the intricacies of the orgasmic pattern can believe themselves unable to achieve regular orgasm. If those same women have been taught to feel shame about self-pleasuring, these fruitless attempts may well confirm their guilt. Without understanding the natural rhythm of their bodies, they believe there is something wrong with them, and that they are not entitled to sexual pleasure.

Add to this our culture’s fairy tale that it is a man’s job to give a woman her orgasm. Now if it is difficult for a woman, who owns a woman’s body, to figure out this complicated stuff, how do we expect a man to know how to do it better than she can?!

What can men do with this situation, then? Spend some long, luxurious time exploring your lover’s vulva in minute detail, requesting feedback. What sorts of touch does she like on her inner labia, her outer lips, her clitoris, her urethral opening, her perineum, around her anus, on her mons? Do those preferences change depending on her state of arousal? Ask her to let you watch her bring herself to orgasm and watch closely how the action stills just before the orgasmic explosion. Let her teach you, and remember to tell her how hot it is to watch—we appreciate that reassurance.

Women do not have orgasms as reliably as men do. When we understand that there is nothing wrong with us and that our next romp will probably reap an orgasmic reward we do not fret about it. When men understand our orgasmic uncertainty, too, we can stop faking orgasms, and we would like to do that. Everyone benefits from this knowledge, and of course, when we relax into open and honest sexual communication with our lovers, sex just gets better and better.

New Birth Control Methods

I want to dedicate this month’s column to the abundance of new and improved contraceptive choices now available to women. Such was not always the case. Reliable contraception (the Pill) did not arrive until 1960. Before then, women relied on nothing more than bulky and fragile condoms, the unreliable rhythm method, and good luck to avoid unwanted pregnancies. Hasty and unhappy marriages resulted when those methods failed and many young women’s dreams of education and career terminated because their pregnancies could not—Roe v Wade did not grant women sovereignty over their bodies until 1973!

How different is our personal landscape today. The new millennium rang in scientifically sound methods of birth control our mothers could not even imagine. We have pharmaceutical choices as well as barrier methods, and better understanding of our bodies’ subtleties resulted in even more reliable natural methods of conception control. Though this column outlines the newest and brightest stars on the pharmaceutical scene, I encourage you to explore all your options and make your decision in concert with your partner(s) and your health care provider(s).

So what’s new? There’s a lot of buzz about the new low-dose pill named Seasonale that allows us freedom not only from worry about unintended pregnancy but also from more than four periods a year. Another option is Lybrel, a low-dose estrogen and progesterone pill taken every single day, eliminating periods altogether and therefore the attendant fluctuations of our hormonal cycles, a boon to those who suffer PMS, migraines, acne, etc. It will be available to us here in Canada next year.

Don’t want to bother with taking pills at all? Or worried that you may forget to take them every single day? A smoker over thirty-five? Not to fret. Perhaps you’d be interested in trying the NuvaRing , a slim, flexible circle you insert into your vagina once a month. It releases a low dose hormone that mimics the effect of the oral contraceptive. What could be easier?

Actually, I have an answer to that. If you have already given birth to a child, you may want to consider an IUD. I can hear you now, complaining of the cramping and the long bloody periods. But, wait. IUDs aren’t what they used to be. The Mirena is an easy-to-insert model that releases just enough progesterone to keep you from becoming pregnant while keeping your periods cramp-free and light in volume. Gone are the days of the Dalkon Shield, recalled like a bad Buick. Women now have real choices about how to regulate their fertility and their menstrual cycles, and they can do so with a high degree of confidence about their physical safety. Hallelujah!

But, you say, you’re not in a steady relationship and you require birth control protection only irregularly? Yes, we have answers for you, too. You might want to investigate the spermicidal sponge. Wasn’t that around years ago, you ask? Yes, it was. Seems water at the plant that manufactured the Today Sponge was contaminated and, rather than invest in the necessary cleanup, the company closed the plant. Consumer demand being what it is, the competition began marketing their own brands and now even the original Today brand sponges are available, but only in Canada. Note well: the effectiveness of the sponge is severely compromised in the presence of yeast-fighting medications, and it works far better in women who have not borne a child.

Add to these recent additions the pharmaceutical storeroom of condoms, diaphragms, cervical caps, contraceptive jellies and foams, natural family planning methods, ‘traditional’ birth control pills (makes me smile), IUDs, and sterilization methods for men and women (some reversible), and we can appreciate how vast are our options for choosing conception. If given proper information, each of us can be responsible for our body and treat parenting as the privilege it should be. Could it be that those who carried placards in the ‘60s bearing the Utopian ideal “Every child a wanted child” might see their dream realized? Science and education could make it so.*

*Below you will find an email communication from Dr Linda Hendrixson (Assistant Professor, Health Education Department, East Stroudsburg University) regarding statistics on the efficacy of various birth control techniques. It’s fairly dry reading, but offers current and accurate data that can help us determine our best choices.


I have the 17th edition of Contraceptive Technology-1998. It lists the failure rate for typical use of “periodic abstinence” (just avoiding intercourse during ovulation) as 25% (% of women experiencing unintended pregnancies in the first year of use). So, typically, it’s 75% effective, so to speak.

CT lists the failure rate for perfect use of “periodic abstinence” as between 1% and 9% (91%-99% effective) depending on which fertility awareness-based method is used:
Calendar method: Typical use=13% failure rate. Perfect use=9% failure rate.

Ovulation method-assessing cervical mucus: Typical use=20% failure rate. Perfect use=3% failure rate.

Sympto-thermal (measuring basal (resting) body temperature + assessing cervical mucus): Typical use=20% failure rate. Perfect use=3% failure rate.

Post-Ovulation ( I presume this means restricting intercourse only to the days after ovulation has occurred): Typical use=no failure rate noted. Perfect use=1% failure rate.
It must be noted, however, that CT takes its typical use failure rates from national surveys done in 1976, 1982, and 1988. Perfect use failure rates are the best “guesstimates” of the authors. Obviously, more up-to-date data are needed for typical use failure rates for this and other methods discussed in CT. Perhaps the 18th edition, recently published, sheds more light on the subject.

Regarding continuous abstinence, the goal of abstinence-only programs: Advocates for Youth carries a report dated 9/27/2004 called “Five Years of Abstinence-Only-Until Marriage Education: Assessing the Impact,” which is a good analysis of short-term and long-term effects of a number of these programs in thirteen states. From the conclusion of the study: “. . .none of these programs demonstrates evidence of long-term success in delaying sexual initiation among youth exposed to the programs or any evidence of success in reducing other sexual risk-taking behaviors among participants.” It is a worthwhile report to read.

So far, then, continuous abstinence, at least among youth in many abstinence-only education programs around the country, is showing a high typical use failure rate.

Premature Ejaculation (PE) for Women

Some time ago a client came to me for treatment of premature ejaculation. Like most men, he had suffered with this condition his whole life. Married many years, he reported with great sadness that his sexual difficulties had so eroded his relationship that his marriage was on the brink of collapse. His wife had given him a final ultimatum: get fixed or get out.

I explained the course of treatment and we began. Starting with a hefty dose of magnesium, but not any old type. Don’t bother taking the cheap stuff like magnesium oxide. The body doesn’t really absorb it well. Go with a high-absorption magnesium if you want to get real benefits. All went well until it was time for his wife to join us. Despite his initial success and my encouragement, she steadfastly refused to attend sessions. She would not even speak with me on the phone. Since this was not her problem, she would not be involved in its resolution. She simply wanted him “fixed.”

Months passed. My client called again, reporting some progress. His wife had agreed to read literature about PE aimed specifically at wives. What did I have? I went to the Internet. Nothing. I appealed to a sexologists’ list serve. They suggested couple’s therapy. Hmm.

Therefore, I designed this month’s Hot Topic for the wives of men who suffer with timing their ejaculation. My hope is that when you finish reading this, you will be inclined to join your mate in counselling, for they need you there with them. In the meantime, I hope this column will address your needs.

Many of you have lived for years hoping that perhaps this time sex will be fulfilling, that he will last long enough for both of you to enjoy the connection and intimacy that intercourse can bring. You may also have invlived sex toys like Fleshlight that would have give you some benefits. Then he comes fast again. He mumbles he is sorry. You look away, tell him it’s all right, and soothe him. You both turn away from each other, silent and disappointed.

Eventually you avoid his touch. You do not let yourself give in to the expectation of arousal and release. What’s the point? You accommodate his advances so you don’t have to have a discussion or, worse yet, a scene. You feel like a receptacle. You resent him. This is not what you signed on for. Why doesn’t he do something to fix this!? God knows, you’ve been patient, forgiving and loving. Inside you start turning to ice.

As time progresses, your frustration leaks into other areas of your relationship. You no longer view him as someone you can count on. The respect and admiration that once made you breathless is long gone. He becomes just another child to be tended. You can’t even rage at him about this given men’s fragile egos. You consider an affair but reject the idea, for you know the only way you can maintain your family and your sanity is to deny your body any touch. The first whisper of sensual pleasure and you know your defenses would collapse. You are a prisoner in your frozen world. You hate him for this. You cannot punish him enough!

Now he goes to therapy and says he is better. On the few occasions you submit to intercourse he is just as nervous and incompetent as ever. He tells you his therapist says it will be that way until you come in for treatment, too. No way are you falling for that! You have been hurt enough. Why should you risk any more?

I have an answer for you.

You should risk now because your mate and his therapist are telling you the truth. He has gone as far as he can on his own. He has done weeks’ worth of masturbatory exercises (and in some cases taken pharmaceuticals) to learn a new sexual response language to replace the one that did not work.

When he comes to you, the sexual scene is the same. He needs this, too, to be different, and he cannot do this alone. As a team, he and I want to teach you his new language so that you two can speak it together – cautiously and haltingly at first – until slowly and lovingly you become fluent lovers once again. Joyous, relaxed lovemaking awaits you.

I am not so naïve as to believe this is happening in a relational vacuum. I want to see you alone as well as with your mate. I am well aware of your need to vent and to grieve. I understand that you have sacrificed your own sexual expression and may be hopping mad. I realize that we must repair other areas of your relationship as we mend your sexuality. You have been silent for too long. Now is the time to have your story heard in an environment of safety and solace.

Are you afraid that it is too late for you? Do you think that your sensual, responsive nature is hard and dry now, that it can no longer be awakened? It can.

You are no more frightened than your man was. Your stakes are the same. Your reward for taking this risk is also the same – a chance to reconstitute the promise you two made so long ago, buried under disappointment, good intention, and inadequate communication.

Please consider joining your husband in his treatment for PE. It offers not only a chance to repair your beleaguered sex life but also an opportunity to work on the damage done by the effects of dashed hopes, disappointments, and unresolved anger. So much more is possible. Isn’t the risk worth the chance of renewing your relationship?

First Visit Reactions

A number of clients have shared with me their reactions to their initial sex therapy visit. I thought it might be instructive to those of you considering therapy to hear what they had to say.

A man in his mid fifties told me that the pre-session homework I ask of everyone had been enormously helpful. This involves answering two simple questions: “What are the problems?” and “What would need to happen for you to know the problems have been resolved?” He explained how this exercise had focused him, even before our first meeting, on the precise nature of his troubles and on his goals. He added that the questions reminded him that this appointment was dedicated solely to talking about him, which he had been avoiding for ages. This brought up mixed feelings of trepidation and relief.

Another new client, a woman in her thirties, disillusioned by the disconnection between the myth of happily-ever-after and the reality of maintaining a real-life relationship, shared her relief that she had found a place where she could admit her fears and doubts to someone who would not judge her. Though her friends offered a comfortable place to vent and share good times, they could not give her a neutral and confidential ear. She also appreciated learning accurate information about her body and its sexual functioning.

Then there was the couple who had grown so estranged that visiting me marked their last attempt to save their marriage. I noticed that they did not touch or even make eye contact. They were still emotionally connected and got along well, but it had been a long time since they had experienced any intimacy. I asked them if they would do exercises at home. They admitted they had not like the idea—felt it was juvenile and pointless—but they agreed. Their willingness to risk feeling awkward and vulnerable with each other signalled their willingness to change the character of their relationship.

Sometimes people come in just because they need a safe place to talk about something. It can be difficult to find someone non-judgmental and uninvolved, especially regarding sex. Clients generally tell me they feel a bit anxious when they first arrive, but that it doesn’t last long.

Other times clients need accurate information and want help in determining how that information best applies to their lives. Often that can be sorted out in a session or two. Still, it can feel a bit humbling to admit we don’t know something about sex. We all want to be knowledgeable about something that’s supposed to “come naturally.” I try to make the learning fun and relaxed.

Still other times clients come in who feel quite hopeless about their sexual situation. They arrive bursting with questions and emotions. I can hardly give them information and support fast enough and I watch their anxiety dissolve as the session progresses. Their body language and even their breathing change over the course of the visit. I hear phrases like “I never thought of it that way before” and “I wish I’d come in ages ago.”

Few people have contacted a sex therapist before. I’m used to that. I appreciate the trust put in me as folks stretch their boundaries to learn more about their sexuality and relationships. I hope this peek into what initial sessions can be like helps you to feel more comfortable in approaching the process of sex therapy with anticipation. It can be an exciting adventure. After all, the potential reward is great sex for the rest of your life!