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Generalized Anxiety and Sexuality

One of the most common issues I see in my practice is the negative effect of anxiety on sexual performance and satisfaction. I’ve written about performance anxiety before, particularly in the context of social anxiety, but in this particular post I want to focus more on a different kind of anxiety– generalized anxiety.  The first thing to understand about anxiety is that it comes in many different forms and flavors. Social anxiety, panic disorders, hypochondria, and obsessive-compulsive disorder (OCD) are all classified as different types of anxieties. The most common anxiety, as it relates to sexual functioning is generalized anxiety.

Now, based on the name alone, most people probably don’t place enough importance to an anxiety that is considered to be generalized in nature. After all, everyone has experienced some sort of “generalized anxiety” before, right? I mean, the commute to work, the looming deadlines, the financial obligations can all make someone feel very, very anxious. So, it’s not really a big psychological problem, right? Not true at all.

At the core, folks with generalized anxiety experience a prevailing, sometimes even debilitating worry that something really bad is going to go wrong, that things are about to fall apart any moment. Often they feel that the anxiety alone is what keeps things glued together. If they stopped worrying, all hell would break loose. Often times this worrying is focused on things that, if they did fall apart, then all hell would indeed literally break loose. These things include pivotal life arenas such as finances, health, and relationships.

The main reason that sexuality often becomes the focus of generalized anxiety is […]

Demisexual? Sapiosexual? What’s in a Name?

Another article making it’s way through the online and especially Twitterverse is this one entitled Young, Attractive, and Totally Not Into Having Sex http://www.wired.com/2015/02/demisexuality/?utm_source=digg&utm_medium=email . The article chronicles the way that some college co-eds self-identify sexually. One considers himself a “heteroromantic demisexual.” What the heck is a “demisexual?” Good question. According to the article, “most people who describe themselves as demisexual say they only rarely feel desire, and only in the context of a close relationship.” Conversely, “gray-­asexuals (or gray-aces)” are different in that they “roam the gray area between absolute asexuality and a more typical level of interest.”

Demisexuals, gray-aces, according to these students, it mainly depends on the day. “So although labels are a big part of it, demisexuals and gray-aces don’t get too caught up in the lingo. They tend to be pretty comfortable with the idea they might change. A few months after that Friday at the outreach center, Genevieve realized she is more of an asexual than a gray-ace, and Sean now isn’t sure if he’s demi or ace. “Every single asexual I’ve met embraces fluidity—I might be gray or asexual or demisexual,” says Claudia, a 24-year-old student from Las Vegas. “Us aces are like: whatevs.””

Got those terms down? Well, that’s not it. There’s more. A colleague of mine asks– “a patient told me he’s seen over 120 girls on Tinder who define themselves as “sapiosexual. Any thoughts or experience with this?” According to Urban Dictionary (of course the most reliable source on these things– joke), http://www.urbandictionary.com/define.php?term=sapiosexual , a sapiosexual is “one who finds intelligence the most sexually attractive feature.” Apparently, sapiosexuality is […]

BDSM or Abuse?

Recently a new article by sex columnist Dan Savage trigged a lot of discussion and debate online, and I thought that the subject matter was important enough to also add another piece of commentary to the already crowded field. Basically, Savage answers a concerned mother whose 15 yr old son has been “watching sadistic porn- and ONLY sadistic porn- for a couple of years” and that “he thinks about this porn all the time-all day, every day- and fantasizes about doing sadistic things to the girls he dates.”

Savage then checks in with a bunch of experts including Canadian sex researcher Dr. James Cantor, who suggests that the woman’s son is a budding kinkster and any concerns that he could be the next Ted Bundy should be put to rest. Some other folks add their opinion, including a professional dominatrix who brings up the importance of “ethical sadism.”

I’ll leave the description of the column at that for the moment, and merely suggest that anyone who is interested in reading more go directly to the column here: http://www.thestranger.com/seattle/SavageLove?oid=21679058 .  I think it’s well worth the read.

So what should we make of this mother’s concerns about her son’s use of violent porn? First, let me get some basics out of the way. As I’ve written in this blog before, there is absolutely no evidence that violent porn leads to acts of sexual violence. In fact, in the aggregate those countries that have legalized porn use have experienced an inversely correlated drop in sex crimes.  Second, fantasies involving themes of seemingly sexual violence are not uncommon as I’ve written about here and here. […]

What is Harm Reduction?

Last post I discussed some ideas around self exploration and peak experiences that strongly resonate with me. In this post, I’m going to address another issue which is just as equally important to me– harm reduction. What is harm reduction and what application does it have for sexuality in general and sex therapy in particular?
First, let me say that my introduction to the field of sex therapy was in harm reduction, so all of my work is firmly rooted through this lens. Initially I volunteered and then worked in several harm reduction facilities in the city conducting outreach to homeless intravenous (IV) drug users, street prostitutes, and transgendered individuals. For example, I would go into Tomkins Square Park in the village and trade clean needles for old, dirty ones. I always wore an ID badge to make sure I wasn’t arrested. I would go into known prostitution areas and hand out fresh condoms to mitigate the chances of them contacting STDs. If they were ready for help, I’d bring them back to the facility and connect them with a benefits counselor who would assist them with getting sober and finding housing and any other necessities they needed.
According to psychologist Andrew Tatarsky at the Center for Optimal Living, harm reduction is “a philosophy and set of interventions that seek to reduce harmful consequences of substance use and other risky behaviors without requiring abstinence.” Without requiring abstinence? What is that about? I think an important point here, and one that many harm reduction theorists and practitioners would argue, is that abstinence doesn’t work for everyone. Or […]

What are Aliveness and Flow?

I’m going to take an interlude from all the fetish talk for a moment to bring up another area of great interest to me, as I believe that the subject matter is not only directly related to sexuality, but to how we understand and synthesize the rest of our life experiences as well. Earlier, I’ve written about bias in the field of sexology here and here (warning: fetish talk). Understanding the mechanics of how biases are developed and reinforced is a very crucial topic for sexologists (and any scientists, really), and dovetails nicely into other important concepts such as “aliveness” and “flow.” If this feels confusing, don’t worry, I’ll explain all.

When we take a look at the genesis of any belief system, we have to take into account two key factors: influence and reinforcement. I’ll examine both of these in turn.  First, no belief system can take hold if an initial seed is not planted, which requires influence. In other words, we believe the things we do because at one point or another, we were influenced by someone or something that had enough influence to change or mold our beliefs. As kids we were influenced by our parents, by teachers, by mentors, by peer leaders. As adults our views may be less moldable, but we still have people around us with varying levels of influence. Said differently, we will pay attention to what we learn from those who have influence over us and dismiss or discard what we hear from those that hold no influence. Yeah, influence is important.

But the seeds of belief that are implanted by […]

More on Working with Fetishes: Important Considerations

My earlier post about whether it is possible to eradicate fetishes appears to have struck a nerve, as I have heard from folks all over the world with their comments, questions, and requests for further information. I want to thank everyone for writing in– everyone’s communications have been very thoughtful and respectful, and it is really heartening to be able to reach so many in constructive dialogue.

As I read over the article however, I realize that, while pointing out what I believe to be inappropriate and unethical treatment, I do not go into any detail about what I do believe to be appropriate treatment protocols when someone is seeking help with a fetish. So, to address that gap, I’m going to go into some treatment protocols here in this particular post. It’s a lengthy and very broad topic, so I think this may very well turn into a series of postings, but I’ll see how it goes. For this article though, I’m just going to focus on initial steps (edit: as you’ll see, I found that laying down some groundwork of important initial considerations took up a lot of writing, so in this post, I am focusing on the groundwork, and I’ll talk about specific interventions in subsequent posts).

First, in the interest of disclosure, let me put it out there that I hold a sex-positive perspective. For more on what this means, you can take a look at my article about sex positivity here. Basically, I start out with the assumption that sexual behavior is neither inherently negative nor pathological unless shown to be otherwise. In other words, the meaning […]

Announcement: New Book Deal

It’s been a lot of hard work and a lot of blood, sweat and tears, but I’m pleased to announce that just this past week I’ve been offered a book deal with a large publisher. The book will be based on my work as a sex therapist and will provide a platform for various ideas that I’ve been developing for years about sociology, society, culture, psychology, and sex. The book’s content is entirely original, with material I mostly haven’t written or shown anywhere before and it maybe only touches on 5-10% of the topics I’ve written about in this blog. In other words, the stuff in this book will be all fresh. My intention in writing this book is to put some ideas out there into the public square and start a discussion going. I’m looking at a publication date somewhere in late spring 2016, so we’ve got a lot of time and I’ll keep everyone posted. My agent is currently working on specifics of the contract, so I will have more details and info to come.

I would like to thank to my literary agent, Matthew Carnicelli, who believed enough in my ideas and in their importance to take time away from his celebrity clients and help me develop and streamline those initially loose ideas into a cohesive narrative that he could show to publishers. Most importantly, he connected me with an editor at the publishing house who really understood my material and has the passion, experience and vision to help me polish and develop it to the next level.

I will keep this post short for now, and I will do most of my […]

Sexuality and Censorship

Earlier this month, UK anti-porn advocates won a monumental and far-reaching victory when the UK government passed the Audiovisual Media Services Regulations 2014, in which a whole host of sexual acts are now banned from British porn, based on what the board deems as “content that is not acceptable.”  I will get into the list of taboo acts in a moment, but first I think it is important to take a look at what this ruling means. In my opinion, it sets an extremely dangerous precedent, in which some third party or government body can effectively censor anything that they may subjectively object to, even if the material is consensual and harms no one.

Avant-garde Yugoslav film director Dusan Makavejev created films in the 1970s focusing on the intersection between government, society, and sexuality. In his work, he raised a critical eye towards authority and its desire, or more like incessant drive, to eradicate and suppress all freedom and dissent. For his efforts, he was persecuted and eventually blacklisted. As Makavejev so deftly shows in his films, the first line of suppression for any authoritarian government is one of the key sources of our human creativity, inspiration, and personal sense of freedom– our sexuality. History shows that as soon as an authoritarian government rises to power, one of the first things to go is human sexual rights.

Take a look around at the world, and you can see for yourself the crackdown of human sexuality imposed by authoritarian and dictatorial regimes– Egypt’s gay community targeted by government crackdown http://www.theguardian.com/world/2014/apr/17/egypt-gay-community-fears-government-crackdown , Russia’s institutional violence and discrimination towards gays http://www.msnbc.com/rachel-maddow-show/religious-right-leader-backs-russian-cra , Uganda’s anti-homosexuality legislation http://www.bbc.com/news/world-africa-29994678 , […]

Is it Possible to Eradicate a Fetish?

In a recent post, I wrote about how the field of sexology is uneven in its application and rife with regional and individual biases, largely due to general sex phobia and a subsequent lack of empirical research within the field. Recently, a debate on the mailing list of one of the sexological organizations to which I belong touched again upon discrepancies within the field. The discussion in question concerned whether or not it is possible to eradicate a fetish. Most respondents were in agreement that, like a sexual orientation, eradicating a sexual fetish is not only not possible, but particularly in fetishes that cause no harm, even unethical.

One clinician, however, stated not only that eradicating a fetish is possible, but then went on to describe exactly how (he/she believes) it is done. The methodology described was so disturbing, however, that I felt it necessary to challenge the ideas presented and to present both his/her perspective as well as my response here on my blog as a cautionary tale to individuals who may have questions regarding their own sexuality so that the know what to avoid in therapy. I have eliminated any details that could reveal the identify of the other clinician.

Below is what the clinician wrote in support of fetish eradication. I am highlighting and italicizing the most objectionable aspects:
I don’t see a fetish as similar to sexual orientation – it is something that does reflect “something wrong”, and in my own experience, DOES respond to therapy! One issue is that sexual fetishes – paraphilias – typically involve sexual activity with something that does not provide the […]

Another Word on Loss of Sexual Desire

Recently, I was interviewed in a Huffington Post article about the most common sexual issues that sex therapists see in their office. To see more on this article, you can click here. Anyway, since the interview response that they posted was a bit abridged, I wanted to spend a little more time exploring this difficulty since it is so prevalent.

When I work with individuals struggling with low libido, I first want to understand the context in which they are having this experience. For example, I would want to know answers to the following questions. What is the relationship status of the person– are they single, dating, in a committed relationship? If in a committed relationship, for how long? When did this problem begin? I would also want to rule out medical issues, so I will refer the individual to a physician for blood work to determine levels of testosterone and other hormones. Sometimes testosterone is a major player, but more often not. In my experience, with individuals low libido tends to be more emotional, rather than physical in nature, while with couples it is more often than not it stems from relational problems.  For more info on the relational aspects of low libido difficulties within couples, you can check out my article “Three Main Reasons Behind Loss of Sexual Desire in Couples”, which was picked up and syndicated by numerous other websites.

As I indicated in my response to the HuffPost journalist, relational issues include stuff like resentment (which is basically a euphemism for anger) and lack of trust, along with other elements I didn’t mention such as inequitable power […]

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Huffington Post: Most Common Sex Problems

November 3, 2014November 3, 2014
imgresI was recently interviewed for a piece in the Huffington Post about common sex problems. Entitled "The Most Common Problems People Have in Bed, According to Sex Experts", the article interviews a number of sex therapists about the most common cases they see in their practice. I indicated that lack of sexual desire rated pretty high, and they kind of bunched it up under the the umbrella of "mismatched sexual desires", which when it comes to couples is definitely fair enough. Solid piece all around, and written by a gifted writer who has a number of other interesting articles on the site. Definitely check it out: http://www.huffingtonpost.com/2014/11/03/common-sex-problems-experts_n_5978560.html?1415023230

Men’s Health- Building the Perfect Sex Machine

October 7, 2014October 7, 2014
Men's HealthI was recently interviewed for a Men's Health article on sex toys designed for men. They wanted to know my take on these "robotic masturbators" (as they called them) and as always, I tried to take a fair and balanced view of things. I pointed out that they could be used as a way to get better acquainted with one's sexuality (as well as get some much needed relief), but an over-reliance on technology may also limit guys from developing the necessary skills that would help them form romantic relationships. At any rate, hurry on over to the article here-- Building the Perfect Sex Machine-- and you can form your own conclusions and decide for yourself.

Upscale Magazine- May 2014 Issue

May 26, 2014May 26, 2014
SwingersGo check out a great, and I mean GREAT, absolutely fascinating article in the May issue of Upscale Magazine, entitled "Secret Lovers," in which I am interviewed regarding the hush hush world of the swinger subculture.  The writer does a really good job of trying to understand the psychology of folks who practice consensual non-monogamy and I think the piece is very even-handed, with some practical tips for couples who are curious about dipping their toes in the lifestyle. I'll leave you with a quote from one of the swingers profiled in the piece, which I think gives a good feel for the tone and depth of the article-- "I love to see her with two guys and two girls at once. I enjoy submissive women, and there is no sexier submission than to watch my wife please me by pleasing others."  If that sounds interesting, then I suggest you head out and grab a copy. It's well worth the read.

Cosmo- April 2014

March 6, 2014March 6, 2014
cosmoI am featured in the Sex Q&A section of Cosmo's April 2014 issue, in which I get asked about BJs, Plan B, sex in hot tubs, and all kinds of other tittilating reader questions. They did a good job of adding all kinds of humor, including a silly picture of tea bags-- need I say more? It's a can't- miss hoot. Go and check it out at news stands now!

Sex For Smart People Podcast

January 23, 2014January 23, 2014
sex for smart peopleI just recently did an interview for a cool podcast called Sex For Smart People. Here is their description of the show: Sex therapist/psychoanalyst Dr. Michael Aaron is our guest of honor this time. Hear his and our perspectives on things like: What to do when you feel less ravenous about sex than your partner feels? Is it really honestly possible to feel coziness/familiarity and also sexiness/mystery/excitement in a long term partnership? How do you begin to talk to your partner about your interest in power play? (Trigger warning, around the half hour mark, we talk explicitly about rape fantasies.) And did you know that *just this past year*, kinky behavior was officially de-pathologized in clinical psychology terms (we think it is about f*****g time)? Plus, Dave is super silly and time)? Plus, Dave is super silly and loopy on NyQuil, and he and Stephanie share their favorite pick-up lines. [audio mp3="http://www.drmichaelaaronnyc.com/wp-content/uploads/2014/01/Episode-7-Relationships-Are-Something-You-Do-Not-Something-You-Have.mp3"][/audio]