“If only it would last”

I hear it from men, and I especially hear it from their disappointed partners.  “If only it would last.”

Premature ejaculation (PE) is very, very common. About a third of all men (and their partners, sadly) are plagued by this problem.

The good news is that for most men PE is fixable. It may take some work, but with some effort most can overcome it.

In a moment, I’ll outline some exercises that can help you or your partner.

But in a world of quick pharmaceutical fixes — Viagra, Levitra and Cialis come to mind for men who suffer from erectile dysfunction — there are now medications being developed that will fix most PE. Some men are already using SSRIs, which are principally prescribed as antidepressants, to very effectively slow things down. In the UK there are tests underway of a “new” drug that contains the active ingredient tramadol hydrochloride which has been used for pain relief since the 1970s but has now been redesigned for treatment of PE. Those tests look promising and I’m betting we’ll see it available commercially in Britain and elsewhere soon.

There is now also a brand new topical anesthetic spray, Promescent, which is approved by the FDA. It contains Lidocaine. It works by decreasing penile sensitivity — but doesn’t inhibit the engorgement of the spongy tissue that makes the penis erect — and so prolongs sexual activity and delays ejaculation.  Desensitization may not sound like a good thing but if it helps with staying power many couples are willing to give it a try. This is an over the counter product–no prescription required.

Also, a new medical procedure for PE is in the works, developed by Dr. David Prologo (yes, his name really is Prolong-o) at University Hospitals Case Medical Center in Cleveland.  Recent research has found that many patients with premature ejaculation have a higher than average number of dorsal penile nerve (PDN) branches, accounting for their sensitivity and therefore their getting off too fast.  What Prologo discovered is that by freezing the DPN it can effectively dull the brain’s response to sexual stimulation, giving the patient a longer time before ejaculating without causing erection problems.  He has performed four surgeries to date, three with 100 percent satisfaction and the fourth showing  some significant improvement.

The old ‘tried and true’ treatments for ED come in the form of exercises. There are two types.

I like for guys who have partners to work with both, unless they do not ordinarily masturbate.  In that case, just work with the Squeeze Method.

The Squeeze Method (with a partner, or solo)

[1] This is best done by a couple, but the man can do it alone by masturbation if there is no partner or the partner is not willing to participate.
[2] The couple starts by being as relaxed as they can, and free from distractions.
[3] The couple kiss and caress until the man is aroused, and then the partner takes his penis in hand and begins stroking it.
[4] The man concentrates on his feelings of arousal, to increase his sexual awareness. (He does not try to think of other things in an attempt to distract himself from ejaculation).
[5] When he feels he is about to ejaculate, he signals to his partner.
[6] The partner immediately stops stimulating him and applies firm but gentle pressure around the penis where the glans (head) meets the shaft. The partner keeps applying the pressure for 10-20 seconds.
[7] The partner then lets go, and they wait without doing anything for about 30 seconds.
[8] The procedure is repeated several times before ejaculation is allowed to occur.

The Stop-Start Technique (solo)

[1] The man sets time aside to be private and to masturbate with dry hands.
[2] He slowly strokes almost to the point of ejaculation and then stops before the point where ejaculation is inevitable.
[3] He should do this three times.
[4] On the fourth time, he is permitted to ejaculate.
Learning to be aware of where the ‘point of no return’ is may take some effort. It takes time to build control.  That’s where practice comes in.

Once a man has achieved the measure of control needed to make it through the above four steps successfully it’s time to go through the same process but with a wet hand using lubricant to make the feel slicker and more like ‘the real thing.’

Six likely reasons you’re alone

From day to day I see all sorts of people about a broad range of sex and relationship issues.  I do therapy.  In my practice, because of my eclectic background and training, this includes a wide range of “interventions.”

One thing I generally don’t do is “give advice.” People’s real issues are rarely so simple and easy to answer. But people want them to be simple, so they still ask.

One of the most common questions I get from women is, “Why can’t I seem to find (or find and keep) that special someone?”  The question is usually followed by some words of self-explanation, a common-sense rationalization to explain “why I am alone.”

We humans seem by nature to be compelled to figure things out. We want to understand why things are the way they are and why they aren’t the way we wish they were or hope they might be. It’s hard for us to not have an answer.

I recently read a refreshingly frank and perceptive article by Tracy McMillan. She’s a TV writer, not a therapist.  Taking on the topic “Why You’re Not Married” she has come up with six likely reasons: 1) You’re a bitch; 2) You’re shallow; 3) You’re a slut; 4) You’re a liar; 5) You’re selfish; and/or 6) You’re not good enough.

McMillan is no misogynist and what she has to say is no self-help column drivel.  She has looked squarely at her own life and observed the lives of women around her. What she means by each of her six reasons is likely not what you think.  Her explanations are, I believe, more perceptive than not.  Perhaps more importantly, they are always thought-provoking.

McMillan’s real purpose seems to be to get women to think in a new, more deeply honest way.  She wants to shake off the easy answers, those rationalizations that make it more or less okay to not be okay with being single.

Treat yourself to a good read. I’d love to hear your feedback. You can post it here for all to read, or send it to me privately and in confidence at drdavidroth@gmail.com .

Here’s Tracy McMillan’s “Why You’re Not Married.”

The Polygamist in the White House… and next door

We may never know if indeed it was a first.

At the White House on Tuesday the president awarded the Presidential Medal of Freedom, the nation’s highest civilian honor, to an esteemed American and de facto polygamist.

His name is Warren Buffett.

In case you didn’t know, for more than a half-century, right up until her death, the celebrated multi-billionaire investor was married to his beloved Susie. And for a quarter-century, at Susie’s behest and with her full approval, he also maintained a committed, intimate relationship and publically shared a home with Astrid.  Holiday cards to friends were signed “Warren, Susie and Astrid.” Upon Susie’s death — which was devastating to Buffett — he and Astrid were able to be formally married.

Warren, Susie and Astrid are a rare exception: most committed, long-term triads are not so public.  Of course, there was no violation of any bigamy statute and no tax fraud. One legal marriage at a time, one spousal tax deduction.

High-profile polygamists — married de facto, if not de jure — may not be running the marriage rights flag up the flagpole, but the Buffetts are not alone.

So respectable a figure as Karl Barth, the twentieth-century Protestant theologian widely held to be the greatest mind in Christendom since Thomas Aquinas, shared the entire second half of his 80-year life in a household with two women.  

When the greatest German composer of the second half of the 20th century, Karlheinz Stockhausen, died in 2007, it was his two common law wives, Suzanne Stephens and Kathinka Pasveer, who jointly announced his passing.

Still, attention in the news media to the subject of polygamy has focused on a single stereotype: fundamentalist Mormons who live on compounds in remote parts of Utah, Arizona and Texas, and on crimes and allegations of crimes by men such as Warren Jeffs against women and children. They are news worthy, sadly real and utterly abhorrent.  But they appear not to be the norm, and according to social scientists who have studied them are not the basis for polygamy.

This is no longer the only image of polygamy in the American media.  The fictional Hendricksons of ‘Big Love’ and the real-life Browns of  ‘Sister Wives’ portray polygamy in a more All American life-in-the-suburbs light. They are for the most part at least approachable and very often endearing. Still, both high-profile TV shows are about families living the Mormon principle of plural marriage as a religious tenet.

The Buffetts’ polygamy is not based on Mormonism. Nor was the Barths’, nor that of the Stockhausen family. And it’s fair to say that none of the women in these three men’s lives was coerced into an underage union against their will by a manipulative prophet or tyrannical patriarch. It was for each of them a life they chose.

As a boy growing up I couldn’t imagine that I knew anyone who was a homosexual.  The thought of meeting one kind of scared me. When I learned that a man I was working with and respected was gay I could barely believe it: he was pretty much like everyone else.  He wasn’t scary. These days, everyone knows someone who is gay. My eldest son is gay. He’s out. No big deal.

I suspect there are polygamists, or would-be ones, in your town, in your neighborhood.  Maybe you know them and maybe you don’t.  And maybe you know or suspect they’re really — de facto — polygamists and maybe you don’t. But chances are they aren’t drawing a lot of attention to themselves and aren’t much like Warren Jeffs — or for that matter Warren Buffett.  Chances are they’re more like you and me.

Perhaps you’re one.

Or perhaps you would be, if you felt you could.

A Bountiful Marriage

So few of us in the United States know much about Canada. 

Mention “Bountiful” and very few think about a town in British Columbia. Fewer still are aware that there is a case, commonly referred to as the Bountiful Case, presently before the BC Supreme Court, that challenges the law that limits a “conjugal union” to the relationship between two persons.

Yes, it’s a polygamy case. And there is a good chance it will ultimately be decided in the Canadian national Supreme Court.

The case is shrouded in a cloak of prejudice. The town of Bountiful is a fundamentalist LDS one. Those involved do not look like the well-adjusted suburbanites on HBO’s ‘Big Love’ or TLC’s ‘Sister Wives’. There are allegations of child brides and spousal abuse in Bountiful. It’s not the perfect crime-free community. But rights have never been predicated upon engendering everything picture postcard perfect.

What is striking about the Bountiful Case is that it brings to the foreground assumptions we make about the fundamental nature of an institution whose definition we have until recently mostly taken for granted. Marriage is an exclusive union between a single man and a single woman.

But this is a very specific historically and culturally grounded definition.  It is by no means universal.

In G.P. Murdock’s magisterial 1967 Ethnographic Atlas, an overwhelming 85 percent of recorded societies were polygamous. No, that doesn’t mean that 85 percent of marriages throughout the world were multi-partner ones. What it says is that our own society’s refusal to accept polygamy is the “odd man out” in a humanity that has as a species typically encouraged or at least allowed for marriage to be defined as other than simply one man and one woman.

We are an ethnocentric lot. Like gay marriage, the thought of more than two people marrying may be hard for most of us to wrap our minds around.

I will be writing more about this landmark case in the days ahead. I will be writing about polygamy in several contexts – historical, religious, sociological and also clinical. For now, here’s a short but very informative article by attorney Jim Quail called The BC Polygamy Case: Be Careful What You Criminalize.

“If only I had a hot lover”

“If only I had a hot lover,” she said to me.

If only everyone had a hot lover, I thought.  But that wouldn’t solve this woman’s problem, or most people’s problems.  It sounded good though.

When people come to me they nearly always identify a “problem” that is rarely the real problem. Most often it’s a symptom of a problem they themselves cannot see. Very often it’s one that is part of what I refer to as ‘core material.’ Core material is not just stuff that’s in our heads. It’s psychological, emotional, spiritual, physical, interpersonal, social. It is tied to our very identity, which is why it’s too risky to look at directly.  Sometimes it is entirely inaccessible to us, and for good reason. It would be too painful or hard to make sense of to face head on. Sometimes, we’re deeply invested in not knowing what’s really going on there.

And so without intentionally doing so we fashion for ourselves rationalizations, and rationalizations about our rationalizations, to make sense of things that are messy, contradictory or simply beyond our ken.  That’s why we come up with solutions such as, “If only I had a hot lover.” It gives us imaginary control over the otherwise uncontrollable.

This young woman wanted to see me because, as she put it, even though she met and dated men she was attracted to, she lacked a desire for sex and when she had it she felt unsatisfied.  Especially if one has had clumsy, incompetent, selfish or boring  lovers, seeking and finding a “hot” one makes a very defensible commonsense solution.  And, depending on the person, it might even offer some hope for better sex and more fulfilling intimacy.

But in my experience it is rarely the answer.

A fresh look at great sex

If you want to know what a great sex life is like, you should ask the real experts – people who believe they are having really great sex.

That’s the revolutionary but commonsense assumption behind research conducted by Peggy Kleinplatz, PhD, and her colleagues at Ottawa University. They interviewed 64 people over a five-year period, mostly from the US, all of whom said they had great sex lives.

Their findings paint a radically different picture of optimal sexuality from what is commonly portrayed in the media.

Truly great sex had little to do with the sorts of things popular men’s and women’s magazines typically focus on – things like multiple orgasms and “lasting all night.”

Popular culture promotes “achieving great sex through ‘secret’ techniques, novelty and variety, suggesting that one is to look outside of oneself to find great sex. In contrast with these sources and mechanistic models … the participants in this study found techniques and sex ‘acts’ mostly irrelevant,” says Kleinplatz.

This is not to say that we don’t want to explore or add variety to our sex lives. Many of us do. It simply means that when all is said and done, those aren’t the keys to what we consider truly “great sex.”

What this research shows is something those of us who work with clients from day-to-day have long known: ultimately a great sex life has less to do with ideal physiological functioning such as rock-hard erections, ultra-slick spontaneous vaginal lubrication, or even successful intercourse and orgasm, than how people connect emotionally and, in a broad sense, spiritually.

The portrait Kleinplatz and colleagues paint of great sex includes eight major characteristics:

  • 1. being present, focused, embodied
  • 2. connection, alignment, merger, being in sync
  • 3. deep sexual and erotic intimacy
  • 4. extraordinary communication and heightened empathy
  • 5. authenticity, being genuine, uninhibited and transparent
  • 6. transcendence, bliss, peace, transformation and healing
  • 7. exploration, interpersonal risk-taking, and fun; and
  • 8. vulnerability and surrender.

They identified two additional components of great sex but characterized them as “minor” because only a minority of participants touched on them and they were not emphasized to the same degree: 1) intense physical sensation and orgasm, and 2) lust, desire, chemistry and attraction.

Although a few believed these two were necessary components, they stated that they were not sufficient in and of themselves to constitute great sex.

The study focused on optimal sex in general, not single, isolated “peak” sexual experiences.

“The actual sexual behaviors and acts performed are far less important than the mind-set and intent of the person or couple engaged in these acts,” Kleinplatz observes.

By focusing on the individual’s subjective experience, the definition of sex may be broadened to include times even when no physical contact is involved.

Those interviewed included members of different racial and ethnic groups, people of different ages and relationship statuses representing a various sexual orientations and levels of physical ability and sexual functioning.

What is perhaps most striking about this qualitative research is that the otherwise dissimilar participants’ conceptualizations of great sex were consistently very much alike.

Kleinplatz writes, “The major components of optimal sexuality seemed to be almost universal among participants of different backgrounds, sexual proclivities and relationship histories.”

What that tells is this: there are undoubtedly various routes to great sex, but when we have it and get around to describing what it is, the essential experience tends to be quite similar among us all.

More about the 8 Components of ‘Great Sex’

  1. Being present, focused and embodied This was the first and most frequently mentioned factor contributing to great sex. As one woman described, “It’s being fully alive in one’s skin, engaged with the partner — emotionally, intellectually, physically, spiritually — in the moment.”
  2. Connection, alignment, merger, being in sync Depth of the connection between partners was one of the most critical elements of the experience regardless of duration of the relationship.
  3. Deep sexual and erotic intimacy This is the foundation of a relationship in which optimal sexuality becomes a possibility. It involves deep mutual respect, caring, genuine acceptance and admiration, but this is easier said than done. As Kleinplatz notes, “you can’t trust just anyone.”
  4. Extraordinary communication, heightened empathy Kleinplatz describes the study’s participants as having ‘black belts’ in communication.These weren’t people who learned all about the other sex’s genitalia and then just applied the technique,” she says. “These were people who were so engaged in and with their partners’ bodies that they could read their partners’ responses, not only touching them, but feeling them.”
  5. Authenticity, being genuine, being uninhibited, transparent “This is pretty much the opposite of self-consciousness,” says Kleinplatz. “It’s allowing oneself to be emotionally naked while being seen by a partner.”
  6. Transcendence, bliss, peace, transformation, healing Participants in the study often reported a sense of timelessness or the infinite during great sex. “Their experience often really was exalted, and they would use language borrowed from religion to describe it,” says Kleinplatz.
  7. Exploration, interpersonal risk-taking, fun Participants described great sex as an adventure, an opportunity to discover things about themselves and their partners and a chance to pursue ever greater depths. “Interpersonal risk-taking and exploration emerged as important components of great sex… undertaken in the context of play and fun,” says Kleinplatz.
  8. Vulnerability and surrender  “Giving oneself,” letting oneself be vulnerable and surrendering to a partner were exquisite aspects of great sex, participants in the study said. Kleinplatz describes great sex as a leap of faith. “It’s saying ‘I’m going to jump off this cliff, be naked and be vulnerable and give myself to somebody else and take them in’ and I hope I feel good after I do that.”

“The Components of Optimal Sexuality: A Portrait of ‘Great Sex’”, was published in 2009 in The Canadian Journal of Human Sexuality

On being alone, and (not) finding someone

Every so often someone will come to me and say I just want to find someone, someone who is right for me.  Or they’ll ask me quite directly So where is Mr./Ms. Right?

This is a particularly vexing problem and a very common one. Like most things commonplace, we don’t usually ask ourselves how it got to be this way. It just is. We may have our own theories based on our own life choices and individual circumstances.  But the truth is that the epidemic of being alone is a very contemporary phenomenon.

I’ve heard every rationalization out there. They’re usually focused on the first person singular. I spent so many years focused on school and career…. It’s just so hard for me to meet people…. Everyone else my age seems to have scooped up the good ones…. I never meet people who want me for ME. They’re just after my…. I’m not going to settle for someone who isn’t…. If I could only get myself to do such-and-such, the right person would be attracted to me. The list goes on and on.

While there may be some truth in these assertions, it’s fair to say that we live in a society and a time where insulating ourselves from vulnerability is not only possible for us as individuals but a given. Isolation is more common than not. Many of us, especially in North America and particularly in the US, have grown up encouraged to make our own way. It’s embedded in the mythology of the American pioneering spirit. I use the term ‘mythology’ precisely because appealing as it may be it defies the historic truth.

The vast majority of pioneers in America and elsewhere have been collaborators, not solitary individuals. Few have ever chosen a new path and fewer still have gone it alone.

As a culture, we have institutionalized the Self Alone. The quintessential American value of independence is as foolish and self-destructive as jumping off a cliff to catch the wind and soar: it sounds wonderful and it’s tempting but ultimately leads to a deadly, solitary splat.

We are by nature fundamentally interdependent, not independent. Self(ish)ness under the guise of freedom may have some short-term benefits – feel the excitement, the exhilaration, the invigorating breeze – but ultimately they prove insufficient. When the truth sets in, it’s nothing nice.

Every culture has its myths. Most prove helpful, some are destructive. Fortunately, cultures change and adapt. If a society is to survive, let alone thrive, its myths change and adapt or simply fade or are relegated to the status of quaint artifacts.  Our society, our “world,” imagines itself a certain way. It is in part an illusion where the Self “freely” makes (or believes it makes) choices – until a powerful reality sets in. I am alone. Damn, I’m alone. I don’t want to be alone. I want to be with someone who gets me, and appreciates me, and cares about me, and… loves me.  I want someone who will stay with me, for more than just tonight  / this year / until the kids are out of the house / until I run out of surgical options to maintain the illusion of eternal youth.

This is not an indictment of anyone; it’s simply the acknowledgment of fact. We mostly just go about our lives without thinking much about it. We buy into what those around us believe and do. That means many of us feel and are very alone. Our freedom of solitude becomes a prison of loneliness with rationalizations about how we got in with no way out.

Few of us spend our lives questioning the given. When we do, we tend to question in a way that is comfortable for us so that we can feel we are at least somewhat in control of our lives. Even those who pride themselves on being open-minded are usually only open-minded to possibilities that intuitively, naturally attract them.  We have limits to what we’ll question, where we’ll go, what we’ll even begin to consider for our lives.

There is ancient wisdom in the biblical assertion attributed to God: It is not good for a person to be alone. But in a Self Alone world how is Ms./Mr. Right to be found?  And is it a matter of finding—or is this a false assumption we readily make?

How is one to become and stay and be happy un-alone?

Because it’s more than just sex, and never simply a relationship

There are countless blogs about sex, and loads of relationship-related ones.  Some are mindless rants, others tired pop-psychology drivel. There are a few good ones too.

“So when are you going to start a blog?”

I’ve been asked this question more times than I can count, and have long resisted.

People figure if you’ve written several successful books as I have — none having to do with my day job as a therapist — then surely you should write a blog.  My view has always been that you should only write or edit a blog if you have something to say that’s worth others’ taking the time to read. It doesn’t have to be profound or original (honestly, how much of what gets into print is?) but it should be worthwhile.  A good topical blog is at very least informative and in some way helpful.  It helps if it is thought-provoking . It should also be reasonably well written and at least modestly entertaining. When it is addressing serious stuff, it must not take itself too seriously: words, like vapor, in the cloud.

So after such persistence on the part of those who know me, I asked myself a question: do I have a blog in me? So often people have come up to me after hearing that I have written books and said “I have a book in me.”  My reply, usually not out loud but in my mind, has usually been and that’s probably where it belongs. So why should I too now add more words on the topic of relationships and sexuality to the blogosphere? DO I have something more to say that is worth your taking the time to read? Something informative, helpful, thought-provoking, modestly entertaining and, on a good day, well written?

Blog launched, I truly hope so.  And when I don’t, I pray others whose words I will share in this space will.

What you will find here in the days, weeks, months and (perhaps) years ahead will be a wide assortment of posts on an array of topics. Some will be useful tidbits. A few will be curiosities. Most, I hope, will be the fruit of my many years’ experience working with people and current news, stuff on the cutting edge.

All I really know is people. All I have studied is people and I have spent most of my adult life doing it. Notice I didn’t say sex. I didn’t say relationships. I said people. I may “do” lots of things — especially sex therapy and relationship counseling — but what I know, what I “read,” is people.

I’m interested in the human person in an integral way. We live in a world of specialization, always focusing on parts and aspects of things. Most sex therapists do this. Like most professionals, that’s how they were trained.  But there is no separating body, mind, emotions and spirit and no isolating the individual from interpersonal and social relationships. I’m interested in life’s big questions and also nitty-gritty realities. Think: Truth-Beauty-Goodness-Unity meets watering the houseplants, caressing and ravaging a lover, grieving the loss of a friend and cleaning up after dinner.  If we are healthy and whole, it all fits together — parts of one seamless whole.  I’m particularly interested in the nexus of sexuality and spirituality, where our most primal self meets meaning and purpose in life. We may speak about separate aspects of life but it’s all connected. And WE are all interconnected.

That’s why this blog is not going to have a very narrow focus. At its best it will look at us humans through a wider lens. When it takes a narrower focus it is likely to be on things beyond the day-to-day field of view of many of us. Its horizon will be past that of most of my colleagues who make their living listening to lives and/or studying people’s sexual and relationship behaviors and habits. At least that’s my hope for the relationshipsandsexuality blog.

I also hope you’ll help me make this a dynamic, vital and interesting experience.  Add your comments. (I don’t intend to play sensor but, like any good editor, will moderate posts for relevance.)  And I hope you’ll contact me if you like what you read and feel you could use professional help. You can reach me through The Center for Relationships and Sexuality website.

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