As a clinician who frequently works with sexual problems, I talk about genitals a lot! A lot! As I embark on these conversations with my clients, I have noticed how many people either don’t use the correct words for their genitals, or don’t even say the words at all. One of the most common errors I see is that people commonly say men have a penis and women have a vagina. While this is true, they are not the equivalent of one another.
I see this error in common culture verbiage also, people
referring to the female genitalia only as her vagina. The vagina however is one
part of the female genitals. It is the canal that leads from the vaginal
opening to the cervix. This is an internal part of the female anatomy. I hear
many people use the word “vagina” to refer to a woman’s external genitalia.
This would be somewhat equivalent to calling the male external genitals a vas
deferens (male internal tube) instead of a penis.
What people mean to say is that men have a penis and women
have a vulva. Vulva is the correct term to refer to the external female
genitals. It is made up of the 2 sets of lips called the labia majora and
minora. It protects the internal components of the female reproductive system.
So, next time you say the word vagina, make sure you are
referring to the correct anatomy. If you have never even said the word vulva, I
encourage you to start using it as the appropriate term for female external
Sexuality is a charged topic for both adults and some children. Messages about what behaviors are appropriate and inappropriate are woven into the fabric of our cultural traditions, moral codes of conduct, and family systems. Negative messages cause a great deal of harm, mainly when the message contains sexual shaming. Masturbation is one of these topics.
Masturbation is extremely common, yet because it is private, we don’t talk about it with our children or a spouse. According to research, self-stimulation is a normal activity experienced by nearly all people starting at very young ages and can be observed in utero (Yang et al., 2005). Masturbation (like any behavior) can be both healthy and problematic; it is also experienced differently based on age. It well understood that nearly all males and most females will, at some point in their lifetime, masturbate.
When is it Healthy?
Nearly all professionals agree age-appropriate stages of self-stimulation is healthy. For example, exploring one’s body and how it responds sexually is a beneficial aspect of maturation. Men and women can learn what an orgasm is, so they are better equipped to educate their spouse on what types of sexual touch they enjoy. Also, individuals can use masturbation to self-sooth as a coping mechanism for mood regulation. For many people who (for whatever reason) are not in an intimate relationship, masturbation can be a healthy outlet to release sexual tension. Many relationships do not have an equal balance of libido. For some “higher libido” partners, masturbation can offer a method to balance sexual needs.
When is it Not Healthy?
Behaviors become problematic when they negatively impact, work, school, or one’s social life. Like all sexual behaviors, masturbation may conflict with religious values. In a recent study from students at Brigham Young University, researchers reported the perception of pornography (a common corollary with masturbation) is the primary predictor of negative outcomes, not the pornography use itself (Leonhardt, Willoughby, Young-Peterse, 2018). It is important to inventory what our values are and why we have them. It can be helpful to challenge what we believe, while still honoring our values and the values of others. In many situations, individuals with strict religious tenets regarding masturbation find themselves in harmful shame cycles leading to increased rates of depression, compulsivity, or suicidal ideation (Beagan & Hattie, 2015). Researchers don’t diminish the value of traditional moral values. However, they do suggest creating a healthy relationship with our values within the normal range of human experiences.
Myths about Masturbation
We tell stories and create myths to justify attitudes about sexuality. Some common myths include masturbation causes homosexuality, is an addiction, leads to infidelity, will lower sexual desire, create hypersexuality, may cause you to go blind, and causes cancer in men. These things are not true. However, there are things that do occur. For example, a partner may feel betrayed when they learn their spouse masturbates. Couples can contract what cheating is, and what betrayal is. Feelings of betrayal are especially common when erotic material is involved. People engage in negatively impacting habit-forming behaviors with all sorts of things, including masturbation. Also, some coping mechanisms prevent healthy attachment in relationships.
Talking about Masturbation to our Children
It’s helpful for parents to have discussions with their children about masturbation in age-appropriate ways. For example, 5-year-old children don’t typically need to learn about orgasm mechanics, but talking about what “feels good” is more appropriate. Also, shaming a child by saying, “don’t touch that,” could be replaced with useful comments such as “that feels good, maybe you should do that in private.”. Children without parental guidance will learn about masturbation from friends or erotic material. Pornography doesn’t typically represent healthy sexual education. It is also beneficial to create safety for children, so as they begin to explore their sexuality (in person or with others), they feel safe to engage a parent about their experiences. Normalizing sexual desire, response, and anxieties create wellbeing for developing children. Lastly, it’s helpful to remember that not all children have the same sexual interests, levels of desire, or attractions at the same age as other children. It’s important to meet our children where they are at.
Talking about Masturbation to a Partner
An important aspect of contracting between couples includes the topic of masturbation. As a part of healthy sexual practices, discussing what is acceptable (or not) is essential. While there are many options, some couples will incorporate self-pleasuring behaviors into their relationship as a method to balance sex-drive differences. Often one partner may feel betrayal if they learn their spouse masturbates. When couples talk openly with each other about their feelings and attitudes regarding sexuality, it usually removes the stress in these situations. A good place to start is becoming aware of your own sexual biases and perspectives. Some couples find it helpful to discuss these feelings with a competent therapist. It’s important to remember masturbation doesn’t constitute cheating. Marriage isn’t the antidote for fulfilling all sexual needs. Many married people masturbate. Much of the time, masturbation creates better sexual experiences for couples.
Talking about Masturbation to Church Leaders
In many faith traditions, ecclesiastical leaders counsel parishioners regarding sexual behavior. Not all religions have sex-positive perspectives. In many cases, such leaders have no training regarding sexuality, trauma, or psychological situations. A lack of training can be problematic. This doesn’t suggest the support of an ecclesiastical leader cannot be helpful. Individuals seeking counsel from their church leader should remember boundaries are essential. It’s okay to tell a church leader what questions or statements are inappropriate or feel uncomfortable. This is especially true for parents whose children may be questioned regarding their sexual behavior, to communicate what forms of communication are acceptable and what is not.
Leonhardt, N. D., Willoughby, B. J., & Young-Petersen, B. (2018). Damaged goods: Perception of pornography addiction as a mediator between religiosity and relationship anxiety surrounding pornography use. The Journal of Sex Research, 55(3), 357-368.
Beagan, B. L., & Hattie, B. (2015). Religion, spirituality, and LGBTQ identity integration. Journal of LGBT Issues in Counseling, 9(2), 92-117.Yang, M. L., Fullwood, E., Goldstein, J., & Mink, J. W. (2005). Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature. Pediatrics, 116(6), 1427-1432.
A 1999 study (Berman J, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54:385–391) found that 43 percent of women suffer from some type of sexual dysfunction. That’s nearly half of all women! There is a lot of history and research behind how we got to this 43 percent number, but simplifying it comes down to the medicalization of female sexuality.
Dr. Leonore Tiefer is an author, researcher, educator, and therapist who has spoken out against the problems she has seen in viewing female sexuality through a medical lens. Dr. Tiefer uses the metaphors of dancing and digestion.
Dancing is something we learn, a skill that is built over time. Dancing has history and culture that informs it. Our enjoyment of dance, and our participation in it can change throughout our lives. People experience differently, but it is often something we share.
Digestion on the other hand is a process that happens to us. It is something that is consistent over the course of our lives, and deviation from the standard is a problem requiring treatment of some sort. We have healthy digestion and unhealthy digestion. Unless there are problems, we don’t spend much time considering our digestion, and sometimes we feel uncomfortable talking about when things aren’t working the way they’re supposed to.
Dancing is a helpful metaphor for looking at sexuality through a behavioral lens, and digestion is more applicable to a medical model. Both approaches have their place, and certainly those experiencing sexual concerns would be wise to rule out obvious medical issues, but Dr. Tiefer suggests we spend more time considering the cultural, educational, behavioral and relational issues that impact female sexual health.
Sex therapy is one area of mental health that
doesn’t always get talked about. Many
individuals feel hesitant to bring up sexual concerns with their therapist,
waiting until later in the therapy process to introduce the topic. Others misunderstand what sex therapy is, and
continue to struggle on their own.
What is sex therapy?
Sex therapy is therapy to improve sexual
functioning and treat sexual dysfunction.
Sex therapy can be done in individual and couples therapy.
What happens in sex therapy?
Just like other areas of therapy, in sex
therapy, the therapist will complete an intake process with the client to
gather information on the nature of the problem and begin to create a treatment
plan. This plan might include goals
about visiting with a medical doctor to rule out or diagnose medical issues.
Is sex therapy safe for my value system?
Just like other areas of therapy, your
therapist is trained to be respectful of and work within their client’s values
system. If you have any concerns that
the content of sex therapy might not fit within your values, talk to the
therapist up front. Talking about our
sexuality with a therapist can be a new experience, and that might feel
uncomfortable, but therapists want to make you feel as safe and at ease as
Will the therapist take sides?
The therapist’s job is not to prove one person
right and one person wrong, but to explore the history and nature of the
concern. The therapist will help the
couple or individual explore their beliefs and values surrounding sex,
identifying and helping to shift harmful or inaccurate beliefs, and provide
resources and educational materials. The therapist will create a safe,
supportive environment as the clients create new, value congruent, healthy
patterns of behavior.
What can a sex therapist help me with?
A sex therapist can provide support, education
and hope in creating sexual wholeness.
They can work with a broad range of sexual issues. Desire discrepancy (where one partner has a
higher or lower libido than the other), problematic sexual behaviors (particularly
compulsive, or what are sometimes referred to as addictive behaviors), LGBTQ
issues (orientation concerns, transitioning, or parenting), trauma, infidelity,
“sexless” marriages, orgasm concerns, ED/premature/delayed ejaculation, painful
intercourse, polyamory, kink, pornography concerns, or resolving
If you have been struggling with an area of
your sexuality or sexual relationships, but have been hesitant to talk about
it, schedule an appointment with Alice at 801-944-4555 today. Sexual health is an important aspect of good
mental health, and you do not need to suffer alone when there is hope and help
If you frequent the many on-line
resources (message boards, blogs, advice columns, podcasts, etc.) related to
dating, specifically dating at a more “advanced” age, you will surely encounter
at least one article about “compatibility” in relationships. What exactly does
compatibility mean? If you read all the advice on the internet, this post
included, then you’ll find that there is a wide array of opinions offered.
Opinions range from the alignment of interests and goals to the notion that
there can’t be any disagreements or conflicts within relationships. However,
according to Merriam Webster’s Dictionary compatibility is, “being capable of existing together in harmony”. Dr. John Gottman (2016), the world-renowned
relationship researcher, described compatibility as, “Agreeability and conscientiousness are the
characteristics that people really mean when they talk about “compatibility.”
These qualities are indexed by a person being able to say things like “Good
point,” or “That’s interesting, tell me more” or, “You may be right, and I may
be wrong” during a disagreement.”
It’s always interesting
to me that couples often fear that they are incompatible if they encounter
conflict within their relationship. Conflict and the ability to address and
resolve it are important aspects to relationships; it says a lot about the
relationship’s strength when a couple or family is willing to confront the
areas of conflict in their relationships. However, there is a myth perpetuated
by society and the media that “healthy” relationships are conflict-free. That’s
an unachievable expectation that can be dangerous to a connected relationship.
How can everyone’s needs
be met if unmet needs can’t be expressed because it is seen as starting a
fight? You’ll notice I changed the wording in my last question from conflict to
fight; I’ve noticed that many times the two words are used interchangeably.
Fight, typically, has a negative connotation that denotes a level of aggression
or force, however. While conflict simply implies a disagreement. Often though,
couples and families see any form of disagreement as a fight and it can feel
dangerous to the relationships. I teach my clients that it’s important to
recognize that you can have a conflict/argument/disagreement and the
relationship can still feel safe. How can you safely have a disagreement? I
believe that if couples can set up a few rules to how they are going to “fight”
that they can maintain safety, not just physical but emotional and
psychological as well. Below I’ve listed a few of the boundaries that I
recommend couples start with while encouraging them to add their own personal
ones that are relevant to their situations:
Use “I” and “me”- if it’s important to you than make sure you are keeping it about who it is important to. “You” statements can feel very blaming.
Keep the volume in check- while some people’s voices get very animated and the volume increases as they get elevated, regardless if it’s from excitement or frustration, it can be very scary. No yelling and screaming!!!
Keep the language respectful. Personal attacks on character, name calling, mocking, being sarcastic, condescending, or patronizing are all ways that can leave people feeling devalued and demoralized.
Telling your partner how they do or should be feeling. Everyone is entitled to their feelings regardless of whether they make sense to others. Use this as an opportunity to be curious about your partner and their experience.
Timeouts aren’t just for kids. A negotiated and stated 20-minute timeout to re-group and calm down can do wonders for a disagreement while reinforcing the importance of safety in the relationship.
Conflict is an important part of relationships, as Dr. Gottman said they introduce diversity and make relationships more interesting. Additionally, they can be used as avenues to deepen our connections with partners by exposing and discussing vulnerabilities. However, for a conflict to be an opportunity to grow it must feel safe for both parties to express those vulnerabilities. Fight for your relationships and connections, not against them!
If you are like me, you find “free
time” to be almost a mythical experience. Then trying to create time for
romance in your relationship, and it seems like we are living a straight
fantasy. However, with today’s fast-paced world and technology every direction,
it seems nearly impossible to have a truly romantic relationship. Often when I
meet with couples, I hear, “We are more like roommates than a couple.” During
my initial assessment and learning about the couple’s daily routine, I find
that these couples are unintentionally avoiding what they want the most –
The best remedy
for this lack of intimacy and romance is to make “intentional” time
with each other and make changes that will create and maintain a loving and
intimate relationship throughout the lifespan. Here are some of my prescribed
remedies for keeping the romance in your relationship.
1- Turn it off. Take the television out of
the bedroom-this includes turning off the cell-phones. If you are not on
bedrest, there is no need to have a T.V. in the bedroom. It takes away time
that could be spent engaging in pillow talk, cuddling, kissing, and making
2- Go on a date.
It is fine to go to the movies now and then but when I say go on a date I mean
GO on an intentional date where conversation can be had throughout. Take
a long drive through the canyon, go on a picnic in the park or at a garden.
Spending time together without a distraction of a movie or comedian allows time
to rebuild intimacy and learn or re-learn about your partner.
3- Hold hands. Staying
close doesn’t have to be complicated. Touch is such a powerful tool for
connection. Human touch is a basic primal need. We do not outgrow this. Holding hands while watching your favorite
show, walking around the neighborhood, or waiting for your table at a
restaurant can create that closeness without a lot of effort.
4- Don’t forget
to play. Research shows that couples who play together have increased
bonding, communication, conflict resolution, and report overall satisfaction in
the relationship. Play can be something
spontaneous like a water fight while in the garden or tickle fight while doing
housework, something planned like going bowling, or just sitting down for an old-fashioned
game of cards. So, give yourself permission to get silly and be a kid again.
5- 5-second kiss. How often do you give your partner
a quick peck goodbye in the morning or hello after work? Sure, that is nice,
but it becomes routine and unpassionate. Holding a kiss for at least 5 seconds
gives you that intentional purpose of showing your partner that you love
them. This doesn’t have to be limited to saying goodbye or hello, you could
engage in the 5-second kiss to say thank you for dinner or helping with the
kids or just because you want to kiss.
These “remedies” are not a cure-all for all relationships.
Sometimes there is an issue that goes a little deeper, and that issue is
impairing your relationship. In that case, these simple steps aren’t where you
need to start, and you may need to look into talking about it with a trained
professional. If you need couples counseling, please call our office at
801-944-4555 to make an appointment. We are here to help.
In honor of Pride month, I wanted to
share some knowledge about human sexuality that can be quite confusing.
Although some of these Frequently Asked Questions may seem obvious to some, I
think most people would be surprised at how little they really understand about
the differences between these words and phrases.
What is the difference between sex and gender?
Sex is defined by our biological position on the spectrum of femaleness and
maleness. Gender is defined by our psychological and sociocultural attributes
that are associated with being female or male.
What does gender identity mean?
Gender identity is defined by one’s personal, subjective
sense of their gender, which is different from our biological sex.
What is sexual orientation?
Sexual orientation is the unique pattern of sexual and romantic desire,
behavior, and identity that each person experiences.
Doesn’t sexual orientation consist of just three categories,
heterosexual, homosexual, and bisexual?
No it does not. After several studies, Alfred Kinsey
discovered that sexual orientation is more of a continuum so he developed the
Kinsey Scale. On the Kinsey Scale, 0 represents exclusive patterns of
heterosexual behavior and attraction, and 6 represent an exclusive pattern of
homosexual behavior and attraction. The numbers in between the two represent
varying levels of bisexuality.
people use sex and gender interchangeably without realizing the difference.
While sex refers to our biology, gender defines our expectations about what
makes us feminine or masculine and is determined by psychological, social, and
cultural characteristics. Knowing the difference is not only important in order
to fully understand what someone is talking about but also important in order
to inform someone who may be confused about this. Additionally, many people
believe that our sex should determine our gender. This is where understanding
sexual identity comes into play. Sexual identity refers to a person’s individual
perception of being female or male. A person could have an outward appearance
of a male but have female sex organs and instead of identifying as female, identify
as male, which is a form of transgenderism. Sexual orientation is often lumped
into three categories such as heterosexual, bisexual, or homosexual. However,
thanks to Alfred Kinsey, we now know that sexual orientation is much more
complex than this and should be described as being a continuum as shown below.
research has shown that sexual minorities such as bisexual, gay, transgender, and
lesbian individuals are at a higher risk for depression than heterosexual
individuals. The reason being that they are (for varied reasons) less open
about their sexual orientation. Knowing this can help aid people in their
journey to discover their sexual orientation and become more comfortable and
supported in being open about it. It can also help you to be more aware of
things to be looking for like signs of depression, anxiety, suicide, and stress
in a friend, family member, co-worker, etc. who may be exploring their sexual
more support and acceptance of the LGBTQ community in this day and age, brings
about those who have been hiding their true gender identity or sexual
orientation. Now more than ever, it is important to understand important terms
and meanings of these terms in order to better serve this community and also
family members and friends of the LGBTQ community who may not understand the
research behind these terms and the importance of supporting them despite their
beliefs. By sharing our knowledge of sexual orientation, we can work together
to end hate and discrimination.
R., & Baur, K. (2017). Our sexuality, thirteenth edition. Cengage Learning.
J. J. (2013). The psychology of human sexuality. Sussex, UK: John Wiley &
der Star, A., Pachankis, J. E., & Bränström, R. (2019). Sexual orientation
openness and depression symptoms: A population-based study. Psychology
of Sexual Orientation and Gender Diversity.
One of the most common statements I hear from women when it comes to sexual dysfunction is, “I know it’s important to my husband, and I want to give that to him, but I just have zero desire for sex. I’m just broken!”
Our culture feeds us the line that there is only one kind of sexual desire. It tells us that sexual desire should suddenly appear, that it’s a wave of hormones that hit us out of the blue. We’re going about our day, filing paperwork, prepping meals, filling the car up with gas, and WHAM, we’re hit with an urge to have sex.
Now sometimes that happens, and when it does, it’s called, according to sex educator, Emily Nagoski, spontaenous desire. Many individuals experience spontaneous desire at least some of the time. Research seems to point toward men experiencing spontaneous desire far more often than women. Women are more likely to experience what is called responsive desire.
Responsive desire means that desire builds in *response* to positive sexual cues.
What does this mean? This means that a woman who finds herself in bed with her partner at the end of a long, tiring day, isn’t broken when she’s not interested in sex. It just means she lacks context for sexual excitement. She’s normal. Not broken. Too often our culture treats women as broken when their sexual response isn’t the same as men’s sexual response. We treat men’s response as the default normal, and anything less than that makes us feel like there’s something wrong with us.
Unfortunately, the idea that we’re broken is one extra hurdle to developing a satisfying sexual relationship with our partner.
Emily Nagoski gave a Ted Talk last year where she shared two keys to sexual well-being. They are confidence and joy. Nagoski states that confidence means knowing what is true about your body. Joy is loving what is true.
If you are someone who feels broken because your experience is not the spontaneous desire depicted in every romantic comedy you’ve ever seen, knowing that your desire, which builds in response to safety, loving connection, physical touch, or other sexually relevant stimuli, is normal, can help you know what it true about your body. Accepting this part of yourself as good and valid can help you love what it true.
For help working through sexual desire discrepancies in your relationship, or if you struggle to accept and love what is true about your body or your own sexual experience, schedule a session with Alice today. 801-944-4555
Every married couple has problems, so why is it that when we’re struggling in our marriages we can feel so alone? I recently sat down with the ladies of “Good Things Utah” to answer some marriage questions that viewers had written in. Perhaps some of them will mirror your own experiences.
As I continually work with couples on improving their sex lives, one concern I hear frequently is, “Are we having the normal amount of sex?” They worry that if they are having less sex than they did at other points in the relationship, that maybe their sex life is getting worse. The reality is, the number of times you are your partner have sex, isn’t the most valuable information about whether or not you have a high-quality sex life. It is very natural for the quantity of sex to eb and flow throughout a lifetime together. Here are some perfectly normal times to see some changes in the frequency, and perhaps quality of your sex with your partner:
Pregnancy: Though there are some changes in the body during pregnancy that can make sex more enjoyable for women, there are certainly some changes that do not. Some women report that fatigue and sickness during the first trimester of pregnancy, make them feel less sexual desire. Typically, women report the most enjoyable sex during their second trimester of pregnancy. During the third trimester, it is a fight for space in the female body! Additionally, after baby comes, there is no sex at all for at least 6 weeks.
Death and Grieving: Some people report that when they are grieving the loss of a loving one, they feel less desire to be sexually intimate. That being said, some don’t feel that way at all. You shouldn’t feel weird or guilty if you still do have a desire for sex after the death of a loved one. All of these responses fall under the normal umbrella.
Illness: Most people don’t feel like being sexually intimate when they are sick. When our bodies are fighting off illness, survival takes precedence over procreation. Luckily, illness usually only influences our sex lives for a week or so. However, when chronic illness is involved this can take a toll on a relationship. When a partner has cancer, or dementia, or kidney failure, sex becomes one of the last priorities, though sex can still be missed and longed for by both partners.
Distance: This one is obvious… You can’t have sex when you are miles apart. Many couples have to spend time apart due to work, deployments, etc. In these cases, couples should have a plan for how they will maintain intimacy and connection during the time apart.
Depression and Anxiety: Mental health issues can certainly influence sex. Specifically, anxiety and depression, somewhat highjack the mechanisms in the brain and nervous systems that influence our sexual reactivity and receptivity. With professional help and treatment of the illness, these concerns can be resolved or better managed, and couples can learn to have functioning sexual relationships.
Stress and Fatigue: Stress also interferes with some of the biological mechanisms that influence sexual receptivity. When our bloodstream is raging with the stress hormone Cortisol, our nervous system is not typically apt to engage in sex. High levels of fatigue can also decrease desire. You may be noticing a pattern. There is an order of operations in the body; survival first, everything else after. Since sex is not essential for survival, but sleep is, the body will prioritize accordingly.
These certainly aren’t all the reason sex may struggle in a marriage. They are however, some of the big ones. Men and women all report times when sex wains. There are stereotypes that men always want to have sex and that women are always the ones turn men down. That’ s simply not true. Men and women,though different, have many sexual similarities. For help with your sexual relationship, schedule an appointment today.