1. Female sexual desire is dependent on male erections. I wish I were making this up. Dr. X stated that the female sexual desire drops due to their partners’ ED; implying that female sex drive is equally as high and as focused as male sex drive. I’m not sure where he came up with this one. Certainly not from the research, which indicates external things like relationship issues, stress, etc. affect female sex drive. I suppose the male erection could be included in that list, but it is far from the only factor. In addition, research shows that the male sex drive is higher as compared to female sex drive. To believe that female sexual desire operates like male sexual desire means you are not keeping up with the literature.
2. If men cannot get an erection their sex life is over. To think that penile-vaginal penetration is the only sex act is myopic at best and devastating at worst. Even with the treatment that is available, what about the men who cannot take ED drugs, are unwilling to take them, or what if they don’t work? Assuming ED means never having sex again is akin to sentencing men to a life alone. Completely unacceptable and unnecessary. Fortunately, that is not the case. There are many more sexual acts to choose from. Plenty.
3. And, the corollary: Having sex = having intercourse. Several times, Dr. X used these terms interchangeably. What about role-play, oral stimulation, manual stimulation, erotic massage, etc., etc., etc.? All of these are very enjoyable ways of being physically intimate with your partner that don’t require penetration. And erections are only required for penetration. Men can experience pleasure, including orgasm, without an erection.
4. There are no psychological aspects of ED. During the show I raised the point that anxiety about ED can make the problem worse, and that the partner’s reaction to ED can also contribute to anxiety about it, creating a negative feedback loop. Rather than acknowledge that there is a psychological component, Dr. X simply spoke of all the “couples he has helped” by giving the men drugs. Clearly, he fails to view the problem holistically. Certainly physical issues are a possible cause (and I always send my clients for a medical check-up for this very reason), but psychological factors also contribute, and if they aren’t addressed the problem can continue. In another words, psychological treatment may make ED drugs unnecessary.

In summary, if you are experiencing ED, or any other sexual dysfunction, be sure to use a practitioner that believes in BOTH the physical and psychological aspects of the problem.

Recently I attended a conference featuring a semi-famous couples counselor. During the conference, as we were discussing infidelity, the topic of whether or not to keep secrets arose. The speaker, although she had been trained otherwise, now believes in keeping secrets. That is, she has “complete confidentiality and privacy” in her individual sessions. A lively discussion ensued, in which I found myself publicly disagreeing with her. Here’s how it went.

Before I tell you her position, I need to tell you that never once did she use the words “research” or “evidence-based.” Instead, she acknowledged that these were her opinions, although there had “recently been articles backing me up.” What kind and how many she did not say. Nor did anyone ask.

The speaker, whom I will call Ms. X, stated that in order to do couples therapy you must keep secrets. Meaning, if one partner told you something they didn’t want the other partner to know then you couldn’t tell the other partner. She gave three main reasons for this. The first is that she “doesn’t want to be the village idiot, the fool who doesn’t have all of the facts.” Second, she also thinks that when people aren’t guaranteed complete confidentiality they will lie in their individual sessions. Third, she thinks counselors are willing to keep secrets in other areas, so why not sex? This last point is based upon her view that Americans are irrational about sex; that in other parts of the world infidelity is much more accepted.

Let me refute her points one by one.

1. I would never make a judgement about what to do in therapy to avoid looking foolish. All of my decisions in the couples therapy process are to benefit the couple. I don’t care what I look like. My ego stays at home where it belongs. The couple’s relationship is my client, and I will do whatever I can in whatever way to benefit that client.

2. Sure, people can lie in their individual sessions. Sometimes people do that. However, if people know they aren’t going to be held accountable for what they say in their individual sessions, doesn’t that create a situation in which they would be more tempted to attempt to manipulate the therapist? On the other hand, by telling both partners up front that anything they share in an individual session that affects the relationship is fodder for future couples sessions, they know they will be held accountable.

3. My policy is consistent whether we are talking about sex or not. There are certain things partners have the right to know. In an attempt to prove her point, Ms. X asked me if stealing $50,000 was a secret that has to be revealed. Yes, it is. What about the fact they were never sexually attracted to their partner? Yes, also a secret I cannot keep. Why? Because these are two very important facts that the other partner has a right to know. Don’t you think that perhaps they may change their mind about being in the relationship if they knew all of the facts? Don’t they have a right to make informed choices? Even though my client is the relationship, sometimes relationships shouldn’t be maintained. And this isn’t my decision to make. Which is what I could be doing if I withheld information.

With all that said, I don’t “out” people by reporting to their partner what they said. Rather, I work with them to communicate the information to the partner themselves.

But my biggest worry about keeping secrets in couples therapy has nothing to do with any of these arguments. It is simply that I have an allegiance to the couple. Not any individual. It is the couple that has sought help, not the individual. If I keep a secret, that affects both my relationship with the couple, and each individual, because I could be perceived as forming an alliance with one partner to the detriment of the other. How is that helpful?

And I until I see evidence to the contrary, this will be my position. No matter how many semi-famous people publicly disagree with me.

Take it away, Joy…

While we can’t avoid every health issue there is more within our control than we may want to admit. Science tells us that health is based on three things: diet, lifestyle, and environment. Our genes may predispose us to certain conditions but do not mandate that we will have them. Put another way, genetics load the gun but environment – the quality of our food, water, air, and lifestyle – pulls the trigger.  Here are three things we can do something about.

Breast Cancer risks increase with age due to longer exposure to toxins, estrogen, and lifestyle choices.  Strengthen your health with Vitamin D-rich foods, also a powerful player in bone health. Not many foods are naturally high in vitamin D but a few good sources are salmon, cheese, beef liver, and egg yolks. Fortified foods such as milk products like yogurt are sources and a small amount is in mushrooms. Leafy greens such as kale and spinach are your new best friends. Others are variety of vegetables – particularly cruciferous – such as cabbage, cauliflower, bok choy, broccoli, kale, collards and Brussels sprouts. Plus healthy oils like olive oil, Omega 3-enriched eggs and cold water fish such as salmon which also increase Vitamin D. By increasing your intake of Vitamin D-rich foods you also knock down your risk of colon cancer, osteoporosis, and multiple sclerosis. Your best source of Vitamin D – the sun. Improve your environment by getting outside and exercise regularly.

Cardiovascular Disease is the number one killer in America according to the Mayo Clinic, and it’s not just a man’s disease.  Magnesium is key to good cardiovascular health and you can find it in whole grains, nuts, seeds, lentils, legumes and dark leafy greens – did I say kale and spinach?  Ditto on Vitamin D and Omega 3 fats which come easily from the foods mentioned above.  Giant leaps towards cardiovascular health include maintaining a healthy weight, not smoking, and getting plenty of exercise which benefits circulation.

Safe Food. Every day we vote with our forks and wallet by the food choices we make. Starting today, buy your chicken raised organically.  Just say NO to genetically modified foods and say YES to leafy greens, vegetables, fruit, whole grains, omega 3-rich foods every day. Be sure to choose organic for those fruits and vegetables that cannot be peeled before consumption as this is where the highest concentration of pesticides are (strawberries, cherries, peaches, celery, blueberries, etc.).  If you choose conventional produce buy US-grown which may have fewer pesticides than foreign produce. Plus we manufacture and export pesticides to countries that grow our produce which they send right back to us.

Lastly, remember to see your health care professionals regularly. Prevention is much better than cure.

Joy, take it away…

For decades the Centers for Disease Control (CDC) has been on the fence about antibiotics usage on livestock citing lack of proof that the practice may create antibiotic resistance in humans. This July ABC News reported that antibiotic-fed chicken has been linked to Urinary Tract Infections (UTI) in women.  DNA evidence – also known as a smoking gun - finds a bug-for-bug match of an E. coli strain on live chickens, their processed meat, and the bacteria found in women’s urine samples.  Those who have had a bladder infection know how impactful it can be on daily life. An increasing number of women are having UTIs for a month or more requiring multiple antibiotics. Aside from real pain, frustration and hours lost hovering near bathrooms, say “hello” to possibly weeks of no or considerably less sex. Add to that a weakened immune system and you’ve just opened the door for other opportunistic disease to occur.

For more information, please visit the Superbug report.

1. Lose weight. The absence of disease doesn’t mean good health. If you are overweight, there is much more going on than larger briefs. Excess baggage sets the stage for diabetes, coronary heart disease, stroke, and cancer, any of which may come without warning or take years to show symptoms. And your penis doesn’t like it, either.

 

2. Eat right. Men’s nutritional needs are different than women’s. Aside from a balanced diet, water, regular exercise, and adequate sleep, a man’s infrastructure requires high performance support.  Active men need a daily supply of vitamin B-rich foods to boost energy levels and stamina. As a team, B vitamins cover the bases of many major body functions, including the nervous and digestive systems, immune system, metabolism, and detoxification. Individual B vitamins will vary in their food sources, so to obtain the whole spectrum choose from a variety of whole unprocessed foods, lean animal protein, nuts, eggs, dairy, dark leafy greens, vegetables, beans, and whole grains.  B vitamins are not stored in the body and must be replenished daily.

 

3. Do right for your age.  Each decade of a man’s life has certain maintenance requirements:

 

1. In your 30’s, regular exercise supports a healthy blood pressure and cholesterol level, both which tend to rise in this age group. ¹ Antioxidants and minerals, including dark leafy greens, multi-colored vegetables, beans, nuts, and seeds are important for sexual health.  Nitric oxide, a vasodilator under study for enhancing athletic performance, is known for decreasing blood pressure and increasing blood vessel integrity. Foods rich in nitric oxide include celery, red beetroot², watercress, lettuce, spinach, arugula, Chinese cabbage, leeks, fennel, kohlrabi, and parsley. ³   Yes, this means eating your veggies will help you maintain an erection. Remember, you heard it here first.

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2. In your 40s’s, exercise and be sure to anti-inflammatory foods that may help joint pain include spices such as ginger, turmeric, sulfur-rich onions and garlic, omega-3-rich fish (salmon), and nut oils. Of course you’ll still keep exercising and keeping up your intake of antioxidants and minerals. Because when you are feeling good and have energy, your sex life will be so much better!

 

3. In your 50’s, a balanced diet with lean protein, whole grains, a wide assortment of greens, vegetables, and fruits fortify the body for quicker recovery from illness. And don’t forget to get your prostate checked because prevention is better than the cure, which can cause erectile problems and lowered sexual desire.⁴ And, of course you’ll still be exercising, keeping up your intake of antioxidants and minerals, and eating anti-inflammatory foods.

In summary, stop the supersized meals and use fried foods as an occasional treat instead. Eat a balanced diet and exercise regularly. Get periodic checkups and lose weight. I know I sound like your mother, if your mother really cared about your penis and your golf game. For personalized dietary recommendations contact a Registered Dietician in your area by visiting www.eatright.org. For sexual issues, visit a qualified sex therapist.

Recommended Reading:

¹Nitrates in Food: Can They Lower Blood Pressure? 

²Beet Juice and Athletes 

³Nitrates lower blood pressure: nutrient found in spinach, other vegetables keeps blood vessels healthy. 

⁴Enlarged Prostate: A Complex Problem

Key findings include:

1. Psychotherapy is effective for a variety of mental conditions
2. Psychotherapy is effective for many different types of people (ie. young or old)
3. The benefits of psychotherapy tend to last longer as compared to psychopharmaceutical drugs
4. The benefits of psychotherapy tend to outweigh the benefits of  psychopharmaceutical drugs
5. Psychotherapy, unlike psychopharmaceutical drugs, does not have any side effects
6. Even when psychopharmaceutical intervention is required, a combination of psychotherapy and psychopharmaceuticals is more effective than psychopharmaceuticals alone

Unfortunately, the APA also found that psychotherapy, despite its many benefits, is underutilized. Perhaps this is due to the stigma of receiving mental health services, or the misconceptions that people have about it. Regardless, it is time to reconsider therapy as a necessary tool and resource for those suffering from emotional issues.

I treat many couples in my office suffering from ED. Note that I stated couples and not individuals. That’s because ED is a couples problem. It occurs (generally) within the context of a relationship, and the reactions and feelings of the partner can have a direct effect. Not only that, but relationship issues themselves, including anger and lack of emotional intimacy, can affect men as well as women and actually cause ED!  In general, the woman feels rejected and unattractive; and the man feels inadequate and pressured to perform. All of these feelings, when not dealt with properly, can make ED worse. If left untreated, ED can end relationships. Ironically, it’s usually not the ED condition itself that ends the relationship. It’s the unresolved and mishandled negative emotions about the ED. That’s where sex therapy can be very beneficial.

Although the male sex drive is generally stronger and more focused than the female sex drive, men are still affected by emotional and environmental factors. Women often forget this. ED can also decrease sexual desire in males, mainly due to the negative emotions and recent memories of the last sexual experiences.

Education and information can go a long way to reducing the negative effects of ED. In fact, a lot of what I do in my office is educate couples. Sometimes, the information alone is sufficient to solve the problem. It’s amazing to me how many couples have perceptions based upon misinformation. Years and years of invalid perceptions.

So…here are some links to slideshows for  more information, including all of the various causes of ED:

1. Things that can deflate your erection
2. A virtual guide to ED

And, remember, you don’t have to face ED alone. Call your local sex therapist, TODAY. Don’t wait. As many of my sex therapy clients state, “Wow, this wasn’t nearly as painful as I thought!”

The good news is that there are ways to cope with bullies. The most important way is to remove their reward. People bully because they enjoy controlling people by intimidating them. They bully people who don’t stand up for themselves and allow themselves to be controlled. Remove the ability to control, and you’ve just taken away the bully’s reward, and therefore their motivation.

In order to do this, you must be assertive. Do not resort to the bully’s low level of behavior, but do not allow yourself to be intimidated, either. Stand up for yourself without personally attacking the bully. But don’t be overly defensive — this could signal weakness to the bully and make the situation worse. Simply state the facts and move on.

Often bullies are sneaky (cowards in disguise). They will make indirect remarks that place your reputation into question. They will twist facts, omit important details and tell half-truths. They will make ambiguous statements that leave doubt in the listener’s mind. When this happens, the best way to respond is to look the bully in the eye and ask “What do you mean by that?” This places the bully in a position where they must defend themselves. Congratulations, you have just shifted the dynamic. You have now joined the offense, placing the bully by default into the defensive position. This will confuse and disorient the bully. And there is nothing more satisfying than a confused bully.

Another effective response is silence. This works best in person, where you can look directly at the bully to indicate that you have heard him or her, and are choosing not to grace them with a response. Body language is key here. Don’t smile or nod, rather, give them a slightly disgusted or exasperated look.

Lastly, if the bully is outright abusive, simply tell them you aren’t going to allow them to speak to you like that. Chances are, none of their previous victims has ever had the courage to do this, and so again, you are disorienting the bully. More importantly, you are training the bully by removing the reward for their behavior.

I have used all of these techniques in various situations over my twenty year tenure in Corporate America. All were successful. One actually got public recognition, a statement of thanks from previous victims, with the hope that if he stopped abusing me, he would stop abusing others. He never spoke disrespectfully to me again.

For more tips, visit this site.

P.S. A shout out to my friend, Maureen Kuntz, for giving me the idea for this post.

Do you have a partner whose behavior is puzzling? Their words don’t match their actions? For example, a partner who tells you they don’t mind going to your parent’s house for dinner every Sunday but always manages  to be at least a half-hour late? And then when you ask them about this discrepancy, they insist everything is fine? That they really do like your Mother?

Well, there could be two reasons for this behavior. One is that they have a character flaw, such as being disorganized and a poor time manager. And people don’t like to admit to character flaws because it shows weakness, so the flaw may not be immediately apparent. The other possibility is that they are trying to send you a message through their behavior, since that is a more indirect and therefore less confrontative way. The truth is your partner really doesn’t want to have dinner with Mom but they don’t want to tell you because they are afraid you will be offended/get angry. In another words, you could be partnered with someone who avoids conflict, and prefers to manipulate situations through their behavior instead.

In order to address the issue, you have to know which of these two situations you are dealing with. If your partner has a character flaw, then that is something inherent in their personality and you may just have to accept it. It’s possible people can moderate their behavior, but if it’s a lifelong habit then progress will be slow, assuming they are willing to change. (They may not be.) On the other hand, if you are dealing with a conflict-avoider, with some prodding you can get to the heart of the issue. In the dinner example referred to above perhaps the real issue is why your partner doesn’t want to have dinner with your folks every weekend. Once you have the real reason for the behavior, you can then address your partner’s concerns and negotiate a compromise.

Therefore, you can’t solve the problem until you understand its root cause. Is this a character defect you just need to accept, or a conflict-avoidant way of getting a need met? Sometimes this is difficult for couples to discover on their own; your local couples counselor can be of assistance in this area.

P.S. A shout out to my colleague, Anna Lively, who gave me the idea for this topic.

Yes, it seems quite innocent at first. Oh look! There’s an old friend from high school! I think I’ll send him (or her) a friend request. I wonder if they will remember me…yes, we used to date, but that was long, long ago. Surely we are past all that and can still be friends. The next step comes so naturally you won’t even notice it — soon you are commenting on their posts, then you are engaging in online conversation, then you are exchanging private messages, then you are locking your office door and lying about the amount of time you spend on Facebook. You have just crossed the line.

The main problem with Facebook, and other forms of electronic communication, is that they are just so darn convenient. Before cell phones and the internet carrying on an affair was hard work. We didn’t have private cell phones that we could take into the bathroom with us. Texting wasn’t even a verb back then. Basically, we had no way of communicating with someone and keeping it secret unless we did it outside of the home. And that was a pain. Required a lot more effort and creativity instead of just typing in your pajamas in the middle of the night, pretending that you are working.

But where is that line? Do we have to commit Facebook suicide in order to stay faithful? Ditch the texting plans and return to the stone age? “I can’t do that: I need my texting/cell phone/Facebook account for xyz reason” is a statement I frequently hear in my office. The truth? These are just excuses. You KNOW what you are saying is ridiculous; no reasonable person is going to make you ditch all forms of electronic communication. I mean, how else would you keep up with Lady Gaga? You also KNOW where the line is; it’s the same line you don’t cross in real life. It’s when casual encounters with members of the opposite sex turn intimate. Trust me, it’s a slippery slope you do not want to go down. If you are still clueless about where that “line” is, check out this blog entry.

If you really want to cheat on your partner, be mature about it. Be open about the issues and deficiencies in your relationship, and seek help if necessary. Then, and only then, should you consider entering into another relationship. Of course you’ll end your current one first. And by “end” I mean inform your partner in a respectful, consistent and clear manner; not just decide on your own and leave your partner in the dark. Here’s where a good marriage counselor can be invaluable. Even if you think you want to end your relationship, talking to an objective third party can help you clear your head, sort out your priorities and make more reasoned decisions. Defriend your old flame and call a counselor instead. Do it today.