In the beginning of a relationship, coming to work sleepy often means that your sex life is going well. But surveys, experts and common sense suggest that people who are chronically sleep-deprived actually have less sex.

"Sleep and sex is not a topic on which a lot of research has been done," says J. Catesby Ware, MD, the chief of sleep medicine at Eastern Virginia Medical School and the director of the Sleep Disorders Center at Sentara Norfolk General Hospital. "But there are a lot of ways that sleep affects one's sex life."

Some people may be skimping on sleep and sex because of an overly hectic schedule. After all, when you're working long hours and doing your grocery shopping at 10 pm, you probably feel like sleeping when you hit the pillow. Even on the weekends, couples sometimes prefer catching up on their sleep to having sex.

People who do shift work at night may find it especially hard to obtain both sleep and sex. Not only is it is difficult for shift workers and their partners to find a time when they're both free to have sex, but sleep-deprived shift workers are also often too irritable to get in the right mood. Being awake at night also throws off the body's internal body clock, or circadian rhythms, which Dr. Ware says can impair sexual functioning.

Others may have psychiatric or medical problems that interfere with their ability to sleep well and perform well sexually. For example, symptoms of depression and anxiety can include both insomnia and a diminished sex drive. And many antidepressants, which can sometimes cause erectile dysfunction and/or a loss of libido, further complicate matters.

The medical condition most commonly associated with problems with sleep and sex is sleep apnea, in which the airway is sucked shut during snoring. People with sleep apnea may wake up as many as 400 times a night in order to breathe again, and this can cause severe daytimes sleepiness, and irritability. According to Dr. Ware, men with sleep apnea tend to have lower levels of testosterone, which can lower libido.

Other medical conditions that affect sleep and sex include diabetes, lung conditions and heart disease. And as with depression, some medications that treat these conditions don't help one's sex life. For example, medications for high blood pressure-which itself may cause erectile dysfunction in men may affect sexual performance in men by inhibiting blood flow to the penis.

As Dr. Ware explains, "Sometimes the complexity of the interaction among the medication, the disease and the disturbed sleep can all gang up on a patient."

If you think your lackluster sex life is due to poor sleep, try to figure out why you're sleepy, and seek the help of your physician if necessary.

Improving your sleep behaviors, which are known as sleep hygiene, may also help. Good sleep hygiene involves practices such as going to sleep and waking up at the same time each day. Regular exercise and limiting sleep-disturbing substances such as caffeine, alcohol and nicotine can also make it easier to get some sleep-and hopefully some sex.

A third of those with ADHD also suffer from depression, but it can be difficult to diagnose and studies indicate that ADHD and depression should be treated separately.

ADHD does not often come alone. There are many other comorbid conditions that are commonly associated with ADHD. Depression, Bipolar Disorder, Oppositional Defiant Disorder, Conduct Disorders and Learning Disabilities are just some of the conditions that can appear with ADHD. Some studies have indicated that between 50% and 70% of individuals with ADHD also have some other condition. The presence of co-morbid conditions can interfere with treatment, render some treatments ineffective and seems to have a direct correlation on whether ADHD symptoms will continue to cause impairment into adulthood. The positive response to treatment is lower in patients with co-morbid conditions. Patients with at least two co-existing conditions are also more apt to develop conduct disorders and anti-social behavior. Early diagnosis and treatment can many times prevent problems later.

Many with ADHD Also Suffer with Depression

According to studies, anywhere from 24% to 30% of patients with ADHD also suffer from depression. In the past it was thought that depression may have been the result of constant failures due to ADHD symptoms. Therefore, if ADHD was successfully treated, the depression should disappear. Based on this assumption, ADHD was considered to be the primary diagnosis and the depression was ignored. However, a study by the Pediatric Pharmacology Department at Massachusettes General Hospital in Boston, MA indicated that depression and ADHD are separate and both should be treated.

Diagnosis can be very difficult. Stimulant medications, commonly used to treat ADHD, can sometimes cause side effects that mimic depressive symptoms. These medications can also increase symptoms of depression and bipolar disorder, making it hard to distinquish what are the true symptoms and which are caused from medication. Many physicians will, therefore, treat the depression first, and, once that has been controlled will begin to treat ADHD. Depression becomes the "primary" diagnosis and ADHD becomes the "secondary" diagnosis. Other physicians will argue that treatment must be simultaneous, with treatment occurring at the same time. Arguments for this method of treatment say that in order to have either condition under control, both must be under control.

Some of the risks of co-existing conditions (especially undiagnosed and untreated) are:

• Substance abuse
• Development of conduct disorders
• Development of Bipolar Disorder
• Suicide
• Aggressive or Anti-Social Behaviors

Some experts recommend that all individuals receiving a diagnosis of ADHD should also have a complete and thorough psychological evaluation to determine the presence (or absence) of any co-existing disorders. Once this has been completed, a treatment team, sometimes consisting of family physician, psychologist and psychiatrist, can work together to create a treatment plan geared specifically for that individual. If you suspect that you, or someone you know suffers from depression, please consult your physician for referrals to a mental health professional in your area for further evaluation and treatment.

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Table I. Height, Weight, and BMI by Gender and Age Group
Height (cm)			Weight (kg)			Body mass index (BMI)
Age Group	M	SD	M	SD	M		SD
Women
18-29	165.24	7.26	63.08	12.01	23.24		4.35
30-49	164.28	7.42	71.32	17.28	26.43		6.23
50-86	162.54	7.56	69.72	13.29	26.46		5.22
Overall	164.00	7.44	68.63	15.13	25.60		5.63
Men
18-29	179.68	8.03	74.87	12.48	23.18		3.55
30-49	180.45	7.22	83.72	14.14	25.75		3.84
50-86	175.69	7.66	82.26	12.66	26.65		3.30
Overall	178.34	7.87	79.84	13.56	25.13		3.86

 

Table II. Body Image Scores by Gender and Age Group
Physical attractiveness				Body image satisfaction
Group	M		SD	M	SD
Gender
Women	18.57	3.51		31.23	8.56
Men	18.51	3.57		35.46	7.21
Age
18-29	19.80	3.68		33.41	7.56
30-49	18.11	3.49		31.73	8.82
50-86	18.00	3.24		34.80	7.95
Body Image Importance				Body concealment
Group	M	SD		M	SD
Gender
Women	32.00	7.44		15.40	5.72
Men	30.94	7.61		9.77	4.73
Age
18-29	30.83	7.93		12.12	5.12
30-49	31.60	7.03		14.07	6.39
50-86	31.93	7.77		11.91	6.07
Body improvement				Social physique anxiety
Group	M	SD		M	SD
Gender
Women	9.22	3.74		34.50	9.46
Men	8.70	3.70		27.68	8.11
Age
18-29	9.40	3.41		32.47	9.27
30-49	9.05	3.38		32.92	9.95
50-86	8.62	3.45		28.25	8.45
Appearance comparison
Group		M		SD
Gender
Women		10.98		3.29
Men		9.17		3.35
Age
18-29		11.00		3.48
30-49		10.64		3.25
50-86		8.76		3.18

 

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Table III. Unique Body Image Predictors From Regression Equations That Significantly Increased the Prediction of Psychological Functioning at Step 2 Among Men and Women of Different Age Groups
Unique body
Outcome variable	Group	image predictors	[sr.sup.2]
Self-esteem	Women 18-29	None	--
Women 30-49		Social physique anxiety	.06
Body Image Importance			.05
Women 50-86		Physical attractiveness	.13
Men 18-29		Physical attractiveness	.07
Body image importance			.07
Men 30-49		Body concealment	.10
Men 50-86		Appearance comparison	.08
Body image satisfaction			.07
Depression	Women 50-86	Social physique anxiety	.08
Anxiety	Women 50-86	None	--
Men 50-86		Appearance comparison	.11

 

Table IV. Unique Body Image Predictors From Regression Equations That Significantly Increased the Prediction of Social and Sexual Functioning at Step 2 Among Men and Women of Different Age Groups
Unique body
Outcome variable	Group	image predictors	[sr.sup.2]
Social anxiety	Women 50-86	Social physique anxiety	.08
Body improvement			.07
Men 30-49		Appearance comparison	.08
Same-sex relations	Men 30-49	Physical attractiveness	.13
Opposite-sex relations	Men 18-29	Body concealment	.09
Sexual self-efficacy	Men 30-49	Body satisfaction	.09
Sexual satisfaction	Men 30-49	Appearance comparison	.12
Body concealment			.10
Body satisfaction			.08
Sexual optimism	Women 30-49	None	--
Men 30-49		Social physique anxiety	.18

 

 

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Tanya E. Davison (1) and Marita P. McCabe (1,2)

(1) School of Psychology, Deakin University, Melbourne, Australia.

Ritalin is not addictive when taken as prescribed by doctors. But there is a high level of Ritalin abuse. 30-50% of adolescents in drug treatment centers report abusing Ritalin. (Source: University of Utah Genetic Learning Center)

Methylphenidate (Ritalin) is a medication prescribed for individuals (usually children) who have attention-deficit hyperactivity disorder (ADHD), which consists of a persistent pattern of abnormally high levels of activity, impulsivity, and/or inattention that is more frequently displayed and more severe than is typically observed in individuals with comparable levels of development. The pattern of behavior usually arises between the ages of 3 and 5, and is diagnosed during the elementary school years due to the child's excessive locomotor activity, poor attention, and/or impulsive behavior. Most symptoms improve during adolescence or adulthood, but the disorder can persist or present in adults. It has been estimated that 3-7 percent of school-age children have ADHD. Ritalin also is occasionally prescribed for treating narcolepsy.

Health Effects

Methylphenidate is a central nervous system (CNS) stimulant. It has effects similar to, but more potent than, caffeine and less potent than amphetamines. It has a notably calming and "focusing" effect on those with ADHD, particularly children.

Recent research at Brookhaven National Laboratory may begin to explain how Ritalin helps people with ADHD. The researchers used positron emission tomography (PET—a noninvasive brain scan) to confirm that administering normal therapeutic doses of methylphenidate to healthy, adult men increased their dopamine levels. The researchers speculate that methylphenidate amplifies the release of dopamine, a neurotransmitter, thereby improving attention and focus in individuals who have dopamine signals that are weak.¹

Methylphenidate is a valuable medicine, for adults as well as children with ADHD.^{2, 3, 4} Treatment of ADHD with stimulants such as Ritalin and psychotherapy help to improve the abnormal behaviors of ADHD, as well as the self-esteem, cognition, and social and family function of the patient.² Research shows that individuals with ADHD do not become addicted to stimulant medications when taken in the form and dosage prescribed by doctors. In fact, it has been reported that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.^{5, 6} Also, studies have found that individuals with ADHD treated with stimulants such as methylphenidate are significantly less likely than those who do not receive treatment to abuse drugs and alcohol when they are older.⁷

Because of its stimulant properties, however, in recent years there have been reports of abuse of Ritalin by people for whom it is not prescribed. It is abused for its stimulant effects: appetite suppression, wakefulness, increased focus/attentiveness, and euphoria. Addiction to methylphenidate seems to occur when it induces large and fast dopamine increases in the brain. In contrast, the therapeutic effect is achieved by slow and steady increases of dopamine, which are similar to the natural production by the brain. The doses prescribed by physicians start low and increase slowly until a therapeutic effect is reached. That way, the risk of addiction is very small.⁸ When abused, the tablets are either taken orally or crushed and snorted. Some abusers dissolve the Ritalin tablets in water and inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels.

Trends in Ritalin Abuse

Monitoring the Future (MTF) Survey *
Each year, MTF assesses the extent of drug use among adolescents and young adults nationwide. MTF 2004 data on annual** use indicate that 2.5 percent of 8th-graders abused Ritalin, as did 3.4 percent of 10th-graders and 5.1 percent of 12th-graders.

Other Studies

ADHD has been more frequently reported in boys than in girls; however, in the last year, the frequency among girls has greatly increased.⁹

A large survey at a public university showed that 3 percent of the students had used methylphenidate during the past year.¹⁰

Other Information Sources

Because stimulant medicines such as Ritalin do have potential for abuse, the U.S. Drug Enforcement Administration (DEA) has placed stringent, Schedule II controls on their manufacture, distribution, and prescription. For example, DEA requires special licenses for these activities, and prescription refills are not allowed. The DEA web site is www.usdoj.gov/dea/. States may impose further regulations, such as limiting the number of dosage units per prescription.

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* These data are from the 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan's Institute for Social Research. The survey has tracked 12th-graders' illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

** "Lifetime" refers to use at least once during a respondent's lifetime. "Annual" refers to use at least once during the year preceding an individual's response to the survey. "30-day" refers to use at least once during the 30 days preceding an individual's response to the survey.

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1 Volkow, N.D., Fowler, J.S., Wang, G., Ding, Y., and Gatley, S.J. (2002). Mechanism of action of methylphenidate: insights from PET imaging studies. J. Atten. Disord., 6 Suppl. 1, S31-S43.

2 Konrad, K., Gunther, T., Hanisch, C., and Herpertz-Dahlmann, B. (2004). Differential Effects of Methylphenidate on Attentional Functions in Children With Attention-Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry, 43, 191-198.

3 Faraone, S.V., Spencer, T., Aleardi, M., Pagano, C., and Biederman, J. (2004). Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J. Clin. Psychopharmacology, 24, 24-29.

4 Kutcher, S., Aman, M., Brooks, S.J., Buitelaar, J., van Daalen, E., Fegert, J., et al. (2004). International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): Clinical implications and treatment practice suggestions. Eur. Neuropsychopharmacol., 14, 11-28.

5 Biederman, J. (2003). Pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) decreases the risk for substance abuse: findings from a longitudinal follow-up of youths with and without ADHD. J. Clin. Psychiatry, 64 Suppl. 11, 3-8.

6 Wilens, T.E., Faraone, S.V., Biederman, J., and Gunawardene, S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 111, 179-185.

7 Mannuzza, S., Klein, R.G., and Moulton, J.L., III (2003). Does stimulant treatment place children at risk for adult substance abuse? A controlled, prospective follow-up study. J. Child Adolesc. Psychopharmacol., 13, 273-282.

8 Volkow, N.D. and Swanson, J.M. (2003). Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am. J. Psychiatry, 160, 1909-1918.

9 Robison, L.M., Skaer, T.L., Sclar, D.A., and Galin, R.S. (2002). Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs, 16, 129-137.

10 Teter, C.J., McCabe, S.E., Boyd, C.J., and Guthrie, S.K. (2003). Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors. Pharmacotherapy, 23, 609-617.

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Trust takes years to develop and only a moment to destroy. Ronn Elmore, Psy.D., explains how trust works and how to rebuild trust in your relationship

Carol had always known Melvin was passionate about cards. The two first met at a bid-whist party, where the host teamed them up. But she had no idea how obsessed Melvin was with gaming until the night she woke up from a sound sleep to find her husband of ten years slumped over the edge of their bed. When she asked what was wrong, he confessed that he'd messed up--really bad. In a series of lunch-hour visits to a nearby casino, Melvin had blown nearly $8,000 of the college fund they'd set up for their three children.

In that moment, Carol* felt as if her world had caved in. Losing the money was bad enough. But what stopped her cold was the realization that if the man she thought she knew inside out could do something like this, then who was he? Carol wasn't sure she could ever trust him again.

The Nature of Trust

Over the years, many women and men have sat on my counseling couch and shared their stories of violated trust. Their reactions seldom vary: "It felt as if he ran me over with a truck--I never saw it coming 'til it was too late." "Now I wonder if loving somebody is too dangerous to let happen again." "I've pretty much gotten over the hurt feelings, but I honestly don't know if I'll ever be able to trust my own judgment."

For trust to flourish, you have to believe that you know your partner's character and conduct intimately. The two should match and be consistent over a significant period of time. Trust isn't an investment blindly made but, rather, is a natural response to another's trustworthiness. Trust follows trustworthiness--not the other way around.

Doling out your trust before it's earned is often a recipe for disaster. Take the story of my client Nicole, a successful 38-year-old graphic designer who used her good credit standing and the equity in her home to launch a consulting business with her new boyfriend Jared. Though she'd only known Jared for a few months, she'd fallen for him in a big way. Nicole couldn't imagine that such a sweet-natured and hardworking man could deceive her, so she gave him full access to everything--including her home.

It proved to be a tragic mistake. Jared was a scam artist with a string of criminal convictions. Nicole lost both her impeccable credit and her house. Five years after incurring huge financial losses, Nicole says, "1 prided myself on being able to read a person's character instantly. Now I know that judging someone based on an instant read is just plain dumb."

On the other hand, it's unhealthy to approach every relationship with your guard up. Far too many of us have been raised to believe that we shouldn't trust anyone, even if that person has proven himself to be trustworthy. When every move your partner makes is filtered through a lens of suspicion, the relationship never really has a chance to grow.

So much in life is unpredictable. That's why we all need to know with some degree of certainty that we can count on the people we keep close to us. When your partner repeatedly makes choices that are consistent with his promises--keeping appointments with you, showing up on time, handling his share of the financial responsibilities--your confidence in the relationship grows. Conversely, when a mate's behavior is marred by selfishness, broken promises, chronic irresponsibility, infidelity or, as in Melvin's case, financial deception, trust is eroded. Can a relationship rebound from such a breach? The answer is a resounding yes, but only with a sincere commitment from both parties to rebuild what has been damaged.

When Trust Is Lost

No two stories of shattered trust are alike. But as these examples (based on real couples I've counseled) illustrate, one principle is universal: It takes time--and lots of hard work--to learn to trust again.

John and Vivian: Undercover Addiction

The situation: John and Vivian met at an Alcoholics Anonymous meeting. She had been clean and sober for more than nine years, he for just more than a year. Vivian first caught John's eye when she stood at the podium to share the gritty story of her troubled life and past addiction to alcohol and prescription drugs. "She was so gorgeous, I couldn't take my eyes off her," he recalls. "But what hooked me was her incredible honesty and the commitment she had to her sobriety." They soon became best friends, and after Vivian supported John through a bout with clinical depression--and the serious threat of a relapse into drinking--romance bloomed. "I thought of her as my perfect angel," he says.

Two days after the couple announced their engagement, John's neighbor, who had just gotten a job at a drugstore on the other side of town, called him and dropped a bombshell: On her first day on the job, she had spotted a poorly disguised Vivian trying to fill a prescription for codeine by using a fake name and ID. With a little more investigation, he learned that his "perfect angel" had been getting drugs there for months. Vivian was using again.

The aftermath: When John confronted Vivian she denied everything. She eventually came clean, tearfully vowing that it would never happen again. John asked her to publicly confess her relapse to their AA group and go to counseling. Vivian agreed to the counseling but persuaded John that the public confession was a bad idea "that would discourage others who looked to her as a role model." John didn't push her. "As usual, when it came to AA stuff, I always went along with what Vivian said," he says.

The turning point: As serious as Vivian's drug use was, it was only a symptom of more deeply rooted issues, as she learned during the counseling process. "I was really addicted to being perceived as perfect and maintaining the approval--from John and everyone else--that comes with it," she explains. John's baggage had also played a part in the couple's drama. "I hadn't owned up to the pressure I put on Vivian by treating her like she was my spiritual guru instead of my girl," he says. "I didn't even want to know that she might struggle with some fears or weaknesses just like anybody else. Who wants to admit that their guru has clay feet, too?"

The road to recovery: For Vivian and John, moving forward meant starting over. They put their wedding plans on hold and, with counseling, worked to build a new, mutually honest relationship. Vivian committed to being more open about her moments of self-doubt and her struggles with perfectionism. John said he would strive to be more attentive to Vivian, even when she revealed things about herself that he didn't want to hear. He also resolved to be more assertive about holding Vivian--and himself--accountable as they worked to rebuild their relationship.

Dina and Lee: Serial Infidelity

The situation: Dina had a gut feeling something was wrong. It was similar to the one she had had when her husband, Lee, stepped out on her for the first time. There had been too many last-minute business trips and too many nights without a call to say he'd made it safely to his destination or simply to see how things were holding up on the home front. And that's not all that was unusual: "I had noticed that we hardly ever argued anymore and that we weren't having sex quite as much as before," she says.

Dina finally followed her hunch and hired a private investigator to check up on her husband's suspicious behavior. Two weeks later he confirmed her fears: Lee, Dina's husband of 17 years and father to their four children, wasn't leaving town as much as he said; he was checking into local motels--and not alone. Dina actually knew Lee's new mistress. It was Celeste, the marketing specialist Lee had hired away from another software firm to help turn his company around. After she came on board, business was booming and Celeste made partner.

The aftermath: When Dina confronted him, Lee was contrite and immediately ended the affair. He agreed to go to couples counseling for as long as she thought necessary. But he refused to fire Celeste. Getting rid of her at that point, he insisted, would leave a gaping hole in the company. To Lee, firing Celeste would be financial suicide.

Dina made vague threats of divorce but never acted on them. Instead, she insisted that her husband recount the minute details of the sordid affair. On more than one occasion she became physically violent toward him. He called her hysterical and tried to stay out of her way.

The turning point: Their tug of war went on for nearly a year until the day Dina realized she was as angry with herself for her passivity as she had been with Lee for his infidelity. She wasn't sure she could rally herself to take necessary action on her own, so she rejoined the women's prayer group that she had abandoned after Lee's affair had become known. "I started feeling my confidence come back after one of the sisters in the group who'd been through this herself looked me in the eye and said, 'If you don't expect your husband to treat you with respect, then why should he?' "Dina summoned her courage and calmly but firmly issued an ultimatum: Either Lee would send Celeste packing, or he'd have to pack his own things and find a new place to call home.

The road to recovery: Lee wanted a business that included Celeste, but he decided that if he had to make a choice, his marriage and family came first. He negotiated a buyout settlement with Celeste and helped her find a position out of state. For a time the business faltered, but it didn't collapse. Within a year Lee's company--and marriage were afloat again.

Whenever Dina began to obsess about Lee's transgression, she reminded herself that most of their time together had been good. I value my marriage, she told herself. Then Lee jump-started his recovery by participating in an intensive therapy group for men with a history of sexual infidelity. "I discovered that my struggle was about selfishness, thinking I had worked so hard that I deserved to have whatever I wanted," he says. And day after day, month after month, Lee did everything Dina asked and more in order to prove to her that having her in his life meant more to him than anything else.

Making Up and Moving On

At first, getting beyond a loss of trust, to have a relationship that feels normal again, may seem impossible. But with time, relationships can and do recover. After Melvin's late-night confession that his gambling had gotten out of control, he and his wife separated briefly but eventually chose to reconcile. "We had had ten great years together," Carol says. "We know we can't ignore what happened, but we just couldn't go out like that." Melvin adds, "I did have to work a lot of overtime to put back what I took, but I did what I had to do." He was probably talking about the balance of their bank account, but he could just as well have meant the level of trust in their marriage. In the end, it's important to take your mate's entire history into account, not merely one dark chapter. Consider that if the situation were reversed, you'd hope he or she would do the same. Rather than wallow in the past, resolve to envision an intimate, trusting future together--and to rise each day focused on your pursuit of it.

* All names and identifying information have been changed.

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STEPS TO RESTORE TRUST

How do you begin again after the confidence you've placed in a relationship has been betrayed? These guidelines can help you regain your faith and get your relationship back on track

1. Expect an apology. You deserve it. It can be difficult for someone to own up to what they've done. But in order to move on, the offending party has to admit guilt and sincerely apologize for the harm they've caused. I'm sorry I squandered our money and deceived you about it. I regret I was unfaithful and put our relationship at risk. An apology won't dissolve the hurt or guarantee a breach of faith won't happen again. But it is a critical first step.

2. Try to understand why it happened. If you focus only on the "dirty deed," you'll find yourself caught up in a whirlpool of debilitating emotions: anger, guilt, withdrawal, depression. Both you and your partner must try to figure out what led to the transgression. Character flaws and bad conduct may not tell the entire story. Inattentiveness, poor communication and misplaced priorities can also lead to behaviors that trigger a breakdown in trust.

3. Get some help. The more devastating the incident, the less likely you'll be able to handle the fallout on your own. Seek the support of professional counselors, a spiritual adviser or a few trusted friends who can help you sort things out in a way that's productive, not punitive.

4. Spell out your expectations. For example, ask that he cease all visits to X-rated Web sites, or that she make no credit-card purchases over $50 without mutual agreement. It may seem as if you're keeping your mate on a short leash, but in fact, his freedom and credibility will grow as he consistently proves by his actions that he can be trusted.

5. Make your commitment clear. Show your mate that you, too, are willing to make some concessions as you work together to reconcile the relationship. Your mutual accountability reinforces your commitment to developing a long, stable future together in spite of what has happened in the past.

Ronn Elmore, Psy.D., is a relationship therapist, ordained minister and author. His latest relationship book is An Outrageous Commitment: The 48 Vows of an Indestructible Marriage (HarperResource).

Phillip Sharp Ph.D. has spent the past 5 years developing a specialty in the field of Sexual Addiction counseling, including incest and sexual perpetration issues. He works with sex addicts, their spouses or partners, and families. Dr. Sharp is our guest speaker tonight.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Sexual Addiction". Our guest is psychologist, Dr. Phillip Sharp, who is a specialist in the field of sexual addiction counseling. Dr. Phillip Sharp's early training included work with families dealing with incest and sexual perpetration issues. Over the past 5 years, Dr. Sharp has developed a specialty in the field of Sexual Addiction counseling, working with sex addicts, their spouses or partners and families. We'll be talking about treatments for sexual addiction as well as the impact it has on family members -- and more importantly, what can be done to help.

Good Evening, Dr. Sharp and welcome to HealthyPlace.com. We appreciate you being here tonight. I know our audience members have different levels of understanding, so briefly, can you define sexual addiction. Then we'll get into deeper issues.

Dr. Sharp: The definition varies depending upon what expert you talk to. Generally, it is a pathological relationship with a mood altering experience. In this case - sex.

David: How does a person develop sexual addiction?

Dr. Sharp: There are various paths by which a person can progress down the road of sexual addiction. Most people have some pain or injury that they seek to heal, numb or medicate. The sexual behavior becomes their primary coping mechanism.

David: And just so everyone knows, does sexual addiction only involve sex with other individuals, or does it cover pornography and other sexual activities?

Dr. Sharp: It covers any activities related to the theme of sex. It is not simply acting out with another person. It includes, pornography, fantasy, masturbation, 900 numbers, etc. The important point to remember is that it is a pathological relationship. Out of the ordinary.

David: When you spoke of "pain" or "injury" a moment ago, I'm assuming you are talking about emotional or psychological pain. Can you explain further?

Dr. Sharp: Yes. The pain usually has to do with some experienced or perceived injury, which the person may or may not be consciously aware of. It can include things such as emotional neglect in the family of origin, rejection from peers or even childhood abuse.

David: What kind of treatment is involved in dealing with sexual addiction?

Dr. Sharp: It depends on the persons underlying issues (pain) and the level of their addiction. Some folks can do fine in a general weekly therapy session with an appropriately trained professional. The therapy will likely need to be supplemented by participation in a 12-step recovery group. Other folks who have a deeper level of addiction may need to go away to an inpatient treatment center.

David: Does a person who has a sexual addiction usually have other addictions (drug, alcohol) as well?

Dr. Sharp: That is often the case. I would say it is more the norm that they will either have another addiction or abuse some other substance or process.

David: We have a few audience questions Dr. Sharp:

lostforwords: Can depression/anxiety bring on sexual addiction?

Dr. Sharp: It can help to trigger it. Usually, depression and anxiety are due to other underlying issues. The underlying issues, such as unresolved trauma often fuel both sex addiction and depression/anxiety.

David: Like other addictions, I imagine there is "no cure," but rather sexual addiction is managed on a day-by-day basis. Is that true?

Dr. Sharp: Yes, that is true. A person is typically in recovery for the rest of their lives.

David: And what about the ability of a sex addict to have close personal relationships?

Dr. Sharp: When the sexual addiction is active, it usually severely hampers and disturbs truly intimate relationships. It is hard to spend all of the time that the addict puts into their acting out behaviors and still maintain the level of attention that a personal and close relationship requires. In recovery, the person has the best chance of maintaining close relationships.

David: Here's another audience question:

iaacogca: I have heard it said that not all love addicts are sex addicts but all sex addicts are love addicts. Comments?

Dr. Sharp: I disagree. Sex addiction has nothing to do with love really. It's really about loneliness, the inability to connect intimately and an attempt to deal with the pain of the real loneliness. At the heart of it, sex addicts, although some are extremely sociable and outgoing, are truly lonely people who feel disconnected.

mrlmonroe: Being new to this, what is "acting out". In other words, what types of behaviors would be considered acting out - besides the obvious?

Dr. Sharp: A person can act out or act in. Acting out refers to behaviors external to the self, such as careless and senseless sex, masturbation, pornography, chat rooms and 900 numbers. A person can act in with fantasy and distorted perception of reality.

Rhino1: What can a person do to help their spouse understand the addiction?

Dr. Sharp: I suggest that first of all, you educate yourself by reading some of the books written on the issue. For instance, Patrick Carnes, PhD has authored a number of good books. His original work was entitled Out of the Shadows: Understanding Sexual Addiction, he also wrote: Contrary to love: Helping the Sexual Addict, Don't Call It Love: Recovery From Sexual Addiction, and Sexual Anorexia: Overcoming Self-Hatred.

Once you get an understanding of the addiction, then you need to think about confronting your partner with the unhealthy behaviors that you have observed. If you find this difficult, you may want to consult with a professional. It's just as important for the partner to get support and assistance.

David: I'm sure it is very difficult on spouses and partners of addicts too, especially since fidelity is the cornerstone of most marriages. How is a spouse or partner supposed to "understand" this type of behavior?

Dr. Sharp: It's a sickness, a disease, and it usually doesn't appear out of nowhere. The disease has been growing for a long time. It may have taken a while to manifest, or your partner may have not been honest with you about past behaviors and struggles.

dreamer1: Has Dr. Sharp ever worked with a married couple where both were sex and love addicts?

Dr. Sharp: Yes. It is a fairly common scenario to have sex and love addicts partnered together. It is a little more common to see women who are sex and love addicts, versus men.

David: Here's a question from someone with Multiple Personality Disorder:

TSchmuker: I am wondering how does Dr. Sharp handle a person with Multiple Personality Disorder, that has an alter who is sexually addicted?

Dr. Sharp: I don't do much work with MPD. To date, I have not worked with an alter that was a sex addict. I would think that a therapist would need to treat that alter for sexual addiction while attempting to continue the integrative therapy.

fm3040: What are the chances of achieving a healthy relationship with a sex addict?

Dr. Sharp: It depends on so many things. For instance, how far into recovery is the addict and how much progress has he/she made on their underlying issues.

FaPiRDaniel: Dr. Sharp, what would you say the percentage is of adult male sex addicts in America today, dealing with homosexual desire for preteen aged children?

Dr. Sharp: I don't know that we have good data available to definitely answer that question. It also depends on what and how you define desire. Many sex addicts who consider themselves heterosexual will occasionally "cross the line" in the service of their addiction. Sexual addiction covers all sexual orientations, and all homosexuals or bisexuals are not sex addicts.

Rae1: Is it odd for a co-sex addict to change her mind about the relationship and decide to leave even after the sexual addict has worked toward recovery?

Dr. Sharp: No. not at all. Often, when one person in the relationship or system starts to get recovery, the other person leaves, because they don't want to give up their co-dependence of the sex addict. If she or he can't have the sex addict the way the person used to be, he/she may look for a replacement.

David: Does that go along the same lines as "misery loves company?"

Dr. Sharp: Yes.

panzena: Do most sex addicts really change?

Dr. Sharp: I can't really answer that, because I don't know most of them. I can tell you it is possible to change. The journey is a difficult one for most people, however, and there is a tendency to experience many relapses, as with other addictions, before a person commits to and stays in recovery.

LAS1027: What level of sex addiction warrants inpatient treatment?

Dr. Sharp: Usually a person who has a significant loss of self-control and the addiction is interfering in a major way with one or more significant parts of their lives, such as family, career, health, etc.

David: Is sex addiction more or less difficult to treat than substance abuse and why?

Dr. Sharp: I would say it is at least as difficult, and at present a little more difficult. I believe that the continuing denial of our society and lack of education makes identification difficult. Identification of and/or diagnosis of the problem is the first essential step that many professionals, partners, and addicts never reach.

David: Is it because they don't see having a lot of sex as a "problem" vs. drugs and alcohol?

Dr. Sharp: I believe that is part of it for many people. Our culture tends to overlook high levels of sexual activity for certain groups such as males, college students, and homosexual men.

fm3040: Isn't it better to just leave the sexual addict if there is such a high rate of relapse?

Dr. Sharp: Please clarify your question. What do you mean by leave?

David: I think what fm3040 is saying, if you are a spouse or partner of an addict, and there's a significant chance of relapse, why stick around for more pain?

Dr. Sharp: That is a decision that each person has to make for themselves. I can't tell you whether it is better to stay or to leave. Some of it may depend on the person's level of addiction and the seriousness/risk of their acting out behaviors. A person with a lower level of addiction who primarily fantasizes and masturbates may be more easily treated and have better prospects for the future.

David: Is that because a person who has sex with many different partners in an addictive environment has a difficult time with personal attachment?

Dr. Sharp: Yes. And the deeper you go into acting out behaviors, the farther you have to come back.

dreamer1 What do you mean the deeper you go into acting out, the farther you have to come back?

Dr. Sharp: Patrick Carnes, PhD., the acknowledged worldwide guru writes about different levels of addiction and acting out behaviors. The types of behaviors, the frequency, the legal and other consequences as well as longevity of the addiction can all influence the course of recovery. "The farther you've fallen into it, the harder it is to get out."

JamesLaws: What groups or organizations are available to people with sexual addictions?

Dr. Sharp: There are several. Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addictions Anonymous, Co-Sex Addicts Anonymous. Sexual Compulsives Anonymous, to name a few.

David: James, these groups are usually listed too in the local phone book or you can call your local psychological association to guide you in the right direction.

paulv54: Doctor Sharp, you mentioned the propensity for relapse in the early stages of recovery. From what I hear at meetings, this is true. However, this should not deter the addict from participating fully in a recovery program, working the twelve steps, etcetera, should it?

Dr. Sharp: Not at all. Every relapse is not a full slide back into all of the previous behaviors. If you don't start your recovery, it will never happen for sure. Don't be put off by the possible enormity of the task. Rather, avail yourself of the many resources such as Mental health professionals, 12-step groups, in town and online. There are increasingly more self-help materials to supplement all of this and aid your recovery.

Rosebud: I'm a recovering addict and I want to know, is it normal to have memory loss of your childhood? I can't remember any, except for bits and pieces.

Dr. Sharp: That suggests that you experienced some abuse or trauma in your past. Most sex addicts have experienced some level of abuse or trauma as children or teens.

Deirdre: What about this scene "Dominance and submission" that I have been seeing with "humiliation". Does it look like a sexual addiction in a new package?

Dr. Sharp: It often is. Sex addicts differ in their preferences or "modus operandi."

David: But Domination and other forms of "sexual play" can be covered under sexual addiction, correct?

Dr. Sharp: Yes. I would not assume that all games of dominance play are Sex Addiction. But, in contrast, it often is a symptom of people's addiction.

David: By the way, are the terms "sexual addiction" and "sexual compulsion" synonymous?

Dr. Sharp: Yes. Different people use slightly different terms that mean basically the same thing. There is some dispute in the professional community as to whether this is an addiction or compulsion, according to guidelines placed in the APA's Diagnostic and Statistical Manual. For the layperson's purpose (and most of the rest of us) they are synonymous.

MikeS: Are there any non-12 Step related recovery programs that have been effective?

Dr. Sharp: There are some religious programs that don't specifically use the 12-step approach, but very similar principles, that are having success.

David: How about approaches that don't deal with a "higher power?"

Dr. Sharp: I believe some programs such as the Masters and Johnson treatment centers may not specifically rely on 12-steps or higher power. They do a lot of work with Trauma Recovery.

David: With substance abuse addictions, there's speculation that in some people, at least they are "organically based" or a person is genetically predisposed to a substance like drugs or alcohol. I'm assuming that isn't so with sex addiction, that it's more of a psychological issue. Is that true?

Dr. Sharp: Again, we do not have sufficient scientific evidence to suggest one way or another. Although I doubt if there is a Sex Addiction gene, it may be fair to guess that some people are neurologically predisposed to sexual addiction.

David: Is there any medication available that helps the sex addict?

Dr. Sharp: Some physicians are finding success with the anti-depressants, SSRIs. These are Selective Serotonin Reuptake Inhibitors, such as Paxil, Prozac. Medication alone is not sufficient treatment, however.

David: If a partner of a sex addict could do one thing to aid in the addict's recovery, what would you suggest?

Dr. Sharp: Avoid enabling. Don't overlook or excuse the behavior, but also be supportive and encouraging of recovery.

Charcy2000: Do they ever recover and lead healthy lives?

Dr. Sharp: Yes. Many do. There are thousands of people who recover from sex addiction and lead healthy lives.

FaPiRDaniel: Dr. Sharp, Are there any really good programs available to assist recovery pedophiles?

Dr. Sharp: I know that there are. I cannot name them off the top of my head. Contact your Sex Addicts and Sex Addicts Anonymous organizations as well as your community mental health system. They frequently can give you leads. I could research that further and have information available at a later date.

iaacogca: Is there anything the spouse can do, such as being more sexually responsive in order to help the addict avoid acting out?

Dr. Sharp: Being more sexually responsive will not typically curb the acting out for long. Sex addiction is about a fantasy relationship, it is not reality oriented. Consequently, the Sex Addict often looks for an excuse to get angry with their spouse or partner. This gives them an excuse to go act out through their unhealthy behaviors.

mrlmonroe: Do you think it is ever possible to have a "kinky" sex life with a sexual addict. My fiance who is a Sexual Addict and I, have had a good sex life, and now that I know of his illness, I am afraid to even venture to places we used to go?

Dr. Sharp: You need to be careful. Although I don't condemn people's sexual peculiarities, it's important to try to find out what significance this behavior has for the sex addict partner. Would your partner ever have non-kinky sex with you and be OK with it? Also, are you OK with it, or does it make you feel used? I would want to know how much of the kinky sex is about loving you, versus simply acting out and getting the high. I guess what I am wondering is, is your partner fully present with you or in some fantasy.

mrlmonroe: Yes, we do vary our sexuality a lot - and it is very fulfilling for both of us. That's why the acting out has me so baffled.

David: By the way, are you saying that having kinky sex with an addict is dangerous, like let's say, putting alcohol before an alcoholic?

Dr. Sharp: It can be. It may simply be part of that person's ritualized behaviors and may lead to other things that you don't know about.

paulv54: What about the sex addict for whom sex has such negative connotations, history, and feelings, that he has almost an impossible time envisioning having a sexual relationship with someone he loves and respects?

Dr. Sharp: That suggests trauma and really requires treatment. That is assuming your goal is, to one day have a healthy sexual relationship. Of course, people can concentrate on having healthy, non-sexual relationships. The important thing is to take care of yourself and not force yourself or let someone force you to do something you are not ready for. Obviously, if you are in a marriage or partnered relationship, that partner may or may not be willing to settle for a sexless marriage.

David: Well, it's getting late. I want to thank everyone for coming tonight. I want to thank Dr. Sharp for coming tonight, sharing his knowledge and expertise. And I want to thank everyone in the audience for participating. If you are interested in conferences like this one, please sign up with the community mail list that interests you. Our homepage is www.healthyplace.com.

Any closing comments Dr. Sharp?

Dr. Sharp: Thanks for inviting me. 

David: Thanks again and good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Dr. Linda Savage is a licensed sex therapist and the author of "Reclaiming Goddess Sexuality: The Power of the Feminine Way." We discussed why so many women are apparently disinterested in sex in their long-term relationships, being sexually unhappy, sexual dysfunction, inability to achieve orgasm, sexual side effects of antidepressant medications, abuse survivors and sex, satisfying sex, and more.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Reclaiming Your Sexuality." Our guest is sex therapist, Linda Savage, Ph.D. Dr. Savage is a licensed sex therapist and author of the book, "Reclaiming Goddess Sexuality: The Power of the Feminine Way."

According to statistics, large numbers of women are reporting that they have little desire for sex in their long-term relationships. Our guest says a surprising number of women are plagued with varieties of sexual dysfunction and unhappiness.

Good evening, Dr. Savage and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Why are so many women apparently disinterested in sex in their long-term relationships?

Dr. Savage: There are a variety of reasons that go from bad relationships to health issues and life problems. The most important thing women say is, they feel something is wrong with their sexuality.

David: And what, exactly, do they mean by that?

Dr. Savage: Most women have been raised to believe that sex equals intercourse and the goal is an orgasm. That's a male model of sex. Since many women enjoy other types of stimulation besides intercourse and may take a long time to achieve orgasm, we have a situation ripe for dissension between partners.

David: One thing I'd like you to clarify. Sometimes we hear that in long-term relationships, the "magic" isn't there anymore or sex isn't that important in the relationship anymore. But when you say "women are unhappy," you're not referring to the relationship just "tiring," are you?

Dr. Savage: No, not necessarily. Many women feel that they love their partners but they do not respond well to the conditions under which sex occurs in their relationships.

David: Are you saying, that still in the year 2000, where men are supposedly more sensitive to their partner's needs, many women still are sexually unhappy? Or is it because women aren't speaking up enough and letting their partners know what they want?

Dr. Savage: Both. Most couples still do not know enough about what is truly satisfying and their sexual options, and they also do not talk about their needs. It's truly amazing that in the year 2000, most people do not talk frankly about sexual needs. They hint at it, and that's the worst think you can do because your partner guesses the worst.

David: But the other thing I noted on your website was that the statistics were also showing that women have "little desire" for sex? To me, that means they don't really want to have sex within, at least, their long-term relationship.

Dr. Savage: The women who report low desire would like to have satisfying sex within their long-term relationships. They are just as frustrated about it.

Men often think their partners will be looking for guys outside the relationship. Their jealousy just compounds the issue. What women want, is to feel the intimate connection before physical sex.

David: We have some audience questions, Dr. Savage, then we'll continue with our conversation:

Aporpoise: Can depression play a part in not wanting sex?

Dr. Savage: Depression is an important factor in low sexual desire. However, often the antidepressant medications given (which are important for recovery) make it more difficult to orgasm.

There are lots of options that will rebuild the intimacy in the relationship and, in fact, address some of the issues that lead to depression. I recommend that women never give up on their sexuality. There are always ways to reawaken the "coiled serpent."

David: We've had many medications chats here at HealthyPlace.com where the doctor states "sexual dysfunction" is a side-effect of certain psychiatric medications. Is it possible to achieve orgasm while taking antidepressants or other medications?

Dr. Savage: First, you can talk to your doctor about giving you a different medication that is less likely to have the sexual side effect.

There are also wonderful ways to experiment with your partner to achieve orgasm: vibrators, new oral sex techniques, finger play. All of it requires spending the time and communicating about it.

Keatherwood: I am an abuse survivor and taking several antidepressants. I've been happily married for 23 years, but have zero interest in any type of sex. I've tried changing medications with no luck. I find myself staying up until early morning to avoid sex. Is it normal to have no sex drive? I also had a total hysterectomy about 12 years ago and I am on estrogen.

Dr. Savage: You have several of the known sex drive depressors in your life. But I am a great believer in the miracle of sexuality, as a way to tap into your life force. Once you find the motivation for yourself to reawaken your sexuality, then the journey begins.

Do not assume that the ways you and your mate have approached sex are the ways you will continue using. It will take lots of communication and many of the techniques in my book are self-directed as well as couple directed. There is hope, however. Please believe me.

David: How does one go about "reawakening" your desire to have sex?

Dr. Savage: First, women need to find within themselves the will to begin. Then you must Practice the Principle of Readiness with your partner (as well as yourself). This means taking the time to tease the energy with erotic massage, non-demand touch and playful time spent together.

David: I need you to define some of these terms. What does "tease the energy with erotic message" mean?

Dr. Savage: Okay, in a nutshell, women need to feel that the touch they are receiving is a little bit behind their pace. That means that the partner must stay with a type of touch until she is ready to move on to a more intense type of touch. Let me give you an example:

If you touch your partner's neck gently and play with her hair lovingly, she will begin to arch her neck and move into the touch, then you may move to her shoulders. But stay with the gentle touch until she wants more.

David: And what is, "non-demand touch?"

Dr. Savage: Non-demand touch is different from erotic message. It came from Masters and Johnson's work in the '70s. It is touching the partner for the pleasure of touch, without the erogenous zones. Erotic message moves into the erotic zones after stimulating the whole body in very pleasing ways. Its intent is to arouse. I have very specific instructions in my book.

David: For women who have lost the desire to have sex, are you saying

• first - reconnect with your partner
• re-establish intimacy
• and then take things slowly in terms of having sex again?

Sort of build up to it.

Dr. Savage: Yes, but even before that, many women must understand the context of a culture in which their desire has not been given the chance to develop. We have only, in the last 30 years, given women permission to explore their sexuality, let alone represented the feminine way of sex. So many women must first get a history lesson. That's why I've written about the ancient Goddess cultures.

David: Here are some more audience questions, Dr. Savage:

waiting: Dr. Savage, in this age of cyber relationships, do you feel that the feelings of love that develop are real, and if so, do you think that because the relationship is based more on conversation at first, i.e. more time to get to know each other, that they have a better chance of becoming a long-term "real relationship" than the standard meeting at a party and sex soon type of relationship?

Dr. Savage: The issue of relationships that begin on the internet is very complex. Yes, I believe getting to know someone's "soul" by many talks is great. But many women have told me when they meet the man, there's no chemistry. So it's tricky.

bubbaloo: Dr. Savage, one of the greatest turn-ons is the challenge of keeping a new partner. How do you keep that interest going in a long term relationship?

Dr. Savage: There is a great difference between the sparks of a new relationship and the passion of a long term relationship. In fact, it's like apples and oranges.

Sometimes, you must let the myth of the early sparks die and mourn the loss of the adventurous chase energy of the new relationship before you can really go deeper to find the passion from a long term partner.

hopedragon: I have no desire for having sex. I don't like it. And when I do have sex, after about 5-10 minutes, I get very bored. If I don't stop, sometimes I freak out. Do you have any idea what may be causing this?

Dr. Savage: If by "sex" you mean intercourse, you may be saying you don't really like this because it does not feel good to you. If you go to a banquet many times but cannot enjoy the food, why would you continue to go?

The feminine paradigm for "erotic encounters" (a different word for sex) is: Pleasure is the goal rather than orgasm, sensual touch is the vehicle, not genital performance and orgasm is multidimensional. So you may find you enjoy a lot of touch and stimulation but not heavy frictional intercourse.

David: Here's an audience member response:

Keatherwood: I understand what hopedragon is saying. I don't enjoy any type of sexual activity and feel like screaming when I'm just being touched. My husband is patient but I mostly just bite my tongue and put up with it when I have to. I don't see how I can get motivated to change when it is so repulsive.

seven: What about lesbian relationships, where one woman is more "aggressive" (like a man) and the other woman has a hard time meeting up to those expectations? Is it the same as a heterosexual situation?

Dr. Savage: Yes, whenever you are accommodating a partner, whether male or female, when you feel uncomfortable (more than a little) you are dousing your sex drive even more. But remember, your sexual desire is not gone, it just became dormant.

There are wonderful ways to get it back. Sometimes you may need to leave a partner who is so insensitive as to push you into unwanted situations. But in the case where there is loving partners, begin with communicating what you'd like to change (I have some scenarios that take you step-by-step in the book). Then you will need to find your own way to sexuality for you. You may need the help of individual and couple therapy, specifically for sex.

David: Are there some people out there, Dr. Savage, who just don't enjoy sex? And is that okay?

Dr. Savage: Of course its okay, if the person is happy with their life. BUT keep in mind, many people who say this, also enjoy self sex, which is another enjoyable sexual outlet. So you see, we must broaden our understanding of the word to include lots of other pleasuring.

David: A couple of site notes here, and then we'll continue with the questions:

Here's the link to the HealthyPlace.com Sex - Sexuality Community Sitemap. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Dr. Savage's website is here: http://www.goddesstherapy.com.

And now, here are some more questions:

MaggieMae: What can help in the case of premature ejaculation in a 32-year-old male with an average sex drive?

Dr. Savage: Rapid ejaculation, as we now call it, is one of the most treatable male dysfunction. The "Stop, Start" techniques can be practiced alone, so that he gets the control. It consists of stimulating self until you feel the urge to ejaculate (point of inevitability) and then calming down until the urge subsides. This can then be practiced with the partner. Anxiety is often a component of Rapid Ejaculation, so sometimes anti-depressant medications can be helpful, so consult your doctor or a urologist about this.

Finally, men can return to pleasurable touching after one orgasm and enjoy pleasuring their partners and get turned on again. Remember, the erotic encounter need not end with the man's first ejaculation. There's lots more fun to be had.

nattygee: I'm a woman, Dr. Savage. So what does it mean when you can't cum? Why can't I achieve orgasm?

Dr. Savage: You certainly can, you are just pre-orgasmic, If you've never had an orgasm with self-stimulation, the best way to learn about what feels good is to pleasure yourself. I have some specific suggestions in my book. You can also experiment with vibrators (the Hitachi magic wand is the best to start with) and find the feelings that are best. Then you can try it with a partner.

R2mny2nm: Being a survivor of extreme sexual abuse, I can't see how it is possible for me to have a healthy sexual relationship. I have never had an intimate moment that didn't end up in a flashback.

Dr. Savage: This is a very difficult situation for you and I have no easy answers. I hope you have considered therapy. If you have done a significant amount of work on the abuse issues, then you may be ready for a sex therapist. You can find a competent one in your area on aasect.org.

David: Dr. Savage's book is "Reclaiming Goddess Sexuality: The Power of the Feminine Way." You can view and purchase the book by clicking on the link.

bubbaloo: How does a woman slowly build intimacy back into a relationship when she is consistently pressured to move at a faster pace? His actions and attitude tend to kill the mood, and then just more complaints arise. Is there any way to avoid this conflict of interest?

Dr. Savage: Your must build your "guardian self" which will stand up for you and stop your partner's insensitivity, even in the face of his anger. If he is behaving like a bully or pouting, tell him so and withstand the urge to give in.

Men have gotten away with bad behavior and demanding sex for a long time. Now it is time for women not to give up on themselves (remember, sex is your life force) but to represent the feminine way of sexuality.

You must discover this for yourself and then make it clear to your partner that you want only the touch that feels pleasurable to you.

David: Thank you, Dr. Savage, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Dr. Savage: Thank you for having me.

David: Thank you again, Dr. Savage. Have a good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Marriage and family therapist and licensed hypnotherapist Randy Chelsey, discusses alternative sexual practices, sex outside of straight heterosexual intercourse, including bondage and being a submissive, fantasies of being raped, the desire to be spanked, foot fetishism, and more. We also talked about people's feelings surrounding sexual fantasies, acting out our sexual fantasies, and living with unfulfilled fantasies and how those things affect our relationships.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

---

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Alternative Sexual Practices." Our guest is therapist, Randy Chelsey. Ms. Chelsey is a marriage and family therapist and licensed hypnotherapist located near Monterey, California. She says that every one of us has sexual fantasies. However, many of us end up repressing them. Ms. Chelsey also has a rather unique method of working with her clients and we're going to be discussing that also.

Good evening, Randy, and welcome to HealthyPlace.com. Thank you for joining us tonight. When you use the phrase "alternative sexual practices," what exactly are you referring to?

Randy Chelsey: I am referring to almost everything other than straight heterosexual intercourse.

David: Why is it that most of us have difficulty acting out our sexual fantasies?

Randy Chelsey: It's a sense of shame, I think. Our fantasies, those middle of the night thoughts, quite often differ from the way we like to think of ourselves acting.

David: I was wondering about the shame aspect of it, but also I think many of us are afraid we can't find a willing partner.

Randy Chelsey: Most of us can't, I think. We don't meet people we want to date with those criteria in mind. We don't find a community of people interested in foot fetishism, or spanking or leather when we are seeking a mate. We find a "vanilla" person we care about and then hope they'll like what we like, or else, we are so ashamed of these urges that we never expect anyone else will share them.

David: So are you suggesting that maybe seeking a "vanilla" person isn't all it's cracked up to be?

Randy Chelsey: I think it's a set up for disappointment not to ensure the person you are interested in being sexual with enjoy what you most enjoy. We make sure they're from our own social class, want children or not, share our religion, but we don't check on the fantasy level.

David: Asking someone to share a fantasy or lifestyle, for instance, involving bondage or some sort of fetish, is pretty difficult. It sort of reminds me of the pressure that guys in high school face when it comes time to ask a girl out and the fear of being rejected. Only in this case, the price you might have to pay for rejection could be rather high -- being branded a deviant. How would you address that?

Randy Chelsey: Absolutely. Unless that is a priority and you explore bondage communities for sexual partners. The internet has really made these communities a lot easier to locate. And being branded as a deviant is exactly what happens when someone asks his/her partner to act out their fantasy.

David: We have a few audience questions, Randy, on what we've been talking about so far, and then I mentioned that you have a unique way of working with clients in therapy and I want to address that. Here's the first question:

Love_and_care: I don't have difficulty with acting out my fantasies, but I am branded a "slut" for doing so. Do you think that people who act on their fantasies are "sluts?"

Randy Chelsey: I don't believe anyone is a "slut." I am sorry that with your opening up to who you really are, you were treated that unkindly. Perhaps the key to avoiding that in the future might be to approach a community who share your interests.

pia: So are you suggesting maybe instead of "vanilla person," which could be boring, seek "a rainbow" person.. :)

Randy Chelsey: Vanilla people are interesting to vanilla people. Few of us are the entire rainbow. Maybe we're red or green or yellow instead.

David: As we continue on here, I want to mention that when we are talking about sexual fantasies and acting them out, we are talking about consensual sex, an agreement between partners, NOT unwanted sexual advances. Just wanted to make that clear.

Randy Chelsey: I want to underline that.

GaryS: Is sex more important to marital or relationship stability than social class, children, or religion? I do not think so.

Randy Chelsey: I agree with you Gary. However, it's easier to find people who are middle class or who share child raising ideas than it is to find someone who appreciates the fact that you like to wear diapers.

David: Here's the link to the HealthyPlace.com Sex - Sexuality Community Sitemap. You can click on the link and sign up for the newsletter, so you can keep up with events like this.

Randy, how can we open up to our own sexual fantasies? How do we get to the point where we can accept it within ourselves as being "okay?"

Randy Chelsey: That's an extremely important question. Most of us judge our fantasies as wrong. It takes creating the time and space to sit with ourselves in our entirety. Our fantasies don't make sense. They don't "mean" anything. They emerge from a deep shadow side of ourselves. If you take the risk to act out any part of the deepest fantasy you have, I think you'll be surprised. Our fantasies are one of the "keys" to unlocking huge parts of ourselves. The part before thought. Our creativity is tied up with these fantasies.

David: I mentioned at the beginning of the conference that you have some unique methods for working with clients in therapy. Can you go into more detail on that?

Randy Chelsey: Yes. I've done a lot of work on myself, explored our cultures and worked with clients for years. During that time, I became aware that traditional therapy just doesn't work. People rush in and out of their therapist's office from a busy day, stay for 50 minutes talking off the top of their head, then they rush back to the lives they just left.

I work with people on a residential basis. They travel to see me and stay at a beautiful Bed and Breakfast across the street from my office. This is in a small ocean village in the Monterey Bay area of California. I work with them on one issue only. We meet for 3 two-hour sessions in 2 days on that one issue. Most of the work is done in trance. Between sessions, clients draw, watch the ocean or sit and think outside of their usual lives. I'm excited to say that I am often astounded by the work people do.

David: One observation, and I've received several emails today on this, is that some therapists, when told by their patients that they enjoy spanking, for instance, tell the patient they are suffering from low self-esteem. In other words, the therapist tells them there's something wrong with having a fantasy or experience like "that." After that, how can anyone walk out and think that what they are doing is alright or healthy?

Randy Chelsey: It's difficult. Therapists are members of society, and society holds a value that unless a sexual activity has to do with procreation there's something immoral, evil, sick, or unhealthy about it. Please don't believe that. Many women (and men) experience fantasies of being raped. That's a hard one to come to terms with. Often, they're powerful people who in their ordinary lives, would never stand for any mistreatment. Yet, in order to orgasm, they play out the rape fantasy. Now, that's not rape. With real rape, there is no control. We don't get to chose our attacker or what he does to us. It's our own fantasy, and it's okay to act it out.

David: We have a lot of audience questions, Randy. Let's get to some of those:

Randy Chelsey: Great.

barb_c: What if you don't have a fantasy, but your partner does. Do you try and fulfill it? He likes two girls to one man. I'm not sure I can do that without getting really jealous of someone touching my man.

Randy Chelsey: It's a part of my value system that says that I will not participate in anything I am not comfortable with. Yes, it's great to stretch and try new things. If you feel excited, or even neutral about what your partner wants, go for it, but if it's not comfortable for you, please respect yourself.

That's why it is often useful to meet people who already enjoy what you do before you become sexual and look at a life together.

steve d: I have been single now for a year. I had some wild times with my ex. Now I am starting to consider dating. Should I tell the person I am dating that I like a variety of sex and have unfulfilled fantasies, or should I just be like a perfect gentleman?

Randy Chelsey: Why do you think one option negates the other? Please be honest from the start. I get a lot of clients who are frustrated that their life partner isn't interested in what they crave day and night. Well, it's not their fault if you didn't ask.

David: I think that's a great point, Randy. If you aren't honest with potential partners, there's a huge chance that things won't work out in the long run.

steve d: Well, in today's society, I do not want to offend another person. Would it be ok to talk this over with a prospective life partner?

Randy Chelsey: Yes, Steve. This is your life. I think it's important to be sexually compatible. But, Steve, if you haven't found your partner in a community of like-minded people, chances are you are not compatible.

brianna_s: I am a submissive and have been involved in the D/s lifestyle. "Vanilla" is not fulfilling for me sexually, and trust is just as important as love in any alternative lifestyle. I feel our fantasies cannot become real without both people finding someone to share love and trust with, although this can be very difficult.

Randy Chelsey: Good for you, Brianna! You've taken this very big step. Everyone needs things sexually. You know that you enjoy being a submissive and you also need a loving relationship. That's true for you. We all have things that we need. I find that there are an infinite variety of desires. Within the D/s community, you have a billion preferences.

David: Here's the next question:

billthecat: What happens if we open up to a long-time partner about our fantasy and it turns them off so much that the relationship can't be saved?

Randy Chelsey: That's a very real risk. The fact that so many people, often after years in a relationship, begin to share their fantasies is an indication of how strong a craving they can be. We lie awake nights wishing for what we want - and need. This is something like the "life force," I think. It's our path, our own myth. And it has nothing to do with reason.

David: Just out of curiosity billthecat, what is your fantasy that you are hesitant about sharing?

billthecat: I pretty much fulfilled my fantasies already. I was just wondering if it would be worth opening up to a partner and risk losing something good.

dash_chance: I was under the impression that the desire to be spanked, in some people, was in a sense how the subject associated spanking with love (from childhood experiences). Is that a falsehood?

Randy Chelsey: Who knows? None of it makes any sense. It also makes it an unhealthy urge. Most people have spent years trying to figure out why they crave what they do. They buy the pornography, and then they throw it away, vowing never to think those sick thoughts again.

mayoz1950: I'm a bisexual, and I've known since high school that I've been attracted to women, too. The only problem is that I don't know how to meet another bisexual woman. I am 50 and I've had a few short relationships with women in my twenties. I don't feel weird; I feel blessed being a bisexual, but I wish I would meet some others.

Randy Chelsey: For every fantasy any of us have, there are thousands, millions, who share it. Use the computer to explore sites. The Internet is a great tool for people to find others who share their fantasies.

mayoz1950: I'm at the time in my life when I finally want what I want, and I think that is female companionship. The man in my life died 6 years ago with cancer and I feel I don't want another man now; I want female friends and companions.

Randy Chelsey: A great place to start - knowing what you want. You can have it if you commit yourself to finding this.

mayoz1950: Yes, the Internet is ok. Almost no one ever lives near where you are though.

Randy Chelsey: People can travel or move. It depends on how high a priority this is for you.

David: You might want to try some lesbian groups or organizations in your community or nearby. Here's the next question:

mschristy: I just found out that my boyfriend is gender confused. I try to accept it but I feel like it's just about him or her. During the day, he is a man but at night he is all women. I try to understand but it seems, sexually, it's all about her.

Randy Chelsey: I would support you in taking care of yourself and your own needs, first of all. Then, you might talk to your boyfriend about your concerns. Sounds like he might have something to tell you about himself.

David: In our fantasies and sexual experiences, is there anything that you would classify as not being "alright and healthy," besides forcible sex with an unwilling partner?

Randy Chelsey: Sex with children, who I consider unwilling partners. Also, sex that has you feeling bad about yourself in any way.

David: Here's an audience comment:

Tink: I am here as a virgin who hopes to stay that way and have a sex life without oral sex.

Randy Chelsey: I support you in your desires. However, I am hearing what you don't want rather than what draws you.

David: Thank you, Randy, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thanks again, Randy, for being our guest tonight.

Randy Chelsey: Thank you, David.

David: Good night everyone and I hope you have a good weekend.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Diabetics with a mental illness have more difficulty controlling blood sugar and more serious complications from diabetes, according to study.

Diabetics with mental disorders do not have as good blood sugar control as diabetics without mental illness and are more likely to suffer one or more diabetes complication including loss of kidney function, loss of sensation in the feet, and visual problems (including blindness) than diabetics without mental illness, according to a study published in the December issue of Medical Care.

"This study provides a solid foundation for further work into understanding whether provider, patient or system factors can be modified to ensure better overall care of diabetic patients with mental disorders,." said Caroline Carney, M.D., M.Sc., associate professor of psychiatry and medicine at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute, Inc. Dr. Carney is the senior author of the study which looked at insurance claims data from more than 26,000 diabetic adults between the ages of 18 and 64 living in Iowa.

"Even when we controlled for utilization of healthcare services, diabetics with mental disorders did less well at controlling their diabetes and had more complications than diabetics who had no mental health complaints," said Dr. Carney.

The researchers found that diabetics with mental disorders were more likely to be young, female, and urban residents and to make greater use of healthcare services than the diabetics without mental illness. Mental disorders presented by the diabetics in the study include mood, adjustment, anxiety, cognitive, psychotic, substance abuse and sexual disorders.

"These findings underscore the need for physicians to treat the whole patient - not simply the mental disorders or the physical complaints," said Dr. Carney who is both an internist and a psychiatrist.

The study was supported by the National Institute of Mental Health.

SOURCE: Indiana University

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