Self-injury quotes can help other self-injurers understand that they're not alone. Reading or hearing the thoughts of another person who struggles with feelings of being emotionally overwhelmed can provide comfort and a place for recovery to begin. Self-harm quotes can also offer people outside the secretive culture of self-harm insight into the phenomenon.

If self-injurers can gain a better perspective on why they self-harm and hurt themselves; and outsiders can garner some sort of understanding into the psyche of these people, perhaps healing can come of it.

Self Injury Quotes

Check out these self-injury quotes from a website owned and operated by Daniel, a 21-year-old native of New Zealand. He says he chose the quotes because they have a lot of meaning to him and, although penned by others, speak his own truth.

"I wear my self-harm scars proudly. They represent the battles through which I have gone, and I am proud because those battles I have won." ~Aly

"Self-injury is a sign of distress not madness. We should be congratulated on having found a way of surviving." ~Cory Anderson

"How will you know I am hurting, if you cannot see my pain? To wear it on my body tells what words cannot explain." ~C. Blount

"I know what it's like to want to die. How it hurts to smile. How you try to fit in, but you can't. How you hurt yourself on the outside to try to kill the thing on the inside." ~Susanna Kaysen, Girl Interrupted

"I can't stop thinking about cutting myself up. Visual bruises can be covered with make-up, but down to the core, I'm all bruises." ~Majandra Delfino, Bruises

Self Harm Quotes

The following self-harm quotes come from the XxDailyDreamxX website. The site owner does not include credit for the origins of the quotes, but they provide frank insight into the minds of self-injurers.

"When will people understand that words can cut as sharply as any blade, and that those cuts leave scars upon our souls." ~Anonymous

"She cuts herself. Never too deep, never enough to die. But enough to feel the pain. Enough to feel the scream inside." ~Anonymous

"Real cutters don't cut for attention or for the pain, real cutters cut for the satisfaction of being in control of something." ~Anonymous

"The lines I wear around my wrist are there to prove that I exist." ~Anonymous

Self Mutilation Quotes

Self-mutilation quotes that offer insight and understanding. Some come from books, celebrities who self-harm or movies about self-injury, others from individuals with some sort of connection to self-harm – either through a loved one or from personal experience.

"Told I talked too much, made too much noise. I took up a silent hobby – Bleeding." ~S. Marie

"Scars on our souls frequently lead to scars on the outside from self-inflicted wounds. Together we can empower one another and move toward healing. ~Amy Tippins, RockScar Love Designs

"I can feel the hurt. There's something good about it. Mostly it makes me stop remembering." ~Albert Borris, Crash Into Me

"Each scar's a cipher rimmed with old barbs and landmines, protecting its truth." ~JLB

Do you have your own self-injury quotes? You don't have to be a self-injurer to feel the weight of these utterances. Perhaps your child, best friend, or loved one inflicts harm upon him or herself. It might help to keep a journal of your thoughts in digital or written format.

For more insight into self-harm, read these self-injury stories.

article references

Personal story of being raped, the impact, and how to heal from the trauma of rape.

I will not deny that rape is a horrible thing. It is an invasion of your senses, it can leave you scarred for life. I know, my first sexual experience was rape, and I was gang-raped two years after that. I will never forget what happened to me, or how it made me feel. What I did choose to do, is not let it ruin the rest of my life, although it almost did. Maybe telling my story will help some of you stop from making the same mistakes I did.

I was raped on the 21st of September 1977; two days after my sixteenth birthday. I consider myself fortunate that my boyfriend at the time did not want to be convicted for 'jail-baiting' and waited until I was 16. We had been dating a month.

I did not even know what was happening, it was over quickly. I remember that, and the fact that I don't think I was there (in my body). I just floated off to get away from the shock of it all.

Unlike many girls my age, I did not have a clue what sex involved, and my only impression of it for a long time afterward was numbness and pain. I did not have a close relationship with my family, although I still lived at home. I remember getting to a girlfriend's place after it happened and ringing my mom to ask permission to stay there the night. I told my girlfriend what had happened, but nobody else. I never saw my boyfriend again - obviously, he got what he wanted. He did make a point of spreading around talk about "how lousy I was in bed." At the time, I did not think this had affected me in any way, except it started an anger against my parents for not being there for me, which only now at almost 40, I am learning to deal with.

At 17, I moved away from home and went to a city about two hours drive away. I could only be termed as 'loose' in those days. I had no respect for my sexuality and it never crossed my mind I could say 'no' to sex. I never actively pursued sex, I just never said no to anyone who asked.

I was also drinking every single day, yet as I still held down a full time job, I just assumed this was how every other teenager lived.

Just after my 18th birthday, I found myself in a situation in a van with three men in their 20's. The woman that I was boarding with was going out with one of them, on the sly. When her husband came home, she sent me out to the van, down the road, to get rid of them. I was so stupid to do this, but have always been willing to help anyone out.

This husband was an aggressive person and I was happy to get out of the house. I wish I hadn't. I was raped by all three, numerous times over a 6 hour period. I was not allowed out of the van until daylight. Again, I didn't tell anyone except the woman I was boarding with and she was more concerned that I would have to miss a day at work than what had actually happened. I just went to work as normal and continued drinking at night. Shortly after this, I started getting really depressed. A doctor put me on , which I quickly got addicted to, and by age 21 I was a mess.

I was lucky. By this stage I did have a few good friends who helped me quit, cold turkey from both the valium and the drinking. I have never had a problem with either since. My sexuality was another matter. I did, what I have since learnt was a particularly destructive thing to do, and made the career change to lady of negotiable virtue. This was my warped way of taking control over my sexuality. My personal slogan for years was that "I only have sex for love or money, and I never love anybody." I worked this way on and off for 13 years, never once realizing I was hurting myself. The work did enable me to pay for counseling which I attended infrequently, but it wasn't until after three children and two disastrous marriages that I realized my rape was the cause of all my anger and hurt, and that I was in a position to change it all.

And that is the heart of the matter. The simplest way to change your life is to change your mind, change your perception of how things are in your life. I did that literally in five minutes. In one moment of clarity, I realized it was not my fault that I had been raped, that my anger was natural and to be expected, that I was okay and I could move on with my life.

YOU have to want to make that choice. You can heal from the trauma of rape, or you can choose to let it affect you for the rest of your life. I figured that my rape cost me almost 20 years of my life. That is such a tragic waste. But I can live with that because as both my partner and I have often discussed, if it was not for what had gone on before in our lives, we would not be where we are today.

What I would hate to see is anyone else going through the same thing, unnecessarily. You can choose to move on with your life at any time in your life. You can choose to love yourself and take care of yourself. You can choose to keep yourself well and safe. You can choose to live life.

You will never be able to forget rape. It will always be a part of who you become. Writing this has been hard for me, even after all this time. But rape does not have to be the negative factor that ruins your whole life, but rather a catalyst you can use to be the best you can be.

Be Well.

You probably see someone with a physical disability almost every day: the blind man tapping his way across the street, the deaf woman signing to her boyfriend, the wheelchair-bound woman shopping at the grocery store, people on crutches, using walkers or leaning on canes. You may have thought of how hard it would be to live with the disability, getting around, doing errands and working at a fulfilling job.

Can you imagine what it is like for that person to date, negotiating restaurants, movie theaters and transportation? How about meeting a potential partner -- where, exactly, do disabled people find romantic love? Did you ever think of what it would be like for a disabled person to have sex?

Just Like Us, Only Different

Disabled people are not lesser versions of able-bodied people, unable to engage in or enjoy sexual behavior. In fact, disabled people are members of a community with its own unique culture, filled with societal norms and behavioral expectations that are different, but no less rich or meaningful, than that of able-bodied individuals.

While it is true that living with a disability is difficult, the disability itself isn't usually a negative or positive factor in that person's life. The paralyzed legs aren't bad or good ; they just are, just as people are male or female, Asian, Caucasian or African American. In turn, a disability, while physically limiting, is no more limiting to that person's sexuality than one's ethnicity or gender.

Sexual Expression

Media, television and movies have represented the sexual lives of persons with disabilities in one of two ways:

1. A master of the tongue, who, limited by his or her lower body's inability to function, has compensated by learning to perform outstanding oral sex, foregoing any sexual needs of his or her own.

2. A bitter, asexual person, who is half the man (or woman) they used to be, unable to sexually perform and thus no longer completely human.

In reality, issues of sexual expression and attractiveness are no more or less important for the disabled than for the able-bodied -- one's desire to be found sexually desirable and have one's sexual desires fulfilled does not simply go away because one has a prosthetic limb or paralyzed legs.

The disabled person must learn to negotiate his or her own mental, emotional and sexual terrain, just as do the able-bodied, coming to terms with their sexuality and finding the best way to express it.

Do You Have Sex?

Historically, people with disabilities have been regarded by much of society as freaks, sub-humans or cripples. Now that we, as a society, have begun to put aside those negative labels and are, instead, exploring the emotional lives of the disabled, we have found new ways to dehumanize them, asking such personal and ridiculous questions as, Can you have sex? Do you still even want to?

Human beings are born with sex drives regardless of ethnicity, gender, sexual orientation or disability status. While other minority groups, especially gay men and lesbian women, may be mocked or questioned about their specific sexual practices, it goes one step further for the disabled, who are not asked how they have sex, but if they are able to do it at all.

Perhaps the best way to address this question is to examine normal sexual behaviors, that is, heterosexual sexual practices. While penile-vaginal intercourse is certainly a common method of sexual expression, it is by no means the only way straight people have sex. What about oral or anal sex, kissing, fondling or cuddling?

Similarly, lesbian women express themselves sexually in other ways than by performing cunnilingus, and gay men don't just have anal sex. Disabled people find a variety of ways to express themselves sexually, limited only by their physical bodies and their imaginations.

Meeting Mr. Right

If you think it's hard to meet someone special, think of what it must be like for people with disabilities. Not only do they have to deal with the usual issues of personality, attraction and emotional behavior, but they must do so in a world not designed for visual, hearing and mobility-impaired people.

For example, think about the behaviors associated with flirting. You walk into a bar, spot a cute guy or girl, make eye contact and smile. A visually impaired person would get as far as the door, and then what? Wait for a seeing person to make the first move? Start talking to someone and hope he or she is nice? Whatever the method, the visually impaired person's chances of meeting Mr. or Ms. Right are greatly reduced from those of the able-bodied.

Likewise, a hearing-impaired person can't readily engage in flirtatious banter, unless he or she is lucky enough to have found a bar teeming with people who know sign language. If the hearing-impaired person finds someone not fluent in sign language who is willing to learn, it will probably take a great deal of time to establish a rapport and move things to a more intimate level.

People with mobility issues can find it harder still to make contact. As a society, we don't much know what to make of people with a visible physical disability. We've made some effort over the last few decades to become unbiased, but given the choice between and able-bodied and disabled partner, most people would chose the person who wasn't in the wheelchair. It's unfortunate for the disabled person, but it's a simple, human fact.

For example, it is often assumed that all persons who use wheelchairs are paralyzed, and therefore unable to make full use of their reproductive organs. While this may be true for some in the community, a large proportion of wheelchair users can function sexually as well as the next person. However, as there's no handy little placard reading, Yes! My penis works, the disabled person's chances of meeting a potential sexual partner are, again, greatly reduced.

Sure, the disabled wouldn't have as many problems if they were to date within their own communities, but shouldn't they have as wide a selection as the rest of us? Most of us wouldn't enjoy being told to date only within our own ethnic or social cultures. Why should it be any different for the disabled?

Dating With Disabilities

Once the disabled person has met a potential partner, he or she faces another host of problems: dating in a world designed for hearing, seeing and walking people.

• Consider Stephen, a blind person, who would like to treat his friend, Sheila, to dinner at a nice restaurant. First, he would have to arrange for transportation, especially if Sheila were also visually impaired and could not drive. Stephen would have to either have to pay for a cab or take the bus, which would involve figuring out the route, knowing when to get off the bus and finding his way back home. Banish the notion that Stephen would pick Sheila up -- unless she were a seeing person, she would most likely have to meet Stephen at the restaurant. Once there, Stephen would either have to ask for a menu in Braille, or, if none were available, rely upon a seeing person to read the entire menu to him. The rest of the dinner would be fine, until the bill was presented; Stephen would have to ask Sheila or the waiter to read the total to him.

• Think about Linda, a deaf person who uses sign language to communicate. Linda would like to go to brunch and a movie with Larry, a new potential partner who knows a little sign language, but she's wary of the obstacles she will have to face. Unless her waiter knows sign language, Linda will have to point at what she wants and won't be able to customize the meal to her liking. Her ability to converse with Larry will be limited by his abilities to sign. After the brunch, they can either select a subtitled foreign film or return to her home to view a close-captioned film. Their options are definitely limited.

• Finally, consider Allan, a mobility-impaired person in a wheelchair, who wants to see a play with his new girlfriend, Amy. First, he or his date must make sure wheelchair seating is available in the theater, ensuring the limited seating isn't sold out for the show they want to see. Next, Allan must find out about wheelchair-accessible restrooms -- are they on the same floor as their seats, or must he take the elevator or negotiate stairs? Then, Allen would have to consider transportation for the evening. Unless he is wealthy enough to afford a wheelchair-accessible car or van, he must rely on others to get around. Either Amy must drive (and hopefully she doesn't have a small car!), or Allen must take wheelchair-accessible public transportation.

While none of these hurdles are insurmountable, dealing with them can be exhausting. Able-bodied people are able to pick up and go at a moment's notice; disabled people must consider the mechanics of the night, plan ahead, and say goodbye to spontaneity.

How Do You Have Sex?

While still a personal inquiry best made only of a good friend, How do you have sex? is a legitimate question whose answer will vary according to the person's specific disability.

• Mobility-Impaired Person with Able-Bodied Partner: The able-bodied person can maneuver the impaired person's body into different positions, stimulating erogenous zones as desired. The sexual experience -- whether it be kissing, touching, cuddling or oral, anal, penile or vaginal intercourse -- is very similar to that of two able-bodied people, although it is likely the able-bodied person will be in charge, as he or she can move without assistance.

• Mobility-Impaired Person with Mobility-Impaired Partner: Depending upon the severity of the impairment in each partner, some, but not all, sexual activity may be possible. For example, kissing and touching may be quite simple, but penile, vaginal or anal sex might be too difficult. Oral or manual sex could be managed if both partners were able to position their bodies as needed.

• Paralyzed Persons: Depending upon the severity and cause of the paralyzing injury, individuals with partial or total paralysis may not be able to experience a physiological orgasm. However, it may feel good to have certain parts of their bodies sexually stimulated: neck, nipples, ears, arms or any other area that is responsive to touch. The hardest part for most totally paralyzed people is their inability to experience sexual release, but some say their sexual feelings have been moved into their heads, claiming they have mental orgasms instead of physiological orgasms. If it works, do it.

Beyond the mechanics of sex, mobility-impaired people also face sexual communication issues. Think of how difficult it is for able-bodied people to ask for and get what they want in bed, and imagine how much harder it might be for a disabled person, who is already battling social stereotypes, physical restriction and emotional discomfort.

In Conclusion

Remember: disability does not necessitate a disabled sex drive. Regardless of the person's disability -- visual, hearing, mobility or paralysis -- he or she has the emotional drive for closeness, affection and sexual stimulation. Granted, it may be more difficult for that person to meet, date and become intimate with another person, but it is far from impossible.

As we, as a society, become more aware of the needs, limits and abilities of disabled people, we will become more comfortable with the idea of having a disabled person as a partner. Ideally, we will learn to see past the person's disability altogether, and learn to know and love that person as the intellectual, emotional and romantic person he or she is capable of being.

Dr. r. Linda Mona, a licensed clinical psychologist specializing in disability and sexuality issues and a disabled woman living with a mobility impairment.

Healthy sex involves knowing how to protect yourself and your partner from serious health problems, such as sexually transmitted diseases and infections (STIs) and unwanted pregnancy. It is important to stay informed and up-to-date on the latest information about disease prevention and birth control.

• Read books, pamphlets and brochures from your local health department or library.

• Check out the information on reputable health education web sites.

• Talk with your health care professional.

• Learn about risks, options, self-care exams, and alternatives.

And then, make wise decisions so that you can do all that is possible to minimize the risk of something negative resulting from your lovemaking.

To test your knowledge of health risks involved in sexual activity, read through the following HealthySex Risks Checklist. This list does not cover all the risks involved in sex. (See the Resources section for links to sexual health and education sites).

The HealthySex Health Risks Checklist

Everyone should know these facts, DO YOU?

_____ 1. There is no method of contraception that is 100% effective.

_____ 2. A woman who does not use any form of birth control has an 85% chance of getting pregnant within one year.

_____ 3. For birth control methods to be effective, they must be used correctly and consistently.

_____ 4. Taking medications, such as antibiotics, can reduce the effectiveness of birth control pills.

_____ 5. When used correctly, condoms (rubbers) can greatly reduce the risk of pregnancy and STIs, such as herpes, gonorrhea, syphilis, chlamydia, hepatitis B, and AIDS.

_____ 6. At least one in four Americans will have a sexually transmitted infection/disease (STI) at some time in their lives.

_____ 7. Every day, over 35,000 Americans get an STI.

_____ 8. STIs can be passed from one person to another through vaginal, anal or oral intercourse.

_____ 9. Some STIs, such as syphilis and herpes, can be passed through kissing.

_____ 10. Birth control pills and diaphragms do not protect against STIs.

_____ 11. Though the likelihood of getting genital warts can be decreased by condom use, contagious warts may exist elsewhere (such as on buttocks, inner thighs, outer lips).

_____ 12. Dental dams or plastic wrap need to be used in oral sex to prevent the transmission of STIs.

_____ 13. For additional protection against pregnancy, latex condoms can be used in conjunction with a spermicide. (However, if a person is allergic to spermicide, the resulting irritation can increase the potential for infection).

_____ 14. When using a latex condom it is very important that you DO NOT use an oil-based lubricant (such as massage oil, baby oil or vaseline). Oil can damage the latex very quickly destroying the condom. (Use water-based lubricants, such as Astroglide or Probe, instead).

_____ 15. Many people with STIs, such as gonorrhea, HIV+, chlamydia, and herpes, show absolutely NO visible symptoms.

_____ 16. Medical tests can determine if you or your partner have an STI.

_____ 17. Some STIs can be easily treated and cured.

_____ 18. Some STIs may stay in the system causing health problems or requiring medications forever.

_____ 19. Some STIs, such as chlamydia and gonorrhea, can cause sterility in a man or a woman, rendering them unable to ever conceive a child.

_____ 20. The more sexual partners you have the greater your risk of acquiring an STI.

Is sexual fantasy a useful way to enhance relationships and build intimacy or the last resort of the lonely and desperate? Psychosexual therapist Paula Hall examines why people fantasize and the safest ways to explore these desires.

What are sexual fantasies?

Fantasies are daydreams. Imaginary visions. Whimsical speculations. Wishful thinking. Everybody fantasizes at some level. If you've ever imagined what you'd do if you won the lottery, you've used fantasy.

Fantasy is a fundamental part of human nature. We see active imagination as healthy in children (watch them playing and you'll see them lost in a world of their own) but something adults should grow out of. Most people never do, however. Even if we manage to suppress our imagination during the day, all those unconscious passions emerge while we're sleeping.

Understanding fantasies

There's a huge range of personal taste in sexual fantasy, just as there is in everything else. But many people feel uncomfortable with their own fantasies, fearing they're somehow weird if they're turned on by things that are unacceptable to others.

Sexual fantasies may express an aspect of our unconscious mind. For example, fantasies about being submissive or passive may be linked to a desire to experience high sexual arousal without personal responsibility.

But fantasies are simply somewhere we can act out things we might never do in real life, such as having sex in a public place or with a particular person. And sometimes they turn us on precisely because they're not real.

Fantasizing about other people

Some people worry that fantasizing about someone other than their partner is an act of betrayal, revealing either a desire to be unfaithful or that they are longer turned on by their partner alone.

In fact, this is very rarely the case. Evidence suggests that those who fantasize the most are in happy, loving, trusting relationships. It's in this kind of context that the mind explores places the body has no intention of visiting.

The benefits of fantasy

Sex generally starts in the brain. So an active imagination can mean you're ready for sex before anything physical has happened. Therefore, desire is heightened and arousal is much quicker.

Some people find an active fantasy life can add novelty to a long-standing sexual relationship. This can be particularly helpful if your partner is not as sexually adventurous as you are.

But conversely, if you find it embarrassing to experiment in bed, fantasy offers an opportunity to give your imagination free rein and to play out roles. It can be used as a practice arena where you can build confidence before embarking on something new.

In psychosexual therapy, fantasy is often used to block out negative thoughts. If you find during sexual encounters your mind wanders to unhelpful images or thoughts, fantasy can help you to refocus on your sexual pleasure.

Learning to fantasize

If you don't find sexual fantasy comes easily, you can learn. Erotica can help; try exploring bookshops for erotic books and art. There's also a wealth of magazines available to suit any taste. And your local video store will stock a range of films, from romantic and slapstick to thrillers and more explicit 18-rated movies.

Find out what turns you on.

Then with the help of relaxation techniques, lie back and allow your mind to build your personal favorite.

The most common male fantasies include:

• having sex with an existing partner
• giving and receiving oral sex
• having sex with more than one person
• being dominant
• being passive and submissive
• reliving a previous experience
• watching others make love
• trying new sexual positions

The most common female fantasies include:

• having sex with an existing partner
• giving and receiving oral sex
• having sex with a new partner
• romantic or exotic locations
• doing something forbidden
• being submissive
• reliving a previous experience
• being found irresistible
• trying new sexual positions

Caution about sharing fantasies

Although some couples find that sharing and acting out their fantasies has increased trust and intimacy, others have not.

Fantasies are extremely personal. There are risks involved in disclosing them, especially to someone you care for. Consider how you'll manage if they don't like your fantasy or if you try acting it out and it just doesn't work.

Sharing fantasies can be liberating, but it's risky. Talk to your partner first about the general theme, then approach with caution.

Related Information:

• Exercises index
• I'd Like You To...
• Pleasing Yourself
• Orgasms

• What is chloral hydrate?
• Street names of chloral hydrate
• How is chloral hydrate taken?
• Effects of chloral hydrate
• Dangers of chloral hydrate
• Is chloral hydrate addictive?

What is chloral hydrate?

The oldest of the hypnotic (sleep-inducing) depressants, chloral hydrate was first synthesized in 1832.

Street Names

"Mickey Finn" or "knockout drops"

How is it taken?

• When chloral hydrate is prescribed by a doctor, it is taken as a syrup or soft gelatin capsule.
• A solution of chloral hydrate and alcohol constituted the infamous "knockout drops" or "Mickey Finn." This form of chloral hydrate is used in drug-facilitated sexual assault, or "date rape".

What are the effects?

Chloral hydrate takes effect in about 30 minutes and will induce sleep in about an hour.

What are the dangers?

• A toxic dose produces severe respiratory depression and very low blood pressure.
• Chronic use is associated with liver damage and a severe withdrawal syndrome.
• Signs of overdose include confusion (continuing); convulsions (seizures); difficulty in swallowing; drowsiness (severe); low body temperature ; nausea, vomiting, or stomach pain (severe); shortness of breath or troubled breathing; slow or irregular heartbeat; slurred speech; staggering; and weakness (severe).

Is it addictive

It is not considered an addictive drug like cocaine, heroin or alcohol because it does not produce the same compulsive drug-seeking behavior. However, like addictive drugs, chloral hydrate produces greater tolerance in some users who take the drug repeatedly. These users must take higher doses to achieve the same results as they have had in the past. This could be an extremely dangerous practice because of the unpredictability of the drug effect on an individual.

Preventing Premature Ejaculation Through Staying Power

Bob feels satisfied with his sex life, but lately, his girlfriend has been voicing disappointment with how long he can perform. He wishes he could last longer but, the harder he tries the more quickly he reaches orgasm. She says her other boyfriends have all lasted longer. Bob too wonders if he has a real problem.

The image of the guy who can "keep it up" for hours no matter what, fills books and movie screens. Although men may not consciously tell themselves "Stallone would never come too quickly, why do I?"--such macho messages and comparisons are surely implied. Staying Power is a crucial factor, not only in male sexual satisfaction but in how satisfied women are with sex. The study of premature ejaculation yields some important information regarding the ability to delay orgasm. In several surveys, in Europe and the United States, up to 40% of men stated that they had a problem with premature ejaculation and were not happy about it.

But when is the problem severe enough to be given this label? How many minutes or hours a guy can keep it up is not the issue. What is more important is how well a man can control his arousal and his physical response to it. Men who have little or no control are said to have a problem with premature ejaculation. However, many men who do not have the disorder may want more control and to last longer. This desire for Staying Power can be helped by what we have learned from the more severe problems of premature ejaculators.

There are a lot of things which affect Staying Power. Sexual inexperience is a common cause. Young guys tend to come quickly, but they improve as they gain more experience and are better able to monitor signs of an impending orgasm. Another common problem is when the woman wants to go on for longer, but the man wants a quickie. The woman is not too thrilled and, if the couple communicates poorly, neither may be aware of the mismatch in their wants.

Anxiety and other emotions arising from problems in one's relationship are other sources of problems with Staying Power. Take Frank and Jane. If they have a fight and are not speaking to each other, it is unlikely that they will feel open enough to have intercourse or, for that matter, interested even in getting each other off.

What most men do to try to increase their Staying Power is to think about something else. They make a mental list of the 10 highest batting averages of all time, count backward from 100, recite the Pledge of Allegiance--anything to put distance between themselves and their fear of coming too quickly. They may try condoms, local anesthetics or other ways of dulling their physical sensations.

What is surprising to most men is that these attempts at distraction--mental or physical--can make them come even more quickly. Not what they bargained for! In addition to focusing away from enjoying sex, the man is distanced from his sexual sensations and responses. A key aspect of Staying Power is the ability to keep in contact with your sensations and when orgasm is about to happen. Men who have problems with premature ejaculation don't know when they are about to ejaculate and thus cannot control it. By making the man more out of contact with his body, these attempts to distract and dull sensations make the problem even worse.

An approach that works better is to be physically, mentally, as well as emotionally, involved with the act of making love. Here are some simple methods to help you along. One is to use positions that provide less intense friction to the penis--like having the woman on top. Thrusting more slowly also helps to delay orgasm.

Sex therapists working with men with serious problems controlling ejaculation use a series of exercises called Sensate Focus. These shared progressive touch activities help both partners become increasingly familiar with their own and each others' bodies by concentrating on their physical sensations and reactions. First they focus on sensations of being rubbed and caressed in different areas, excluding the genitals, and work gradually up to being genitally stimulated.

The Stop-Start technique is often used when the couple begin genital stimulation and move to intercourse. During stimulation/intercourse the man thrusts a few times and then stops if he senses he's about to come. This is repeated until he eventually feels in greater control.

One thing that clinicians actively discourage is apologies. Men who are worried about not lasting long enough are often anxious and apologetic during and just after orgasm. This makes their partners more tense and further interferes with their ability to be physically, mentally and emotionally in the lovemaking encounter.

What makes sex good in general also makes for good Staying Power. Good sex is based on good communication between partners. It is also based on working out issues in the relationship so that emotional pressures do not distract from sex.

So, for better Staying Power, don't distract yourself by counting backward from 1000, don't use a desensitizing cream or feel guilty about having an orgasm. Be more fully emotionally and physically available to your partner, master your responses and ENJOY a deeper sense of sexual intimacy.

Terry Riley, Ph.D. , is on the staff of the San Jose Marital & Sexuality Centre where he works on a variety of male sexuality issues and is in private practice in Fremont, CA.

There are two types of professional, specialized treatment available for the sex addict and/or the partner of a sex addict: out-patient treatment and in-patient treatment.

Out-patient treatment usually consists of counseling sessions in a psychotherapy or counseling office scheduled one session or more each week. The out-patient treatment may be mainly individual sessions or marital sessions with a particular counselor or may be more in the form of a treatment program consisting of individual, marital, group and educational sessions. Either way, the treatment is most effective when combined with special free support group attendance available in many areas.

In-patient treatment is more intensive and involves staying at a special facility on a 24-hour basis for several weeks or a month or more, where treatment, educational and support group sessions are conducted each day. An advantage of this type of treatment is that the patient receives a large amount of information and help over a short period of time. It also permits patients to leave their daily routine and concerns in order to focus fully on their treatment. And, for the patient who is in a more serious emotional or psychological state, the in-patient facility provides more safety and medical support.

Further down on this page are suggestions for locating specialized out-patient counseling and out-patient programs that might be accessible to your location as well as the several specialized in-patient facilities that exist.

Locating Specialized Out-Patient Treatment in Your Area.

Effective professional help for sexual addiction problems is best obtained from counselors and therapists who are specially trained and experienced in treating these issues. The number of specialists around the country is relatively small. If you think you may need this help and don't know of a sexual addiction specialist, you can try the following sources for possibly locating someone near you.

One option is to try http://www.sash.net/, to access the website maintained by The National Council on Sexual Addiction and Compulsivity. The site includes a Member Directory with names which are, for the most part, professional clinicians and programs specializing in sexual addiction treatment. Click on "Member Directory" on the left side of the homepage. Scroll down to a small window showing state abbreviations. Scroll to your state, click on it, then click on the "Submit" button below the window. If there is a listing in your area, you can contact the individual or program directly to get more specific information. In most cases, there will be a link to a website, or a clickable email address.

You can also call a number where referrals are available for sexual addiction specialists that may not be on the NCSAC list described above. Call 1-800-MEADOWS between the hours of 6 a.m. and 6 p.m. Mon. thru Fri., and 8 a.m. and 4:30 p.m. on weekends. Ask for Intake, then ask if there is a clinical associate of Dr. Patrick Carnes in your area. (The Meadows is an in-patient treatment facility near Phoenix, Arizona, specializing in the treatment of sexual addiction, other addictions and codependency. Dr. Carnes, of the Meadows, is the leading authority on sexual addiction.)

If you attend recovery meetings for sexual addiction another way to find professional help is to ask others attending the meetings for names of specialized therapists they may be seeing.

Locating Specialized In-Patient Treatment Facilities

Various in-patient and residential centers can be found by going to the site provided by The National Council on Sexual Addiction and Compulsivity at http://www.sash.net/. Click on "Institutional Members" for the facilities listed. Phone numbers and web site links will be provided.

PTSD in rape and abuse victims is common. Rape and abuse are violent acts intentionally committed against a human being. These crimes violate the survivor’s sense of self and the world and shatter any sense of safety that once existed. The malevolent nature of these acts contributes to the development of PTSD in rape and abuse victims.

How Many Rape Victims Develop PTSD?

It is estimated that in the course of their lifetime, 13 percent of American women will be raped. (National Center for Victims of Crime, 1992; Kilpatrick, 2000). Regarding PTSD in these rape victims:

• Nearly all (about 94 percent) experience some PTSD symptoms in the first two weeks after the assault (National Center for PTSD, 2015).
• Almost a third of rape victims still have PTSD symptoms nine months later (National Center for PTSD, 2015).
• About a third of all rape victims (approximately 3.8 million women) will develop PTSD at some point during their lives (National Center for PTSD, 2015; National Center for Victims of Crime, 19992; Kilpatrick, 2000).
• About 11 percent of rape victims develop chronic PTSD.

PTSD in Rape Victims: Reactions and Symptoms

Rape-related PTSD (RR-PTSD) is not an official diagnosis, but it is a term that is often used to describe the reactions and symptoms of PTSD experienced by victims of rape. Among common RR-PTSD reactions are:

• Disorganization
• Shock and disbelief
• Physical health problems
• Lifestyle changes (avoidance, moving, leaving a job, etc.)

The National Center for Victims of Crime (1992) describes four major symptoms of RR-PTSD:

• Re-experiencing the trauma through intrusive thoughts, nightmares, flashbacks and upon being reminded of the event through triggers
• Withdrawal resulting from numbing (feeling no emotions of any kind and even feeling emotionally dead); loss of interest in life
• Avoidance of anything that reminds the person of the assault, including talking about it
• Heightened arousal, which involves jumpiness/startling easily, hypervigilant watchfulness for signs of danger, sleep problems, difficulty concentrating and remembering things, irritability, anger

Why PTSD Develops in Abuse Victims

PTSD is also common in abuse victims. Like rape, all types of abuse are violent and done on purpose. Abuse violates love, trust, and safety, and it threatens the victim’s physical health, mental health, emotional wellbeing, and even his/her very life.

PTSD in abuse victims can be particularly intense because of the nature of abuse.

• It’s typically repeated over time
• Because the abuse never goes away, neither does PTSD in abuse victims; the abused child or adult never has a break or a chance to begin to heal
• Abuse is committed by a parent, family member, spouse, etc. When someone who is supposed to be loving and protective instead becomes dangerously violent in words or actions, it’s frightening, confusing, and shatters one’s world.

Symptoms of PTSD in Abuse Victims

Abuse is all-encompassing, and PTSD in abuse victims negatively affects thoughts, feelings, and behaviors. Abuse and the resulting PTSD change the way people see the world and see themselves in that world.

PTSD symptoms in abuse victims involves:

• Intrusion symptoms; recurrent unwanted memories
• Avoidance; going through great lengths to avoid causing more abuse, and avoiding interacting with others so as not to give away the abuse
• Negative alterations in thoughts and mood; depression, anxiety, thoughts of suicide, feelings of shame, guilt, worthlessness, difficulty concentrating
• Arousal and reactivity; jumpiness, general anxiety, watching for signs and reactions in the abuser, and an inability to relax or even sleep

PTSD in Rape and Abuse Victims Can Be Overcome

The development of PTSD is a natural response to trauma such as rape and abuse, but it also can be a temporary one.

Rape crisis and trauma centers, as well as domestic violence shelters, are available in many communities. Online helplines exist to provide assistance to both rape and abuse victims. Support groups are great resources for people to share experiences and coping skills. Therapy, too, has been proven to be extremely effective in healing PTSD in rape and abuse victims.

The effects of PTSD in rape and abuse victims are profound, but with time, treatment, coping skills, and positive ways of dealing with it, PTSD doesn’t have to forever plague rape and abuse survivors.

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One class of HIV medicines has been associated with problems related to the central nervous system. Side effects include vivid dreams and sleep problems. Learn how to manage these side effects.

Participants:
Graeme Moyle, MBBS, MD
Associate Director of HIV Research, Chelsea and Westminster Hospital
Peter Reiss, MD, PhD
Associate Professor of Medicine, University of Amsterdam

Webcast Transcript

ANNOUNCER: HIV medications have a wide range of side effects. Ones that affect the central nervous system can be especially disturbing.

WINSTON BATCHELOR: I've had weird dreams where I'm being chased by zombies. I've saving Captain Kirk and Spock from the Borg and I get assimilated and I die. All these weird things where I'm losing the battle, not winning the battle. So that's kind of, to me, the very scary thing.

ANNOUNCER: Winston Batchelor is 34 years old. He's been HIV positive since he was 19. Winston has been on antiretroviral therapy for seven years, and over that period, various drugs have made him feel nauseous, exhausted and lightheaded. When Winston switched regimens, and went on Sustiva in 1998, he experienced the strange dreams.

GRAEME MOYLE, MD: The most common thing that comes on with the first dose of medication and then tends to fade over the course of the next two or three weeks are sleep disturbances where people get more vivid dreams or remember their dreams more clearly over the course of the evening.

ANNOUNCER: Sustiva is a commonly-used anti-HIV drug, in a class of medications called non-nucleoside reverse transcriptase inhibitors.

There are reports that other drugs in this class have also caused central nervous system side effects. But they're more common with Sustiva.

As they should with any drug, doctors discuss Sustiva's side effects, especially sleep disturbances, with their patients.

PETER REISS, MD: It's common in patients who you put on efavirenz. But in the majority of patients, it's transient. So it's something that you need to forewarn them about. You need to tell them before you put them on that this may appear. This is what it may look like, that they shouldn't be surprised, that they shouldn't get scared and try to talk them through.

ANNOUNCER: Sleep disturbances are not the only central nervous system side effects with Sustiva.

GRAEME MOYLE, MD: Some people feel that they have a dizziness where they've not really got the spins, but they just feel as though they're a little perhaps intoxicated by the medication.

ANNOUNCER: That's exactly how Winston felt the first time he took the drug.

WINSTON BATCHELOR: About an hour, hour and a half later, I got up out of the chair and it was like someone had drugged or given me a bottle of wine. I felt so inebriated, I just fell back into the chair and my world started spinning and everything started moving.

ANNOUNCER: Other, less common, side effects with some of the non-nucleoside medicines include headache, impaired concentration, and depression. To help patients manage the side effects associated with Sustiva, doctors prescribe taking the drug at a time-of-day when the side effects may be the most tolerable.

PETER REISS, MD: It's usually given at night, efavirenz, so before bedtime, because the perception is that it may bother people less if they take it at night and the problem sets in when they may already be asleep. ANNOUNCER: Doctors say that for most patients, the best advice is: Stick with the drug, and wait out any problem with side effects.

GRAEME MOYLE, MD: In general, the average time that these effects last is around three to four weeks so we usually advise people that once you're through that first month of dosing, you'll probably find that either those effects have completely gone or they've diminished to a point that they're not noticeable. There is a small proportion of people, perhaps five to ten percent who get episodes of dreaming that last for a lot longer than that and perhaps persist with the medication for a longer period of time. But it rarely leads to those people discontinuing their medication.

ANNOUNCER: For help with sleep problems, doctors have other suggestions.

GRAEME MOYLE, MD: A lot of the patients report that the content of their dreams may relate to their activities of daily living, their job and those sorts of things. So trying to avoid thinking negative things in the late evening so don't watch the news, don't watch a horror movie, may help avoid having negative experiences as part of the dreams.

ANNOUNCER: Still other management strategies include avoiding heavy meals at nighttime, and taking other medications, including sleeping pills.

Despite the side effects with Sustiva, Winston says his HIV is under control.

WINSTON BATCHELOR: My recent test, about two weeks ago, like I said, my viral load's down. I think it was down to 64, the count was down to 64, so it was pretty good. And my T-cells are up to about 650 or 630, the highest it's been in the past two years. So the doctors are very happy about that.

ANNOUNCER: The effectiveness of Sustiva, in combination with other medicines, is one reason to stick with the regimen.

WINSTON BATCHELOR: Here I am 13 years later, and I'm still alive, thank God. So I just count every day. Even though I get sick and I come out of it, I always count every day.