Tantra, Squirting, BDSM—Not For My Patients, Thanks

Squirting, BDSM, teledildonics, riding glass elevators without panties—for people who enjoy such things, that’s fine. For them. Really.

But when people with inadequate, frustrating, or painful sex lives come into my office, those kinds of exotica are not what I think of first. Or second.

In fact, one way that therapists undermine therapy is by suggesting alternative kinds of sexual expression to people or couples who are just not ready for them. That’s like a physical therapist suggesting a patient run a marathon when he or she still has shin splints or hip pain.

It’s great that the public now has access to such a wide variety of sexual variations, including swing clubs, polyamory, sex toys, anal play, pornography, various Eastern techniques, and BDSM. For people who are eager and ready to experiment, have at it.

But too many patients approach such things with a sense of desperation, and many are angry with their partners or ashamed of themselves. That’s not a very good foundation for sexual experimentation. And yet therapists call me all the time asking for suggestions, and patients come to me in the wake of sexual experiments that didn’t quite work out the way they hoped.

If activities like Tantra, BDSM, and squirting are perfectly fine for millions of people, how then can they be problematic for so many other people?

* Rules: Most sexual variations have rules, guidelines, or predictable routines. Tantra shapes male orgasm. BDSM involves breathing, high levels of trust, and monitoring your partner’s (or your own) reaction. Vaginal squirting is of course goal-oriented.

Prescribed rules and routines can be so distracting that people have trouble enjoying the sex. And they contradict the single best approach to sexuality—no rules, no routines, no hierarchies, and other than (if necessary) birth control, no have-tos.

* Communication: Effective communication is central for people to be satisfied with alternative sexualities. Whether before (establishing a safe word), during (“I don’t care for this as much as I thought I would”), or after sex (“Next time, please spend even more time with my nipples”), this is fine—unless you really don’t like communicating about sex.

When patients ask me about consensual non-monogamy, I often say, “Mary, you know all those conversations George wants to have about sex that you find so boring? Non-monogamy will require way more of those conversations than you’ve ever had.”

* Expectations: Acolytes fond of alternative sexualities, and therapists working with people who don’t enjoy sex, both tend to raise the expectations of the uninitiated way too high.

Those who enjoy alternative sexualities sometimes forget the complex path they took to get there. And sexually uninformed therapists sometimes underestimate the emotional sophistication it can take to enjoy non-traditional forms of sexual expression.

And so for many hurting or inhibited people, the payoffs of learning how to combine sex with theater, or becoming experts in gynecological function, or of challenging cultural norms about privacy, gender, and the body, may simply not be worth the effort.

* Lifestyle: For some people, an activity like using handcuffs is a twice-yearly spice in their usual life’s soup. For others, things like exhibitionism or squirting are part of a normal week, part of the ongoing fabric of their sexual expression.

While we could argue that more men and women should take sex more seriously and make more time for it, the fact is that people who struggle with sexual boredom, frustration, anger, or shame are already taking sex quite seriously—just not in a way that provides healing, pleasure, or intimacy. Thus, encouraging these men and women to make sex a bigger parts of their lives is counterintuitive and possibly even counterproductive. At the very least, it may easily seem pointless.

* *

Giving yourself permission to, say, enjoy a finger in your butt or get aroused going braless in public can certainly enhance your sense of empowerment and self-acceptance (especially if the experience turns out OK).

But how does someone get there? People who feel self-conscious about their bodies aren’t going to enjoy showing off in public. People who are afraid to ejaculate too quickly, too slowly, or not at all aren’t going to enjoy following rules about how to orgasm properly.

So for many people, there have to be steps before experimenting or practicing new sexual activities or techniques. What might such people need?

* Self-acceptance
My imperfect body is OK; my lack of sexual experience or expertise is OK.

* Communication skills
How to say yes; how to say no; how to ask for something a little different; how to say “I’m not sure what I want, but this isn’t it;” how to say “Please tell me you care about me.”

* Sense of entitlement & empowerment
It’s OK to enjoy sex; it’s OK to shape sex the way you want it; it’s OK to not know exactly what you want; it’s OK to want something yesterday but not today.

When the subject is sex, these three are an important part of effective therapy for individuals and couples. Referring people to sexual enhancement seminars, BDSM clubs, pornography, or books about “stripping for your husband” almost always miss the point. Unless, of course, people are already high functioning in bed—in which case that’s presumably not why they’re in therapy.

* *

Some people have physical considerations regarding sex—for example, because of pregnancy, back pain, menopause or surgical recovery. In such cases, different positions for sex may be appropriate and enlightening.

But for most people who ask about “different positions for sex,” the one position worth encouraging is a position of self-acceptance and communication. And a sense of humor, of course. That will take people much further than trying the reverse cowgirl or the pirate game.

*  *

One more thing. If you enjoy vanilla sex, there is absolutely nothing wrong with that. Like vanilla ice cream, it has a lot to recommend it. And as with ice cream, so with sex: depending on your taste, less can definitely be more.

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