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Robert W. Birch, Ph.D.

Sexologist & Adult Sexuality Educator
         Volumes have been written on the topics of body-image and on self-esteem, but very little has been said about one important aspect of a woman’s self-perception... her sexual self-esteem. This is a delicate topic, but to understand it we are required to look unflinchingly at the psychological and sociological factors that influence a women’s concept of her sexual self. At the onset, however, let me first acknowledge two obvious things: First, I am a male (which for some readers will automatically disqualify me as an expert on this topic) and second, many women already have a marvelous sexual self-esteem (and what I will be saying will not apply). With this said, I will risk continuing.
         Anatomically, young females see little of their genitals as they look down their bodies. Well know sexuality educator Jessie Potter had remarked that girls have “privates,” boys have “publics.” Because of female anatomy, I would suggest that for many girls their “privates” were also their “secrets.” A female’s genitals are not only secret from the world, they often remain secret for many of their owners.
         There can be something exciting about having something secret. Mystery and intrigue surround things held secret, but things secret also have a more negative potential. If what is concealed by design and held in private by mandate is also portrayed as bad, anxiety and shame can become associated with it. The socially responsible message to “just say No” does not help a sexually response young woman deal with her erotic desire. If a teenager identifies this natural desire as ‘lust’ or as ‘sin,’ she is likely to feel guilty about her sexuality and shameful of that part of her body that seems responsible.
 Add to the perception of genitals as bad is the stereotype of a vulva as being ugly and smelly. The concept ‘dirty’ becomes associated with female genitals. A revered physician and sexuality educator, Dr. Mary Calderone, would often remind us that may women have grown up with the bizarre message, “Don’t touch yourself down there, it’s dirty. Save it for the one you love.” One must wonder, if what is down there is so dirty, why would a woman ever want to give it to someone she treasures?
         To some extent, the well-intended messages about menstruation can also add to a young woman’s sexual self-consciousness. Menstruation is something that must remain hidden. Tampons don’t show, pads with wings keep the secret, and mini-pads allow for normal appearing movement. Belts went the way of the bell bottoms, so women no longer had to worry about telltale lines,  I wonder how many women grew up thinking they were called ‘sanitary pads’ because there was something sick or dirty about a very normal process. The cross section of a woman’s pelvis in the flier of a tampon box is drawn without a clitoris. A brochure on benign prostatic hypertrophy would never show a cross section of a man’s pelvis without including a penis. Boys have ‘publics,” girls have ‘privates!’
         Aging women are faced with the challenge of maintaining a good sexual self-image in the face of the media presentation of sexy as a woman with a perfectly proportioned and remarkably firm body, and as sex as an activity engaged in by this perfect woman and a perfect male partner. Aging heterosexual women and lesbian women of all ages are disenfranchised by the notion attracting a sexy young man is the mark of a woman’s sexual attractiveness. Bodies change as we age, but we do not see these aging bodies in hot steamy love scenes. Sex is for the young, the beautiful and heterosexuals. There are jokes about we older folks doing it, or more often than not, about we older folks not doing it.
         There is another problem that many older women have grown up with, but I think might finally be changing. This is the image of the passive female and the sexually aggressive male whose role is to seduce her. Once seduced, the woman having been turned on by the man is laid in a passive position and mounted, the male orchestrating the coital dance. Many women still in that supine position wonder why they are not reaching orgasm during intercourse, never realizing that the majority of women never do reach orgasm during intercourse and that the missionary position is one of the most ineffective ways to attempt to do so. Men in the superior posture act out their image as active, dominant, in control, and reliably orgasmic. The women on the bottom remain passive, receptive, to some extent helpless, and often wondering “Is that all there is?”
         As I stated at the beginning of this article, many women have a wonderfully positive sense of sexual self-esteem, and most of these have probably quit reading this by now. Those of you who are still with me, bear with me a bit longer as I now attempt to offer some tips on improving your sexual self-esteem.
         Get your genitals out of the closet. Perhaps nurses more than any other women have seen genitals with problems. They have not been sensual loving lustful vulvas... they have those that are infected, diseased, or injured. When was the last time you looked at yours, other than wondering about that itch or worried about that discharge. When did you last look and say to yourself, “Neat!” Take a hand mirror and with ample light, look and say “Hello” to that very special part of your body. Give your vulva a playful nickname! Take pride in your womanhood and remind yourself that there is nothing dirty or ugly or smelly about your body.
         It is hard when a woman loses one or both breasts to cancer. Remind yourself that sexuality is not about anatomy, it is about attitude. It’s no secret that breasts change their appearance as women age... lots of things begin to sag. Reminisce joyfully about the firmness of your youth. Value your past without morning your loss. Stand in from of a mirror and find the angle that are most attractive. Look for the areas that are still sexy.
         Take responsibility for your body and for your satisfaction. If you have never masturbated, give yourself permission to try... it really is a very effective way to own your body and your sexuality, not to mention learning what really does work best. If you have a partner, be more active, ask for what you want, and try new things. If that partner happens to be male, have him lay on his back and you mount him. The female superior position is very effective for many women, as they are able to control the movement and get the clitoral stimulation needed for maximum coital pleasure. (Typically this works best when the woman leans forward, stays in tight against her partner, and slides back and forth... rather than sliding up and down.) Take charge, be in control and get what you want. Most men love being “used.”
         Allow yourself to have sexual fantasies in which you are the pursuer... the seducer. Wear comfortable underwear that helps you feel sexy. Do it for yourself, not for others. Be playful with your little harmless sexual secrets... chase away any old guilt or shame.
         Talk to other women about the myth of the passive sexual female or the over-the-hill stereotype. Talk to your partner about your positive sexual attitude. Share your understanding of your own body and what you like and need. Flirt with your partner.
         Remember, you are a complete sexual being, packaged in a marvelous body and capable of superb sexual experiences... of your choice.

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Concerns with Levels of Desire

Robert W. Birch, Ph.D.
Sexologist & Adult Sexuality Educator

      Most sex therapists would agree that of all the problems presented in their offices, the largest category of concerns are those centering around levels of sexual desire. They would also agree that these cases are the most difficult to understand and the hardest to treat. But, let's begin at the beginning and try to understand what sexual desire is and where it comes from.

Sexual Desire Defined
     Sexual desire is the internal motivator that signals the biological hunger for arousal and orgasm. In the past it has been called "libido," and today its stirring is commonly known as "getting horny." It is a biological hunger, not too unlike our hunger for food, although no one has ever died from lack of sex. The sexual hunger begins as a subtle yearning and might stay at that level, or it might escalate in intensity and become quite demanding. Given the opportunity for arousal and the eventual orgasmic satisfaction, the level of biological desire decreases. This biological need will, however, resurface in a period of time, this cycle being different for each one of us depending on our biology and our environment. By "our environment" I mean, of course, the amount of sexual stimulation around us, in the form of a desirable and interested partner, exciting visual stimulation, and sensual sounds and aromas.

     I'll back up again to point out that there might be confusion in our definition of "sexual desire," for it is often used to identify sexual thoughts, as well as physical urges. I prefer to refer to the former, the sexual thoughts, as "sexual ideation," and reserving the term "sexual desire" for that biological ache that captures a person's attention and directs his or her behavior toward a sexual goal. Thus, someone might honestly say they think about sex, but they have no desire to do it. They might say that their sexual ideation includes memories of wonderful sexual encounters, but there is no physical need to repeat them.

     There are those who have positive thoughts about sexuality and a biological sexual need that periodically arises. The satisfaction of a sexual appetite does not automatically require that it be done within the context of a relationship. Some people might abstain from a sexual exchange for reasons relating to their morality or personal values, or just because a suitable partner is not available. Therefore, there are obviously those who respond to their sexual drive with masturbation. Self-pleasuring is an option for one who is waiting or one who is without a partner, and self love should always be practiced without guilt. It is interesting, on the other hand, there are also those with strong physical needs, but with negative sexual ideation and this prevents them from seeking fulfillment of their sexual appetites, alone or with a partner. Celibacy is a matter of choice, but a lot easier for one who has little or no desire.

Three Types of Sexual Arousal
     Let me back up again, for this topic of sexual desire is complex and I need to make another point about arousal. (Remember, the physical sexual response cycle begins with desire, which leads to arousal, and, with effective stimulation, culminates in orgasm.) There are essentially three types of arousal. First, there is that spontaneous arousal that is closely intertwined with desire and springs up without provocation. The horniness suddenly emerges, closely followed by the physical manifestations of arousal (men get firm, women get wet). This spontaneous arousal is most likely the result of a biological cycle driven by the person's hormonal system, and the most obvious example are the spontaneous erections of the adolescent boy which occur with no external or mental stimulation. The desire and arousal just appear.

     With age, other physical changes, and a lot of unknown factors, the incidence of spontaneous arousal diminish. However, there is another avenue to arousal that we can call "psychogenic." The genesis or beginning of the arousal is in the person's psyche or mind, although the biological/hormonal component is still operative. Psychogenic arousal occurs when a person, with positive sexual attitudes and a subtle but growing biological need, begins a sexual fantasy; or sees, hears or smells a desired partner; or sees or reads something erotic or explicit. Psychogenic arousal can be stimulated by a nonsexual touch, a gentle kiss, or some other sensual touch other than on the erogenous areas. We could guess at a percentage and say that the origin of psychogenic arousal is 65% within the mind and 35% within the body. It should be obvious, however, that the percentages can change, but arousal might still occur if the numbers add up to 100.

     All is not lost if the percentage of the spontaneous biological contribution is low. This is when we must rely on nature's backup plan. This we can call "neurogenic arousal" or "reflexogenic arousal," for the pathway to arousal is via a neurological reflex. Remember this avenue, for it is important and I will get back to it.

Sexual Issues Centering Around Desire
     Now, let's look specifically at the types of concerns that center around issues of desire. However, I first want to remind the reader that there is no national standard that everyone must meet. If both partners enjoy there mutual sexuality once a month and are both happy about that, there is no problem. If another couple mutually enjoys their sexuality twice a day, seven times a week, and still makes it to work on time, there is no problem. Too often there is a tendency to label someone as "undersexed" or "oversexed" based on some statistic or, more likely, the level of desire of the persons doing the labeling. This is subjective at best, disrespectful at worst.

     Each couple must decide what is right for them and, if in agreement, no one should judge their performance. However, a problem might arise if one partner feels the need for sex once a month and the other partner desires it more frequently. This has been called a "desire discrepancy," and can become a major issue in a relationship. I should hasten to add that the old sexist jokes always have the woman saying, "Not tonight," and then claiming the proverbial headache. In reality, a good estimate is that the ratio between women and men is about six to four. That is, out of 10 people with a level of desire lower than their partner's, six will be women. Four of these 10 people will be men.

      Issues of desire are further complicated by the fact that newness or novelty are very powerful aphrodisiacs. There might be a lot of spontaneous and psychogenic arousal early in a relationship, but as time goes on, the level of desire diminishes. Although not exclusively, it is often the man who continues to feel the biological desire when time cools what had begun as a passionate relationship. It is recognized that testosterone plays a major role in triggering sexual appetite... women produce it also, but not in the same quantity as men. So we have issues of familiarity and issues of hormone production, and these are not easily sorted out.

Two Categories of Low Desire
     I need to get academic again... forgive me. Low desire might be life-long (chronic) with the person saying, "I never really had a need for sex," or it might be a more recent change and the person reports once having a strong desire but somehow losing interest. With the former, blood chemistry might be involved. With the latter, biological changes (e.g., a pregnancy, menopause, or medication side-effects) might be the culprit, or the introduction of mistrust, disrespect or anger into the relationship could undermine the desire.

     Typically, if the lose of desire is related to some physical change, it is "global." That is, the person never feels desire. However, if a decrease or loss of desire has something to do with a change in the relationship or something to do with the partner, it is called "partner-specific." In this case the person feels desire, but is not attracted to their partner. Such a person might report that they are avoiding sex with their partner, but are masturbating on a regular basis.

The Partner's Reaction
     Even in a relationship that is otherwise good, partners with a higher sexual interests and drive often have difficulty understanding why their mate is indifferent. All too often they think it is intentional (e.g., withholding sex to punish) or a sign of the loss of love ("If you loved me, you'd want me"). Feelings might be hurt, self-esteem might suffer, and rejection might be perceived when this is not what it is. The one with the higher desire might feel abandoned and undesirable, but the partner with the lower level of sexual drive might be equally bewildered. Not having the appetite, this partner might wonder why their hornier mate has placed so much importance on something that holds so little interest for them. They might feel pressured, could feel guilty, and may even wish they could feel more desire but do not know how to make it happen.

     Unfortunately, a chain of events might begin. One partner shows little interest, but tries. The other partner senses disinterest and begins to question. The one with the lower desire could then feel self-conscious and back off. The hornier partner might then lay on a guilt trip. The one with the lower appetite might begin to resent this and shut down even more. The hornier partner might then begin to pressure and the one with less drive becomes angry. This couple is now in serious trouble!

The Place to Start
     Let's begin with two first steps that many, many people resist. If the absence or lose of sexual desire is global, the person with the lower sexual appetite should consult a physician and request a complete evaluation of his or her hormone levels. If the absence or lose of libido is partner-specific, it is time to take a good look at the quality of the relationship, both emotional and sexual. Look for anger, resentment, or maybe just boredom! If sex has become mechanical, routine, hurried and one-sided, without a powerful push from hormones, desire will plummet.

     People with higher desire than their partners should be aware that the more they push, the more likely it is that their mate will back down. Sexual desire is a natural biological drive and can not be talked, coerced, or shouted into action. The other thing people must learn is to avoid what I have called "all-or-nothing sex." That's when the only time one partner touches the other is when he or she wants physical gratification and does not stop until they get it. There is nothing in- between. This can be particularly devastating to a woman who has low desire for sex but a high need for nonsexual physical affection. Perhaps is she was touched more she would be more willing to try. Men need to remember that for many women, sex is more about the total relationship than about having an orgasm!

It's a Tough Problem
     I'll be honest and state that the chances of someone going from zero desire to full steam ahead even with the help of a qualified sex therapist is pretty slim. Hormone supplements might help, but folks should always be aware of any possible side-effects. I do feel, however, that there is a way to deal with a desire discrepancy within the context to a loving and committed relationship if both parties are willing to compromise.

     The strategy begins with the couple's mutual agreement to redefine what their sexuality is all about. If one insists sex is only about orgasms, there is going to be trouble! Sexuality must be redefined as the intimate expression of caring, with or without orgasms. It must be viewed as the physical expression of their emotional passion, with or without arousal. This new definition of sexuality should include sensual massage, nonsexual fondling, and the verbal exchange of positive thoughts, fantasies and memories.

     It must be understood that no one is purposefully rejecting the other, and love still exists even in the absence of frequent and spontaneous arousal. It must also be accepted that strong overwhelming feeling of desire are unlikely, and that this is as much a loss for the one with less desire as it is for the one with the stronger drive. However, it must also be recognized that some compromise must be met if the relationship is going to continue undamaged.

There is Hope
     I had written of spontaneous arousal generated by a powerful biological drive. Forget it! I had also written of the influence of the environment in allowing psychogenic arousal, even in the absence of strong desire. To do this, all-or-nothing sex must be avoided. The level of romantic encounters should increase as should the amount of nonsexual touch and loving caress. Turn-ons and turn-offs should be openly discussed, and the couple should reminisce about their past loving and erotic activities together. Communication about pace and timing is essential. Novel and creative activities acceptable to both might be explored to bring some novelty into the bedroom... in fact, novelty can be added by playing in locations other than the usual room of the house where sexual attempts typically occurred.

     Now, all of that probably is something you have read elsewhere. But, the main element in the intimate compromise is to agree to set aside time in advance to relax together and, in a non- pressured atmosphere, to play. Bathing or showering together could be a start. Candle lite and soft music might help set the mood. Nonsexual caress with a warm massage oil would help the relaxation. I might happen that in the sensual process, the desire of the less interested individual might be stirred, and the session might move slowly into sexual activities. The partner with the stronger desire should realize that even if it moves in this direction and even if his or her mate experiences a pleasurable orgasm, the level of spontaneous desire of that partner will not increase. This is a strategy, not a cure!

Focusing on the Process, Not the Goal
     In this process that begins almost from ground zero, it is absolutely essential that there is agreement that when one partner says something like "I'm gone about as far as I am going to go," that the other partner will not push. The contribution of the hornier partner to the success of this strategy is his or her agreement to back away from the urge for completion so as not to pressure the other participant. However, the contribution of that partner with the lower desire is the promise to try the next level before asking that the progression end. In other words, if the nonsexual massage feels good and relaxing for a woman with a low sexual appetite, breast stimulation should be tried even in the absence of desire. If that feels good, the next step including genital stimulation should be tried, even in the absence of arousal.

Ignition Problems
     Do you remember what I wrote about reflexogenic arousal. It is a neurological reflex that is triggered by direct stimulation of the clitoris of a woman or the penis of a man. With a woman who is not aroused, this should happen only with the added slipperiness of a safe and water- soluble lubricant (like K-Y or Astroglide), or with oral stimulation. There is a chance, if the person without spontaneous desire was able to relax and if the touch was unhurried and in just the right places and just the right time, that arousal will occur with this direct stimulation of the most erogenous areas. This is what I have called the "jump start" for people with "ignition problems." Many people discover that even though their starters are broken, their motors will run just fine.

     But, the jump start might not always occur and so the agreement to back up when something is not working holds true, even when the activities have moved to this level of genital involvement. When a limit is reached, it is very important to back up and slowly back out, even when there has been manual or oral caress of the genitals. However, care should be take to maintain the expression of sensual caring in this "cool down phase." The person with the higher desire can always ask permission to masturbate while their partner holds them, and some partners might even be willing to help. This must never, however, be done to embarrass or intimidate a mate, but rather as the conclusion to an understandable, one one-sided, hunger that craves satisfaction.

     Desire discrepancies can be troublesome, but with understanding, compassion, and a willingness to risk starting something that might not get finished, partners can avoid the anger and avoidance that might otherwise occur. The physical bonding in a long-term relationship is important enough for couples to seek a compromise that both can live with.

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Robert W. Birch, Ph.D.

Sexologist & Adult Sexuality Educator

Author of ORAL CARESS: The Loving Guide to Exciting a Woman

     Most of us already know that men love receiving oral stimulation and probably have been begging for "blow jobs" (fellatio) ever since they first discovered there was more than one opening into which a woman could incorporated a penis. However, turnabout is fair play, and most women, if they give themselves permission, will thoroughly enjoy being on the receiving end of a talented tongue. They will receive this oral stimulation (cunnilingus) with equal or greater enthusiasm than they experience when giving. However, people seem to come in all varieties, and so there are couplings in which the woman loves sucking on her partner's penis, but will not allow herself to be orally stimulated. There are certainly relationships in which the woman loves being "eaten," but refuses to return the oral pleasure. Then there are the men who are pigs when it comes to getting, but adamantly refuse to go down on their partners, and conversely, there are those men who will turn down a blow job, but love orally stimulating their women. People certainly have the right to decide what they want to do and what they want to receive, but within an intimate relationship it is important for both parties to agree on what will and will not be practiced.

     I would like to propose to those couples having an interest in oral stimulation that it is important to work together in perfecting the art of both giving and receiving. Open and honest communication is essential, for we are each the expert on our own body and we must, therefore, communicate our unique wants and desires to our partners. Each individual should learn the skills needed to be a good giver, but each must also learn to open up to the full enjoyment of being on the receiver. Men, it seems, are better at being "selfish" in this regard than are some women. With that special partner, a woman needs to learn to enjoy giving the perfect blow job of her choice (and it should be her choice), but she should also learn how to get the most out of receiving her partner's stimulation when he lovingly begins orally stimulating her. It might help a woman to relax and enjoy the oral encounter if she knows that most men truly love arousing a woman and most love doing so orally. Most men love the textures, the aromas, and the tastes associated with cunnilingus. Trust me on this!

     The point I wish to make is that oral sex is best when it is exchanged. It is a loving act that should never become routine or mechanical, and no book should set out to give you a Step A, Step B, Step C set of instructions. Orally pleasuring a special person is too important, to unique, and too intimate to be boiled down to a set of rigid directions. Be playful and experimental. Enjoy your partner, but enjoy yourself as well. Oral sex is much too good to only go in one direction. Some couples, therefore, enjoy simultaneously stimulating each other in a sixty-nine position and this seems to work well for those who can pat their heads and rub their stomachs at the same time.

     I would like to suggest, however, that there is also an advantage to taking turns, so that when giving, the giver can joyfully specialize in giving and the receiver can "selfishly" concentrate on the erotic pleasures of receiving. (I hope it is realized that I use the word selfish in a positive way to indicate the willingness to fully enjoy one's own erotic pleasure.) But positions must at some point be exchanged, so that the one had been giving now has their turn to lay back and wallow in the pleasure of this wonderful gift of the oral caress. Simultaneously or taking turns, to orgasmic completion or as foreplay, on a bed or on a table... however you and your partner choose to express your oral intimacy, remember that the most important message I am attempting to communicate is that all of your sexuality should be open, adventurous, and, above all, great fun for both participants!

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Dr. Birch writes on the importance of communication

Women write about their introduction to cunnilingus

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Guidelines for finding a qualified sex therapist

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Ideas for using a sexual lubricant during foreplay, masturbation, and fellatio.

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