Good sex, forced sex and points in between

Before you click away from one more article on sexual misconduct, what do you think of this: gadgets as the answer to sexual violence?  The article details a number of ingenious repellants to rape.  My first thought was, while a gadget might prevent vaginal rape, the resulting rage may very well provoke physical injury or death.  Surely the answer lies elsewhere.

The article reminded me of the teaching tool I used in high schools – the continuum of consent.  I would draw a line on the board.  At the right end of the continuum, I wrote violent sexual assault.  Starting at the left side of the continuum, I wrote mutual consent, then playful seduction, coercion and so on back in the direction of forcible sex.  The current tsunami of sexual misconduct allegations lives here in the centre of the continuum: coercion due to male entitlement and power.

On a call-in show today, I heard the phrase “feminist agenda” regarding the latest misconduct allegations against local politicians.  The caller blamed media’s political leanings and feminists for ruining careers.  Callers also wanted to know why women do not just walk away from a bad situation.  “She was of age”, is the argument.  Susan Cole writes, “…women tend to want to ‘solve’ the situation rather than remove themselves”.  She adds, “How about talking?  Ask a woman what she wants and when she answers, take her seriously”.

But even mutual consent on the left of the continuum is not always straightforward.

After an early dismissal from jury selection the other day, a young woman recognized me from puberty classes I had taught about two decades before.  She said she had thought of me lately as she was trying to figure out what consent means. To celebrate this unexpected gift of time, we decided to continue to chat over coffee.

She believes one should ask for consent every time.  I asked her, “every time what?  Every time you kiss, every time you seem to be heading towards intercourse?”  She is married and said that her husband knows her so well that consent for any intimate activity is unspoken.

As an educator, my question is, how do we promote affirmative, ongoing consent for adolescents, for adults who have just met, and, yes, even for couples that have been together for years? How do we engage all genders to desire true intimacy and the communication skills to find it?

People who were brought up in a society where rape culture is prevalent may experience misguided expectations leading to miscommunication: mixed signals coupled with a lack of self awareness and clarity.  Even if one has overtly agreed to a particular form of sexual intimacy, there may still be discomfort, distaste or regret during the act – or afterwards.

Zosia Bielski quotes Karen B. K. Chan, a Toronto-based sex and emotional-literacy educator. “We have been saying for a while now that consent is a low bar. It is the lowest bar there is. After that, we need to talk about sexual pleasure and good sex – sex that you actually want to have…” .  Her article raises the notion of good sex .

Lili Loufbourow takes up the issue writing about pain during vaginal sex.

Research shows that 30 percent of women report pain during vaginal sex, 72 percent report pain during anal sex, and ‘large proportions’ don’t tell their partners when sex hurts.”

During classes on sexual assault I would pose the following question: Is it OK to say no at any time?  In other words, is it ever OK to interrupt sexual activity once it has started?  Most students were ready to acknowledge that one could.  The question remains, do we actually do this?

While there may not be pain during a sexual activity, there may not be pleasure either; for example, it may be boring.  If it is not pleasurable, what is the point of continuing?  We agree to sexual activities for a variety of reasons; and we may not be proud of all of them.  We may acquiesce because it is expected, or because of our partner’s needs; we may not want to hurt their feelings; we may not want to jeopardize the relationship; we may hope that it will start to feel better soon – as it sometimes does.  While we may have progressed beyond the Victorian dictum “close your eyes and think of England”, we want a great deal more.  Why should we have to work ourselves into a state of desire with a partner who is unaware of its absence?

I remember an incident with a long-term partner.  I had lost interest in the proceedings and told him so.  He got very angry, sat up in bed and said in a menacing voice, “But I want to”.  That incident could have ended up quite differently than our turning away from each other in distress and anger.

The WHO definition of sexual health includes “the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence”.   No gadget will get you there.

 

 

 

 

 

 

 

 

 

Advertisements

Teaching sex ed – what’s love got to do with it?

Reading this article, I was reminded of an interview I had done on a national radio program last spring.  I guess it’s time to revisit this discussion.

The article above explains the dilemma for (heterosexual) boys:

“…while boys crave closeness, they are expected to act as if they are emotionally invulnerable. Among the American boys I interviewed, I observed a conflict between their desires and the prevailing masculinity norms – if they admit to valuing romantic love, they risk being viewed as ‘unmasculine’.”

The writer encourages sexual health educators to teach boys about emotional intimacy; but there is a distinct difference between emotional intimacy and love.  One can certainly have one without the other.  Let’s be frank.  Adults know full well that we don’t have to be “in love” or in a committed relationship to enjoy the pleasures of sexual intimacy.  And one can have emotional intimacy in a casual sexual relationship to which one would not necessarily apply the “love” label.

The Canadian Journal of Human Sexuality has published numerous articles on casual sexual relationships (CSRs). This article identifies four types of casual sexual relationships: One Nights Stands, Booty Calls, Fuck Buddies, and Friends with Benefits.    Despite the apparent crudeness of the terms, these are indeed intimate relationships, which hopefully include the basic requirements of good communication, honesty and respect.  Sex educators need to acknowledge the reality of CSRs rather than insist on a societal ideal.  In the early days of sexual health education, we used “love” as part of the discussion of heterosexual pairings leading to commitment and babies.  “When a man and a woman love each other…” etc.  For sex educators, in the same way that we have sought to be broadly inclusive in terms of gender and orientation, we need to avoid upholding a hierarchy of intimate relationships with marriage at the pinnacle.

Not so very long ago, lesson plans abounded with examples of the difference between infatuation and love.  No doubt these classes evolved from educators’ fear of talking about pleasure: we were afraid it might lead to early, risky experimentation.  But what would be the point of raising the question of “love” with children having their first crushes who are just discovering the pleasure of holding hands or enjoying that first kiss?  With older adolescents, at what point in the discussion of the sexualization of relationships would we then introduce the notion of love?

The article insists that we talk with young people about feelings.  And we do.  We want them to be able to evaluate whether they feel happy and satisfied in their relationships.  We encourage them to ask themselves: Do I look forward to seeing my partner?  How do I feel when we are together?  Does my partner treat me the same when we are alone as when we are in public?  On the whole, do I feel happier because I am in this relationship?

Not all feelings measure up to the standard set by romantic notions of love.

What we really need to teach young people are the bases of healthy relationships; viz., integrity, honesty, respect, fairness and good communication.  These are, after all, the values that we hope will inform their relationships.  Depending on the individuals, all of these qualities may be found in CSRs as well as long-term committed relationships.  Moreover, we can teach them the prerequisites of sexual activity – consent, safety and pleasure – which are also rooted in equitable, clear communication.

Let’s teach young people about emotional and sexual intimacy, so that when they are ready to engage in more sophisticated sexual activity, they are able to be present, find connection, take risks, experience erotic intimacy, communicate their desires, explore and be authentic.  After all, aside from asexual people who may only want to experience emotional intimacy, the rest of us also want our sexual desires to be fulfilled.

It is important to point out that many people in battered relationships are in love, albeit a love that is based in a power imbalance.  This tie is particularly hard to break.  Not only do women find it difficult for complex reasons to leave their male abusers but the dynamic also holds true for same gender partners.  We may think we can change the person or control the situation, but it is no exaggeration to say that the scenario may also escalate into murder.  As Maya Angelou says of jealousy,

“Jealousy in romance is like salt in food. A little can enhance the savor, but too much can spoil the pleasure and, under certain circumstances, can be life-threatening.”

So let’s teach young people about equitable relationships, and offer them the skills to seek happiness in their relationships, whether they consider themselves to be in love or not.

 

“Pink Viagra” approved in US: Big Win for Big Pharma

Is Addyi coming to a drugstore near you?

With the Canadian purchase of Sprout, the company that convinced the US Food and Drug Administration to approve flibanserin (now marketed as Addyi), Canadian approval may not be far behind.  Does this medication really “even the score” with men by increasing women’s sexual desire?

The New View Campaign (http://www.newviewcampaign.org/) has been arguing for years that female sexual dysfunction was manufactured to pave the way for a medication to treat it.  The Journal of Medical Ethics agreed in their commentary, “Hypoactive sexual desire disorder: inventing a disease to sell low libido” (http://jme.bmj.com/content/early/2015/06/28/medethics-2014-102596.short).

But female sexuality and desire are complex.  Back in 2004, a CME (continuing medical education) guide was written to help doctors integrate the “New View” approach.  They included a section on the medicalization of male sexual problems and a similar history for women, including an account of the search for a female medication akin to Viagra, which had already begun by the late 1990s.  The CME detailed a step by step response to this medicalization.  They began by explaining that women’s sexual problems may be due to:

  • sociological, political or economic factors
  • problems relating to their partner and relationship
  • psychological factors
  • medical factors

Clearly, no medication is going to address all of these issues.

The big sell for a female equivalent to Viagra began with faulty research, which soon became medical gospel.  The New View Campaign repeatedly criticized the oft quoted 43% figure, which was said to represent the total prevalence of sexual dysfunction for women 18 – 59.  Where did this figure come from?  The researchers, including two authors paid by Pfizer, asked 1500 women to answer “yes” or “no”, if they had experienced any of seven problems – for example, lack of desire or difficulty with lubrication – two months or more in the past year.  If they answered “yes” to even one of these questions, they were popped into the sexual dysfunction category.

There is no clear biological indicator for abnormally low desire because desire is entirely subjective.  In order to be diagnosed with female sexual interest/arousal disorder, one must report “significant distress” which is also highly subjective.  Given the above list, what woman has not had life experiences that tamp down her desire or ability to lubricate?  Just had a baby?  Don’t touch me.  In a loveless relationship?  You don’t need lube or a pill.

There were already two failed attempts to get the FDA to approve flibanserin despite their widely publicizing the (manufactured) need for it.  The FDA cited lack of effectiveness (4.4 satisfying sexual experiences vs. 3.7 for women taking a placebo: a whopping difference of 0.8%).  There was also concern about side effects (e.g., dizziness, nausea, fatigue, insomnia).  In fact, many women discontinued participation in the clinical trials because of these side effects.  And for women who like a glass of wine before sex, forget about it.  Flibanserin’s concentration – and accompanying side effects – increases with alcohol.  There is a similar increase if she is using oral contraceptives or other common medications.  Moreover, a woman would have to take a daily pill without expecting any change for weeks, as is the case with anti-depressants.

The International Business Times agrees “it is more like an antidepressant and works by changing brain chemistry over time, in a similar way to serotonin and dopamine. While male Viagra is taken before engaging in sexual activity to increase blood flow to areas of the body to help treat erectile dysfunction, Flibanserin is to be taken daily to improve sexual desire over time.” (http://www.ibtimes.co.uk/female-viagra-addyi-approved-us-what-flibanserin-how-does-it-work-1516090)

What’s a drug company to do?

The third attempt was preceded by the creation of Even the Score (http://eventhescore.org/the-problem/), backed by pharmaceutical companies – a brilliant marketing ploy.  They argued that medical sexism was withholding medication from women whose sexual desire was perceived as less important than men’s.  Co-opting feminism is an old game, but one which, in this case, was very effective.  They won the American round.

It remains to be seen if Canadian women will fall for the same ploy.

Don’t believe the hype.

Read more:

Drug Facts Box: http://www.informulary.com/informulary-drug-fact-boxes/addyi-for-women-distressed-by-decreased-sex-drive

Oral sex – is the getting still good? September 10, 2013

Besides Human Papillomavirus (HPV), there are other issues that should be raised following Michael Douglas’ oral sex and throat cancer theory.

Who’s giving, who’s getting, who’s at risk and who cares?

Let’s start with cunnilingus (a very good place to start, some would say). There have always been negative attitudes about oral sex on women because of repugnance towards female genitals. Apparently, we smell, we’re dirty; and we don’t look the way we should. Feminine hygiene products included Lysol in the early days of making women feel bad about their genital scent. Female genital cosmetic cutting and anal bleaching are the contemporary equivalents. However, it would appear that some people have gotten over that prejudice, because in films and on TV, men are going down on women in droves, not to mention woman on woman action as well. However, I’ve met many young men who gave their female partners oral sex, but didn’t want their male friends to know; it was considered unmanly.

Interestingly, there are also prejudices against oral sex on a man. I worked with young women who said they could never kiss their baby after they had put their mouth on a man’s penis.

Oral sex has been on the menu for a long time, soon to be replaced in popularity, at least according to the media, by anal sex, even though statistics do not bear this out. We have some statistics regarding oral sex for adolescents. They mirror age-related statistics on vaginal intercourse—about half of the teen population are having vaginal and oral sex by age 17. The “epidemic” of teen oral sex never did materialize since the first hysterical media stories more than 15 years ago. Unfortunately, we can only guess at who’s giving and who’s getting. As sexualityandu.ca suggests, “It is sometimes assumed that with respect to teen oral sex there is a gender discrepancy in which females are more likely to be giving (fellatio) rather than receiving (cunnilingus) oral sex from their male partners.”

It is a fair assumption that for young women, oral sex on a young male partner is one way of preventing pregnancy and postponing vaginal intercourse. A lot of ink has been spilled over whether young women find it enjoyable and/or empowering to give oral sex to a male partner. I’d like to see a good study on that.

These days, adults are seeing oral sex in a different light: will it give me cancer?

Oddly, there has not been much discussion about a risk that is much more common: genital herpes. A person with a history of cold sores (even when no sore is present) can pass herpes simplex virus 1 (HSV-1) to a partner’s genitals. Part of my health promotion message has been that is it a courtesy to tell a person you have a history of cold sores, offering to cover your partner’s genitals before oral sex. Part of someone’s decision might include the fact that HSV-1 tends to recur less frequently than HSV- 2 on the genitals and tends to be less painful. I was recently called “sexist” for suggesting that men would tend to dismiss such protection in a nanosecond. A propos, I have never met a woman, no matter with whom she had sex, who used an oral latex barrier to receive oral sex.

Men having unprotected oral sex with multiple male partners are at risk for syphilis. My clinic experience tells me that, like heterosexuals and women who have sex with women, they are not likely to use protection for oral sex. They need to be tested more frequently, since untreated syphilis puts them at higher risk for HIV.

But Iet’s get back to Michael Douglas and throat cancer.

I have been following the HPV and oral sex story for several years. Although there has been speculation that the increase in HPV-related mouth and throat cancers (which is on the rise) may be related to the increase in oral sex in earlier decades, there has been no definitive proof. The non-HPV-related head and neck cancers are related to alcohol and tobacco abuse.

HPV is only a problem when it is persistent. Most people clear the virus in the first or second year after infection.

This information leaves people with some decisions to make.

The Public Health message, which I consider unrealistic, has always been to use a latex barrier for oral sex. People don’t, and then they feel guilty.

Unfortunately, there are no screening tests for HPV in Canada; i.e., although a Pap test may indicate the presence of HPV, it does not test for it. Genital warts are generally diagnosed on visual examination. The overwhelming majority of adults will have been infected with some strain or other of HPV in their lifetime. Most of them will have gotten rid of it.

So here are your homework questions:

If you always use condoms with a male partner for intercourse (or at least, until you’ve both been tested), does that also apply for oral sex?

If someone tells you they have a history of cold sores, are you going to politely decline oral sex, use a latex barrier or say, just do it?

Will fear of cancer mean you’re going to cover your next lover’s genitals with latex before you give them oral sex, even though the numbers of these cancers are still relatively low?

If you’ve ever had a bout of genital warts, do you need to tell a partner before they put their lips on yours (the other ones) even though genital warts are more a nuisance than a danger?

Bottom line, we need to decide on the level of risk we are willing to take.

Great sex – January 9, 2013

Do you ever watch a movie, riveted by those slow, languorous, delicious lovemaking scenes; or the rip-your-clothes-off-and-get-sweaty-in-the-heat-of-the-moment scenes that make you want to howl at the moon: “I want that!”

Sex columnist, Dan Savage, says as partners, we are to be “good, giving and game.” I don’t know about you, but I think some more specific guidelines for good sex would be really useful.

A wonderful piece of research asked the question about great sex to an eclectic group of participants. I had jotted down the list below of the common themes that emerged, tucked it away and then forgotten where I’d seen it.

  • being present
  • connection
  • deep sexual and erotic intimacy
  • communication
  • interpersonal risk-taking and exploration
  • authenticity
  • vulnerability
  • transcendence

So this is my personal take on these themes.  Feel free to compare them to the original research.

Being present: We hear more and more these days about the importance of being fully present in all of our activities. When you are with someone—here and now—and they are with you too, your presence creates the basis for physical and emotional intimacy. If you are truly there with each other, every move you make, every caress and kiss given and taken with deliberation resonates with both of you.

Connection: Presence forms the basis for connection because you are embarking on a journey together. Although our sensations are our own, being connected to another person sensually allows both to appreciate the other’s sensations.

Deep sexual and erotic intimacy: No matter how simple or complex your sexual activity, you may feel like you have never done this activity in this way with anyone else before. There is nothing but feeling and connection. Turning on a partner can be very erotic, as is stripping away layers to get to basic instincts.

Communication: Think about what turns you on. Ask yourself about the key elements of why it turns you on. Now try to express this to a partner. When your partner asks you to say or do certain things, if you find yourself wondering why and want to find out, try to ask them from the viewpoint of true curiosity rather than criticism.

Perhaps the best example of good communication happens when you are trying something different, like adding a potentially charged sexual activity to your erotic repertoire. A colleague of mine adds to this, saying that when there is a “high degree of communication due to embarrassment and pain there is also a nod to the high degree of intimacy from joint discovery, new pleasures and the communication of desires that may feel taboo.”

Interpersonal risk-taking and exploration: If your partner suggests something or starts to initiate a new position or activity, the basis of this exploration is trust. If you make it clear you are ready to go there, clear communication now plays a vital role. Do you like it? If not, perhaps there something you can do that will make it more enjoyable/comfortable. If you don’t like it and want to stop, it is important that you can count on your partner to continue to think well of you and desire you as before. The same holds true if there is something you suggest that they reject.

Authenticity: This is not a movie (even if you are recording it for future pleasure). You are being as real with this person as you know how to be. Even if you are role playing, it is with the part of you that you are willing to share with your partner. How unfortunate that people sometimes feel they need to pretend enthusiasm for something that gives them no pleasure, either personally or through their partner’s pleasure.

Vulnerability: Acknowledge that this incredibly intimate activity can end in physical or emotional distress—or joy. If you are a survivor of sexual or emotional trauma, your partner has to pay particular attention to your sensibilities. If you have a disability and must put your trust in your partner’s assistance and tender caring, you are opening yourself completely, trusting that you will come to no harm. Anyone engaged in sexual activity is wide open: with concerns about physical “imperfections” and the secrets of the most intimate parts of their bodies. Breaking down barriers and allowing your partner to see your vulnerabilities is a great gift.

Transcendence: Did the earth move? Perhaps not, but how wonderful if while being in your body and present with your partner, you are still able to go somewhere you have never been before, whether it be a spiritual experience or a letting go that is so powerful you feel lost—and found—at the same time.

I’ve been thinking about orgasm – February 15, 2013

For years, women have been told we are responsible for our own orgasms; no one can hand it to us on a silver platter. And most of us can manage to get there very nicely on our own, thank you.

There are some obvious blocks to orgasm, like prior trauma, repressive sexual upbringing, shyness, overthinking, inability to relax, control issues, problems in the relationship or other stresses. What is a partner’s role in a woman’s desire or ability to come?

Two-thirds of women who have sex with men don’t have orgasms during vaginal intercourse. These women often minimize their desire for it, saying they enjoy the good feelings and intimacy that they get during sex. But women’s partners—male or female—sometimes feel cheated, both by women’s lack of desire for orgasm or because they don’t know how to get us there. There’s nothing new here. Shere Hite reported the same dilemma in the 1970s (The Hite Report, 1976). Communication is, of course, key. But “I really want you to come” may be perceived as pressure. “How can I get you there?” assumes that’s where you want to go. On the other hand (so to speak), “I want to come. Let me show/tell you what to do” sounds like a plan.

Most workshops about reaching orgasm focus first on familiarizing yourself with your own sexual response and eventually finding the type of stimulation that leads to orgasm. Some women have orgasm that is qualitatively different depending on whether there is anal, G-spot, or clitoral stimulation. You may like direct or indirect stimulation of the clitoris with a finger, vibrator, something inside your vagina or anus, anal stimulation, with lubricant or without, direct, strong pressure on the vulva, like a thigh or a pillow, or not.  Women may ejaculate or not, or only some of the time. We don’t always want—or are not always able—to come the same way every time; nor do our orgasms always feel the same, even when we have a session with several orgasms.

Let’s say you can already have orgasm on your own. How comfortable are you having an orgasm in front of your partner? Is it exciting, embarrassing, eyes open, eyes closed, watching your partner watching you, getting off on their pleasure? Is there an alternate kind of stimulation that your partner can try? If you’re used to hard and fast stimulation with a finger or vibrator and your partner tries to bring you to orgasm with oral sex, do you feel the pressure to perform? Are you worried your partner will get tired or frustrated? And maybe more importantly: can you show your partner what works for you without detailing an exhaustive list? Sex is primarily for pleasure. If performance worries get in the way, where’s the fun?

A hilarious example of how sex can become too much work and turn off a partner appears in Carol Shield’s Republic of Love.

“He’d rather enter a life of celibate denial than go through the hard labor and humiliation of bringing Charlotte Downey to quality orgasm … Quality orgasms were the only kind worth having, she told him”  (pp. 144 – 145).

Some women feel the need to stay in control of all aspects of their lives, which may impede erotic intimacy. What a gift to put yourself in your partner’s hands and allow the barriers to fall away. Sometimes I wonder if dealing with barriers to orgasm is as simple—and as complicated—as dealing with insomnia.  Instead of anxiously wanting it (orgasm or sleep), we just let go and it “comes”.

It would be lovely if two people could go with the flow. If it feels good, do it. If you or your partner gets tired, stop and do something else. And all of this can happen with a smile, a laugh, the conspiratorial joy of discovery. This is intimacy; it happens between the two of you.

And what about your partner’s orgasm? Again, it depends on how important it is to him/her. Is it your role to be The One who finds their magic formula? Answer: the magic is what happens between you, not between their legs.

Read this excellent article: http://www.brainpickings.org/2013/09/23/naomi-wolf-vagina/

When sex gets boring – September 5, 2014

I guess it depends on what you call “sex,” but sexual routines, even when they work, can become repetitive.

Although you may get off with partnered sex, you may also find yourself observing your pleasure rather than mindfully enjoying it. Author Carol Shields called it, “going through the motions of love.” If the running internal commentary sounds like this: “Now they’re going to move to the other nipple; now they’re going to check to see if I’m wet…” it doesn’t sound like fun. Recognizing that it’s no fun is a good place to start.

When boredom sets in, it may affect frequency of sexual contact, resulting in a discrepancy of desire in the couple. Of course, there may already be other relationship issues requiring attention. Avoidance, or a shoulder shrugging “let’s get it over with” attitude; or worse, the possibility of a real or implied threat of coercive sex, may lead to the end of the relationship entirely.

An article in The Walrus quotes the 2011 Canadian Living Intimacy Survey regarding frequency and mismatched desire. The study found that 53 per cent of Canadians would like to have sex a few times a week, but that 39 per cent are having sex a few times a month, and even less for 23 per cent of people surveyed. Amy Muise is lead author on the paper, Keeping the Spark Alive: Being Motivated to Meet a Partner’s Sexual Needs Sustains Sexual Desire in Long-Term Romantic Relationships which discusses this decline of sexual desire over the course of a relationship. The authors suggest that when desire decreases, couples should focus more on their partner’s needs. They call this “communally oriented sex” or “communal motivation:” “Being motivated to meet a partner’s sexual needs is beneficial to the self.” This approach differs from simply being accommodating; it means actively seeking to find out more about your partner’s needs, which involves better and more specific communication.

So let’s talk–about fun. Fun often includes excitement. I’ve sometimes wondered why some people find sexual role play so alluring. Then it struck me: it’s the ultimate “let’s pretend” that we enjoyed as children. It may bring back the thrill we get with a new partner and a new situation.

So, let’s pretend that you are with someone who may be open to a new game. How do you raise it? If you have always been sexually frank, it won’t be a problem. But if shyness and embarrassment are part of the reason you have not been able to say that you are bored with your routine, you may welcome a few tricks. In a professional workshop I attended years ago, a sex therapist gave the following suggestion: use the metaphor of treats. If you just feel like having a cuddle, slip a note under your partner’s pillow that says something like “cookie.” If you are looking for the whole shebang (sorry), write “Bavarian chocolate cake” or whatever your equivalent baked desire might be. Notes these days are more likely to be texts. An erotic text like, “let’s play a game tonight…” may open the door to a new experience.

The next time you are getting ready to be intimate, start small. “Do you remember when we first met? Do you remember where we were? Let’s pretend it’s that first time.” Then you can explore memories to set the scene. Some couples who are titillated by this first scene may want to move on to others.

Another possibility is playing “don’t touch me there.” Sex therapists often forbid certain sexual activities when there is a problem with orgasm in order to allow individuals and couples to explore other parts of the body with more attention. You can tell your partner that you want to play a game. They can only do X, Y or Z but not A, B or C. You could make it more exciting by begging them when you get really excited, to pl-e-e-ease touch you there (or to do A, B, or C) with the understanding that they are not supposed to give in.

There may be a sexual activity you’ve always wanted to try but you have been unable to ask for it. Again, a note or text might work, or you can do something out of character like renting a video that demonstrates it in great and graphic detail.

But some of you are shaking your head. You just want to be able to talk openly about an aspect of your sexual relationship that–you feel–needs work. Aside from overcoming the obstacle of finding the words and getting them out, you may be worried about hurting your partner’s feelings. Perhaps the next time you set out to be intimate, start with expressing appreciation. “I love it when you/we…Let’s do that some more the next time.” Or, “I remember once you did X. I fantasized about that for days. I’d love you to do that again.” Or, “you would probably enjoy Y and I would love to give you that pleasure.”

If you like your routine, fine. If you’re bored, fix it. Or at least enjoy trying.