Another variation of the male-superior position is called the butterfly position. The woman lies on her back, but she tilts her pelvis so that her vagina is pointing almost straight up. This position can be varied a good deal depending on the positioning of her legs. She can bend her knees and spread her legs, raise them into the air, or wrap them around her partner’s waist. In this position, the man kneels in front of the woman.
For a man, any version of a male-superior position is usually very arousing. These positions contribute to a feeling of bonding and intimacy because the couple can easily make eye contact, talk, and kiss. We tend to idealize the male-superior position in this culture because it reflects our conception of traditional male and female roles—that the man is the sexual initiator and the woman is the receiver. Many people find it a turn-on when the man is the more dominant partner.
The straight missionary position is one of the least effective positions for clitoral stimulation, whereas the CAT version is used specifically for clitoral stimulation. Some men find it difficult to delay ejaculation in the male-superior positions, and say that supporting their weight in these positions can be tiring. The straight missionary position doesn’t give very much depth of penetration; therefore, in this position it’s difficult for a woman to receive stimulation of her G-spot and the other erogenous zones deep in her vagina.
As I’ll explain later in some of the chapters on healing specific sexual problems, certain positions are recommended for certain problems. The straight missionary position is good for couples who need help with intimacy or desire issues. The coital alignment technique is good for women with female sexual arousal disorder because it provides a lot of stimulation to the clitoris. The butterfly version of the male-superior position is excellent for female arousal and orgasm problems because it allows stimulation of both a woman’s internal and external orgasm triggers.
Since the male-superior positions usually are very arousing for men, I initially advise a man with premature ejaculation to stay away from them while he is learning ejaculation control. That said, within this group some positions are better than others for helping a man learn ejaculation control. For example, it’s much easier for a man to maintain ejaculation control in the butterfly position than in the straight missionary position. The male-superior positions are also good for men with male orgasm disorder (difficulty ejaculating). In the butterfly position, the man has a very exciting view of his partner’s breasts and of his penis going in and out of her vagina. Men with erection problems generally also do well in the butterfly position. In this position, if you feel your erection go down, it’s easy to take your penis out of your partner’s vagina and stimulate yourself.
Female-Superior Positions
These are the woman-on-top positions. In the most commonly used version of the position, the man lies on his back while his partner kneels on top facing him. Her legs can be placed in several different ways. She can lie on top of her partner in such a way that they have total body contact. Or she can squat over her partner’s body with her knees on either side of him. In this way she can raise her body so she is almost sitting up.
The female-superior positions are great for female arousal and orgasm because they give a woman so much control. She is in charge of the speed of intercourse as well as the depth and angle of penetration. In this position it’s easy to maintain eye contact and intimacy. There can be full body contact. It’s easy for either partner to caress the other’s body. Either the man or the woman can stimulate the woman’s clitoris to help her get aroused and have an orgasm. Or she can use a vibrator on her clitoris in this position. From an emotional standpoint, the female-superior position has often been considered a “bad girl” position, and for that reason a lot of people find it especially arousing.
From a negative standpoint, some men are uncomfortable with their partner appearing dominant or aggressive, and some women are equally uncomfortable appearing or feeling dominant. Some women don’t like the way they look and feel in this position because they believe their bodies jiggle and sag when they’re sitting upright and moving rapidly.
The female-superior position is highly recommended for women who have desire, arousal, and orgasm problems. I wouldn’t generally recommend it for men with male orgasm disorder, because most men need to be more active in order to ejaculate. When men have erection problems, sometimes it’s difficult to maintain an erection when their partner is on top of them.
Side-to-Side Positions
In the side-to-side positions, both partners lie facing each other, and one person puts a leg over the other’s hip. There are several variations. In one of them, called the scissors position, the man lies on his side, while his partner lies on her back perpendicular to him. The couple interweaves their legs so their genitals meet.
The side-to-side positions are very relaxing because they don’t require either person to support his or her body weight. Many people find that these are great positions first thing in the morning, when neither partner is in the mood for major sexual acrobatics. Many people like the eye contact and sense of intimacy these positions provide. With a couple of small bodily adjustments, these positions allow for the possibility of the man sucking and kissing the woman’s breasts. The side-to-side positions tend to be the least genitally stimulating for both sexes because they are so relaxing. They don’t allow much depth of penetration, so they are not generally stimulating to the woman’s internal orgasm triggers like the G-spot, cul de sac, and cervix.
Because they are not physically strenuous, the side-to-side positions are often recommended for older people or for people who have physical limitations like arthritis. These positions are very good for men who have erection problems, because the penis doesn’t have to be super-hard to penetrate the woman’s vagina. In fact, a man can penetrate in these positions without even having an erection at all. These positions are also very good for men with premature ejaculation, because they allow a man to spend time inside his partner’s vagina without moving, just getting used to the warmth and containment. Because these positions are relaxing rather than stimulating, I don’t recommend them for men who have difficulty reaching orgasm.
Although the side-to-side positions tend not to be stimulating for the deeper areas inside a woman’s vagina, I definitely recommend them for women who have difficulty with arousal and orgasm, because either the woman or the man can reach down and manually stimulate the woman’s clitoris. These positions are also good for both vaginismus and sexual pain, because it’s easy to lie in these positions with the man’s penis held against the woman’s vagina, without actual penetration.
Rear-Entry Positions
In the basic rear-entry position, the woman kneels on the bed on all fours, while the man kneels behind her. The variation I recommend is one in which the woman kneels at the edge of the bed and the man stands on the floor behind her. She puts her folded arms on the bed so she can rest her head on them. This is more comfortable than kneeling on all fours because due to the change in the angle of penetration, the mattress rather than the woman’s back absorbs the energy of the thrusting. In another version of this position the woman lies flat on her stomach and the man lies on top of her.
These positions may feel primitive and animalistic, and for this reason they can be an exciting turn-on for many people. They sometimes turn people off for the same reason. Some people say that the rear-entry positions feel too impersonal. It’s more difficult to kiss and make eye contact in these positions, although for that to happen all the woman has to do is turn her head. Then her partner leans over so she can see his face.
The rear-entry positions are the best for fast stroking and depth of penetration. They’re also great if the woman likes to have her cervix stimulated, and they offer some of the best ways for the penis to make contact with the woman’s G-spot. While in one of these positions, if a woman chooses she can shift her arms and hands so that she can easily stimulate her clitoris.
The rear-en
try position is a rather advanced position that I don’t recommend for the early stages of most sexual healing programs. It’s good for women who have difficulty with arousal, because of the possibility of intense stimulation to the G-spot and the cervix. However, I don’t recommend this position for men with erection problems, because the angle of penetration is a little tricky and can cause some “entrance anxiety.” I do recommend it for men who have difficulty reaching orgasm, because in the early stages of learning to ejaculate more easily during intercourse, sometimes it works well for a man to use a more impersonal position. Getting to the point where they can enjoy intercourse in this position can be a real breakthrough for women who have successfully dealt with vaginismus or sexual pain, because it’s the position in which the woman has the least amount of control over penetration.
In addition to the four major categories of positions, you can combine positions from different categories. For example, you could combine the rear-entry and side-to-side positions, so that the man lies on his side behind the woman, who is also on her side. That way you get the stimulation of the rear-entry position but neither person has to support his or her own weight. Or you could do a combination of the rear-entry and female-superior positions in which the man lies on his back and the woman straddles him facing away from him. Combining positions gives you the advantages of both.
Theoretically, the number of position variations is infinite. Every time you move an arm, a leg, or even a finger, technically it’s a different position. But when it comes to using sexual intercourse to heal your problems or doing it just for sheer enjoyment, there’s more to it than just positions. Your healing capacity and potential enjoyment depend on comfort and predictability as well as novelty. For your sexual healing process, comfort and predictability are probably more important than novelty. Once you are more confident in your sexual abilities and in your ability to enjoy intercourse, then it’s time to branch out into some of the more exotic positions.
Part II
SEXUAL PROBLEMS
In this section you’ll find detailed descriptions of each of the nine sexual dysfunctions, along with information about what causes them.
chapter 5
Low Sexual Desire
In the DSM, low sexual desire is called hypoactive sexual desire disorder, or HSDD. A former name for this condition was inhibited sexual desire. Low sexual desire can affect both men and women, although it is more common in women. The DSM defines low sexual desire as “persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity.” This diagnosis has to be made by a clinician based on factors that affect sexual functioning, including age and the context of the person’s life.
In cases of lifelong low sexual desire, a person has never felt sexual desire for someone else. This is extremely rare. Most people experience the desire to have sex with another person at some time in their lives, even if they never act upon it. In acquired low sexual desire, the person at one time had what would be considered a normal level of sexual desire, but no longer experiences desire. In generalized low sexual desire, a man or woman does not experience desire in any situation—that is, he or she doesn’t have the desire either to have sex with a partner or to masturbate. In situational low sexual desire, a person may experience sexual desire with one partner but not with another.
What’s Normal?
This is a really tough question to answer. I’m going to start with the simplest possible explanation and say that I think it’s normal to feel sexual desire for another person at some time in one’s life. I believe this experience is common to the vast majority of people throughout the world.
Yet low sexual desire is extremely common, especially among women. In fact, in the 1980s, inhibited sexual desire (as it was called then) was thought to be of epidemic proportions. But a diagnosis of low sexual desire is fraught with complications. When Helen Singer Kaplan modified Masters and Johnson’s sexual response cycle and added a desire phase into the model, unfortunately she was unable to adequately define sexual desire, and nobody has really been able to do so since. It’s clear that sexual desire has at least two components, and probably more. The physiological component, which I call sex drive rather than desire, is a result of testosterone, a hormone produced by both men and women. If you don’t have testosterone, you don’t have a sex drive. The presence of testosterone is a necessary condition for sexual desire, but by itself it isn’t enough to create sexual desire. There’s another aspect of sexual desire, especially for women, that is highly psychological.
The most common form of low sexual desire is acquired. In other words, a person felt desire in the past but no longer feels it. This is often transitory—the result of stress or overwork. There is nothing wrong with you sexually if you feel no desire when you are tired and overworked! If you have ever felt sexual desire (as you understand it) in the past, you can feel it again—if you take the time to create the conditions to allow yourself to do so. Following the program I describe in Chapter 28 will almost certainly restore your feelings of sexual desire, just because committing yourself to a program will force you to set aside time for yourself.
In a less common but more severe case of low sexual desire, a person may say that he or she is just not interested in sex. It is actually very rare for a person to have never felt any sexual desire whatsoever. The person who says he or she is not interested in sex is more likely to mean that he or she is not interested in doing a particular activity with a particular person at a particular time (for example, intercourse, with you, right now). You do not need to feel any sexual desire to do any of the exercises described in this book. You only need a willingness to spend time touching. “I guess I’m just not interested in sex” may have been a good enough excuse for avoiding sexual activity with your partner in the past, but it is no reason to avoid the exercises outlined in this book. Doing the exercises will increase your level of desire.
An expressed lack of sexual desire may in fact more accurately be described as a desire discrepancy: One partner desires sexual activity more often than the other. When it comes to sexual frequency (how often a person wants to engage in sexual activity), the range of what is considered normal is broad. One partner might like sexual activity many times a day, while the other may feel sexual desire only a few times a year. Both are quite normal. But it can become a problem if long-term partners have highly discrepant desire patterns. If your partner feels little sexual desire and is not interested in treatment, you will have to decide whether you want to stay with a person who does not even want to attempt to feel greater sexual interest in you. Often, people who feel they have no desire simply suffer from lack of knowledge or a lack of experience. They have never engaged in activities that were really stimulating and memorable. This program includes a range of such activities that you can try.
Finally, there is the rare case in which an absolute lack of sexual desire is caused not by fatigue, repression, or inexperience, but by physiological problems such as a lack of the necessary hormones or brain damage. Of all the clients with whom I have worked, I have seen only two for whom this was the case.
Changes in Thinking about Sexual Desire
As I’ve mentioned, in the 1970s noted sex therapist and researcher Helen Singer Kaplan added the concept of sexual desire to Masters and Johnson’s model of the human sexual response cycle. The diagnosis of low sexual desire or inhibited sexual desire became very popular in the 1980s. It was thought to be quite widespread and was known as the “yuppie disease.” The idea was that people didn’t want sex because they were all working so hard. Back then the theories about the causes of and remedies for low sexual desire were pretty unsophisticated. The main insight was that overwork and stress could cause low sexual desire. The recommendation was that a couple take a weekend off, go to a hotel, turn off the phone, and have sex all weekend. Another insight was that sometimes what looked like low sexual desire was really desire discrepancy: a case in which one partner w
anted sex significantly more often than the other partner did (or significantly less often than the other partner did, if you want to look at it that way). Treatment (or, as clinicians sometimes call it, “intervention”) for couples most often included examination of the power struggles involved in scheduling sessions of sexual intercourse, and introduction of communication techniques for compromise in agreeing how often to have sex.
In the 1990s, the thinking about low sexual desire became much more sophisticated. The role of testosterone was recognized. A baseline level of testosterone is necessary for sexual desire, especially in women. It began to be recognized that many of the hormonal events that women undergo (such as long-term use of oral contraceptives) can cause low testosterone. During this period I used the following conceptualization of low sexual desire to help my clients: I thought of causes for low sexual desire as falling into three categories, ranging from the not-so-serious to the very serious. I based these categories on psychological causes for low sexual desire. I believe that the first thing anyone experiencing low sexual desire should do is to have his or her testosterone level checked. If your testosterone level is low (or nonexistent), no amount of psychological intervention is going to help.
In the not-so-serious category, I listed things like overwork, boredom, stress, lack of stimulating activities, poor time management, and lack of sexual knowledge or education. I call these not-so-serious because they are fairly straightforward and the solutions are easy to understand (even if they’re sometimes difficult to implement). These are the cases where the advice to take a vacation, get away from the kids, rent a hotel room, and turn off the phone makes sense. Often people who experience low sexual desire due to one of the above causes really just need to set aside some time to reconnect with each other. Stress caused by overwork can be very serious. In addition to reducing your sex drive, it can affect your physical health in the form of psychosomatic illnesses. Often, once you have gotten yourself into workaholic mode, it can be difficult to change. But it can be done. Other solutions for problems in this category include reading books about sexuality (such as this one) or taking classes. Behavioral contracts or agreements about time management can also be helpful. Sometimes couples are so strung out and overworked that they actually need to make agreements about when to see each other. It also helps to give up expectations about sex happening spontaneously.
Sexual Healing Page 6