Sexuality

Article written by Zentai in the series "Beyond the 12 Steps"

-------------------------------

Sexuality


Let's talk about sex and good gosh, why not? Everyone else does.

Talking about sex can be uncomfortable for most of us. In our society and in many of our families, it is a taboo subject. Many of us deal with sexuality through humor. Just think of all the "dirty jokes" we've told and heard over the years. For many
of us this is a mask for the discomfort and confusion we have experienced about our sexuality. We are the most vulnerable in sexual relationships, no matter how we might try to disguise it. Most of us are not educated about sex and so take many misconceptions about sex to the bed room with us. Our sexual identities have been shaped and fashioned by the stereotyped roles and attitudes presented to us by society, religion, and family. They color what we should do, how we should do it, and how we should look as sexual beings. Sexuality can't follow rules and roles, "it just is," so many of us experience a sense of failure by not measuring up to these notions. This can leave us confused, guilty, and ashamed.

Reasons for sex: Procreation; Bonding; and Pleasure.

The Impact of Chemical Dependency on Sexuality: Initially our use of chemicals can decrease sexual anxiety and inhibitions However, over time these same chemicals can affect our performance and judgment in sexual relationships. Prolonged chemical use for men can cause neurological difficulties in erection, premature ejaculation and impotence. For men and women, prolonged use of chemicals also affects hormonal balances. In women, this may be experienced as changes in the menstrual cycle. For both sexes, chronic use effects libido. Men and women both have shame related to poor judgment around their sexual behavior. This shame increases and has a negative impact on their feelings of self-esteem and self-worth. Sexual recovery must be addressed as an integral part of treatment. Some of the issues we need to explore as part of sexual recovery are: Sexual Identity; Sexual Boundaries; Homosexuality/Bisexuality; Concerns About Sexually Transmitted Disease; Sexual Abuse; Pregnancy; Abortion; Child Birth; Menopause; Impotence; Prostate Problems

We frequently hear in recovery that "We are as sick as our secrets." For most of us, our greatest secrets revolve around sex. We keep secret those things which cause us the most shame. Working with a sponsor or therapist and working the 4th and 5th steps, helps us resolve our shame and reveal our secrets. The only way to heal the shame within us is to allow others to know about our pain and receive the nurturing we lacked. Messages we often got: Sex is dirty; Don't talk about sex, just do it; Men should take the lead in sex; The sole purpose of sex is procreation; Women don't make sexual advances; It is the woman's duty to always be available sexually to her man; Sex outside the marriage is a sin; Man is the provider; Men are the dominant sex; Homosexuality is a perversion; Women who don't experience orgasm are frigid.

Sexual Boundaries And Intimacy: We live in a sexually dysfunctional society. The misconceptions, unrealistic expectations, and pressures associated with sexuality make defining our sexual identity confusing and difficult at best. We have all been influenced by the Hollywood/media guidelines of what "sexy" looks and acts like. Let's face it folks, most of us are not "Tens". We are sexual beings, however, with sexual needs and desires and the capacity for attaining intimacy with others. Sex and Intimacy is not the same thing. Sex is a physical interaction. Intimacy ("Into Me See") covers wider ground. Being intimate is about sharing who I am: My thoughts, feelings, and beliefs. My capacity to achieve intimacy with others is first dependent upon the development of my own identity and boundary. Increasing self-awareness, self-esteem and trust in who we are, will help us develop healthy sexual boundaries. Being aware of unhealthy sexual boundaries can help us initiate changes in our sexual recovery. Sometimes it's easier to see what doesn't work rather than to see what does work. What are some signs of unhealthy sexual boundaries? Having sex when I don't want to; Manipulating others through sex; Inability to distinguish love from sex; Sense of self-esteem tied to sexual relationship; Discomfort discussing sex with partner; Demanding sex from partner; Sexual put down related to performance or physical appearance; Sexual abuse; Falling in love at first site; Using sex as a means of avoiding conflict or to resolve conflict; Indiscriminate sex as a way to relieve loneliness; Irrational jealousy; Promiscuity; or overt/covert sexual "playing around."

Sexual Recovery: Suggestions

1. Get help for issues of sexual dysfunction. Most problems in sobriety are temporary. If they persist for greater than three to six months seek professional help.

2. Beware of using sex as a replacement addiction.

3. Practice assertiveness in your sexual expression of sexual needs and preferences. Begin to own who you are sexually.

4. Be prepared for surfacing of tension and fears related to sex. They have been buried in alcohol and drugs for a long time for most of us. Talk about them if they arise.

5. Avoid the pressures of the performance and appearance traps. Doing the best we can with what we have got is good enough.

6. Own responsibility for your sexual behavior.

7. Be sensitive to the rights and needs of others.

8. Get the secrets out. Use your sponsor or therapist. Place your secrets in a place that feels safe for you, so that you may begin to decrease feelings of shame.

9. If you are in a relationship with another recovering person, be sure to keep your programs separate.

10. Avoid the possibility of romance with a sponsor. Choose a sponsor who is not the gender or preferred sexual partners.

11. Work the 12-steps of recovery or an analogous program guideline.

What is the role of sex in a relationship? This question is frequently asked by people who have "good" sex in a "bad" relationship or who have a "good" relationship with minimal to no sex. Nothing seems to be more confusing than sexual issues in relationships. Sex and money are the two issues that most couples disagree about. Our training teaches us that one of the most important qualities in the relationship is our sexual attraction to the other person. As most of us are painfully aware, what initially attracts us to the other is usually not sustainable over the long term and often repels us in the end. Sexual compatibility certainly adds a wonderful dimension to the relationship but sexual compatibility is not enough to sustain the relationship! Good sex is one of life's great joys, one of the rewards for being and a marvelous release of stress and tension. It allows us to play, to share, and to be aware of ourselves and others in a natural, nonverbal dimension that is unique. Good sex heightens a good relationship. It cannot substitute for a dysfunctional one.

If a relationship is based on sex, chances are it will not last. Frequently, there is confusion between sex and intimacy with sex providing the only means of closeness in the relationship. Sex accentuates intimacy; it does not provide it! It is an interesting phenomenon that many couples involved in dysfunctional relationships report having incredible, intense sex which adds to the confusion about their relationship. It is as if the bedroom is the only arena in which the couple can agree and feel connected. When this occurs, sex is being used as a substitute for all the missing variables in the relationship - communication, nurturance, acceptance, sharing, etc.

We are sexual beings; our sexuality is a natural attribute. Unfortunately, most of us have become conflicted and confused about our sexuality. This again is a result of our training and the bad press and exploited sexuality of the media and entertainment in our culture. There has been too much emphasis on the use of our sexuality and of the sexual act itself in order to achieve other goals. We have been taught either to emphasize our sexuality to attract others or to hide it from others, as if being sexual is "bad" or "dirty." We have learned that men get to be more overtly sexual than women (this has changed dramatically) and sex is often used as a power and control issue, particularly by women. Because our sexuality is a natural part of our being, being comfortable with our sexuality is a natural process strongly related to our self-esteem. The more we love ourselves, the more comfortable we feel in our own bodies, the more accepting we become of what we physically look like, the more aware we are of our own sexuality and the less we fear it.

Good relationships, those that are composed of two healthy people, will not use sex as a contest. The persons in a good relationship will allow sex to be a natural part of the relationship and will not worry about frequency or always having phenomenal sex. Long-term couples know that sex is like any other part of the relationship - sometimes it works better than at other times. Almost all couples go through periods where sex seems to be less important than usual and they allow for this flexibility. There are periods in our lives in which we are more sexual and periods in which we are less. Often, these periods do not coincide with what is going on with our partner. Some compromise, acceptance, and understanding are necessary in order to keep sex in its proper perspective. If we cannot do these things in other areas of our lives, it will be impossible to be flexible and allow our sexual needs and desires to change across time.

Part 2

Female Sexual Dysfunction

Behavioral Definitions

1. Consistently very low desire for or no pleasurable anticipation of sexual activity.

2. Strong avoidance of and/or repulsion to any and all sexual contact in spite of a relationship of mutual caring and respect.

3. Recurrent lack of usual physiological response of sexual excitement and arousal (genital lubrication and swelling).

4. Consistent lack of subjective sense of enjoyment and pleasure during sexual activity.

5. Persistent delay in or absence of reaching orgasm after achieving arousal and in spite of sensitive sexual pleasuring by a caring partner.

6. Genital pain before, during, or after sexual intercourse.

7. Consistent or recurring involuntary spasm of the vagina that prohibits penetration for sexual intercourse.

Long-Term Goals

1. Increase desire for and enjoyment of sexual activity.

2. Attain and maintain physiological excitement response during sexual intercourse.

3. Reach orgasm within a reasonable amount of time, intensity, and focus to sexual stimulation.

4. Eliminate pain and promote subjective pleasure before, during, and after sexual intercourse.

5. Eliminate vaginal spasms that prohibit penal penetration during sexual intercourse and achieve a sense of relaxed enjoyment of coital pleasure.

Short-Term Objectives (numbers in parentheses correspond to the list of suggested therapeutic interventions)

1. Share thoughts and feelings regarding relationship with sexual partner. (1,2)

2. Openly discuss with partner conflicts and unfulfilled needs in the relationship that lead to anger and emotional distance (2)

3. Discuss sexual attitudes learned in family of origin experiences. (3,8,9,10)

4. Verbalize positive and healthy sexual attitudes (1,7,19,23)

5. Verbalize a resolution of feelings regarding sexual trauma or abuse experiences. (4,5,6)

6. Describe negative feelings regarding sexual experiences of childhood or adolescence. (4,5,8,9)

7. Verbalize a positive body image. (6,7,18)

8. State acceptance of sexual feelings and behaviors as normal and healthy. (18,19,23)

9. Provide a detailed sexual history that explores all experiences that influence sexual attitudes, feelings, and behavior. (3,4,8,9)

10. Verbalize an understanding of the role family of origin experiences have played in development of negative sexual attitudes and responses. (3,8,9,10)

11. State an understanding of how religious training negatively influenced sexual thoughts, feelings, and behaviors. (8,9,10)

12. Verbalize negative cognitive messages that trigger fears, shame, anger, or grief during sex activity. (11,12)

13. Verbalize the development of positive and healthy automatic thoughts that mediate relaxed pleasure. (11,12,13,14)

14. Practice sensate focus exercises alone and with partner and share feelings associated with activity. (13,14,22,23)

15. Abstain from substance abuse patterns that interfere with sexual response. (8,15)

16. Verbalize an understanding of the role physical disease or medication has on sexual dysfunction. (15,16,17)

17. Cooperate with a physician's complete examination and report results. (15,16,17)

18. Demonstrate healthy and accurate knowledge of sexuality by freely verbalizing adequate information of sexual functioning using appropriate terms for sexually related body parts. (18,19,23)

19. Write about sexual feelings and thoughts in a daily journal. (18,19,23)

20. Verbalize increasing desire for and pleasure with sexual activity. (20,21,22)

21. Report to therapist regarding progress on use of masturbation and vaginal dilator to achieve relaxed comfort with penetration. (14,21,26)

22. Practice gradual client-controlled vaginal penetration with partner. (14,21,22)

23. Read and discuss books assigned on human sexuality. (18,23)

24. Verbalize and understanding of the connection between lack of positive sex role model in childhood and current adult sexual dysfunction. (3,8,9,24)

25. Verbalize connection between previously failed intimate relationships as to behaviors and emotions that caused failure. (4,8,25)

26. Write a journal of sexual fantasies that stimulate sexual arousal (18,19,26)

27. Implement new coital positions and settings for sexual activity that enhance pleasure and satisfaction. (27,28)

28. Engage in more assertive behaviors that allow for sharing sexual needs, feelings, and desires; behaving more sensuously; and expressing pleasure. (26,27,28)

29. Resolve conflicts or develop coping strategies that reduce stress interfering with sexual interest or performance. (1,2,29)

30. Discuss low self-esteem issues that impede sexual functioning and verbalize positive self-image. (5,6,7,30)

31. Communicate feelings of threat to partner that are based on perception of partner being too sexually aggressive. (28,30,31)

32. Openly acknowledge, if present, homosexual attraction. (8,26,32,33)

33. Discuss feelings surrounding secret affairs and make decision for termination of one of the relationships. (8,33,34)

34. Discuss feelings of and causes for depression. (1,4,29,34,35)



Part 3

Female Sexual Dysfunction

Therapeutic Interventions (Conducted by clinical professionals/physicians)

1. Assess the relationship with sexual partner as to level of harmony and fulfillment.

2. Direct conjoint sessions that focus on conflict resolution, expression of feelings, and sex education.

3. Probe family of origin history for causes of inhibition, guilt, fear, or repulsion.

4. Probe client's history for experience of sexual trauma or abuse.

5. Process emotions surrounding an emotional trauma in the sexual arena.

6. Discuss feelings regarding body image focusing on causes for negativism.

7. Assign client to list assets of her body.

8. Obtain a detailed sexual history that examines current adult sexual functioning as well as childhood and adolescent experiences, level and sources of sexual knowledge, typical sexual practices and frequency of them, medical history, and use of mood-altering substances.

9. Explore role of family of origin in teaching negative attitudes regarding sexuality.

10. Explore role of religious training in reinforcing feelings of guilt and shame surrounding sexual behavior and thoughts.

11. Probe automatic thoughts that trigger negative emotions before, during and after sexual activity.

12. Train client in healthy alternative thoughts that will mediate pleasure, relaxation, and disinhibition.

13. Give permission for less inhibited, less constricted sexual behavior by assigning body-pleasuring exercises with partner.

14. Assign body exploration and awareness exercises that reduce inhibition and desensitize client to sexual aversion.

15. Assess the possible role that substance abuse, diabetes, hypertension, or thyroid disease may have on sexual functioning.

16. Review medications taken by client with regard to their possible negative side effects on sexual functioning.

17. Refer to a physician for a complete physical to rule out any organic basis for dysfunction.

18. Disinhibit and educate the client by talking freely and respectfully regarding sexual body parts, sexual feelings, and sexual behavior.

19. Assign client to keep a journal of sexual thoughts and feelings to increase awareness and acceptance of them as normal.

20. Assign graduated steps of sexual pleasuring exercises with partner that reduce performance anxiety and focus on experiencing bodily arousal sensations.

21. Direct the use of masturbation and/or vaginal dilator devices to reinforce relaxation and success surrounding vaginal penetration.

22. Direct client's sexual partner in sexual exercises that allow for client-controlled level of genital stimulation and gradually increased vaginal penetration.

23. Assign books that provide accurate sexual information and/or outline sexual exercises that disinhibit and reinforce sexual sensate focus.

24. Explore sex role models client has experienced in childhood or adolescence.

25. Explore client's fears surrounding intimate relationships and whether there is evidence of repeated failure in this area.

26. Encourage development of and indulgence in sexual fantasies that mediate enhanced sexual desire.

27. Suggest experimentation with coital positions and settings for sexual play that may increase security, arousal, and satisfaction.

28. Encourage client to gradually explore role of being more sexually assertive, sensuously provocative, and freely uninhibited in sexual play with partner.

29. Probe stress in areas such as work, extended family, and social relationships that distract client from sexual desire or performance.

30. Explore fears of inadequacy as a sexual partner that led to sexual avoidance.

31. Explore feelings of threat brought on by perception of partner as sexually aggressive and demanding.

32. Explore homosexual interest that accounts for heterosexual disinterest.

33. Discuss any secret sexual affairs that may account for sexual dysfunction with partner.

34. Assess role of depression in suppressing sexual desire.

35. Refer for antidepressant medication prescription to alleviate depression.

Diagnostic Suggestions: Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder, Female Sexual Arousal Disorder, Female Orgasmic Disorder, Dyspareunia, Vaginismus, Sexual Abuse of Child (victim), Female Hypoactive Sexual Desire Disorder Due to an Axis III Disorder, Female Dyspareunia Due to Axis III Disorder, Sexual Disorder NOS

Part 4

Male Sexual Dysfunction

Behavioral Definitions

1. Consistently very low or no pleasurable anticipation of or desire for sexual activity.

2. Strong avoidance of and/or repulsion to any and all sexual contact in spite of a relationship of mutual caring and respect.

3. Recurrent lack of usual physiological response of sexual excitement and arousal (attaining and/or maintaining an erection).

4. Consistent lack of subjective sense of enjoyment and pleasure during sexual activity.

5. Persistent delay in or absence of reaching orgasm (ejaculation) after achieving arousal in spite of sensitive sexual pleasuring by a caring partner.

6. Genital pain before, during, or after sexual intercourse.

Long-Term Goals

1. Increase desire for and enjoyment of sexual activity.

2. Attain and maintain physiological excitement response during sexual intercourse.

3. Reach orgasm (ejaculation) with a reasonable amount of time, intensity, and focus to sexual stimulation.

4. Eliminate pain and achieve a presence of subjective pleasure before, during, and after sexual intercourse.

Short-Term Objectives (numbers in parentheses correspond to the list of therapeutic interventions)

1. Share thoughts and feelings regarding relationship with sexual partner. (1,2,)

2. Openly discuss with partner conflicts and unfulfilled needs in the relationship that lead to anger and emotional distance. (1,2)

3. Discuss sexual attitudes learned in family of origin experiences.(3,8,9,10)

4. Verbalize positive and healthy sexual attitudes. (11,12,18,19,23)

5. Describe negative feelings regarding sexual experiences of childhood or adolescence. (3,4,5,9,10)

6. Verbalize a resolution of feelings regarding sexual trauma or abuse experiences. (4,5)

7. Discuss feelings of a cause for depression. (1,4,6,7,29)

8. State acceptance of sexual feelings and behaviors as normal and healthy. (13,14,18,19,23)

9. Provide a detailed sexual history that explores all experiences that influence sexual attitudes, feelings, and behaviors. (3,8,9,10)

10. Verbalize an understanding of role of family of origin experiences in development of negative sexual attitudes and responses. (3,8,9,10)

11. State an understanding of how religious training negatively influenced sexual thoughts, feelings, and behavior. (8,9,10,11)

12. Verbalize negative cognitive messages that trigger fears, shame, anger, or grief during sex activity. (11,19,30)

13. Verbalize the development of positive and healthy automatic thoughts that mediate relaxed pleasure. (12,13,14,18)

14. Practice sensate focus exercises alone and with partner and share feelings associated with activity. (14, 19,20,27)

15. Abstain from substance abuse patterns that interfere with sexual response. (8,15)

16. Verbalize an understanding of the role physical disease or medication has on sexual dysfunction. (16,17)

17. Cooperate with a physician's complete examination and report results. (17)

18. Demonstrate healthy and accurate knowledge of sexuality by freely verbalizing adequate information of sexual functioning using appropriate terms for sexually related body parts. (18,19,23)

19. Write about sexual feelings and thoughts in a daily journal. (18,19,26)

20. Verbalize increasing desire for and pleasure with sexual activity. (18, 19,20,27,28)

21. Discuss feelings surrounding secret affairs and make termination decision on one of the relationships. (6,21,30)

22. Openly acknowledge and discuss, if present, homosexual attraction. (11,19,21,22)

23. Read and discuss books assigned on human sexuality. (23)

24. Verbalize an understanding of the connection between lack of positive sex role model in childhood and current adult sexual dysfunction. (3,8,9,24)

25. Verbalize connection between previously failed intimate relationships as to behaviors and emotions that caused failure. (8,25,30,31)

26. Write a journal of sexual fantasies that stimulate sexual arousal. (19,26)

27. Implement new coital positions and settings for sexual activity that enhance pleasure and satisfaction (23,27,38)

28. Engage in more assertive behaviors that allow for sharing sexual needs, feelings and desires; behaving more sensuously and expressing pleasure. (13,26,27,28)

29. Resolve conflicts or develop coping strategies that reduce stress interfering with sexual interest or performance. (6,29,30)

30. Discuss low self-esteem issues that impede sexual functioning and verbalize positive self-image. (4,9,10,30)

31. Communicate feelings of threat to partner that are based on perception of partner being too sexually aggressive. (2,30,31)

32. Implement the squeeze technique during sexual intercourse and report on success and feelings. (32)

Part 5

Male Sexual Dysfunction

Therapeutic Interventions (conducted with clinician or physician)

1. Assess the relationship with sexual partner as to level of harmony and fulfillment.

2. Direct conjoint sessions that focus on conflict resolution, expression of feelings, and sex education.

3. Probe family of origin history for causes of inhibition, guilt, fear, or repulsion.

4. Probe client's history for experience of sexual trauma or abuse.

5. Process emotions surrounding an emotional trauma in the sexual arena.

6. Assess role of depression in suppressing sexual desire or performance.

7. Refer for antidepressant medication prescription to alleviate depression.

8. Obtain a detailed sexual history that examines current adult sexual functioning as well as childhood and adolescent experiences, level and sources of sexual knowledge, typical sexual practices and frequency of them, medical history, and use of mood-altering substances.

9. Explore role of family of origin in teaching negative attitudes regarding sexuality.

10. Explore role of religious training in reinforcing feelings of guilt and shame surrounding sexual behavior and thoughts.

11. Probe automatic thoughts that trigger negative emotions before, during and after sexual activity.

12. Train client in healthy alternative thoughts that will mediate pleasure, relaxation, and disinhibition.

13. Give permission for less inhibited, less constricted sexual behavior by assigning body-pleasuring exercises with partner.

14. Assign body exploration and awareness exercises that reduce inhibition and desensitize client to sexual aversion. Consider "Hin Yin" exercises - Ancient secrets of relaxation & self-eroticism.

15. Assess the possible role that substance abuse, diabetes, hypertension, or thyroid disease may have on sexual functioning.

16. Review medications taken by client with regard to their possible negative side effects on sexual functioning.

17. Refer to a physician for a complete physical to rule out any organic basis for dysfunction. Assess for need of sexual enhancement medications such as Sildenafil Citrate or Alprostadil.

18. Disinhibit and educate the client by talking freely and respectfully regarding sexual body parts, sexual feelings, and sexual behavior.

19. Assign client to keep a journal of sexual thoughts and feelings to increase awareness and acceptance of them as normal.

20. Assign graduated steps of sexual pleasuring exercises with partner that reduce performance anxiety and focus on experiencing bodily arousal sensations.

21. Discuss any secret sexual affairs that may account for sexual dysfunction with partner.

22. Explore homosexual interests that accounts for heterosexual disinterest.

23. Assign books that provide accurate sexual information and/or outline sexual exercises that disinhibit and reinforce sexual sensate focus.

24. Explore sex role models client has experienced in childhood or adolescence.

25. Explore client's fears surrounding intimate relationships and whether there is evidence of repeated failure in this area.

26. Encourage development of an indulgence in sexual fantasies that mediate enhanced sexual desire.

27. Suggest experimentation with coital positions and settings for sexual play that may increase security, arousal, and satisfaction.

28. Encourage client to gradually explore role of being more sexually assertive, sensuously provocative, and freely uninhibited in sexual play with partner.

29. Probe stress areas such as work, extended family, and social relationships that distract client from sexual desire or performance.

30. Explore fears of inadequacy as a sexual partner that led to sexual avoidance.

31. Explore feelings of threat brought on by perception of partner as sexually aggressive.

32. Instruct client and partner in use of squeeze technique to retard premature ejaculation.

Diagnostic Suggestions: Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder, Male Erectile Disorder, Male Orgasmic Disorder, Dyspareunia, Premature Ejaculation, Male Hypoactive Sexual Disorder Due to Axis III Disorder, Male Erectile Disorder Due top Axis III Disorder, Sexual Disorders NOS, Sexual Abuse of Child (victim)