Better Sex Jessa Zimmerman

Dr. Belous is an Associate Professor, the Director of the Couple and Family Therapy Center at Purdue University Northwest, and a practicing therapist. He is a certified sex therapist and educator, a certified family life educator, and a certified gay-affirmative psychotherapist. He is on the editorial board of the Journal of Marital and Family Therapy and the American Journal of Family Therapy. He is the founding chairperson of the Couples and Intimate Relationships Topical Interest Network and is the treasurer of the Queer and Trans Affirmative Network for the AAMFT. He is a sex and sexuality researcher focusing on social justice and couple and family therapy education and supervision. He has over 20 published works, has given more than 40 presentations at national and international conferences, and has completed 7 different research grants.

The Cass Identity Formation Model
Dr. Belous has done research on the process of coming out and helped people integrate their sexual identity into their holistic concept of themselves. He explains that science has worked to understand the coming out process for years. He gives The Cass Identity Formation Model as an example from the 1970s. Dr. Belous tells us her model begins with ‘confusion,’ the stage where people discover they aren’t heterosexual. ‘Comparison,’ the stage where people decide to act straight or gay, is second. ‘Tolerance’ is the third step; which Chris describes as the stage when people acknowledge their sexuality without fully accepting it. He says that leads to ‘acceptance,’ when a person’s sexual identity is fully accepted, and people start coming out. He tells us the fifth step is called ‘identity pride,’ which is when people become activists, march in parades, and broadcast their sexuality. Her final stage, he explains, is ‘identity synthesis,’ when a person’s sexual identity is integrated with their everyday personality. Chris mentions that this model has many drawbacks, including its presumptions that straight people don’t have to go through sexual identity integration, and its presumption that gay people must believe they’re heterosexual before they realize they’re gay.

A Multidimensional Model of Sexual Identity Formation
Dr. Belous more often works with a multidimensional model of sexual identity formation rooted in social constructionism and developed by Horowitz and Newcomb. He explains that in their model sexual identity is more fluid, and their system is less linear. With the Cass model, people look at their behavior to see where they are on a very linear scale. However, Chris describes Horowitz and Newcomb’s model as referencing behaviors, desires, and experiences to form a coherent but temporary understanding of one’s sexual identity.

The Minority Stress Theory
Chris explains that the minority stress theory was initially developed by Ilan Meyer to describe LGBTQ+ identities, but has expanded to include other minorities like race, ethnicity, and culture. When used in the context of sexual identity it codifies the fact that being LGBTQ+ is more stressful than being cisgender and heterosexual. Dr. Belous relates that the crux of the matter is that gay people have to come out repeatedly and coming out always involves theoretical or actual threats to their emotional, physical, and social safety. Stress is also compounded, Chris tells us, by the need to constantly fight against assumptions due to their sexuality. Mental health concerns like anxiety and depression are much higher in the LGBTQ+ community, and Dr. Belous believes that this theory accounts for that disparity.

Coming Out is More Stressful than Staying Closeted
Chris tells us that research has proven coming out is more stressful than staying closeted. In many parts of the world, he reminds us, coming out means you’re risking your life, while it

After accumulating nine years of experience working as an obstetrician and gynecologist at Swedish OB/GYN Specialists First Hill, Ashley Fuller transformed her practice into gynecology and sexual health. She claims that she was better able to pursue her passion for women’s sexual health by removing the obstetrics branch of her practice. In her practice she offers checkups, gynecological surgery, and regular exams including pap smears and STD screenings. She aims to help women with sexual and gynecological problems evaluate treatment options and make the best choices for their needs and lifestyles.

Gynecologists are often Ill-prepared for Sexual Health Problems
In her previous practice as an OB/GYN, Dr. Fuller would have women present with sexual health problems such as low libido. While managing women’s sexual health is an important part of gynecological practice, the treatment of sexual health issues related to the vulva are not covered with any depth in residencies or medical training programs. Because of this oversight, Ashley says that when women asked her about sexual health problems, she frequently didn’t know how to help them. In an effort to fulfill this need of her patients, Ashley shifted her focus from obstetrics and gynecology to gynecology and sexual health.

Evaluating Low Libido in Premenopausal Women
While menopause does affect libido, when a premenopausal woman presents with low libido, Dr Fuller begins by having her patient fill out the Decreased Sexual Desire Screener (DSDS), a worksheet that asks about SSRI use, possible relationship problems, painful sex, stress and fatigue, and several other common causes of sexual dysfunction in women. Ashley points out that not all of the possible causes are physical, and in those cases, she often refers patients to a therapist or sex therapist. Some causes of sexual dysfunction are physical, and in those cases, medication, hormone treatments, or other tangible interventions may be needed. The great news is Ashley tells us about libido treatment for pre- and post-menopausal women! Tune in for the details!

How Giving Birth Impacts Libido
Dr. Fuller lists several bodily and environmental changes involved with giving birth that negatively influence libido. As physical causes go, Ashley explains that breastfeeding women often have a very dry vagina, which can cause unpleasant or painful sex, and being postpartum entails hormonal changes that can lower libido. Psychosocial factors change the relationship between partners, as newborns often require nighttime care and fail to sleep through the night, leading to parental fatigue and increased stress.

Mental Health Influences Libido
Ashley mentions that depression and the SSRIs that treat it can both reduce libido. She looks for chronic opioid use and addiction issues, obesity, poor body image, and even poor heart health, all of which can contribute to low libido and need to be treated before hormone therapy should be attempted.

Painful Sex
We learn that tight muscles in the pelvic floor can cause pain upon deeper penetration. When the muscular source of pain is found, physical therapy is often helpful. Ashley also suggests the Ohnut to allow for shallower penetration, and she says that women with this problem can improve with physical therapy.

Psychological Treatment
Dr. Fuller finds that many of her patients have psychological issues that influence their pain levels. Ashley emphasizes that she isn’t saying their pain is imaginary, but she believes pain influences our psychology. “When you know something is going to hurt, she says it’s natural to tense up, but tensing up also activates the pelvic muscles, causing pain during intercourse.” The secret is to relax!

Vulvar Pain Causes and Treatment
Ashley treats a lot of patients with vulvodynia. She says it often stems from hormone changes, especially

Domina Franco is a New York City based sex educator, coach, and writer. Franco completed her Masters in Human Sexuality at Widener University and helps clients of all genders and orientations clarify, explore and enhance their sex lives. She guest lectures at universities around the country and provides one-on-one coaching as well as trainings and workshops that cover pleasure exploration, empowerment, kink and alternative relationship models.

Defining Sexual Authenticity
Domina defines sexual authenticity as approaching your sexuality in a way that’s true to your desires while honoring what you need, what you want, and your boundaries. She warns that it requires a lot of honesty with yourself and others, both of which can be difficult.

Unpacking Hang-ups
“People don’t give themselves enough credit for acting against social norms.” Domina says accepting ourselves and our sexual selves despite cultural resistance requires courage and involves the hard work of cultural unpacking. She admits that overcoming stigma and shame takes a lot of courage.

Many people, Domina reminds us, were raised in conservative social or religious groups, and beliefs about sex, gender, and sexuality inherited from those groups can create lifelong hang-ups. Even people who don’t come from conservative backgrounds can have hang-ups, she admits, but regardless of your hang-ups or their origin, she insists that it’s imperative to get in touch with your genuine needs and align yourself with your authentic sexuality.



Not Accepting Your Sexuality Divorces You from Your Partners
Even if it’s condemned by social norms, Domina believes it’s important to accept or, better, rejoice in our sexuality. If we can’t do that, she warns that sex will be unfulfilling. She further warns us that if our genuine sexuality is too different from what we act out in reality, we may be traumatized by the sex we force ourselves to endure.

She believes sex is about connection, but we pull away and compartmentalize our true emotions when we engage in sex acts that we don’t find fulfilling. When we aren’t present and attentive during sex, we aren’t just pulling away, we’re also growing more distant from our partners, which she says defeats the relationship-building purpose of sex.

Sex is Something We Learn to Do Safely
Domina warns that your first few times authentically expressing your sexuality may not grant you the full connectivity found in sex either, because it can be difficult to relax into activities that society condemns or stigmatizes, but embracing and acting upon your true sexual desires allows for the vulnerability and joy that create emotional connections between people. In short, she assures us that the connection and enjoyment will improve with time and practice.

Human Sexuality is Relative
We hear what Domina things about this when she asserts that everything is relative, “Somebody’s flogging and needle play is somebody else’s doggy style.” But despite these differences, she makes it clear that ‘vanilla shaming’ people is not okay while reinforcing the fact that there’s no hierarchy of sexual desires, and it doesn’t make sense to compare human sexuality in that way. Knowing that everyone—including you—deserves to be sexually fulfilled is what’s most important.

Embracing Truth Can Change Your Relationship
You need to roll the dice and share your sexual truth if you want to be fulfilled. The alternative is being perpetually unsatisfied, according to Domina. She acknowledges that this can be scary but reminds that courage is acting while feeling fear. Domina always hopes that people find the mustard seed of courage they need to pursue their true desires.



Talking about Sexual Goals with Your Partner
Once you know your authentic self, she says, you can speak your truth. She tells us we ca

Dr. Sara Nasserzadeh is a global thought leader in psychosexual therapy, couple counseling, and social psychology. A former member of the International Federation of Journalists, Dr. Sara combined her journalism experience with her expertise in sexuality and relationships, to host a program called Whispers for the BBC World Service. The show received the BBC’s Innovation of the Year Award in 2007 and continues to gather Farsi-speaking viewers around the world. In 2007, she earned the World Association for Sexual Health runner-up award for Excellence and Innovation for her human development work. Harper’s Bazaar named her as one of the Best Love Doctors, and DatingAdvice.com named her one of the 10 Best Sex and Dating Experts in 2015.

She is the author of three books in English: Orgasm Answer Guide, Sexual Health Needs and Preferences of Young People, and Wheel of Context for Sexuality Education. Recently, she developed the Emergent Love model as an antidote to Love Confusion and the design of a validated inventory called the Relationship Panoramic Inventory to help couples assess and develop their relationships. Her personal and professional life is defined by her goal of creating world peace one relationship at a time.

Types of Love
Dr. Sara explains that there are several types of love. Eros is the passionate, romantic love we usually think about. Philia is the affectionate love we feel for family members. Storge is friendship love, Ludus is game-playing love, Mania is possessive love, Pragma is practical love, Philautia is self-love, and Agape is selfless love. She suggests listeners take the Love Attitudes Scale test to find out what types of love show up in their relationships. In her practice, she found that a lot of couples who scored highly in the Philia aspect of their relationship came to her with the statement, “I love my partner, but I’m not in love with my partner.” Dr. Sara believes that it’s useful to be aware of these different types of love, as it can clarify the fact that people truly do love their partners, even if their current love feels different than it did initially.

Dr. Sara’s contribution to the realm of love and sex is making the distinction between submergent and emergent love in relationships. Submergent love happens when two people need to spend a lot of time together and are over the moon when they’re with each other, she tells us, and emergent love is the developed, calmer love that comes after partners know each other better.

What if You Don’t Feel Butterflies when They Walk in the Room?
Dr. Sara explains that Helen Fisher researched this infatuated, honeymoon period of love and found out that it lasts, on average, two years. According to Dr. Sara, this early, submergent stage is something to build up the relationship from, not an experience meant to be sustained indefinitely. She also mentions that submergent love isn’t necessary to create a fulfilling romantic relationship, and people shouldn’t feel bad for not feeling that way about their partner. Many people she consults worry because they don’t feel butterflies or intense passion, and it makes them wonder if they’re supposed to feel their love in their heart and ‘just know’ if a person is right for them. Dr. Sara shares her distinction between submergent and emergent love helps people better understand these foundations of love “it is something you do, not something that happens to you that you have no control over.”

Five Ingredients of Emergent Love
Dr. Sara spent time studying 312 relationships to discern what qualities were important to couples who were not only happy but thriving in their current relationships. The five ingredients that they shared are a shared vision, compassion/empathy, physical attraction, respect, and shared values. This research is where she says she learned that

Lauren is a qualified sexologist and permission-granter who helps her clients reduce stress and reinvigorate their sex lives. Through her writing, online classes, and one-on-one sessions, she helps high-achieving, introverted women release their physical and psychological blocks to liberate their libidos for sex and life. She is the author of Permission: Personal Liberation for Switched-on Women.

Defining Libido
Lauren takes her definition of libido from Alisa Vitti, the author of Woman Code, who defined libido as “the ability to give and receive pleasure, enjoyment, and acknowledgement.” Using this definition, she’s free to acknowledge nonsexual actions as integral stimulators of her libido. She shares examples of planting her feet in nature, brushing her children’s hair, and working towards and achieving goals as libidinous activities that help her drop into softness and feel powerful in a giving way. Her definition of libido is “a sort of energy that we gain familiarity with and exercise whenever we take part in sensual giving or receiving that becomes easier to channel the more we access it.”

She mentions that her broader definition of libido takes the focus away from exclusively desiring the really passionate, intense, sexual forms of libido, and encourages us to focus on smaller, softer, more day-to-day manifestations of libido. She tells us that focusing exclusively on our desire for intense desire, especially in circumstances that aren’t favorable to it, leads to a loop of dissatisfaction that can make us frustrated while focusing on tinier pleasures can help us escape that frustration loop and clears the way for us to experience the bigger, more passionate emotions.

Women are Held Back by Doing Too Much
Lauren argues that the need women feel to spread themselves thin doesn’t leave a lot of room for the erotic and sexual. While she admits women are good at juggling obligations and multitasking, she thinks a disservice is done when women mistakenly internalize “I can do anything” as “I can do everything” or, worse, “I should do everything.”

Lauren advises women to sit down and make conscious choices about where their energy—their libido—is going. She encourages people to keep doing what they’re doing if it’s fruitful and fulfilling. However, she claims that if there’s a cost to the activity, it’s better to focus on things like personal relationships that you genuinely need to invest in. She says it’s also important not to fall so deeply into work or hobbies that you forget to keep dating.

How to Identify a Withered Libido
In Lauren’s experience, withered libidos usually come to light when women’s partners turn to them and ask why their sex life diminished. For a lot of the women she sees, their loss of libido began with a valid cause, like grief or the loss of a pregnancy, but then refraining from sex became a habit until their partner brought it to their attention. Other times, she sees women who notice their own loss of libido when something in a movie or their friends’ lives brings their loss of vitality to their attention. Gentle wake up calls that remind them of the confident women they used to be do happen, but usually when people have a partner, their partner is the one who brings up the topic.

“I don’t care if I never have sex again.”
Many women who come to see Lauren do not care about sex anymore. She recalls that for many women who have lost their drive for sex, their drive for other activities and their basic sensuality has evaporated simultaneously. She says it’s rare for the sex drive to diminish all by itself, usually lots of other joyous, playful, and pleasantly purposeless activity is also absent. Fun is usually missing too, which she claims is important, because all of those nonsexual indicators of a lack of libido also need to b

Jeff Abraham is a man dedicated to doing the right thing. After winning a court case against Hyundai who asked him to actively discriminate against female and African American candidates in 1999, he moved to Promescent as CEO, a company founded by his late friend, Dr. Ronald Gilbert. Jeff has continued his legacy by fulfilling his companies dreams in his honor. In addition to this Jeff has spent the last decade advocating sexual health and wellness by educating the public on the importance of intimacy and how to resolve common sexual dysfunctions.

Premature Ejaculation Can Cause Erectile Dysfunction
Jeff learned that 10% to 15% of erectile dysfunction cases are misdiagnosed cases of premature ejaculation. He clarifies that premature ejaculation is diagnosed when a man suffers from a complete inability to have sex, m********e, or engage in oral or anal sex for more than 90 seconds without ejaculating. He explains that having clinical PE often causes erectile dysfunction, as when men are aware that PE is going to be the result of sexual play, anxiety can prevent an erection from forming. He says clinicians often diagnose this as ED, but as treating the PE would also cure the ED, a PE diagnosis and treatment is more correct.

Healthy Male and Female Climaxes, “The Orgasm Gap.”
According to Jeff, a healthy male climaxes after an average of five minutes of sexual stimulation. Meanwhile, he reports that women who are capable of orgasms from penetration take an average of 18 minutes of thrusting to reach orgasm. This gap in climaxes is called the “arousal gap” or “orgasm gap” among sex therapists and neurologists. He points out that even healthy males have good reason to want to last longer, even if they don’t meet the diagnostic criteria for PE. He hopes that treatment for longer-lasting sex becomes more respected and acknowledged by the medical community.

Causes of Premature Ejaculation
Jeff reminds us that premature ejaculation has been needlessly stigmatized. People claim that men ejaculate early due to not caring enough about their partners or not having the mental fortitude to wait longer to orgasm. Jeff admits that some cases of premature ejaculation are psychological in nature, but he lists hypersensitive penile nerves, prostatitis, and low testosterone as some of the physical causes of the condition. Due to the number of physical causes of PE, he hopes that we can reject the notion that men with PE don’t care about their partners or that they’re mentally weak. PE is a problem with physical roots and as real and treatable as diabetes or cancer. He advocates a combination of behavioral therapy and products like Promescent or SSRIs to help men build confidence and overcome their physical and psychological difficulties.

Consequences of Premature Ejaculation
Jeff points out that PE destroys men’s confidence and limits their ability to satisfy their partners. This lack of confidence, he suggests, isn’t confined to the bedroom, but extends to all aspects of life. He calls it the layering effect, which he describes as a sort of chain reaction. In the layering effect he describes, PE can lead to lowered sexual confidence, which leads to being less amorous, which leads to the PE sufferer’s partner feeling unattractive due to the lack of sexual attention, and finally leads to a disconnect between the members of the couple. He says he’s seen this happen over and over again, all without people realizing that the root of their problems is a single, treatable issue. Jeff advises men not to avoid sex due to PE, pointing out that this leads to men having less control over his own ejaculation, and creates a less pleasant sexual experience than the couple had before.

How to Approach Your Partner About PE
When approached by women on how to tackle PE with their partners, Jeff suggests setting up a spec