Sexual Issues and Questions, Online Conference Transcript

Dr. Marlene Shiple is a certified sex counselor. Dr. Shiple's areas of expertise include sexual dysfunction, sexual addiction, sexual relationships, and intimacy issues.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Sexual Issues and Questions". Our guest is Marlene Shiple, Ph.D., certified sex counselor. Dr. Shiple became interested in the specialization of sex therapy because she recognized how many people are fearful or nervous about their sexual interaction, when this should be a normal and enjoyable process of the human experience. She is here to give information and practical ideas on the topic of sexuality. Click here for more information about Dr. Shiple.

Good evening, Dr. Shiple. Thank you for being our guest tonight and welcome to HealthyPlace.com. Can you tell us a little more about yourself?

Dr. Shiple: Good evening, David and everyone out there who was able to join us tonight. I am certified with the American Association of Sex Educators, Counselors & Therapists (AASECT) as a Sex Counselor, and with the American Board of Sexology as a Sex Therapist. I have been interested in sexual issues for all of the twenty-four years that I have been in private practice. I found early in my practice that clients were fearful and uncomfortable with their sexual being. I was struck by how this held them back in their personal growth with sex being such an important area to our well-being.

David: Have you found that in the new millennium people are more or less comfortable talking about sex?

Dr. Shiple: Actually, no, I've not found most people more comfortable talking about sex, and that to me, is surprising. With all of the sexually transmitted diseases, which are of concern to many people, I was hoping that potential partners would become more verbal, more easily and more quickly. This does not seem to be happening.

David: Also, in this day and age of easy availability of sex sites over the internet, you would think more people would feel comfortable discussing it. What is it that keeps many people from feeling comfortable about expressing themselves about sex?

Dr. Shiple: I think it is lack of practice and the sex-is-bad ideas that still persist. I find in working with clients that we role play them being open and honest about sexual issues. It takes them some time to begin to feel at ease with this. Then, once they get going, they have so much to say that they have not said in so long, that it is hard to get them to stop.

David: Since we are a mental health site, I want to get directly to several issues. The first issue is sex after sexual abuse. How difficult is that, and can one expect to have "normal" sexual relations after being sexually abused?

Dr. Shiple: In my experience, it is possible to have satisfying sexual relations after being sexually abused. However, the beginning experiences in this direction require considerable awareness on the part of the person who was abused. What am I feeling, am I safe to go on, can I say hold it here? It requires a very sensitive partner, who is willing to listen and understand these requests, not take them personally, and respond according to what is being requested. With this, patience, and focused therapy working on releasing any abuse issues, I have found clients able to resume very satisfying personal and sexual relationships.

David: Here's an audience question on the subject:

punklil: Thank you for coming here to talk to us, Dr. Shiple. My question is how do you stop flashbacks in the middle of sex?

Dr. Shiple: First, I would ask if you had worked through the issues contained in the flashbacks. If not, that would be procedure number one. If you have worked through these issues, then I would suggest practice on focusing on the present, on what you are experiencing RIGHT NOW, on how you feel within you RIGHT NOW. I would suggest you take the time to remind yourself, "This is NOT the past, this is the present. I want to be here with this partner, enjoying one another."

David: What makes for great sex?

Dr. Shiple: So many ideas flooded my mind to answer your question. Actually, that is such a personal experience, that it is hard to create an answer that would fit for each person. Elements of great sex would include feeling a sense of harmony and oneness with one's partner. Freely expressing and hearing what each partner wants and doing one's best. As long as each party is comfortable to provide it. Taking the time to let it be good. Giving each partner focus for being pleasured and satisfied. Including the elements that each partner finds GREAT!

David: Here's an audience question:

slowdown: How do you get your partner to feel sexier about herself.

Dr. Shiple: Do not be distracted by the simplicity of this, consider it seriously. Does she WANT to feel sexier about herself? If not, there is not a way. If so, ask her what she thinks it would take for her to feel sexier about herself and listen carefully to what she tells you. Ask for clarification if anything is unclear about what she thinks would make her feel sexier. Then create a plan together, if she is willing, to begin to address whatever she has said. Compliment her on each step, or any beginning step she is able to make. Recognize that this is probably very, very difficult for her. After all, she has spent all of these years, however old she is, not feeling all that sexy. Ask her what she needs to help her feel more comfortable with this.

David: Why would someone see a sex therapist and when is it time to consider that you need to see a sex therapist?

Dr. Shiple: There are many reasons that clients see sex therapists. Some of these include sexual dissatisfaction, sexual dysfunction (the inability to attain an erection and/or have an orgasm if the person wants to), disagreements in frequency of sexual interaction, painful intercourse when all physical and medical reasons for this have been eliminated. These are just a few.

When it is time? That would be when you and your partner are dissatisfied with some aspect of what is going on between you two in your sexual relationship. Oftentimes, we find that the real issues may not be sexual. They may be in some other areas of communication, or, more often still, LACK of communication. Seeing a sex therapist can help you sort this out. Then, together with the therapist, you both create a strategy for solving the difficulties.

rtn12760: I am thirty-nine and have had one encounter with one female twelve years ago. What if a fear of sex has removed all desire for it, except for occasional pornography and masturbation?

Dr. Shiple: You would be surprised at how often a fear of sex, or some aspect of the sexual encounter, is EXACTLY what prevents someone from having satisfying sexual interaction. I would suggest that you find a good, sensitive sex therapist in your area and outline for him/her what you have said above.

The first step in dealing with this, would possibly be, to go back to that event and discover the dynamics that created the outcomes you experienced. Then, awareness of the thoughts that you have used over time, that have kept these dynamics active and present, would be in order. Having a sex therapist's guidance, in this case, would be very beneficial. I would expect that, in clearing up what was going on in the past, you would be in the position to create new sexual directions in the present. This would be the goal and focus of sex therapy.

David: Would you say that you, generally, have to feel good about yourself to have satisfying sex?

Dr. Shiple: In general, it certainly is a help! That, and knowing what you find to be satisfying and pleasing, so you CAN relate this to your partner.

Silvie: What number of women can achieve an orgasm through intercourse?

Dr. Shiple: There have been several research studies to quantify this. In general, somewhere in the fifty percent range. There is a false belief in vogue that the only satisfying sex is having orgasms together. This is not only not necessary, but it happens rather infrequently. It can be a problem to limit the ways that you are willing to "accept" or allow yourself pleasure. This can also limit the pleasure that you have

nett: Is it okay to have anal sex, and does it have any lasting ill effects? I'm in a heterosexual relationship.

Dr. Shiple: In terms of human sexual practice, anal sex is OK. In terms of some religious proscriptions, there are differing opinions. The problem with anal sex can be tearing the lining of the anus. If the man's penis is really large and you do not use ample lubrication this can happen. Why is that a problem? Because you will be using your anus for other purposes later on (when you defecate, this carries bacteria). If the lining of the anus is torn, you can get the infection in your body. So, you would want to use plenty of lubrication and if your partner is very large, get him to enter you before he is fully erect. If that is not possible, you might want to forego the experience.

jullian: I was wondering if you know about how medications affect sex life? I am on Paxil and it has changed my sexual experience. Is this common and do you know of any meds that do not have this effect?

Dr. Shiple: Oh, Jullian, you are entering touchy territory. Yes, many medications affect your sexual interaction. In my experience, Paxil is certainly one of them. One difficulty in answering the "any meds that do not" question, is that people experience different results from different medications. As a general rule, I would refer you back to your doctor. She or he better knows your history and can make recommendations. One word of encouragement: do not give up your quest. Keep working to find a medication that does not adversely affect your sexual interest and/or pleasure until you find one. Having satisfying sexual relations is worth it!

David: How do you broach your sexual "desires" with your partner. For instance, for some, the idea of asking for anal sex might be difficult to bring up?

Dr. Shiple: Timing would be important. Choose a time that you are relaxed and your partner is relaxed. Then set the stage. By this, I mean to say something like, "I have something that is important for me to ask you, but I am embarrassed (if you are) or nervous (if you are) about it." This lets your partner know to be appropriately ready. If you need your partner's encouragement at this point, ask for it by saying something like, "I would really like you to say it is all right, that you want to know, that you are listening." Then give your partner time to respond to this. If she/he does not respond appropriately to this, it probably is not time yet to go on to something more sensitive like stating that you would really enjoy experiencing having anal sex with her/him.

Questions: Hi Dr. S :) Here is a brief summary: I don't think I know how a "healthy" sexual relationship starts. Can you give me general ways of knowing when I'm ready? I know I'm either the "aggressor" or the "passive" participant. I don't feel sex as an emotional extension, but almost separate of "love". I can't "feel" sex as necessarily emotional, just physical.

Dr. Shiple: Is that OK with you? Or does it cause you problems? If what you are doing is satisfying to you, and to your partner, it may not be necessary to change it. However, let's presume that you are saying that you want to change it. First, you would want to take plenty of time to get to know your partner and not rush the physical, sexual interaction. Then, in that time, you would begin to experience other emotional responses with your partner. Emotional feelings that are not just sexual. This will get you on your way. Then be sure to ASK your partner what she wants. See if her expression of her desires, and how she feels, can spark some emotional response in you. These are beginnings.

TheArtOfBeingMe: Is it impossible to get out of the "sex is bad" frame of mind after sexual abuse as a child?

Dr. Shiple: YES. Let me repeat that because it is so important: Yes! With work. You would want to find an excellent and skilled cognitively-oriented sex therapist, because what you are dealing with, is how concepts and ideas affect your behavior. Then really dedicate yourself to WORK with this therapist.

Other issues, which would be a part of this, would be accepting and loving yourself as good and beautiful! Yes, you can!

ladyofthelake: In times of extreme stress, when I least want sex, my husband seems to need it the most. Is this a normal reaction?

Dr. Shiple: Absolutely, and it is not just a male-female thing. It is the difference in personal expressions. Sex provides incredible tension release. So, at a time of extreme stress, this element alone can make sex desirable for some people. For other people, as you so well point out, it is just the opposite. The stressful event takes center-stage in your mind, with all lights focusing on it. Who can think about having sex?

In a relationship, the difficulty with these differential ways of responding, is how you resolve the two poles. Does one of you look at what benefit the other partner might see in his/her approach, and get in the other person's shoes, as it were? Or does it become an argument as another way of diverting the stress-filled energy?

David: In terms of a relationship, where you have been with your partner for some time, is part of the "deal", whether you are a man or woman, to have sex when your partner wants it -- even though at occasional times you may not want to have sex at that moment? Or maybe a better phrasing of the question is, is that part of having a good relationship?

Dr. Shiple: Sometimes, and sometimes not. What I mean by that is, I think there have to be three modes of interacting:

1. we both want to have sex and we do
2. one of us wants to have sex and the other of us has no serious problem/objection with that. Maybe she or he is tired and not up to generating the energy herself or himself, but if the desirous partner can get the action going, the other party is amenable; and
3. it's just NOT the right time.

I would add that I think (c) needs to be used sparingly. But, by not having a (c), it sets up the circumstance in which one partner might feel forced, or create resentment. This resentment can undermine and destroy a relationship fast!!

rtn12760: I have a therapist who works with me on my pornography issues but doesn't touch on the fear of intimacy. Should I get a new therapist? This one was supposed to specialize in sexual addiction.

Dr. Shiple: Have you brought up to your current therapist that you want to work on fear of intimacy? Do you want to work on fear of intimacy (rather than to presume this from your question.)? If your current therapist feels competent to deal with intimacy fears, I would certainly stick with this therapist. It takes a considerable amount of time to build a therapeutic relationship, one of deep trust and benefit. I would not be looking to have you throw that over too quickly.

However, if you have asked to deal with your fear of intimacy, and the therapist is just not doing so, I would ask if she or he could refer me to someone capable in this area. Intimacy is such a crucial area to sexual satisfaction that I encourage you to take the steps to pursue this.

David: When I hear the term sexual dysfunction, I, maybe because I am a man, think about "inability to get an erection." What other categories does that cover?

Dr. Shiple: Sexual dysfunction for a male can also include what used to be called premature ejaculation. It can include problems with sexual desire. It can include not being able to sustain the erection long enough for mutual satisfaction and pleasure.

For a female, sexual dysfunction can also be inhibited sexual desire. It can include the condition of vaginismus -- in which the mouth of the vagina tightens up so fiercely and so strongly that it can prevent penetration. Even if penetration is possible, this condition creates incredible pain in the female partner, and, in her partner.

punklil: I have DID ( dissociative identity disorder, multiple personality disorder) and when I say "no" to my partner, he would call out another alter that would say "yes". Is this wrong, or does he have a right to do this?

Dr. Shiple: That would depend on the relationship between the alters. Is it OK with you that what you requested is not listened to? Is it a relief to you that one of the others would be able to please your partner when this is not possible for you? As I mentioned above, if a dynamic is going on that creates resentment for one of the partners, including the main personality, this will be a serious problem to the relationship. Does he have the right? I would seriously consider, outside of the sexual interaction, having the two of you define what you need from your partner and what you are willing to do about your partner requests. If this is absolutely unacceptable to you, Punklil, you would need to help your partner understand, and together, create other options to use when this situation comes up. If you cannot do this yourselves, I would advise you to seek a good relationship therapist for assistance.

Dawnie3: I have diabetes and get splits in the skin, which really hurt. Is this normal and what helps to relieve them and prevent them? I think it's caused from dryness.

Dr. Shiple: Dawnie3, I think that this is an excellent question, but it is out of my area of expertise. Have you asked your medical doctor about this? If not, I encourage you to do so. I would tend to bet that there is some medical treatment that could help you. I just do not know what it might be.

David: What is the best way of "complaining" about your partner's sexual habits or preferences? Some people have trouble communicating in general, but in sexual matters "tact is critical."

Dr. Shiple: Once again, timing is of the essence in this area. Choose a time when you and your partner are relaxed together. Then set the stage I mentioned above. You do this by saying something along the lines of, "I have something I need to talk to you about that is very important to me; yet I am concerned that you might get upset, angry, hurt (whatever fits). I absolutely do not want that result, yet I still need to talk with you about this."

Then proceed to talk in terms of I-messages: "I would feel so much more aroused if you ...", "I would be willing more often to initiate sex and be an active partner if we did more ...", "Sometimes I need a light touch and sometimes a need a harder touch. Would it work for you if I put my hand over yours to show you which I would enjoy most when?" If your partner says, "no" to this. Ask him/her what works for them. Get your partner actively involved in creating solutions that are helpful pleasing to him/her. You have great expertise between the two of you. You are an expert on yourself and your partner is an expert on his/her responses and inclinations. Don't miss out on the opportunity to use these areas of expertise for your mutual benefit. By all means, however, avoid "You always ..." kinds of messages; or, "You never ..." messages. These tend to create defensive responding, the very opposite of what you are looking for when you and your partner could be focusing on one (or several) solutions. As always, timing and "how you say what you say" are crucial.

spudrn: My question is that I was sexually abused as a child, and now, for me to have a successful orgasm, I have to hurt myself sexually to the point of bleeding to release my tension. How can I heal myself from this need of self-injury?

Dr. Shiple: Spudrn, that is a courageous question! Have you worked with a therapist on this? Let me assure you -- you are not alone! I have worked successfully with many, many clients with the "need" to hurt themselves physically (self-injury). This is a treatable condition. However, it requires some basic psychotherapy in the areas of increased positive self-esteem, learning self-love, developing ways of kindness with yourself. These are important skills to learn. Working with a skilled therapist to develop them is step number one. And let me say again, this condition is treatable. So, I encourage you to do the work to get this resolved.

David: For everyone's information, Dr. Shiple's website is: http://www.sexualtherapy.com/therapists/shiple.htm.

Thank you, Dr. Shiple, for being our guest tonight and sharing your expertise with us. And I want to thank everyone in the audience for coming and participating. I hope you have found the information helpful.

Dr. Shiple: Thank you, and good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.