by Pat Love
Late on a chilly spring night several years ago, my husband inquired when I would be coming to bed. "Mmm, a little later," I replied. Translation: "Do you want to make love?" Answer: "Not a chance." The dialogue was familiar, but this time it was edged with a quality of brooding tension that distinguished it from the hundreds of similar invitation-and-refusal scenes we'd enacted before. When I finally came to bed that night, my husband was still awake, bristling with outrage and hurt. "Every night, it's the same routine," he stormed. "Aren't we ever going to have sex?"
I began to marshal my usual arguments about being exhausted after a day of chasing two small kids when, suddenly, I felt myself go limp with dejection. I felt bone-weary of the years of conflict, guilt and crushing sense of inadequacy that pervaded my lack of interest in lovemaking. Turning my face to the wall, I said softly but entirely audibly: "I don't care if I ever do it again."
From the other side of the bed, there was silence.
How had it come to this? When I first began dating my husband, a rangy, dark-haired college athlete with a chiseled physique and a talent for making me feel like the only woman on the planet, I was plenty attracted. Saving sex for our wedding night only heightened my desire. But even after our marriage, we made love frequently, passionately and often for hours at a time. If, during those early years, he wanted sex slightly more than I did, the difference in our sexual setpoints seemed negligible. On the erotic front, we seemed about as perfectly matched as any couple could hope to be.
Until it all ended. Two years into our marriage, my libido began to wilt; after giving birth to our first child, it went permanently AWOL. Truth to tell, I didn't much care about the demise of our sexual synchrony. Furiously busy with the demands of an infant son, homemaking and church work, I rarely even thought about sex, much less craved it. My husband's desire for me, however, had dimmed not one iota. One evening he arrived home, full of hope, bearing a book on sensual massage for couples. When I glanced through the photos of smiling, nude women pleasuring their partners, I felt my inadequacy like a physical attack and threw the book into the trash.
Silently, I blamed my husband for being inconsiderate enough to desire me when the feeling wasn't mutual, and while he never explicitly said so, he must have felt profoundly unwanted. For years, we coped by simply repressing all of our anger and sorrow--each of us fearful to say out loud how desperately unhappy we had become in our marriage.Â Then, on the night I finally spoke the unspeakable--"I don't care if I ever do it again"--our mutual disenchantment bottomed out into despair. Like many people, my husband and I equated sexual passion with love, so we concluded that if I had lost all interest in sex, I must no longer love him. At the very least, it seemed that each of us was trapped in an unbearably incompatible marriage, a union that doomed one partner to everlasting sexual frustration and rejection, and the other to feeling perpetually invaded and, at the same time, somehow defective. These convictions led to an action that remains the deepest regret of my life--an unnecessary divorce from a thoroughly decent, loving man and the father of my two children.
I say "unnecessary" not because we didn't try to work things out. We sought therapy and got the best that was available. But the intensity of shame and hopelessness that permeated our mutual sense of sexual failure was beyond the usual therapeutic jump-starts. Rather, I believe our divorce was unnecessary because we did not understand then that our desire gap was rooted, to a large degree, in powerful, automatic, biochemical processes that had little to do with how attractive I found my husband or how much I actually cared for him. In fact, I did love him; the problem was that my body didn't know it.
If the idea that desire is orchestrated by our body chemistry hasn't yet found its way into the clinical conversation, it may be because the evidence is still largely buried in scientific journals, primarily from the emerging fields of behavioral endocrinology and psychophysiology. The provocative core of the new research is this: Each of us approaches our erotic encounters already primed by a premixed neurochemical and hormonal "cocktail" that influences both the strength and staying power of sexual passion. Having delved into this new biological evidence and observed its impact in my own couples therapy practice, I am convinced that as long as our clients remain unaware of these bodily processes, they are at high risk for making disastrous decisions about their intimate commitments. Some clients will misread their clashing desire levels as the death of love and lose faith in basically sound marriages, as my husband and I did. Others will choose badly to begin with, making lifelong commitments while under the influence of short-lived, highly irrational brain states.
But I believe that both catastrophes are largely preventable. The emergent data on the biology of desire offers therapists a potent new tool for helping troubled couples--a genuinely new kind of sex psychoeducation. This form of "desire ed," which I now use routinely in my work with couples, doesn't dwell on the usual sex therapy instruction about performance anxiety or the search for the elusive G spot. Instead, its objective is to help clients understand how their hidden neurobiological agendas may operate in the bedroom, so that they can make conscious, thoughtful decisions about their intimate relationships rather than ones that misinterpret the critical messages of the body.
But let me be clear: I am not proposing that the complexities of sexual desire can be reduced to Chemistry l0l. There is no question that problems of passion also can be influenced by relationship conflicts and a long list of other factors, from depression, stress and past sexual trauma to certain medications and a host of medical disorders. Likewise, it goes without saying that chronic sexual problems can contribute hugely to relationship difficulties. Nonetheless, the biochemical action of the human brain--the organ that nature writer Diane Ackerman calls our "three pounds of blood, dream and electricity"--may influence how often and how badly each of us wants sex more than we ever imagined.
To begin to understand the biology of desire, think back to the last time you fell fiercely, feverishly in love. He, or she, merely walked into the room and your body was zapped by a thousand-watt current, transforming you from a reasonably rational, functional adult into a trembling, mushy puddle of pure yearning. When the two of you were together, the most mundane activity--say, going to Wal-Mart for poultry scissors--became an exhilarating, deeply rewarding event. Not to mention the sex. Remember? The sex was amazing .
Most of us who have spent any time in infatuation's clutches also remember the sense of pure, utter helplessness that permeates this state. In the throes of new romance, there is something strangely involuntary about one's behavior--the workaholic misses deadlines; the penny-pincher blows his paycheck on plane tickets for two to Paris; the solidly married woman finds herself whispering on the phone, making furtive, high-risk plans with her paramour. Our culture speaks of "falling" in love. Other societies have compared infatuation to divine revelation, and to psychosis. We often say, in jest, that this experience of hurricane-force passion is "like a drug."
But that oft-quipped analogy may turn out to be no joke. Some scientists now believe that the frenzied euphoria of romantic love may well be a bona fide, altered state of consciousness, primarily brought on by the action of phenylethylamine (PEA), a naturally occurring, amphetamine-like neurotransmitter. Michael Liebowitz, a research psychiatrist at the New York State Psychiatric Institute, believes that when we come into contact with a person who highly attracts us, our brains become saturated with a "love cocktail" comprised of PEA and several other excitatory neurotransmitters, including dopamine. This chemical brain-bath theory explains why new lovers can talk till dawn, make love for hours on end, lose weight without trying and feel so outrageously, unquenchably optimistic. Their neurons are soaking in natural speed.
Thus far, much of what we know about PEA's action comes from animal studies. When mice are injected with PEA, they cavort and squeal in displays of rodent rapture, while rhesus monkeys dosed with PEA-like chemicals make pleasure calls and smack their lips, a courting gesture. While the brains of romance-besotted humans have yet to be directly studied, Theresa Crenshaw, a sexual medicine researcher and author of Sexual Pharmacology , reports that elevated levels of PEA have been found in the bloodstreams of lovers. Crenshaw also has found that women's PEA levels tend to rise at ovulation, which suggests a role for this potent molecule in the survival of the species.
Still, speed-spiked blood and the antics of small animals hardly prove a pivotal role for PEA in firing human passion. To date, the most compelling evidence comes from studies on a group of people suffering from a disorder known as hysteroid dysphoria, characterized by a desperate, boundless craving for attention and admiration, coupled with an acute hypersensitivity to rejection. Unlike most adults, who succumb to infatuation upon occasion, the hysteroid dysphoric is a kind of "romance junkie," falling in love constantly, violently and often with unsuitable partners. This person's usual pattern is to enjoy a brief, thrilling infatuation, followed by a traumatic breakup, often precipitated by his or her anxious, seemingly bottomless need for displays of love and affection. Upon rejection, the romance-hooked person predictably plunges into deep depression, which he or she tries to cure by falling in love all over again.
Research psychiatrist Liebowitz and his colleague Donald Klein suspected that such "infatuation junkies" might suffer from some kind of biochemical imbalance--perhaps abnormally low PEA levels. They wondered: Was it possible that these individuals jumped compulsively from lover to lover in order to keep their PEA sufficiently revved up to feel normal? To find out, Liebowitz and Klein treated a group of hysteroid dysphorics with the class of antidepressants known as monoamine oxidase (MAO) inhibitors, which block the action of brain enzymes that break down PEA. MAO inhibitors, therefore, act to boost PEA levels. Within weeks of starting their medication regimen, some of the lovesick subjects began to choose partners more judiciously, while others reported feeling reasonably comfortable without any love interest in their lives at all. Apparently, these individuals no longer craved the PEA jolt they once got from their euphoric, disastrous romances.
But one doesn't have to have a diagnosable love disorder to be influenced by PEA. Researchers propose that in the presence of a sufficiently intense sexual and emotional attraction, virtually everyone's neural lattices become marinated in natural speed. Given some of the dangerously delusionary thinking that accompanies new romance, the concept of an overstimulated brain makes compelling sense. If the frenzied action of lovers' neurons tends to render them maniacally optimistic, it is no wonder that they tend to discount patently alarming qualities in their sweethearts. You may gently remind a love-struck client: "Have you really considered the fact that she is a practicing alcoholic, has lost three jobs in a row and has been divorced only two months?" Your client sweetly responds: "We can work it out." Indeed, in a study of 400 men and women involved in a new romance, psychologist Dorothy Tennov found that while infatuated individuals had no trouble identifying shortcomings in their lovers, they tended to recast even the most serious liabilities as trivial, tractable and even charming.
What about sex? We don't need a slew of studies to convince us that with a new lover, sex is the Mount Everest of romantic peak experiences. Some neuropsychologists now think that the sexual euphoria that accompanies infatuation issues from brain secretions of both PEA and dopamine, a neurotransmitter that both stimulates libido and mobilizes people to actively pursue the pleasure of lovemaking. With two potent brain molecules working overtime, it's as though our erotic thermostat gets overwhelmed--we want scads of sex with our beloved, we get our fill, then in short order we're ready for more. It must be love.
Until it's not. For the universal and much-denied truth is this: Romance has no legs. Numerous studies that have measured the duration of infatuation--from the first moment of stuttering euphoria to the first feeling of neutrality for one's love object--have found that the state of romantic rapture predictably burns out after 18 to 36 months. And while the demise of infatuation certainly encompasses emotional components, such as the resentment that attends the inevitable discovery that our lover has other priorities besides keeping us happy, our wilting desire is also likely to be grounded in brain physiology. Liebowitz and others theorize that the brain cannot eternally maintain its revved-up, lust-crazed state of romantic bliss, either because the nerve endings become habituated to the brain's natural stimulants or because levels of PEA and related substances begin to drop. It certainly makes sense that if infatuation is a "high" that is chemically analogous to an amphetamine jolt, lovers would develop a tolerance for each other over a period of time. Whatever the precise mechanism involved, all of us have experienced this downshift in desire--slowly but predictably, euphoria sneaks out the back door while reality, that perpetually unwelcome houseguest, makes its sullen entrance.
If the sexual reality facing postinfatuation couples were limited to plummeting desire, it would be tough enough to cope with. But the dilemma of many disillusioned lovers is made far more difficult by a substantial desire gap between partners. To fully understand this element of a couple's sexual struggle, we need to introduce a second biological factor--testosterone. When most of us think of this steroid hormone, we reflexively think "male," and a pumped-up, perpetually horny one at that. We almost never think about the ways in which testosterone influences women--and consequently, we may be missing one of the biggest clues to the desire difficulties of many couples.
Scientists have known for decades that both sexes produce testosterone: men manufacture gobs of the stuff in their testes and adrenals, while women pump out smaller quantities from their ovaries and adrenals. But while testosterone has been conclusively shown to highly correlate with male libido, it was long dismissed as a nonfactor in the sex drive of women. Then, in 1987, Barbara Sherwin, a psychologist and psychoendocrinology researcher at McGill University in Montreal, published her now-classic study on the impact of hormone replacement therapy on women's sex lives. Sherwin divided her 43 subjects, all of whom had undergone surgical removal of their ovaries, into three groups, giving one group estrogen medication, a second group a regimen of estrogen and testosterone and a third group a placebo.
The results were swift and dramatic. The women who received the testosterone-estrogen cocktail reported a greater upsurge in sexual arousal, more lustful fantasies, a stronger desire for sex, more frequent intercourse and higher rates of orgasm than the women in either of the two other groups. Sherwin replicated these findings in several other carefully conducted, double-blind studies.
Subsequent research on women's naturally produced testosterone has yielded similar results. In the absence of infatuation, women with high baseline levels of testosterone--so-called "high-T" women-- tend to be significantly more sexually interested and responsive than "low-T" women. This now-substantial body of psychoendocrinological research has exploded decades of mythology about female sexuality by establishing that libido requires a goodly supply of testosterone in women as well as in men. But herein lies a key source of the postinfatuation desire gap. Both genders rely on testosterone for a robust sex drive, yet on average, men have 10 times more of the stuff circulating in their systems as women do. This doesn't mean that women are typically only one-tenth as lusty as men; many endocrinologists suspect that because women are exposed to lower levels of testosterone, they are more sensitive than men to a given amount. Nor does it mean that all men are the sexual equivalents of the Energizer Bunny. Testosterone levels drop gradually with age, and at any stage of life, the genetically determined sensitivity of androgen receptors in the genitals and brain influences how strongly testosterone pumps up male libido.
Nonetheless, the biological reality remains that, on average, men tend to be hornier than women--by quite a bit. Surveys show that, among both heterosexuals and homosexuals, men think about sex more frequently, masturbate more often and rank sex as more important in their lives than women do. Of course, there are millions of exceptions to this gender-typed scenario. I worked with one young couple in which the woman wanted daily lovemaking, while her husband felt the urge maybe once a week. Sharing a bed with him aroused her to such a pitch that she had taken to sleeping alone in a back bedroom. I also have worked with many lesbian and gay couples on problems of mismatched desire, indicating that passion quotients vary within as well as across gender lines.
Whatever the gender positions of this lust gap, it is a commonplace phenomenon: A survey of 289 sex therapists found "desire discrepancy" to be the single most common presenting problem of clients. Yet couples might be able to cope more sanely with their divergent desire levels were it not for the biochemical blinders they wear in the early stages of their relationship. It is during the infatuation stage that the two major components of the biology of desire--the time-limited PEA factor and T-level mismatches--collide to create sexual catastrophe for many couples. If the brains and bloodstreams of new lovers are awash in the aphrodisiac properties of PEA and other brain molecules, any disparity in libido is, at first, likely to go blissfully unnoticed.
Let us say, for argument's sake, that you are a "low-T" woman who has fallen fervently in love with a "high-T" man. You, a person whose needle on the sex meter usually points close to zero, suddenly find yourself fantasizing about sex in graphic, Omnivision detail, and approaching lovemaking with a level of gusto bordering on zeal. You think to yourself: "I am a sexual person--I just needed the right partner." Your naturally highly sexed new lover, meanwhile, finds himself in a state of erotic nirvana: "Finally, I've found someone as hot as me!" Over and over again, I have heard clients recall their mingled sense of exhilaration and relief at having finally found their "perfect" lover. Even if they had experienced a similar sense of sexual harmony in the early months of a past romance, infatuated people tend to discount history: It is this lover, at this moment, who satisfies me more deeply than any other. That is, until the tide of PEA begins to recede and preexisting T-levels emerge, unveiling for each person his or her "real" sexual partner.
At this juncture, the "high-T" person is apt to feel bitterly disappointed, even betrayed. For even though his or her brain may no longer be drenched in a PEA-dopamine cocktail, he or she typically has sufficiently high T-levels to still want plenty of action in the bedroom. The "low-T" partner, meanwhile, is likely to feel bewildered by the loss of his or her temporarily turbocharged libido, as well as sexually pressured by what now seems like an insensitive, even predatory, partner. A downward spiral of mutual anger, bad sex, more anger and still worse sex--or none at all--finally leads many couples into therapists' consulting rooms, raging with sorrow, shame and profound doubts about the future of their disappointing marriages.
At first glance, the proposal that something as fluffy-sounding as "desire education" could make any difference to dispirited couples sounds inflated, if not preposterous. As University of Washington psychologist John Gottman's research indicates, on average, couples straggle into therapy a full six years after their troubles first erupt. If anything is going to help at this late date, it seems as though it would have to be an intervention that does something fairly dramatic--something that packs a real emotional wallop or teaches potent relationship skills or both. Faced with the typical couple's end-of-their-rope discouragement, how is dispensing a bunch of facts on body chemistry going to make any difference?
In my experience, the difference is as profound as hope. For beneath the "dry" facts on neuronal and hormonal processes lies a radically normalizing, shame-reducing message: Sexual passion is rooted in our natural body rhythms. That means that if the thrill is gone or if the thrill is different for you than it is for me, I have not failed and you have not failed. Nor has our relationship failed. There may be plenty of emotional junk that is also mucking up our sexual connection, but that's not all that's going on. If our desire problems are at least partly innate--mirroring neither messed-up psyches nor a bankrupt relationship, but rather the pulse and flow of ordinary bodily processes--then maybe we don't need to feel quite so ashamed and despairing about the muddle we're in. Maybe each of us, and the embattled, fragile relationship we're trying to sustain, are even fundamentally okay. Maybe we've got a chance.
Of course, every therapeutic approach tries to engender hope. The particular potency of desire education is its capacity to plant seeds of optimism so early in therapy--sometimes as soon as the first session. Every clinician who works with discouraged couples understands that there is no time to waste: You need a way to show them, quickly and compellingly, that what they view as a sorry excuse for a relationship is even worth expending further energy on. The problem here is that the palpable rewards of most couples work--the profound emotional breakthroughs, the fruits of well-learned relationship skills, the mastery of new sexual techniques--take time to emerge. By contrast, the matter-of-fact, calming information of "desire ed" can be dispensed almost immediately to interrupt the furious, toxic, blame-shame cycle that sabotages so many sexually polarized couples at the very outset of therapy. As a potent, front-end couples intervention, desire education can make the difference between a willingness to plunge into relationship work with a measure of motivation and the decision to prematurely quit in despair.
When Eddie and Joyce, a couple in their mid-thirties, arrived for their first session with me, it quickly became clear that their sexual standoff was already calcifying into a kind of listless bitterness. Slumped in his chair, Eddie complained that Joyce was his "wife in name only"--that is, she had avoided sex with him as much as possible duringÂ the past five years. "Your basic ice queen," he quipped grimly. Joyce countered that Eddie made her feel ugly and invisible by openly flirting with other women, to which she often responded by collapsing into tears, panic stricken that she was losing her husband. Eddie made clear that this was a real possibility. "Do you know what it feels like to get down on your knees and beg for sex?" he asked me. Joyce snapped, "It's more like being cornered by a dog in heat." Twice before, they had tried therapy, which had focused on improving communication and injecting more novelty into their erotic repertoire, to little effect. In a last-ditch attempt to stave off separation, Joyce had dragged Eddie to see me.
In the past, I would have begun therapy with a couple like Joyce and Eddie by focusing immediately on communication about relationship issues, such as Joyce's anger and "withholding" of sex and Eddie's motives for his blatant attentions to other women. But my experience has been that sexually struggling couples can rarely focus on such efforts at relationship repair at the outset, because they feel too deeply flawed and full of shame to believe that genuine change is even possible.
Instead, I began by empathizing with each of them about how painful it must be to live in a relationship in which one partner wants sex more than the other. Then, gently probing about their desire history, I learned that both partners had experienced their particular passion level over time, with several different partners. This suggested to me that Eddie and Joyce's sexual problem wasn't purely relationship-driven, but probably also had a hormonal component. So I introduced some information about T-levels and the consequent normality, even near inevitability, of their desire gap.Â As I spoke, Eddie and Joyce became quiet and attentive. Neither of them had had the slightest idea that testosterone--or the relative lack of it--was such a major player in female desire. I concluded with my core message: "What all of this means is that it's entirely possible to love someone a lot, but still not be very sexually turned on by him or her." Joyce and Eddie remained silent for a moment. Finally, Joyce spoke up. "So what you're saying," she said slowly, "is that I'm not just trying to punish my husband."
She glanced quickly at Eddie, who seemed lost in thought. "Well," he finally said, "I guess the good news is that maybe I don't have to feel like such a jerk when I get turned down." I sat quietly with them for a few minutes, letting the deeper message of my mini-primer soak in. I wasn't expecting any big epiphanies or tearful embraces, nor did they materialize. All I wanted was to give this couple sufficient relief from their mutual sense of sexual failure to commit to the work ahead. I wanted time. Eddie gave me my opening. "I like the idea that the trouble we're having maybe isn't all personal," he began. "But, not to be rude, so what? If I'm some kind of hormone factory and she's not, what the hell are we supposed to do now?" I responded that even if their hormonal makeup contributed to a natural difference in libido, it was entirely possible, with sufficient time and effort on their part, to develop a satisfying sexual connection. When, in the last few minutes of the session, they agreed to try, I felt a small jolt of elation.
Having now worked with scores of couples who suffer a substantial desire gap, I understand more about the private hell that couples like Joyce and Eddie inhabit. In our sex-saturated culture, the woman or man who is "low-T" is already, by definition, defective. But if you are that person, imagine then the experience of living with a "high-T" partner, who comes to you for sex again and again and again, when you truly feel you have little to give. The screws of inadequacy get turned still tighter as you experience your many varieties of unworthiness--unworthiness for not matching the "normal" sex drive of your partner, unworthiness for failing to live up to a fundamental expectation of a committed relationship, unworthiness for repeatedly turning your back on your partner's helpless, fervent desire for you.
And the inescapable truth is that your partner is hurting. How could it be otherwise, when he or she inhabits a reality of constantly slamming doors? Because of the raw exposure of self that attends sexual intimacy, this more ardent partner may experience chronic sexual rejection as an existential wound. Again and again, I have heard the more sexually desirous partner say to the other: "I've shown you myself--the real me. And you don't want it."
As I worked with Joyce and Eddie in the succeeding months, my goal was never to transform them into the hot couple of the month; nor was it theirs. Using other strands of "desire ed" that I wove into our therapy sessions, they understood that they had long since spent their allowance of PEA-spiked passion; from now on, whatever sexual intimacy they might experience would have to be consciously created.
To begin this process, I asked each partner to share with each other what kind of sexual-emotional activity would feel most loving and satisfying to them. For Eddie, it was what this couple jokingly came to call a "marital"--a periodic, 15-minute session of sex that gave him both a measure of physical release and, more important, the feeling that Joyce cared for him. For Joyce, it was receivingÂ regular, leisurely massages from her husband, which might or might not culminate in intercourse, depending on her wishes. Haltingly at first, each tried to respond to the other's requests for behavior that seemed, initially, alien to his or her own impulses. But as they gradually deepened their understanding that their partner's experience of passion was both different from their own and entirely valid, they became more generous in their capacity to stretch to respond to it. The result wasn't blood-boiling sexual fireworks, but rather a budding sense of mutual intimacy and trust that began to energize both their erotic and emotional connection. Slowly but perseveringly, they began to feel their way toward a state of marital grace that I call mature love.
I am not arguing here for any particular therapeutic approach to sexual desire problems. My observation is that a number of useful ones already exist, from the skill-building orientation of traditional sex therapy to the more emotion-centered approaches of numerous schools of couples therapy. Many therapists, no doubt, pick and choose from several models. My point is that whatever overall approach you favor will almost certainly be rendered more potent and effective by integrating some basic education on the biology of passion. By the same token, if you omit desire education, you risk giving your clients a hazardously incomplete understanding of their situation.
For example, if Eddie and Joyce had taken their dilemma to a mainstream sex therapy clinic, their problem would likely have been diagnosed as "hypoactive sexual desire" on Joyce's part, with a program of sensate focus exercises prescribed. There is much to be said for sensate focus, in which partners are taught to hold and stroke each other while attending to the sensations that emerge, to help each discover what kind of touch is pleasurable. The limitation of traditional sex therapy antidotes is that they are typically taught in the absence of context: They rarely give unhappy couples a way to feel less flawed and freakish about the sexual afflictions they have laid bare. In fact, a couple's shame may even be deepened by sex therapy's habitual use of such pathology-laden labels as "hypoactive sexual desire" or "retarded ejaculation." Desire education, by contrast, avoidsÂ the medicalization of sex in favor of a gentle, humanizing context. It conveys the idea that nobody here is inherently damaged or inherently unlovable. Desire differences are natural and normal. Relax.
Desire education also has a key role to play in couples therapies that focus explicitly on the emotional aspects of sexual desire dilemmas. The hazard of purely relationship-centered sex therapies is that by focusing solely on the interpersonal factors that fuel passion problems, a therapist may convey the message that once partners resolve these emotional conflicts, they will become, once again, the effortlessly synchronized sexual match of their courting days. But by judicious melding of information on the psychology and the biology of desire--especially about the experience of red-hot sex as a short-lived, PEA phenomenon--a therapist can convey reasonable optimism about a couple's sexual future without raising erotic expectations to untenable levels. For the reality is that when a substantial, hormonally mediated desire gap exists between partners, their ultimate erotic satisfaction will depend on a steady, vigilant effort to sustain their sexual connection. Even when two people love each other deeply, postinfatuation passion is rarely a free ride.
Even as I write this, I am confronting this challenge in my own life. I am still a classic "low-T" woman who, just three months ago, married an unmistakably "high-T" man. Fortunately, this time I knew--and so did he--that the exquisite tango of brand-new love would downshift, inevitably, into the reality of differing sexual setpoints. We know, now, that our work together for the long term will encompass much stretching beyond our respective sexual comfort zones--stretching to understand, to empathize with and to accommodate the other's unique experience of passion. Neither of us expects this process to be easy; at times, it may well be excruciating. Our hope is that during the toughest moments, when even our best efforts cannot bridge our differences, we can hold fast to the conviction that our desire dissonances are rooted in nature, not in an insufficiency of love.
For clinicians, perhaps the most invigorating potential of the emerging science of passion is the challenge it poses to radically reenvision our concept of human sexual relationships. Up to now, therapists have been offered two divergent, even diametrically opposed, ways of looking at clients' sexual problems: Either they are a direct reflection of the troubled state of the relationship, requiring deep emotional work, or they are a set of physiological problems, requiring primarily technical intervention--usually through referral to a sex therapist. The biology of desire offers a more encompassing vision: Our sexual selves are mind-body creations in the deepest, most inclusive sense. To consider the influence of our neural and hormonal processes is neither to diminish the power of emotional factors nor to deny the usefulness of sexual skill-building; instead, therapists can use the lens of human biochemistry to enlarge clients' understanding of the entire spectrum of influences on human erotic connection.
All of us need to become active, knowledgeable sex educators in this new, more inclusive sense. While we may think of this realm as belonging to clinicians who somehow "specialize" in sexual difficulties, the reality is that virtually all therapists work with people who are struggling with problems of passion--the woman who wonders whether she should leave her boring husband for the new, more enthralling man she has met at the office; the love-struck, single man who is rushing to the altar far too precipitously; the couple on the verge of splitting up because she wants it and he doesn't. These are deeply emotional concerns, but they are also matters of raw, palpitating bodily desire, and our clients can ill afford to have us uninformed about them. The emerging science of passion, which has relevance for nearly every sexual-emotional event that transpires between two individuals, can help us explicate these dilemmas for clients with a new level of depth and authority.
Still, it can be tricky, demanding work. As we teach clients more about the biology of desire, the age-old, inexorably human tug-of-war between biological imperative and moral responsibility is likely to emerge with renewed force in the consulting room. If desire is tied to biological processes, how responsible are clients for their sexually motivated behavior? Under the influence of PEA, can a long-married man "help" having an affair with his sexy new law partner? Or, if a woman now comfortably accepts herself as a "low-T" person, is that a legitimate reason to abandon all efforts to revitalize a sexually stagnant, otherwise committed relationship?
These are the moments when therapy becomes a high-wire act, as we try to maintain a fragile balance between a generous acceptance of biological reality and a fierce, nonnegotiable allegiance to consciousness, the quality that makes us human and saves us from being utterly at the mercy of our molecules. If we are serious about trying to stem the tide of marital and family misery in this culture, our clients' most torturous questions about their intimate relationships--Do I stay? Do I bail? DoÂ I officially stay but just go through the motions?--will require arduous discussions about choice and responsibility, as well as about the proclivities of neurons and hormones. Our body chemistry counts--much more than we ever imagined. But in the end, biology is only backdrop.
Pat Love, Ed.D., a family life educator, trainer and lecturer, is the coauthor of Â Hot Monogamy. Â Address: 6705 Highway 290 West, Suite 502-291, Austin, TX 78735; e-mail address: Pat@patlove.com
Rx for Passion
Antidepressants needn't depress the libido
by Valerie Davis-Raskin
As a psychiatrist and couples therapist, some days it seems as if I never talk about anything but sex. And increasingly, I find myself educating my patients about the impact of the new selective serotonin reuptake inhibitors (SSRIs) on sexual interest and pleasure. Sure, I've had patients blush or change the topic, but most welcome the invitation to discuss problems in their sex lives, some related to medication, others not.
I didn't used to talk so much about sex and the sexual side effects of antidepressant medications. When I started practicing psychiatry a dozen years ago, we weren't yet in the better-sex-through-modern-chemistry era. Then the landscape changed. We began to live and practice in a culture that has come to consider pharmacology an acceptable (if not ideal) means of reducing depression. But until we had some ideas about how to counteract the sexual side effects of antidepressants, it still didn't much matter whether we talked about them or not.
Things are different now. We know that sexual side effects are among the most common and most troublesome difficulties experienced by antidepressant consumers. And more important, I know that I usually can help my patients recover from debilitating depression or anxiety without paying a sexual price.
When Prozac first came on the market, the medical profession didn't have a clue about how vital serotonin was to sexual pleasure and responsiveness. We didn't realize that Prozac and its two bestselling counterparts, Paxil and Zoloft, can and often do greatly reduce human suffering, but they also frequently kill sex drive, cause delayed ejaculation or completely eradicate orgasms. To this day, the Physician's Desk Reference (PDR) grossly underestimates the rate of sexual dysfunction caused by SSRIs. The PDR lists an incidence rate of medication-induced sexual dysfunction in the range of two percent or less. Would that this were true! In reality, between one third and one half of all individuals taking the most commonly prescribed antidepressants experience sexual side effects. And these three drugs--Prozac, Paxil and Zoloft--are among the top 10 most common prescriptions written in the United States for any condition--affecting, literally, millions of Americans.
The target of antidepressants are the neurotransmitters, our brains' chemical messengers. But neurotransmitters like serotonin are also found outside the brain wherever there are small blood vessels, a fact that accounts for many of the common side effects of SSRIs, such as nausea or jitteriness. Because serotonin is a sexually inhibitory neurotransmitter, increased serotonin in the brain may curtail the urge to have sex. Outside of the brain, serotonin may reduce genital sensation, somewhat like a mild anesthetic: what used to feel great feels good, what used to feel good feels okay, and what used to feel okay doesn't even register now. This means that arousal, both the psychological interest and physiological blood vessel reaction (blood flow to the clitoris, while less obvious, is as important for pleasure for females as blood flow to the penis is for males), may be suppressed by antidepressants that increase serotonin. Clinically, this translates into any combination of possibilities: lack of interest in sex, difficulty reaching an orgasm or outright absence of orgasm, inability to maintain an erection or prolonged erection. Some individuals experience a variety of side effects, while others experience only one, in an unpredictable fashion. And of course, it's just common sense that if you can't have an orgasm, eventually the libido falters as a consequence.
The chart below summarizes the degree of sexual side effects likely to be caused by the most frequently prescribed antidepressants.
Prevalence of Sexual Side Effects Caused by Antidepressants
Monoamine oxidase inhibitors (Nardil, Parnate)
One common intervention for any SSRI-induced sexual side effect is simply to lower the dose, as long as effective treatment for the psychiatric condition can be maintained. Since arousal, erection and orgasm changes are all dose-related phenomena, a substantial number of people will continue to benefit emotionally from smaller amounts of the offending SSRI. However, lowering the dose always carries the risk of a symptomatic relapse, and should symptoms exacerbate following dose reduction, other strategies are necessary.
Some people will benefit from a so-called "drug holiday" (an intervention that does not work for Prozac, due to the much longer time that Prozac remains in the bloodstream, compared with the shorter-acting SSRIs). A physician might recommend a regular drug holiday, in which the medication is taken on Thursday morning, skipped on Friday and Saturday, and resumed on Sunday morning. Ideally, a couple would opt to make love first thing Sunday morning, but many couples would find that a Saturday-night schedule is preferred.
Should these more conservative measures fail (or be clinically inappropriate in the prescribing physician's or patient's view) there are other options. Three of the new antidepressants--Wellbutrin, Serzone and Remeron--have no sexual side effects at all. Wellbutrin is generally well tolerated, but may cause insomnia, headache, tremor or increased anxiety. Its major drawback is that it is only effective for depression and may exacerbate conditions such as panic disorder. Wellbutrin is pharmacologically distinct from the SSRIs in that it enhances the neurotransmitter dopamine rather than serotonin. As a result, while it has comparable efficacy for depressive disorders in general, any particular individual may respond preferentially to an SSRI (or vice versa).
Both Serzone and Remeron are very sedating, although this effect often wears off over time, especially for Remeron, which is taken at bedtime. However, Serzone must be taken in the morning as well, and sedation is a troublesome side effect for many. Remeron's major drawback is the high incidence of weight gain, a side effect far less tolerable in many cases than low libido.
The tricyclic antidepressants, such as Elavil, Norpramin, Pamelor and Tofranil, may cause sexual side effects, including erectile or arousal problems and anorgasmia. Nevertheless, the incidence is far lower than with the SSRIs. The major drawback to tricyclic antidepressants is their potentially negative cardiac effect, elevating the risk of suicide and overdose. Higher doses may cause sedation, constipation, dry mouth and weight gain. Tricyclics have a particular utility for panic disorder, since lower doses than those needed for depression may be effective, allowing a mid-range dose that causes neither sexual dysfunction nor other significant side effects. Antianxiety medications, such as Klonopin and Xanax, do not affect serotonin and do not have sexual side effects as a rule.
Finally, some physicians may recommend St. John's wort, which is not believed to cause sexual side effects, although this has not been systemically studied. Unfortunately, because St. John's wort is not regulated as a pharmaceutical substance, efficacy may vary widely among preparations, and even from one bottle of the same brand to the next. This, along with the fact that it has not been rigorously tested in head-to-head comparisons with traditional antidepressants (for efficacy and also for side effects), limits its use to mild cases of depression or anxiety. St. John's wort should be taken three times per day and many people have a problem remembering the midday dose.
If switching to an alternative medication is not clinically appropriate or effective, a physician might recommend adding another medication on a daily or as-needed basis. Taking a second medication may be problematic on several counts. Women often feel awkward about actively seeking sexual pleasure. Many people also are extremely hesitant to take anything for depression, let alone two drugs. For others, a second medication offers a wonderful antidote to the side effects of an otherwise helpful medication.
Most commonly, psychiatrists prefer a single low dose of Wellbutrin for patients complaining of sexual side effects from other antidepressants. It is prescribed initially only as needed, but daily if required. This comedication strategy employs lower doses of Wellbutrin than would be necessary to treat depression. Pharmacologically, Wellbutrin enhances dopamine, which has the opposite effect on libido and orgasm of serotonin. Small doses may restore the serotonin-dopamine balance, alleviating sexual side effects.
The list of agents used to comedicate for sexual side effects include stimulants such as Ritalin (methylphenidate), Urecholine (bethanechol), Yocan (yohimbine), Symmetrel (amantadine) and Periactin (cyproheptadine). Anecdotal evidence suggests that the botanical preparation ginkgo biloba may reverse libido, arousal and/or orgasm problems. Anecdotal reports also suggest that Viagra (sildenafil) is effective for SSRI-induced absence of orgasm--even in women--but its use may be limited by cost ($9 per pill).
At times, it's easy to distinguish whether sexual problems are a relationship issue or are caused by side effects. SSRI-induced sexual dysfunction follows a typical pattern: it begins within days or weeks of starting the new medication. For example, soon after she began takingÂ Prozac for obsessive-compulsive disorder, Maria found she could no longer reach climax with her husband, Steve. She did not volunteer this information, which is one reason I routinely ask women about inability to orgasm. My male patients can tell me that "things aren't working right sexually," without having to look me in the eye and complain that sex is no longer pleasurable. Many women, however, experience an ambivalence about whether nice girls are allowed to like sex or should just go along with it. And some women are terribly embarrassed to talk about orgasms. "He could stand on his head and nothing happens" is Maria's euphemistic description of her sexual difficulty. "It's like a switch turned off down there." Maria hasn't talked about this with Steve, and I suggest that she let him know that medication is the problem, since he may be wondering if it's his "fault." Maria looks horrified at the thought, so I give her some written information to hand him.
I invite Maria to bring her husband to a session so that we can talk this over together. In our joint session, I explain that she is on a high dose of an SSRI for Obsessive-Compulsive Disorder, an illness that only responds to serotonin enhancing antidepressants. Because an SSRI is the only reasonable medication, switching to something like Wellbutrin isn't an option. Further, I explain to her that since effective doses of SSRIs are typically higher for OCD than for depression or panic disorder, lowering the dose isn't a good idea. Likewise, the drug-holiday approach isn't appropriate for Maria. This leaves co-medication, an idea that Steve likes a lot more than does Maria.
Steve reveals that he feels so selfish since Maria stopped having orgasms, and he would like things to be the way they were before. He feels that he is imposing on Maria, because these days, he's the only one reaching a climax when they make love. Somewhat reluctantly, Maria agrees to try comedication and I review the alternatives. Does trying something just when needed prior to intercourse seem best, or would a regular daily comedication be better? I explain that the only-when-needed medication is like a diaphragm--you lose spontaneity, but you don't have to ingest it all the time. When I mention that the only "natural" remedy I know of that may alleviate inability to orgasm requires daily use, however, Maria jumps at this, stating that she'd rather take something natural even if it means taking it every day. I tell her about ginkgo bilboa, which she purchases at her health food store. Six weeks later, she reports that "it's not like fireworks or anything, but it's lots better. Steve says thank you."
Maria remains reluctant to "own" sexual pleasure, continuing to describe her medication-induced sexual side effects-- and return of orgasms--as Steve's issue. Until Prozac came into her bedroom, Maria's unexamined belief was that Steve mostly cared about his own pleasure, and that she was just there fulfilling her wifely duties. Now she's heard from Steve loud and clear that her sexual pleasure is an integral part of his pleasure. A seed has been planted. For the first time, she and her husband have discussed their sexual relationship openly, and she has an opportunity to reframe her sexual self-image.
Valerie Davis-Raskin, M.D., is the director of academic psychiatry at MacNeal Hospital in Berwyn, Illinois, and a clinical associate professor of psychiatry at the University of Chicago. She is the author of When Words Are Not Enough: The Women's Prescription for Depression and Anxiety Â and coauthor with Karen Kleiman, M.S.W., of Â This Isn't What I Expected: Overcoming Postpartum Depression.
by Katy Butler
Freud once said that four people--two mothers, two fathers--lie in bed with every couple making love. If only that were all. Hugh Hefner is under the covers with us, and Carl Djerassi, who invented the birth control pill, and Alex Comfort, who wrote The Joy of Sex. Shere Hite is there taking notes, and a doctor from the Centers for Disease Control, and Pope John Paul II and Kenneth Starr. Cindy Crawford's perfect body may float in space above us, or Long Dong Silver's, daring us to turn on the light and look at how we don't measure up.
When a man sleeps with a woman, he sleeps with her past as well, including her memories of pregnancy, date rape, abandonment or shame. When a woman sleeps with a man, she sleeps with the young boy caught reading his father's Playboy magazines and the teenager in the back seat, expected to know everything without being shown. Each of us in the industrialized West carries into the bedroom not only personal memories, but collective ones: we are layered with exhortations, like sedimentary rock. Sex, the Victorians told our great-grandmothers, is dirty: Save it for the one you love. The mature female orgasm, said Freud, is the vaginal orgasm: That comes only to women who resolve their penis envy. Women's sexuality, said the marriage manuals of the 1950s, is problematic, like the delicate wiring of an old MG: Husbands must be master mechanics. Vaginal orgasm is a myth, said the feminist theorists of the 1980s. Find the clitoris. Now.
Sleeping around will ruin your reputation, we were told in the fifties: Why buy the cow when you can get the milk through the fence? Sleeping around will free you, we were told in the sixties: Smash monogamy. Men and women are pretty much alike, we were told in the seventies. Men are from Mars, women are from Venus, we are told today.
Many of us enter the bedroom now as if we have been told we are about to play a high-stakes game. There is no rule book, or else it's been hidden. Everyone else, we think, knows how to play. We charge down the field. We pass the ball. A whistle blows. The rules have changed. The teams are being shuffled. We'll be playing with a shuttlecock now instead of a ball, and the goalposts have been moved to the other end of the field. We start running and the crowd roars, but we're not sure what we did right. Now we are on the bottom of a pile of bodies. We are given five different rule books and told to choose one that suits us. (We have no idea what book the other team is playing from.) Bleeding from the shin, we strap on our battered equipment again and once more run down the field.
We lie down with all of this, and more, when we lie down in bed with each other. We sleep with the war between men and women fueled by patriarchy and differences in physiology, and with the uneasy cease-fire in the erogenous zone that followed the feminist and sexual revolutions. We sleep with the legacy of the 1970s, when you could find, on many a middle-class nightstand, the dry, clinical bestsellers of William Masters and Virginia Johnson, the pioneers of behavioral sex therapy. The bright lights of their science were supposed to banish our fears and superstitions, like crucifixes held before a vampire. Yet the fear of pleasure, and of being discovered having pleasure, still runs beneath our bedroom floors like an underground river.
For most of us, our first sexual act was also an act of secret rebellion against our parents. The memory of this defiant split lives on in our cells in the disembodied, suppressed yet obsessed way our culture approaches sex today. Few of our fathers talked to their sons about how to enhance a woman's pleasure or prolong their own; few of our mothers ever told their daughters about the delights or even the location of the clitoris. We found out anyway, and paid the price.
In the dark recesses of our mental closets lies a negative cultural dowry--the muumuus that missionaries gave the naked Polynesians; the penitentes' cat-o'-nine-tails; the chastity belt; and the confessional--all the trappings of the Augustinian Catholic tradition that declared sex a dirty distraction on the path to God and the source of original sin. ("As the caterpiller chooses the fairest leaves to lay her eggs on," wrote the poet William Blake two centuries ago, "so the priest lays his curse on the fairest joys.") All of this we bring into the bedroom.
When we sleep with each other, we sleep with images we've absorbed and, without knowing it, those our lovers have absorbed as well. Like fast food, images of other people's orgasms, stripped of context and connection, are now available 24 hours a day and consumed alone and on the cheap. They demand of us a bravado we rarely feel. They lurk eternally on the Internet and in the phone-sex banks, at the corner video store and in the Congressional Record . Our bedrooms are colonized by them. When a woman lies down in bed with a man, a light show of images plays over her body without her knowing it: red-satin garter belts, perhaps, or beaver shots or Marilyn Chambers or Monica Lewinsky or the Penthouse Pet of the Month. When a man lies down with a woman, images of imaginary men play over his face without his knowing it--the hero of Tristan and Iseult, perhaps, or a Tammy Wynette song or a romance novel. No wonder we feel split within ourselves and from each other. We expect sexualized romantic love to carry a greater psychological burden than does any other culture on earth while we simultaneously denigrate the sexual. And so we reverberate between sexual obsession and sexual shame.
Last September, we found on our doorsteps newspapers full of the details of the president's intimacies with Monica Lewinsky--the thong underwear, the cigar, the joke sunglasses, the rejected girl crying in the rain. It didn't matter what the details were or the context in which they occurred. All that mattered was the telling of them. Opening the paper, some of us imagined how our own intimacies would read some morning, printed in black and white and dumped on our neighbors' doorsteps.
What we read in the papers that day reflected the impoverished language we bring to sex. In 1931, the English novelist Virginia Woolf wrote in The Waves, "I need a little language such as lovers speak, words of one syllable." But we can speak of lovemaking everywhere except the bedroom. For the delicate skin that touches our lover's most tender places, we have no words except the pornographic, the childlike and the scientific. We speak of vaginas, labiae, clitorises, cunts, hair pies and "down there." We call it a prick, a dick, a sledgehammer, a penis, a pee pee or Mr. Happy. Our worst insults are sexual: cunt, slut, whore, dickhead, pussy-whipped, cocksucker.
And so we lie in bed with each other, reaching for pleasure, tenderness and connection, with both too much and too little to guide us: Hustler on the newsstand, Dr. Ruth or Dr. Laura on the radio and Debbie Does Dallas on the VCR. "You do not have to be good," wrote the poet Mary Oliver. "You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves." But that's a big only. No wonder we are sure that someone, somewhere, is having better sex than we are. No wonder someone, somewhere is pretending to have better sex than we are. No wonder we fear we will never get it right.
Yet sometimes we do get it right--or it gets us right. Many of us have experienced something in bed that the languages of pornography, sex therapy, feminism and the double standard could not contain. It might have been the afternoon we washed our partner from head to toe in the shower, kneeling under the spray to scrub even the soles of her feet, until washing became a ritual of tenderness and awareness. It might have been a dawn when we woke from a dream experiencing what the radical psychoanalyst Wilhelm Reich called a "full-body orgasm," in which we were the wave and also a body drifting at the water's edge, pulsating to our fingertips as the wave broke on the shore. It might have been a night a man looked into our eyes and stroked our nipples for hours until we gave in to our own responses rather than following what we imagined to be his timetable. Or a night a woman looked into our eyes while we were coming and we felt safe, seen and known.
In these moments, lovemaking is sensed as healing, wholesome and holy. Our focus broadens out beyond orgasm. Our small selves are no longer in command, and we give ourselves over, little boats on a deep river. The fear of not performing well disappears, the ghosts are banished from the bedroom and the present moment absorbs us. The West's self-created divisions--between sacred and profane, heart and pelvis, male and female, victim and predator, body and soul--are temporarily healed. We understand what Walt Whitman meant when he wrote, "If anything is sacred, the human body is sacred," and what the 16th-century Anglican marriage ceremony meant when it included among its vows, "With my body, I thee worship." Our bedroom is no longer hostage to the porn palace, the sex lab or the unfinished war between men and women. For a moment, the bedroom becomes a ritual space where we enter trance and forget time.
For most of us, such moments are rare and random, despite the mixed sexual blessings of the past three decades. The sexual revolution rightly told us that sex could be a domain of pleasure and self-expression. But its prescription--quantity over quality--did not free us. The feminist revolution challenged the practice of sex as a ritual of loving female submission and encouraged women to speak of their sexual desires and sexual violations. It lit up ancient chasms between the genders, but did not bridge them.
Modern sex therapy helped thousands with simple, effective behavioral techniques, usually focused narrowly on achieving erection, intercourse or orgasm. Yet few of us have much of a clue about continuing to create the more profound joys of sexuality--especially after the first six months to two years of a relationship, when hormones subside and desire fades. We may move from arousal to contentment or indifference or contempt. We may not know how to contend with softer, slower erections and other changes related to aging. A surprising number of stable couples stop making love much, or altogether. The ghosts return to the bedroom. We may lie down in resignation in the bed we've made together, or walk once more out the door.
Or not. Some of us will embark instead on a quest for a fuller experience of intimate sexuality. We will use whatever tools we can, depending on who we are and the decade in which we set out. We may enter Reichian therapy, wrap ourselves in Saran wrap, read Nancy Friday, follow The Rules, or repeat phrases from Men Are From Mars, Women Are From Venus, but we will not give up. We want to banish the bedroom's ghosts or at least replace them with more benign presences. Risking the humiliation our culture visits on those who speak of their own sex lives rather than other people's, we will try to decolonize the bedroom. We sense that this quest requires not "more of the same"--not more sexual perfectionism or ever-more-exotic partners or positions--but a broader context, a change at the metalevel. If we embark on this quest today, we may buy a book, watch a video or go to a weekend workshop on Tantrism, which is now the West's most popular form of adult sex education.
Presaged by the popularity in the 1960s of the Kama Sutra of Vatsyayana, a 3rd-century Indian sex manual, Tantra has become a postmodern hybrid. On the most prosaic level, it is nothing more than a pastiche of positive sexual attitudes and techniques drawn from Western humanistic psychology, Chinese Taoist sexology and classical Indian Tantrism--a wild sexual and religious tradition that influenced both Buddhism and Hinduism and flourished in India about 500 A.D.
This esoteric system used breath, visualization and other yogas to arouse, channel and transform energy throughout the body. Its meditations often took the form of visualizing gods and goddesses in sexual union. In India, adherents of the tiny sect of "left-handed" Tantra took things a step further: in secret rituals, they broke all the rules of their caste-bound society, consuming taboo foods, such as alcohol and meat, sounding yogic bijas or sacred syllables and coupling with one partner after another. In contrast to monastic traditions that suppressed sexuality and avoided women, Tantrikas welcomed the energies of aggression and sexuality and transformed them. Men did not ejaculate, and the goal was to move arousal up the spine to the brain in an explosion of enlightenment and bliss. Sex was not a dirty detour from the path to God, it was the path
Today, Tantra's esoteric practices are being pressed into the service of goals that are tamer, more domestic and less religious: uniting sexuality and intimacy, and enhancing sexual pleasure for long-term couples. It's not the techniques that count so much as Tantra's enlargement of the context in which sex is held--as pleasurable, inclusive, healing, and holy. This widening of the lens was apparent as soon as modern Tantrism first registered on the American cultural radar in 1989, when a 450-page book called The Art of Sexual Ecstasy: The Path of Sacred Sexuality for Western Lovers tried to sweep the clutter of negative sexual images out of the Western bedroom. Written by Margo Anand, a writer and sex workshop leader who had studied psychology at the Sorbonne and meditation in India, it was like no sex manual the West had ever seen. She spent eight pages alone describing how to prepare a bedroom for lovemaking. Think of the bedroom as a "sacred space," Anand wrote. Vacuum the bedroom and take out the newspapers and coffee cups. Bring in plants, flowers and candles. Drape a scarf over the bedside lamp to create soft lighting. Walk three times around the room with your partner, misting the air with a plant sprayer of scented water while saying "As I purify this space, I purify my heart." This, Anand implied, was as much a part of sex as kissing.
The suggestions might seem impossibly precious. But ceremonially cleaning the bedroom and bringing in flowers and soft lights contained a metamessage: You do not have to go somewhere else or become a sliver of yourself to have sex. You don't have to "do the nasty" while hiding in the dark from your disapproving parents. When you bring flowers into the bedroom, you bring in more of yourself as well, and that can make you realize how much you had previously left outside the bedroom door. And if the bedroom is already inhabited by ghosts, why not bring in flowers as well?
In the place of pornographic slang and Latin words, Anand suggested Taoist phrases that were free of negative Western sexual connotations. Try saying "jade stalk"or "wand of light" for penis, she suggested; for vagina, substitute "cinnabar cave" or "valley of bliss." Or call them "yonis" and "lingams," after the Sanskrit words used to describe the stone sculptures of sexual organs that are still bedecked with flowers and worshiped in rural temples in India. "Behold the Shiva Lingam, beautiful as molten gold, firm as the Himalaya Mountain," she quoted the "Linga Purana," a Hindu ode to the penis of the god Shiva, Lord of the Dance. "Tender as a folded leaf, life-giving like the solar orb; behold the charm of his sparkling jewels!" It was heady stuff for a culture where "testosterone poisoning" is a running joke and the only goddess worshiped is a virgin mother. And it cleared the decks for something new.
Anand and other teachers of modern Tantra suggested that sex could involve all of us, including the warring inner parts we think we've transcended but have merely avoided: the lustful and soulful; the wounded and voracious; the slutpuppy in her Victoria's Secret lingerie and the good girl in her flannel nightie; the sensitive postfeminist man and the crude teenage boy.
Last October, at a five-day, $795-a-person workshop for couples at the Esalen Institute, yoga and Tantra teacher Charles Muir wove these warring inner and outer sexual worlds together. On the first night, he spoke about his own sexual upbringing to 23 couples sitting before him in a circle. His listeners ranged in age from 22 to 73. Among them were two Latin American academics, four lawyers, a black woman doctor, two construction managers, two women who worked in television, several massage therapists from the Esalen staff and an Irish farmer. Some sat as entwined with their partners as trailing vines, while others betrayed, in their gestures and body language, uneasiness with each other and an inequality of love or desire.
Muir, who is now separated from his wife and coteacher, Caroline (she wanted sexual fidelity; he didn't), runs the Source School of Tantra in Maui, Hawaii, and leads frequent workshops around the country. He was wearing a silk shirt and an amethyst pendant. He was slim, in his early fifties, with brown hair, protuberant eyes and spatulate fingers that gave him the look of an elongated frog. His language was closer to New York street than Hindu temple.
He had come of age in the Bronx, he said, during "The Great Fuck Drought of the Fifties." Everything he knew about sex, he said, he had learned from Johnny Patanella, the leader of his childhood street gang: Get it up, get it in, and get it off. Fuck 'em hard and fuck 'em deep. Muir said that before he discovered Tantra, he was a yogi on the mat and a "sleazebucket" in bed. He said that men give nicknames to their penises because they want to be on a first-name basis with the one who makes all their important decisions.
There were shocked laughs, a snigger. The men thought they were long past this. The women didn't want to think their men had ever thought this way.
But there was a method to his crudeness. Once Muir bonded with the part of the men that had eternally remained the teenage boy, he gently, without emasculating them, brought them into the sexual realm of context, emotion, feeling and intimacy traditionally defined as female. "In lovemaking, women lead with their hearts," he went on more softly. "Men lead with their second chakra [their groins]. We hurt each other."
Tantra, Muir said, could help them make love stay. "The average couple makes love 2.3 times a week for the first two years," he said. "After two years, the average couple makes love once a week--and making love can be a well of energy and healing.
"Chemistry is temporary. You're going to learn to base love not on chemistry--which lasts six months or two years, if you're lucky--but on alchemy. When the chemistry is no longer there, alchemy says you take what is there and you change it. Become a master alchemist."
Easier said than done, given some of the histories that the couples revealed in private conversations. One couple came to Esalen to put the "pizzazz" back in their marriage; later they acknowledged they'd hardly made love in the nine years since the birth of their son.
Paula, a Mexican American academic in her fifties who was there with Carlos, the professor with whom she lived, had not had an orgasm in the year since her hysterectomy. She had been raised a Catholic and was date raped in college. She still couldn't shake off a notion her mother had given her--that only bad girls are good at giving men sexual pleasure; at night, she still put on her pajamas behind the bathroom door. Carlos was in his forties; he had been divorced twice and had been raped and tortured a decade earlier in a South American prison.
Russ Solomon, a retired San Diego real estate developer, had raised four children with his wife, Liz, during 40 years of marriage. They looked as comfortable together as old shoes and clearly liked and respected each other. But sex, they said, had been disappointing on their wedding night when they'd both been virgins and disappointing ever since. "All I knew," Russ told me one day, "was that I was to get my penis in her vagina, and that was it." He had lain back, expecting Liz to arouse and satisfy him.
She said nothing that night, and nothing for many nights to come. She had no language then, no woman had language then for what she felt or wanted. "When you were born in 1937," she says, "it wasn't your place to show him."
Since then, they had rarely taken more than 15 minutes to make love. She spoke frequently, in front of Russ, of "40 years of shit and disappointment in the bedroom." Russ didn't treat her like a woman, didn't measure up. "I would love a flower on the pillow or a note," she said one day. "But Russ cuts articles out of the newspaper that he thinks I would be interested in. And I am. But it's not the intimacy I long for."
Couples like these could have taken their "sexual dysfunctions" and marital issues into the private confines of a sex therapist's office. But they were seeking something that Western sex therapy, for all its strengths, does not provide. Sex therapy's pioneers, Masters and Johnson, had brought thermometers, charts and transparent vaginal probes mounted with tiny video cameras to the study of sex. Sexual problems, they argued, weren't usually rooted in intractable intrapsychic or interpersonal conflict; they could often be solved by learning new behaviors. They, and those who followed them, taught women to masturbate to orgasm and men to squeeze their penises just below the coronal ridge, before they reached the "point of no return," to resolve premature ejaculation. Their techniques often worked with amazing ease, and they drained sex of some of its shaming power by making things seem as brisk, practical and scientific as a good recipe for apple pie.
But they also drained sex of magic. If their governing metaphor was the bedroom-as-medical-lab and sexual practice as an antiseptic medical-behavioral prescription, Muir's guiding metaphor at Esalen was the bedroom as temple and sexual practice as worship. And if sex therapy was predicated on healing people so that they could have sex with each other, Muir suggested that sexual pleasure itself could be healing.
In the course of the week, Muir gasped, held his breath, bugged out his eyes to demonstrate how men could use yogic breathing, pauses in lovemaking and finger pressure on their perineums to delay or forgo ejaculation. He and his coteacher, yoga practitioner Diane Greenberg, showed women how to take a man's "soft-on" and "use it like a paintbrush" to stimulate their clitorises and outer lips, or stuff it softly into the vagina. And he extolled the sensual pleasures of the half-erect penis. Referring to the Kama Sutra , he talked of varying strokes, pressure and speed. "If we go straight down the fairway--deep deep deep--we'll only be stimulating one area, guys," he said one afternoon, stroking a Plexiglas wand inside an anatomically correct, purple-velvet and pink-silk "yoni puppet" from San Francisco's House of Chicks. "Try shallow, shallow, shallow, deep! The more variety, the more information floods the brain, and the more you wake up."
A sex therapist, or in a more enlightened society, a sex educator, could have said the identical words, but the context--playful, normalized and semi-public--would not have been the same. A miniature culture, as transient and self-contained as a dewdrop, was being formed. For a handful of days, as the couples strolled the Esalen grounds above the Pacific, moving from cabin to hot tub to class, nobody was too busy or too tired to have sex. Nobody read anything about Kenneth Starr, or looked at the Sports Illustrated swimsuit issue or downloaded pornography from the Internet. Every night, in their TV-free, phone-free cabins, they looked at and touched each other's flesh-and-blood bodies rather than electronic images and paper dreams.
In class, Muir held out to them the possibility that sex could be more than a source of pleasure: it could be a source of intimate bonding as well. He taught them how to lie together spoon-fashion and breathe in unison. Sex, he said, could be more even than emotional intimacy: it could be an interplay of invisible energies that coursed through each lover's body and radiated beyond it. Every day, he led participants in yogic breathing and stretching, and then asked them whether they could feel an "energy hand" the size of an oven mitt growing beyond their flesh-and-blood hands. He had them fluff and clean their "auras" by sweeping their hands in circles a few inches from the body.
He acted not only as sex educator and yoga teacher, but priest. He taught them to chant one-syllable Sanskrit mantras designed to activate each of the body's seven chakras or energy centers that are believed to ascend the body's core. And he formed them into slow Tantric circle dances in which the men and women stared into the eyes of partner after partner while visualizing sending love and healing to virtual strangers.
If the West has defined male sexuality as the norm and female sexuality as the problem, Tantra glorifies the female: a woman's orgasms are said to increase her capacity to act as a channel for the flow of shakti, the universal female energy that powers the universe. And by deemphasizing the moment of ejaculation and emphasizing energy and context, the workshop provided the women with more of what they often complain is missing from standard-issue sex--love, sensuous touching and intimacy.
Under Muir's tutelage, lovemaking was not, as some feminists put it, a recapitulation of the power inequalities of rape, but a worship of the female and a reenactment of the drama of Shiva and Shakti, the Hindu god and goddess whose lovemaking created the universe. Partners were to see in themselves the flow of divine fundamental energies; the act of love as reproducing the first stages of the creation of the world.
Women, Muir declared, could and should have multiple orgasms, while men were depleted by ejaculation and should sometimes try the "valley orgasm"--orgasm without ejaculation. And he transcended the no-win squabble Freud started over the virtues of clitoral versus vaginal orgasms by teaching effective techniques for vaginal stimulation of the G-spot; he declared that women, too, could ejaculate when sufficiently stimulated.
This is a tall order for a culture in which 24 percent of women surveyed say that they, like Paula, have not had an orgasm during the previous year. A complex history lies behind this statistic. If the sexual lives of many men begin with repeated sexual rejection and shame, the sexual lives of many women begin in choicelessness: breasts stroked in a laundry room by a best friend's father; the struggle lost in a back seat; the unwanted kiss from uncle, teacher, boss or neighbor. When women sleep with men they sleep as well with their fear or memory of the peeper, the flasher, the child molester, the rapist, the Don Juan, the womanizer, the sexual predator, the horrible first husband and the just plain jerk. Women, too, have a double standard: we divide men not into virgins and whores, but into predators and marriage material. In a reverse of the fairy tale, we fear that while we lie in bed, our lovers will metamorphose from Beauty to the Beast.
Such memories and fears, Muir suggested, are embedded not only in the brain, but in the cells of the body. His cure was a sexual ceremony to be held in the privacy of each couple's bedroom on the third night of the workshop. In a men-only meeting beforehand, he showed videotapes and coached each man on how to do for his lover what no therapist or body worker could do--massage her "Sacred Spot," the G-spot inside her vagina.
The G-spot, Muir said, is a little known and widely misunderstood area of sexual sensitivity--a raised, furrowed area of tissue about the size of a quarter, an inch and a half inside the front wall of the vagina, against the pubic bone. When stroked, it can become erect, firm and responsive and can trigger vaginal orgasms and ejaculation of a clear liquid. But it is also the dark closet in which old sexual pain is stored. "Sacred Spot" massage, he said, might release ecstatic sexual pleasure. It might also release old memories: the women might complain of numbness or bruising, or explode in fear, sobbing or rage. "This is Tantra kindergarten," he said, coaching the men to simply be loving and to be there, no matter what. "You get an A just for showing up."
After supper, before the ceremony began, the men fanned out to their cabins all over Esalen to take on the traditionally female task of "preparing the space" for the ceremony. While Liz and the other women relaxed and giggled in the Esalen hot tubs, Russ cleaned their cabin, combed his white hair and took a shower. In another cabin, one of the construction managers lit incense and paced his room. On the other side of the garden, one of the lawyers scattered rose petals on the sheets. Carlos, the Latin American academic, arranged a vase full of flowers he had cut from the Esalen garden, cued up a CD on his laptop, lit candles, put on a formal Mexican shirt called a guayabera , turned back the sheets and waited for Paula.
When the couples shared their experiences in the group the next day, it was almost as though the sexes had exchanged roles. "Carlos massaged me so gently so tenderly," Paula said. "The other times he had massaged me it was like, let's hurry up and get this over with." After an hour or so, she said, Carlos had turned her over and asked permission to stroke her "sacred spot" with his finger. Not long afterward, she had her first orgasm in a year. "I just had a whole strand of pearls full of climaxes," she said. "It kept going on and on, the pleasure."
One woman--whose husband had left her for another woman 14 months earlier--was floored by the tide of anger and fear the exercise released. It was, she said, "like a bad acid trip." Other women came close to bragging about having multiple orgasms and ejaculations (one woman had 22 over an hour and a half), while their men were quiet, tearful and open. The men had taken on the traditionally feminine role of focusing wholeheartedly on the pleasure of another, and it had changed them. The construction manager cried, describing how he'd waited nervously for his girlfriend, terrified that he wouldn't measure up. Another man told the group that whenever he'd made love before, his consciousness had zigzagged back and forth, first checking in on his own erection and then checking in on his partner. "Last night, my presence was so totally focused on Andrea that I didn't have to worry about myself at all," he said. "When she came, I was wailing with her like I was having the biggest orgasm of my life, and I was totally limp."
Here, in a context where differences between men and women were not only acknowledged but glorified and mythologized, and where men's performance fears were out in the open, women were getting what they wanted.
The next evening came the turnabout. After supper, Muir took off his amethyst crystal pendant, blue silk shirt and oatmeal jeans. He lay on pillows on the floor in his boxer shorts, holding a clear black plastic wand from a magic store at his groin like a surrogate penis. One man pushed his girlfriend to the front of the crowd. "I don't want you to miss any of this," he said.
Diane Greenberg knelt between Muir's legs and showed the women an unbelievable range of ways to pleasure a man's penis. She was competent and sure. She twirled her fingers around the wand like a feathery screw. She squeezed it at both at the top and the bottom, explaining that this way the blood wouldn't be forced out. She slapped it and tapped it and pretended to use it like a microphone. She clasped her fingers and encircled the wand, running her thumbs in circles up and down the frenulum as though winding a bobbin.
She was leading the women into the dangerous territory of the slut goddess. If some women's sexual lives begin in choicelessness, others begin with an inner war: lying on a blanket on a hill on a warm night, grabbing at the hands that give such pleasure and pulling them away, worrying what the owner of these hands will call her to his friends the next day-- slut, pig, whore. There are years of this, and then the rings are exchanged, the rice is thrown, the church doors open and the woman is expected to become as sexy and free as the bad girl she struggled for years not to be. Fear of taking on the slut archetype can persist through years of financial independence and supposed liberation, narrowing the range of pleasure a woman dares to give a man in the bedroom. By way of antidote, Muir and Greenberg spoke of Uma, a Hindu female divinity who "wears her sexuality on the outside." They lauded Hindu temple dancers and sacred prostitutes, and urged the women to try on this aspect of the powerful divine feminine. They encouraged the couples to let loose with noise--Esalen had heard lots of it, they said, and if couples got too self-conscious, they could shout or wail into a pillow.
Then Greenberg coached the women on the coming evening's ceremony. This time, the women would "honor" the men, first massaging their bodies and their penises. ("First get him hard, ladies," Muir interjected. "Then he'll agree to anything.") Next, Greenberg said, the women were to insert one finger into their man's anus and stroke and stimulate the exquisitely sensitive "sweet little hollow" at the base of the prostate. This, she cautioned, was a delicate business. "Rather than me entering him, I'll have him sit on my finger," she explained.
Then Greenberg turned to the men. "You're going to be penetrated, guys" she said, "as we are penetrated."
As Greenberg pulled the women into new territory, Muir took the men into the unknown as well. "Every man has gone through a war of his own that has robbed him of his yin [female aspect]," he said. "Each young boy is taught that men don't cry, don't feel. The job of reclaiming your yin is sweet. You won't wake up the same guy in the morning. Tonight, you get to be the illogical one. You get to have feelings tonight. Ladies, I want you to show up big. He may test you, he may be irrational. He may become terrified.
"You give and you're strong and you fix things." he said, turning to the men. "You're gigantic. How much can you let yourself be small and feel? Allow yourself to be penetrable and vulnerable? Five million homosexuals can't be wrong. There must be something up there that's good."
When Carlos and Paula described their night's experience in the group the next morning, Carlos was in tears--deep, strong tears. During the ceremony, he had reexperienced being raped and tortured in a South American prison and had not "left his body," as he had when having flashbacks before. He had also experienced something beyond the personal as though a great wind were blowing through him and breathing his body for him. And Paula had faced something she'd once held at arms' length. "Being raised Mexican Catholic, women who do that are sluts," she said, referring to the way she'd stroked Carlos' penis and penetrated his anus. "I gave myself permission not just to touch it with my eyes closed, but to look at it and be there in all my glory, and I felt pure."
On the last day of the workshop, Muir urged the couples to try a "10-day test drive"--to connect somehow sexually, physically and emotionally for at least 10 minutes every day. By the time the couples were packing their bags, few of the men displayed the sexual bravado they'd come in with--the bravado this culture trains them for. One man, a lawyer, had told the group the first night that he'd come to the workshop because he wanted to experience a 30-minute orgasm. He left muttering about "Tantra kindergarten."
His desires had become simpler and more ambitious: to only connect with his wife of 22 years. One busy day he left work, met his wife at their son's soccer game and drove with her to the far end of the field, where they kissed and held each other for 10 minutes in the car.
Some couples--like the pair who told me brightly that they wanted to put the "pizzazz" back in their marriage--left with little. Others took away all the bells and whistles you'd expect from a sex workshop: sobbing, wailing, energy releases, multiple orgasms, female ejaculations. Others left with something perhaps more precious: the understanding that good sex--wholesome, healing and holy--is an accumulation of small mercies, beginning with whatever mercy you need right now. Like being able to take off all your clothes in front of your lover, and touch his penis in all your glory and feel pure.
They went home--to San Diego and Cleveland and Denver, to the impeachment hearings and football games and a larger culture reverberating, more publicly than usual, between sexual obsession and sexual shame. Ghosts inevitably reentered their bedrooms. Old marital squabbles reared their ugly heads again. But sometimes old disappointments were held in a new way.
If anyone had come to understand the meaning of small mercies, it was Liz and Russ. On the night that Russ had pleasured her, Liz had come to their cabin door and found him still in the shower. Something about that melted her heart. "I brought to last night 40 years of lack of trust and feeling I'm not seen as a woman," she had said in the group next day. "I've stayed in the relationship oftentimes with doubt."
"I was so touched Russ was washing his body for me, that he would even be late to do this," she said. "All the resentment and fear was gone. I felt like a woman. It was enough."
"He put on a Japanese robe," she told the group, turning to her husband. "You looked very manly in it. I wore a white silk Dior nightgown and felt like a bride. When we slipped it off, I loved the look of my body. If we had only done this on our honeymoon, what a difference it would have made."
"She could have said, 'This is your obligation,'" said Russ. "But she dismissed all that. We didn't shout and cover our faces with pillows, but it's nice to know that it's possible. We take away the hopes and stories we've been told. I pray that we will remember."
"It was enough." said Liz. "Russ was willing, after 40 years of marriage, to try something. That was enough."
When they returned home, they followed Muir's suggestions for the "10-day test drive." Every day, she and Russ lay down with each other in the morning and the evening, and snuggled and held each other. "It's been wonderful," Liz told me. "There's been no anxiety, no repulsion. It's not about making love. It's about breathing together, holding hands, the eye contact, touching the heart, the forehead. We are doing our homework. But I'm not sure we're doing it right."
In her last sentence, I heard the reverberations of our culture's sexual perfectionism. She and Russ had returned to a society with bigger work to do than any person or couple can do alone. Yet they had grasped the essence of classical Tantra as practiced in India nearly two thousand years ago, and that essence is not purely sexual. At its base, it involves welcoming and transforming all energetic and powerful states, even negative and difficult ones, by holding them in a different context.
That context involves knowing that Saint Augustine and all his intellectual and spiritual heirs, including our parents and Larry Flynt and Kenneth Starr, were wrong: Sex is neither a nasty secret pleasure nor a sin, but a part of the pattern of the universe. To put it one way, the desire to make love, connect, procreate and survive has been programmed, along with pleasure, into our genes and dreams. To put it another: Sex is sacred--intricate and dangerous and pleasurable and utterly ungraspable.
Networker associate editor Katy Butler, a former reporter for The San Francisco Chronicle, has contributed to The Los Angeles Times, The New Yorker, The New York Times Book Review and The Washington Post. For more information on Charles Muir, write to P.O. Box 69, Paia, HI 96779. Correspondence to Katy Butler may be sent to the Networker .