Difficulty experiencing pleasure isn’t just a personal problem: It’s a driving force behind soaring rates of anxiety and depression, and behind what researchers are calling the sexual recession—the well-documented trend of people having significantly less sex than previous generations.

Good news about a revolutionary new treatment for reclaiming our capacity for pleasure

I have recently learned about a newly developed therapy for anxiety, depression, and trauma, which specifically addresses how to reboot our pleasure systems, positive affect treatment. In this post, I will introduce this evidence-based approach, shown to be more effective than traditional therapies, and share how you can begin using its core practices. Note: This is not a replacement for professional help, but a validated toolkit for rebuilding your capacity for joy.

The problem isn’t just stress—it’s a pleasure shutdown

My book, Why Good Sex Matters, grew out of years of witnessing scores of clients lose the capacity for satisfying pleasures—in and out of the bedroom. This “pleasure crisis” is driven by the relentless demands of the attention economy—the pings, the scroll, the low-grade overstimulation that never really stops—and is quietly eroding our capacity for embodied, felt pleasure.

Layered on top of this is the traumademic: the collision of our personal trauma histories with the collective stress, loss, and uncertainty of living in an era of relentless upheaval. When individual nervous systems—already impacted by early wounds—encounter chronic activation in a world that feels genuinely threatening, the result is compounded dysregulation. Nervous systems locked in fight, flight, or freeze lead to brains with diminished pleasure capacity.

And this is exactly what positive affect treatment (PAT) was designed to address.

PAT, developed by Michelle Craske and colleagues at UCLA, is built on a key insight: low positive affect (emotion)—the absence of joy, enthusiasm, and engagement—is a distinct clinical problem, not just a symptom that disappears when anxiety or depression lifts. You must actively rebuild it. The good news? You can.

Meet your SEEKING system

To understand why PAT works, you need to meet one of your brain’s most important core emotional systems: SEEKING. Identified by affective neuroscientist Jaak Panksepp, the SEEKING system is your brain’s primary engine for motivation, curiosity, and anticipatory pleasure. It’s what makes you lean forward into life.

When we’re stuck in survival mode—when the three-story brain-mind is locked in the basement, flooded with stress hormones—SEEKING goes quiet. We stop wanting. We stop anticipating. We lose our motivation to explore. We lose our lust for life. This is the neurological core of anhedonia, and its epidemic right now.

PAT works directly on this system. Its practices are, in essence, a set of evidence-based tools for waking SEEKING back up.

The practices—and how to actually do them

Here’s what PAT looks like in daily life. These aren’t abstract concepts. They’re concrete moves you can make, starting today.

Savor something—on purpose. Savoring is the practice of deliberately slowing down to fully absorb a positive experience. Not just noticing it but lingering. The warmth of your coffee cup. The specific quality of morning light. A moment of genuine connection. Research shows that savoring amplifies positive emotion and consolidates access to these brain states. Try this: Once a day, identify one moment worth savoring and give it at least 30 seconds of your full, embodied attention.

Activate toward pleasure, not just productivity. Schedule activities specifically chosen because they generate enjoyment and meaning for you. Not what you think you should enjoy. What actually lights you up, even a little. This is healthy hedonism in practice: treating your own pleasure as data, as legitimate, as worth protecting.

Use positive imagery to prime SEEKING. Your brain’s anticipatory circuitry doesn’t distinguish well between vividly imagined futures and real ones. When you spend a few minutes imagining something you’re looking forward to—in sensory detail—you activate SEEKING. You feel the motivational pull. Try a brief daily practice: close your eyes, breathe, and imagine one positive experience coming up in your life. Let yourself feel the anticipation.

Practice gratitude as a directed attention skill. The evidence supporting gratitude’s healing powers is solid. The PAT version of paying attention to gratitude isn’t just making a list of blessings—it’s a practice of genuinely noticing what is working, what you appreciate, and what you can view as positive in your day. It’s training your attention to scan for good, which your stress-wired brain has likely stopped doing automatically.

Bring self-compassion into the mix. This might seem surprising, but low positive affect is often actively maintained by harsh self-criticism. When we beat ourselves up, we are diminished—emotionally, physically, and relationally. Self-compassion practices—treating yourself with the warmth you’d offer a struggling friend—directly creates space for positive emotion. PAT treats self-compassion as a core skill for rebuilding positive affect.

Connect—and really feel it. Social warmth is one of the most powerful activators of positive affect. PAT includes deliberate practices around connection: reaching out, expressing appreciation, and allowing yourself to receive care. Oxytocin, the social bonding neurochemical, directly modulates your brain’s reward circuitry. This is critical to our well-being.

A note on starting small

Here’s something I tell my clients and remind myself: you don’t need to feel motivated to begin. In fact, waiting to feel motivated is a trap—motivation follows action, not the other way around. The SEEKING system wakes up when you give it something to seek.

Pick one practice from this list. Just one. Do it today, imperfectly, for five minutes. Notice whatever you notice. That noticing—that tiny flicker of attention toward positive experience—is the beginning of rewiring.

A special offer for this interested in more pleasure and joy in life

For a limited time, when you purchase Why Good Sex Matters, I’m including two complimentary gifts:

✦ A free one-on-one coaching session with me

✦ A personalized Core Emotion Analysis based on your unique emotional profile

Together, these give you a real roadmap — not just the science in the book, but a direct look at what’s happening in your own nervous system and emotional landscape, and where your greatest opportunities for healing and pleasure actually live.

Here’s how to claim your gifts:

1. Purchase Why Good Sex Matters
2. Forward your receipt to me at nan@askdoctornan.com
3. I’ll be in touch within 48 hours to schedule your session and send your analysis

This offer is available for a limited time, and I’m keeping the number of sessions small so I can give each person real attention.

The post Reclaiming Joy With Positive Affect Treatment A highly effective new therapy to reclaim joy and reduce anxiety and depression. appeared first on Nan Wise.

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One of the biggest debates in the field of human sexuality is whether sex addiction is a real thing. Some colleagues adamantly deny that the label “addiction’ is ever appropriately applied to sexual behavior. In contrast, others have overzealously applied this diagnosis when not warranted. Understandably, my colleagues are reticent about validating a diagnosis that has been erroneously aimed at people whose sexual behaviors don’t match what the larger society considers “conventional”.

In other words, anybody who did anything a little bit kinky or had a bit higher libido than deemed “normal” was labeled as being disordered. Remember, up until 1974 homosexuality was diagnosable as a mental disorder.

Recently I was called to weigh in on the topic because of my unique qualifications as a sex therapist/neuroscientist after another sex therapist dismissed the validity of the diagnosis during an appearance on the popular podcast Shameless Sex. This resulted in a backlash from some listeners who felt that their experiences with problematic sexual behaviors were being invalidated. I discussed both the dangers of over-diagnosing sexual behaviors as problematic, as was as the hazards of dismissing concerns. To listen to the full interview, click here. Here are the highlights.

Is Sex Addiction a Real Diagnosis?

Short answer: No. But Compulsive Sexual Behavior Disorder is.

There are two main guides for diagnosing diseases and disorders: the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Statistical Classification of Diseases). The main guide for mental health professionals in the US is the DSM and it does not include a diagnosis of Sexual Addiction in its most current version (DSM 5 R). The diagnosis of Compulsive Sexual Behavior Disorder is included in the current version of the ICD ( ICD 11 ).

What is CSBD?

Short answer: a pattern of engaging in repetitive sexual behaviors despite experiencing adverse consequences.

Long answer: To qualify for the diagnosis, several criteria must be met, and the symptoms must persist for six months: The sexual behavior needs to become the central focus of life, to the point of neglecting health, other interests, and responsibilities. The person has been unable to control the sexual behaviors despite making attempts to do so. The sexual behaviors result in adverse consequences such as disruption of relationships and cause marked distress or significant impairment in personal, family, social, educational/occupational, or other important areas of functioning. Additionally, sexual behaviors are often associated with a lack of enjoyment or satisfaction.

How to better understand problematic sexual behavior?

In my opinion, what makes this topic so controversial in mental health circles is a misunderstanding of what “addiction” is. Rather than the old view of addiction as a disease, a newer model informed by neuroscience looks at this kind of behavior as “learning gone bad”. We can learn habits to self-soothe or regulate painful feelings by using behavior or substances. I address this kind of emotional learning in my book as a hijacking of the SEEKING system, a core emotional system that drives our attention, motivation, and learning. And yes, some people might be predisposed to learn to regulate painful feelings with sexual habits because of issues with how the reward circuitry of their brains work but to think of these habits as an addiction is both misleading and inaccurate. The term addiction when applied to sexual behavior lacks scientific validity and hijacks the conversation by attaching a label that stigmatizes rather than explains. It is my experience as a sex therapist that this label is used far too often as a matter of opinion rather than based on evidence. For example, how do we decide when a person has a problem with porn? How much porn is okay? Who decides? The client? The partner? The professional?

We need to keep in mind that the determination of the diagnosis of CBSD cannot be made based on moral disapproval or opinion which is far too often the case.

What about CBSD and porn use?

Most people who use pornography don’t have problems regulating their behaviors. A recent study that examined pornography use across 42 countries and over 82,000 participants found that a total of 3.2% of participants were estimated to have problematic pornographic usage. That’s a lot of people but considering the frequency that the “porn addiction” label is bandied about, one would expect a far larger percentage of people studied to be at risk. There are indeed individuals for whom pornography usage is problematic, but is it the epidemic that some would have us believe?

Listening rather than labeling.

It is my opinion as a clinician and human being that many of us are suffering from a rush to judge. Whether it is about sex or politics, we appear to have knee-jerk reactions that shut down our ability to hold the space to listen deeply and climb into each other’s experiences in ways that foster connection and compassionate inquiry. Whether we rush to judge a person’s sexual behaviors as problematic or at the other extreme, be too ready to dismiss concerns, we are not doing what needs to be done: a deeper dive into understanding another person’s experience. Slowing down sufficiently to listen over time to the many levels of an issue is a necessary skill. For example, I saw a couple in my practice who on the surface appeared to be dealing with a discrepancy in sexual desire, as is often the case with the male partner wanting more sex than his wife. Upon deeper listening, it became evident that the male partner was experiencing signs of problematic sexual behavior which warranted attention. The ability to listen deeply and tolerate our feelings in holding space is a skill that we could all benefit from honing.

Building a Sex-Positive Future

My work as a sex therapist extends beyond addressing the challenges associated with CSBD. It involves fostering a sex-positive mindset – one that embraces healthy and consensual sexual expression. By destigmatizing discussions around sexuality, we create a space for individuals to explore and understand their desires without judgment.

The post Unraveling the Controversy: Is Sex Addiction a Legitimate Diagnosis or a Misunderstood Phenomenon? appeared first on Nan Wise.

In my last post, inspired by the Netflix documentary about Phil Stutz, author of The Tools, I wrote about how harnessing attention on new ways of “being,” (being your most social self), rather than “doing” (certain things to get desired results), in conjunction with practicing radical acceptance, can greatly enhance our capacity for happiness.

The challenge for most is how to practice radical acceptance of what is, when what is, is painful

Tolerating feelings (especially the hard ones) can be a pathway to pleasure

Understanding the symbiotic relationship between pain and pleasure can help us tolerate and embrace all of our emotions. This is key to enhancing our capacity to experience pleasures in the moment and happiness over the long haul.

The relationship between pain and pleasure

Much of our understanding of what enables us to experience pleasure counterintuitively comes from the more abundant research into pain. When we investigate the brain correlates of pleasure more closely, we discover that the pathways for pleasure and pain are closely intertwined.

This interdependent relationship between pleasure and pain is part of our survival network. We are designed to feel them both viscerally. Pleasure and pain, interconnected in the brain, function as signals that get our attention, prompting us to approach things to fulfill our needs as well as to avoid potential harm. When these signals get disrupted, we feel depressed, vulnerable, anxious, and out of sorts—all symptoms of anhedonia, which is the inability to feel satisfying pleasure. When we avoid our painful feelings, we can end up becoming emotionally blunted, with little capacity for joy.

All mammals have built-in pain pathways designed to pick up on painful stimuli and respond by releasing pain-relieving chemicals. These built-in pain inhibitory mechanisms stimulate brain regions that release key internal opioids (endorphins and enkephalins) that make us feel good. Pain functions as survival information, with its own direct line to the brain signaling us to fight, flee or freeze. These wired-in pain-relief mechanisms are the source of our internally produced pleasure chemicals.

In my research on genital stimulation and orgasm, both activated the “pain circuits.” This observed activation of the pain-pleasure pathway provides clear evidence of the biological roots of the pain-relieving effects of genital stimulation. Indeed, this is one way our internal opioids help regulate pain in childbirth when certain neurochemicals are released to buffer what might otherwise be even more painful.

Our culture shapes us to avoid pain at all costs

Further exacerbating this connection between pain and pleasure is our difficulty with tolerating any measure of negative feelings. At the first sign of pain, we take an aspirin. At the first sign of emotional discomfort, we may be encouraged to take an antidepressant. In fact, as a culture, we are told not to feel too much of anything! Ironically, this attitude about pain and discomfort points to a profound misconception about how we experience pleasure.

In the popular book, Big Feelings, author Liz Foddlein proposes that we embrace the pain of anxiety associated with uncertainty, and, in so doing, transform it into an energizing part of the adventure of life.

When we avoid pain, we are also learning to avoid pleasure. We shut down emotionally as well as physically. For example, though we may lose a pet and mourn the loss, most people eventually want the pleasure of another pet. Those people whose intolerance for pain is too much will avoid these feelings entirely by refusing to get another pet.

Paying attention to sensations in our body is a route to reversing anhedonia

If you are trapped in pleasure-seeking mode all the time and trying to avoid discomfort or emotional pain, the result will be that your experience of pleasure will also be diluted and numbed. In other words, we need to feel both pain and pleasure to keep our brain and body in balance. The avoidance of feeling pain or pleasure is strikingly obvious when clients first show up for therapy and seem disconnected from the awareness of the sensations in their bodies. It is hard to get them to even respond to the simple question, “What are you noticing in your body as we discuss this issue?” Their blank stares in reaction to my query speak volumes.

My life’s work has taught me that the ability to notice, experience, and tolerate the sensations in the body that accompany the thoughts in the mind is critical to empowering wholeness and well-being. We dwell so much in our (often negative) thoughts and interpretations, strivings, and expectations that we register very little of what is actually happening in the body. When we do attend to our body, we often get caught up in wanting it to be different instead of appreciating what is. When signals from the body are interrupted, the result is that there is no result. No response, no stirring of the imagination. No tingling, no desire. This is the state many of my clients find themselves in, having lost their capacity for pleasure.

How do we get back on the path to pleasure? We need a road map.

In her bestselling book Dopamine Nation, Anna Lembke offers one. “Immerse yourself in the life you’ve been given, stop running away from whatever it is you’re avoiding, turn and face it. Now walk toward it.”

And we need tools, too. In my book, Why Good Sex Matters, I explain how learning about our core emotions, identifying sensations in the body, and consciously experiencing them more fully in the moment with curiosity, tolerance, and self-love can increase the frequency of pleasurable feelings that are good for us and make our lives happier, more balanced, and more enjoyable.

It is a helpful cure for anhedonia, and what a great map for moving beyond the victimhood of the past and into an empowered and exciting present time wherein healthy pleasure is a possibility.

References

Wise, N. J., Frangos, E., & Komisaruk, B. R. (2017). Brain activity unique to orgasm in women: An fMRI analysis. The journal of sexual medicine, 14(11), 1380-1391.

Wise, N. (2020). Why Good Sex Matters: Understanding the Neuroscience of Pleasure for a Smarter, Happier, and More Purpose-filled Life. Houghton Mifflin.

Lembke, A. (2021). Dopamine nation: Finding balance in the age of indulgence. Penguin.

The post Neuroscience Hacks: The Healing Power of Pleasure appeared first on Nan Wise.

As a sex therapist and researcher, I can easily say that the number one reason people end up seeking sex therapy is not the loss of desire, differences in sexual styles, problems experiencing orgasms, or erectile dysfunction (all of which are common complaints) but rather the shame and fear that prevent them from openly and honestly addressing their sexual concerns, needs, or wants with their partner.

And given recent findings from research indicating that people across many countries are having less sex than ever, coupled with evidence that we are suffering from more mental health challenges than previously, we might consider that the health-promoting and relationship-lubricating benefits of sex might just be more important now than ever.

And here’s a true confession from a sex therapist-neuroscientist

Due to my work, I spend so much time talking about sex, thinking about sex, and researching sex that I sometimes get tired of the subject.

There was even a time when conducting sex research put a damper on my own sex life. While doing my own fMRI study on what happens in the brain during sexual stimulation and orgasm, I couldn’t stop thinking about what was happening in my own brain, which seriously hijacked my ability to relax during the experience. Fortunately, that was just a temporary side effect of being immersed in the daunting process of doing Ph.D. research. But suffice it to say, one of the biggest ways to shut down a good sexual experience is to be thinking distracting thoughts, such as what’s happening (or not) in your brain or body, when you are attempting to enjoy the sensations.

Good sex is rooted in simply being in the sensations rather than being in your head about what’s happening!

Most of the time, I feel like I have the best job in the world, helping my clients enhance their capacity for more pleasure and joy, both in and out of the bedroom.

And as I never get tired of saying, pleasure is not a luxury but a necessity for a well-functioning emotional brain, physical well-being, happy relationships, and a life worth living. This is so critical I wrote a book about it.

And I truly believe that learning how to talk to our partners about sex and pleasure will help some people avoid a visit down the road to a sex therapist or even a divorce lawyer.

Good sex doesn’t always just happen; it often requires ongoing communication.

One of the most pernicious myths about sexuality stems from the mistaken belief that good sex “just” happens. That a good sex life should organically and spontaneously bloom in a relationship, and if it doesn’t, something is “wrong.” We each have different unique erotic fingerprint types—or sexual styles. After the honeymoon period ends, sometimes these erotic fingerprints are compatible, and sometimes not so much.

Talking about what turns us on, how we like to have sex, or even what we mean by “having sex” can help us bridge the differences between different sexual wants and needs in a relationship. And in long-term relationships, the willingness to keep updating our sex lives is key to keeping them alive and vibrant.

Key to this is appreciating that there are no rules as to how often we need to have sex with partners.  Our sex lives ebb and flows over time and space.  When we expand the notion of what having sex means to include having pleasures in our bodies together, we get more inventive, more creative, and more likely to find more intimacy and pleasure in our partnerships.

Talking about sex can be challenging; get ready to be uncomfortable and let that be okay.

Realize that talking about sex with your partner can be anxiety-provoking for both parties. What we know about partners who end up creating lifelong sexual potential is that they learn to lean into the edges of difficult conversations and confront the issues head-on. I often coach my clients if they are anxious or avoidant about raising an issue; it is best to dive right in.

Because of the blend of emotional and physical drivers of sex, any sexual experience or activity—even just talking about sex—can stir up all kinds of emotions.

One of the most important lessons for good sex (and good relationships, in general) is to learn how to tolerate our feelings, other people’s feelings, and our feelings more fully about other people’s feelings.

In many cases, if people spoke more honestly about sex with their partners, things would go better. with needs and wants for closeness and connection better met, affairs averted, and more fun had, overall.

Do not try to talk about sex spontaneously: Make a date to talk and set a positive intention.

Do not try to talk about sex without creating a safe space to do so. You are likely to have a more productive and constructive conversation if you create it with intention. How you frame the desire to discuss sex is key. When you ask to have a sex talk, partners may jump to the conclusion that something is wrong, which is the “problem frame.”

Even if there is an issue in your sex life that upsets you, think about how to enroll your partner in seeing this kind of conversation as both scintillating and empowering (making a shift to the “outcome frame”—what would you like and how can we create it together?).

 Ask for a date and time to talk. Think about waiting to have the conversation as a kind of “foreplay,” a new and sexy game that two can play.  This gives both parties a chance to think about what they have to say. And think about what you want! You can even suggest you read about ways couples can explore their sexual potential in preparation for the meeting.

Fun sex game for grown-ups, Foreplay for your sex talk

Get a copy of The Joy of Sex and look through the index.  Note which sexual activities you might like to try, which turns you off, and what turns you on. If you do this on your own, you can take risks to compare notes with your partner.

Steps for creating and nurturing a constructive sex talk

Set a date and time to talk when you’re both likely to be relaxed and receptive. Don’t attempt this after a long stressful day. And before you even begin, make sure your partner is in the right headspace for the talk. If your partner shows any sign of distress or resistance to having the conversation at that time, don’t panic or jump to negative conclusions; team up to make another date to talk.

If the partner is good to go, make sure you will have a quiet, private space with no interruptions.

Set up a safe space for “thinking out loud”

Ask your partner what they need or want to make this conversation feel like a safe space to explore. The best kind of soulful communication happens when we feel safe and free to speak our thoughts, dreams, fears, and fantasies without repercussions. Think of it as an “off the record” conversation. Establish that what goes on in the conversation “stays in Vegas.” This is what partners who create lifelong sexual potential do: they penetrate their own and each other’s minds such that they can explore and experiment together.

Start by reassuring your partner that you’re keen to create even more fun for both of you. 

Thank your partner for being willing to listen. And reassure your partner that you are excited about hearing what they have to say as well. Think about what you want to create together. Remember that taking risks to let your partner know what you want (or don’t want) is key to expanding the capacity for pleasure.

And if you don’t know exactly what you want when it comes to sex or changing things up in the bedroom, be honest and curious.

I suggest we expand what we mean by sex to be adult fun—with or without including genitals, friction, or orgasms.  Don’t even focus on sex:  think about what you can do together that feels good.  For example, in my own 4 decades plus relationship, we often talk about how to reboot our pleasure life by concentrating on getting back into our “pleasure bodies” by taking walks together or soaking in the hot tub.  We find that by engaging in pleasure practices, the drive for pleasure comes back online, and our sex life reanimates.

Think about enrolling yourself and your partner in the idea that our sex lives can be like a playground for grown-ups—with many different options to pursue partnered exploration.

Take turns speaking, and when it’s your turn to listen, try to keep an open mind, avoid judging yourself or your partner, and let feelings of shame or embarrassment be felt and shared.

Lock it down by asking, “what I hear you saying is__ (repeat your partner’s request) __is that correct?” Ask for details for extra clarity. It will make your partner feel well-heard and well-received.

Make a date for further conversations.

Once you create a safe space and quality connection, the conversation can go deeper and become a regular part of your interaction with your partner. This is key to promoting lifelong sexual potential, as explained in my book, Why Good Sex Matters,  Sex is your grown-up playground. Explore it.

–

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What Are the Core Emotions?

We humans, just like other mammals, are born with emotional operating systems or “instincts” that are hard-wired into the evolutionarily oldest parts of the brain, what I affectionately call the “brain’s basement.”

How Do We Know About These Systems?

The late neuroscientist Dr. Jaak Panksepp, through decades of meticulous experimental work, established that all mammals have seven distinct circuits buried in the deep, ancient parts of the brain—which, when experimentally stimulated, evoke specific emotions (responses that get us to move into the world) to meet our needs. These core emotional systems—SEEKING, FEAR, RAGE, PANIC/GRIEF, LUST, CARE, and PLAY—serve as the “primary colors” of our basic emotions, which, in concert with the higher brain regions, drive our emotional lives.

A Very Brief Introduction to The Core Emotions

The predominant system is called the SEEKING system (as it is designed to motivate us to find that which we need). As such, it also helps to regulate the other systems, which fall into two categories that are about ensuring our survival: the defensive emotions (FEAR, ANGER, PANIC/GRIEF) and the social emotions (LUST, CARE, and PLAY). Together these seven core emotional states are wired into our human DNA.

SEEKING = Motivation

To survive, we must automatically seek what we need. This is true of food, air, water, safety, love, companionship, and sex. Pleasure is embedded into these basic survival needs. As such, the experience of SEEKING can be highly pleasurable under the right conditions. However, when we get stuck in the SEEKING system, which is powered by dopamine, we can start looking for the right things in all the wrong places! We get hijacked. Sound familiar?

The Defensive Systems

FEAR = Scared

We are born with an innate fear response designed to protect us from danger. All vertebrates have evolutionarily encoded the ability to recognize external threats that reliably cause pain or predict danger. For humans, our FEAR system is relatively flexible. Other than being innately afraid of pain and evolutionarily based tendencies such as fear of heights, snakes, and spiders, we learn to fear other things through our experience. But what is clear is that all mammals are exquisitely wired to quickly and robustly learn to respond to a vast array of stimuli that predict dangerous stuff —stuff we indeed come to FEAR.

RAGE = Angry

A balanced RAGE system is associated with appropriately being able to de‐ fend against threats. It also allows us to take appropriate stands when angered that are constructive and facilitates the resolution of conflicts.

An overactive RAGE system can cause a hair-trigger temper and high hostility levels, compromising our ability to enjoy life. An underactive RAGE system can interfere with our ability to set boundaries and stand up for our needs.

PANIC/GRIEF = Anxious/Sad

This system contributes to protecting our “life-sustaining social bonds” and is built into our brains to protect us by keeping us close to significant relationships and resources that are critical to physical survival and emotional “thrival.” Built in to keep us connected to others—essential for a social animal—this system gets triggered when we lose a loved one. It is the source of our grief and the neural substrate of heartbreak.

The Social Emotions

CARE = Love

Powered by our own internal opioids, a balanced CARE system is associated with feelings of well-being and security in relationships. Those with balanced CARE systems will have at least one or two close, reliable sources of support and regularly engage in social activities. They can love those closest to them without needing to control them. They are also in touch with the capacity to self-love and practice self-care.

An overactive CARE system typically shows up as an inability to comfort yourself because you are overly attuned to others. When this system is underactive, it can hamper the ability to nurture or form lasting social bonds.

PLAY = Joy

PLAY is the joyful occupation of all young mammals (and some other lucky critters, too). Play is how we learn to explore and experiment with ourselves, each other, and the world and learn how to socialize. The PLAY system tends to be highly developed in the young but begins to ebb for many adults.

A balanced PLAY system is indicated by an adult who has a good sense of humor, continues to know how to relax and have fun, how to amuse oneself, has hobbies or interests, and otherwise enjoys the zany aspects of life.

When PLAY is overactive in adults, it can manifest as the refusal to engage in mature adult behaviors—the perpetual Peter Pans.

The PLAY system can only be expressed when the person feels safe, whether it be an adult or a child.

LUST = The Urge to Merge

Mother nature has enduringly wired all animals with a primary urge to merge. On one level, it appears to be about the survival of the species, but it goes deeper. Our sexuality creates connections that enhance our relationships and bond us deeply.

When the LUST system is in balance, we experience a desire for sex and satisfaction when we have it. We feel comfortable with our desire level and are open to exploring ways to experience pleasure. An overactive LUST system typically shows up as some form of out-of-control, compulsive, inappropriate, or harmful sexual behavior. An underactive LUST system usually shows up as a lack of sexual desire.

In Conclusion

Balancing SEEKING + CARE + PLAY + LUST = Big fun in and out of the bedroom

The ability to experience pleasure is not a luxury. It is a necessity for a well-balanced emotional brain. Forget about the sex drive. Focus on getting back your pleasure drive. This is the first step to reclaiming a life worth living and loving. Stay tuned for more about why core emotions matter and how to balance them.

The post Lost Your Sex Drive? Not Sexually Satisfied? (Here’s what you need to know about core emotions) appeared first on Nan Wise.

In addition to my upset (which is considerable, motivating me to pen this post as an attempt to actively cope), my clients, friends, family, strangers in the supermarket, and followers on social media have all been reeling in the wake of the supreme court decision–not to mention grave concern about the repercussions of where this may be leading us. What’s next?

Some of what appears to be heading for the chopping block:

Gay marriage. Rights for people to decide who they can be in terms of gender identity. Access to contraception. The banning of certain forms of fertility treatments. Denial of care for ectopic pregnancy crises and further erosion of health care quality for women. The list goes on.

How are we going to have choices, as women, about our reproductive rights?

We are a nation already divided by politics, apparently stressed beyond our resources following the pandemic long-haul, which itself wreaked unprecedented havoc on our everyday lives. And now, we are navigating a challenging economy that threatens to destabilize our finances further and our means to provide for our families. How does this leave us feeling?

Burnt out, sad, mad, enraged, disillusioned, traumatized, deflated, and in despair, for starters.

What can we do with these feelings to actively cope and push back?

What’s active coping?

Simply put, active coping involves taking concrete actions that draw upon our inner resources to help create changes in the situation that help us feel empowered, even if those changes are focused on shifting perspectives when actions may not be feasible. Active coping helps us stay engaged with problem-solving to create the internal and external resources we need to navigate the challenges.

Here are some ways we can take motivated action, from personal to political.

1. Defend your rights: Donate money to organizations that support abortion rights.

For those of us old enough to recall life before Roe v. Wade, this reversal comes as a body blow. It is important to remember that women (and the men who support the cause of women’s rights) have made huge strides before, and we can again! In the wise words of a 20-year-old client, “we young women aren’t going to take this sitting down.” Get mad and get loud and get active. Put your donations into action. Or volunteer to help fundraise for the causes fighting the good fight.

2. Educate ourselves and each other about the issues.

In our country, abortion rates have been declining, likely because we have had more access to effective birth control and morning-after medications as options. Abortion, however, remains a relatively common procedure in America: Approximately one out of four women will have an abortion by age 45. That’s a lot of us! Rates vary considerably among race and ethnicity, likely due to racism and discrimination that make access to high-quality and affordable health care more challenging.

There are two time periods in our lives where we are more likely to end up with an unwanted pregnancy; early in our reproductive years (say ages 20-24), when we haven’t quite mastered contraceptive practices and aren’t yet ready for parenthood, and conversely at the very end of our reproductive years when we are experiencing the kind of hormone fluctuations which can play havoc with our cycles.

Making sure that our sisters, daughters, mothers, friends, and partners have access to this information will help people anticipate and prepare for these risky periods and gain access to the resources to navigate them.

3. Speak up: Destigmatize abortion by sharing our stories.

The #MeToo movement was a big call to action to stand up against sexual abuse, harassment, and rape culture. It was a global wave of speaking to power, sharing truths to release shame, and holding perpetrators accountable.

Perhaps we might consider creating a movement to destigmatize abortion by saying, #UsToo. Many of us have had abortions. We are not in this alone. And deciding to have an abortion is a heartbreaking, wrenchingly difficult choice for any woman to make, but we women are faced with having to make many difficult choices over our lifetimes.

Here is my #UsToo abortion story. I, Nan Wise, during my reproductive years, had two abortions, one early in the game, and the other, at endgame time when a vasectomy failed.

And accidents happen even if your unwanted pregnancy doesn’t occur during the two “higher-risk” periods of our reproductive lives.

Condoms break, and contraception methods, even the pill, can fail. Who can recall the “Today Sponge,” a contraceptive method immortalized by the character Elaine on the show Seinfeld? That method was less effective than touted and was taken off the market, but not before I managed to conceive my beloved second child during the first week of using it. And let’s face it if you figure that, on average, women can be fertile for approximately three decades, there are a lot of opportunities for mishaps or slip-ups to occur.

And unfortunately, as we too well know, women don’t always get to plan when and if they have sex. The idea that a woman who is the victim of sexual abuse or rape is forced, under these conditions, to carry a pregnancy to term against her will if abortion is unavailable is unconscionable and quite frankly inhumane.

From the personal to the political

As I write this, I am anxious. Revealing my abortion history feels scary. In addition to the current political climate, where some people are quick to judge and potentially threaten those whose ideas conflict with their beliefs, I have been trained to be professional.

But here is my truth. I feel called to speak up. As a sixty-five-year-old woman, way beyond my reproductive years, I look back at these choices with sadness but not regret. I made those choices because they were the right ones for me at the time. I was fortunate enough to receive proper medical care, courtesy of abortion being a legal right protected by The Roe v. Wade decision.

But many American women will not be afforded the freedom of choice. Let’s push back together.

The post The Heartbreak of the Roe v. Wade Reversal A Personal Perspective: Three ways to actively cope and feel empowered. appeared first on Nan Wise.

1. Do not judge your erotic self or the erotic experience.

Practice radical self-acceptance. Learn to love your body, exactly as it is. This is one of the biggest lessons, mentioned by nearly all our research participants. They also become curious about their own sexuality and went about exploring what turned them on. Learn to embrace your unique erotic fingerprint — whatever it is. Learn the difference between spontaneous and responsive desire, and where you are on the desire curve. Let yourself be exactly as you are in the moment. And let the moment be exactly as it is.

Sex is our willingness to be sexual beings however that shows up. Remember first and foremost that good sex is about being present.

2. Tune in.

Shift your focus inward to listen closely to what you want and what your body yearns for. What are your fantasies? How do you like to be touched? Why not explore all areas of your body that can give you pleasure? Become keenly aware of what pleases you across the senses — don’t forget about sounds and tastes. Are you interested in perhaps being more active when you tend to be receptive? More receptive when you’re usually more active? Making subtle shifts in your habitual roles may reveal new ways that you can be turned on. Paying attention to sensations is key for pleasurable sex. If your mind wanders and starts to get into “spectatoring” mode — becoming goal-directed or self-conscious — simply notice that without judgment, letting those thoughts be exactly as they are while you bring your attention back to the senses.

3. Be patient — about getting turned on.

When you want to have intercourse, for example, don’t begin until you and/or your partner are sufficiently aroused. Allow the sex to unfold without rushing into it. Although this advice may seem simplistic, it’s hugely important for experiencing the pleasure of sex. Slow down and savor the sensations. Let them build. Enjoy the journey without concern about the destination.

4. Stay connected to your partner.

Often the best way to connect is actually going beyond words. Simply do new lovers spend tons of time doing — eye gazing. Look into your partner’s eyes and breathe with your partner while sitting silently. See the person in front of you, the being you fell in love with. Spoon your partner and hold them and synchronize your breath to synchronize your nervous systems. This actually works. Learn how to harness the stress-busting and connection-promoting power of the breath. We are like tuning forks and go into “cardiac” entrainment with lovers (and even our pets) when we settle into the connection. Good sex is connected sex.

5. Take risks.

We often feel hesitant to speak up with partners about parts of ourselves that we think they will judge or worry that if we tell them how we truly feel we will hurt them. We tend to play it safe when in doubt. But another way to look at this is that there is a risk to not taking risks. If we don’t explore some of the scarier places with our partners, if we don’t explore the corners of our erotic selves, we tend to shut down and stagnate. And stagnation, itself, is dangerous to relationships. Sexual potential unfolds when we bring all of ourselves into the mix. We are always, always shifting and changing and growing. Taking the risk to reveal how these changes impact us, our thoughts, our fears, our feelings, even our fantasies tend to revitalize the partnership.

6. Prioritize pleasure.

Allow sex to play a larger role in your life. Your work with your seven core emotions has paved the way for more keen awareness and insight into how and why pleasure is so important to your life, so allow sex to play a larger role. Make time for sex, expand your notion of what sex is, nurture it, and explore it. It’s a journey without an end.

7. Tolerate emotions and embrace the transformative nature of sex.

Because of the blend of emotional and physical drivers of sex, any type of sexual experience or activity has the capacity to stir up all kinds of emotions. One of the most important lessons for good sex and good relationships, in general, is to learn how to more fully tolerate our feelings, other people’s feelings, and our feelings about other people’s feelings. And sometimes the most challenging feelings to tolerate, believe it or not, are intense feelings of pleasure — which for some can feel scarily out of control. When we can learn to simply allow the feelings to be as they are, stay present to ourselves and to each other, the experiences we can have with and through sex can be truly healing and can revitalize our mind, body, and spirit. It is a tangible form of connection to others, a source of immune-boosting energy, and a vast reservoir for pleasure.

And last but not least

Remember that pleasure is not a luxury. It is a necessity for a well-balanced emotional brain and overall well-being. Cultivate a pleasure mindset to reap the benefits!

The post Seven Ways to Increase Your Sexual Satisfaction appeared first on Nan Wise.

 

Why talking about sexual pain disorders is key to promoting awareness and fighting the stigma and shame

In my book Why Good Sex Matters: Understanding the Neuroscience of Pleasure for a Smarter, Happier, and More Purpose-Filled life I explore how the ability to experience pleasure-both in and out of the bedroom- is not a luxury, but a necessity for overall wellbeing.

Having a happy, healthy sex life can greatly contribute to promoting a pleasure-positive relationship with ourselves and our partners. There are, however, some people for whom sex is a place of pain, rather than enjoyment and satisfaction.

A question I often get asked by readers is how to deal with pain related to sexual activity. Here I address some of what’s known about genital pain disorders to help women and their partners seek information and get proper treatment.  (Men also can suffer from pain related to sexual activity which will be a topic for another column).

For starters, we do know that genital pain complaints are quite prevalent. Since many women are hesitant to report pain associated with sexual activity to their health professionals due to embarrassment or shame, and their providers often don’t inquire, the prevalence of these disorders has been significantly underestimated.

End result?  Many women (and their partners) suffer in silence and simply don’t get the help they need to address the pain and improve the quality of life.

What are the various types of genital pain in women?

Dyspareunia is a term that refers to recurrent or persistent pain that happens before, during, or after having sexual intercourse.

 Superficial dyspareunia is when the discomfort is localized to the entrance of the vagina or the vulva- which includes the external parts of the genitals such as the inner and outer lips (the labia), clitoris, mons (the fleshy mound), and even the opening of the urethra.

In the case of deep dyspareunia, the discomfort or pain is felt more internally, extending deeper into the vagina and in some cases involving pain in the lower pelvis. This version can be associated with intercourse that tends to involve deep penetration.

Some women experience primary dyspareunia that occurs from the very first time they attempt intercourse, while others develop secondary dyspareunia that shows us after periods–perhaps even years-of painless sexual intercourse.

Another term, vulvodynia, can also be used to characterize painful intercourse.

Although the terms dyspareunia and vulvodynia are often used interchangeably, vulvodynia is further defined as chronic genital pain that persists for longer than three months, has no established cause, and can occur without any provocation–which means in the absence of sexual activity or touch–and is localized to the entrance of the vagina and the vulva.

In other words, dyspareunia can be thought of as a descriptive term for painful intercourse in general, whereas vulvodynia is used when the pain is chronic and localized either to the vulva or entrance of the vagina.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which is the guide that health care providers use for diagnosis of mental health and pain disorders, now uses the term, “genito-pelvic pain/penetration disorder,” which encompasses both vulvodynia and dyspareunia, as the well as “vaginismus” –a condition in which intercourse is hampered or made impossible by involuntary muscle spasms that create pain upon attempted penetration.

As mentioned previously, it is difficult due to stigma surrounding sexual health issue to get a good read at the numbers of women affected by genital pain disorders, but It has been estimated based on a comprehensive review done in 2016 that 10-28% of women of reproductive age suffer from vulvodynia. A more recent paper published in 2020 indicates that vulvodynia impacts 8-10% of women of all ages. Rates appear to differ by country and how the condition is diagnosed and studied. More specifically, studies in the USA have found that approximately 16% of women experience vulvodynia during their lives with 7–8% of women experiencing symptoms by age 40. And of note, young women before the age of 20 appear to be at even higher risk of experiencing these symptoms.

What is truly distressing is that studies suggest that only 60% of women with symptoms of vulvodynia seek help and that 40% of these women never receive the appropriate diagnosis.  This contributes to the high toll these disorders take on those afflicted.

Here’s a direct quote from Dr. Bergeron’s primer on vulvodynia:

“Although pain is the characteristic symptom of vulvodynia, the effect of the disorder is far-reaching as it is associated with reduced sexual desire, arousal, sexual frequency, and sexual satisfaction, and can adversely affect women’s and their partners’ psychological and relationship adjustment.”

The diagnosis and treatment of sexual pain disorders

As a sex therapist, I always take a comprehensive approach to this issue. There can be many causes of physical pain during sex. As sex is a biopsychosocial phenomenon involving our bodies, our minds, our experiences, and our culture’s messages, physical pain during sex can result from any number of interacting factors.

 Biological factors

Issues affecting our bodies can underlie sexual pain disorders (such as physical problems with our genitals or reproductive systems, dysfunction with muscles such as those of the pelvic floor, infections, hormone imbalances, issues with the peripheral nervous system such as damage to nerves or increased inflammatory processes, and central nervous system mechanisms such as altered pain processing involving increased sensitivity in brain regions processing sensation or pain.

Starting with a check-up with a knowledgeable ob-gyn is always a good idea. See the resources section to locate a health care provider with experience diagnosing and treating sexual pain disorders.

Psycho-Social Factors

These factors involve our experiences and learning in the context of our families and our culture. What have we been taught to believe about sexuality? Have our experiences regarding our bodies and sexuality been pleasurable or unpleasant? Have we had negative sexual experiences or traumas?  “Yucky” experiences can range from being shamed as a kid by a parent for touching ourselves– to being touched inappropriately by someone else. And as we unfold our sexuality, traumatic experiences can range from having partners not honor our boundaries or give us a chance to truly consent to sex– to the extremes of rape, sexual or relational violence, or abuse. Having a history of sexual trauma can contribute to physical pain experienced during sex. And having a painful relationship with a partner may be part of the genital pain picture.

In the biggest of pictures, culture impact our beliefs about sex and sexual pleasure. Some cultures are more permissive as to how sexuality is viewed, others more restrictive. Cultures differ in gender equality which is a big factor in how women feel about their sexuality. Religion can play a key factor in how comfortable we are taught to be about our sexuality in general and our sexual pleasure in particular. And the stigma surrounding our sexuality is the biggest obstacle we face in approaching our sexual selves.

Treatment

Effective treatment of any type of genital pain disorder should start with contacting a sexual medicine professional. For example, certified sex therapists are specially trained to help clients take the biopsychosocial approach to find answers. They can coordinate treatment with physicians who can help address the bio part of a good treatment plan, which may include ruling out medical causes for the symptoms, prescribing medication as indicated, pain management therapies, and referral for pelvic floor physical therapy. Sex therapists can provide a multilevel approach using psychotherapy to help address and manage the various symptoms to improve the quality of life.

How to get more information and find a sexual medicine provider? 

Here are links to important resources for information and referrals

The International Society for the Study of Women’s Sexual Health (ISSWSH).

Includes physicians and therapists who specialize in sexual medicine here and abroad.

 The American Association of Educators, Counselors, and Therapists (AASECT)

Has resources for referral to sexual health providers in the USA and abroad.

The National Vulvodynia Association (NVA)

Great information and also a resource for finding health care providers specializing in sexual medicine in the US.

And you can always contact me to ask questions and seek help!

 

 

 

 

 

 

 

The post Ask Dr. Nan: What if having sex hurts? appeared first on Nan Wise.

The story of NXIVM is a teaching moment for us all.

Those of you unfamiliar with the NXIVM cult probably haven’t been paying much attention to the news. The cult founder, Keith Raniere, and his protege, actress Allison Mack were indicted in 2018 on federal charges of sex trafficking. Five others, including the heiress to the Seagram fortune, Clare Bronfman, who bankrolled the evil shenanigans, have pleaded guilty to a host of crimes associated with their involvement in the cult. If you managed to miss those details as they unfolded,  recent media productions such as The Vow on HBO and the upcoming docuseries, Seduced: Inside The NXIVM Cult are giving us a very sobering look at the long and harrowing journey that led to the crash and burn of the cult, as well as the wrenching collateral damage inflicted on those who Raniere enrolled along the way.

As an aside, I had the privilege of participating in the filming of Seduced. In my role as a sex therapist, I was called upon to do an onscreen session with the subject of the documentary, India Oxenberg, to help her continue the process of healing from her ordeal.  India is one of the loveliest human beings I’ve ever met. She’s kind, friendly, and a genuinely down-to-earth person, in spite of being raised by Hollywood royalty, and even being related to real royalty– her mother, actress Catherine Oxenberg is the daughter of the Princess of Yugoslavia. It’s incredibly hard to imagine such a gentle human being getting wrapped up in what turned out to be such a dark debacle.

And India was not alone in being enrolled in Raniere’s insanity.

The question becomes: how can so many smart, savvy, and sophisticated people get bamboozled into participating in what ended up becoming a veritable nightmare for both the men and women at the effect of the leader’s lunacy?

And secondly, what can we all learn from their experience?

Let’s start with some myth-busting

Myth #1 Only certain people are susceptible to cults as they prey on the weak and the wacky

Fact:  Everyone is susceptible to cult conversions.

Cult leaders and recruiters tend to go after the best and brightest in society. Cults manipulate by appealing to our desire to grow and create a better world for others. Cults prey on the heartfelt desires of decent honest human beings. Cults don’t always start out looking like cults. Over time, the dark side emerges and through a process of immersion, like the veritable frog in water that heats up slowly and over time, the individual is subjected to mind control and the breaking down of personal power until they are indoctrinated and have “imbibed” the Kool-Aid.

Two factors, however, can make individuals particularly susceptible; depression and being in transitional periods. That sure describes a whole lot of us

Myth #2 There can be consensual sex between cult leaders and followers.

Fact: By definition, a cult involves a huge power disparity between the leader and followers. And this disparity makes it impossible for the followers to actually give true consent to sex. This makes sexual involvement with the leader potentially deleterious and damaging for the member.  It is important to take note that in any situation in which there is such a power disparity, true consent is not possible.

Myth #3. Sexual abuse is unusual in most cults

Fact:  Sexual abuse of women is quite common in cults.  It is hard to find present-day statistics on this, but previous and very conservative estimates have indicated that as many as 40% of women in cults are abused, dominated, controlled, and otherwise sexually exploited.

This might seem surprising, but at the same time, think about how many women in everyday life have reported experiencing some form of sexual trauma, abuse, exploitation, or harassment. One need look no further than the Me Too movement.  And my own clinical experience, although not a random sample, has indicated that many women have experienced some sexual harassment or abuse along the way.  Whether it’s being manhandled by a friend of the family, or groped at a party, or date-raped, many women, unfortunately, have histories of sexual distress or trauma.

 Why is sexual abuse (in and out of cults) so sadly prevalent?

Short answer? In our culture, there remains a deeply embedded structural sexism that tolerates the covert and overt misogyny and sexual inequality that shows up in our everyday lives. One does not have to look further than a certain president of the United States who was heard on camera talking about grabbing women by their genitalia. This man was elected president.

This institutionalized sexism is what makes women in particular susceptible to leaders who exploit the fact that females in our culture are not equally valued as a result of rigid and outdated traditional gender roles that are disempowering.

And finally, what can we learn from all of this?

The dark side of sex is essentially a product of our keeping sexuality in the dark and not embracing, appreciating, and celebrating our sexual selves. As I write in my book, Why Good Sex Matters, our capacity for pleasure– in and out of the bedroom– is not a luxury, but a necessity for a well-balanced emotional brain and healthy life. When women take a stand for their own sexual healing and embrace sexual pleasure, we’re taking stands for all women. Although each woman’s journey is different, speaking up and accepting the support and love of family and friends– with a bit of help from an experienced therapist-can make all the difference.

Bottom Line?

Men and women need to stand together to create a culture of equality in which our sexual lives connect us deeply with ourselves and each other.

The post The Dark Side of Sexuality: What cults like NXIVM can teach us about ourselves appeared first on Nan Wise.