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Interview With Sex Expert and Author David Yarian

Prominent Nashville psychologist and sex therapist David Yarian recently shared his views with eDrugstore.com on the role of sexual harmony in long-term relationships. This interview is one in a series of expert interviews on the eDrugstore blog. We add new interviews on a regular basis. Please see our complete list of insightful interviews

1. How common are sexual difficulties in relationships? What might be some contributing factors to these problems?

I believe sexual difficulties are quite common in relationships! The challenge is that many people have few tools or resources to address these difficulties, keep their struggles to themselves, feel anxious and worried, and conclude that something must be wrong with them – or maybe they are just with the wrong person.

It is an illusion to believe that sex is “natural” and should therefore come easily without some effort or the benefit of experience. In humans, sexual behavior is learned behavior. It is not instinctive behavior, as in most animals.

So the question is, how do we learn how to do sex? In most Western cultures, there aren’t many good options. All other adult behaviors that are important to a child’s success in life and in relationships are taught to us — by parents, by teachers, or by other adults.

Necessary life skills — like how to read, how to drive a car, balance a checkbook, write a thank-you note, have good manners, how to dance, how to be a team player, skills for employment – all are the subject of intensive focus and study and practice from childhood well into adulthood.

And learning about sexuality? For the lucky, sex is talked about at home – in ways that transmit information without a burden of shame or anxiety – and children feel comfortable to ask questions or speak up when they have curiosity about a sexual matter. For the unlucky, sexuality is presented as dirty or shameful, or it is a topic that is prominent by its absence. Children quickly sense that it is not okay to talk about sex, to be openly curious about sex, or maybe even to be sexual at all.

When I ask my patients how they learned about sexuality, the most common answer is “from friends.” “Oh,” I reply, “you learned from experts!” Locker room talk or girlfriend talk is mostly hearsay, bits of misinformation gathered from snatches of overheard conversation, popular songs, or TV shows. Exaggeration and distortions are common.

The second most common response to this question is, for men – porn; and for women – romance novels. The ubiquitous presence of these media in the lives of young people can lead to many misperceptions about sexuality and intimate relationships. Porn can promote the notion that everyone should be ready and willing for sex at all times – and there is no time for foreplay or emotional connection. Romance novels enchant with the idea that there is a Prince Charming out there who can anticipate our emotional needs and always make us feel special.

Learning about sex from these fictional resources is, as Michael Castleman famously pointed out, like learning to drive by watching action movies filled with car chases and spectacular crash scenes. Action movies can be fun to watch, but it’s not how we drive safely and responsibly in the real world. Porn and romance novels can be entertaining and stimulating, but they are not reliable guides to adult sexual and intimate relationships.

2. How can therapy benefit long-term couples who have lost that spark? What are your top 3 sure-fire ways to get and/or keep things hot in the bedroom?

Pent-up resentment can disrupt long-term relationships.

Sex therapy provides a safe context in which the couple can talk about what they really want – in sex and in their relationship. Many people find it challenging to tolerate the anxiety stirred up by telling the truth to their partner. Many long-term couples have a lot of painful feelings, disappointments, and woundedness stored up over the years. So talking about one’s deepest longings is not a simple matter, and it may take some time for an honest discussion to take place. It’s easy to feel defensive, hurt, and pessimistic about any good outcome. Why dredge up all this stuff?

Many couples have a lot to learn about how to resolve arguments and conflicts. It takes more than compromising to begin to feel trustful and open. The essence of compromise is “you can win this time, but I get to win next time”; true resolution is when it is possible to conceive of a third option that feels desirable to both parties.

In my experience, unresolved conflicts in the relationship are the number one contributor to “losing the spark.” Ignorance about sexuality or lack of sexual experience may also play a significant role. The couple may have only a limited range of ways to express their sexuality together. They may be viewing their sexual relationship as an arena in which they must perform – which can lead to viewing sex as a chore to be done, or a big test of some kind, which they could flunk. They have lost (if they ever had it) the feelings of curiosity and relaxed playfulness that characterized the early days of their relationship.

Physical symptoms, including illness and medication effects, pain syndromes, and disabilities, can also contribute to a loss of desire. It’s important to have these conditions carefully assessed by appropriate physicians. When pain is present, many partners are tempted to try to tough it out and push through the pain. With sexual pain, this is never a good idea! The ultimate effect is to diminish desire and create instead strategies of avoidance.

What to do about all this? It’s usually not simple: if it were, people would not be in my office discussing it, they would be at home having fun! But I would advise three practices, or processes that I believe can lead to reawakening sexual desire in loving couples.

The first practice is Relaxation. By this I mean removing stressfulness from the intimate relationship. If there is anger or resentment or hurt, address it and find ways to move to genuine resolution. We can only relax our guardedness when we feel safe and secure. If there are performance expectations, let them go. Forget about being the world’s best lover! Forget about equating sex with intercourse; there are a million ways to make fabulous love to your partner that do not require putting a penis into a vagina. Forget about doing anything fast. What’s the hurry? Forget about counting orgasms, or lovers, or erections. Relax. Take a breath. Give yourself credit for addressing this vital part of your life and your relationship.

The second practice is Tell the Truth. This means to speak honestly and directly about what you want and what you need. It also means that you listen deeply and openly to what your partner wants and needs. (It may be important here to remember the first practice and put it into action!) Great sex happens between two people who know themselves and who are open to each other. True intimacy comes only when we are vulnerable and our hearts are open. Being genuine is of fundamental importance to a thriving sexual relationship. It is no gift of love to go along with something that is painful or boring or abhorrent. Allowing this only subtracts from the desirability of connecting sexually in the future.

The third practice is to Play. Someone once said that great sex is like being part of a pile of puppies – all wiggly and delighted to be together. As I mentioned before, performance expectations tend to diminish the playfulness and curiosity of healthy sex and substitute performance anxiety and sexual phobias in their place. Play means being experimental, being curious and open to new experience. It means enjoying who you are playing with. Play does not mean being competitive – sex is not a competitive sport! Play could mean trying on new identities or dressing up or playing games. Sex is where it’s okay for adults to be playful, to relax our guard and give into the inclination of the moment with the playmate we’ve chosen. Practices One and Two are important here as well. We can’t play unless we are Relaxed, and Telling the Truth makes playing safe. If my partner wants to play in a way that makes me uncomfortable, I have to let her know this and we have to come to a resolution we both feel good about.

3. Can relationships survive through all or most adverse sexual conditions?

Most relationships can survive sexual discord.

Yes, just as good relationships between people who trust and love each other can survive bankruptcy, serious illness, affairs, loss of employment, and other crises.

With the tools I’ve described – accurate information about sexuality; good communication skills; the willingness to be open and honest; the ability to listen deeply to each other; trust and mutual self-respect; and, most of all, a shared desire to continue the relationship day by day – yes, relationships can certainly survive adverse sexual conditions. And that doesn’t mean giving up on sex! It may involve the willingness to change, to stretch and to grow one’s ideas about what sex is.

4. You also offer a method called Tantric Sexuality Education in your practice. Can you explain what this is and how it might be of benefit to individuals and couples?

Tantric Sexuality Education applies the insights of ancient Tantra to the needs and challenges of modern American couples. Tantra was developed two thousand years ago in India as a meditative practice leading ultimately to enlightenment. Tantric practice focused upon the senses as the primary avenue to gaining enlightenment. By meditating upon sensory experience while focusing on the breath, the practitioner is able to access deep and profound realms of experience. Since sex is filled with heightened sensual feelings, some tantric rituals employed lovemaking as a meditative practice. Modern versions of tantra tend to focus primarily on the sexual component.

Here is how this is useful: clinical sex therapy focuses primarily upon removing symptoms. Erectile dysfunction, pelvic pain, vaginismus, premature ejaculation, low desire – people come to therapy to find out how to move beyond these experiences. I emphasize that sexual health is much more than simply removing symptoms. It’s really about creating a sexual life that is rich and full and satisfying for both partners.

I sometimes ask couples to think about where they fall on the following continuum: No Sex – Bad Sex – Good Sex – Great Sex – Transcendent Sex. Usually by the time I reach the final category on the continuum, their eyes have widened! Tantric Sexuality Education offers couples tools – Intimacy Practices – they can use to move as far along this continuum as they want. It’s a lifelong journey, and I think it helps couples to conceive of what is possible and what is desired, and to move towards that, rather than focus simply on removing symptoms. Human beings are not cars, and sexual relationships are not carburetors to be repaired or adjusted.

Along with the steps I outlined before (Relax – Tell the Truth – Play) I encourage the couples I work with to have a vision of their sexual relationship as a kind of meditation in which their bodies are showing them the way to Enlightenment. It’s a wonderful thing.

5. Can you please explain what gender dysphoria is? How serious of an issue is this and how might you go about treating it?

Gender dysphoria is discontent with the biological sex you are born with. The American Psychiatric Association views this as a medical condition and provides the diagnosis of Gender Identity Disorder in its Diagnostic and Statistical Manual IV-R. This diagnosis may be made if the following criteria are met:

  • long-standing and strong identification with another gender
  • long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex
  • the absence of physical intersex characteristics
  • significant clinical discomfort or impairment at work, social situations, or other important life areas

For the person who does not feel fully at home in his or her body, gender dysphoria is very serious. Many cultures (including our own) have strong expectations for behavior that are gender-specific. (Girls/women can wear dresses; boys/men may not.)

Low self-esteem and depression are often associated with gender dysphoria. Suicidal ideation and successful suicide are not uncommon. People who want to be a gender other than what they are often feel isolated, ashamed, alone, and without emotional support.

The causes of gender dysphoria are unknown. There is some evidence that certain areas of transgendered persons’ brains show some differences from regularly-gendered persons’ brains. It is not realistic or possible to counsel people out of gender dysphoria. It is possible to provide education, support, and counseling to help gender dysphoric persons find a meaningful and purposeful life.

Addressing the issues of gender dysphoria may lead the dysphoric person to move ahead in a variety of ways. She may come to a more profound acceptance of herself as she is and find creative ways of expressing her uniqueness in the world. He may choose to dress as the desired gender and to play roles that help him feel more congruent within himself. And she may, with the help of hormone replacement therapies and surgeries, opt for creating the body that more closely matches her internal experience of herself. The World Professional Association for Transgender Health ( wpath.org ) provides standards and criteria for this process.

It is important to emphasize that no one would choose gender dysphoria as some kind of neurotic response to general unhappiness. Persons with this condition are worthy of our respect and support as they struggle for genuineness and a sense of true belonging in the world.

About David Yarian, Ph.D:

David Yarian, Ph.D., is a licensed psychologist and certified sex therapist in private practice in Nashville, Tennessee. He specializes in marital and sex therapy with couples and individuals, and leads workshops and training on Spirited Loving, a meditative approach to sexuality. He is the author of the online Guide to Self-Help Books, which contains short reviews and recommendations of over 1,000 self-help books in 46 categories.

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