A Missing Piece of Occupational Therapy Education: Attitudes About Sexual Health;
Published in Occupational Therapy in Health care; April, 2024.

Jennifer L. Valli, Katie Shearer, Anne H. Zachry, Orli Weisser-Pike, John D. Boughter Jr.

Abstract: Following a lecture on sexual health, occupational therapy students were surveyed regarding their past sex education and their comfort level with the topic of sex. Students indicated a lack of sexual education received from parents/guardians and a prevalence of fear-based education from formal or informal sources. Results reflected a significant increase in students’ perceived comfort level with the topic following a two-hour lecture on sexual health from a provider trained and certified in sexual health. As sexual health falls within the domain of occupational therapy, these results suggest a need for comprehensive sex education taught to students by qualified instructors.

Keywords: Sex education, survey, comfort level, training.
Disclosure Statement: The authors report there are no competing interests to declare.

https://pubmed.ncbi.nlm.nih.gov/38557162
PMID: 38557162
DOI: 10.1080/07380577.2024.2325069

By Jennifer Valli,  Published in Memphis Health and Fitness, February, 2018. 

Every day we’re bombarded with ads for products to help relieve pain, reduce stress, and improve sleep, but one of the most effective things to do all three may already be in your bedroom. According to The British Medical Journal, orgasms boost the immune system and increase life span. Those who orgasmed two times a week or more added eight years to their lives. A recent study showed that 50-to-89-year-olds who engaged in sexual activity in the past year had higher levels of cognitive functioning. One study reported men who sexually engaged once a month or less had an 45% increased risk of cardiovascular disease compared to those who engaged 2-3 times a week. The Journal of the American Medical Association reports the more a man ejaculates, the lower his risk of getting prostate cancer. Endocrinologists at both Columbia and Stanford found that women who have sex at least once a week have more regular cycles and less painful menstrual cramps.

Some health benefits are related to orgasm, alone or with a partner, but other benefits relate to partnered interactions. For example, many studies link lower blood pressure and orgasm, but a landmark study found that intercourse specifically lowered systolic blood pressure.

Strong pelvic floor muscles help women maintain healthy vaginal tissue and avoid incontinence, with the latter being an issue experienced by 30% of women over a lifetime. During orgasm, women experience contractions every tenth of a second. Vaginal penetrative sex, whether producing an orgasm or not, helps keep a woman’s vaginal barrel and muscle tissue healthier. In fact, if women aren’t having vaginal penetrative sex weekly, they should use a dilator once a week to maintain healthy vaginal tissue, strengthen pelvic floor muscles and to prevent atrophy to the vaginal barrel.

After orgasm, there is an increase in the calming hormone oxytocin and a decrease in the stress-producing hormone cortisol. This improves the ability to fall asleep, and according to a study in the Journal of Women’s Health, increased estrogen levels allow for deeper REM cycle sleep.

Increased levels of oxytocin had added benefits for monogamous couples. Researchers in Germany found that oxytocin impacted monogamous men’s choices when encountering an attractive stranger. Male subjects either received oxytocin or a placebo via nasal spray. An attractive researcher would stand about 24 inches away from the subjects, moving toward and away from them. The men were asked to determine when the attractive researcher was at an “ideal distance” or if she made them feel “slightly uncomfortable” from being too close. The monogamous men who had received oxytocin preferred keeping 4 to 6 additional inches between themselves and the tempting researcher compared to those who were single or didn’t receive the oxytocin. The hormone promoted bonding with their significant other, not the stranger.

But what about those who engage in consensual non-monogamy or BDSM (bondage, discipline, sadism and masochism)? Reuters found BDSM-identified people were less neurotic and felt more security in their relationships. In the field of sexual health, we sometimes say that BDSM, poly or open people should teach classes stressing communication and negotiation. They have to be able to understand what they want and what they don’t, and they have to be able to communicate this clearly to their partners. On the other hand, not telling a partner about a different erotic interest/fetish can create distance and a lack of intimacy and emotional connection.

As an individual or as partner involved in any kind of relationship, sex is not just an enjoyable part of life, but helps you enjoy even more life in the long run.

By Jennifer Valli,  Published in Memphis Health and Fitness, December 2016

Someone once said, “With sex, all roads lead to shame.” Society sometimes tells us that women are supposed to be sexual, but other times it is frowned upon. Some religions approach sexuality with fear and shame and rarely talk about pleasure. Many people carry guilt for fantasies that are not considered socially acceptable. With all this socialization— have you thought about sex as something that is healthy?

Studies show orgasms help relieve pain, reduce stress, and improve sleep. According to The British Medical Journal, orgasms boost the immune system and increase life span. Those who orgasmed two times a week or more added eight years to their lives. A recent study showed that 50-to-89-year-olds who engaged in sexual activity in the past year had higher levels of cognitive functioning. Self-stimulation and meditation both promote mindfulness, teach people to quiet their minds, and focus on one thing, even when they are not directly engaging. Here is how can you gain these benefits and establish a lifetime of sexual health.

DON’T WAIT FOR PERFECT:  With lack of interaction, partners lose emotional and physical connection and eventually communication. Make pleasure your goal, not the orgasm. In long-term relationships, women tend to find their desire “during” rather than “before,” so don’t wait until desire is overwhelming to engage. A lack of drive at the start doesn’t mean a woman is dysfunctional, hormone-deficient, or not into her partner. Men, however, frequently withdraw from engaging intimately altogether because they don’t want to feel or appear incompetent. They may wait for the perfect erection and think anything less than 95 percent rigid is not good enough, but with direct stimulation, and piggy-backing their arousal off of their partner’s, men can orgasm without being fully rigid.

FREQUENCY IS YOUR FRIEND: A lack of intimacy over time results in resentment or couples relating like friends. If you haven’t been sexual recently, add intimacy in slowly but engage often, which will not only lower the pressure for everything to go perfectly but also increase testosterone and estrogen production.

BE FLEXIBLE: Many people narrowly define sex as intercourse and everything else as second-class sex. Consider broadening your definition.

DON’T TAKE IT PERSONALLY: It can be very difficult if your partner never initiates, or if you are repeatedly turned down. Rather than wonder if you are the problem, communicate. Remember that lack of desire or sexual dysfunction is usually due to a combination of physical and psychological causes, with both elements impacting one another. Intimacy is a complex issue with many layers and addressing only testosterone levels, for example, will not solve the complex dynamics involved.

SHAME-FREE ZONE: A desire discrepancy where one person’s drive is higher than the other is very common between couples and neither partner is dysfunctional. Don’t label the lower desire partner as dysfunctional and the higher drive partner as an addict. “Sex addict” is an overused term by the general population and addiction therapists, but the medical community does not recognize it as a diagnosis. The 12-step method of treatment, at least for sex, comes from a place of shame, often framing the partner as the enabler, and labeling any “out of the box” erotic interest as pathological.

CONSENT, EQUALITY, AND MUTUAL RESPECT: Enthusiastic consent, equality, and mutual respect are key elements to keeping sex emotionally healthy. Without these, sex becomes damaging. One out of four females and one out of seven males has experienced sexual trauma. Bring these three elements to every intimate relationship, whether you are just dating or with your partner for a lifetime. If you can’t be kind to a person before, during, and after being intimate, you shouldn’t be with them at all.

As a therapist with extensive training in sexuality and sex therapy, I emphasize that healthy sex is not everything going perfectly each time. It is more about feeling desired and connected with another, and handling barriers as they occur with maturity.

 

By Jennifer Valli, Published in Memphis Health and Fitness, September 2015

Sexual health throughout one’s lifetime is achievable, but many couples make the mistake of defining sex too narrowly, thinking sex is intercourse. For them, the goal of sex is orgasm, and if possible, orgasms occurring simultaneously. This idea actually originated from Greek and Roman times, when people believed that simultaneous orgasm helped couples conceive.

Couples that maintain intimacy know they can engage in other sensual ways. The majority of women orgasm with clitoral stimulation, while only 30% of women reliably orgasm from intercourse alone, so there are several reasons to view intimacy in a broader sense. Consider a menu of possibilities that includes penetration on some nights, or genital touch or oral stimulation on others. These elements don’t just constitute foreplay; they can be a goal unto themselves.

Remember that with sex, giving and receiving does not have to be equal in every encounter. One night may be about both partners, but another night may be about only one person. Measure equality over time, work to feel more comfortable as both a giver and receiver, and keep in mind that the most important aspect of sex is allowing yourself to create a space to connect with another intimately.

Another important concept that is often misunderstood is a women’s sexual response. Although sexual response can play out in many ways for women, after the honeymoon phase of the relationship, women often initially engage with a neutral feeling rather than because of a biological urge for sex. Many times, women are motivated to be intimate from an intellectual space, wishing to connect with their partners, but as they proceed they feel physically aroused in the process.

Frequently it is not until after a woman feels aroused that she experiences the sexual thoughts and fantasies we associate with desire. This is very different from what we see in the movies, with women first feeling biological desire and then bursting into orgasm. A woman can feel shame when she doesn’t feel overcome with desire prior to sex and many hormone clinics capitalize on this anxiety. If a woman is not becoming aroused in the process, then hormones should be checked, but don’t label yourself as dysfunctional just because you are not overcome with a biological drive for sex prior to interacting.

The aging process has the greatest impact on the arousal stage of sexual response, rather than orgasm. When engaging with a partner, the right lubricant is critical. Silicone lubricants are the best choice for those going through menopause. Uberlube is an excellent choice as it is glycerin-and paraben-free, and has a healthy Ph balance. Also consider a vaginal moisturizer, such as Luvena or Replens; these are different than lubricants and should be used regularly as a part of maintaining sexual health. If you are having pain with sex, contact a pelvic floor physical therapist and also a psychotherapist that is certified by AASECT to discuss a plan to integrate sex back in, so that you can have success when intimately connecting.

Recently, the FDA has approved a new medication, Flibanserin or Addyi (trade name) that may help treat low sexual desire in some women. Even though this medication has been referred to as the “female Viagra” in the popular press, it works in a very different way. Unlike Viagra, which increases blood flow to the genitals, Flibanserin works on neurotransmitters in the brain, and must be taken daily. Based on clinical trials, the FDA estimates that only 8-13% of women with low desire may be helped by the drug.

Understanding any differences in how you and your partner approach and respond to intimacy is an essential element of lifelong sexual satisfaction. It’s never too late to let go of myths and embrace your own needs and desires.

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By Jennifer Valli, Published in the Memphis Flyer

Is there a magic pill? Addressing Low Sexual Desire in Women

The FDA has approved 26 sex-related drugs and treatments for men. Finally, women get one for themselves. But does it work?

As a psychotherapist who specializes in sexual health, I work with couples and individuals to improve their emotional and physical intimacy, and I have been asked this question since the announcement of “the female Viagra” Flibanserin, or Addyi. This drug, however, works very differently than Viagra, which treats dysfunction by increasing blood flow to the genitals. Addyi, in contrast, works on neurotransmitters in the frontal cortex in the brain, increasing desire and decreasing sexual inhibition.

So what is the drug’s effectiveness? According to the FDA, only 8-13% of the subjects were helped by the drug, reporting an average of one more sexual experience a month compared to placebo. Some medical groups felt like the benefits of the medicine didn’t outweigh its side effects, as it may cause low blood pressure and loss of consciousness, especially if consumed in combination with alcohol. Others advocated strongly for the drug, seeing the lack of FDA-approved drugs for women as an issue of inequality.

As I have often seen in my practice, sexual response is often misunderstood and therefore women may be inaccurately seen as dysfunctional. Female response is complex and related to a variety of factors that may impact desire. Many times, women are motivated to be intimate from an intellectual space, wishing to connect with their partners, but as they proceed they feel physically aroused in the process.

A woman can feel shame when she doesn’t feel overcome with desire prior to sex and many hormone clinics capitalize on this anxiety. Addyi is also trying to elicit desire on the front end, a response more likely to be consistent with more males than females, but one that can vary between people and even within one person from experience to experience.

Many women will be willing to take this pill despite its side effects, but hopefully they will address the other factors that impact desire. For example, some women experience larger barriers to connecting related to past infidelity, or other difficult relationship dynamics. One out of four women prior to age 18 has had some past sexual trauma and that plays into how they see themselves as a sexual person.

Many women aren’t comfortable with body image and this directly affects their desire and ability to orgasm. A University of Texas study showed that 70% of women cover some part of their bodies during sexual activity, rather than tuning into the moment, and researcher Thomas Cash found that body image impacted how women experience sex itself. Body-conscious women reported experiencing orgasms 42% of the time, compared to body-confident women who experienced orgasms 73% of the time. The insecurity about body image doesn’t stop there – common irrational fears of women include thinking that their genitals may not look or smell normal. This is yet another thing that impacts desire; we each need to feel comfortable when connecting intimately.

Often couples present with a desire discrepancy where one person’s drive is higher than the other’s. The lower drive person is labeled “the problem”, while the higher drive partner is labeled the “sex addict”. But are they really an addict? Do they have a history of substance use, gambling or any other addictive behaviors, or is it just that he or she has a stronger sex drive? This asymmetry can create resentment with the higher drive partner feeling rejected after initiating sex fails repeatedly, and the lower desire partner feeling used. If the couple is still waiting for that initial desire in the woman to kick in, she will likely see sex as a task. All of this results in both partners feeling angry and resentful, and certainly hoping there is a medicine to fix all of this. Sex offers a powerful, non-verbal way of communicating. The question remains, do women need a medicine to achieve what is a normal sexual response?

Have drug companies had trouble creating a successful drug because desire in women is a complex issue or do companies spend less money on women, as a more marginalized population? Certainly we are less comfortable thinking about sexuality in women compared to men. Seeing ourselves as sexual is deeply rooted in religion and culture, and taking a pill isn’t going to override that. Women may take the pill, wait for it to work, and then feel more inadequate when they don’t feel overcome with desire. With or without the pill, those individuals and couples who examine sexuality in depth and continue to engage regularly despite hiccups will enjoy quality intimate interactions.

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