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Staying Hot & Sexy in Midlife

Posted on March 15, 2022 by Wendy Maltz - Sex & Love

One day when I was in my late 40s, I was standing in line at a little bakery in Cannon Beach, Oregon thinking about the fact that I hadn’t had a period for months and worrying what that would mean for my sexuality. In front of me was a couple wearing matching blue jean jackets and hats, barely able to keep their hands off each other. She had her arm around his waist under his jacket, rubbing up and down on his back, while his hand gently massaged her butt. They giggled like school kids. Ah, young love, I thought to myself. Their sexual energy was palpable, and I was more than a little envious. Just then they took off their hats and turned around. These young lovers, these school kids must have been at least 70-something! Her hair was white; his was a distant memory. They were both wearing gold and turquoise jewelry against their wrinkled skin. And, oh, those smiles. Smiles that said “We had sex this morning!”

That day in the bakery I had come face to face with a woman much older than myself and experienced firsthand the strength of her sexual energy. The experience went a long way towards reassuring me that, regardless of all the hormone and desire fluctuations of menopause, as a middle-aged woman my sexual future could be as bright as I chose to make it.

As a seasoned sex and relationship therapist, I knew that maintaining a good sex life has a lot to do with getting accurate information, developing positive attitudes, having access to helpful interventions, and learning new behaviors that can be put into play when needed. The biggest issue for most of us as we age is not the natural sexual change that our bodies go through, but our general tendency to ignore sexual concerns due to feeling embarrassed about sex. Self-inflicted isolation and avoidance can produce a lot of needless suffering and missed opportunities for pleasure.

In the years following my experience at the Cannon Beach bakery, I became fascinated with researching, learning, and passing on to others the secrets to staying sexually vibrant as we age. Here are a few key ideas that I discovered to help empower anyone, regardless of sexual orientation or preferences, who wants to stay hot and sexy in midlife and beyond.

Sex is ageless

Unlike other species, we humans have a sexuality that lasts well beyond the years of fertility and procreation. In fact, barring serious health problems, we have the ability to stay sexually active (with or without a partner) until we die. Freda, an 87-year-old poet I interviewed, told me that she enjoyed pleasuring herself to orgasm every day by imagining a man with a big erection wanting to make love to her. “You never lose your fancies,” Freda chuckled, “Your fancies never die.”

Numerous sexuality surveys reveal that many people in their 50s, 60s, 70s and beyond, continue to enjoy sex regularly. One-third of postmenopausal women report no change in their sex lives, and another third say their sexual experiences have actually improved with age. Consider the upside: no messy periods, more privacy at home with children gone, and more time to develop intimacy and enjoy sensual moments with or without a partner.

Women who report a decrease in sexual satisfaction usually attribute this change for the worse to vaginal dryness, lack of a partner, health problems, and relationship difficulties. Similarly, men reporting diminished sexual satisfaction in midlife often cite untreated erectile difficulties, along with troubling health and relationship concerns, as the cause.

It’s normal and natural for hormone levels to fluctuate and gradually decrease with age. Sexual problems occur when a woman’s lowered estrogen levels produce symptoms such as night sweats, hot flashes, skin sensitivity and vaginal atrophy, that interfere with sexual enjoyment. And, regardless of gender, low levels of testosterone (known as the hormone of desire) can decrease sexual fantasies and diminish sexual thoughts and cravings.

People in midlife also tend to have an increased use of medications, many of which, such as high blood pressure meds and anti-depressants, are notorious for negatively impacting sexual functioning. Some individuals face sexual challenges caused by the impact of important surgeries. However, these issues don’t have to be deal breakers for maintaining a good sex life. A wide variety of effective traditional and alternative medicines and interventions are available to address the sexual problems caused by natural aging, hormone, surgical, and medication-related concerns.

Given the information and help now available, many people in midlife can continue to experience sexual interest, arousal, and orgasm for a very long time. As with any physical response (e.g., vision, hearing, or physical activity), though, we need to accept and work with the idea that some gradual slowing down and natural weakening occurs as time goes on. Actor Jack Lemmon once quipped, “After a certain age, I found out not only did it take twice as long to rev up my motor, but it stalled frequently.” The trick is to learn to be comfortable with and adjust to changes in our bodies and their abilities, and to seek help when we need it, rather than giving up on sex altogether because it’s different than it was when we were younger. When she was well over fifty, silver screen actress Mae West once said, “Fifty men outside? I’m feeling a little tired. Send ten of them home.”

Sexual fitness makes a difference

Good sex has a lot to do with stamina, flexibility and blood flow. Thus, keeping yourself in general good health — by eating well, exercising regularly and not smoking – may be the most important thing you do to keep sex alive as you age. Low-fat, high fiber eating in small amounts throughout the day can help you have more energy and ward off that sluggish, uncomfortable (“I’d rather sleep than make love”) feeling. And if you want choice in lovemaking positions and want to be physically spontaneous and intense at times, you will probably need to build muscle strength and stamina with yoga (flexibility), weight training (strength), and aerobic activities (stamina and heart health.) One study showed that a good workout on an exercise bike increased sexual interest in women more than a candlelit dinner. The more blood flow to your genitals, the healthier they will be and more you will feel like a sexual being.

But your biceps and thighs aren’t the only muscles in your body that need continued exercise and attention for good sex. Regardless of your gender, you need to keep your pubococcygeus muscle – or PC muscle, for short – in shape. In animals, the PC is the muscle that wags the tail. In women and men, it’s the muscle that contracts when we climax. The PC muscle is a hammock-like muscle that extends from the pubic bone to the coccyx (tail bone). Also known as the “love muscle,” the PC holds up our sex organs. When it is thick and strong it gives good support (and keeps us from peeing when we laugh or cough) and when it is weak, it can reduce pelvic blood flow and cause weak orgasms or no orgasms at all.

To keep your PC muscle strong for enjoyable sex, you will need to exercise it frequently – ideally, daily, for the rest of your life! No, I’m not kidding. This one belongs right up there with flossing and bathing regularly. The standard PC exercise consists of TIGHTENING, HOLDING, and RELAXING the muscle over and over again — sometimes quickly, sometimes slowly — for up to 100 times a day. Also known as “Kegel exercises” these PC exercises are effective in treating urinary incontinence and, for women, in improving recovery after childbirth.

Many people have told me that they experience stronger, longer-lasting orgasms when their PCs are in shape. (Doctors often provide detailed descriptions of the Kegel exercises to patients, and they are often described in childbirth and human sexuality books.) Sex therapists recommend them to men who want better body awareness so they can last longer before climaxing in sex. PC exercises can be tedious and time-consuming. People who do them regularly have learned to integrate them in with activities such as when in a car waiting for a light to turn, texting, or streaming their favorite shows. You may also find at times that a few sets of PC exercises will increase sexual arousal. Thus, they can be great to do when waiting for your lover to join you in bed or when fantasizing about a hot date.

Comfortable settings, comfortable bodies

The older we get, the more we need to focus on being comfortable in sex. Creating settings for lovemaking and self-pleasuring that are relaxed and relatively stress free makes everything about sex more pleasurable. Mute your cellphone. Play some soft, sensual music. Give yourself lots of time. Make sure you have lots of privacy.

It’s important to identify what you need to feel more comfortable sexually and then give yourself permission to take action. Mattie, a 52 year-old, self-described hot and sexy midlifer, likes to keep a wide variety of different size and shape pillows near her bed. This way she has them handy when making love to prop up a hip or a lover’s head. Max, a man in his late 60s, does a series of warm ups and stretches to loosen his limbs before climbing into bed, to reduce the possibility of pulling a muscle or getting a cramp. Joan, a woman in her mid-40s, suddenly developed a self-consciousness about her own vaginal odor. This new anxiety made it difficult to touch herself at night. To remedy this concern, she created a ritual of gently cleansing her vaginal opening and lips before retiring to bed.

But it’s not just external comforts that need addressing. It’s important to be sensitive and responsive to how you feel in more intimate ways, as well. For instance, it is natural for vaginal lubrication to diminish as people age. The ability to lubricate can fluctuate according to our levels of stress, hormonal changes, and the influence of various medications. Many women express concerns with vaginal dryness in midlife. A lack of vaginal lubrication can create discomfort for both women and their partners. And sex toys can become distracting, sometimes painful, irritants when the sensitive body parts they are attempting to pleasure are dry.

Continuing to have sex when you feel physically uncomfortable could damage tissues, or at the very least, promote negative feelings about sex. Older women are more susceptible to bladder and vaginal infections, so it’s a good idea to consult a health care professional when problems with vaginal discomfort persist. Ask your doctor about what types and brands of lubricants are best suited for you to use alone or with a partner, and use them liberally during self-pleasuring and lovemaking. Speak up and stay informed, as some lubricants contain ingredients that are not considered safe for use with condoms or for medical reasons.

Doctors often recommend treating serious problems with vaginal dryness and soreness with hormone creams that are applied directly to the vaginal tissues. When Toby, a 49 year-old who had been skipping periods for several years, consulted her doctor, she was surprised to learn that her vaginal discomfort and dryness problems could be traced to visible changes in the cushioning layers of her vagina. She went on a program of inserting .5 gram of estriol cream (from a compounding pharmacy) twice a week. It plumped up the tissues to where she rarely needs to use lubricant anymore. Toby says, “I feel like I’m 25 again. . . that is, on the inside, where it counts!”

It’s time for new thoughts and a few new moves

Midlife is a great time to move away from thinking that you have to look a certain way in order to deserve and enjoy sex. Good sex is not a matter of how you look, but rather depends on how you feel and what you choose to do. All of us can be sexy at any age if we accept and appreciate our incredible bodies and tune into enjoying touch and other sensual pleasures. There is no time like the present to put on those silk sheets, light some candles, and spend an afternoon with your lover and a jar of chocolate body paint – or whatever turns you on.

Given the natural physical changes that occur during midlife, it’s a good idea to develop skills for enjoying deeper sensual and emotional connection. Wanting something different from his sexual encounters, Daniel, a single gay man in his late 60s, took a “men’s touch” retreat where he learned how to make better eye contact, expand his ability to give and receive sensual massage, and communicate his emotional feelings with other men.

The willingness to be creative and open to new things is one of the best ways to keep sexuality alive as you age. Studies show that the couples who have satisfying long-term sex lives are those who are open to experimentation. Vibrators, sex toys, romance novels, and sexually explicit materials of your choice can add to excitement and help get the juices flowing. Think about Grace and Frankie and their vibrators for older women; what great role models for healthy, sexy aging! (You can also find inspirations in my best-selling anthologies: Passionate Hearts: The Poetry of Sexual Love and Intimate Kisses: The Poetry of Sexual Pleasure).

Even small changes, such as the time of day, the place, the positions, the music in the background, or the words you whisper to each other when you make love can go a long way in changing things up a bit. Novelty creates excitement. Anticipation builds arousal. It’s fun to go wild imaging what might happen next.

As physical problems surface now and then, having a variety of activities to choose from can enable you to stay sexually active. If one thing doesn’t work, don’t roll over and go to sleep — try something else! Some couples experiment with different sexual positions that a reduce stress and strain on the body. The “side-by-side” sexual position is such a favorite. In this position both partners recline next to each other rather than one person being on top of the other. Thus, for a male-female couple, the man might roll on his side towards the woman as she lies on her back, draping one or both of her legs over his hips so he can enter from the side. Similarly, two women may chose a reclining side-by-side position, as it facilitates mutual sexual arousal and vaginal stimulation.

Consult with medical professionals, physical therapists, and other reliable resources about what positions are best and recommended for you. Many orthopedic physicians have informative handouts for how best to relate sexually when challenged by hip, knee, back, and other issues. These alternative positions can be less stressful when people are tired or their bodies ache for one reason or another, and they can help prevent stresses and strains that could cause problems that get in the way of enjoying sex.

Older couples often say that oral sex, manual stimulation, and other forms of foreplay become more important with age. Due to natural changes in blood flow, the penis’s ability to get and stay erect can diminish. And regardless of gender, as we age, most of us need more stimulation to inspire action and response. Erectile difficulties matter less when a partner has another option for sexual release, such as with oral, manual, dildo, or vibrator stimulation. Everyone can benefit from time taken in massaging the genital areas to increase blood flow and response. And, it’s important to know that men are able to climax without becoming erect. Since many physical sexual problems are made worse by anxiety and holding on to rigid ideas about what sex has to look like, the ability to explore new options together can make for a more satisfying sex life.

It’s a good idea to do a little soul searching when you are considering something new that you aren’t sure about. When Rachel, a 52 year-old single woman who likes to date comes up with a sexual idea — whether wearing a shorter skirt or tickling her nipples in front of a new partner – she says, “I always ask myself first: Does this fit with my personal values? Am I feeling healthy excitement or dreadful anxiety? While I want to be open to new things, I don’t want to do anything that will hurt me or anyone else.”

Sexual changes are inevitable as we age, but they are not insurmountable. With good information, professional help when needed, and a lively and creative approach to sexual sharing, anyone can improve sex and intimacy for many years to come. Midlife brings with it a sense of freedom to approach sex and pleasure in new ways, more boldly, trying out new things, treasuring physical enjoyments, while also exploring deeper emotional and intimate dimensions of sex. It’s a time to be more relaxed and less self-conscious in sex. When we’re older, we know, as time goes by, how precious it is to be a sexual person and share in the delight of sexual sensation and connection.

©2022 by Wendy Maltz, all rights reserved.


Favorite Sex & Love Quotations

Posted on March 15, 2022 by jack - Sex & Love

You can learn more about healthy sexuality through discovering what other therapists, writers, and sexual health advocates have said about it.

Here are some of Wendy’s favorite quotations on sex and love:

Only the united beat of sex and heart together can create ecstasy. – Anais Nin

Nothing is sexier than the naked mind–nothing more seductive than the inventive imagination. – Michael Grosso

The flower, the sky, your beloved, can only be found in the present moment. –Thich Nhat Hanh

An embrace should fill the heart as well as the arms. – Hugh & Gail Prather

Sexual love is the most stupendous fact of the universe, and the most magical mystery our poor blind senses know. – Amy Lowell

Good sex begins when your clothes are still on. – William Masters & Virginia Johnson

To climb to the heights, sex education is not enough. We need to learn how to love. – Joseph & Lois Bird

Our organic drives and urges are never separable from the search for meaning and the quest for communion. – James Nelson

Sexual love is socially responsible; nurturing the fabric of the larger community to which the lovers belong. – James Nelson

Sexual love is joyous; it is exuberant in its appreciation of love’s mystery and life’s gift. – James Nelson

Sex is more than sensation and is within life rather than outside or apart from other experiences. – C. Leon Hopper

The sacred meaning of sexuality is not located in sexuality itself, but rather in human mutuality. . .Sexuality is a mode in which mutuality is expressed. – John Buehrens

The reason people sweat is that they won’t catch fire making love. – Don Rose

Never be ashamed of passion. If you are strongly sexed, you are richly endowed. – Margaret Sanger


Common Types of Sexual Fantasies

Posted on March 4, 2022 by Wendy Maltz - Featured, Understanding Sexual Fantasies

What do you think of when you think of sex? What types of images and ideas come to mind? What sexual scenarios and stories turn you on?  The possibilities are endless and not only vary from person to person, but can change substantially over the course of our lives. 

An inclusive definition

Sexual fantasies can take many forms, from fleeting thoughts and images to elaborate, detailed scenarios that play out in our minds like a scene in a movie. By definition, sexual fantasies include all sexual thoughts and images that alter our emotions, sensations, or physiological state.* While all of us experience non-sexual fantasies as well,  those thoughts that have an erotic effect on us or include images we commonly associate with sex, are considered sexual fantasies.   

Old ways of categorizing sexual fantasies miss the mark

Categorizing sexual fantasies into “common types” can be challenging because the range of possible sexual fantasies is immense and subjective. Popular articles in magazines, as well as sexuality textbooks, frequently divide sexual fantasies according to the type of sexual activity featured in them. For example, does the fantasy involve masturbation, standard intercourse, oral sex, anal sex, threesomes, kinky sex, etc.? 

Sometimes sexual fantasies are categorized by the assumed sexual orientation of the fantasized characters or the social roles and status of a character (e.g., stranger, current partner, celebrity, neighbor, babysitter, teacher, etc.). And it’s not unusual, especially in early psychological literature, to find fantasies categorized by the “deviant” or illegal sexual behaviors they portray (e.g., fetishes, bondage, incest, rape, child abuse, prostitution, etc.). Furthermore, writings about sexual fantasies often interchangeably refer to them as “desires,” which is inaccurate and misleading.  

While fitting sexual fantasies into neat boxes may be common and sometimes entertaining, doing so tends to over-simplify, misrepresent, and trivialize the real value of sexual fantasy. 

Categories aren’t helpful if the fantasizer wants to understand why they are drawn to a particular fantasy, how it impacts them, and what they might learn from the sexual fantasy that could enhance their real-life sexual experiences. Just because a straight man fantasizes about sex with other men doesn’t mean he’s gay. And a woman who entertains sexual fantasies of being overpowered and “forced” into sex by a stranger doesn’t mean she actually wants to be raped. And if your erotic imaginings go to random images and sensations, like floating in warm water over rocky waves or listening to sexy words whispered in your ear, that doesn’t mean that what you experience and enjoy isn’t actually a sexual fantasy.

As with dreaming, sexual fantasies may best be understood when we look at them as windows into our rich and creative libidinal thoughts, rather than as mirrors of our actual desires. In my counseling and training work on sexual fantasies, I found it more productive and positive to categorize sexual fantasies in a way that shines a light on how we feel about the fantasy and what it might tell us about our sensual and emotional anxieties, needs, and preferences. 

A more revealing way to describe sexual fantasies

In my research and clinical work for my book, Private Thoughts on women’s sexual fantasies, discovered two major categories of sexual fantasies – scripted and unscripted. 

Scripted sexual fantasies are based on character roles

Scripted sexual fantasies involve characters and often follow a narrative plot or storyline. They can be further categorized by taking into consideration how the fantasizer sees themself in the fantasy, the relationship dynamics between the characters, and how sexual energy builds. From this perspective, six common types of scripted sexual fantasies appear to organically emerge:   

GOOD-LOOKER. You are the object of another’s desire. In the fantasy you see yourself as a pretty maiden, hot guy, or otherwise sexually attractive, desirable person—you don’t have to do much more than exist and someone else desires you and initiates sexual activity with you.

VICTIM. You are the object of sexual humiliation or violence. In the fantasy you see yourself as a victim of another’s sexual lust and aggression – you lack power and control and may be treated with disrespect.

GO-GETTER. You are the initiator of sexual activity. You fantasize about being  a sexual go-getter, putting yourself out there, choosing a partner, making the moves – you’re in charge and unashamed of your sexual energy, desires, needs.

DOMINATOR. You satisfy your sexual desires through exercising power and control over another person. You create scenarios in which you dominate, act, and take what you want despite how the other may feel, or what the other may want or need.

VOYEUR. You take pleasure in watching others engage in sexual activity. In these fantasies, you are a voyeur – watching and engaged from a position of being outside the action. You may be hidden or exposed to the other characters.

BELOVED. You’re intimately engaged in love-based sex with someone of equal power or status. In this type of fantasy, the arousal builds due to mutual initiation of activity, pleasuring, response, and satisfaction.

Most of us experience and enjoy more than one type of scripted sexual fantasy. You may, for example, fantasize about being a good-looker one day and a go-getter the next. Similarly, a fantasizer might have many fantasies in which they are a voyeur witnessing sexual aggression during one stage of their lives, and then at another stage when they are older, shift primarily to fantasizing two people engaging in a mutually tender, beloved sexual exchange. 

Unscripted sensual fantasies highlight sensory elements

The other main sexual fantasy category is unscripted fantasies. These focus on sensory stimuli or images and do not follow a traditional storyline or involve characters. The contents of unscripted fantasies vary widely and include fleeting images, feelings, and sensations, as well as, longer experiences such as imagining a flower slowly growing from bud to blossom, opening up, and releasing a delicious scent into the air, or gracefully diving off a diving board deep into a pool of water.  

Unscripted fantasies often contain images not normally associated with sex. It’s common for people to describe scenes from nature, such as a waterfall or storm clouds building in intensity, or other images of tension increasing and releasing, as with music surging to a climax. These images correspond with stages of the sexual response cycle in which we travel from interest (desire), to awakening arousal (excitement), to heightened strong arousal (plateau), to release (orgasm), and then to a state of calm (resolution). 

Unscripted sexual fantasies often appeal to one of our senses, as you can see in the list of examples below: 

• Visual (cascading waterfall, fireworks exploding, a nude body or body part…)

• Auditory (sexy words, moaning, the sound of slapping, music…)

• Tactile (body massage, pinching, water spray, kissing…)

• Olfactory (of body or body part, scented candle, earthy smell…)

• Kinesthetic, relating to body movement (dancing, rocking together, flying…)

• Flavor (of genital area, mouth, skin, chocolate..)

Unscripted sexual fantasies can be goldmines in terms of pointing out the sensual modes a person enjoys best in real life. Thus, if you find yourself having lots of tactile fantasies, that may indicate that touch is important to you and there’s a good chance you can up your sexual enjoyment by increasing touch-related pleasures in lovemaking. And if you realize your sexual fantasies are primarily sensual in nature, this insight can help you validate and appreciate them more for their connection to the natural world, as well as their unique erotic charge.

Fantasy types can merge and change

The line between scripted role-based and unscripted sensory-based types of sexual fantasies is not distinct. For example, scripted fantasies can be filled with important sensory elements. Imagine a “good-looker” lying naked on pink satin sheets or a “go-getter” whose leather-smelling outfit adds a critical thrill. And similarly, unscripted fantasies can hint at a storyline, as with the erotic image of galloping brazenly across a field on a beautiful horse. The possibilities are endless given how the common types of sexual fantasies can appear and swirl together during arousal.

Remember, sexual fantasies are best understood as creative outlets, erotic imaginings, separate from our regular lives. Like with dreams, sexual fantasies are not always consistent with how we see ourselves or prefer to behave. Regardless of what type they are – role-based scripted fantasies or sensually-rich unscripted fantasies – they generally serve as important psychological outlets that reduce anxieties, take us away from the distractions of everyday life, add excitement, and enhance real-life sex. 

*This definition was first shared in Private Thoughts: Exploring the Power of Women’s Sexual Fantasies by Wendy Maltz & Suzie Boss (aka In the Garden of Desire).

© Copyright 2022 by Wendy Maltz for HealthySex.com 


teens on a hillside

Why Steer Clear of Porn?

Posted on February 28, 2022 by Wendy Maltz - Featured, Porn Problem Recovery

Singer Billie Eilish made a shocking denunciation of porn on the Howard Stern Podcast, calling it a “disgrace” and admitting she used to watch a lot of it, starting at age 11. For a long time, she considered herself cool for being an advocate of porn, but looking back as a 20-year-old, she believes porn destroyed her brain. “I feel incredibly devastated that I was exposed to so much porn,” she said. Eilish attributed her problems with night terrors, sleep paralysis, and bad choices in sexual relationships to having been heavily into abusive porn as a teen. She spoke in particular of how porn distorts women’s body images and desensitizes them to harmful behaviors and sex roles. “I’m so angry that porn is so loved, and I’m so angry at myself for thinking that it was okay,” she shared.

If you’re a teenager, young adult, or even someone older, it’s not weird or “uncool” for you to be worried about the ways porn can impact sexuality and general health. Because of its ready availability on the Internet and society’s tacit acceptance, porn is having an increasingly negative impact on the personal well-being and sexuality of millions of people all across the globe. There are porn recovery websites, such as Fight the New Drug, No Fap, and Remojo app, where people talk about the often unspoken and ignored serious problems porn use can create for anyone who wants to date around or establish and maintain a healthy long-term sexual relationship in real life.

Easy exposure

Just a few decades ago, it was much harder to get your hands on porn, especially for kids and teens. And when they did find a magazine or two, it was usually not as graphic or filled with harmful images as it is today. These days, a steady stream of porn can easily be accessed on the Internet, on cable television, on cell phones, and even in video games. And much of the commercial porn contains scenes of aggression and violence which can cause real problems for anyone, especially easily impressionable young people. Due to a lack of discussion, warnings, regulation, and guidance, all of us are on our own, in the dark, about the product and its potential for harm. Many young adults today report that they feel they were tricked, betrayed, and not protected from porn’s potential for causing serious harm. 

The numbers are startling. According to statistics, one-third of us have viewed porn by age 12. One in four children with internet access are accidentally exposed to porn while online. We all know how easily that can happen. Just by typing in a search word while doing research for a class project, for example, a child can land on one of over 400 million pages of porn on the Internet. An alarming 80% of 15-17 year-olds have had multiple exposures to hardcore pornography. Surveys show that kids under the age of 18 are now some of the largest consumers of the more than $97 billion dollar global porn industry.

Formative sexual learning

When we’re young, we have a right to sexual innocence. And as we grow up, we have a right to have our sexuality advance at a natural pace, based on our own readiness and natural curiosities. It is unfair to us and our potential future partners to have this pace sped up by an industry with a primary goal of making money. 

Unfortunately, for many young people, porn elbows its way in as their first and most formative sexual experience. It has become the world’s de facto sex education system. It is easy for kids to look at it on-line and mistakenly think that it represents what sex looks like and how they should act sexually. 

False ideas about sex take hold quickly in the absence of comprehensive, science-based sex education. The lessons about sex that porn teaches have little to do with learning sexual self-care or how to approach sex in a respectful, responsible, mutually enjoyable and genuinely affectionate manner.

People who regularly use porn are frequently unaware of just how much porn they view, how much of their time they spend with it, and how the circumstances in which they view it can affect their real lives. They may not recognize when their porn interests are trending towards extreme and unhealthy themes. These factors can make a difference in whether or not they develop future sexual intimacy and relationship problems. We can all benefit from factual and honest information about the possible negative consequences and hazards of porn use and how porn-related sex differs from leading a healthy sexual life.

Seven benefits of staying away from porn

Porn presents itself as supportive, encouraging, and positive about sex, but the truth is it can disrupt healthy sexual development and lead to problems that weaken sexual health. 

If you are concerned about your or your child’s use of porn, it is helpful to realize the many benefits of staying away from porn.

Advantages of reducing contact with porn include, helping you to:

  1. Heal your brain-body chemistry. Porn can hijack brain chemistry in a way that actually harms emotional attachments and diminishes your ability to feel pleasure. If you find yourself needing more, more, more, you’ve already experienced one way porn can change your chemistry. And if you’ve tried to purge porn from your life only to find yourself going back to it when you really don’t want to, that’s your biochemistry talking.
  2. Increase your ability to be sensually and emotionally present in sex. Porn conditions us to get sexually aroused and respond to visual images and fantasies of strangers. Without it in your life, you can focus on your experience of full-body sensuality, where all your senses are alive and engaged. And without it, you are better able to tune into feelings of caring and love for yourself and your partner.  
  3. Develop your own attitudes about sex. Porn often portrays sex in unrealistic, misogynistic, callous, and sexist ways. For example, most real people don’t want to have sex immediately upon meeting someone. Anal sex isn’t a lot of folks’ cup of tea. Orgies aren’t that common. Rough sex can harm sensitive tissues. But you wouldn’t know these things if everything you’ve learned about sex has been from porn.
  4. Avoid a dependency on or addiction to porn. Having sex with porn is highly addictive for some people. Reducing or eliminating exposure can make the difference between whether or not you become hooked. 
  5. Feel good about yourself and pursue a healthy social life. Using porn can cause feelings of shame, anxiety, and inadequacy, that lead to social isolation. It can also monopolize your time so that you’re not getting out there and meeting possible real sexual partners.
  6. Feel and be more attractive to an intimate partner. Most people are turned off by the idea of a long-term partner who is heavily reliant on porn. “Regular porn user” is not a description most people are drawn to in online dating profiles.
  7. Make responsible decisions concerning your sexual health. Porn encourages unhealthy sexual practices, such as sex without consent, premature sex, sex with strangers, sex with children, sex without protection, violent sex, and more. Staying away from porn reduces the allure and influence of sexual behaviors that can hurt you and others. 

Support and caring

No matter your age or situation in life, take time to consider your feelings about pornography and whether or not you want it to be part of your sexual life going forward. Find safe people, such as trusted friends and family members (who aren’t into porn themselves), and non-judgmental and well-informed mental health professionals and clergy with whom you can openly discuss the subject of porn. Seek out quality sex education resources, such as articles, books (such as The Porn Trap), and videos produced by medical professionals and certified sexuality educators and therapists. Focus on developing a comprehensive understanding of sex that includes an accurate awareness of sexual body parts and functioning, as well as essential concepts and skills needed for approaching sex in a responsible, respectful, caring, and mutually pleasurable way. 

If you decide you want to steer your sexual interests and involvements away from the influence of pornography, it is possible. Like singer Billie Elish, many people are waking up to the harm porn can wreak on their own sexuality and deciding they prefer a life without it. 

Check out our Links section for a list of resources and organizations that offer sex education materials, help people recover from porn problems, and provide referrals for therapeutic support. 

© 2022 Wendy Maltz, HealthySex


When is a Sexual Fantasy a Problem?

Posted on February 9, 2022 by Lily McAndrews - Featured, Understanding Sexual Fantasies

Sexual fantasizing is a normal and natural mental process that can increase sexual desire, self-esteem, intimacy, sexual functioning and satisfaction. However, it’s not unusual for fantasies to occasionally make us feel confused, guilty, or ashamed. While we control many of our fantasies, others can slide into our minds like dreams, without much forethought, and seem to have a direction and will of their own. Indeed, the open, unfettered, risk-free, anything goes, nature of sexual fantasies is a large part of their delightful appeal and effectiveness.

Even when we feel good about the fact that we have an active imagination during sex, we may sometimes question whether our use of fantasy, or the contents in a particular sexual fantasy, is good for us. For instance, should we see it as a problem if we imagine sex with someone who is clearly unavailable or inappropriate? If we are in a committed sexual relationship, should we be alarmed when our sexual fantasy features sex with someone other than our intimate partner? And what if we are imagining activities that clearly go beyond our comfort zone, good health, and values?

Sexual fantasizing is such a personal, subjective experience that no one else can accurately tell you that a particular sexual fantasy is good or bad for you. And because sexual fantasy by definition is a temporary mental trip into a fanciful, otherworldly realm, no one can else can truthfully tell you a particular fantasy of yours is too extreme, too unreal, or too perverse.

The list of questions below can serve as guidelines to help you evaluate whether a particular sexual fantasy is a problem for you. These questions come from extensive research and clinical work with individuals who reported why they had concerns with their sexual fantasies [Information on the research and identifying (and addressing) problems can be found in the book, Private Thoughts by Wendy Maltz and Suzie Boss.

Evaluating Sexual Fantasy Problems Checklist

Ask yourself the following questions to help evaluate whether and to what extent, a particular fantasy may be causing you problems:

  • Is the fantasy leading me into risky or dangerous behavior in real life? (e.g., sex with someone inappropriate, unprotected sex, or sexual activity that is physically harmful}
  • Does the fantasy feel out of control, obsessive or compulsive? (e.g., it takes over your sexual experience when you don’t want it to, you can’t stop thinking it, you feel drawn to it like a drug)
  • Is the content of the fantasy disturbing or repulsive? (e.g., the scenario is emotionally upsetting, reinforces of past trauma, or causes internal emotional conflict)
  • Does the fantasy hinder recovery or personal growth? (e.g., you turn to it instead of addressing psychological, relationship, or addiction-related concerns)
  • Does the fantasy lower my self-esteem or block self-acceptance? (e.g., it makes you dislike yourself, normalizes mistreatment by others, or generates shame)
  • Does the fantasy distance me from my real-life partner? (e.g., it makes it difficult to emotionally and intimately connect with your partner, accept your partner, or feel worthy of intimate affection)
  • Does the fantasy harm my intimate partner or anyone else? (e.g., it encourages or leads to behaviors that jeopardize your partner’s health and happiness)
  • Does the fantasy cause sexual problems? (e.g., diminish sexual desires for a real partner, generate sexual dissatisfactions, interfere with sexual functioning and pleasure)
  • Does the fantasy really belong to someone else? (e.g., you feel like a role you have to play, it feels forced upon you, or does not feel of your own design or desire)

If one or more of your fantasies check some of these boxes, keep in mind that the extent of the problem may be related to how often you have fantasies that you find disturbing. Just as we may occasionally have nightmares, it’s usually only when they recur and interfere with our daily lives that we may want to examine the underlying cause and find ways to stop having them. Remind yourself that your fantasies – especially those that come unbidden – do not define you.

A number of effective techniques exisit for dealing with troublesome fantasies. They include reducing stress during sex, increasing present consciousness and communication, and changing the contents of the fantasy. When upsetting sexual fantasies persist, it is a good idea to seek therapeutic help from a therapist or sex therapist who is skilled in helping individuals take a closer look at the contents of the fantasy and lessen its power. (For more detailed suggestions on how to effectively address fantasy concerns, see “Healing Unwanted Sexual Fantasies” )

Sexual fantasies are not fixed in stone, they are constantly changing. As the fantasizer, you have the ability to influence and shape what goes on in your erotic imagination during sexual desire, arousal and pleasure. And, if you’re not happy with particular sexual fantasies, you can create new ones that you like better. (For specific suggestions, see “Creating New Sexual Fantasies”) From a position of knowledge, openness and power, you can enjoy a whole world of sexual fantasies that are optional, harmless, fun, inventive, sexually exciting, and exquisitely satisfying.

© Copyright 2022 by Wendy Maltz for HealthySex.com


The CERTS Model for Healthy Sex

Posted on February 9, 2022 by Wendy Maltz - Sex & Love

We believe the following five basic conditions are key to creating experiences that are sexually healthy and mutually rewarding:

Consent, Equality, Respect, Trust, and Safety

Let’s look at each of these conditions more closely:

CONSENT means you can freely and comfortably choose whether or not to engage in sexual activity. This means you are conscious, informed, and able to stop the activity at any time during the sexual contact.

EQUALITY means your sense of personal power is on an equal level with your partner. Neither of you dominates or intimidates the other.

RESPECT means you have positive regard for yourself and for your partner. You also feel respected by your partner based on how your partner is treating you.

TRUST means you trust your partner on physical and emotional levels. You accept each other’s needs and vulnerabilities and are able to respond to concerns with sensitivity.

SAFETY means you feel secure and safe within the sexual setting. You are comfortable with and assertive about where, when and how the sexual activity takes place. You feel safe from the possibility of negative consequences, such as unwanted pregnancy, sexually transmitted infection, and physical injury.

Spending time together and engaging in lots of honest, open communication are good ways to make sure that the CERTS conditions are in place. Thus, it’s helpful to become friends with a desired sexual partner first and talk about sex, before becoming physically involved as lovers. Since the overall goal in healthy sexuality is mutual pleasure and satisfaction, these conditions work best when mutually understood and agreed upon.

Meeting the CERTS conditions does not ensure that you’ll experience terrific sex, but it can help you feel secure knowing you’ve minimized the possibility of negative consequences and maximized your potential for positive, mutually enjoyable sexual experiences.

(These five CERTS conditions were first presented in Wendy Maltz and Beverly Holman’s, Incest and Sexuality: A Guide to Understanding and Healing, Lexington, MA: Lexington Books, 1987.)


Sexual Health Risks Checklist

Posted on February 9, 2022 by Wendy Maltz - Sex & Love

Healthy sex involves being safe from negative physical consequences. You need to know how to protect yourself and your partner from serious health problems, such as sexually transmitted diseases and infections (STDs), injury, and unwanted pregnancy. It is important to stay informed and up-to-date on the latest information about disease prevention and birth control.

  • Read books, pamphlets and brochures from your local health department or library.
  • Check out the information on reputable health education web sites.
  • Regularly visit and talk with your health care provider.
  • Learn about risks, options, and self-care exams

And then, make wise decisions so that you can do all that is possible to minimize the risk of something negative resulting from your lovemaking.

To test your knowledge of health risks involved in sexual activity, read through the following HealthySex Risks Checklist. This list does not cover all the risks involved in sex.

Everyone should know these facts, DO YOU?

  1. There is no method of contraception that is 100% effective.
  2. A woman who does not use any form of birth control has an 85% chance of getting pregnant within one year.
  3. For birth control methods to be effective, they must be used correctly and consistently.
  4. Taking medications, such as antibiotics, can reduce the effectiveness of birth control pills.
  5. When used correctly, condoms (rubbers) can greatly reduce the risk of pregnancy and STDs, such as Herpes, Gonorrhea, Syphilis, Chlamydia, Hepatitis B, and AIDS.
  6. About 1 in 5 people in the U.S. currently have an STD/STI, more than half are youth ages 15-25 years old.
  7. About 50% of all people will get an STD/STI at some point in their lifetime.
  8. Every year, there are about 20 million new cases of STDs/STIs, some of which are curable.
  9. STDs can be passed from one person to another through vaginal, anal or oral intercourse.
  10. Some STDs, such as syphilis and herpes, can be passed through kissing.
  11. Birth control pills and diaphragms do not protect against STDs.
  12. Though the likelihood of getting genital warts can be decreased by condom use, contagious warts may exist elsewhere (such as on buttocks, inner thighs, outer lips).
  13. Dental dams or plastic wrap need to be used in oral sex to prevent the transmission of STDs.
  14. For additional protection against pregnancy, latex condoms can be used in conjunction with a spermicide. (However, if a person is allergic to spermicide, the resulting irritation can increase the potential for sexually transmitted infection).
  15. When using a latex condom it is very important that you DO NOT use an oil-based lubricant (such as massage oil, baby oil or Vaseline). Oil can damage the latex very quickly destroying the condom. (Use water-based lubricants, such as Astroglide or K-Y jellie or liquid instead).
  16. Many people with STDs, such as Gonorrhea, HIV+, Chlamydia, and Herpes, show absolutely NO visible symptoms.
  17. Medical tests can determine if you or your partner have an STD.
  18. Some STDs can be easily treated and cured.
  19. Some STDs may stay in the system causing health problems or requiring medications forever.
  20. Some STDs, such as Chlamydia and Gonorrhea, can cause sterility in a man or a woman, rendering them unable to ever conceive a child.
  21. The more sexual partners you have the greater your risk of acquiring an STD.

For more statistics, visit the Center for Disease Control website.


The Maltz Hierarchy of Sexual Interaction

Posted on January 21, 2022 by Wendy Maltz - Featured, Sex & Love

You will need a clear understanding of sexual energy, in all its possible expressions, to set a healthy course for yourself. This thoughtful, empowering journal article presents a simple model to help. It explains how the conditions that exist in our interpersonal relationships hold the key to creating positive sexual experiences. 

“Only one who, tragically, has never experienced love would question whether sex can be fulfilling when love is absent. Physically satisfying, perhaps, but never fulfilling. It can never reach the depths of what we are as human beings, and what we are capable of becoming [emphasis added]. To climb the heights, sex education is not enough. We need to learn how to love.” (1)

– Joseph and Lois Bird, Sexual Loving

Sexual energy is a powerful force in our society. Like water, it can be channeled for constructive, noble purposes, or left untamed to wreak potential damage and destruction. If we hope to direct sexual energy in a positive way, towards a safer society in which people have more fulfilling interpersonal experiences, we need to construct a goal-oriented paradigm that provides guidelines for evaluating sexual behavior within the context of relationships.

The need for a new model

In my twenty years of work as a sex therapist and researcher, I have encountered thousands of people suffering from sexual problems caused by negative sexual experiences, such as, sexual addiction, sexual abuse, sexually transmitted disease, and unwanted pregnancy. These negative sexual experiences have become more prevalent in our society and are tragic consequences of mis-channeled sexual energy. (2)

It can be difficult for people who have been exposed to negative sex to conceptualize sex as potentially positive and healthy. Traditional sexuality models which focus simply on the need for consent between two adults, or on how to improve sexual pleasure, ignore the complex circumstances, distinguishing factors, and serious consequences of contemporary sexual interactions. Lacking a different way to conceptualize sex, recovering sex addicts and others may jeopardize their healing because they fail to aspire to sex that is more than a commodity or a performance.

I have developed a new model to assist in sex education, sexual addictions recovery and therapy. The Maltz Hierarchy of Sexual Interaction is an attempt to offer both men and women, regardless of sexual orientation, a progressive framework for understanding and evaluating sexual behavior. Because it describes conditions for optimum sexual interaction, it can help individuals grow and evolve as sexual beings, channeling their sexual energy toward more deeply fulfilling interpersonal experiences.

In other fields, such as psychology, we have seen the benefits of looking at human behavior according to such models. Maslow’s model for the hierarchy of human needs, (3) for example, sets out a continuum along which one can progress from a foundation of safety and trust toward self-actualization. Erikson’s model for the stages of human development is helpful as a tool to help us understand universal truths about growth and maturity. (4)

Why have we lacked a similar model for understanding human sexuality? Our cultural attitudes have been in the way. Until very recently in human history, information about sexuality was obscured by a moralistic, puritanical veil. (5) Prevailing social mores taught for generations that normal, healthy human sexuality was, at best, a taboo subject, and, at worst, a source of guilt and shame. The body was seen as the receptacle of sin, and sexual feelings were seen as intrinsically bad and dangerous.

During the generations when patriarchal thinking dominated our culture, women were defined as the property of men. A woman’s sexual behavior, whether or not she was virginal before marriage and faithful once married, determined her worth in society. Sexual repression became a way men insured dominance over women. It was commonly assumed that women had few sexual desires or needs of their own.

Another social mindset limited men’s sexual behavior. Men were supposed to be in control, in charge, of sexual relating. Non-aggressive, “intimate” sexual expressions were condemned as effeminate. And only certain sexual practices–typically, those leading to procreation–were defined as acceptable. Hence, the once-common teachings that masturbation could lead to insanity, or that anal sex or homosexual sex were “perverse” or “unnatural.”

According to the most rigid religious teachings, sex has been defined as only for procreation, not for pleasure. These attitudes have persisted, even though we know that humans have an awakened sexual interest well past their child bearing years. Unlike other animals, humans experience sexual desire throughout the year, not only during a mating season. Our sexuality is linked with our intrinsic human desire for love, for connection, for community. (6)

Although the notion of romantic love dates back for centuries, due to religious doctrines and cultural attitudes, it was not until the sexual revolution of the 1960s that we begin to throw off those trappings of guilt, and embrace our sexuality as something to discuss, to enjoy, to celebrate.

Perhaps, now, three decades after the sexual revolution, we have reached a time when we understand enough about sexuality, we understand enough about the possible repercussions of sexuality, and we understand enough about human growth that we can benefit from a new model for sexual relating — a model that offers guidance, without leading us back to moralistic myopia or sexual repression. This would not have been possible 25 or 100 years ago. But given what we have learned about sexuality in recent decades, and given our increasingly egalitarian society, perhaps we are ready to move forward.

Interpersonal conditions are key

The Maltz Hierarchy of Sexual Interaction model is predicated on the notion that certain conditions shape the nature of sexual interaction — whether it is experienced as healthy or hurtful. This way of evaluating sex according to conditions has become popular in the fields of sexual abuse,(7,8) sexual addiction, (9) and sex education. (10) Conditions such as consent, equality, respect, trust and safety lead to healthy interactions, while conditions of dishonesty, disregard for physical safety, domination, objectification and shame lead to negative interactions.

Within this model, we don’t automatically judge specific sexual behaviors. Instead, we look at the context in which any behavior takes place. In a certain context, for example, spanking might be seen as lighthearted and playful, a way to enhance arousal. In another context, the same behavior could be humiliating, painful or degrading. Similarly, marital intercourse in one context could be experienced as intensely passionate, while in another, as spousal rape.

For this model, we look at both the context and the consequences of any sexual behavior. Sexual energy can unite a couple in a dance of tenderness and passion, heightening their self-awareness and strengthening their self-esteem and commitment to one another. Or, if used in a violent act like rape or humiliation, sexual energy can shatter trust and destroy one’s sense of self-worth and safety.

Two main directions

According to the Maltz Hierarchy, sexual energy is channeled along one of two routes: the path to disintegration and disconnection, or the path to integration and connectedness (see Figure 1). The positive qualities build and intensify as one travels upward and the negative qualities build and intensify as one travels downward in the model. To help explain the hierarchy, I encourage individuals to visualize sexual energy as “ground zero,” like the lobby level of a hotel. Here, sexual energy enters our lives as a benign natural force. Neither good nor bad, this energy is a continuous influx of our drives and hormones.

Figure 1

Three negative levels and three positive levels

We each have a choice to make, in how we direct this energy. The path to disintegration, the underground levels in the hotel, leads to negative repercussions (-1: Impersonal Interaction; -2: Abusive Interaction; and -3: Violent Interaction). The path to connectedness, leading eventually to authentic intimacy, is all positive and “above ground” (+1: Role Fulfillment; +2: Making Love; +3: Authentic Sexual Intimacy). By designing the model this way, with two divergent paths, it illustrates that positive relating is distinctly separate from negative behavior (see Figure 2). Which way will we take the elevator from the lobby? On which level will we exit? We can choose how we channel our sexual energy.

Figure 2

Negative direction levels

Level -1: Impersonal Interaction

This first level of destructive sex involves a lack of responsiveness to one’s own, or one’s partner’s personal experience and safety. This is the realm in which partners operate out of ignorance, denial, callousness, and self-centeredness. Level -1 is commonly seen in situations such as engaging in unprotected sex, sex under the influence of drugs or alcohol, dishonest circumstances, legal forms of compulsive or addiction-driven sex, and sex which is endured though upsetting or painful. Regret and sexual shame are generated. Partners are depersonalized and sexually objectified. The sexual interaction ends up being at someone’s expense.

In Level -1 one or both partners may act dangerously. A woman client evaluated a sexual interaction she experienced as -1 because she had unprotected sex with a stranger she met in a bar. While both she and her partner consented, the manner in which she approached the sex put herself and possibly her partner at risk of emotional and physical harm. A male client rated the extra-marital affair with his secretary as -1 because of the possible future harm that could come to him (if his secretary accused him of sexual harassment), and to his wife (when she learned of the affair), and to his secretary (if she fell in love with him). (11)

At Level -1 sexual partners are more misused and misunderstood, than intentionally abused. Because the sexual behaviors in Level -1 are legal, sex addicts may rationalize a lot of sexual acting out at this level as harmless. Individuals may find themselves stuck in this level due a wholesale adoption of societal myths, such as: Sex is uncontrollable; People are objects; Sex is a way to get love; Females should be sexually subservient to males; and, Men must adhere to rigid standards of sexual performance.

Level -1 interaction is automatically “chosen” when couples fail to insure on-going mutual consent or fail to use protection against sexually transmitted disease and unwanted pregnancy. Without mutual respect and responsibility, sex can become an act of reckless endangering with unpleasant, sometimes serious, negative consequences.

Level -2: Abusive Interaction

At this level, sexual relating is an act of conscious domination and exploitation. One person acts to control the other person through psychological pressure or manipulation. Level -2 is commonly seen in situations of non-violent acquaintance rape, spousal rape, and incest, but can include situations of public or private humiliation. The victim, trapped in a submissive role, is seen as an object, with no options to change or control what is happening. The dominant perpetrator tricks or degrades the other person, damaging the other’s self-esteem and trust in the process.

In Level -2, perpetrators often act from a position of feeling entitled to sexual contact. They frequently suffer from distorted thinking, which attempts to rationalize or deny the personal harm they cause the victim. One female client’s father coerced her into sex with him during a time when she was a teenager and her mother required hospitalization. He told her that sex was her duty as the next oldest female in the family.(12)


In Level -2, communication is colored by lies, put-downs, shaming, threats, manipulation and coercion. Victims may feel paralyzed to effect change in the sexual interaction due to their innocence and fear. Because of the exploitation and coercion involved, Level -2 sexual behavior is often against the law.

Level -3: Violent Interaction

This is the lowest, most disintegrated and disconnected level. Here, the perpetrator incorporates abusive traits from the previous level, and also strives to have absolute control over the victim. Sexual energy is purposefully employed to express rage and hostility. Sexual pleasure is rigidly defined, perverse and often ritualized. The perpetrator may operate in a preprogrammed, almost mechanical way, strongly dissociating from his or her own body. Sex organs are weapons and targets. In this level, we find warped thinking, to the extent of serious psychological disturbance and pathology. In the extreme, this is the zone inhabited by serial killers and cult abusers who sexually torture their victims for sadistic pleasure. In such cases, the perpetrator carries control to the extreme of deciding whether the victim may live or die.These underground levels become progressively constricted. As one travels downward, the interpersonal options decrease and the negative consequences intensify. Eventually, sexual experience is merely a sideline to an act of murder.

Due to the progressive, escalating nature of sexual addiction, sex addicts can slide lower on the hierarchy, as they seek the excitement of more risky and shame-filled sexual behaviors.(13)

At lower levels, sex is not a journey that two people willingly take together, but an upsetting or traumatic ordeal imposed on one person by another. The person in the submissive role may have his or her self-image and sense of sexuality seriously damaged by the sexual experience. A person who is treated as an object may begin to see himself or herself in this way. Especially if a victim is young or lacks other life experiences for reference, these negative encounters can become primary experiences. Tragically, as a result, victims may view sex as bad and themselves as dirty or disgusting. Future sexual relationships may be wrought with fear, suspicion, and sexual shame.

People who experience negative sex may require years of therapy to overcome the emotional, sexual, legal, social, and spiritual repercussions that follow. The damage incurred on these lower levels is not limited to the couple, but resonates into the lives of family members and others in the larger community.

Now that we have looked at the worst ways sexual energy can be channeled, let’s go back to the imaginary lobby and, looking upward, consider the positive expressions of sex in human relationships. Keep in mind that these “upper floors” are built on conditions of mutual choice, caring, respect and safety.

Positive direction levels

Level +1: Role Fulfillment

This is the first level on the path to connectedness, leading to enhanced self-esteem, integration and positive intimate bonding. At this first level, sexual energy is channeled in terms of social customs, typically based on well-defined gender roles. Society provides a template for such behavior, defining how partners should meet, how sexual relating is initiated and who does what to whom within the relationship. In heterosexual relationships, the male is assertive, the initiator. The female is passive. Sexual repertoire is limited, and, because the relationship is built on shared assumptions, there may be little communication.

Level +1 is often the setting for new relationships, courtship, and for couples who follow strict religious doctrines or particular cultural prescriptions. Thus a wife may agree to sex to please her husband even when she isn’t feeling particularly interested. Her husband doesn’t force her and she doesn’t feel coerced. By participating, she gains some positive sense of herself as one who fulfills what she considers to be her wifely duty. A sense of fairness exists because the wife perceives her husband as having duties that he must honor as well. Obviously, Level +1 would not be the level of choice for feminists. They might see this sexual scenario as destined to slide downward into Level -1 and Level -2.

Still, partners can enjoy a sense of safety and satisfaction within this level of relating. They know what’s expected of them, and they know which acts are acceptable and which are taboo. There is mutual respect, physical safety and commitment to a relationship. These aspects are generally positive, enhancing self-esteem. For a recovering sex addict, establishing the conditions of respect, safety and caring essential for this level, can be a major accomplishment. If we think of sex as a journey, these partners would be boarding a tour bus, with a scheduled route and destination. The predictability of their choice offers security, helping them avoid anxiety and chaos if their travels should take them to unfamiliar territory.


However, positive role fulfillment is ultimately limiting. Sex can become boring and relied on mainly for drive reduction. There’s little creativity. Partners can easily get stuck in their roles, lacking opportunities to talk about or experiment with other ways of channeling their sexual energy. Thus, a man who is naturally passive forces himself to be the initiator. A woman who would be better as the initiator remains passive. They don’t communicate about intimacy, or risk breaking free of their roles. Staying in Level +1 leaves couples with few options for enhancing sexual pleasure and deepening emotional intimacy.

Level +2: Making Love

In this level of relating, the partners focus on creating mutual pleasure. They break out of prescribed roles, giving one another permission to experiment, to express individuality and creativity through intimacy. Partners share a view that sex is special, worth learning more about and enhancing. They are willing to talk about sex, to try out different positions and stimulation techniques. They may plan special times for intimacy. The sexual fulfillment needs of both partners are taken into consideration in sexual interaction.

At this level, sex becomes a celebration of the body — recreation mixed with personal caring and sensual sharing. Through experimentation and exploring, partners learn to recognize different levels of experience that are possible in sexual pleasure. Recovering sex addicts learn they can express and receive caring through very passionate erotic touch. For inspiration, guidance or reference, couples may consult such books as The New Joy of Sex (14) or Dr. Ruth’s Guide for Married Lovers.(15) This is the sex of steamy Hollywood love stories, romance novels, and soft porn. This is what many of us in the last thirty years have been led to believe is the ultimate in sexual relating.

Although they have broken free from stereotypical roles, partners on Level +2 may feel another, more subtle, pressure: to be “good lovers.” They may feel they have to be able to perform, to be sexual gymnasts. They may see orgasm — even mutual or multiple orgasms — as a goal they are expected to reach. If they see sex as a journey, they might envision a scenic care ride, stopping at delightful resorts and gourmet restaurants enroute. They can plan their own trip, focus on pleasure, and take time on the way to their destination.At this level, partners reveal more of themselves and are thus able to feel more intimately connected. The shared sexual enjoyment can create a pleasure bond which increases feelings of mutual caring and specialness.


Level +3: Authentic Sexual Intimacy

This is a natural outgrowth of Levels +1 and +2, emerging from the established qualities of respect, safety, communication, mutual commitment, sensual pleasure, and love. It is the roof garden level on the top of our imaginary hotel. Authentic relating may be a momentary peak experience, or overlay a whole lovemaking experience. When it happens, there is a shared sense of a deep connection, a reverence toward the body and toward one another. During lovemaking, while enjoying sensual pleasure, partners have a consciousness of really expressing love for the other person.

When sex becomes an act of conscious loving, it can open up new dimensions in the relationship.(16) Partners may feel a spiritual connection or sense of ecstasy as their two selves merge, but are not lost in one another. Through this merging, each gains a greater sense of his or her own wholeness. While they cannot plan for these transitory moments of ecstasy and communion, partners who glimpse this level of relating draw on tools they have learned together. They feel secure and safe in the relationship. They communicate easily, knowing they are able to stop and talk at any time. They are aware of the full range of sensual activities and pleasures. They share a sense of freedom, knowing they can go where they want, together. But rather than using sex to get to a specific place, couples recognize that the moment they are sharing on this deeper level is their destination. Emotional honesty and intimacy are more important to the total experience than how long sex lasts or whether either of them climaxes. When they are authentically in the moment with one another, they have arrived.

For the recovering sex addict, achieving this level of sexual intimacy represents a release from old psychological attachments to sex. Being real and feeling close are more important than engaging in a particular sexual activity. The power of sex has been transcended.


If sex is seen as a journey at Level +3 the options for travel are limitless. How and where a couple travels is less important than just being together with whatever they are experiencing. They open to sensual pleasures and feelings of the heart and let the sexual energy fuel them on a magic carpet ride.

A fluid model

Although this model for viewing sexual relating is a hierarchy with authentic sexual relating as the pinnacle, it is also a fluid construction. Partners are never locked into only one way of relating, nor are two partners necessarily experiencing a relationship on the same level. Some examples: A couple may be making love when one partner tightly holds down the other’s wrist. The other partner may communicate discomfort and ask to be released. If that does not occur, their relationship would, at that moment, shift down the hierarchy to violent sexual relating. Similarly, partners who have always stayed within prescribed roles may one day decide to experiment or talk about trying new ways of relating. Their relationship thus moves up the hierarchy, with pleasure as a new focus.

The levels in the hierarchy are not rigidly distinct. They may merge into one another, like colors in a rainbow. A moment of high arousal in making love may suddenly awaken a sense of deep honoring and shared intimacy with one’s partner. Thus, a particular sexual encounter may include a combination of various attributes from different levels.

Helpful in recovery and healing

When I show this model to couples in my practice and we discuss the different ways they can channel sexual energy, they gain an awareness of the different interpersonal skills necessary at different levels of relating. For example, the nature and content of communication become more personal as one moves up the positive levels of the hierarchy. A recovering sex addict may need to develop skills for self-awareness and disclosure, before being able to achieve the degree of honest communication required for Level +3.

The hierarchy also provides couples in therapy with a model to help them understand where they are now, and where they may be evolving within their relationship. As couples begin to sense that they can enhance their relationship — by learning how to move up the hierarchy — they often experience a feeling of pride. They realize that they are progressive as a couple and that they can progress further as they experience the pleasures of relating more authentically.

For survivors of sexual abuse, this model can help them to understand the negative repercussions of the abuse and the possibility for other, more positive kinds of sexual relating. They see graphically that sexual energy can be channeled in an entirely different direction than what they experienced during abuse. They see, for example, that arousal can occur in a context that is not tinged with shame, fear or pain. They see the possibility for sexual intimacy to be nurturing, beautiful, and life-affirming.

For victims of abuse and their partners, sexual recovery requires a level of communication and emotional honesty which goes beyond the standard in our society. Someone who has never been abused may never have developed some of these skills nor ever have expected to master them to enjoy a satisfying sex life. If, for example, a husband has been operating in a role-based model of relating he may assume that his role is to be kind to his wife, and that hers is to have sex with him whenever he initiates it. Because of cultural messages, he may assume that is how she shows her love for him. But if the woman is a survivor of abuse, she may have flashbacks triggered by his demands for sex.(17)

In recovery work a therapist may ask the husband to be patient, to listen, to respect his wife’s need for comfort and safety, to develop a deeper sensitivity to her needs. This may involve communication skills he has never learned. But when he sees the hierarchy model, he may finally understand why he needs to develop such skills to help his wife relate with him sexually. The attributes he acquires higher up on the hierarchy clearly distinguish him from an offender. He also learns that the changes he makes will enable him to advance in his own sexual enjoyment and satisfaction.


In addition to its application as a tool in therapy, sexual addiction, and sexual abuse recovery work, this model can be useful in sex education. It helps people realize that the nature of our sexual behavior has to do with the choices we make. To make healthy choices and have positive experiences, we need to recognize interpersonal dynamics as much as learn safe sex practices and pleasuring skills. Similarly, since it emphasizes the differences between abusive and healthy sex, this model can also be used in rape prevention and sex offender treatment.

Another benefit of this model is that it is not based on heterosexuality. It respects different sexual orientations. Because the focus is on the interpersonal context rather than on specific behaviors, this model has universal applications for any two persons in a relationship.


Far from encouraging sexual repression, this model strives to increase our capacity for a higher level of sexual interaction. It complements recent trends in therapy that promote equality, fairness, mutual respect and deeper intimacy in relationships. The hierarchy can inspire couples to create long-lasting, more satisfying sexual lives together.

If authentic sexual relating were to be embraced as a broader social goal, imagine the benefits to our communities. Our media might offer tangible images of authentic intimacy, rather than the current focus on exploitive sex. If the skills required for authentic relating were the norm, we would reduce the likelihood that sexual energy would get channeled in destructive, violent, abusive ways. Similarly, the increased honesty in communication and respect for the body would decrease the spread of sexually transmitted diseases. All of these are sex-positive benefits, rather than a lapse into the repression of a more puritanical era.

If sex is truly like water, it is both life-sustaining and a source of tremendous energy. As a society, we are willing to plan for the quality and uses of our water. If we allow sexual energy to go undirected, we are opening the floodgates to sexual abuse and harm. We can only benefit by channeling this natural energy to positive, life-affirming purposes.

REFERENCES

  1. Bird J, Bird L: Sexual Loving. Garden City, Doubleday, 1976.
  2. Thirty Years. SIECUS Report 22(4), 1994.
  3. Maslow A: Toward a Psychology of Being. Princeton, Van Nostrand, 1968.
  4. Erikson E: Childhood and Society. New York, Norton, 1963.
  5. D’Emilio J, Freedman E: Intimate Matters. New York, Harper & Row, 1988.
  6. Richards D: The Moral Criticism of Law. Encino, Dickenson, 1977.
  7. Maltz W, Holman B: Incest and Sexuality. Lexington, Lexington Books, 1987.
  8. Maltz W: The Sexual Healing Journey. New York, HarperCollins, 1991.
  9. Carnes, P: Don’t Call It Love. New York, Bantum, 1991.
  10. Reiss, I: Sexual Pluralism: Resolving America’s Sexual Crisis.SIECUS Report, 1992.
  11. Author’s clinical files, 1994.
  12. Ibid.
  13. Carnes, P: Out of the Shadows. Minneapolis, CompCare, 1983.
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  14. Comfort A: The New Joy of Sex.. New York, Crown, 1991.
  15. Westheimer R: Dr. Ruth’s Guide for Married Lovers. New York, Warner, 1986.
  16. Gramunt M: Sacred Sex. Yoga Journal, May/June: 58-140, 1994.
  17. Maltz W: Identifying and Treating the Sexual Repercussions of Incest. J Sex & Marital Therapy, 14(2): 142-170, 1988.

© 1995 Wendy Maltz (all rights reserved), 2022 for HealthySex

Note: “The Maltz Hierarchy of Sexual Interaction” by Wendy Maltz, LCSW DST, was first printed in Sexual Addiction & Compulsivity, Volume 2, Number 1, 1995. Special thanks goes to Dr. Patrick Carnes, Ph.D., editor of the journal for special permission to reprint the article on www.healthysex.com.


Couples Trust Contract

Posted on January 19, 2022 by Wendy Maltz - Sex & Love

Trust is an important quality in healthy sex. It helps us feel emotionally safe and secure about choosing to remain in an intimate relationship with a partner. Without trust, we’re likely to feel growing amounts of anxiety, fear, disappointment, and betrayal.

Trust grows when both people in the relationship act responsibly and follow through with commitments. While no one can guarantee that any relationship will last and remain satisfying for both people, you can strengthen mutual trust by having a clear understanding of what you expect from each other in the relationship.

Spend time with your partner discussing what you need and expect in the relationship for you to feel emotionally safe. From you discussion, create a list of understandings you will both agree to honor. You may want to formalize your list into an actual “contract” you will follow.

A Sample Healthy Sex Trust Contract

These mutual understandings are often important to building trust in a healthy sexual relationship. Feel free to use this sample list to help you and your partner generate your own set of relationship ground rules.

We agree that:

  1. It’s okay to say no to sex at ANY TIME.
  2. It’s okay to ask for what we want sexually, without being teased or shamed for it.
  3. We don’t ever have to do anything we don’t want to do sexually.
  4. We will take a break or stop sexual activity whenever either of us requests it.
  5. It’s okay to say how we are feeling or what we are needing at ANY TIME.
  6. We agree to be responsive to each other’s needs for improving physical comfort.
  7. What we do sexually is private and not to be discussed with others outside our relationship unless we give permission to discuss it.
  8. We are each ultimately responsible for our own sexual fulfillment and orgasm.
  9. Our sexual thoughts and fantasies are our own and we don’t have to share them with each other unless we want to reveal them.
  10. We don’t have to disclose the details of a previous sexual relationship unless that information is important to our present partner’s physical health or safety.
  11. We can initiate or decline sex without incurring a negative reaction from our partner.
  12. We each agree to be sexually monogamous unless we have a clear, prior understanding that it’s okay to have sex outside the relationship (this includes virtual sex, such as phone or Internet sex, or using pornography as a sexual outlet).
  13. We will support each other in minimizing risk and using protection to decrease the possibility of disease and/or unwanted pregnancy.

© 2007, 2022 Wendy Maltz, all rights reserved


Out of the Shadows – Is Porn Bad for You?

Posted on January 18, 2022 by Wendy Maltz - Featured, Porn Problem Recovery

In this highly acclaimed and still relevant article, Wendy provides a moving personal account and clinically-based overview of how pornography has changed in the last fifty years from a relatively benign, even therapeutic, source of entertainment to an extremely powerful product capable of harming individuals, relationships, sexuality, and public health.

Article Table of Contents

  1. How we feel about porn
  2. A peephole to adult pleasure
  3. Liberating adult entertainment
  4. A therapeutic intervention
  5. A cousin to sexual abuse
  6. A possessive mistress
  7. A drug
  8. A threat to public health
  9. Five key questions 

by Wendy Maltz

Porn is an easy outlet, a one-way outlet. What a rush! What a release! The Internet puts an endless stream of images at my fingertips. I’ve conveniently conned myself thinking it’s okay, but deep down I know it’s wrong. It makes me feel dirty and has hurt my relationship with my wife. I beat myself up afterward, hate myself, and swear that was the last time. But before I know it, I’m back at it again. I’m scared where it’s leading. Can you help me?”

— Scott , 44 years old

Scott, a successful lawyer with a wife and two children, showed up at my office for his first session confused and angry about his relationship with pornography. He could see the damage his internet porn habit was having on his marriage, health, and career, but he couldn’t stay away from it. His story is typical of men and women of all ages, backgrounds, incomes, and lifestyles who are seeking counseling for serious problems related to pornography.

When I began counseling in the mid-1970s, cases like Scott’s were rare and almost inconceivable. Hardcore pornography was difficult to obtain. But in recent decades, new technologies, such as cable television, computers, and iPhones, have transformed it into a product that’s available to anyone, anytime, anywhere, and often cheap or free. It’s become a substantial part of our economy, boasting annual revenues in excess of $13 billion dollars in the United States and $100 billion dollars worldwide.

The revolution in accessibility has led to record consumption. According to statistics on the Internet Filter Review site, 40 million Americans visit internet porn sites at least once a month. Some porn users visit sites for only a few minutes at a time. Others, like Scott, visit them daily, spending more than 15 hours per week. One-third of all downloads each month and one-quarter of all online searches each day are for porn. And, according to a 2008 Nielsen Online survey, a record-breaking 25 percent of employees in the United States are accessing porn at work, despite the risks involved.

Not surprisingly, concerns about the effect of porn on individuals and relationships are also on the rise. According to a 2004 survey in Men’s Health, more than 70 percent of the men surveyed said they’ve looked at more porn since the advent of the internet, and one in two expressed concern about their use of it. The American Academy of Matrimonial Lawyers and the British Nielsen NetRatings organization have identified it as a major cause of divorce and relationship difficulties. An MSNBC study in 2000 revealed that 70 percent of porn users keep their use secret and that from eight to 15 percent of regular Internet porn users develop compulsive sexual behaviors that significantly impact their lives. In total, up to half of all regular pornography users report some type of negative consequence or concern about their use. No wonder sexual addiction experts, such as Patrick Carnes, have begun calling pornography addiction “our newest and most challenging mental health problem.”

Changes in how people access and use pornography have taken the therapeutic community by surprise. The explosion in porn use has happened so fast that many therapists have been caught unprepared; they may not yet comprehend the extent of the problems porn can cause, or how deeply its use can harm individuals and their intimate partners. Despite the increase in the number of people suffering from anxiety, depression, sexual problems, relationship distress, and other serious consequences of habitual porn use, few therapists feel comfortable and confident in addressing porn-related concerns.

How we feel about porn

Pornography draws strong responses – from the public at large and within the therapeutic community. Many of us have such strong feelings about pornography that we automatically label, condemn, or reject anyone who sees it differently. If we’re critical of porn, we might judge people who like it as “excessively permissive,” “exploitive,” “addicted to sex,” or “misogynistic.” If we’re supportive of porn, we may see those who don’t share our view as “sexually uptight,” “religiously conservative,” “radically feminist,” or “against free speech.” Unlike other common mental health concerns, such as depression or substance abuse, we have no reasonably coherent and agreed upon clinical perspective for what constitutes a “porn problem” or how to approach it.

Recently, at a professional training, I asked a group of therapists to share their knee-jerk feelings about pornography. The answers came quickly and from all over the emotional map: “disgusted,” “excited,” “angry,” “anxious,” “saddened,” “afraid,” “horny,” “repulsed,” “ashamed,” “shocked,” “amused,” “curious,” and “ambivalent.” I wasn’t surprised by the range of feelings: I’ve had all those feelings myself, even though I’ve been a sex and relationship therapist for 35 years.

In the past, understanding and dealing with our personal reactions to porn may not have been that important to our success as psychotherapists. But today, when clients who develop problems with porn range from 90-year-old men to 9-year-old girls, examining our own attitudes about porn is critical to our success as healers. Without an informed understanding of porn and its effects, we can easily discount clients’ concerns or respond to them in unhelpful, emotionally reactive ways. A study in the January-March 2009 issue of Sexual Addiction and Compulsivity by Michelle Ayres and Shelley Haddock found that therapists’ personal attitudes about pornography play the strongest, most significant role of any factor, including training and clinical experience, in influencing their approach to treatment.

I’ve been thinking about how significantly my attitudes towards pornography have changed during the course of my life and counseling career. To a large extent, my personal journey reflects the evolution of pornography from a product that was hard to get to an experience that can be hard to avoid.

A peephole to adult pleasure 

It was 1961 and I was 11 years old – the average age of first exposure to pornography -when a neighbor girl showed me some picture cards she’d found in her grandfather’s nightstand. They featured pretty women in frilly corsets, posed to reveal breasts spilling out and bottoms exposed. I giggled with my friend but found them both shocking and stimulating. Soon after, I discovered a stash of Playboy magazines hidden in a home where I babysat. I perused them, praying that my secret activities would never be discovered. I barely understood the captions, but I liked the cartoons showing shameless, wide-eyed females.

As I grew older, I had only infrequent and experimental contact with pornography, usually when babysitting or at a girlfriend’s house when her parents were away. To me, pornography was for adults, definitely a guy thing, not something a “good girl” should pursue. In the East Coast middle-class suburb, getting my hands on more pornography would have taken some effort, and even though my parents were more open and communicative about sex than most, I knew they wouldn’t approve of my looking at “dirty” magazines or reading steamy novels. Consequently, scarcity, fear, and guilt served as formidable barriers to their use.

Later, in high school, my boyfriend took me to a party where we watched grainy black-and-white “stag films” from Europe. This live-action form of pornography was much more exciting than anything I’d seen before. Motion pictures made sex real and brought it into the here and now. We stood transfixed by the images, trying to look cool while heating up inside. The images were as disturbing as they were arousing – a young woman slowly stripped and fondled by an older man, and several men being sexual with one woman. Flushed with sexual heat and embarrassment, I looked over at my boyfriend. He seemed uncomfortable, embarrassed and a little afraid. We left the party early, never discussing what we’d witnessed or felt.

In my early exposures, I saw pornography as a forbidden product, offering a peephole into the off-limits adult world of sexual pleasure. Like smoking in the back of the schoolyard or taking a shot of alcohol from Dad’s liquor cabinet, looking at porn felt rebellious, but at the same time, a necessary rite of passage. As a way to understand sex, those “dirty” stories, pictures, and films offered a far more compelling view of sexuality than the cryptic sex-education materials I was shown in health class. In spite of how the images degraded women and portrayed men in a position of sexual power, porn gave me a vision of sex that validated sexual passion and pleasure.

Liberating adult entertainment

In the early 1970s, I graduated from college and moved to Berkeley, California, to attend social work graduate school and pursue a career as a mental health therapist. The sexual revolution – at least as it was widely portrayed in the media – was in full swing, and had transformed the public perception of sex and its possibilities. Anaïs Nin, David Reuben, Shere Hite, Betty Dodson, and others were raising my consciousness about the great possibilities inherent in sexual liberation and freedom from ignorance, old hang-ups, and unnecessary taboos. My peers and I thought that almost anybody could become a healthier, happier, more productive human being – and society itself might change for the better – if only people could transcend their parents’ puritanical training about sex and overcome unnecessary inhibitions.

It was an exciting time of sexual awakening. Sexual pleasure became a recreational sport and “free love” a spiritual practice. I soaked naked in hot tubs with friends, hiked bare-chested in coastal forests, and skinny-dipped in mountain streams. I volunteered at the Berkeley Women’s Health Collective, helping women perform their own pelvic exams and learn how to recognize common gynecological problems. I delighted in what seemed radically new ideas then – that it’s OK to learn about and regain control of our bodies, that nothing is ugly or disgusting about sex (and genitals), and that, like men, women have sexual feelings and needs.

During this period of expanding sexual awareness, hardcore pornography entered the mainstream marketplace. While capitalizing on the changes in social consciousness, this expansion in commercial pornography seemed to reinforce the new spirit of sexual openness, freedom, and acceptance. Penthouse magazine made Playboy look tame by brazenly revealing the pubic hair of its monthly pets. In 1975, when Playgirl magazine, featuring sexy pictures of men, appeared on the market, I wondered whether pornography might be headed in a direction of sexual equality.

Soft and hardcore movies started appearing in adult-only movie theaters in major cities across the USA. Porn titles and stars were showcased on marquees, not hidden away in dark-alley cigar shops. Now the public had easy access to gay porn films, erotic cartoon movies, and full-color features. Adult movies emerged as a new and wildly popular form of entertainment. Though Larry, my live-in boyfriend (now my husband), and I were involved in social work, feminist causes, and men’s consciousness-raising, we’d occasionally slip into a nearby adult movie theater to watch a talked-about release. Any trepidation that these films were inconsistent with our social values was overridden by our curiosity and our desire to feel we were becoming sexually liberated.

A therapeutic intervention

My perspective on pornography underwent another shift in the early 1980s, when I started specializing in sex therapy. I’d initially worked as a drug and alcohol counselor, but switched to sexuality counseling when I noticed a strong connection between people’s self-esteem and self-confidence and how good they felt about themselves sexually.

Sex therapy was a new, exciting, and much-needed clinical specialty, providing solid information, advice, and a safe place to discuss and get help for a wide array of sexual-functioning problems and concerns. Leaders in the field – people like William Masters and Virginia Johnson, Lonnie Barbach, Helen Singer Kaplan, Joseph and Leslie LoPiccolo, and Bernie Zilbergeld – were opening doors and providing information that had long been needed. 

My training to become a certified sex therapist included attending a required Sexual Attitudes Reassessment (SAR) seminar. With my fellow aspiring sex therapists, I watched a wide assortment of sexually explicit movies, some blatantly pornographic, others made and intended specifically for educational and instructional purposes. We watched films on masturbation, heterosexual and homosexual lovemaking, oral and anal sex, sex in the aging and disabled populations, sadomasochism, bondage, and more extreme sexual practices. Then we discussed our reactions in small groups. The seminar enabled us to explore our attitudes, feelings, and beliefs about all kinds of sex, and to gain confidence in helping clients with sexual problems. I found the direct and graphic nature of the SAR helpful for recognizing and challenging harmful myths and stereotypes, such as the mistaken idea that only young and beautiful people can have really good sex.

I began to consider pornography as an intervention that could be used for educational and therapeutic purposes. In sex therapy manuals, trainings, and conferences, it was touted as a product that could help clients reduce inhibitions about sexual practices, avoid boredom, and spice up their sex lives: “harmless visual stimulation” – an easy way to expand sexual awareness and safely explore sexual fantasies and desires, inside or outside a committed relationship.

To the extent that sex therapists had concern about the dangers of watching porn, professional discussions were limited to whether porn use could lead to sexual violence. Then, as now, no clear and reliable link emerged. The consensus was that pornography became a problem only when the viewer couldn’t distinguish between fantasy sex and real sex (believing, for example, that women enjoy being raped), or was using it in ways that endangered children (leaving it out where it could be seen), or harmed trust in an intimate relationship (pressuring a partner to do something he or she didn’t want to do).

In tune with the times, I sometimes assumed that when one person was into porn and the other wasn’t, the reluctant partner was likely “sexually uptight,” “withholding,” or “unadventurous.” Therapeutic strategies often focused on negotiating the type, use, purchase, and storage of the porn, rarely on discouraging its use. I might, for instance, help a couple reach a decision that they would only use porn together and would choose movies that they both enjoyed.

Like many of my sex therapy colleagues, I kept a box of classic pornographic novels in my office closet. I’d lend copies of Fanny Hill, The Pearl, and Lady Chatterley’s Lover to female clients who were learning to become orgasmic. Erotic literature coupled with genital stimulation was and still is promoted in the field as an effective therapeutic intervention for boosting sexual excitement and helping a woman to have her first orgasm. I suggested porn, as I might a heating pad or a vibrator, because of its stimulating effects. Porn, with its repeated descriptions of seduction and sexual activity, offered a way a woman could stay focused on sex and leave distracting thoughts and worries behind. The result of sexual functioning – climaxing – justified whatever means it took to get there.

I did have occasional misgivings, however, about advocating pornography in treatment. It was usually poorly made and portrayed sex in unrealistic, inaccurate, unsafe, and impersonal ways. For example, even though surveys show that monogamous partners are actually the most satisfied with their sex lives, porn kept featuring extramarital sex, multiple partners, and impulsive sex between strangers as more exciting. It often portrayed women as mere objects and playthings for male sexual enjoyment. It gave little or no consideration to hygiene and protection from pregnancy and disease. It promoted a callous attitude toward sexual exploitation, coercion, and aggression. Recommending pornography to clients began to make me feel, for lack of a better analogy, somewhat like a pimp, introducing clients to a “sleazy” worldview of sex. But I silenced my concerns, reminding myself that an open-minded sex therapist could regard pornography as simply a “tool of the trade.”

A cousin of sexual abuse

As time progressed, I became increasingly uncomfortable with pornography. On the few occasions when Larry and I saw pornography together, we now found it disturbing and distracting to the physical love we regularly enjoyed. The dialogue in porn didn’t make us blush, but the interactions seemed increasingly humiliating and violent, with behaviors such as a man ejaculating on a woman’s face becoming more common. Rather than inspire, pornography appeared to compromise one’s private erotic imagination and values, blurring boundaries between fantasy and reality and lowering standards for sexual interaction. I didn’t like how porn images would linger in my mind long after we’d turned off a rented videotape, taking my attention away from Larry and fixing it onto images of the porn actors and activities I’d just seen on screen.

At the same time I was experiencing personal concerns, many of my clients began complaining about porn. They appreciated well-made, instructional, sexual-enrichment books and videos and sexy romantic novels, but their contact with porn often left them feeling “dirty,” sad, disgusted, or angry. They told me they were turned off by its lack of human caring, its racism, and especially the way it depicted women and children as targets for sexual exploitation.

In the mid-1980s, when I began specializing in treating survivors of sexual abuse, I became increasingly aware of the role that porn had in abuse. One client said that when he was a teenager, a 50-year-old male next-door neighbor had “groomed” him into oral sex by showing him a stash of pornographic magazines. Women told me their perpetrators used porn as a template for the specific type of sexual behavior they coerced them to perform. Some clients recalled being forced by their perpetrator to pose for pornographic pictures during their abuse.

It was during the 1980s that I researched and wrote two recovery books, Incest and Sexuality and The Sexual Healing Journey, for survivors and their partners wanting to reclaim sexuality as something positive and healthy. When porn came up in the interviews and surveys I conducted, survivors overwhelmingly spoke negatively about it, saying, for example, that reading pornographic stories or watching porn on videos “felt like the abuse all over again.”

Added to my pile of concerns about porn, the realization that it could be used as a weapon against vulnerable children and women was the last straw. The clearer I became about conditions necessary for experiencing healthy sexuality – consent, equality, respect, trust, safety, and mutuality – the more doubt I had about advocating pornography as a sexual-enhancement product. How can I support something that portrays sex as a commodity, people as objects, and violence, humiliation, and recklessness as exciting? What am I doing encouraging people to condition their arousal to self-centered, sensually blunted, loveless sex? Do I really want to be advocating a product that’s associated with causing sexual harm and relationship problems?

My primary concern about porn wasn’t that it was sexually graphic, explicit, or hot: it was that porn conveyed harmful ideas about sex and could lead to hurtful and ultimately unrewarding sexual behaviors. During the 1990s, I switched from recommending porn to suggesting scenes in popular movies. In addition, frustrated with the lack of materials honoring love-based sexuality, I compiled two anthologies of erotic love poetry to recommend to clients and others for inspiration: Passionate Hearts and Intimate Kisses feature classic and contemporary poems in which “heart connection” is at the core of sexual experience.

One day, my concerns about pornography reached a tipping point. I grabbed the box of pornographic novels I’d kept in my office closet, marched outdoors, and tossed it into a bin. From then on, I felt that personally and therapeutically it was best to avoid porn. I made a commitment to obtain and clinically recommend only sexually explicit materials that educate and inspire while honoring respectful, responsible, and caring conditions for sexual interaction.

A possessive mistress

I may have thought I was done with porn, but it wasn’t done with me! In the late 1990s, people began calling my office seeking help for problems they felt had been caused by porn use. One after another, the requests came in, often several per week. Some pleas for help came from porn users themselves, worried about their own dependencies and the possible repercussions – losing interest in their partner, experiencing a compulsive need for sex, and getting into risky and hurtful sexual practices. But many calls came from the intimate partners of porn users, and these callers, primarily women, were in obvious emotional distress. 

The number of inquiries took me by surprise, so I began to ask my colleagues if they were having similar experiences. Many were, and we began to talk about how porn had changed from a side issue, which arose only occasionally in sessions with clients, to the primary reason many people were now seeking therapy.

Despite my decision to stop using porn personally and professionally, until this point, I still frequently thought of it as a temporary, experimental sexual activity, and even a benign adolescent phase in sexual development. But the growing client base experiencing problems with it and the depth of their pain opened my eyes to the fact that, for many, porn was becoming a critical, even essential part of their sexual repertoires. Porn was competing with real-life partners, and it was even emerging as the most important object of some clients’ sexual desires.

Perhaps we should all have seen it coming. Within a short period of time, with the aid of high-tech electronic devices, such as VCRs, cable television, and the internet, porn had broken through old barriers of scarcity, expense, and fear of exposure and evolved into a product that was available for pleasure on demand. With 24-hours-a-day availability, media saturation, and unlimited variety, porn was starting to overwhelm people’s ability to resist it. As one man shared: “About five years ago, I discovered the Internet, and that’s when the shit hit the fan for me. Suddenly it was ‘Close your eyes and imagine something and go look for it, and with a click of the mouse, there it is!’ And best of all, it was free and nobody the wiser.”

At this point, porn started looking to me like a compliant mistress who promised an exciting, personalized, highly charged erotic alternative to the mundane realities and complex challenges of sex with a real partner. Always ready, willing, and reliably sexy, the porn mistress catered to the user’s needs. It never got old or tired, required no emotional or sensual attention for “herself,” never said no or rejected her “lover,” and was always willing to explore any and all sexual acts, or even invent new ones. I was shocked one day when one man disclosed that, even though he loved his wife and experienced satisfying sex with her, when he masturbated to porn, it was “the best sex ever.”

The reactions of intimate partners to what was happening were almost identical to that of clients I’d counseled whose partners had been having affairs. Women came to me shocked and traumatized when they’d learned about their partners’ relationships with porn. I remember one who sobbed, “His betrayal feels like a knife has been thrust in my heart.” It didn’t matter that her husband’s “mistress” was on celluloid and pixels on a screen; he’d still betrayed her by channeling his sexual attention and energy away from her, onto someone else, and then lying about it! She felt angry, hurt, alone, powerless, and unable to compete with the perfect, airbrushed young bodies of the women featured in the videos she’d found her husband masturbating to. Her trust in and respect for him were gone, and she told me she felt as sexually abandoned, insulted, and betrayed as if he’d been with another woman. As with an affair, female partners often spoke of their partner’s porn use as absolutely incompatible with their ability to stay in the relationship.

Many of the male porn users in committed relationships were surprised by the intensity of their female partners’ reactions. They generally felt entitled to use porn and were ready with rationalizations for their behavior: “It’s safer than a real affair,” “All guys do it,” and “It’s nothing personal” were among the most common reasons they gave to try to get their partners to understand and accept it.

My deeper understanding of the emotional pain that partners of porn users were feeling, coupled with an awareness of the growing number of couples for whom porn use had become a significant relationship issue, changed the way I focused my treatment. Instead of automatically considering porn use as something to be negotiated, I began to address it as I might an extramarital affair. I tried to help both partners understand their relationship crisis, process their feelings, empathize with each other, and rebuild trust, security, and intimacy. With this approach, I reasoned that many porn users would come to see their behavior, and especially their accompanying deceptions, rationalizations, and emotional withdrawal, as inconsistent with their personal goals and the needs of the relationship. I thought that, on their own, they’d decide to give up porn, allowing their partners to process their feelings of betrayal, overcome resentments, and move toward forgiving and trusting again.

Even with my newfound awareness about how porn could assert itself as an easy sexual outlet, I remained naïve about one vitally important issue. I assumed that once couples could address negative repercussions and get the “real” sexual relationship back on track, the person who had the porn interest would no longer “need” or “desire” it, and could easily give it up. I couldn’t have been more wrong! Some clients were able to “ditch-the-mistress,” but many weren’t. It became apparent that I’d underestimated the power of the new pornography. Something more insidious was going on.

A drug

Soon after the turn of the new millennium, a new client helped me see what else was at play that made quitting porn so difficult, even for people who wanted to do so. Sam, a shy young man whom I’d been seeing for a few weeks, told me, “Doing porn feels like an incredible rush of life blowing through my veins, and the good part is, I can always go back for more.” His description of his porn experience sounded eerily similar to the language used by the patients with drug and alcohol problems I’d worked with through the years. Over time, more of my clients experiencing the impact of porn in their lives began using words and phrases usually associated with hardcore drug addiction. They often referred to using porn as a “high” and a “rush.” They started needing a stronger product in higher doses to get the same effect, and when they decided to quit, they frequently complained of continual cravings, preoccupations, and sensations of “withdrawal.” 

In 2004, concerned about what we were seeing in our practices, Larry and I began working on a recovery book entitled The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography (HarperCollins, 2008). Our goal was to create a sex-positive resource for individuals and couples that would help them understand how porn has changed and empower them to address porn problems directly and compassionately with effective strategies for recovery and relationship healing.

What we discovered in researching the book confirmed my feelings that porn use had many of the same properties as drug use. Addiction specialists and neuroscientists, such as Harvey Milkman, Peter Shizgal, Patrick Carnes, T. M. Grundner, and Helen Fisher, were finding that pornography did indeed have a druglike effect on the body and mind. Despite being ingested through the eyes and ears instead of the mouth or bloodstream, porn stimulates the reward and pleasure centers in the brain, instantly and dramatically increasing the production of dopamine, a neurotransmitter associated with both sexual arousal and drug highs. In addition, using porn for sexual stimulation has been shown to increase the production of other “feel-good” chemicals, such as adrenaline, endorphins, testosterone, and serotonin; with a sexual climax, it releases powerful hormones related to falling in love and bonding, such as oxytocin and vasopressin.

Research shows that, like compulsive gambling and shopping, porn use can lead to a “process addiction,” in which a person becomes addicted to a set of behaviors (e.g. consuming porn) that, in turn, powerfully alter brain chemistry. The internet and other electronic devices allow porn users to click through a never-ending stream of stimulating material as they look for just the right porn site, the sexual activity of interest, or the ultimate fantasy partner. Like a carefully calibrated slot machine, it rewards only intermittently, compelling the user to stay engaged and not give up. Users can end up looking at porn for longer and longer periods, often seeking riskier content to “hit the jackpot” of landing on an extremely stimulating image.

Porn wasn’t just operating like a drug – it was operating like a designer drug, able to give the user multiple types of results: novelty, excitement, escape, mastery, and (with orgasm) relaxation. All the new information about porn we were gathering helped explain why people of all ages and from all walks of life could develop such strong attachments to porn that they craved it compulsively, couldn’t control their use, and couldn’t stop, despite negative consequences.

My newfound knowledge of pornography’s drug-like effects helped me bring more compassion to the issues porn users faced. Not only were their partners in distress: anyone trying to quit using porn faced his or her own difficult emotional and physiological struggles. I started recommending that clients supplement their individual and couples counseling work by attending 12-step sexual addiction recovery programs, such as Sex Addicts Anonymous, Sexaholics Anonymous, and Recovering Couples Anonymous, or porn recovery groups of their own choosing. I began encouraging intimate partners to attend Codependents of Sex Addicts meetings and to check out supportive websites. 

I began working with clients to develop effective strategies for preventing relapses. Many clients find the “trigger-zone” model and exercises that are described in The Porn Trap beneficial for identifying how close they are to having a possible relapse and knowing just what steps to take to get to safer ground. Given the importance of healthy sexuality to overall recovery and quality of life, advanced work is done to heal troublesome sexual fantasies and develop healthy strategies for self-pleasuring, relaxed sensual touch, and enjoying sexual intimacy with a partner.

Even though my research opened my eyes to porn’s potential addictiveness, I know that not everyone gets addicted. Someone can have a problem with porn – for example, broken integrity, relationship difficulties, work problems, or an interest in child porn – and still not have addiction issues. But I began to understand more clearly that, for most of my clients and other porn users and partners with whom I spoke while doing research for the book, porn use almost always carries with it some negative consequences that can’t be avoided.

A threat to public health

Since The Porn Trap was published, I’ve had numerous professional and personal conversations about porn that have sensitized me to the expansion and significance of problems caused by porn. I recently spoke with a woman who told me how, after her father had died, she’d found a stash of hardcore porn videos and magazines in his bedroom. “No matter how much I tried not to let it bother me, it changed the way I think about him,” she said. A man came up to me after a workshop and asked what he could do to help his 13-year-old son break a habit of masturbating to bondage porn. In my practice, I’ve seen several soldiers back from the Iraq war suffering from porn addictions they developed there as a way to deal with traumatic stress. And some people told me there were times they’ve seriously contemplated suicide as a way to escape the isolating nervousness of their obsessions with porn.

I never wanted to be out beating the drum against pornography. At the beginning of my career, if anyone had suggested I’d be here now, I’d have laughed at them. But from my own clients, my research, and my personal experience, I’ve come to the conclusion that pornography is moving from an individual and couples’ problem to a public health problem, capable of deeply harming the emotional, sexual, and relationship wellbeing of millions of men, women, and children.

As a sex therapist, I’m amazed that what I once saw as a liberating sexual experience and a therapeutic option for improving sex with an intimate partner has evolved into something that can easily hijack and harm people’s sexuality. Increasing numbers of clients report that porn has become “the great spoiler” for them sexually by spawning unhealthy interests and reducing their natural responsiveness. One man confided that he could no longer get an erection with a real partner. “I want to go back to how it used to be before I was into porn – when just being near a woman I cared about turned me on. How can I get my old sexuality back?” he asked. 

Many female partners of porn users tell me they’re turning off to sex with their partner because of the increased pressure they feel to act like porn stars and respond to porn-inspired sexual advances. And women looking for long-term partners are worried about how pornography is shrinking the pool of desirable men. “It’s hard to find a guy who isn’t into porn and genuinely doesn’t like it. But that’s who I want as a life-mate and father to my children,” one woman explained.

I’m especially troubled by the way contact with porn appears to be harming young people’s mental and sexual health. Teens have been identified as one of the largest consumer groups of porn. A 2009 research study of one thousand 13- to 16-year-olds in the United Kingdom by CyberSentinel found that teens are spending an average of one hour and forty minutes a week (87 hours a year) looking at online porn. Studies in the US report similar exposure rates, with a 2004 study by Columbia University finding that 45 percent of teens admit that they have friends who regularly view and download porn.

Tech-savvy and naturally curious, young people are increasingly turning to internet porn to learn about sex and as the primary focus of their masturbation. Some teenagers have begun showing signs that exposure to pornography could be undermining their ability to make healthy choices about sexual activity. For example, a 2009 Harris Interactive survey revealed that despite the legal and personal risks involved, 19 percent of teenagers are engaged in sexting – sending and receiving sexually suggestive, nude or nearly nude photos through text messaging or e-mail. And, according to recent data made available in 2009 by the Centers for Disease Control, the age of first sexual involvement has fallen, the teen-pregnancy rate has increased (following nearly 15 years of large decreases), and sexually transmitted disease rates have increased. 

Because of cultural shame and silence, children aren’t receiving messages informing them that there’s a difference between porn fantasies and the real world, where interpersonal dynamics matter and sex has consequences. Without these touchstones, kids may fail to realize how harmful and unfair it is to measure their own sexuality (or anyone else’s) against porn standards and how dangerous it can be to try to mimic what they see in porn. A colleague recently told me about a college student who’d inadvertently maimed and almost killed himself trying to act out a sex scene he’d viewed in a porn video.

The only way to prevent the spread of porn-related problems is for people to be informed and to get help early, and for society to be alert to the problems. I’m not in favor of censorship, but with other professionals and health advocates, I support honest, age-appropriate discussions of pornography and its potential repercussions in public forums and health education classes. I believe we need a government body devoted specifically to researching the effects of pornography and developing policies, prevention campaigns, and treatment resources. I see a great need for parents, teachers, employers, clergy, healthcare workers, law enforcers, and therapists to start addressing pornography problems with the same kind of shame-free directness with which we’ve learned to tackle other public health concerns, such as smoking, alcohol consumption, domestic violence, and drug abuse.

As therapists, perhaps our most important role is in providing clients a safe place to discuss and examine their concerns. It’s best to analyze porn-related situations on a case-by-case basis, taking into consideration a client’s personal values, sexual experience, sexual orientation, and relationship status. I often rely on the following questions to help clients increase awareness and begin to evaluate their involvement with porn: 

Five key questions:

1. Is porn increasing or decreasing your self-esteem and integrity? 
2. Is it upsetting or alienating your intimate partner (or harming your future chances of being in a healthy relationship)? 
3. Have you become preoccupied, out-of-control, dependent on, or compulsively engaged with porn? 
4. How is porn shaping your sexual thoughts, desires, and behaviors? 
5. What negative consequences could occur if you continue to use porn?

Only when clients determine they want help quitting porn do we proceed in that direction, utilizing the dynamic strategies that exist for achieving sexual recovery and healing.

As mental health professionals, I believe we’re most helpful when we resist our tendencies to automatically condemn or advocate porn. Our effectiveness depends on our ability to join with clients in regularly evaluating porn’s impact on their lives. While I remain aware that porn use isn’t a problem for everyone, I keep in mind that, given its unprecedented power and accessibility, it can become a problem for anyone.

___

© Wendy Maltz, 2009, 2010, 2022

Note:  The “Out of the Shadows” article first appeared as the lead feature in The Psychotherapy Networker magazine’s Nov/Dec 2009 issue. It was later published on AltNet.org under the title “Is Porn Bad for You?” and again, in Feb 2020, in the British magazine, Therapy Today, under the title: “The Porn Trap.” The above article presents the Therapy Today version of the article. 


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