sexual health

Sexual Health in Paradise Nature, Norms, Nexus

Way back at the beginning of our relationship, I remember my husband saying to me, only very slightly in jest, that there are really only three important activities to do on vacation: “eat, sleep and make love.” At the time, now over thirty years and many vacations ago, that was actually a terrifying prospect. Not only due to the apprehension of two old survivors of trauma and neglect spending 24 hours a day in the presence of another human but because all three of those activities were quite fraught and certainly not easy or fun for me. 

It took a long time for us to find our way and create vacations together that “work” (play? Relax? Whatever!) It seems as if I am writing this about two strange other people, thankfully, as we wrap up a glorious week in Hawaii, USA.

My last few blog posts have been dark and pretty serious. This week, being largely unplugged and reading only the lite version of the San Francisco local paper – the weather, horoscope, food, and books sections – I thought would be a good time to lighten things up and write optimistically about sex. We may all be weary and beleaguered by recent coverage of the topic: abortion, harassment, assault and other abuse and discrimination, so I thought I would flip it and talk about a fave subject of mine: Sexual Health.

In the neglect household, things, for the most part, don’t get talked about at all, and there is no one to ask questions to about much of anything. So when kids experience changing bodies at puberty, “discover” masturbation or notice the differences between their own and siblings or other kids’ bodies, they may be confused, even scared. What might be an area of wonder and expansiveness becomes a shadowy, enclosed secret. Add to that childhood sexual abuse and all the secrecy, dysregulation and emotions that come with that, and we have a child locked in frightening and silent tabu. When I started menstruating at age 9, I did not know what that was. Aghast that something was fatally “wrong” with me, I was also horrified and ashamed of the mess, smells, and evidence. I remember being at school and being terrified to get out of my little desk and leaving a bloody puddle on the chair. And I was afraid of getting caught throwing my little undies in the trash. I don’t remember how my older sister somehow found out and helped me out of that quandary. 

The larger world, sadly, is not much better. Although we are bombarded with sexual imagery, innuendo and titillation, there is a poverty of information or, certainly, information that is accurate and useful. Rather sex is commercialized, commodified, sensationalized and distorted by truly impossible role models of bodies, relationships, and functions: instantly rock hard ever-lasting erections, always feverishly wet vulvas, chandelier swinging, explosive simultaneous orgasms – at least in heterosexual couples. 

And because there is no safe and reliable education to be had, kids (and adults too) get their “information” and advice from movies, porn, locker rooms and of course, Google and chat rooms of every stripe. And with sex being wildly subjective and colored by culture, values, morals, and individual and mass conscious and unconscious biases, the silent resounding question remains, “What’s ‘true’?”And for the most part, no one knows that everyone else is asking the same thing. Oy vey! 

An interesting book I read maybe 20 years ago has stood the test of time even in the book-cluttered recesses of my head: When Sex Goes to School: Warring Views on Sex–and Sex Education–Since the Sixties, by Kristin Luker. It is a brief historical overview of the shapeshifting pendulations of sex education in the US. Essentially it graphically posits the obvious (but not so obvious?). 

Sex education in schools historically reflects the prevailing political and moral perspective of the ruling government at any given time. In effect, “s— rolls downhill, and the available information shapes the sexual attitudes and behavior of that era. It is a worthwhile little read. Many who know my work have heard this rant many times before. So let’s talk about a happy and also unifying subject! You might ask, “unifying? did you not just get through saying that it is wildly subjective?” Well, yes, I did. But from a brilliant colleague and friend, Doug Braun-Harvey, I learned the Six Principles of Sexual Health (also to be found in his book, co-written with Michael Vigorito: Treating Out of Control Sexual Behavior: Rethinking Sex Addiction) which cast a wide enough net as to be universal, truly inclusive, even practical. Thanks Doug! 


It is easy to believe that because sex is a “natural” function, we are all innately supposed to know what to “do”, and we are all essentially the “same.” After all, birds do it, bees do it. Most notably, children of neglect, living in a world of echoing silence and finding their own answers about most everything, generally tend to default to the belief that what I know about applies to everyone else too. Clearly, I am a freak if I do not know what I am supposed to do. Many a child of neglect avoids sex with a partner completely for a variety of reasons, this shameful ignorance being one of them. So let me start by proclaiming a resounding “NO!” We are NOT all the same, and sexual tastes, much like food tastes, are as widely disparate and diverse as the gourmet (or not!) palette. When you partner with someone new, do you assume you know what their food preferences, allergies, ethical or religious restrictions, or even rhythms of meals might be? Hopefully not! We need to ask! Listen and learn! Then, ultimately, we can cook and eat and if we are compatible and have enough overlap and enough common predilections enjoy a meal together.

And so it is with sex! We must similarly speak, ask, listen, disclose and learn! It seems like a “no-brainer!” No? Well, because in general, no one really talks about sex, including oncologists who fail to alert patients about possible sexual ramifications of their cancer, its treatments, and surgeries; psychiatrists who fail to inform/warn patients about sexual side effects of medications, even psychotherapists and couples’ therapists fail to inquire – it is not obvious that it is OK to ask and to speak up. It is really most “natural” if one is honest, to not know! 

In all fairness, I must add that there is the occasional sex-positive exception to the gross generalization above. Let me just say, I am committed to breaking the silence by raising sometimes shocking tabu sexual subjects (hopefully with dignity, tact, and respect for all) with explicit language to model, teach and desensitize talking openly about sex. It is quite remarkable how many long, long-term couples never have! No shame in that! Talking about sex is not “unnatural”; it is just, well, unnatural! Let’s do something about that!


 So, once we have “normalized” talking about sex, we must define “what is “normal” anyway?” So many individuals and couples both worry, “I am not “normal!” or my partner is not “normal,” our frequency of sex is not “normal,” etc., making for shame, criticism, blame, confusion, uncertainty, bitter recrimination, prejudice and often sexual impasses and long droughts. (Most people who are not sex therapists have no idea how many “monogamous” long-term partners haven’t had (partnered) sex in literally years!) I once heard a sex therapy expert say, “So-called ‘sex addicts’ are anyone who has sex more than me!” So, in addition to tabu busting and myth-busting being vitally important to me, so is defining our terms! As I often say, and it can be a hard sell, particularly with survivors of neglect for whom “doing things my own way” has been a means of survival, there are few absolutes about anything. Even more controversial, I am known for saying, “There are no facts in a relationship! Just your world and my world,” but we won’t debate that now.

Certainly, with sex, there is no universally agreed on “normal” for sexual feelings, preferences, and practices. There are some that are difficult for me to imagine and understand, and certainly would do anything but try! But I don’t have to do those if I am adhering to the Six Principles. What a blessing! If done well, a true democracy! So here are the Six Principles, only briefly fleshed out here (no pun intended). Assuredly, we shall return again and again to these topics!

Pretty basic, huh? Yet truly game-changing when scrupulously adhered to! And within this frame, the sky is the limit as to what we choose to do!

The Six Principles


1. Consent

Consent is, of course, foundational and delineates the difference between trauma/neglect-ridden interaction and healthful, connected and free expression. Couples must agree that “No means NO!” and, in turn, yes means authentic yes! There must be agreement, commitment and safety to be candid, as well as precision about exactly what we are consenting to.

2. Non-exploitation

Non-Exploitation means thoughtful assessment and correction for any imbalances of power and care taken to share the responsibility to equalize and equally respect the dignity of each.

3. Protection from STIs and unintended pregnancy

Protection against STIs is a shared responsibility and endeavor, including agreement and cooperation about both “pre-existing” and newly acquired conditions or infections, agreement about methods to be utilized, and who is responsible for what.

4. Honesty

Honesty means transparency, both overtly and by omission. It also means having the humility to disclose likes and dislikes and to practice consistent and effective communication. Also agreed upon boundaries of “Privacy.”

5. Shared Values

Shared values is again the practice of good communication about what the meaning of sexual intimacy to each partner. Is it about play and fun? Intimacy? What makes me unique, special and sets me apart from everyone else in your life? Self-regulation, procreation, spirituality? Is it even interesting at all? Couples must determine are we, in fact, “in the same movie?”

6. Mutual Pleasure      

Mutual pleasure is about creating an interaction in which there is room for the pleasure of both partners. What makes sex really “work” is when each partner is both present with themselves and present with the other while in the present moment. It is a commitment to that, which includes finding out what exactly brings pleasure to them.

7. Bonus Principle: Lifelong Regular Practice

Sexuality pioneer and icon Betty Dodson would add a seventh principle. She taught that regular sexual activity, with or without a partner, is as essential as  food, sleep and (other) physical exercise. She joyfully practiced what she preached until she recently passed at 91.     

Cursory and introductory for now, this topic will be amply addressed in my forthcoming book now in the works and, to be sure, in many upcoming blogposts. The eager might look up Doug Braun-Harvey, who offers a wealth of information about sexual health! 


Sexual health does indeed mean inclusivity, elasticity, growth and acceptance, not only about the vast diversity among us but in ourselves through our lifespan. When I was growing up, categories were rigidly binary and few: male or female. Even gay or straight came later. Then we got bi-sexuality and, little by little, all the other letters coming after LGB in a growing list. Sexual health is widening our lens to include them all but also learning how to observe with acceptance and grow with the changes in our own bodies and sexual functions, including our own feelings and attitudes about sex and ourselves. So many things we might never have thought about until we got there.

Our species has only recently begun to live this long. Only a century ago, humans did not live long after their reproductive years, so the challenges of long-term monogamous sexual activity with one partner for decades post-child-bearing is a puzzle we are still working out! If you don’t have answers yet, well, join the human race.

So much more to say! As Terry Gross would say, “Let’s take a short break. And then we’ll talk some more!” And as Rabbi Hillel taught about the Golden Rule, these six (or seven) principles are all you really need to know. The rest is commentary. So now go and practice! 

Today’s Song:

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

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