Sex Matters: Regulation, Sex-Ed, Voice

As we head into mid-life, it is natural and typical to think about the passing of time, what is behind us and what lies ahead; what we have and have not achieved or accomplished; what we have treasured, and what we may have missed out on. Looking ahead, we may contemplate what we want to make sure we do get to before it is too late. Some windows may close if we fail to get there in time. I have noticed in recent years many adult child of neglect, crossing into their fifties- particularly men, who seemingly suddenly awaken to the poverty or even absence of sex that they have coexisted with over often many years. What may have been tolerable, or perhaps they have been too busy to notice for a time, begins to gnaw at them, and become unbearable. Many clients who are partnered, (or not,) may have gone years with little or no sexual interaction- with their spouse or anyone at all. As time marches inevitably on, it becomes imperative to many, to change that.

Sex is something we rarely talk about, for some incomprehensible reason. given that most of us if we are honest, probably do think about it a fair amount. Perhaps we have learned that it is “wrong,” dirty or inappropriate to talk about sex; perhaps we believe that we are supposed to “know” things about which we have no clue, and don’t want to be caught in ignorance; shame, guilt, some sort of moral tabu from one’s culture or religion, simple embarrassment about even saying the words? So many reasons to not talk about sex. Well, I for one admit I have always been inordinately fascinated with the topic, (which is often cited as the main reason why people become sex therapists!) And I am particularly interested in breaking silence about all matters sexual, because I am passionate about eradicating sexual trauma. And I believe that in addition to the undeniable, vast gender power inequalities, lurk problems of both dysregulation and ignorance.


I have seen many and varied iterations of sexual impacts in children of neglect. Because any sort of interpersonal dependency, which would likely include authentic intimacy, is experienced as threatening and even lethal, some sort of “solution” to the problem of sexual need is in order. I have seen a wide range of adaptations, where a person can be sexual and not risk intimate entanglements. They may rely on inanimate or virtual sexual “partners,” essentially relating to  images on a screen. They may enlist the services of sex workers, so they can have safely circumscribed erotic encounters with no risk of intimacy. Anonymous sex in parks and bath houses, less common now since the AIDS epidemic scared us all too much; serial infidelities or monogamies that do not last long enough to result in attachment; some becoming sex workers themselves, simple abstinence, or partnering with someone sexually unavailable and enduring even years without gratification. I have seen all and combinations of these variations over the years. And many come to a “head” or critical mass at mid-life, often in a swirl of bitterness, shame, blame and/or grief, and fear that it is already too late.

Of course, we know that the nervous system of neglect is embedded in an early matrix of dysregulation. The safety and calm that accompany reliable comings and goings of needed care and supplies; the safety and calm of being comforted in the inevitable moments of pain, fear or other distress, make for a resilient, flexible, reasonably stable and voluntary sense of arousal and even to some extent mood. The withdrawal, loss or simple absence of that kind of regularity, make for bodily (in addition to interpersonal) chaos.

Sexual ease and satisfaction rely on a gentle interplay between sympathetic and parasympathetic, relaxation and stimulation. The vulnerability that allows us to connect and make love, requires a measure of safe calm; and to be turned on, become engorged, orgasmic, we need the charge of arousal. A relatively balanced organism is foundational to sexual health. The dysregulations of neglect, are bound to wreak havoc on the sexual self. Not inevitably, but I have certainly seen many and diverse iterations of problematic sexuality in my years of studying neglect. Including compulsivities, being  (even dangerously) “out of control.” Probably most common in my practice, have been those who have “done without-” well, up to a point. And when that point, or that age is reached, it becomes a crisis-like, even identity “emergency.”  Partners may feel blind-sided by the perhaps previously unexpressed resentment, and what they experience as blame-racked urgency. They might be hurt, angry,  bewildered and uncertain about what to do. Compassionate and non-pathologizing couples’ and sex therapy are often indicated. 


Besides the internal chaos of dysregulation, the outer world, certainly in the US is sexually equally out of balance. Barraged by titillation and inuendo, we are simultaneously met with a poverty of information. Failure to talk about sex, seems to be unanimous. I often complain about how medical providers fail to educate patients about sexual sequelae or side effects of conditions, procedures or medications. It is as if “sex does not matter?” or does not matter to them? Oncologists, psychiatrists, even couple’s therapists often fail not only to inform or inquire, but even mention sexuality.

Many of our clients will tell us that their parents never talked to them about sex. We have all heard the stories of girls thinking they were bleeding to death, when shocked by a menstruation they had known nothing about. All genders might be caught unawares, buffeted by unexpected pubescent urges and impulses, not knowing what to do with them. The child of neglect has no one to ask. Other kids do their “research” online, via porn or all manner of “chats,” or in locker rooms. What on earth will they “learn?”  Where might they be taught about consent? About non-exploitation? Values? Mutuality? Pleasure? Prevention of STI’s, let alone unwanted pregnancy. And love? In school sex education programs, if there are any at all, they might learn about reproduction.  

In a world rife with rampant dysregulations wrought by trauma and neglect, chasms of power differential between gender, sexual orientation and race, even age; and barren of practical, accurate and unjaundiced information, is there any wonder that the intergenerational transmission of sexual trauma is of the unmitigated “me too” proportions, that overwhelm not only our psychotherapy offices, and the larger world, but even ourselves? So many reasons for breaking chains of intergenerational transmission. The perpetration and perpetuation of the colossal impacts extend their all-destructive tentacles into every aspect, public and private, of our lives.


One of our paramount goals in neglect recovery is learning to speak on one’s own behalf in relationship: “getting a spine and getting a voice,” in the interpersonal to use the words of attachment research pioneer, Stephen Johnson. The mid-life child of neglect who reaches their limit with sexless partnership are to be supported and helped in their endeavor to speak, and regain, or acquire for the first time another lost human “birthright.”  Similarly, I encourage all of us in whatever capacity: medical or mental healthcare provider, teacher, parent, partner, friend: every walk of our lives, to become a willing and fluent mouthpiece, at speaking, (and speaking explicitly and not euphemistically or metaphorically, or in “baby talk!”) about sex. And even being willing to ask, and answer about it. Bringing sex out of the shadows, and out from under its cloak of tabu and shame, will contribute, even a little to making a safer world.     My friend and colleague, clinician and author Doug Braun-Harvey has identified and written about what he calls the Six Principles of Sexual Health. I highly recommend his work. The Six Principles are: Consent, Non-exploitation, Honesty, Shared Values, Protection from STI’s and Unwanted Pregnancy, and Mutual Pleasure. Within those parameters it is all good!

Today’s song:


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