First, back in 1999, BMJ.com (originally the British Medical Journal) posted an article showing an MRI scan of penis-vagina intercourse. Up until then, we had drawings like the one to the left, which comes from Dickinson’s amazing book Human Sex Anatomy: A Topographical Hand Atlas, which I consider a must-read for anyone who wants to be a sex nerd. (As is Netter’s Reproductive System, btw.) You can click on the picture for a larger image.

While these drawings are really useful, they’re still based on one person’s understanding of anatomy, as well as their artistic skill. So I’m geeking out on the MRI scan shown to the left. Click on it to see a larger version, along with a chart showing some of the organs that are a bit hard to identify. Maybe it’s just me, but I think it’s fascinating. Plus, as the authors of the article discuss, it shows that the root of the penis goes much further into the body than most people realize. They also correct some of the information that sexologists had previously accepted. For example, it looks like the uterus doesn’t actually increase in size during arousal. Let’s hear it for the advance of science! (Of course, we need replication of this work to fully validate it, but it’s still cool.)

In other sex geekery, an article in Evolutionary Psychology (pdf available here) examined the evolutionary purpose of the scrotum. We’ve long understood that past of the function is to keep the testicles at a lower temperature than the body cavity in order to maximize sperm production. But there are some amazing adaptations that are part of that, and I admit that much of this info is new to me.

First, one possible explanation for why one testicle usually hangs lower than the other is that “with one testicle suspended slightly above (or below) the other, there is a corresponding increase in the available surface area subject to heat dissipation and cooling.” Scrotum asymmetry as an evolutionary advantage!

I’m intrigued by the notion that part of why the testicles tend to pull up close to the body before ejaculation is in order to warm the sperm up and get them swimming. The same mechanism serves to protect the testicles during sex. (The authors note that fear triggers the same reflex, perhaps in order to avoid damage when in danger.)

It’s also really interesting that, as part of the temperature regulation functions of the scrotum, the arteries that supply blood to the scrotum are next to the veins that take blood away. That means that the cooler venous blood lowers the temperature of the blood entering the scrotum in a rather efficient heat exchange. Amazing!

This sort of research is really helpful to me as a sex educator. I rely on scientists like these folks to do this work so I can make sure that I’m offering accurate information. Even if you don’t geek out on it yourself, thank a scientist the next time you meet one. Without them, we wouldn’t know as much as we do.

Tell us a little about your background and your interest in this area.

My name is John Beiter, Ph.D. and I earned my doctorate in clinical psychology later in life than most. I had been working in the corporate world in treasury & finance and decided after reading Scott Peck’s book The Road Less Traveled that my calling in life was to pursue my childhood dream of becoming a psychologist. After graduating in 2007, I still had not decided what to specialize in until I had a serendipitous encounter with another therapist who inquired about my interest in becoming a certified sex therapist and connected me to Dr. Shirley Kurtz who not only became my supervisor but mentor as well. Anecdotally, my interest in sex therapy goes back to my High School days. In 10th grade I presented a controversial lecture on the school system’s blatant lack of preparing students for sexual relationships concluding with the following attention getter, stating that “as High School students we are going to learn very quickly that there is a lot more to sexual intercourse than a man sticking his penis into a woman’s vagina!” As far as the teacher was concerned my lecture was over and the seeds for the sex therapist were planted.

What prompted you to develop this particular survey? Did you base it on previous research?

I developed this survey in response to my clients’ struggles of finding ways to comfortably discuss their sexuality. Since I grew up in the corporate world and was familiar with many of the instruments available to help individuals improve and develop in many different aspects, especially communications – I naturally looked in this area for ideas. In other words, what communication tools in the corporate world could give me ideas, structures and frameworks to build in the clinical world? One thing that struck me as rather odd was that there was no one ideal instrument out there to apply to my practice, so this motivated me to create the Beiter Sexuality Preference Indicator.

Can you tell us a little about how you’ve found participants? How many people have taken it? Any interesting patterns among the demographics?

I started administering the BSPI to my clients and manually captured the data into a spreadsheet. The client response early on was overwhelmingly positive. One couple was so excited after having taken the instrument that they stated, “I wish you would have had this [BSPI] when we first started seeing you, it would have made our communication around sexuality so easy!” From there it started to grow. Based on those positive comments, I decided to socially administer it to friends and family. Again, I received an incredible amount of positive acceptance. My girlfriend, Renee had been behind me the whole way and decided that we should think about the BSPI in a much larger way. So we decided to create a website devoted to the BSPI and create a logo to brand it. Renee started using social media to market the BSPI and was able to get the Playboy Radio Channel interested. As a result of her incredible efforts, I was interviewed by Tiffany Granath the day the website was launched. Within hours of that radio spot the number of visitors to our website increased by hundreds. By the end of the first week of being launched on June 10, 2009 – 1,000 people had taken the BSPI. My goal is to reach an unprecedented 100,000 from peoples all over the world. To date, over 3,000 people have taken the survey and the numbers grow daily. I continue to participate in radio shows throughout the country, and am in talks with various newspapers and magazine. I am also expanding traffic to my Facebook and Twitter site @DrJohnB to connect with more people involved in the sexual community, with relationships, and intimacy.

Some of the patterns that have emerged include the following:
• To date, more men have taken the BSPI [60% vs 40%]
• Women are more likely to be satisfied in their sexual relationships with 3 out of every 4 women reporting satisfaction
• Women as well as men prefer to be the Dominant partner – meaning that they like to initiate sex with their partner and both prefer an adventurous approach to their sexual activities.

What have you seen in the data? What trends have you noticed? What about differences based on gender, sexual orientation, age, race, etc.?

Some of the trends that are starting to emerge indicate that when men are reporting not being satisfied, it is because they have not been able to connect physically while women report the lack of an emotional connection. When it comes to sexual activity most people regardless of gender want to take an active role in initiating. One surprising trend is that does not seem to be any major differences in overall preferences when looking over the various ages, which may lead one to believe that our sexual preferences do not change all that much over time. Men tend to spike around three distinct sets of preferences while women spiked around six sets, leading one to think that women are able to encompass broader roles sexually while men tend to limit themselves. There is not enough data to report on race at this time as most of the data to data is from Caucasians. As the data pool grows the trends will become more evident.
I have started to analyze individual questions where there is a significant difference between men and women and have found it to be very interesting.

• Prefer lights on vs. lights off M- 76% W- 36% – What does this say about a woman’s self esteem?
• Prefer Romantic partners vs. express excitement through touch M- 18% W- 45% – Are men missing something here?
• Always have fun in sex vs. sometimes get bored M-67% W-53% – Why are almost half of the women bored with sex?
• Prefer to masturbate vs. initiate sex on partner M- 60% W-47% – Why do so many of us prefer to masturbate?

How have your results informed your professional practice? How do you think other people could use your results?

I use the instrument in my clinical practice. After explaining the instrument, I ask my clients to guess what they know about their own sexuality. Some people have guessed wrong and then when reviewing the results have had an ‘aha’ moment claiming that it makes sense to understand it that way. When I use it on couples, it is surprising just how little partners really know about each other. I have created some standard questions to ask couples after taking the test with the goal of increasing communications around their sexuality. For example, I will ask – What surprised you most about your partner and what surprised you most about yourself?

Many couples, especially in the age group of 21 – 30 years old, have stated that the instrument made it easier and more comfortable to talk about sex. Additionally, as a result of feeling more comfortable communicating about their sexuality some individuals had also been able to more thoroughly explore their sexual needs from a pleasure base rather than an orgasm/performance base. Instead of viewing sex as a performance where the main actors are an erection and two [or more] supporting orgasms, I am working with couples to tailor their sexual activity to focus on pleasure, fun and intimacy. It is not the intention to deny or avoid intercourse and orgasm, but to experience many other aspects of sexual activity to enjoy.

What kinds of feedback have you received from participants?

The feedback remains incredibly positive. I have received so many letters of support and encouragement as many have indicated that my work is critical and important for the advancement and understanding of human sexuality. Many people that have taken the BSPI thus far have stated that while they felt it was important to be aware of their own preferences, they stated it was equally if not more important to know their partners preferences in order to better relate and respond to their partner’s sexual needs, wishes and desires.

There are assumptions that have been made before understanding preferences. One couple reported that because the wife had more sexual experience with many different partners before the marriage and he had not, the assumption was made that she knew what she wanted and would prefer to be the Dominant partner, when in fact she clearly enjoyed being the Submissive. Another assumption that has been teased out between married couples is the expectation that the male is expected to prefer the Dominant role and the woman the Submissive. The research does not support that assumption and demonstrates it as an individual choice regardless of gender orientation.

What’s your vision for this project?

The vision of my project is for the BSPI to become the standard instrument for all people to use world wide in learning about their sexuality. I want to capture over 100,000 respondents and publish a book on the results so that we can understand the differences between people from various parts of the world, different sexual orientation, gender, age, etc. I see the results informing our educational leaders in promoting a sexuality that is based on pleasure replacing the outdated and harmful performance based one that too many of us have adopted.

I should clarify what I mean. Shame exists at one end of a continuum of emotions that also contains guilt, remorse and other less intense feelings. It’s comparable to how rage exists at one end of a continuum that also includes anger, irritation, and annoyance. What differs is the scope and scale of the emotion, but the basic foundation is the same. While the differences between guilt and shame are as important as the differences between rage and annoyance, I think it’s also valuable to recognize the commonalities. I tend to use “shame” and the umbrella term for all of these emotions, just as I tend to use “anger” as an umbrella term.

According to neuropsychologist Allan Schore, the emotion of shame serves the purpose of helping us learn social and cultural rules, as well as important safety rules. If you’ve ever yelled at a child who was in danger (for example, running towards a busy street), you’ve probably seen them freeze and hunker down. That’s a shame response and it serves the child’s well-being by stopping whatever dangerous behavior was going on. Similarly, when we break social rules, shame is one way that we learn where the boundaries are. As we grow and develop, it becomes more subtle and complex, but that’s the basic foundation. There’s a great article in the New York Times today about some research on this.

In order to be effective, shame requires that there is a positive and healthy relationship between the caregiver and the child. That’s because shame triggers a disconnection or what Gershon Kaufman calls a “rupture in the interpersonal bridge.” The discomfort of that disconnection motivates us to change our behavior in order to reconnect with someone who’s important to us. But if the relationship isn’t positive to begin with, there’s no reason to reconnect and shame becomes an ineffective tool.

Where this comes back to well-being is that when the rules are reasonable and when the response from those around us is proportional to the situation, we can learn how to move through the world in more positive ways. Unfortunately, caregivers who have unresolved shame have a tendency to apply unreasonable rules, have reactions that are out of proportion to the situation, or are unable to foster reconciliation. Any or all of these tend to create more undigested shame and the cycle repeats. As layers of undigested shame are lain down over the years, it can become toxic and we become highly reactive to anything that triggers it.

So of course, many sex educators, therapists and other folks with good intentions see the toxic version of shame and start assuming that that’s all there is to the experience of the emotion. And when that happens, they start talking about shame as if it’s always bad but that’s not the case. If we hurt someone by, for example, breaking a relationship agreement, I think that’s a perfectly fine reason to feel shame. Our emotions motivate us- that’s why they have the same root word. The discomfort of that experience of shame is part of what keeps us from hurting other people over and over. Shame isn’t supposed to be comfortable- that’s the point. But that doesn’t make it bad. In fact, Schore points out that people who truly feel no shame are sociopaths because they have no motivation to take other people’s experiences of their actions into account.

Developing a more positive relationship with our shames requires a few different pieces. One of them is learning to discern between the rules that make sense and those that don’t. “Don’t masturbate in public” makes sense. “Don’t masturbate” simply doesn’t. Another step is learning how to move through the discomfort of shame and listen to what it says so that we can grow from the experience. If we’re so uncomfortable with the emotion, we tend to dissociate or get stuck in it, neither of which helps us digest it. Another piece of the puzzle is learning to create true atonement and reconciliation. That often includes learning to hold space for the injuries we cause other people, to not flinch from them, to do whatever we can to heal them, and to take steps to not do it again.

One of the biggest ways in which I see shame connect to sex is through the word “should.” For example:

I should want sex as often as my partner.

You should  not be gay.

We should like this type of sex.

Sometimes the “shoulds” are as explicit as these examples and more often, they’re implicit in the language we use  and attitudes we have. And anytime we obey a “should” instead of listening to our authentic selves, it’s probably worth looking for the shame that’s underneath it. The shame might be external to ourselves or we might have internalized it so deeply that we can hear the voices in our imaginations.

And yes, I think that there are some “shoulds” that are worth keeping. We should care for the pleasure, health and well-being of ourselves and our partners. We should actively seek the informed consent of anyone included in or affected by a sexual interaction. But beyond that, the “shoulds” just get in the way. And those are the shames that we can learn to let go of.

Of course, it’s not an easy task and it can take a lifetime. There are quite a few resources and this isn’t meant to be an extensive list.

I’m a big fan of Pema Chödrön. She’s a Buddhist nun and her teachings are accessible to anyone of any religious affiliation, including folks with none at all. Her lecture Getting Unstuck has lots of wisdom that applies to letting go of the “shoulds” although that’s not the main focus.

If you’re dealing the the dynamics of shame in group settings, Karen McClintock’s Sexual Shame: An Urgent Call to Healing is a great resource. Her focus is on Christian religious congregations, although at least 90% of the book applies to most groups.

For folks who want to geek out on this stuff and like a somewhat denser read, Allan Schore’s books are really thought-provoking. One thing- he’s writing for a more scientific audience and his books are super dense. Affect Regulation and the Repair of the Self is probably the most relevant, although it’s the third book in the series and the first two lay a good foundation. There’s also Shame and Pride: Affect, Sex, and the Birth of the Self by Donald Nathanson if you want a less dense but still amazing read.

There are quite a few self-help books out there. I’ve read quite a few, although none are really as sex-positive as I’d like to see. And of course, lots of people get a lot of help from therapy of whatever flavor works for them.

Ultimately, learning to let go of the toxic shames and developing a positive relationship with shame is an ongoing process. It’s not something that will happen overnight, although I often wish it could be. Wherever we each are in that journey, I hope that we can find whatever ease and comfort that we can.

Leaving aside the fact that withdrawal doesn’t offer protection against STIs (although I’d expect the risk to be lower, which is why “cum on me, not in me” was an educational slogan during the early days of the AIDS awareness movement), this is pretty striking. Correct condom use requires a fair amount of knowledge and skill, not to mention negotiation and practice. But I have to say that I’m surprised that there’s such a wide discrepancy between the ideal and perfect use of withdrawal. Granted, orgasm can catch guys by surprise sometimes, but I have to wonder what else makes withdrawal so hard to get right.

Also, while 2% and 4% sound pretty similar, over a longer span, that difference racks up. If you use condoms for 5 years, you have a 10% chance of pregnancy sometime during that span, but withdrawal over the same span gives you a 18.5% chance. Which just goes to show that using more than one method is a good idea.

On the other hand, withdrawal certainly improves your odds significantly, which may be why 56% of women have used it at some point in their lives. Further, as Carnal Nation reported, countries like the Ukraine that face severe economic challenges are finding that condom prices are increasing, which will result in fewer people using them. A free risk reduction method seems like a great idea. Of course, it’s not a guarantee of safety. Think of it as a seat belt- it won’t guarantee 100% safety, but it improves your chances.

The biggest surprise for me in all of this is that many of the peope surveyed “did not mention withdrawal when asked what they thought of when they heard the terms “birth control” and “contraception,” because they did not consider withdrawal a contraceptive method or thought it was ineffective at preventing pregnancy.” Maybe it’s time to rethink that.

There’s a new survey out that the researcher hopes will contribute to the research on female sexworker’s experiences of seeking mental health services. There’s a gap in the research and many therapists and social workers don’t really know what their clients who happen to be sexworkers need. That tends to result in ineffective care.

For example, Sex in the Public Square has a blog about a woman being outed as a sexworker. Here’s a relevant snippet: “Everyone knew I was depressed, and my boss at the time, in my real world job, hooked me up with a therapist. But even the therapist received the sugar coated version. So everything that was truly going on, I really kept to myself.” If you don’t feel like you can trust your therapist, you’re not going to get the support you need. That’s not specific to sexwork- it applies to any experience.

But sexworkers are in an especially difficult spot because most therapists know very little about what they need. Plus, there are lots of prejudices and anti-sexwork judgements, concerns about legal issues and other complicating factors. One way to get this to change is to have solid research that can help overcome preconcevied ideas about what sexworkers need.

So if you’re a female-identified sexworker, click on the link and take the survey. It’s anonymous and fast. Or pass this along to folks who might want to take it.

www.sexworksurvey.com

First, according to MSNBC.com, 3% of Washington DC residents are living with HIV or AIDS. As if that weren’t appalling enough, “almost 1 in 10 residents between ages 40 and 49 are living with HIV, and black men had the highest infection rate at almost 7 percent.”  Another MSNBC.com article reports that older folks (50+) are increasingly at risk for HIV, both because erectile dysfunction drugs increase the numbers of people having intercourse and because there’s a lower rate of safer sex practices. To make matters even worse, older women are especially susceptible since the vaginal lining gets thinner with age, and older HIV-positive people have a shorter time from diagnosis to the onset of AIDS, probably due to less resilient immune systems.

The question of safer sex information for older people has been something I’ve been aware of for a while. When I was working in the store, I would regularly talk with people who were back on the dating scene for the first time in decades, whether because of divorce or death of a partner. And they consistently reported that most or all of the safer sex information they could find was written for the 16-25 year old crowd, making it less accessible or relevant for them. For example, lots of safer sex education for young adults focuses on decision making skills or communication & negotiation. But by the time you’re 50, either you have those skills or a website/pamphlet isn’t likely to be a lot of help.

Meanwhile, the pope has said that condoms are not the way to stop AIDS in Africa- abstinence is the way to go. Despite the overwhelming scientific evidence that condoms do, in fact, work well and that they are the most effective way to reduce HIV transmission.

But some good news, finally. Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA) are about to introduce a bill that will authorize federal funding for comprehensive sex education. The Responsible Education About Life (REAL) Act will “provide federal money to support responsible sex education in schools. This education would include science-based, medically accurate, and age appropriate public health information about both abstinence and contraception.” Here’s some more info about the proposed bill (taken from the Advocates for Youth website).

The REAL Act would fund programs with important characteristics, including:

• Being age-appropriate and medically accurate;
• Not teaching or promoting religion;
• Teaching that abstinence is the only certain way to avoid pregnancy or sexual transmission of diseases;
• Stressing the value of abstinence while not ignoring young people who have had or are having sex;
• Providing accurate information about the health benefits and side effects of all contraceptives and barrier methods as a means to prevent pregnancy;
• Providing information about the health benefits of condoms and other barrier methods as a means to reduce the risk of sexually transmitted diseases, including HIV;
• Encouraging family communication about sexuality;
• Teaching skills for making responsible decisions about sex, including how to avoid unwanted verbal, physical, and sexual advances and how not to make unwanted verbal, physical, and sexual advances; and
• Teaching that alcohol and drug use can affect the ability to make responsible decisions.

How about that? A sex education program that’s based on actual research instead of ideology, offers comprehensive information about risk reduction AND abstinence, helps youth develop the decision making and communication skills they need, and makes it easier to communicate with family members about sexuality.

Clearly, there’s a long way to go in the work to end HIV, and this is a big step in the right direction. If you feel moved to send an email to your congresspeople about this bill, you can go to the Advocates for Youth website. There’s a link at the bottom of the page.

A recent article published in the Journal of Economic Perspectives takes a look at patterns in online porn and found some fascinating information. First off (but not too surprising), online porn use is higher among younger people and those who live in urban settings. On the other hand, a higher marriage rate correlates with fewer porn subscriptions, but so does a higher divorce rate.

What I find more interesting is that in areas where people report more regular religious attendance, the overall subscription rates are pretty much the same as elsewhere, but people in those areas shift their porn use to days other than Sundays

It turns out that there’s more porn use in the 27 states where “defense of marriage” amendments have been adopted (making same-sex marriage, and/or civil unions unconstitutional). There’s also more porn use in states where survey participants express conservative positions on religion, gender roles and sexuality. It turns out that Utah has the most online porn subscriptions per broadband internet users. I wonder how much porn the guy in this photo watches.

The article doesn’t explore the possible reasons for this pattern, but now that we know about it, maybe someone else can look into that. I have my guesses, but I’d much rather find a grad student who’s looking for a dissertation topic.

CARAS is conducting an online survey to assess the educational needs of the BDSM community. The goals of the project are to identify what educational needs people have, determine what practices educators and organizers have, and increase the quality of content and professionalism among BDSM educators. There are a lot of sex educators and “sexperts” (I really dislike that word) out there and while many of them are quite skilled, there are also plenty that don’t really know enough about their topics and/or how to teach. But then, my degree is in Adult Sex Education so I get picky about it. <sex nerd self-promotion> If you want to read my dissertation “Sex and Shame: Authenticity in Adult Education“, click on the link. </sex nerd self-promotion>

Anyway, we’re about halfway to our goal of 1200 completed surveys and we’d love your help. The participation criteria are:

“You should complete this survey only if you have actively participated in a “face to face” BDSM community event, such as attending a conference, organizational meeting, social event, or other gathering. You do not need to be a member of any BDSM organization. Intimate relationships, friendships, and mentoring are important avenues of BDSM education, but this survey is focused on activities of the public, organized BDSM community. If you have no direct experience with BDSM or “kink” community events please do not complete this survey.”

But even if that doesn’t include you, please feel free to pass the link to the survey along. This is the first community-based survey of sex education workshops and I want it to be the best it can be. It’ll make lots of sex educators really happy. And no, that’s  not me in the picture. But that’s how happy I’ll be when we see what the results are.

The survey is here:

https://www.surveymonkey.com/s.aspx?sm=iG8LaEIcMpw_2bRR9spo_2bXig_3d_3d

Feel free to send the link itself, or send someone to this blog. Thanks a lot for your help.

They save money and they reduce the number of women who seek abortions. Somehow, that sounds like a no-brainer to me. Plus, it’s much more effective than trying to convince people to not have sex.

Just because two or more things happen at the same time doesn’t mean that one causes the other. One might cause the other, each might cause the other, they might both be the result of some other factor, or it might simply be coincidence that they both happen at the same time. One of the reasons for using the scientific method in conducting research is that it’s a systematic approach to inquiry that helps us avoid mixing all of these things up.

Here’s an example of what I’m talking about. This recent article describes research showing a correlation between frequent masturbation in younger men and a higher rate of prostate cancer as they age. Now just to be clear, the article is very specific about the fact that they’re not suggesting that masturbation causes prostate cancer. In fact, the speculation is that “young men genetically predisposed to have hormone-sensitive prostate cancer will be at higher risk if their bodies naturally produce high levels of male hormones” and these hormones are likely to cause a higher sex drive, which would then lead to more masturbation. This is just speculation at this point- more research is needed into both the effects of hormones on sex drive and prostate cancer before we can say for sure what’s going on.

So we have a correlation: more masturbation and more prostate cancer. And we have a plausible hypothesis about why that is: more hormones. So why do so many people feel the need to present it as:

MASTURBATION CAUSES CANCER!
Masturbation May Cause Cancer?
PROSTATE: TOO MUCH SEX AT YOUNG AGE INCREASES CANCER RISK

and my personal favorite:
Too much sex = Increased Prostate Cancer Risk

Of course, part of the answer is that sensational stories about scary things get attention and increase website hits. And a lot of the answer is that many people don’t understand the difference between two things happening at the same time and one thing causing another. It makes me a little bit crazy (no, that’s not me in the picture) because these ideas stick around for a long time, even when they’ve been proven to be false. I expect that I’ll be hearing people ask “doesn’t masturbation cause cancer?”, and “isn’t too much sex dangerous?”, which just makes my job as a sex educator harder.

So when you hear the latest scary article about sex (or anything else for that matter), I suggest that you take a look at the original research and find out what it actually says. It’s usually not nearly as scary as most bloggers make it sound. And remember- correlation is not causation. Say it with me- correlation is not causation. It won’t necessarily make the fear go away, but at least you’ll know something that the bloggers don’t.