Sexual Positions for Women with Paralysis

Dr. Mitchell Tepper, leading expert on sexuality and disability, talks about strategies for sexual positions that work, despite paralysis or muscle weakness. Also, Anne who has a T-9 complete spinal cord injury (SCI) and her partner demonstrate a few positions they find comfortable. Finding the right position for you and your partner is a matter of open-mindness, creativity, experimentation, adventure, adaptation, and maintaining a sense of humor.

Screen Shot Sex Files

By Mitchell Tepper, PhD, MPH
Gerrad and Laurie (not real names but real people) developed an online relationship over a two-year period. Casual turned intimate, and intimate hot. After 24 months of mounting passion, they decided it was time to cross the digital divide and meet flesh-to-flesh. Their plan was to consummate their relationship in person.

After great anticipation, their dream of being together in the biblical sense was thwarted by the realities of their disabilities. Gerrad has a neuromuscular disease resulting in overall physical weakness. Laurie has quadriplegia. While she had enough biceps strength to help Gerrad get on top–the only position he can thrust from–they weren’t able to position their body parts for intercourse.

Gerrad and Laurie came to me for advice. They were both aware that good sex and strong intimacy can happen in the absence of vaginal intercourse, and had explored other options for sexual expression. Recognizing that simple touch and closeness satisfies many people, they were still intent on having intercourse. After brainstorming about different positions and assistive devices, we talked about asking a personal care assistant (PCA) to help.

Gerrad was open to the idea. For several reasons, Laurie wasn’t quite as comfortable. She didn’t want a third person–likely one of her female PCAs–present during these most intimate moments, and broaching the subject seemed risky. She not only feared that her PCA might refuse, but that a positive reply would make their day-to-day working relationship awkward. And there were underlying issues surrounding her disability. She questioned why Gerrad would want to go through all this trouble when, in her eyes, it would be easier for him to have a sexual relationship with a nondisabled woman, and she worried that Gerrad might like the sensation of her PCA’s physical assistance as she positioned him.

For Gerrad and Laurie, and for most people with disabilities, this is uncharted territory. On the surface, one might jump to the conclusion that their difference in comfort levels is gender-related. Isn’t it every heterosexual man’s fantasy to be with two women, and wouldn’t any disabled woman feel jealous or threatened by the presence of an attractive nondisabled woman? One might also conclude that this has something to do with their age of onset of disability. Gerrad’s disability arrived before he was an adult, and he has relied on assistance for many years. Laurie’s came later in life, and she might not be as comfortable accepting help.
But the truth is that we don’t know if these or any other speculations have validity because there is little published research exploring the use of PCAs to help with sexual expression.

Three’s a Crowd
One day, Laurie gathered up the nerve to ask one of her PCAs if she would put a condom on Gerrad. The PCA felt the request was plain and brave, although at first she thought Laurie was joking. The PCA decided that it was just part of being mature, and she agreed to assist. Then help with the condom progressed to help positioning Gerrad for intercourse. This PCA completely understood their situation and was very willing to help.

In practice, the situation became too clinical for Gerrad. Accurately or not, he sensed awkwardness on Laurie’s part; he says he saw it in her eyes and felt the tension in her body. Concerned about her well-being, he was unable to maintain his erection. But once they were positioned, they asked the PCA to leave the room. When they called her back for help, Gerrad says he felt the tension rise again.

Laurie feels that their sexual relationship was good while they were alone, but uncomfortable the second her PCA entered the room. It wasn’t so much awkward, she says, but as if sex had become a job. She also says she would prefer help from someone who is more experienced.

“I can’t lift my head to see what needs to be moved where,” Laurie says. “Gerrad can’t either. I need someone who can take charge.”

If I were a therapist and not just an educator, I might guess that Gerrad and Laurie, to some extent, projected their individual discomfort onto the situation. Yet Gerrad felt that another occasion, with a different attendant, was even more clinical as the PCA put on rubber gloves and reminded them both that this wasn’t part of her job. She had reluctantly agreed to help because it was important to Laurie. Gerrad says he couldn’t ignore the fact that were three people in the room trying to accomplish what is usually done by two.

Informal Research
Determined to learn if using a PCA to facilitate sex is a common occurrence, as believed by a small core of sex and disability advocates, I did some informal research of my own. I put a call out to half a dozen listservs asking for the experience of other people with disabilities who had tried facilitated sex.

One young woman with cerebral palsy wrote with some humor that she and her boyfriend with muscular dystrophy discussed asking a PCA for help but broke up instead of following through. She was evidently comfortable with the idea, but he was not. She acknowledged that facilitated sex is a complex issue, but also that if she were in love with someone, she would ask for help. Sadly, no one else volunteered their experience.

I also reached out to Ray Aguilera, personal assistance services coordinator at the Berkeley Center for Independent living. I thought if sex facilitated by PCAs was going on anywhere, it would be happening in the Bay Area, where there is unusual openness about sexuality. But if it is happening there, it’s primarily undercover, no pun intended.

Although Aguilera says that CIL Berkeley doesn’t formally address sexuality issues, he has been able to use his previous experience in sexual health education to provide information informally to members of his community.
“I’ve had four or five men approach me about how to ask for this kind of assistance,” Aguilera says. “Oftentimes their PCAs are female, so the men are afraid the PCA may feel threatened or sexually harassed if they were to approach them. It’s really a double-edged sword for people. They don’t want their request to be rejected by the PCA because they want or need sex; at the same time, they may be terrified of a positive response because of how that could affect their relationship with the PCA.”

Aguilera says his female consumers have never broached the topic with him, but suspects that probably has more to do with his being a man than that women feel more discomfort addressing the issue.
I asked Aguilera if the topic of facilitated sex was ever included in the interviewing and hiring of PCAs. Evidently not. The disabled people he knows who have negotiated this kind of assistance usually discuss it after establishing a good working relationship with the PCA.

“I generally encourage people to be upfront about their needs,” says Aguilera, “but many of my consumers are still afraid to ask for assistance with partnered sex or masturbation.” While he thinks that help with masturbation may be more common than with partnered sex, he, like me, is relying on intuition.

In general, facilitated sex and details of personal sexual activities are seen as private matters. While most of the responses to my informal survey were supportive of exploring this subject, one respondent said that in her opinion, when two people need assistance with intimacy it’s no longer intimacy. She said she would choose celibacy instead, and assured me that “No lady would dare share.” She asked why I couldn’t just research rats instead of concerning myself with people’s private lives.

I acknowledged that not having sex is a valid choice, and that I have the utmost respect for the hundreds of women and men who have shared the most intimate details of their sexual lives with me. As for rats, they’re a little weak at shedding light on the social and emotional aspects of sexuality.

More to the Story
There is more to the story of PCAs facilitating sex then just lending a hand. The potential for complicating what is usually simple is great.
Russell Shuttleworth is a medical anthropologist studying how men with cerebral palsy negotiate sexual relationships, and was a PCA for 16 years. He says most of the men in his research who have been successful in sexual relationships insist that it’s essential to risk rejection.

But when does assertiveness in asking for sexual assistance cross the line to sexual harassment? When is taking a risk seen by a PCA as an unwelcome proposition?
And what about the employment relationship between a disabled person and a PCA, or the intimate relationship between the partners? If both partners have an assisting attendant, then the circle grows. If one or both partners are under 18, yet a new set of considerations arise. An additional level of complexity is added by relationships taking place in a hospital, nursing home or other institution.

Gerrad and Laurie are adults living in the community, but their experience with assisted sex has been a mixed bag and anything but simple. Their sex together without intercourse was fun, but when they tried to add intercourse to the menu it turned out to be much more work and added pressure than they’d expected. Had PCA-assisted sex been a more accepted and known option, Gerrad and Laurie might have been able to make it work to their advantage. As it is, they are a couple no more.

Addressing the complex issues of PCA-facilitated sex is truly the next frontier in sexuality and disability research and advocacy.

Intimacy After War

Hidden Battles on Unseen Fronts

Tepper, M. “The Battle for Love.” Hidden Battles on Unseen Fronts, Stories of American Service Members with Traumatic Brain Injury and PTSD. Edited by Celia Straus. Drexel Hill, PA: Casemate Publishing, 2009.

The Battle for Love

Mitchell S. Tepper, Ph.D., M.P.H.

U.S. Marine Corporal William Berger talks about how his TBI soured the relationship with his girl friend. He describes how he was childish, irritable, withdrawn and unable to be intimate. His mood swings and reactions to medications became so extreme that she finally called it quits.

Chief Warrant Officer Richard Gutteridge describes how, during his struggle with severe PTSD after two deployments to Iraq, he became withdrawn from his wife and two sons,. His dependence on alcohol combined with depression and insomnia drive him to the brink of suicide. His wife appears with his packed suitcase when he leaves the Army base to check himself in to the psychiatric ward at Landstule Medical Center in Germany.

After recovering from his spinal injury Army Specialist 1st Class Duval Diaz left Walter Reed Medical Center armed with medications for depression and sleeplessness. He’d been seeing a psychiatrist at Walter Reed for PTSD and TBI for over a year. His wife, Mercedes describes him as not the man she knew before going into combat. She finds him withdrawn and extremely childish and demanding. His nightmares are so severe that he sometimes hits and kicks her in his sleep. She says she loves him but just doesn’t understand.

The trauma of war often results in wounded bodies and wounded psyches – both of which can dramatically impair a person’s capacity for intimacy. For some, returning from combat and transitioning back into an intimate relationship is not a big problem. Reuniting after a long separation in combination with an overwhelming feeling of gratefulness may even fuel desire and strengthen bonds. However, for Corporal William Berger, for Chief Warrant Officer Richard Gutteridge, for Army Specialist 1st Class Duval Diaz and his wife, Mercedes, and for many of the tens of thousands of those who are experiencing symptoms related to deployment and combat related stress, PTSD, mild traumatic brain injury (TBI) and major depression, being emotionally and physically intimate can present a real challenge.

The RAND report Families Under Stress: An Assessment of Data, Theory and Research on Marriage and Divorce in the Military (2007) suggests that people who return from deployment with a serious physical or mental injury bear a disproportionate burden of marital stress and divorce than their non-disabled counterparts. In addition to divorce and strain on relationships, the RAND report Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (2008) found that failed intimate relationships contribute significantly to suicide, intimate partner violence, child abuse, reduced quality of life, homelessness, and substance abuse (Tanielian & Jaycox, 2008).

The relationship between combat related trauma, risk and resilience factors, including guilt, shame, and anger and the resultant impact on the capacity for intimacy is poorly understood. However, in light of just the few excerpts of stories repeated here, it is not difficult to picture how a mental trauma like PTSD and depression, or a physical wound like TBI can create significant barriers to establishing and/or maintaining intimate relationships.

The symptoms of deployment and combat related stress, PTSD, depression, and TBI can erode the foundation of intimate relationships. Intimate relationships are founded on things such as communication, trust, a sense of safety, the ability to accurately perceive and tend to another’s emotional needs, impulse control, vulnerability and love. The constellation of problems distilled from the collection of stories in these pages including nightmares, night sweats, sleeplessness, loss of concentration, irritability, anger dyscontrol, hypervigilance, forgetfulness, short-term memory loss, depression, denial, migraines, seizures, emotional numbing, avoidance of sex, social withdrawal and loneliness plague both the person wounded and their intimate partners.

Overwhelmingly, the partners of these returning veterans were unprepared for what they faced. It was difficult for them to understand their loved ones’ radical changes in mood, behavior, and reactions. Many a partner has experienced what Mercedes expressed so candidly, “It’s like having a child again who demands all my attention and all my love but has trouble giving it back to me.” The combination of not understanding, the feeling of being in a relationship with a child, and the experience of being the target of anger, frustration, and blame makes maintaining emotional and sexual intimacy difficult.

Sexual intimacy at its core requires vulnerability on the part of both partners, and vulnerability is inconsistent with survival in the battlefield. In the vernacular, to be caught “with your pants down” means to be caught unprepared, to be vulnerable to a negative outcome; so to in sexual intimacy. To bear oneself literally, as in to get naked in front of a new lover, or figuratively, as in to share a personal fear or insecurity leaves one vulnerable. Hence, intimate sexual relationships, like emotional intimate relationships, require a sense of security and trust, commodities that are often hard to come on the battlefield.

Some partners like Mercedes stick around and hope their partner will change with time and that they will be affectionate with each other again, while others who cannot or do not want to cope with the changes leave. Partners who stick around may experience a heavy caregiver burden that can result in cumulative physical and emotional stress over time or even a phenomenon called secondary traumatization. Secondary traumatization is a situation in which the intimate partners of trauma survivors themselves begin to experience symptoms of trauma, a major factor contributing to the breakup of William Berger and his fiancé. While patience and hope are two important factors that can contribute to resilience, these too can be elusive and are not sufficient on their own to alleviate suffering.

The battle for love does not take place within a vacuum. Research shows that people with pre-existing vulnerabilities – like less education, less supportive extended families, lower socioeconomic status, or a history of adjustment problems – may experience worse family outcomes than individuals without these vulnerabilities. Also, in the case of marriage, the quality of a marriage before the trauma is predictive of the resilience or adjustment afterwards.

Our service members get some of our nation’s best medical care and physical rehabilitation services but access to mental health services is both limited and often ineffectual, as it is in the civilian healthcare arena. We need to work more aggressively to identify and get into treatment those struggling with depression, combat related stress, PTSD, mild brain injury, and spiritual issues. And we have to do more to educate and support their partners emotionally, and to lesson the burden of caregiving on them by providing adequate personal care or support services for the wounded partner.

The stories in this anthology talk of relationships that have either ended or been damaged by the veteran’s wartime experiences. Overall the picture painted for intimate relationships is not a rosy one. At the moment we need to look beyond the stories of OEF/OIF veterans in this anthology and outside of the limited research literature on intimate relationship adjustment after combat and then conduct research and develop evidence-based interventions.

We can start with the first person story of a mental health care volunteer for Give An Hour, 55 year-old George Alexander, the civilian son of a Marine Corps sniper during WWII. George tells this story as part of his counseling to veterans coping with PTSD. George’s father “came home from the war a damaged man and turned to drinking to relieve the demons that haunted him.” George describes a pattern of abuse he experienced when his father would get drunk and take out his anger on him and the secondary traumatization he developed by age six, complete with nightmares of combat, insomnia and other symptoms indicative of PTSD. George’s parents divorced when he was ten.

George’s early life experiences translated into a series of fights, substance abuse, risky sex, dropping out of school and violence. By the age of 19 – having already been married and divorced once – he took on a new identity and life under the witness protection program. George’s new life, however, was haunted by his past traumatic experiences. After 35 years of failed relationships (including three divorces and two broken engagements) and a painful medical condition that led him to the brink of suicide, he checked himself into a psychiatric ward. There he was diagnosed with Complex PTSD and received treatment. George is now in a stable marriage, works as a veterans’ advocate in honor of his father and volunteers providing counseling to veterans.

George often shares some of his insights after reflecting on his intimate life and relationships. “I had built a wall around me to protect myself, which ultimately wound up preventing anyone from getting close enough to love me.” He describes himself as withdrawn, emotionally numb, unable to trust anyone and always afraid of being rejected if a woman were to find out who he really was inside. He says he’s reminded of the famous line from Cool Hand Luke where Strother Martin says to Paul Neuman, “What we have here is a failure to communicate” since communication was a main problem. In his own words he describes, “being unable to let my shield down long enough to connect, to open up to another human being for the love I so desperately wanted.” He says that as a child he was never taught the skills necessary to have a successful relationship or to manage conflict, so as an adult he would just recoil and withdraw like an 8 year-old. George thought he was doomed to spend the rest of his life alone and unloved. He says, “I was depressed most of the time and frequently turned to substance abuse to get me through the lonely nights spent trying to figure out why I couldn’t maintain a loving, committed relationship with someone, which is what I wanted more than anything in the world. Then, totally by accident, I would meet the woman who would teach me what to be in a loving, committed and enduring relationship really meant, and we have now been together for the last 10 years. She also taught me the difference between love, sex and intimacy. I learned that intimacy meant sharing our feelings, our values, our thoughts and most importantly, our love. It was the love for this woman, who is his fourth wife, and their child that gave him the will to live and get help when he was in his deepest moments of physical and emotional pain.”

I know of other anecdotes of individuals who have ended up in happy marriages after several tries and much heartache, and even couples who have weathered the storm together. However when we see case after case of relationships disintegrating between returning veterans and their partners, we cannot standby and just let things happen “totally by accident”. Formal research needs to be done to understand what factors contributed to successful relationships and what type of therapeutic interventions can foster success in intimate relationships before, during and after going to war.

In addition to access to Chaplain counseling, anger management, stress management, and substance abuse treatments offered through the Department of Veteran’s Affairs’ system, we need to add classes on topics like: communication skills; conflict management; sexual enrichment strategies; adapting to changed bodies, changed minds, and changed relationships; adapting to changed roles within relationships (e.g., partner as caregiver, patient instead of provider), and; effects of disability and chronic conditions on sexual response and expression, and; access to couples counseling. Ideally, the VA will develop retreats for veterans battling for love as the Department of Defense does for active duty personnel via the Army Strong Bonds program.

We can also help people explore and understand the nature of love in their relationships, specifically who does it serve and what needs does it meet. Sometimes, as in the case of Duval and Mercedes and George and his new wife, love is the critical glue that holds relationships together. Other times, feelings of isolation and withdrawal can lead to suicidal thoughts as experienced by Richard. It is said that unselfish or compassionate love lasts for ever. Compassionate love serves the other and meets the needs of the other; archetypal examples are the love of God toward man, the love of a mother toward her new baby, and the love that Jonathan and David shared in the bible. Conversely, self-centered love is seen as conditional. If the condition is met, I feel love; when that condition is no longer present, the feeling of love is lost.

The battle for love on the home front requires a new type of bravery, a new type of hero. If we accept the notion that a hero acts in the face of fears, then we can say a hero rises above his or her nature. It is human nature to focus on what you had and what you lost and to want to hide in shame when you are feeling vulnerable. It takes a small act of heroism to move forward into the unknown, armed only with what you have at the moment. Now our heroes – both those who were deployed and put themselves in harms way to protect the greater good and those who stayed at home and held down the ship – are fighting for their lovers and their families. This virtuous fight requires the ability to see the good, to not let evil prevail, and to not let the spirit be broken.

While we cannot expect every relationship to survive, we owe it to our wounded troops and partners to give them the support they need to have a fighting chance to avoid unnecessary dissolution of marriages and committed relationships. A lack of healthy intimacy can significantly impair recovery and contribute to ongoing mental health problems. Healthy intimate relationships add meaning to life in the face of substantial loss and can contribute to a person’s recovery from physical and mental trauma. Those who have sacrificed for our country deserve our full support in their battle for love.

Covers Sexual Health

Description

Doctors, psychologists and educators nationwide detail how sex – or lack of it – affects our mental and physical health. Includes a focus on potential threats to sexual health, be they mental, physical, cultural or religious.

In this unprecedented four-volume set, doctors, psychiatrists, psychologists, educators, and clergy join forces to present information vital for sexual health. Topics candidly discussed include the meaning of sexual health, the effects of ignorance or neglect, and the role of love, touch, and communication. Doctors explain the roles of physical systems, while psychologists and members of the clergy detail the roles of religion, culture, and parental or family beliefs in spurring or squashing sexual health. State-of-the-art treatments and research are also featured. Each volume includes a chapter on how to talk with a doctor, therapist, or patient about sexual health.

Americans feel free to tell medical doctors of health ills from headaches to hemorrhoids, and to tell psychologists about mental problems from depression to delusions. Yet, there is one area that affects both physical and mental health most people don’t discuss with either doctor or psychologist: sexual health. According to a survey published by the American Medical Association, 43 percent of women and 31 percent of men in the United States experience some form of sexual dysfunction, problems are largely hidden, and so exacerbated. Doctors don’t initiate the topic with patients; neither do most psychologists aside from trained sex therapists. The problems might not even be rooted in disorders commonly understood as illness. As officials at the World Health Organization have defined it, sexual health is more than the absence of disease. It is a state of physical, emotional, mental and social well-being related to sexuality.

Reviews

“The editors interweave areas of basic and clinical science that are not often seen together–to the benefit of students and scholars alike. In doing so, they clarify the diverse contributions that have been made to the field of sexual health….[T]he editors have skillfully brought multiple disciplines and perspectives together into one comprehensive anthology….I know that these volumes will certainly help me to educate medical students, residents, and physicians about sexual health. I believe this collection will be a valuable resource for clinicians, researchers, sexual health educators, and even persons outside the field who are simply interested in enhancing their own sexual health.” – The New England Journal of Medicine

“This four-volume set is founded on the World Health Organization’s definition of sexual health as being more than just the absence of disease; instead it is a state of physical, emotional, mental, and social well-being related to sexuality. Each volume focuses on a broad area of sexual health, and the chapters within each volume, written by academics and health practitioners, treat various topics in language that is scholarly but accessible to lay readers….[a] comprehensive, nonjudgmental resource on a high-interest topic. Access to information is through each volume’s table of contents and a subject index; cross-referencing would have made this set more useful as a reference resource. However, its chapter-based format makes it appropriate for placement in either circulating or reference collections. Recommended. All levels.” – Choice

“Tepper is a sexual educator, researcher, and advocate; Owens is a certified sexuality counselor. Both are with the Sexual Health Network, an organization of health professionals and educators providing online information and guidance to the public. They present a four-volume set comprised of 61 chapters contributed by some 70 doctors, psychiatrists, psychologists, educators, and clergy addressing the meaning of sexual health, the effects of ignorance or neglect, and the role of love, touch, and communication. Each volume focuses on one of four subcategories of sexual health psychological foundations, physical foundations, moral and cultural foundations, and state-of-the-art treatments and research and contains a subject index specific to the individual volume. A list of print and nonprint resources is also included at the end of each volume for further information. For students and healthcare professionals, and general readers interested in sexual health.” – Reference & Research Book News

Endorsements

“This monumental work presents in-depth knowledge and extensive information from many different points of view. Several chapters deal with the cultural and religious aspects of sexuality, of great importance in our present world. An excellent work!” – Gorm Wagner, M.D., Ph.D., Senior Researcher, Copenhagen University Hospital, Denmark

“This is an incredibly complete text on sexual health, and includes chapters from many of the most prominent researchers and clinicians in the field. Contributing authors provide detail without losing sight of the big picture, which is organized by the editors into three volumes on the underpinnings of sexual health, and one on treatments and research. This comprehensive anthology of sexual health is an essential resource for clinical practice, medical education, and further advancements in our understanding of human sexuality.” – Anita H. Clayton, MD, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia

Tepper, M & Owens, A. (eds). Sexual Health, Vol. I: Psychological Foundations. Sex, Love, and Psychology series edited by J. Kuriansky. Westport: Praeger Publishing, 2007.

Tepper, M & Owens, A. (eds). Sexual Health, Vol. II: Physical Foundations. Sex, Love, and Psychology series edited by J. Kuriansky. Westport: Praeger Publishing, 2007.

Tepper, M & Owens, A. (eds). Sexual Health, Vol. III: Moral and Cultural Foundations. Sex, Love, and Psychology series edited by J. Kuriansky. Westport: Praeger Publishing, 2007.

Tepper, M & Owens, A. (eds). Sexual Health, Vol. IV: State-of-the-Art Research and Treatment. Sex, Love, and Psychology series edited by J. Kuriansky. Westport: Praeger Publishing, 2007.

Essential Tantra

By Mitchell Tepper, Ph.D., M.P.H. Many of us were taught before we became disabled or in adolescence that sex entails excitement that grows more and more intense until it results in a climax. The goal is usually seen as orgasm and the release of pent-up sexual tension. We learned about sex in a culture that treats it as sinful and unspeakable, yet uses a medical model to describe it. According to the medical model of sex and orgasm, a buildup of muscular tension leads to a peak, followed by a release – ejaculation for men and contractions of the muscles surrounding the vagina for women. Since what science can measure is primarily physical in nature, orgasm is seen basically seen as an autonomic reflex, a mere spasm of genital contractions. The medical model doesn’t work for all of us. When our disabilities are accompanied by loss of genital sensation, limited movement or inability to ejaculate or have genital contractions, we may feel like giving up. The sexual pleasure we learned about or once knew has become inaccessible. Tantric sex – based on the esoteric teachings of several eastern religions – provides an alternative way to experience sexual pleasure and bring new meaning to a loving relationship. Tantric orgasm is counterintuitive to the medical model. In Tantra, excitement is just the beginning rather than the means to the end. Instead of rushing toward a climax, a Tantric practitioner slows down, remaining in the moment, and travels toward deep relaxation. In the medical model, sexual energy builds, then is lost. In Tantra, energy is not lost but gained. Instead of using a partner for one’s own gratification, Tantric partners provide vital energy to each other.

Sex Transformed

Ray Stubbs, sexuality educator, author, massage therapist and a fairly recent quadriplegic, has spontaneous orgasms while meditating despite his injury and describes ecstatic experiences I can only hope to someday achieve. He has written several books, the latest being The Essential Tantra: A Modern Guide to Sacred Sexuality. Stubbs’ extraordinary experiences do not occur in a vacuum. They follow many years of conscious seeking and study with Tantric teachers and Native American shamans. He has also practiced and taught contemporary meditation in the form of massage that embraces sexual energy. Gary Karp, a paraplegic and the author of Life On Wheels, also has an interest in Tantric sex. He says that after his injury, a book on Tantra prompted him to consider that “normal” orgasm might not all it’s cracked up to be. He particularly liked the Tantric teaching that two “energetically appropriate” lovers have complimentary polarities. “Making love,” says Karp, “is an act of fulfillment and bonding for each person on a deep, evolutionary and innate spiritual level.” Stubbs’ connection is with the divine; Karp’s is with the other. Both approaches are spiritual. In fact, Tantra is not about sex at all. It is about transcendence. Although the outcome of Tantric sex may be prolonged sexual pleasure, that is not the goal. Sex is a vehicle. Sex is transformed into love, love into meditation, to light, to knowledge of the divine, to ecstasy, to bliss. According to Bhagwan Shree Rajneesh’s Tantra, Spirituality and Sex – my first exposure to Tantra many years ago – once you know that bliss, you are grounded in reality. The reality is that in deep sexual orgasm, it is not sex that gives you bliss. Once again, sex is only the vehicle. Something else is generating the euphoria, the ecstasy. That something else, according to Rajneesh, can be divided into three elements – timelessness, egolessness and being natural. These are the components that produce ecstasy and bliss. I know all of this might sound strange or simply corny, but bear with me. Even Tantric teachers say that practice and experience must precede belief. Transcendence comes through experience, not through ideology. My challenge to you is to begin to think of sexual pleasure and orgasm in a different way.

In the Moment

For a Tantric orgasm to occur, there is no need for a build up of sexual tension, for friction, for ejaculation or for muscular contractions. In fact, there is no need for sex at all once you have discovered that orgasm can be a deeply relaxing meditation, a state combining Rajneesh’s three components of timelessness, egolessness and being natural. When you are timeless you are in the moment, not comparing to past experience or focusing on future expectations. When you are egoless, you become one with your partner or the universe, not an individual limited by physical disability or negative thoughts. When you are in your natural state, in the words of Rajneesh, “The unreal is lost; the facade, the face, is lost; the society, the culture, the civilization is lost. You are part of nature – as trees are, animals are, stars are. You are in a greater something – the cosmos.” Still seem far-fetched? Well consider this. Drs. Beverly Whipple, Gina Ogden and Barry Komisaruk have shown in laboratory studies at Rutgers University that women can have orgasms through fantasy alone, without any physical stimulation. Some of the women’s orgasms were not associated with genital contractions. Still skeptical? Think this only applies to nondisabled women? My recent research with men and women with spinal cord injuries documents experiences that were identified as orgasm by the participants but could hardly be described as medical-model orgasms. While some participants still experienced traditional orgasms, others – of both sexes – said their orgasms happened “by surprise.” There was not the usual buildup of muscular tension, yet ecstatic feelings occurred in their heads or entire bodies, even for those with no sensation below their level of injury. Is your mind beginning to open to new possibilities?

Getting Started

Stubbs writes in his book The Essential Tantra that Tantra is basically a teaching of acceptance and nonattachment. When we grasp for something, we are attached. There’s no freedom. When we avoid something, we are attached. There’s no freedom. It is through the acceptance of all as it is that we become free. Acceptance is neither submission nor giving up. Here, acceptance means nonattachment. What does that mean for us? It means accepting ourselves as we are and letting go of preconceived notions of sex and orgasm. It means becoming aware of the feelings and sensations that we do have, subtle as they may seem at first. In total acceptance, in nonattachment, there is transformation. Stubbs warns us not to get caught up in the mainstream media’s sensationalization of Tantra that has packaged it as a royal road to sexual pleasure. The essence of Tantra is not having sex in a particular position or prolonging intercourse. The real thing, says Rajneesh, is the ability to relax, to let go, to transform the physical into a meditative experience. It is attentiveness to sensations, mindfulness, being in the present. Stubbs notes that when we can transform energy at will, we are liberated. For me, a casual student, Tantra is a way of tapping into my subtle energy body that I had been aware of but unable to express. It has provided another way for my wife, Cheryl, and I to stay sexually and spiritually connected in those times between what many would refer to as ordinary sex. Mastering Tantra takes many years of study and practice. All of us, however, can begin to reap the benefits of this sacred perspective by practicing a few simple exercises that can be incorporated into our everyday lives.

• Raise your awareness that you are a conscious being. If you are accustomed to wearing a watch on your left wrist, wear it on your right. Every time you go to check the time on your left wrist instead of the right, say “I am a conscious being.”
• Focus on your breathing. Most of us are shallow breathers. Deep relaxation begins with deeper breathing. Whenever you pass through a door, check your breathing. Take a good deep breath if you can, hold it and exhale fully. At a later time you can learn to harmonize these three stages of breathing.
• To get a better sense of your energy body, focus on the palm of your right hand. Notice the sensations. Then focus on the palm of your left hand. Switch the focus back and forth. Then slowly move your hands together until they almost touch. Pay close attention to the changes and what you feel between your palms. If you don’t have sensation in your hands than focus on one ear, then the other. Then move or have someone else move your palm within an inch or so of your ear. You will see that your energy body extends beyond your physical body.
• To enhance your awareness of expanding sensations, slow down when you’re eating. Truly taste the food and drink. Notice the texture and temperature. Keep track of the sensations as the food travels down your esophagus. I do this with orange juice first thing in the morning.

Practice is essential as we relearn ways to experience the full energy of our bodies. According to Stubbs, sensuality, sexuality and spirituality begin with ourselves. They are all within us. Barriers to these experiences during sex include concentrating too much on performance and not enough on sensations, judging others, making comparisons with the past to invalidate the present, and focusing on expectations instead of the richness available in the moment. To overcome these barriers, let go of expectations. If you are the receiver, let go of attachments to outcomes. If you are the giver, let go of performance expectations. Allowing, rather than striving, is the key to acknowledging that we are not bound by the medical model of orgasm.

Janet Jackson Wardrobe Failure

By Mitchell Tepper, Ph.D., M.P.H.

HSAB Affiliation: Managing Director

It may be a little late for Monday morning quarterbacking as the public media hype over Super Bowl XXXVIII has come and gone in about the same time it took Janet Jackson to flash her nipple, barely covered by a silver sunburst nipple attachment. That being said, let’s get right to the point. As a sexologist and as the Managing Director of the Health and Science Advisory Board, I’ve seen my share of private parts. I didn’t think there was much left in the realm of sexual expression to surprise me until I peeked over my shoulder at half-time at the boob tube only to catch a glimpse of Justin Timberlake making his move.

Now, I have to admit that I am not a big sports fan. However, I felt compelled to keep my 20-year-old Emerson 19-inch TV that sits above the filing cabinet in my office on while I was working at my computer so as to be part of the action; to be connected in some way to the other 100 million people around the world watching at the same moment. And what a moment it was! I was shocked. I could hardly believe my eyes. It was a small screen a couple of yards away and I didn’t have the benefit of TiVo to pause and replay the titillating scene.

I was now focused on the TV, waiting in anticipation for the blow-by-blow recap from some sports commentator of what I thought I just saw. However, Jackson’s breast didn’t get much coverage that night. I was left wanting and fixated on the staged event until this very day.

People who know me, and many who don’t, often find me to be a contradiction. How is it that someone who disseminates explicit sexual information, advocates for access to sexuality education for people of all ages, and consults for a company that provides adult entertainment over the Internet, is so troubled by a little nipple? Well, it is the context, not the content, that disturbs me.

It is not a nipple, or a bare breast, or even the glimpse of a bare butt on TV that gets under my skin. It is the mass media that exploits sex for gain on a daily basis and then quickly acts to distance itself from one of its own creations. MTV, which produced the offending show, and CBS, which broadcast it, both said they had no idea the show would include such a display, which was edgy for a G audience even without the breast exposure incident. Had the Super Bowl halftime show aired on MTV, the FCC would have been powerless to fine it and I doubt I’d be writing about it.

While CBS rushed out an apology, there had been clear indications for a week prior to the super bowl that Jackson had planned something. MTV had hinted during its afternoon programming that Jackson’s appearance would be “one for the record books.”

“CBS deeply regrets the incident,” spokeswoman Leslie Anne Wade said. “We attended all rehearsals throughout the week and there was no indication that any such thing would happen. The moment did not conform to CBS broadcast standards, and we would like to apologize to anyone who was offended.”

What broadcast standards? The media uses sex to sell everything from records, to vacations in Disney World, to their own news at the expense of all who are subjected to it with little choice but to not watch TV at all, not turn on the radio, and not open or even look at the cover of a magazine or newspaper. In these days of supposed women’s equality it seems like the only standard the media stands by is the double standard.

You don’t need a degree in marketing or media literacy to see that television shows, commercial advertisements, and music videos are using women’s bodies as a marketing tool to increase ratings and sales. Men are typically in sexual situations fully clothed, while women are in provocative clothing or less. On music videos, Maynell Thomas, an entertainment attorney and producer, said they were products of commercialization, taking the place of music tours, and that the women are “a promotional tool to use…to sell music.”

The media sends impressionable young women a message that they need to show more skin, an image portraying women as brainless, but with a desirable body. At the same time we do a disservice to young men, fueling pressure to perform in the sexual arena as well as in the football stadium in order to maintain their masculinity.

To add insult to injury, politicians use sex as a political football, tackling consensual adult entertainment and comprehensive sexuality education while choosing to punt on the more persuasive and intrusive commercial advertising that is targeted largely to minors. Marketing professionals with degrees in psychology prey on sexual insecurities that are the result of the lack of sexuality education by families, schools, religious and medical institutions. Media advertising that exploits sex sets up precarious expectations for both young women and men and contributes to the said delinquency of minors.

Body parts in and of themselves are not “obscene” or “indecent.” What makes them patently offensive or indecent to me is their exploitation by mainstream media that profits from a government granted privilege to use the airways. FCC chairman Michael Powell said he was outraged at what he saw during the halftime show of the Super Bowl. “Like millions of Americans, my family and I gathered around the television for a celebration. Instead, that celebration was tainted by a classless, crass and deplorable stunt. Our nation’s children, parents and citizens deserve better,” Powell said. “The whole performance was onstage copulation.” It makes me wonder where he and the FCC have been all along?

Some argue the half-time entertainment was more suited to a porn video. Perhaps they are right. At least in consensual adult entertainment, consumers know what they are buying.

In a press release, Free Speech Coalition Executive Director Kat Sunlove said the entire half-time performance had distinctly sexual overtones and was therefore inappropriate for a family show such as the Super Bowl.

“We see it as a matter of giving parents adequate and timely warning that such adult-oriented material is coming up,” said Sunlove. Parents know what children will see if they let them watch programs labeled as having adult themes. That is obviously not the case with the Super Bowl, which is expected to be family fare.

“It is significant that this show was produced by MTV, not by any adult entertainment group,” Sunlove said. “There is a time and a place for adult entertainment and the Super Bowl is not it.”

Reprinted from http://loveandhealth.ifriends.net/Article.cfm?Topic=2&SubTopic=6&Article=60

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