Sexuality IQ Quiz

Top 10 most popular questions, myths, tips

Stereotypes still linger when it comes to sex. Outdated notions can get in the way of sexual health and satisfaction. Below are my most popular questions that have come up in my over 20 year practice.Take my Sex IQ quiz to find out of you are Sex Savvy!

1) A man is responsible for a woman’s orgasm


We live in an orgasm-focused society and many men (and women) still believe it is a man’s job to “give” a woman an orgasm. Although a man certainly helps facilitate a woman’s orgasm, ultimately women are responsible for their own sexual response—especially orgasm. If a woman is not in the right frame of mind, all the stimulation in the world will not be enough to bring her to climax. Religious, social, moral or psychological conflicts can cause a woman to hold back during sex. Also, in order to allow someone to witness them in the sometimes awkward state of orgasmic euphoria (arched spine, eyes rolled back in their head, curled toes, etc), a woman must be reasonably comfortable with her body and the context of the sexual interaction. Women who know their own bodies (and can bring themselves to orgasm) are much more likely to be orgasmic with a partner than women who have never masturbated to orgasm.

Many men feel sexually inadequate if their female partner does not achieve climax from intercourse. They interpret it as a direct reflection of their masculinity. Women must be open and honest with their partners about the type of stimulation that feels best. Partners are almost always receptive to feedback in this area, but many women find it difficult to give this feedback. We don’t want to hurt our partners’ feelings or damage their sexual ego. Many women, in an attempt to stroke their partners’ ego, “fake” orgasm. Although this may seem like the right thing to do in the moment, it sets a precedent that is robbing both parties of long-term sexual satisfaction.

Helping your partner achieve orgasm is a wonderful way to connect and feel close. Suggesting new positions or techniques, determination to find the “sweet spot,” and willingness to accept feedback can help a woman reach the “Big O,” but, in the end, women must take ownership of their own sexual satisfaction.

2) A healthy man should be able to achieve erection under any circumstance


The arousal phase of sexual response (when men achieve and maintain erections) is more delicate than most people realize. However, myths and stereotypes about male sexuality still dominate our culture. Many men still believe they should be able to get hard (and stay hard) at the drop of a hat.

Medical conditions like Diabetes, Hypertension, and Obesity affect the vascular process that enables blood to fill the penis. Certain drugs, like antidepressants, antipsychotics, blood pressure medicine, and hormonal preparations may also undermine the arousal phase of sexual response. Although alcohol has an often appreciated socially-disinhibiting effect, it is not a friend of the penis. Alcohol is a depressant, and thus depresses sexual response. Chronic illness, surgery, chemotherapy, pain, injury, smoking, certain recreational drugs, and even bicycle riding can all affect a man’s ability to get and keep an erection. In addition, many men seem to be unaware of the “Refractory Period.” The refractory period is the period in which your penis “recuperates” after an orgasm before it can get hard again. As a man ages, his refractory period increases.

In addition to the many physical risk factors for ED, more and more men are coming to see me for help with “pschogenic” impotence. Psychogenic impotence is when a man has trouble getting or keeping an erection due to psychological barriers. I treat many men in their 20’s and 30’s who are physically healthy but cannot get or keep an erection with a partner. I’ve developed an acronym to capture the most common emotions that interfere with arousal. I call it SHAARD, like a shard of glass that pierces the heart of sexual function:


Depending on one’s social status, coping skills, developmental history, etc., any one of these emotions can take the wind out of the sexual sail in no time flat. I spend thousands of hours talking to men who are surprised that feelings can interfere with sex. As a result of therapy, they come to understand that their penis actually does not have a mind of its own, but rather is an organ attached to a real live vulnerable person.

3) Two thirds of women are unable to reliably achieve orgasm from intercourse alone


The sobering truth is that as many as 80% of women are unable to reliably achieve orgasm from intercourse alone. That means that up to 8 out of 10 women need some sort of supplemental stimulation (manual, oral, vibrator, etc) to reach orgasm. This statistic can be very validating to women who feel like something is wrong with them. They come in with the misinformed belief that all of their female friends, neighbors, family members, etc. are orgasmic from intercourse alone. When they learn that they are actually in the majority, they often feel immediately relieved and normalized. There are some men (and even some women) who are highly invested in the coital orgasm. They feel “gypped” if female orgasm is not achieved from intercourse. In this case, a little psycho-education goes a long way. There is more than one way to skin a cat, and as long as a woman “gets off”, who cares how! The goal is to share a mutually satisfying sexual encounter—how you get there is up for grabs!

4) One third of men achieve orgasm before they want to


This statistic may, in fact, be low. After talking to men about sex for more than 20 years, I find that men expect to consistently provide a rock-hard erection for indefinite periods of time. They expect to last until their partner achieves coital orgasm, yet up to 80 % of women are unable to achieve orgasm from intercourse. When I ask men how long they think they should last, I hear anything from half an hour to all night. This notion stems from cultural messages about male sexuality that sets men up to feel inadequate. There are, however, men who are legitimate “quick triggers” and believe it is causing problems in the bedroom. Historically, it has been difficult to operationalize “premature” ejaculation (now called rapid ejaculation). There are so many variables that affect sexual satisfaction. The definition of this “dysfunction” has changed over the years and is now defined as ejaculating before one wishes. One man’s trash is another man’s treasure:

  • John reaches reach orgasm after 5 minutes, but his wife is highly sexually responsive and often achieves two orgasms during those five minutes.
  • Joe lasts 20 minutes, but his wife never achieves orgasm.

John will not be in my office, but Joe might. Beauty is in the eye of the Beholder:

  • Example 1–Steve cums after 5 minutes—his wife says, “That’s it? That’s all you’ve got? Why did I bother? You are a joke!”
  • Example 2—Michael also cums after 5 minutes—his wife says, “Wow, I must really turn you on! That is so hot!”

Same ejaculatory latency—but two very different outcomes! A partner’s reaction to sexual dysfunction is key in whether or not it becomes a problem. I find that talking about the meaning of orgasm, and sex in general, can temper rapid ejaculation. Medication (low dose of SSRI antidepressant) is also very effective treatment for rapid ejaculation. Keep in mind that a man could last all night, but if his partner hates him, it isn’t going to matter. No amount of sexual stamina will heal a broken relationship.

5) It is abnormal for women to experience fluctuations in sexual desire


All humans experience fluctuations in sexual desire throughout the lifespan, but women are especially vulnerable to these fluctuations. Desire is the first phase of sexual response, followed by arousal, orgasm, and satisfaction. Desire is the most complex and fragile phase of sexual response, especially for women. I like to divide desire into three separate and discrete sub-components—biological, social, and psychological. Biological desire represents the physiological experience of sexual energy in your body. Think of it as libido, horniness, or drive. It is hardwired into our DNA. It is our hormones in action. It has nothing to do with the quality of your relationship. It is simply a primal urge. The social manifestation of desire is shaped by the messages we internalize from culture, religion, society, parents, peers, the media, etc. Although these messages are not always healthy or accurate, they become deeply embedded in our psyches. They shape our feelings about our gender role, sexual behavior, fantasies, comfort with sex, masturbation, and much more.

The psychological component of desire represents the quality and tone of your relationship. If you hate your partner or don’t trust your husband, this will surely affect your motivation to be sexual with him/her. Women, for the most part, want to feel connected to their partner. If there is “ill will” or consistent negative interactions, this will likely interfere with a woman’s receptivity toward sexual contact. Many additional factors affect a woman’s desire, including fatigue level (sleep deprivation is a woman’s sexual enemy!), physical health, mental health, hormonal status, pregnancy, motherhood, extended family obligations, gender identity, drugs and alcohol, body image, self esteem, etc. Female sexual desire is extraordinarily complex.

6) A vast majority of those who commit infidelity are male


Although this used to be true, it is definitely no longer the case. In our modern world, women are just as likely to be unfaithful as men. We now know that although women cheat as often as men, they tend to cheat for different reasons. Generally speaking, men cheat to satisfy sexual needs or wants. Women, on the other hand, tend to cheat for more emotional reasons. Why is the gap closing? The two main reasons are 1) more women are in the workplace, and 2) The Internet.

Now that so many women are in the workplace, they have access to not only other men, but to their own income. When women were primarily homemakers, they were reliant upon men for money and opportunities to socialize. Working also provides women the opportunity to be unfaithful because they are away from the home without having to account for every minute of their time or constantly supervise young children. Men are no longer the only ones to travel for business. The Internet was also a game-changer for women when it comes to being unfaithful. With 24-hour access to men all around the globe, the opportunity to meet someone online and fall in love (or at least “believe” they are in love) is staggering. Even women who are not in the workplace and have small children at home can make time to enter cyberspace and connect with another man (or men).

The internet provides a sort of “pseudo intimacy” that allows people to feel like they are being understood in a deep and profound way. Because of the anonymity of cyberspace, people feel they can be more honest, share personal information, and even explore certain private fantasies that they would not share with their actual partner. This “liberation” can be quite compelling, causing the brain to activate and release Dopamine, the feel-good chemical. This euphoric feeling may lead people to feel like they are falling in love. Many researchers believe that “online cheating” is more dangerous than physical cheating because it is of an emotional nature. Emotional affairs are often idealized. “He understands me so much better than my husband,” or “I can tell our sex would be amazing,” or “he always knows just what to say.” I hear statements like these from women who leave her husbands and kids to pursue real-life relationships with online lovers. Once real life kicks in, and the clay beneath the marble starts to show through, many women realize the grass was plenty green on their own lawn. I have, however, treated women who find the courage to leave unhealthy, abusive, or unfulfilling relationships with the support of that online guy.

Over the years, I have treated hundreds of women who reach out to an old flame via Facebook. Nostalgia is a powerful thing—and reconnecting to the power of “young love” or a “first love” is hard to resist. This is a dangerous, yet very common, practice. Like most things, the Internet is both a blessing and a curse.

7) Occasional use of Fantasy is not Problematic


Fantasy is underrated! As a culture, we are quite threatened by the use of sexual fantasy. The truth is, fantasy about our partner can serve as private, personal foreplay to help individuals get in the mood for sex. Imagining your “hottest” sexual encounter with your partner (the time you ‘did it’ outside on the beach or at a movie theater) can help one reconnect to those early euphoric feelings. And in my clinical experience, it can be very hot to share some of your sexual fantasies with your partner. In general, they are more open than you think.

Many people worry if they have a fantasy about someone other than their partner. Although this can be a slippery slope, there is nothing inherently wrong with fantasizing about someone else—as long as you take that sexual energy and bring it to your partner. In fact, it is completely natural to do so! Fantasy should serve to enhance sex. If fantasy starts to interfere, it is time to talk to a professional. I treat many individuals who become reliant on fantasy in order to be sexual. Fantasy becomes a requirement. They cannot maintain arousal or achieve orgasm without it. This is definitely a red flag, especially if the fantasy is of an aggressive or hostile nature. Dependency on fantasy may trigger guilt and shame.

And as you recall from question #2, shame can cause sexual dysfunction. Maybe you (or your partner) are having trouble in the bedroom because of shame related to the content of a fantasy? This is something that a qualified sex therapist can help you figure out.

8) When an individual is transgendered, they invariably want hormones and surgery


Since I started practicing sex therapy 22 years ago, the area of transgenderism has experienced a massive shift. In the early 90’s, mental health practitioners made many inaccurate assumptions about gender dysphoria. The first assumption was that if someone experienced gender dysphoria, they invariably wanted to permanently change their gender through hormonal and surgical means and live their life fully as the opposite sex. Another flawed assumption was that mental illness was likely fueling their decisions. Now, the gender continuum is fluid.

Individuals have MANY options when it comes to exploring and expressing their gender. Some of my clients want merely to talk about their gender identity and its impact on their emotional and sexual world. Others want to try hormones to “see how they feel.” Others want to take hormones to experience certain physical and psychological changes, but do not wish to surgically alter their bodies. Some want to interact with others as the opposite sex. Others choose to retain their gender role in society. Others want to surgically change their bodies. Today, one can stop on any point along the way. There is no clear path toward a specific outcome. Anything goes! The “gate keeping” aspect of treating transgendered individuals is, luckily, no longer relevant. Prior to the Internet, an individual had to undergo intensive psychotherapy, developmental history, and sexual history before they could be considered a candidate for hormonal or surgical treatment. This was a humiliating, time-consuming, and expensive process. Now, you can buy hormones on the Internet! The mental health and medical communities no longer have the muscle to force clients to jump through hoops.

Autonomy now belongs to the client. As it should (although many endocrinologists and surgeons still prefer an endorsement from a mental health professional). In spite of this welcomed shift away from psychiatric monitoring, I still encourage anyone who struggles with gender dysphoria to explore their goals and options in psychotherapy with a qualified sex therapist. Any major decision, whether it be related to sexuality or not, may generate ambivalence which can lead to conflict. Also, if one is taking hormones, I strongly encourage them to be under a physician’s care. I have treated clients who started hormones on their own without being screened and monitored by a physician and became quite ill.

9) One’s sexual script is usually in place by puberty


What is a sexual “script?” Think of a sexual script as a map or a blueprint. It represents the themes and content that turn you on. As a movie script captures a story, a sexual script captures one’s sexual story. It is hard to think that one’s sexual script is in place by puberty because one typically has limited sexual experience when puberty begins. However, the tone and feel of one’s sexual intentions become evident by the time hormones facilitate sexual changes in our bodies.

A majority of men and women develop a sexual script that is conventional, involving predictable patterns and themes. Sometimes, especially for men, the themes and tone of the script are unconventional in that they lack intimacy and are steeped in aggression, coercion, and humiliation. When I take a sexual history from men who have unconventional sexual scripts, they almost always date the genesis of these themes back to puberty.

By puberty, most boys know if they are gay, if they are transgendered, if they are aroused by shoes, if they want to have intimate, loving sex, or if they want to have coercive, hostile sex. They know if they like peeking in windows, if they like showing their penis to people, if they are attracted to outgoing or shy girls. They know if they feel masculine, if they are popular, if they feel their sexual thoughts are “normal” or “weird.” These themes become “hardwired.” And although there is some wiggle room, it is extremely difficult to change one’s sexual script. The script becomes a deeply ingrained, long-standing component of who they are sexually. Many men ask me to help them alter their sexual script because their interests are illegal or violent. Others ask for help because they think they are weird or freakish. Others come in to seek validation and support for their unconventional, yet harmless, sexual interests.

I have devoted my career to helping people reduce shame around their sexuality. I try to depathologize unconventional sexual interests. As long as the activity is safe, sane, and consensual, who cares? The only caveat I want to add is that some interests make it difficult to connect to a partner, thus undermining intimacy. As a psychotherapist, I own my bias that emotional intimacy and relational interactions are healthy. If one cannot maintain an erection or achieve orgasm without popping a balloon, sniffing a shoe, wearing a diaper, or inflicting pain (if these behaviors are an absolute requirement), it might be time to seek help. If I can sprinkle some intimacy into the equation, a happy medium may be achieved.

10) Individuals with serious or chronic illness do not have time to worry about sex


Sexual health is a key component of overall health and life satisfaction. Nothing magnifies one’s sense of sexual health (or lack thereof) more than physical or mental illness. Although the primary goal is obviously to stay alive and achieve a reasonable quality of life, much energy goes into trying to maintain (or salvage) one’s sexual function and satisfaction. Many patients I treat with medically-induced sexual dysfunction are keenly aware that their partners’ needs are not being met. They worry that their partner may be unfaithful, no longer find them physically attractive, be afraid of hurting them, be afraid of “catching” their illness, or “write them off” as a sexual partner. If they do not already have a partner, they worry they will never find one. They further worry that their sexual function may never return. They worry they will never enjoy sex again. They worry they will lose mobility. They worry they will be infertile. They worry about a lot of things. Physically ill and mentally ill individuals are sexual beings. Their sexuality is affected by their illness, but it is not rendered invisible.

Answer Key:

1 – 4   You need major enlightenment

5 – 8   You understand the basics, but are still stuck in certain stereotypes

9 – 10  You are Sex Savvy

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Professional Therapy Never Includes Sex

Sex therapy never requires the removal of clothing or touching between therapist and client. Provocative subject material may be discussed; and intimate topics may be explored, but professional therapy never includes any sexual contact.

Kimberly’s Professional Affiliations & Memberships

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