Preventions: Part 2

STDs: What Are They and How Do You [not] Get Them?

By Everyday Health. Listen to the ► Podcast at How To Sex.

This episode deals with the following STD concerns:

 Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis, Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis.

The number of cases of sexually transmitted diseases (STDs), now more commonly referred to as sexually transmitted infections (STI), in the United States hit an all-time high in 2019, according to data released on April 13, 2021, by the Centers for Disease Control and Prevention (CDC). The CDC’s surveillance report shows that nearly 2.5 million new cases of gonorrhea, syphilis, and chlamydia were reported that year.

Chlamydia remained the most common condition reported to the CDC, with close to 1.8 million cases, up 19 percent since 2015. Gonorrhea diagnoses reached 616,392, up 56 percent since 2015. And primary and secondary syphilis diagnoses reached 129,813, up 74 percent since 2015.

Of high concern is that congenital syphilis cases, that is, syphilis in newborns, nearly quadrupled between 2015 and 2019, reaching 1,870 cases. From 2018 to 2019 the number of stillbirths caused by syphilis increased from 79 to 94, and the number of congenital syphilis-related infant deaths rose from 15 to 34 deaths.

While the 2019 STD statistics reflect pre-COVID-19 pandemic numbers, preliminary data from 2020 suggests many of the same trends continued during the pandemic. Experts attribute some of the growth in STDs in 2020 to disruptions in STD testing and treatment programs caused by the pandemic.

While 2.5 million cases of chlamydia, gonorrhea, and syphilis may sound like a lot, it’s likely an undercount: Many people with these and other STDs, formerly known as venereal diseases, go undiagnosed and untreated. The CDC estimates that nearly 20 million new sexually transmitted infections occur every year, accounting for almost $16 billion in healthcare costs annually.

Inequities in STD Burdens

The numbers of STDs increased in all age groups and among all racial and ethnic groups in 2019, according to CDC statistics. However, some groups saw higher rates of STDs than others:People ages 15 to 24 accounted for 61 percent of chlamydia cases and 42 percent of gonorrhea cases.
Gay and bisexual men accounted for nearly half of all primary and secondary syphilis cases.

Here’s what you need to know about how to spot, treat, and prevent STDs.

What Is the Definition of an STD?

“STDs are diseases that are passed from one person to another through sexual contact,” a representative of the CDC says.

According to the CDC, some of the common STDs are chlamydia, gonorrhea, herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis. "Many of these STDs do not show symptoms for a long time," per the CDC, "but they can still be harmful and passed on during sex.”

Virtually all STDs can be transmitted through anal, vaginal, or oral sex. In addition, some STDs can also be transmitted through close skin-to-skin contact, even if no intercourse occurs.

HPV, for example, can be spread through skin-to-skin touching. In addition, “Molluscum contagiosum, a viral skin disease, can be spread through sexual or casual contact, as can scabies, an itchy skin condition caused by a mite infestation. It is also possible to get scabies from an infected sleeping bag or bed,” says Edward W. Hook III, MD, an endowed professor of infectious disease translational research in the departments of medicine, epidemiology, and microbiology at the University of Alabama in Birmingham, who works with the CDC.

STDs don’t just affect the genital regions: “Oral herpes can be transmitted through oral and genital sex,” says Dr. Hook.

It is important to remember that STDs may have no symptoms. However, new vaginal or urethral discharge or a new rash after sexual contact should be evaluated by a medical professional.

When symptoms do occur, they can include the following:

Chlamydia Symptoms of chlamydia can include vaginal discharge in women, penile discharge in men, and burning during urination in men and women.

Gonorrhea Gonorrhea can cause thick, cloudy, or bloody discharge from the vagina or urethra, and pain or burning when peeing. If you have gonorrhea in your anus, it may cause itching in and around the anus, discharge from the anus, and pain when defecating. Gonorrhea in the throat may cause a sore throat.

Hepatitis B Acute hepatitis B can cause fever, fatigue, loss of appetite, nausea or vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellowing of the skin and whites of the eyes). Symptoms can appear anywhere from six weeks to six months following exposure to the hepatitis B virus. Chronic hepatitis B sometimes causes symptoms similar to acute disease.

Genital Herpes Signs of genital herpes typically include red bumps that develop into blisterlike sores in the genital area and sometimes on the buttocks or thighs. A new infection with HSV-2, the virus that causes most cases of genital herpes, may also cause flulike symptoms, including fever, headache, feeling tired and achy, and swollen glands.

Oral Herpes Symptoms of oral herpes can include itching of the mouth or lips, sores or blisters on the lips or inside the mouth, and flulike symptoms such as fever, headache, body aches, and swollen glands.

HIV Early symptoms of HIV infection can resemble those of the flu: fever, headache, muscle aches, and sore throat. They may also include swollen lymph nodes, diarrhea, nausea and vomiting, a fungal infection of the mouth, and a rash on the abdomen, arms, legs, or face. If HIV goes untreated, later symptoms can include fatigue, weight loss, night sweats, joint pain, short-term memory loss, and recurrent infections.

HPV Most strains of HPV cause no symptoms and are detected only after abnormal cells are discovered during a Pap smear. However, some types of HPV cause genital warts, which appear as skin-colored or whitish growths on the genitals or anus.

Molluscum Contagiosum Often the only sign of this skin disease is pink or flesh-colored bumps with a dimple (indentation) in the center. It is most common in children, who typically get it from skin-to-skin contact or from shared towels or similar items. In adults, it can be sexually transmitted.

Pubic Lice Symptoms of pubic lice include itching in the genital area, tiny bugs in your pubic hair, and visible nits (eggs) on hair shafts. Pubic lice can also infest the hair on legs, armpits, eyebrows, eyelashes, and other facial hair such as mustaches and beards.

More on Scabies and Pubic Lice



How to Know If That Rash Is Scabies

Scabies This skin infestation causes intense itching that is typically worse at night. It can also cause small red bumps or a rash and raised lines on the skin where the mites have burrowed.

Syphilis In the primary stage, syphilis causes a painless sore, or ulcer, at the location the bacteria entered the body, often in the genital area. In the secondary stage of syphilis, a rash may occur on the torso and elsewhere on the body.

Trichomoniasis Another common STD, trichomoniasis is a parasitic infection that can cause burning and itching in the genital area for men and women as well as painful intercourse. Trich can also cause a smelly discharge and painful or frequent peeing.

Can I Have an STD and Not Know It?

Yes. Many STDs don’t cause any symptoms, especially during the early stages, so the only way to know for sure if you have one is to get tested. Keep in mind that you can get an STD from having sex with someone who has no symptoms and may not know they have an STD.

Are Adolescents Disproportionately Affected?

The CDC reports that half of newly reported cases of STDs occur in people between the ages of 15 and 24, noting that young women’s bodies are biologically more susceptible to STDs.

“Chlamydia and HPV are common as soon as you become sexually active,” Hook says. “Gonorrhea and genital herpes peak in the late twenties to thirties.”

All STDs, though, including HIV, can and do occur at any age.

When and How Often Should I Get Tested?

“Women should be tested for chlamydia on a regular basis. Some gynecologists test for it automatically, but not all do,” Hook says.



Chlamydia Treatment and Prevention

Testing for chlamydia, gonorrhea, and trichomoniasis involves collecting either a urine sample or a swab from the vagina or penis.

For other STDs, including HIV, syphilis, and genital herpes, blood testing is most accurate.

To test for HPV, a sample of cervical or anal cells must be collected.

How often an individual needs to be tested for STDs depends on their level of risk for infection.

The CDC recommends the following for testing for chlamydia:Annual screening in sexually active women age 25 and younger and in older women who are at an increased risk for infection because of a new sex partner or multiple sex partners
Annual screening in men who have sex with men, based on exposure history, with more frequent screening in people at the highest risk
Screening in all pregnant women at their first prenatal visit
Annual screening in sexually active people living with HIV

The CDC's recommendations for gonorrhea testing include the following:Annual screening in sexually active women who are at risk for infection, which includes women ages 25 and younger
Annual screening in men who have sex with men, based on exposure history, with more frequent screening in people at the highest risk
Screening in all pregnant women under age 25 and older women who are at an increased risk
Annual screening in sexually active people living with HIV

The CDC's recommendations regarding screening for syphilis include these guidelines:Screening in all pregnant women at their first prenatal visit
Annual screening in men who have sex with men
Annual screening in sexually active people living with HIV

The CDC has additional recommendations for other STDs.

In all cases, more frequent screening or screening for additional STDs may be appropriate for certain individuals, depending on their risk factors, including sexual behavior and how common a particular disease is in their area.

Where Can I Get Tested for STDs?

Your family doctor or ob-gyn should be able to do STD testing. In some areas, other options include specialized STD or sexual health clinics.

You can find locations in your area that offer fast, free, and confidential testing using the CDC’s Get Tested tool.

How Can I Protect Myself From Getting an STD?

Abstaining from all sexual contact is the only way to reduce your risk of STDs to zero. But the following measures can also help:Having only one sexual partner, and ensuring that person is monogamous too, lowers your risk of STDs.
Proper use of a condom every time you have sex greatly reduces the risk of all STDs.
Getting vaccinated against hepatitis B is the best way to avoid this viral infection. The hepatitis B vaccine can be given to people of any age.
Getting the HPV vaccine protects you against strains of the virus that cause genital warts and cervical and other cancers. The HPV vaccine is routinely available to people ages 9 through 26. It is additionally approved for adults ages 27 through 45 but not routinely recommended. Adults age 27 or older who believe they would benefit from HPV vaccination should discuss it with their doctors.

What Are the Treatment Options for Common STDs?

Some STDs are curable with medical treatment, while others can be managed to control symptoms and reduce the risk of transmission.

These STDs can be cured with antibiotics:Chlamydia
Gonorrhea
Syphilis
Trichomoniasis

STDs that can be cured with insecticides include the following:Pubic lice
Scabies

Minor surgical procedures such as cryosurgery (freezing) or laser surgery can treat certain STDs:Genital warts caused by HPV
Molluscum contagiosum

STDs that can be managed with antiviral medication include these infections:Chronic hepatitis B
Genital herpes
HIV

When precancerous cells caused by HPV are found on the cervix, treatment may include watchful waiting or surgery to remove the abnormal tissue.

Does Having One STD Make You More Likely to Get Another?

“Having one STD does not predispose you to others, aside from the behavioral risks shared by all STDs,” says H. Hunter Handsfield, MD, a professor emeritus of medicine at the University of Washington Center for AIDS and STD in Seattle, who also served on the board of the American Sexual Health Association.

“However,” says Dr. Handsfield, “having genital herpes due to HSV-2, but not HSV-1, roughly doubles the risk of HIV if sexually exposed to the virus.”

What Happens If STDs Are Left Untreated?

“The longer something goes untreated, the more likely it is to cause complications,” Hook says. “Left untreated, infections from gonorrhea and chlamydia can travel from a woman’s cervix to her uterus and fallopian tubes, which may cause infertility.”

Untreated syphilis "can become neurosyphilis, causing neurological disease,” says Suzanne Fenske, MD, an assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City. Late-stage complications of syphilis also include aortic aneurysm and other cardiovascular problems.

Untreated HIV can impair the immune system’s ability to fight off infections and diseases, leading to so-called opportunistic infections, neurological complications, and sometimes cancer.

Untreated chronic hepatitis B can lead to liver failure, cirrhosis, liver cancer, and death.

Failing to treat STDs can have risks for future generations as well. Women who have herpes, chlamydia, gonorrhea, or syphilis can transmit the infection to their baby at birth, which is why testing for STDs; and following safer sex recommendations; during pregnancy is so important.

HIV can also be passed from mother to child during pregnancy, labor, or delivery, but the risk of transmission can be reduced if the mother takes antiretroviral drugs throughout her pregnancy and the baby receives HIV medicines for several weeks after birth.

Complications of STDs

Does the Number of Sexual Partners Affect My Chances of Getting an STD?

“As a broad rule, more partners means higher risk,” Handsfield says. “However, there are innumerable exceptions. Some people have 100 or more partners per year and remain free of most if not all STDs. Others have one or two partners and multiple infections over time.”

The bottom line is to use condoms or dental dams (small sheets of latex) to lower your risk and discuss STD testing with your medical provider if you are sexually active.

Can STDs Recur?

A curable STD that has been treated correctly will not recur, but it is possible to get the same STD again. In fact, it’s fairly common. To avoid getting the same STD again, your sexual partner, or partners, must also be treated. And to avoid getting the same or other STDs after treatment, practice safer sex, including using condoms each time you have sex.

The good news is that getting infected more than once does not appear to cause more long-term complications.

“In women, a second or third infection with chlamydia may raise the risk of complications like pelvic inflammatory disease,” says Handsfield. “But for the most part, people with multiple episodes of STDs do not fare any worse than after the first infection.”

Chlamydia: Often a Silent Disease

Many people don't realize they have chlamydia because they don't experience symptoms. That's why the condition is often called a silent infection. But untreated chlamydia can cause serious complications in both men and women, including ectopic pregnancy in women. To prevent such complications, young women and men at high risk of chlamydia are advised to get tested for it yearly.

Genital Herpes: A Lifelong Infection

An easily transmitted disease, genital herpes is caused by a virus that stays in the body for life. The infection can cause painful sores to form on the genitals, thighs, or buttocks, but the severity of symptoms ranges widely from no symptoms at all to recurring sores, painful urination, and flulike symptoms. Medication can prevent or shorten outbreaks, as well as lower the chance of passing the virus to a sexual partner.

Gonorrhea: Still Curable, but Antibiotic Resistance Is a Problem

Gonorrhea is highly contagious and, like chlamydia, may cause mild or no symptoms. If left untreated, though, it can cause serious complications, including pelvic inflammatory disease in women and epididymitis in men. While gonorrhea is curable, some strains of the bacteria that cause it have become resistant to most antibiotics.

As of December 2020, the CDC recommends a single 500-milligram (mg) intramuscular dose of the antibiotic Rocephin (ceftriaxone) for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for seven days) should be administered when chlamydial infection has not been excluded.

Hepatitis B: Disease of the Liver

Hepatitis is an inflammation of the liver, and the hepatitis B virus is one of several viral causes of hepatitis. There are also nonviral causes. In the United States, infants have been routinely vaccinated against hepatitis B since 1991, and the rate of acute hepatitis B in the United States has plummeted since then. Worldwide, however, chronic hepatitis B infection is common.

HIV: Incurable but Preventable

HIV is a virus that attacks the body's immune system, impairing its ability to fight off infections and diseases over time. The final stage of HIV infection is called acquired immunodeficiency syndrome, or AIDS. AIDS is a life-threatening disease. You can reduce your risk of getting sexually transmitted HIV by using condoms correctly and consistently.

Just about everyone who is or has been sexually active has had HPV at some point. In most cases, the virus clears up on its own, but when it doesn’t, it can cause genital warts and a variety of types of cancers, depending on which strain of the virus you have. The Gardasil 9 (HPV 9-valent) vaccine protects against both warts and cancer and is approved for adolescents and young adults.

Molluscum Contagiosum: May Clear on Its Own

This viral infection can be sexually transmitted or spread through contact with infected skin or contaminated objects, such as towels and toys. It can also be spread from one area of the body to another by touching a lesion then an unaffected area of skin. In many cases it goes away on its own, but treatments are available if it doesn’t.

Syphilis: Life-Threatening if Not Treated

Syphilis is a bacterial infection that is growing more common in the United States, particularly among men who have sex with men. It can be cured with penicillin or, in the case of a penicillin allergy, other antibiotics. Left untreated, syphilis can affect the heart and brain and be life-threatening. Syphilis that is passed from mother to infant (congenital syphilis) is also a severe, life-threatening condition.

Trichomoniasis: A Parasitic Infection

Trichomoniasis is more common in women, particularly young women, than men. The parasite that causes trichomoniasis can infect the penis or vagina but not the mouth, anus, or other body parts. While symptoms of trichomoniasis may raise a medical provider’s suspicions, a definitive diagnosis requires a laboratory test.

By Everyday Health. Listen to the ► Podcast at How To Sex.

Preventions: Part 1

The Many Pregnancy Prevention Options

By Everyday Health. Listen to the ► Podcast at How To Sex.

Contraception Options 101: Everything You Need to Know About Birth Control

Here’s the lowdown on pregnancy prevention with pills, patches, implants, and other types of birth control, plus information on effectiveness, availability, cost, and more.

By Cheryl Alkon; By John Paul McHugh, MD courtesy of American College of Lifestyle Medicine

Updated on August 28, 2023

It’s a fact: If you’re a woman, and you have sex with a man, it’s possible you’ll get pregnant. But if you don’t want to have a baby, there are many forms of birth control to help prevent pregnancy.

Broken Cock

 Recklessness ruptured my plumbing, and permanently curtailed my sex life.

By Anonymous. Listen to the Podcast at How To Sex.

I Fucked up.

I am writing this mainly because there is not a lot of information about this particular injury

Around October of last year I was having sex with my girlfriend, when I thrust too hard at the wrong angle and tore my Urethra and two blood vessels in my penis.

When the injury first occurred I was close to climaxing. Because of this, when the injury happened and the blood vessels and urethra were torn, blood started mixing into my urethra. I was cumming blood

An Intro To 'Tease & Denial'

Tie up your man and go to town.

By alf_2712. Listen to the Podcast at How To Sex.

Bondage sex is often associated with Sado Masochism. But that vaste generalization does a great disservice to a wide range of sexual proclivities. Each part of this grouping ought to be understood on it’s own attributes.

Bondage is simply adding real or perceived restrictions in a sexual encounter. It’s the fantasy of lost control over a situation which thrills many lovers. It often incorporates a fantasy scenario and some role-playing.

Intro To BDSM

Fundamentals, Types and Roles, Safety Rules, and More

By Nuna Alberts, LCSW. Listen to the Podcast at How To Sex.

If you’ve ever fantasized about getting kinky in the bedroom, you’re not alone. The runaway success of E. L. James’s Fifty Shades of Grey trilogy of books; the three top-selling print and e-books in the United States between 2010 and 2019; not to mention the sales of the movies they generated, prove that interest in BDSM (bondage and discipline, dominance and submission, and sadism and masochism) is anything but rare.

BDSM can involve role playing, sensory manipulation, and more. Here are a few popular ways enthusiasts like to get kinky!

Prevalence: How Many People Practice BDSM?

Further proof: Nearly 47 percent of women and 60 percent of men have fantasized about dominating someone sexually, while slightly more women and less men are aroused by the idea of being dominated, according to a 2016 study. The same study also found that almost 47 percent adults would like to participate in at least one nontraditional type of sexual activity, and 34 percent said that they’d done so at least once in the past. No wonder if you search the phrase “BDSM” on Google it will return more than 500 million results. By comparison, the phrase “missionary sex” returns about 163 million results.

The History of BDSM: Not So New

Explore a little more and you’ll also discover that BDSM is nothing new. Among BDSM’s historical high points:

• Art and texts from ancient Greece and Rome show physical pain being used as an erotic stimulus, per the book An Illustrated History of the Rod, by William M. Cooper, first published in 1868.
• The Kama Sutra, the revered Sanskrit text on sexuality written in India about 2,000 years ago, describes six appropriate places to strike a person with passion and four ways to do it. It also has chapters titled “Scratching,” “Biting,” and “Reversing Roles.”
• The Marquis de Sade, a French aristocrat who lived from 1740 to 1814, wrote a variety of erotic novels and short stories involving being beaten and beating others. Eventually the author’s name gave rise to the term “sadism.”
• Similarly, the term “masochism” is derived from the name of Austrian nobleman and author Leopold von Sacher-Masoch, whose 1870 novel Venus in Furs describes a dominant-submissive relationship.
• Back in 1953, a Kinsey Institute study found that 55 percent of women and 50 percent of men were aroused by being bitten.
• And even pre-Fifty Shades of Grey, 36 percent of U.S. adults reported having had sex using masks, blindfolds, or other forms of bondage.

Is BDSM Still Considered a Medical Disorder?

At one time, mental health experts were dubious about whether those who practiced BDSM were mentally healthy. But the American Psychiatric Association took a huge step in destigmatizing kink with the release of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. For the first time ever, the guidelines drew a clear distinction between consenting adults who engage in sexual behaviors outside the mainstream, such as BDSM, and those who force others to engage in those behaviors without consent.

That means simply experimenting with, say, whips and chains, is no longer a sign of mental illness that by itself “justifies or requires clinical intervention,” the manual states.

There are true sexual disorders that are similar in theme. Sexual sadism disorder, for instance, involves inflicting physical or psychological pain on another for the purpose of sexual pleasure. And sexual masochism disorder involves deliberately involving yourself in a situation in which you are humiliated, beaten, or abused for the purpose of sexual excitement.

The difference between these two disorders and BDSM is consent, in the case of sexual sadism disorder, and that BDSM does not go to the degree of causing significant distress or impairing function, in the case of sexual masochism disorder.

The Psychology of BDSM: Why Are People Drawn to It?

Most of the available evidence shows that the majority of BDSM enthusiasts are mentally healthy and typical in every respect except that they find traditional (“vanilla”) intimacy unfulfilling and want something more intense.

“People always ask if it’s normal to be interested in BDSM,” says Michal Daveed, a spokeswoman for The Eulenspiegal Society, a nonprofit organization in New York City that describes itself as the “oldest and largest BDSM support and education group” in the country.

“Normal is a funny word to describe a really widespread and diverse humanity. If your definition of normal is how many people are doing this, it’s way more people than you may think,” says Daveed. “And if your definition of normal is ordinary, the BDSM world is full of ordinary people whose sexuality happens to be hardwired a particular way.”

One landmark 2008 study backs Daveed up. It found that people who engaged in BDSM were more likely to have experienced oral sex or anal sex, to have had more than one partner in the previous year, to have had sex with someone other than their regular partner, and to have taken part in phone sex, visited an internet sex site, viewed an X-rated film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting, or rimming.

However, they were no more likely to have been coerced into sexual activity and were not significantly more likely to be unhappy or anxious. Indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men.

“Our findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with ‘normal’ sex,” the researchers concluded.

“BDSM is a healthy expression of sexuality,” says Filippo M. Nimbi, PhD, a researcher at the Institute of Clinical Sexology and in the department of dynamic and clinical psychology at Sapienza University, both in Rome.

Dr. Nimbi is also the coauthor of a study that compared 266 consensual BDSM practitioners to 200 control subjects who described their sex lives as traditional. (10) Echoing the earlier study, the researchers found that the BDSM group tended to report fewer sexual problems than the general population.

“People engaging in BDSM are usually people who have thought a lot about their sexuality,” Nimbi said. “They have explored and faced their sexual boundaries. Basically, they know what they like, and they do it. This has a positive outcome on their sexual experiences and on the overall quality of their lives.”

Many people think it’s a pathology or a perversion to, say, want to be spanked hard and to be happy about that, he added. “We each develop our erotic fantasies from our different tastes, experiences, and curiosities, beginning in childhood and lasting until the end of our lives. Everyone is different. We can develop the same fantasy from different stories, and we can develop different fantasies from the same stories. Some people find in BDSM a way to be free, to get wild, to let go, and to play a different role from their everyday lives. And if they get satisfaction and respect the ‘rules,’ why should it be abnormal?”

The Physicality of BDSM: Why Does It Feel Good?

Patti Britton, PhD, MPH, cofounder of the credentialing and training institute Sex Coach U and a past president of the American Association for Sexuality Educators, Counselors, and Therapists (AASECT), as well as other experts are quick to point out that seeking the pain-pleasure connection is not unique to the BDSM community. Think of athletes who push past physical comfort to experience a “runner’s high,” or people who chase thrills by engaging in dangerous extreme sports, like skydiving. Think of the bliss that aficionados of super spicy food experience when biting into a pepper sets their mouth on fire, or the rush of fear that riding a roller-coaster or watching a horror movie can bring.

“The same chemical cocktail of endorphins, dopamine, and other hormones that make those experiences pleasurable to some makes BDSM actually quite wonderful to others,” says clinical sexologist Francesca Gentille, coeditor of The Marriage of Sex & Spirit, and host of the podcast Sex: Tantra & Kama Sutra. “I like to compare sexual preferences to taste in food. Most of us don’t like bland food, but we have a range of how spicy we like it.”

Common Questions & Answers

What does BDSM stand for?

BDSM is an acronym that stands for bondage and discipline, domination and submission, sadism and masochism.

Why do people like BDSM?

In the past, it was thought that BDSM might be a sign of unhealthy sexuality. But increasingly, even medical professionals say that BDSM is a healthy expression of sexuality. Erotic fantasies that fall into this category develop from different tastes, experiences, and curiosities that develop in childhood.

What is a rigger in BDSM?

A rigger is someone who, in engaging in BDSM play, ties rope for bondage purposes.

What is a brat in BDSM?

A brat, in the context of BDSM, is someone who misbehaves toward the dominant party in the BDSM scene being played out.

Is BDSM illegal?

BDSM occupies murky territory, legally. The foundation of BDSM “play” is consent between the parties engaging in it. However, you cannot legally consent to be tortured or assaulted. And what seems to be “play” to some may appear differently to others.

Roleplaying and BDSM: The Variety Is Endless

Doctor and patient. Teacher and student. Roleplaying is a common aspect of BDSM “play.” It may involve two or more people who “act out” a particular scene or fantasy. BDSM roleplay can happen in person or virtually. It almost always involves at least one individual being dominant and another being submissive. It may be simple, or it may be complicated enough to require a script. And actual sex is not the focus.

“The core of BDSM is the psychological part,” explains Mistress Damiana Chi, a dominatrix in Los Angeles who holds a PhD in clinical psychology. (She asked that her real name not be used, citing privacy concerns.) “For BDSM to be real, it has to involve an exchange of power with a lot of trust and respect. The couple has to decide which role they want to play, the dominant one or the submissive, and it’s that dynamic that creates erotic intensity.”

Common themes for BDSM role play include:

• Kidnapper and victim
• Law enforcement and prisoner
• Owner and pet
• Royal and commoner

Most Recent

While chains and whips might excite Rihanna (as she proclaims in the hit song ”S&M”), it’s wrong to think all manifestations of BDSM involve inflicting extreme pain. The range of erotic expressions that fit under its umbrella is huge.

At one end there’s “light” BDSM, which includes activities like tickling, using a blindfold, tying your partner to the bedposts with silk scarves, slapping their rear playfully, and making verbal demands, such as “Call me Sir” or “Call me Madam.” No pain. No force. Just playful and pleasurable.

At the other end of the spectrum is “hardcore” BDSM. This can include whipping, caning, binding with ropes, dripping hot wax directly on the skin, and hundreds more forms of erotic expression, many of which you might find impossible to imagine.

“There are universal themes, but I’ve seen things that have shocked even me, not because they were unsafe, but because they were so infinitely creative,” says Dr. Britton.

Asking to have clothespins attached to your tongue. Being mummified with plastic wrap so that you’re completely immobilized. Living as a submissive wearing a leather collar while serving a dominant partner. Yes, there are people who choose these activities — the key word being “choose.”

“There are two essential things to know about BDSM,” explains Britton. “It is always voluntary, and the reason people do it is because it feels good. There’s something about transcending pain that can be almost a spiritual experience,” she adds. “It releases the self from the body. I’ve had people tell me, ‘the more my body is restrained, the freer I feel.’”

Common forms of BDSM play include:

• Bondage (restraint or restriction)
• Wax (dripping hot wax on the skin)
• Impact (spanking, slapping, caning, flogging)
• Sensation (using tools such as feathers, a paddle, burlap, on the skin)
• Sensory deprivation (blindfolds, earmuffs, ear plugs)

The Importance of Communication, Consent, and Using Safe Words

How can having someone strike you, perhaps to the point that you cry out in pain, not be abuse? “Consent is the magic word,” says Nimbi.

“While mainstream sexual encounters also stress the importance of consent, consent often takes the form of an unstated, implicit assumption based on perceived behavioral displays of interest or willingness,” note University of British Columbia psychologists Cara Dunkley, PhD, and Lori A. Brotto, PhD in a 2019 paper. “The BDSM community takes consent further, demanding explicit rather than tacit consent.”

In a dominant-submissive “scene,” for instance one in which one person is going to be flogged, it’s standard practice for the “dom” or “top” and the “sub” or “bottom” to first negotiate at length and then contract, often in writing, what the sub is definitely willing to do, what he or she might be willing to do, and what is absolutely off-limits before they begin to “play.”

They also must agree on a safe word or gesture that the sub can use at any time to stop the action. That means that if there’s any potential for pain, both players are aware of the rules and of their own limits. Ironically, it also means that the sub actually has more control of the scene than the dom, since he or she defines the parameters and has the power to stop the action at any time, for any reason.

“There is no community on the planet more committed to the concept of consent than the BDSM community,” says Valerie White, a lawyer and founder of the Sexual Freedom Legal Defense and Education Fund, a nonprofit advocacy and education group based in Sharon, Massachusetts. “Of course, you can come across a rogue, just as you can in any group. But if anyone crosses the line, they are cast out so quickly it would make your head spin to see it.”

Common safe words include:

• Red
• Pineapple
• Banana
• Peach

Safe and Risk-Aware Kink: How to Try It Safely at Home

If you’re planning on trying kink at home, experts advise going to a class, reading a book, listening to a podcast, or checking out informational videos on YouTube before trying anything other than light BDSM at home to see and learn how to engage in this type of erotic expression safely.

“You have to learn this,” says Britton. “You don’t just go to Home Depot and buy a rope and tie your husband up. BDSM play is not random. It’s not built on spontaneity. It’s built on anticipating a set of behaviors that are negotiated beforehand.”

“People playing at home without training is dangerous,” says Gentille, who spent four years as a collared submissive at home with a dominant partner in a relationship. “You can’t, for example, just leave a person alone in a room, tied up and gagged, and expect it to go well.”

Social Etiquette and BDSM

It might sound contrary, but there’s most definitely a code of behavior with regard to practicing BDSM properly. If you’re thinking about trying BDSM at a social gathering, often dubbed a “play party,” which can be an informal gathering hosted by someone or an organized event, you’ll need to do some prepping beforehand about the social mores. Can you touch someone else’s toys? How do you handle consent? Can everybody play? Learning the ropes before you go will ensure that you have a good time.

The BDSM Terms You Need to Know

BDSM also has its own language to describe who takes part, how they take part, and how things work. Among common terms you’ll encounter in this world are:

• Bondage and discipline
• Dominance and submission
• Male dominance
• Male submission
• Female dominance
• Female submission
• Sadism and masochism

BDSM and the Law: What You Need to Know

The legality behind BDSM is murky. Legally, for instance, you cannot consent to be tortured or assaulted. And, to the outside eye, some BDSM activities can appear to fall into that category. So, for example, if police raid a BDSM event and see activities that they object to, they can charge the participants even if there is consent. While it’s unlikely you’ll encounter a problem, especially in the confines of your own home, it’s good to know the lay of the land, legally. And there are special cases — like custody battles — where people need to know how this kind of information can be used in court.

BDSM: Beyond Taboo

Of course, while BDSM is not for everyone (Britton herself identifies more as vanilla than kink), there is more and more recognition that it is 100 percent normal to fantasize about it. What’s more, given the reclassification of BDSM and related behaviors in the DSM-V and the Fifty Shades of Grey phenomenon, it’s easier than ever to explore those fantasies in real life without shame, if one desires to.

One sure sign that kink is becoming less and less taboo: The Harvard College Munch, which brings together students with interested in kinky sex, is now recognized by the university as an official campus group. (12)

“It’s very out in the culture right now, but it’s not fully out of the shadows yet,” says Gentille. “People are still embarrassed to talk about sex. What they discover when they dive a little deeper into it is that in BDSM you actually get to talk about what you like, what you’re curious about, and what is a definite ’No.’ It’s clear, overt, and collaborative and that can feel delightful. And if you like it, if you have control over what happens, it’s all good fun.”

Speaking BDSM: A Glossary of Terms Used to Describe BDSM

Curious about BDSM? Here’s the lowdown on the vocabulary you’ll need to ask questions and learn about it.

By Julie Lynn Marks

BDSM enthusiasts have created an entire vocabulary around their lifestyle.

If you’re interested in exploring BDSM (bondage/discipline, domination/submission, sadism/masochism), you’ll need to understand BDSM terms. The glossary below will make it easier for you to parse the technical terminology as well as the not-so-scientific vernacular — aka, slang — you’ll need to speak BDSM.

Aftercare

When a scene is over, aftercare is the emotional and physical care that’s administered, usually by a top. Proper aftercare may be used to prevent a drop.

Age Play

When participants take on an older or younger role.

BDSM

An umbrella term used to describe a sexual practice that involves the use of physical control, psychological power, or pain. It typically includes the components of bondage and discipline, domination and submission, or sadism or masochism.

Bondage and Discipline

A type of BDSM practice that incorporates bondage (tying, binding, or restraining someone) and discipline (punishing a submissive partner when they break a rule).

Bottom

The person in a scene who follows the orders and receives the sensations.

Breath Play

A form of play when one participant controls their breath. This may include choking or holding the breath.

Consent

Agreeing to certain acts in a BDSM scene or relationship. Practitioners believe that consent is what separates BDSM from assault.

Contract

An arrangement that outlines the rules and structures of a BDSM relationship. It may be written or oral.

Dom

A dominant role, often referring to a male.

Domina

A dominant who is female and embraces a feminine gender role — sometimes called a Domme or Dominatrix.

Dominance and Submission (D/S)

A term for the behaviors or rituals that a submissive person follows in a BDSM relationship. In D/S, one person usually has power over another.

Dominant

A person who has the authority in a BDSM relationship or scene.

Drop

The physical or emotional exhaustion that takes place after a scene. Both tops and bottoms may experience a drop. Crying, feeling sad, and physical shaking are all signs of a drop.

Dungeon

A location where BDSM play takes place (usually in a person’s home or at a club).

Dungeon Monitor

A person (or group of people) who supervises BDSM activities at a club or play party to make sure the acts are safe and consensual.

Edge Play

BDSM acts that are considered more intense or dangerous, such as breath play.

Female Dominance

When a woman takes the dominant role in a BDSM relationship or scene.

Female Submission

BDSM activity in which a woman submits to a sexual partner.

Fetish

An obsession with a specific experience, body part, or object.

Fetish Wear

The clothing worn by those who practice BDSM (usually leather attire or other role-playing costumes).

Gender Play

A type of BDSM play when an individual in a scene takes on the role of the opposite gender.

Hard Limits

An activity that a person in a BDSM relationship absolutely won’t do. A hard limit can’t be negotiated.

Impact Play

A type of BDSM play that involves striking the body. This can be done with a hand, paddle, cane, whip, flogger, or other instrument.

Kink

Nonconventional sexual practices. BDSM is often referred to as kink.

Master

The person who has control over a slave in a consensual master-slave relationship.

Male Dominance

BDSM acts when the dominant partner is a man, also called maledom.

Male Submission

BDSM activities when the submissive participant is a man, also referred to as malesub.

Masochist

An individual who likes or becomes sexually gratified by their own pain or humiliation.

Munch

An informal meeting or party, often at a public place, where people interested in BDSM can mingle.

Play

A term used to describe the BDSM acts themselves.

Play Party

A social gathering where guests can engage in BDSM activity.

Pro Domme

A woman who is a professional top and dominant.

Protocol

A rule or rules that people practicing BDSM agree to follow.

Role Play

When one or more people take on a different identity during a scene. Examples may include teacher-student, doctor-patient, or boss-employee role plays.

Sadism and Masochism

This subset of BDSM involves inflicting pain or humiliation for the purpose of pleasure or sexual gratification.

Sadist

A person who enjoys or becomes sexually aroused by inflicting pain or humiliation on someone else.

Safe, Sane, and Consensual (SSC)

This phrase describes what the BDSM community considers ethical behavior. Kink enthusiasts stress that activities must always be safe, sane, and consensual.

Safe Word

An agreed upon word or phrase that a bottom, sub, or slave can say during a scene to stop the activity or session immediately. Some common safe words are “red,” “red light,” “pineapple,” and “banana.”

Soft Limits

A limit that’s more flexible than a hard limit. It might be an act that a person is hesitant to perform but may be willing to try.

Scene

The actual BDSM activities or encounters that take place.

Slave

A person who gives up total control of one or more parts of their life to a master.

Submissive

Someone who submits to a dominant person in a BDSM relationship or scene. Submissive can be shortened to sub.

Switch

A person who sometimes plays a top and sometimes plays a bottom in a BDSM scene.

Top

The person who performs the BDSM acts in a scene.

Topping From the Bottom

When a bottom tries to control a scene even though it was agreed that the top would be in charge.

24-7s

When individuals in a relationship engage in some form of BDSM at all times (24 hours a day, 7 days a week).

Vanilla Sex

 Used by people in the BDSM community to label sexual behavior that doesn’t involve kink.
 

This post is part of the How To Sex podcast. Subscribe in your favorite apps.

Sexy Seniors

A discussion of Advanced Maturity and Sexuality

By Mark Stibich, PhD. Listen to the ► podcast at How To Sex.

Many people in their 70s and 80s are not only sexually active, but satisfied with their senior sex lives.

University of Michigan Institute for Healthcare Policy and Innovation. Let’s talk about sex. Though the frequency or ability to perform sexually may decline with age due to physiological changes, these don't necessarily affect how a person experiences or enjoys sex.

Aging-related problems like erectile dysfunction (ED), vaginal dryness, or urinary incontinence can affect sex. But their impact can also be minimized by using medication, managing chronic conditions, seeking individual or couples counseling, and changing sexual practices.

This article explores the sex lives of adults 65 and over and the problems that can interfere with sex as the body ages. It also discusses the various treatment options and ways to maintain—or even jumpstart—your senior sex life.

Studies suggest that men are almost twice as likely as women to still have sex or masturbate in their later years. A British study found close to 60% of men ages 70 to 80 and 31% of men ages 80 to 90 are still sexually active. In women, those figures drop to 34% and 14%, respectively.

This lower rate of sexual activity in older women may be due to a lack of opportunity rather than a lack of desire. Research shows that older women are less likely to have partners (due in large part to the fact that they often outlive their partners). This is sometimes referred to as "the partner gap."

It is common for men to experience sexual problems after age 40. Reasons include a natural decline in testosterone levels, heart disease, and prostate problems. The inability to achieve or sustain an erection or reach orgasm or ejaculation are common concerns.

Erectile Dysfunction

Erectile dysfunction (ED), formerly known as impotence, is the inability to achieve or maintain an erection firm enough for sexual penetration and long enough to achieve orgasm.

While ED is more common in older men, aging itself does not cause the problem. ED is related to conditions, sometimes several at once, that directly or indirectly interfere with erections.

Risk factors include high blood pressure, diabetic nerve damage, smoking, obesity, Peyronie's disease, depression, and even certain medications. An accurate diagnosis is needed to ensure the right treatment.

ED drugs like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) are often the first-line treatments for ED. Lifestyle changes and counseling can also help. For some men, hormonal therapy, penis pumps, and penile implants may be recommended.

Is There a Female Viagra?

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a non-cancerous enlarged prostate and one of the most common health problems in older males.6 BPH can cause symptoms like difficulty urinating, frequent urination, or waking up in the middle of the night to urinate (nocturia).

On top of this, BPH can cause sexual problems like low libido (low sex drive) and delayed ejaculation (difficulty reaching orgasm).

Among the treatment options, testosterone therapy may help restore libido. There are also certain drugs used off-label that may help with delayed ejaculation, including cabergoline (originally marketed as Dostinex) and Wellbutrin (bupropion).7

Because some BPH medications can also cause sexual dysfunction, a change in the dose may help resolve these concerns.

Lifestyle Changes to Treat Erectile Dysfunction

Sexual Health Problems in Older Women

More than a third of older women experience sexual problems. These are typically due to menopause, when estrogen levels steeply decline. Hormonal changes can lessen sexual desire and make it harder to become aroused.

Sexual organs also change as a person gets older. A woman's vagina will shorten and narrow. The vaginal walls become thinner and less flexible, tearing more easily. Vaginal lubrication decreases, making vaginal intercourse more painful.

Hypoactive Sexual Desire Disorder

Hypoactive sexual desire disorder (HSDD) is diagnosed when an absence of sexual fantasies, thoughts, and desires causes personal distress. It is a problem that is common among many older women.

A medication known as Addyi (flibanserin) is used to treat HSDD in women. It is currently only approved for premenopausal women, but research shows that it can also improve libido in older women as well.

Risk of Low Libido After Menopause

Vaginal Dryness

Vaginal dryness is uncomfortable and can make sex painful. Over-the-counter (OTC) remedies that can help relieve irritation and itching from vaginal dryness include lubricants such as K-Y Jelly or vaginal suppositories like Replens.

If OTC remedies don’t help, your doctor may prescribe estrogen cream as well as estrogen-containing vaginal rings and vaginal suppositories.

There are also plant-based products, like black cohosh, that have estrogen-like effects. These should be used with caution in women who have had or are at risk of breast cancer.

Pain With Sex

Painful intercourse is more likely in older women as vaginal tissue tends to thin and tear easily after menopause. Standard treatments for vaginal dryness can often help ease pain during sex.

If that is not effective, prescription drugs like Osphena (ospemifene) and Intrarosa (prasterone) can treat thinning vaginal tissues and help relieve moderate to severe vaginal dryness.

Dealing With Painful Intercourse After Menopause

Pelvic Organ Prolapse

The pelvic floor muscles and tissues hold the bladder, uterus, cervix, vagina, and rectum in place. Pelvic organ prolapse (POP) occurs when the pelvic floor weakens, causing the pelvic organs to drop and bulge (prolapse) in the vagina. This can cause pelvic pain and pressure, pain with sex, and urinary incontinence.

POP is often treated with pelvic floor physical therapy to strengthen the supporting muscles. In some cases, surgery may be needed.

What Is Uterine Prolapse?

Other Health Concerns

Chronic medical conditions become more common as a person ages. Many of these can interfere with an older person's sex life.

Arthritis and Chronic Pain

Arthritis and other chronic pain conditions are common among older adults and can make sex very difficult. Depending on the cause, doctors may recommend physical therapy to strengthen muscles and improve flexibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs), both over-the-counter and prescription, can be taken before sex to help ease the pain. Opioid drugs, while effective as a pain reliever, can cause a drop in testosterone and contribute to ED.

If the pain only occurs in certain sexual positions, let your partner know and try different positions. Bolstering your bodies with pillows and cushions can also help.

Best Positions for Sex With Back Pain

Diabetes

In the United States, almost one-third of adults over 65 have diabetes. Approximately half of these are undiagnosed.

Diabetes can cause sexual dysfunction in both men and women. This can be due to circulation problems, medication side effects, or nerve damage. Problems include: 

• Low libido
• Difficulty with arousal
• Erectile dysfunction
• Painful intercourse
• Reduced genital sensation
• Urinary tract infections
• Yeast infections

The best way to reduce the impact of diabetes is to gain control of your blood sugar. Speak with your doctor if you have difficulty managing your blood sugar, and be sure to mention any sexual health problems you may be having. It's important for your doctor to know.

Heart Disease

Older age is the greatest risk factor for heart disease. Heart disease causes problems as arteries start to narrow and harden (referred to as atherosclerosis). This reduces blood flow throughout the body, including the pelvis and genitals, resulting in sexual dysfunction in both men and women.

Heart disease is one of the leading causes of erectile dysfunction in men. It can also cause women to have difficulty achieving orgasm due to the decreased blood flow to the genitals.

There is no one way to resolve these issues, but there is evidence that statin drugs used to reduce the risk of heart disease can improve erectile dysfunction in some men.19 Some studies suggest that similar approaches may improve sexual function in women with heart disease.

People with heart disease may also be nervous about sex due to fear of a heart attack. While sexual activity is generally safe, talk to your health provider if you are concerned.

Navigating Sex After a Heart Attack

Obesity

Today, more than 40% of adults over 65 meet the definition of obesity. Research shows that women who are obese are more likely to experience sexual dysfunction than non-obese women. In addition, obesity increases the odds of erectile dysfunction in men.

These issues may be directly related to higher rates of diabetes among people who are obese as well as reduced blood circulation due to atherosclerosis.

Weight loss, achieved with a healthy diet and routine exercise, is considered the best strategy to overcome obesity. It may also improve a person's self-image and sense of well-being while making sex easier to navigate.

Urinary Incontinence

Urinary incontinence is the loss of bladder control. This becomes more common with age, especially in women.

Incontinence can be embarrassing and make sex awkward. Women who experience stress incontinence may be afraid to orgasm. Extra pressure on the abdomen during intercourse can also cause urinary leakage.

If you have incontinence, empty your bladder before sex. Changing sexual positions can help prevent urinary leakage by avoiding the compression of the bladder. Pelvic floor exercises can also help strengthen the muscles that aid with urine control.

Medications

Some medications used in older adults can cause sexual dysfunction in both men and women. These include:

•  Antidepressants
• Antihistamines
• Chemotherapy
• Diuretics ("water pills")
• High blood pressure medicines
• Opioid painkillers

If you are having sexual difficulties, let your doctor know and advise them of any drugs you are taking, including over-the-counter, prescription, or recreational.

Lifestyle and Mental Health

Lifestyle and mental health issues can also contribute to sexual problems in older adults. These issues can be just as difficult—and sometimes even more difficult—to overcome than physical ones. If you are faced with any of these issues, there are things you can do to turn them around.

Alcohol

For some people, drinking a glass of wine helps them relax and get in the mood. However, too much alcohol can end up impairing sexual function. According to the National Institute on Drug Abuse, alcohol is the most-used drug among older adults, with 65% of people 65 and older reporting high-risk drinking.

Alcohol can impair a man's ability to get an erection, cause premature ejaculation, or delay orgasm. In women, too much alcohol can make it difficult to climax.

Reducing the amount you drink can help, but if you are unable to control your alcohol use, speak to your doctor about treatment options.

Depression

In the United States, between 5% and 10% of adults over 65 are estimated to be depressed. This can lead to many health concerns, including sexual dysfunction.

In people with depression, neurotransmitters—chemical messengers that send signals between the brain and body—are out of balance. This can affect sexual desire, arousal, and orgasm. Ironically, medications used to treat depression can have the same effects.

While the benefits of antidepressants often outweigh the risks, therapy and counseling may offer a reasonable option for those with mild depression.

Stress

Stress can be a contributing factor to sexual dysfunction. Financial worries and health concerns are just some of the common stresses affecting older adults.

To relieve stress (and the effect it has on your sex life), consider stress management techniques like mindful breathing, tai chi, yoga, and meditation. Research shows practicing mindfulness and meditation can ease the effects of stress and improve overall feelings of well-being. This alone may help improve sex.

In addition, seek professional assistance from financial advisors, health advocates, and social workers to help better deal with the other stresses in your life.

Relationship Issues

Lack of sexual intimacy is often related to relationship problems. If you are and your partner are not connecting emotionally, it can lessen your desire to be intimate.

On the flip side, studies show that older couples who engage in sexual intercourse with their partner are likely to share a closer relationship. Moreover, closeness to one’s partner has been shown to increase overall well-being.

While this issue is not unique to older couples, many people find talking to a marriage counselor can help them work through relationship issues and rekindle sexual feelings and attraction.

Self-Image

With age can come weight gain and other body changes that may affect one's sense of physical attractiveness. Self-consciousness can spill over into the bedroom and affect a person's confidence during sex.

A 2019 study among older women found that those who were self-conscious about their bodies reported less sexual satisfaction. By contrast, those who had greater self-acceptance of their bodies irrespective of weight or aging-related changes had a more satisfying sex life.

Self-acceptance is ultimately the key. Working with a therapist, either alone or as a couple, can help you discuss your feelings openly and find a way to embrace a more positive self-image.

How to Maintain a Healthy Sex Life

The benefits of maintaining your sex life as you age are physical and emotional. Being sexually active is associated with a lower risk of medical conditions and a longer life. It's also associated with a greater sense of happiness and overall well-being.

If your sex life has become stagnant and you'd like to rev it back up, here are a few things you can do.

Communicate

Good sex begins with good communication. Couples who have been together a long time often think they know what the other is thinking. But no one is a mind reader.

Talk to your partner about any concerns you have. You may feel as though your mate is no longer attracted to you because sex has become infrequent, when in fact they are experiencing a decline in sexual interest.

In addition, as sex organs change with age, what felt good before may no longer feel good or may even be painful. Be open with your partner about these changes.

Communicating about sex can be challenging at any age, however. If you and your partner struggle to talk about sex, consider seeing a sex therapist.

Redefine Sex

Sex, as you get older, may need to change. But different can still be good, if not better. With an empty nest and possibly retirement, there’s more time and privacy to explore.

Research shows older adults have a broader definition of sexual activity than younger adults. In other words, they better understand that there is more to sex than just intercourse. Foreplay on its own can be quite satisfying.

Be creative and willing to try new things.

Rethink Intimacy

Sex isn't just physical. It’s an emotional expression of intimacy. As you grow older, sexual intimacy changes. What this means to you and your partner may need to be redefined.

Emotional intimacy can be expressed through non-sexual physical touch. Examples of non-sexual physical touch include: 

• Back rubs
• Cuddling
• Holding hands
• Hugging
• Placing your hand on your partner's shoulder or arm
• Playful nudges
• Sitting next to each other
• Touching feet under the table

Another non-sexual way to build emotional intimacy is spending quality time together. Things you can do:

• Go out on dates with other couples.
• Look through old photos and reminisce.
• Play cards, board games, or word games.
• Read aloud to each other.
• Play music together.
• Travel, explore new places.
• Visit with friends or family.

Just Do It

Instead of waiting for the desire to strike, experts recommend that older adults just go for it. This is because sex has physical and emotional benefits. Orgasms release oxytocin, a hormone that induces a state of calm and improves sleep.

Even if you’re not in the mood, having sex can set the stage for more sex in the future. This is especially true for women. Having sex regularly helps increase natural lubrication and vaginal elasticity. It may also improve erections in men.

Summary

Older age can lead to sexual problems in different ways. Age alone increases the risk of erectile dysfunction, delayed ejaculation, low libido, vaginal dryness, and pelvic organ prolapse. Medical conditions like arthritis, diabetes, heart disease, obesity, and incontinence can also directly or indirectly interfere with sex.

Lifestyle and emotional issues that can impair sexual function in all ages can become even more profound in adults 65 years and older. These include stress, depression, negative self-image, relationship problems, and alcohol abuse.

By working with a doctor or therapist, you can overcome many of these concerns and improve not only your quality of life but your sex life as well. Keeping open lines of communication and embracing change as a natural part of life can also help keep your sex life fresh as you approach your later years.

By Mark Stibich, PhD for Very Well Health 

This post is part of the How To Sex podcast. Subscribe in your favorite apps.

Wild Pregnancy Sex

 Weird Hormones and suppressed fetishes can make expecting, a delight.

By various parents. Listen to the podcast at How To Sex.

A young and frisky married couple is contemplating having a baby. They’re seeking advice on lots of things, but the question that came to us is;

“What is sex like, during pregnancy and after?

Some details are straight-forward and answers are easy. Like;

The Ten Best Positions For 'Anal-ysis'

The Ten Best Positions For Anal.

By Daniel Fucking Davis. Listen to the Podcast at How To Sex.

All you faithful readers know I’m a big fan of knocking on a girl’s back door. It feels great. It’s naughty. What’s not to like about it?

Nothing… for the guy.

For the girl, anal can often be traumatic. I’ve posted a bunch of times on how to prepare for anal sex. You can type “anal” in my search bar and get a ton of info. But let me highlight some things:Anal sex requires preparation to keep it from being messy.

Anal Sex: What's the Big Deal?

Fred Requests a woman's point of view to help him understand.

Then Maye weighs in with good memories and advice.

By BOSTON FICTION WRITER & MayhemLass Listen to the Podcast at How To Sex.

Fred’s Question

Dear BFW;

I've never tried anal sex before. It never appealed to me. Actually, I never have given it much thought until I perused the anal sex category here at Literotica and found it so popular.

I am a bit embarrassed to admit it, but I have never even had sex doggie style either. Yes, I realize that doggie style sex is an overwhelming favorite for hordes of people but not for me. It is not that I did not try having sex doggie style, it just did not work for me; my cock did not reach far enough for me to feel like I was fucking her. I mean, really fucking her.

What Are Sex Toys?

Can a device make it better for us?

By Anonymous. Listen to the Podcast at How To Sex.

A battery-charged vibrator

Sex toys — also called adult toys or “marital aids” — are objects people use to have more pleasure during sex or masturbation. Sometimes sex toys can also have medical uses if you have a sexual dysfunction or medical condition. There are many different types of sex toys, and people use them for lots of different reasons.

It’s totally normal to use sex toys, but it’s also totally normal not to — it’s a personal decision, and everyone’s different. As long as you’re using sex toys safely, there’s nothing harmful about it.

10 Ways To Female Climax.

What Kind Of Sex Does Your Woman Want?

based on a post by Arse Gratia Artis. Listen to the Podcast at How To Sex.

The Female Orgasm

Being a man, I'm obviously an expert on what women experience. Although I have never had a female orgasm, I have caused quite a few, and have some observations. I'm going to make a generalization here, and that is that most women, probably excluding committed lesbians, like cum and feel some thrill at getting a guy off. But this isn't about that; it's about what gets women off. And what they say when they're cumming is a whole different topic.

What follows is not based upon a random sample nor a scientific study. It isn't random since it includes only women I have enjoyed, and it isn't scientific because it's just observations without analysis. Women's response is highly varied, much more so than men. Here are a few types, although they are not rigid categories; there is overlap.

Sex Positions: Part 2

Prone Positions for intimacy

BY THE EDITORS OF MEN’S HEALTH. Listen to the ► Podcast at How To Sex.
 

A fun, new sex position is an easy way to immerse yourself in a sexual experience. Take a much-needed break from stressing about work or the state of the world by attempting something adventurous in the bedroom, like the many sex positions you’ll find on this list. (Don’t worry, we also included fan favorites like missionary, cowgirl, spooning, and doggy style.

Which positions should you try next? Start by asking yourself what you’re hoping to achieve by changing up your usual routine. This will guide how you approach this list of sex positions, explains Ian Kerner, sex therapist, and author of; She Comes First; and, So Tell Me About the Last Time You Had Sex.

Sex Positions: Part 1

Creative positions for intimacy: Standing or Sitting

BY THE EDITORS OF MEN’S HEALTH. Listen to the ► Podcast at How To Sex.


 

If you suddenly have an itch to try some new sex positions, we’re not surprised. When we recently surveyed 1,229 American men about their sex lives, a third of respondents said they’re feeling more sexually experimental now than before the pandemic began.

According to Justin Lehmiller, Kinsey Institute researcher and member of the Men’s Health Advisory Panel, stress could have something to do with the widespread craving for sexual novelty. “When we’re stressed, it’s often harder to feel desire or to stay in the moment, because our mind is distracted and wandering,” Lehmiller says. “Trying something new can create this immersive experience that lets us be in the moment and raises sexual arousal.”

Creepy In The Swingers Club

Why creepy guys often don't get laid, even at a swingers’ club

By Hord Holm. Listen to the Podcast at How To Sex.

I've been to a Swinger Club on roughly a dozen occasions, so perhaps not enough to count myself as an expert. But perhaps enough to have observed some common behaviors, and these are what I want to address here, particularly in relation to single guys who go to Swinger Clubs.

The Swinger Club Scenario

What usually happens is that my husband suggests that we go to our preferred club about a week ahead of time (or further out, if there is an enticing theme advertised for a particular night.)

Guidance For 'Hot Wives'

Ms. Evangelina Vargas advises wives who want to be “hot.”

By vargas 1 1 1. Listen to the Podcast at How To Sex.

This topic comes up more often than our society is comfortable with. To illustrate the matter, imagine the scenario of a couple of 50 year old English gentlemen down at the corner pub; when one of them says; “Nigel, I don’t know how to say this, but I have it on reliable certitude that your wife has been shagging a younger bloke from church.”
To which Nigel responds with a relaxed breath; “Well, at least someone is shagging her.”