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Introduction

Sex Matters

Some years ago, my mother peevishly inquired, “When are you going to write a book that won’t embarrass me?” She was dismayed that her nice Jewish daughter studied a subject that she considered dirty. To her, sex was a private, embarrassing act, like using the toilet. It was disgusting to discuss it openly, much less spend time brooding over what goes on “down there.” It’s down there, for goodness sake.

Most of us are raised to believe that sex doesn’t — or at least, shouldn’t — matter. It shouldn’t even matter that much in marriage. In fact, nice people shouldn’t spend too much time thinking about sex. As the social narrative goes, if civilization is the sum of our intellectual achievements, then sex is the shameful burden of our primal roots. It’s dirty. It’s something you have to do to have children so put it off as long as possible and then just close your eyes and do it. Preferably with the lights off.

It’s a strange dogma to apply to one of humanity’s greatest and most enduring obsessions. Whether or not you talk about it, you cannot escape sex. Sex is all around us all the time — in the texts we send and the sites we visit, in the catcalls from construction workers on the street, in the hot outfit your neighbor’s wearing, in the bouquet of flowers someone’s bringing home to a sweetheart. Sex is not merely a part of life, it is integral to human life and human identity.

Human mating rituals are so seamlessly threaded throughout human life that we don’t realize that many casual behaviors are in fact spurred by sexuality. You see, sex is not just all around us, it is inside of us. Sex traits are in our genes, sexual chemistry floods our brain and our bloodstream. The brain continually conveys sexual information to our entire system. The brain perceives sexual opportunity, prepares us for intimacy (or a “mating opportunity”), and when we engage in sex, our brain causes a chain reaction of events that bring us to orgasm and reward us with a flow of beneficial brain chemicals, such as oxytocin, vasopressin, serotonin and prolactin, all of which enhance mood and relaxation.

There is overwhelming evidence that sexual happiness and satisfaction promote a longer, healthier life. In a 1999 study of 3,500 adults, Dr. David Weeks, an American psychologist, was able to show that people who have sex at least three times a week look 10 years younger than their real age. Sex promotes blood circulation and cardiovascular function, improves muscle tone, and lowers the risk of stroke and heart attack. Brain chemicals released during and after orgasm contain natural opiates which combat pain, depression and stress. Sex hormones influence our moods, productivity, and social function; they profoundly impact our mental stability. Without the hormones that steer sexuality throughout out lives, the emotional experience of being human would be completely altered. Sex is at the core of human identity, not merely an appurtenance to human identity. Indeed, sex matters more than most of the things people uphold as more important than sex.

How and why we developed so many rules and taboos around sex has fascinated me since I worked on my first book, Different Loving (with co-authors William D. Brame and Jon Jacobs), a comprehensive study of sadomasochism, BDSM, and fetishes. I read scores of books and articles, focusing on original sources so I could build cultural frameworks and social history for each of the types of BDSM we covered. It became increasingly apparent that even authoritative texts on sex and sexual normalcy were profoundly flawed. Virtually all of the great 19th century theorists, for example, misunderstood, mischaracterized and discounted female sexual drive. Case studies of the day were analyzed through a filter of elitism, religious doctrine and, sometimes, sheer quackery. Nor did the situation measurably improve in the medico-forensic establishment throughout the 20th century, as psychiatrists and courts continued to rely heavily on the biased opinions rendered in the 19th century. While new discoveries have changed the face of virtually all the social sciences, and public attitudes towards sex had undergone numerous revolutionary changes, underlying attitudes about sex itself were literally frozen in Victorian time.

By the time I was working on my next volume on kinky sex (Come Hither: A Commonsense Guide to Kinky Sex), I was obsessed with this problem. I was in the last stages of completing my Ph.D. in human sexuality, and like every grad student, had a mania for reading and collecting data. I read, for example, the sobering statistics that 31% of all men and 43% of all women in the U.S. are sexually dysfunctional ( Journal of the American Medical Association, 1999). The following year, American Family Physician reported that over 50% of women were dysfunctional because they cannot achieve orgasm from intercourse and 15% have never had an orgasm at all. I started adding up the numbers. The National Institute of Health estimates that 30 million American men are impotent and tens of millions more have problems with low libido, premature ejaculation, and orgasm disorders. 15% of men and 30% of women have Hypoactive Sex Disorder, (Endocrinology Review, 2001), the clinical term for lack of desire. Dysfunction everywhere one turns, or so it would seem.

It struck me then that, perhaps, the problem was not that Americans were spiraling into mass dysfunction but rather that the interpretations of the data were fruit from the poison tree. If our model of what is normal is flawed, our definition of things like “dysfunction” and “perversion” must be flawed too. Did the medical researchers ask all these dysfunctional people if they thought they could be more orgasmic from a different type of sex? Were some of the subjects secretly gay or lesbian and thus would never find complete sexual fulfillment from heterosexual acts?

What if some cases of dysfunction are in fact the product of people continually trying to have a type of sex that doesn’t actually turn them on because they believe that is the only type of sex they are allowed to have? If 50% of women can’t orgasm from vaginal intercourse, instead of calling that a dysfunction, perhaps — as most sexologists today would agree — vaginal intercourse isn’t quite as sexually important to all female sexual function as commonly assumed. Today’s therapist would encourage such women to experiment with vibrators, fingers, tongues and sexual fantasies. If they can enjoy the experience and achieve climax, it is not a true dysfunction.

When everyone is held to the same pre-emptive model of how they are supposed to feel sexually, it’s inevitable that a sizeable segment of the population will always be dysfunctional or considered perverts or weirdos. As things stand, we live in an age when most people still hold their great-grandparents’ belief that masturbation is bad or wrong, while data are released weekly showing that orgasms are vital to human health. There is a cognitive dissonance between the facts about sex and the beliefs about sex. Missionary-position sex is still believed to be the “best” or “most natural” type of sex even though a 2010 study by the Kinsey Institute demonstrated that oral sex is actually the most popular type of sex.

The schisms in our culture’s attitudes towards sex are cracking wide open, in part because of Internet culture. In 2006, Babytalk magazine created a furor when an issue’s cover showed a woman breast feeding a baby; although no nipple was visible, 25% of readers protested that the image was pornographic. A few months later, the infamous “2 girls, 1 cup,” a trailer for a hard core copraphilia video, became an Internet sensation. It is not, as some prudes might have it, that depravity is taking over; it’s that sexual beliefs about what is and is not permissible, or what is and isn’t normal, do not mirror actual human sexual behavior. Real human sexuality is, and always has been, diverse.

When I set up my private practice in 2000, my clients’ needs for better information about sex pushed me to examine new and more urgent questions about the role of sex in daily existence. I had expected to see depression and despair in victims of abuse, but I had never appreciated how unhappy life felt for people who experience sex as a stressful or distasteful act. Whether it was the woman who had never had an orgasm with her husband, or the man who said that intercourse was nothing more to him than masturbating into a sleeve, people felt incomplete, and somehow inferior to those who they imagined were having hot, passionate sex — which they, naturally, believed was everyone in the world but themselves.

Sex matters. My clients convince me of that every day. Each problem, each life story, continually shapes and reshapes my perspectives on sex as it is truly lived, and gives me new tools to unlock its mysteries. This book encompasses the cumulative knowledge I’ve applied to my practice, set out for the first time in writing. Using social histories of sex, and relying on hundreds of sex studies, my mission here is to build evidence-based models of human sexuality. I also use composite case studies (to protect the identities of my clients) to give the dry facts a warm human face and to show how sex truly and deeply impacts people’s lives, relationships, self-image, and mental health.

Why We Don’t Know What We Know about Sex

Imagine if our current understanding and treatment of diseases were based on what people believed 130 years ago. Barbers would perform surgeries, blood-letters would leech us, caustic enemas and emetics would be daily rituals, and the bumps on our head might figure in our treatment plan. We have come an astonishing distance from the magical thinking, charlatanism, alchemy, and fraud that dominated medicine until the 20th century.

Yet, our ideas about sex remain welded to antiquated beliefs first articulated by ancient Greco-Roman philosophers. Echoing Aristotelian theory, Roman philosophers posited that sexual desire poisoned the mind with passions and drained men of virility. Seneca boiled it down to a simple edict: “Do nothing for the sake of pleasure.” The philosopher Artemidorus declared that missionary position intercourse was the only moral form of sex and pronounced oral sex an abomination.

The Greco-Roman concepts of sex for pleasure as a morally weakening force received perhaps its most critical advocacy a millennium later in the work of Saint Thomas of Aquinas, whose opinions became the basis of European and American beliefs about sex for the next five centuries. In essence, Aquinas retrofitted the sexual theories of the pagans to Roman Catholic purposes. Aquinas asserted that sex served only one purpose in life: reproduction. Bearing children was a sacred duty. Sex merely for pleasure was a sin, even when the partners were married.

It was only in the 19th century that belief-based ideologies began, at last, to shift in favor of the growing evidence that sex was a truly complex phenomenon. With the blossoming of medicine in the mid 19th century, some of the greatest minds of the Victorian age — most notably Sigmund Freud — set about unraveling the meaning and biology of sex. For the first time, sexual behaviors were classified, categorized, diagnosed and treated by medical doctors.

Unfortunately, by modern standards, Victorian science was woefully unscientific. While the doctors themselves were serious men, some of their conclusions were absurd. The fatal flaw in Victorian sexology was that, in their eagerness to establish diagnostic models of sexuality, they never asked the single most important question: “What is normal sexuality?” Instead, they assumed they already knew what it was: vaginal sex in marriage for the purpose of reproduction. (I’ll call it the Reproductive Model and will use RM as short-hand from here on.)

While they analyzed hundreds, perhaps thousands, of cases which contradicted their assumptions, rather than question the validity of those assumptions as a good scientist should, they diagnosed everyone who did not conform to their expectations as being mentally unbalanced and in need of psychiatric intervention. They assumed that women by nature do not have independent sex drives. They believed that masturbation caused debilitating disease. For decades after, women with high sex-drives, masturbators, hedonists, homosexuals, transpeople and others who defied the Victorian standard were subject to involuntary treatments and hospitalizations.

Today, we have an exuberance of data across numerous medical specialties that prove just how wrong our predecessors were to limit their definition of normalcy to reproductive function.

Diversity is Normal

Think of all the people you know who have had casual sex, one-night stands, same-sex encounters, or threesomes. Add to that all the people who watch adult movies, surf porn, sext, go to strip clubs, patronize call-girls, and get happy endings at massage parlors. Then think of the tens of millions of North Americans who identify as swingers, bisexuals, gay, kinky, polyamorous or fetishist, and the scores of millions who enjoy sexual role-play, fantasies, new positions, and sensual adult toys. By Victorian standards, all of the above are deviants. Yet if you eliminate all of the above populations, just how many “normal” adults are left?

After 20+ years of sexual research and 11 in clinical practice, I have come to realize that it’s only the tiniest minority of people who faithfully adhere to the RM by choice. Even the most conservative and religious people will grant themselves some leeway when it comes to sex. Cosmo magazine makes it sound new every time, but oral sex techniques were undoubtedly old news to adults long before Ancient Rome was founded.

Perhaps most telling of all are the lessons of history. No matter how many repressive regimes have come and gone, no matter how many laws and religious mandates dictate sexual behaviors, no matter how much persecution a sexual minority may endure, each new generation repeats the sexual patterns of preceding ones. This suggests a biological basis that surpasses cultural expectations. It is reasonable to conclude that the reason adults may find it difficult to conform to the traditional standard is because the social standard conflicts with their biological make-up.

I see the individual suffering that confusion about sex and normalcy causes people. I also see that knowledge, education and the simple truths about sex, delivered candidly without judgment, alleviates that pain. Throwing out some of the old beliefs about how sex “should be” and embracing the evidence about how sex is actually lived is profoundly therapeutic.

A Universal Solution

To move forward, we can’t keep pretending that sex is a less vital concern to the quality of human life than history or philosophy or literature. Sex is one of humanity’s central obsessions. Whether we’re browsing porn or signing petitions to stop porn, whether we’re taking tantric courses to expand our orgasmic potential or trying to pray away our lust, whether our sex lives are an oasis of joy or a pit of torment, we are all preoccupied with sex.

Sex is with us from birth to death. Sexual events occur undetected inside your body, as our hormones fluctuate according to moods, life events and aging. Sexual emotions are happening in your home, whether you are celibate or sexually active. Sexual events occur in our private worlds — whether it’s an affair at the office, a scandal at one’s place of worship, or a sex club moving into one’s neighborhood.

The time is overdue for a modern dialogue about sex and new models of normalcy based on the facts we know instead of the beliefs our ancestors held in the absence of knowledge.