I Am Dr. Britney Blair, a board-certified sexual medicine psychologist and expert in sexual health. AMA

Are there any underlying causes to sexual health problems that aren’t usually attributed as such?

This is an important question. Sexual health problems are often the first sign that there are underlying medical problems and they also are a very common side effect of many medications. There are many things that contribute both positive and negatively to our sexual health but I always recommend getting a physical workup to make sure we clear other medical problems.

Why do SSRI's have such a strong impact on sexual desire and performance?

The “why” here is a bit too long to answer…but the reality is that most people on SSRI antidepressants will experience sexual problems. Problems with libido, arousal and orgasm. It SUCKS! Depression also sucks. The good news is that there are alternative medications that have fewer sexual side effects and there is some scientific evidence that certain medications (bupropion and sildenafil) can counteract the negative sexual impact of SSRIs. I’d recommend a chat with your prescribing doc. There are also super effective treatments for depression that do not involve medication though for some folks with depression, medication can literally be life saving.

Is there any recommended material for men who have anxiety about sex? Anxiety about size and performance?

This is a huge part of why we built the Lover app…there is loads of material in there about sexual anxiety as well as scientific info on size and performance. Truth: the average ERECT penis is 4-6 inches. Sadly, most sex education comes from porn and porn stars are hired for performance and camera angles and medications make for very unrealistic size and staying power!

I am a female and I have no idea how to masturbate. It feels both overwhelming to try to learn and embarrassing that I don't understand my own body. Any resources or advice you could give to someone who wants to connect with their body in that way?

You are not alone! Because our genitals are located on the inside of our body, it may not be intuitive how to touch them to generate pleasure. A great resource to both learn about your body AND to learn to masturbate or experience pleasure and even orgasm is the Lover app we made. This is one of the reasons we created the app in the first place. There are many ways your body can experience pleasure, just lean into your discomfort and start slowly. I promise it will be worth it!

Good evening Dr. Blair! I'm a father to two daughters, ages 12 and 4, respectively. How do I approach the subject of sex to my eldest, who's current on puberty stage? Would it be better if my wife would talk to her about it instead? Personally, I feel awkward about it.

Well, you’re not alone here. Talking about sex with their kids is one of the most terrifying things for parents! And…had you rather her learn from porn or from friends telling dirty jokes? The average age of first hard core porn exposure is 8 years old so it is never too early to start talking to your little ones about healthy sex and sexuality. The key is to bring it up in a casual way, like you’d talk about anything else. There are loads of books that can help you as well.

Well, you’re not alone here. Talking about sex with their kids is one of the most terrifying things for parents! And…had you rather her learn from porn or from friends telling dirty jokes? The average age of first hard core porn exposure is 8 years old so it is never too early to start talking to your little ones about healthy sex and sexuality. The key is to bring it up in a casual way, like you’d talk about anything else. There are loads of books that can help you as well. This one may be help This one may be helpful for your older daughter: https://www.amazon.com/Celebrate-Your-Body-Its-Changes/dp/164152166X/ref=sr_1_5?dchild=1&keywords=how+to+talk+about+sex+with+kids&qid=1624893108&sr=8-5 Lean into embarrassment and talk to her about sex in the same way you wish your Dad had chatted about it with you when you were 12! If you open the door to the discussion, she’ll be coming back to you when she has questions…which is far preferable than her searching for answers online.

No reason to have your wife do the heavy lifting here. ;-)

What do you think of porn being a young man's and woman's (less often) first exposure to sex? What implications could watching pornography at a formative age like that have for their future sexual relationships?

Porn can both be helpful and super unhelpful tool as it relates to sexual health. Porn is NOT sex education. Unfortunately, this is the most sex education many kids get. Porn is a performance. So, if you grow up thinking porn sex is the same as real-life-sex, you may be in for performance anxiety and disappointment. Kind of in the same way if you felt super hero shows are similar to walking through the world on a random monday. :-)

Hello Dr! I’m 33 y/o male and never feel like having sex with my girlfriend for a few years. I view it as a chore. What’s wrong with me?

Before we jump into what is wrong with you, let’s get curious. Are you no longer attracted to your partner? is she just too familiar after all this time? Are there things that turn you on that you haven’t shared with your partner? How often are you masturbating and to what? The answers to these questions may lead us to a deeper understanding of what is going on for you and then we can understand what is happening between you and your partner.

What's defined as a "sexual problem"?

Let’s define terms, love it! A sexual problem is a problem when there is something affecting your sexual health (biological, psychological or social) that is causing distress for you! This could be problems with sexual desire, sexual arousal or orgasm.

simple question: is watching porn on a regular basis harmful?

thanks!

This is a sensitive question. I am very pro-porn...but in moderation! There are studies that now seem to show an excessive use of porn may be linked sexual dysfunction including loss of sexual desire, delayed ejaculation and erectile dysfunction. I suppose it's like anything else, too much of a good thing is still too much. Try taking a break from porn for a few weeks and vary your masturbation routine and see what you discover in terms of desire and pleasure.

Hi, Dr Blair. Thanks for doing this.

Despite your having a self-confessed passion for doing what you do - which I think is imperative, because doing something one hates is never really a good thing, is it? - what made you interested you in your profession? What sparked it for you? Had you known from a rather young age that you wanted to work in this profession?

Also, would you say you have learnt anything from your working in this profession?

Good day, ma'am.

That's a great question! I had no idea that this would be my life's work or such a passion. During my first year at graduate school, i went to a workshop on sexual health and learned that one in 2 women and roughly 1 in 3 men have a sexual problem and the treatments are fast and effective. it was an "ah hah" moment and i knew this woudl be my life's work.

Any tips for a woman who struggles to get physically aroused when she is very much there mentally?

Sometimes it's even worse, I want to want but nothing happens physically so we end up using lube but I don't get much sensations :/

’m sorry to hear this is stressing you out. Rest assured, it’s actually very common. So common in fact that there is a name for it - disconcordant arousal. The more pressure you put on your body to “get there” the less it is likely to do so. I’d recommend slowing way down and then slow down some more. Give you body ample time to catch up with your sexy mind! Also, 100% of people report sex is better with lube so that is never a problem. Finally, there are many medications (including oral contra ceptives) that can negatively impact lubrication and sensation…go get checked out by your doc!

I have a cuckold fetish since my teenage years that I have struggled to resolve and figure where it stems from . This has affected many relationships and currently affecting the health of my marriage. It’s too embarrassing as a subject to talk to a therapist by itself . Where does it stem from and how does one resolve it to be interested in other more productive things ?

Many people have fetishes and the unfortunate thing is that our society seems to shame us. There is absolutely nothing wrong with a cuckolding fetish, many people think it's hot! Sometimes we can ascertain where a fetish comes from and other times we cannot. It's kind of like say why am I attracted to women...I don't know, i just am. If possible, i would invite you to explore and accept your fetish. This doesn't mean that 1000% of your sex life needs to involve some form of cuckolding but you and your partner’s advantage.

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I’m sorry you’re having this experience, it can be deeply distressing for lots of people. But, you’ve already uncovered the lurking unhelpful pattern underlying psychogenic ED! It’s performance anxiety. And..if you feel anxious, an erection is the last thing that’s going to pop up. Intermittent loss of erection is extremely common. So common, in fact, that every person with a penis will, at some point, lose their erection. We have this idea that we can control erections, the opposite is true. An erection comes and it goes…the more you try to force it the less well things will work. I’d encourage you to focus on something else, take off the performance pressure and see if this doesn’t resolve the problem. We also have a specific program in the Lover app specifically designed to address erectile dysfunction, check it out!

Sometimes I dissociate and flashback to a traumatic experience. This obviously kills the mood. Is there a standard way to deal with the flashbacks? (Already doing PTSD treatment) Thank you.

I’m sorry to hear that you had a traumatic experience and really inspired to hear you are seeking treatment, that’s not easy so good for you! While flashbacks are common, there are some helpful tips that can bring you back into the present. First of all, notice that you’re not present and then shift your attention to the sensations in your body. Use your 5 senses (sight, smell, touch, taste, sound) to get back aligned with your Lover (or yourself if you’re having solo sex). If you need to stop or slow down. If it feels safe, tell your Lover what is happening for you and then slowly re-engage w/ the erotic. Never push yourself to do something that feels unsafe but definitely lean into discomfort…as you already know…this is where the healing happens.

What are your go-to tips for spicing up the bedroom to re-ignite some passion?

Great question!

Best tip - communication. Have you and your partner ever shared fantasies with one another? if not, do it! and decide if one or more of those fantasies would be fun to manifest in real life.

You can also try introducing sex toys, having sex in a novel location, role playing, introducing an additional partner, using erotica. The ideas are only limited by your imagination.

Just make sure you and your partner are consenting even if uncomfortable. Sometimes great sex requires us to lean into discomfort.

What are your thoughts on polyamory and non-monogamous relationships? There are so many different versions of polyamory (hence the prefix poly), could you shine some light on them give us some general information for people seeking those types of relationships?

I have more thoughts than we have time or space on here to chat on this subject. In a nutshell, monogamy (or non-monogamy) is a behavioral choice. Humans are naturally novelty seeking. We may choose monogamy for many valid reasons but it is not the human default. Both monogamy and non-monogamy can be quite complicated to navigate.

Jealousy is a basic human emotion experienced by most, if not all, of us so learning to navigate that is imperative to a successful non-monogamous agreement. Consensual non-monogamy runs the gamut from polyamory to swingers and everything in -between. An interesting study out of UCLA suggests that Swingers (where sexual activity with additional partners is only explored as a dyad) reported the highest relationship and sexual satisfaction compared to monogamous, polyamorous and other types of non -monogamy.

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I’m sorry to hear you are having a bit of a disconnect with your SO over sex. Sadly, this is one of the top 3 reasons people split up. Because your partner is not on here and I can only give advice as to what you can do…I’d suggest maybe seeing how you can connect with her outside of the bedroom. I know that sounds a bit lame but maybe there are needs she feels are not being met in other areas of the relationship that is causing her to shut down sexually. It sounds like she may be a bit inhibited around sex and that can be a tough nut to crack! But, if she feels safe in other areas it may translate to your erotic connection.

Our lab is beginning to study sexual desire discrepancy in cohabiting couples. What advice would you give (individually) to high libido and low libido partners? I saw in a different comment that you suggested connecting outside the bedroom. While that may boost the relationship, it may not necessarily prevent infidelity. Unmatched and unsatisfied sexual desire is still sexual desire, even if you have more date nights.

I totally agree that having more date nights is not going to magically resolve desire discrepancy! For some, it can help them feel more emotionally connected. All couples will at some point experience discrepant desire. My best advice for the low desire partner is…don’t wait until you want. In long term monogamous relationships, it is natural for spontaneous desire to wane over time. A rocking sex life requires effort and needs to be made a top priority. Just as we would with diet, exercise or sleep. My advice to the higher desire partner…does your partner not desire sex or do they not desire the sex you’re having with them! Make sure you are prioritizing your partner’s pleasure…you may find that his amps up their sexual desire.

Could there be a reason that, despite being quite happy with my sex life with my wife, I still want to have sex with like every woman I see?

The reason is that…you’re human. ;-) Just because you are married and super happy with your sex life with your wife does not mean you’re dead or blind. It is super normal, natural and even healthy to desire frequent sex with varying partners. This, however, does not mean it is healthy to act on those desires (unless of course you have agreed this with your wife and all is consensual). Also, your wife is likely feeling the same thing. It is normal and natural to have desire outside of our partnership. Try taking that desire home and letting it fuel your erotic connection with your wife! e should be talking more frequently about the normalcy of wanting to have sex with other people but choosing to be monogamous with our partner. Monogamy is a choice…not our natural default. It is a valid and often less complicated choice that non-monogamy but a choice nonetheless. :-)

Howdy Dr. Blair, good onya for doing this :)

What do you see as the most common issue that you come across in your work, and what's the advice or quick-fix you would give to help the most people with this issue?

The most persistent problem I see is low sexual desire BUT this is often low sexual desire for the sex you’re having not low sexual desire in general. The best way to think about this is to slow down and talk to you partner (and yourself) about the type of sexual activity you’re engaging in and what would amp up the pleasure.

u/DrBritneyBlair_AMA are there any resources which teach a deep-dive into pleasuring your partner?

Having read up on what feels good, the anatomy of the clitoris, etc. I'm frequently given glowing compliments from my partners, but I feel like there's so much more I can learn and I can't find any decent resources.

On the flip side, I enjoy my partners but they rarely have a similar level of knowledge/skill about me and I'd like something for them too.

I love that you are committed to learning more and more about the erotic and pleasuring your partner and makes sense you want the same in return! TBH, the best resource is what’s between your partner’s ears. Ask them what drives them wild…what works for one person may not rock the world of your next lover. Along that same line, share what works for you. Either verbally or non-verbally. If you want something to read, you can check out tips on our app Lover or read Ian Kerner’s work. She Comes First is awesome as well as He Comes Next by the same author.