Contemporary Male Sexuality (Barry & Emily McCarthy)

“Barry and Emily McCarthy continue to produce high-quality, highly rele-
vant, and extremely readable books that can be enjoyed by professional and lay
readers alike. In their most recent collaboration, they address the complexi-
ties of male sexuality. Male sexuality is often misunderstood as being simple,
straightforward, and unsophisticated. The authors quickly debunk that myth
and recognize that male sexuality is every bit as complex and nuanced as female
sexuality. With beautifully presented case studies, as well as thoughtfully de-
signed behavioral exercises, the McCarthys have given us a book that will not
only make men better men, but also make them better relationship partners. I
am certain to recommend this book to many, many of my patients.”
— Daniel N. Watter, Ed.D., past president, The Society for
Sex Therapy and Research (SSTAR)
“Contemporary Male Sexuality is well written and with very clear and direct mes-
sages which are easy to understand. This will be a very valuable contribution
to a new model of male sexuality from two of the most preeminent and prolific
authors in the history of sex therapy.”
— Pedro Nobre, professor of psychology, Porto University, Portugal;
president of the World Association for Sexual Health
“I am pleased to have the opportunity to endorse this insightful and timely book
by Barry and Emily McCarthy. In an era of changing sex roles and sexual po-
lemics, the McCarthys offer a clear perspective and guidepost for couples. They
emphasize that male and female sexuality are both complex and that both sexes
are more similar than dissimilar. The goal should be empower both members
in a relationship to develop their mutual manner of sharing intimacy and to
celebrate their uniqueness as individuals and as a couple. This is the fifteenth
book co-authored by the McCarthys and written for the general public. In my
opinion, this text is their best.”
—R. Taylor Segraves, MD, editor, Journal of Sex and Marital Therapy
“This timely book belongs on every mental health professional’s shelf, as it adds im-
portant knowledge and perspective, yet is written in a style accessible to the general
public. Emily and Barry McCarthy identify the dangers of toxic male behavior and
attitudes, yet sensitively express how male sexuality is more complex and nuanced
than portrayed in the media; emphasizing that males do not belong on a pedestal nor
should they be shamed. The McCarthys offer both a solution and a pathway to it,
utilizing their models of female-male sexual equity and Good Enough Sex (GES),
that promote acceptance and valuing male and couple sexuality.”
— Michael A. Perelman, PhD, co-director, Human Sexuality
Program and clinical professor emeritus of psychology in
psychiatry, Weill Cornell Medicine, NewYork-Presbyterian
“The dynamic duo of Barry and Emily McCarthy have written another block-
buster presenting their vision for transforming the manner in which men,
women and couples think about and engage in lovemaking. While this volume
focuses on men’s sexuality, be they young or old, gay, straight or unconven-
tional, it goes beyond the man and stresses the importance of the partner and
the relationship. There are chapters on sexual desire, erection, ejaculatory
disorders, sexual orientation, compulsive sexual behaviors, fetishes and affairs
describing the McCarthys’ unique vision on these distressing issues and varied
solutions as to how they might be resolved.
Mythbusters, Barry and Emily McCarthy rip apart the destructive influence
on boys and men regarding traditional sex roles and sexual expectations in the
Western world and how these destructive influences lead to sexual and rela-
tionship dysfunction. Each chapter is filled with scientific information on the
development of sexual and relationship problems, alternative solutions to these
difficulties as well as case illustrations and recommended exercises for men to
gain a deeper understanding of the issues. This is definitely a book I would use
with patients in my clinical practice to augment our therapy sessions.”
— Stanley E. Althof, PhD, executive director, Center for Marital
and Sexual Health of South Florida; professor emeritus, Case
Western Reserve University School of Medicine
CONTEMPOR A RY M ALE
SEXUALI T Y
This accessible guide confronts myths and pressures surrounding men and sex,
promoting a positive and healthy model of male sexuality that replaces tradi-
tional expectations.
The chapters in this book engage with cultural assumptions about male sex-
uality, from harmful early messaging, to the importance of enjoying intimacy,
pleasure, and eroticism over the age of 60. The authors challenge the effects
of toxic masculinity and traditional gendered roles in sex, celebrating sexual
diversity, confronting double standards, and empowering men and couples to
develop an equitable sexual bond. Case studies and psychosexual skill exercises
are integrated throughout to make each concept personal and concrete, and
incorporate the Good Enough Sex (GES) model to promote an authentic sexual
self throughout the lifespan.
With a focus on mutual consent and pleasure, Contemporary Male Sexuality
offers a new model of male sexuality that helps men and couples achieve a satis-
fying, secure, and sexual bond, replacing damaging expectations with healthy
sexual values.
Barry McCarthy and Emily McCarthy are a writing team. Barry is a pro-
fessor emeritus of psychology, a diplomate in clinical psychology, a diplomate in
sex therapy, and a certified couple therapist. He has authored 120 professional
articles, 33 book chapters, and 22 books. In addition, Barry has presented 450
professional workshops nationally and internationally. He received the Masters
and Johnson award for lifetime contributions to the sex therapy field. Emily
McCarthy received a B.S. degree in speech communication. Her writing and
wisdom provides a balanced, humanistic perspective to issues of male and cou-
ple sexuality. This is their fifteenth co-authored book.
CONTEMPOR ARY M ALE
SEXUALIT Y
Confronting Myths and Promoting Change
Barry McCarthy and Emily McCarthy

First published 2021
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 Barry McCarthy and Emily McCarthy
The right of Barry McCarthy and Emily McCarthy to be identified
as authors of this work has been asserted by them in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this title has been requested
ISBN: 978-0-367-42721-4 (hbk)
ISBN: 978-0-367-42720-7 (pbk)
ISBN: 978-0-367-85460-7 (ebk)
Typeset in Perpetua
by codeMantra
CONTENTS
1 Men Are Not Simple: Promoting Male and Couple Sexuality 1
2 The Sexual War between Men and Women: Changing

the Dialogue 10
3 Confronting Contemporary Male Sexuality: Breaking

the Abusive Cycle 19
4 Female-Male Sexual Equity: Confronting the

Double Standard 28
5 The Sexual Development of Boys and Adolescents:

Healthy and Unhealthy Learnings 37
6 Young Adult Sexuality: Time for Change 47
7 The New Sexual Mantra: Desire/Pleasure/Eroticism/

Satisfaction 57
8 Adult Sexuality: A New Model of Masculinity 68
9 Desire: The Core of Sexuality 78
10 Integrating Intimacy, Pleasuring, and Eroticism:

Broad-Based Sexuality 87
11 Developing Your Couple Sexual Style: The Autonomy/

Couple Balance 95
vii
C ontents
viii
1
MEN AR E NOT SI MPLE
Promoting Male and Couple Sexuality
One of the best-selling books in the history of “pop psych” was “Men are from
Mars, Women are from Venus”, including spin-off books such as “Mars and
Venus in the Bedroom”. These simplistic, humorous books were based on the
mistaken assumption that relationally and sexually, men and women are entirely
different species. The individual male sex performance model was glorified as
the natural way to be sexual-easy arousal, totally predictable intercourse, and
reliable orgasms. Men were simple sexually, while women were emotionally
and sexually complex. The challenge for women was to catch up to the sexually
superior man. Female sexuality was inferior.
This book presents a very different model of male and couple sexuality. Psy-
chologically, relationally, and sexually, there are many more similarities than
differences between men and women, especially those in a married or part-
nered relationship (Hyde, 2005). Both men and women are complex, not sim-
ple. This is especially true sexually. A key for healthy sexuality is to accept the
individual responsibility/intimate sexual team model. Each person is responsi-
ble for your sexuality. It is not the man’s responsibility to give the woman desire
or an orgasm. Nor is it her responsibility to convince him to value intimacy and
pleasuring. Each partner affirms the value of the new sexual mantra –desire/
pleasure/eroticism/satisfaction (Foley, Kope, & Sugrue, 2012). Male, female,
and couple sexuality are complex with large individual, couple, cultural, and
value differences. Sexually, one size never fits all. Value your individual and
couple uniqueness.
Understanding and accepting the complexity of male sexuality are healthier
than putting men on a sexual pedestal or demonizing men. In the media, on the
internet, and in bookstores, male sexuality is viewed as simple, predictable, and
one-dimensional. Sadly, the focus is on destructive male sexual behavior – child
sexual abuse, rape, affairs, sexual harassment, inability to express emotions, re-
lational ignorance, and sexual entitlement. Our culture engages in male blam-
ing and shaming.
1
M en A re N ot S imple
In this book, we explore the strengths and vulnerabilities of men and male
sexuality. We carefully assess the psychological, bio-medical, and social/
relational factors that promote and support sexuality as well as confront de-
structive male sexuality. Knowledge is power. We provide information and
guidelines so that you can make “wise” sexual decisions (wise means it works
emotionally and practically, in the short and long terms). You deserve for sex to
have a 15–20% positive role in your life and relationship. Rather than the “war
between the sexes”, we provide a positive and realistic approach to male sexual-
ity which empowers and motivates both partners to make wise decisions. Male
sexuality is more complex and nuanced than portrayed in the media. Males do
not belong on a pedestal nor should they be shamed. Understanding male sex-
uality from the perspective of psychological, bio-medical, and social/relational
factors is valuable for you and your relationship. This book is addressed to men,
women, couples, and clinicians. We focus on mainstream heterosexual married
and partnered men. In addition, we honor diversity and non-traditional values
in sexuality and relationships.
In a previous book, “Finding Your Sexual Voice: Celebrating Female Sexual-
ity” (McCarthy & McCarthy, 2019a), we strongly argued that female sexuality
is first-class, not inferior to male sexuality. Female sexuality is more varia-
ble, flexible, complex, and individualistic. Sexuality is healthy when men and
women are intimate and erotic allies. Treat your partner in a respectful and
trusting manner. This is much more than socially desirable words. It entails
changing attitudes, behavior, emotions, and accepting new values about gender
and sexuality.
We emphasize the importance of recognizing vulnerabilities and challenges
in order to achieve female-male sexual equity. Each gender has vulnerabili-
ties which can subvert or even poison sexuality. Rather than blaming men and
feeling oppressed by male sexuality, the woman’s challenge is to strengthen
her sexual voice (especially her power to veto sexual scenarios which are aver-
sive) and replace these with healthy sexual attitudes, behavior, and emotions.
Healthy sexual attitudes and values promote psychological, relational, and sex-
ual well-being.
Vulnerabilities for men are different than vulnerabilities for women. A
major vulnerability is the difficulty giving up the individual perfect sex per-
formance demand and replacing it with variable, flexible, pleasure-oriented
couple sexuality. Although gender vulnerabilities are different, the chal-
lenges for healthy couple sexuality are similar. Affirm that desire/pleasure/
eroticism/satisfaction is the essence of couple sexuality. Understanding the
complexity of male sexuality promotes being an intimate sexual team. Be
clear what you value sexually. Create a respectful, trusting, emotional com-
mitment. As well, confront and change components of male sexuality which
are oppressive and unacceptable.
2
We explore healthy and unhealthy components of male sexuality to increase

awareness and understanding so you’re in a position to make wise personal,
relational, and sexual decisions. You deserve a healthy sexual relationship.
It is crucial to challenge the belief that love and sex are magical, so when
you find your “soul mate”, all you need is loving communication. Inherent in
the romantic love/soul mate model is the mistaken notion that sex is the man’s
domain with the woman following his sexual lead. The myth “As long as you
are in love everything will be fine” has caused untold damage to relationships
throughout generations and cultures.
On the other extreme, confront the cynicism that results from labeling men
as sexual predators. Barry remembers a professional workshop where a female
participant yelled “All men are rapists. Given the opportunity all men will rape”.
Cynicism about men and male sexuality causes women to be hypervigilant and
defensive. This is not in anyone’s best interest. Certainly, there are men whose
sexual attitudes and behavior are toxic (we will confront this in Chapter 3),
but they are in the minority. The great majority of men want a healthy emo-
tional and sexual relationship. There is solid scientific evidence that men benefit
from a respectful, trusting, intimate marriage even more than women (Stanley,
Rhoades, & Whitton, 2010). Single, divorced, or widowed men are more vul-
nerable to emotional distress and physical illness than married men. Culturally,
men are not supposed to value women or an intimate relationship, doing so only
for sex. Like so much in our culture, this is based on simplistic myths not genuine
scientific understanding about men, women, couples, and sexuality.
The Myth of Male Sexuality

A core male learning is that sex function is easy, predictable, in his control, and
most important “autonomous”. As an adolescent and young adult, he has spon-
taneous erections, intercourse, and orgasm, needing nothing from his partner.
This is the basis for the assumption that male sexuality is stronger and better
than female sexuality. Most males experience first orgasm between ages 10 and
14 with either nocturnal emission or masturbation. Very few males experience
their first orgasm during partner sex. First orgasm during partner sex occurs
between ages 15 and 21 with manual, oral, intercourse, or rubbing stimulation.
Most males begin intercourse as premature ejaculators (intercourse lasting less
than two minutes and not feeling in control of when you ejaculate). Autono-
mous sex function is idealized, especially in porn videos. In porn, he always
has a firm erection and needs nothing from the woman. This simplistic view of
male sexuality is almost totally wrong. Male sexuality is complex, with large
individual, couple, cultural, and value differences. Men are intimidated by the
simplistic performance model. An example is that 80% of men believe that
their penis is smaller than average. This makes no statistical or logical sense,
3
but demonstrates the tyranny of sex demands and expectations. The message is
clear – you need to perform perfectly; otherwise, you’re a “sexual loser”. Fear
of not being “man enough”, not having enough partners, and not being as sex-
ually skilled as other men dominates male culture. The pressure is to perform
perfectly, needing to give your partner an orgasm the “right way” with a large
penis and hard-driving intercourse. Sex is about performance to impress your
partner as well as male peers.
Men are notorious sexual braggarts and liars. You are not supposed to have
questions or anxieties.
It is no wonder that it is so challenging to have a genuine sexual dialogue
between a man and a woman. Adolescent and young adult men and women
learn such different sexual languages, feel such different pressures, and have
such different vulnerabilities.
Healthy Male, Female, and Couple Sexuality

This book is for men, women, and couples to learn the language of desire/
pleasure/eroticism/satisfaction and be intimate and erotic allies. This is a chal-
lenge for men, women, couples, and the culture. Yet, it is a very worthwhile
challenge. Sexuality can have a positive 15–20% role in your life and relation-
ship. Understanding the strengths and vulnerabilities of male sexuality is im-
portant in accepting yourself. Female sexuality has many more similarities than
differences from male sexuality. The important concept is that female sexuality
is more variable, flexible, complex, individualistic, and, most important, first-
class, not inferior. This understanding is the foundation for the female-male
sexual equity model (McCarthy & McCarthy, 2019b). It is the basis of a new,
healthy dialogue about sexuality. This opens you and your partner to be inti-
mate and erotic friends rather than the traditional war between the sexes. It
allows you to have genuine conversations about the roles, meanings, and out-
comes of sexuality rather than a destructive, adversarial argument where male
sexuality is either on a pedestal or demonized. It provides an opportunity to be
allies, not adversaries.
Sexually one size never fits all. Men, women, and couples are complex and
unique. The information and guidelines we present are based on scientific data
and clinically relevant perspectives (Metz, Epstein, & McCarthy, 2017). We
strongly believe in these guidelines scientifically, clinically, and try to apply
them in our lives. We believe in individual differences and honoring each per-
son’s unique sexual voice, relationship, and sexual reality. It is your respon-
sibility to implement these guidelines into your life and relationship. There
are couples who choose to stay with the traditional double standard and are
comfortable with the woman being in a subservient role. However, the great
majority of women embrace the challenge of “finding your sexual voice” as
4
a first-class woman. Healthy sexuality is a one-two combination of personal

responsibility and being an intimate sexual team. The female-male sexual eq-
uity model promotes this, while the traditional double standard subverts it.
The essence of a healthy marriage (life partnership) is a respectful, trusting,
emotional commitment. The paradox is that sex dysfunction, conflict, and es-
pecially avoidance can destroy a relationship, but good sex cannot save a bad
relationship. The 15–20% function of healthy sexuality is to energize your bond
and reinforce feelings of desire and desirability.
Special Issues for Men

This book focuses on understanding male sexuality. We want to increase psy-
chological, relational, and sexual understanding of the complexity of men and
male sexuality. Although it should be read by men, you are not the sole audi-
ence. This is written for men, women, couples, and clinicians. The simplistic
theme regarding male sexuality focused on strength with a sex test of erection
and intercourse. This must be challenged. The mistaken belief is that male sex-
uality is superior because it is autonomous. A “real man” is able to experience
desire, erection, intercourse, and orgasm without needing anything from the
woman. The extreme is that “A real man can have sex with any woman, any
place, and any time”. Spontaneous erection, a large penis, totally predictable
intercourse, and orgasm are in his control.
The great majority of men have been exposed to porn and use porn images
to accompany masturbation. In porn videos, the man always has a firm erection
and needs no additional stimulation. The message of porn is male dominant/
female submissive. The crazier the scenario and the crazier the woman, the
more erotic it is. He always ejaculates whether on her body, or more typically,
on her face. She is portrayed as lusting for dramatic sex whether double penetra-
tion (vaginal and anal) or turned-on by pain and aggression. Erotic sex is male
dominant/female out of control.
These scenarios intimidate men, not empower you. The message is that sex
is a competition, and in order to not fall behind, you need to perform perfectly
to impress your partner and male peers. She is not an intimate partner; she is
someone to perform for, impress with your large erection, a strong sex drive,
and a dominance scenario. In the individual performance model, there is no
space for sharing intimacy or pleasure.
These sex images are pervasive and destructive. They are not challenged by
men for fear of being labeled a “wimp” or” not man enough”. Sex myths domi-
nate men, couples, and the culture. This is the basis for the male-female double
standard and sets up the power struggles of intercourse or nothing.
In describing myths and misinformation, our intention is not to minimize
problems or explain them away. The male performance model of sex and the
5
degradation of female sexuality must be confronted. Demonizing and shaming

men and male sexuality are not in your best interest as a couple. Awareness
regarding myths and destructive elements of male sexual socialization does not
mean accepting them. Just the opposite. You can replace these with a genuine
understanding of male sexuality, female sexuality, and couple sexuality. Con-
front the myth that male sexuality is superior. Confront the myth that sex is
an individual performance test. Confront the myth that an erect penis is the
measure of male sexuality. As an intimate sexual team, build healthy sexual
attitudes, behaviors, emotions, and values. You do not change for the woman;
you change for yourself and your relationship.
Special Issues for Women

This book is also for women. She makes wise decisions about her sexuality. Un-
derstanding the complexity of men and male sexuality is a solid foundation for
couple decision-making. A healthy relationship promotes psychological well-
being, including intimacy and sexuality. Being in a satisfying, secure, and sex-
ual relationship is a major factor for both physical and psychological well-being.
A healthy marriage meets needs for intimacy and security better than any other
relationship (Doherty, 2013). People in a healthy relationship report high lev-
els of psychological well-being. Interestingly, women get more out of a healthy
relationship than men. Sadly, men do not value their marriage as much as they
should. However, both in terms of physical and mental health, men need mar-
riage more than women.
A dissatisfying or destructive marriage has more impact on women than men.
Men tolerate mediocre or dissatisfying marriages better than women. A major
cause of depression (which has considerably higher rates for women) is a medi-
ocre, dissatisfying, or destructive relationship. We are pro-marriage, but are
not anti-divorce. We advocate for a satisfying, secure, and sexual marriage (life
partnership). Satisfying is the major factor. Satisfying does not mean romantic
love and idealization. Satisfying means accepting your feelings, life experiences,
and values. It means knowing and accepting your spouse with his strengths and
vulnerabilities. A healthy relationship makes you a healthier woman.
A healthy relationship is non-perfectionistic – you are not perfect, your
spouse is not perfect, and your marriage is not perfect. The core of respect is
accepting yourself and your spouse with strengths and vulnerabilities. It is the
opposite of the romantic love belief that “if you love me, you will change for
me”. The scientific reality is that only 30% of marital problems are resolvable,
the majority are modifiable, and even in the most loving marriages, 10–20%
of problems are not changeable (Gottman & Silver, 2015). You love and re-
spect your spouse for who he really is. A favorite example is that before we
married, Barry told Emily that he had a perceptual-motor learning disorder
6
(she remembers that conversation but feels that he did not make clear how se-
vere it was). As the world has become more technological and on-line, Barry’s
disability has become more problematic. I regret it, but am not ashamed of my
disability. I am grateful that Emily loves and respects me in spite of this chronic
problem.
Respect, Trust, and Intimacy

Respect is based on genuine understanding and acceptance, the opposite of ide-
alistic romantic love. If you do not respect yourself, your partner, and your
bond, no amount of great sex will save your relationship. The best sex integrates
intimacy and eroticism. It is possible to have good sex with a partner you don’t
respect or even like. Throughout cultures and generations, people have been
harmed by the belief that love and sex was the sign of a healthy relationship
and the major reason to marry. The paradox is that sex problems can destroy a
loving marriage, but good sex cannot save a bad marriage.
The second core factor in marriage is trust. Trust does not mean you won’t
be disappointed or hurt by your spouse. Trust means your spouse would not
intentionally do something to harm you emotionally or sexually. Trust involves
believing that she acts in your best interest and wants you to thrive personally,
relationally, and sexually. Believing that love means “Never having to say you’re
sorry” is self-defeating. In a respectful, trusting, marriage, you say you’re sorry
at least once a month. The core trust issue is the belief that your spouse will act
in your best interest. Hurt or disappointment was not intentional or meant to
harm you. You trust your spouse “has your back”.
Many women trust their partner emotionally, but not sexually. When you are
aroused and erect, she fears your sexual wants override her emotional needs.
Sexual pressure is a major cause of low desire. Unless she has the power to say
no to sex she doesn’t have the freedom to embrace desire/pleasure/eroticism/
satisfaction. She can learn to trust you sexually. It is a one-two process of trust-
ing her sexual voice, including her power to veto a sexual scenario and trusting
you to be her intimate and erotic friend. Her sexual feelings and preferences are
as important as yours. She trusts you will honor her veto. A healthy relationship
involves emotional and sexual trust.
Emotional intimacy and sexual intimacy are different dimensions, but both
are crucial.
Emotional intimacy is an integral component of your respect, trust, and inti-
macy bond. She feels emotionally open and confident. Emotional intimacy rein-
forces a secure attachment. Emotional intimacy is different than “romantic love”
or a “perfect relationship”. She is herself in this relationship. She feels accepted
and loved by you. She is accepted with her vulnerabilities and accepts your vul-
nerabilities. She loves you for who you really are not a “perfect romantic image”.
7
Sexual intimacy is particularly challenging. Sexual intimacy involves integrating

intimacy and eroticism. Many women value emotional intimacy. She experiences a
split between intimacy and eroticism. In his clinical work, Barry has heard “I love
my spouse, but am no longer in love with him” hundreds if not thousands of times.
She has “de-eroticized” you and your relationship. The challenge for both men and
women is to integrate intimacy and eroticism into your relationship. Finding her
“erotic voice” is a challenge. Eroticism is as important for her as for you. Challenge
the traditional gender split of eroticism being the man’s domain while intimacy
is the woman’s domain. In a healthy relationship, both partners value integrated
eroticism. Each partner has a different vulnerability and different challenge. Your
relationship is stronger when both of you are fully functional sexual people.
The Challenge of Couple Sexuality

You are responsible for your sexuality. Yet, at its essence, understanding sexuality
is a team effort. Turn toward each other as intimate and erotic allies. Sexually you
win or lose as a team. The female-male sexual equity model is much superior to the
traditional double standard. As adults in an intimate relationship, there are many
more psychological, relational, sexual, and value similarities than differences. This
is especially true with the aging of your relationship. Recognizing these similar-
ities helps you be successful individually and as a couple. Being aware personally,
relationally, and sexually facilitates making wise decisions. Knowledge is power.
Implement your understandings so that you can enjoy a healthy life, relationship,
and sexuality. A core understanding is that your emotional and sexual relationship
is based on a positive influence process. Your relationship brings out healthy parts of
you. You deserve sexuality to have a positive, integral role in your life.
Who We Are and the Format of This Book

Barry and Emily McCarthy are a husband-wife writing team; this is our 15th
co-authored book. When we married in 1966, the male-female double standard
was dominant. We were the first in our families to graduate college, and were
committed to living our lives in a healthier manner than our backgrounds. We
wanted to create a life we would be proud of personally and relationally. How-
ever, we assumed there would be major differences sexually. We challenged
this assumption and committed to creating a satisfying, secure, and sexual mar-
riage. We are not clones of each other. We approach our sexual bond as equita-
ble partners who affirm desire/pleasure/eroticism/satisfaction.
Writing this book has been a challenge. We are pro-male, pro-female,
pro-couple, and pro-sexuality. We promote the 15–20% role of sexuality for
individual and couple well-being whether you are 26, 46, or 76. This book has
value for men, women, couples, clinicians, and the culture. We confront the
8
harmful effects of the double standard which emphasizes male-female differ-

ences and splits intimacy and eroticism. Scientifically, clinically, and personally
we advocate for the female-male sexual equity model.
We respect each other’s contributions to the writing of this book. Emily’s
background is in speech communication and her writing and wisdom pro-
vides a balanced, humanistic perspective. Barry’s background is a professor of
psychology and a clinical psychologist with a specialty in sex and couple ther-
apy. This book is grounded in scientific and clinically validated psychological,
bio-medical, and social/relational information. We empower and motivate
you to embrace sexuality. In his clinical practice of 42 years, Barry addressed
chronic psychological, relational, and sexual problems. If the couple had the
motivation and skills to prevent sexual problems or dealt with them in the acute
phase, their lives would have been much better. Prevention is the best, cheap-
est, and most efficacious way to address sexual issues.
We present scientifically and clinically validated sexual information, and
provide personally relevant guidelines, psychosexual skill exercises, and case
studies (we use composite cases with details altered to protect confidentiality)
to make concepts personal and concrete. This is not meant to be read as a text-
book. Each chapter is self-contained. Start with chapters which are personally
relevant. The material can be read for information and concepts but is best used
as an interactive learning medium. Share this book with your spouse/partner.
Talking and sharing (especially the psychosexual skill exercises) make concepts
personal and meaningful. Implement relevant strategies, skills, and coping
techniques so that sexuality has a positive role in your life and relationship.
Healthy Sexuality
Be your “authentic sexual self”. We affirm sexuality whether you are married,
partnered, divorced, single, or widowed. Our message is relevant whether you
are 30, 50, or 80. We emphasize traditional heterosexual married couples, but
these learnings are applicable to partnered and gay couples as well as single, di-
vorced, or widowed individuals. This book is meant to be inclusive and respect-
ful of diversity and individual differences. Rather than use “he” or “she”, we
utilize “you” when possible. We also alternate use of “married” or “partnered”.
This is a book of ideas, guidelines, and exercises. It is not a “do it yourself
therapy” book. The more information, understanding, and resources, the more
likely you will make wise relational and sexual decisions. The psychosexual
skill exercises help you assess and change sexual attitudes, behaviors, and feel-
ings. Seeking sex, couple, or individual therapy is a wise decision. Appendix A
provides information and guidelines on how to choose a sex therapist, couple
therapist, or individual therapist.
Let us begin our journey to healthy male and couple sexuality.
9
2
THE SEXUAL WAR BET W EEN
MEN A ND WOMEN
Changing the Dialogue
The cultural theme is that because men and women are so different, it is natural
to always be at war, especially about sex. Whether arguments at a bar, on a
talk show, or at academic conferences, the theme of a war between the genders
is widely accepted. This is especially true when arguing about differences in
sexual behavior, feelings, and values. Sex is the man’s domain, not a shared do-
main. The double standard is the basis for the war between the sexes.
This chapter confronts sexual war myths and introduces a new, healthy dia-
logue about sexual roles, meanings, and values. It is based on the female-male
sexual equity model. Rather than a war, sexuality is a couple process of sharing
intimacy, pleasuring, and eroticism. Men and women are intimate and erotic
allies, not enemies. Television sit-coms and talk shows are filled with stories of
the sex war. Although funny and entertaining, it is not healthy for men, women,
couples, or our culture. Replace it with a dialogue featuring a respectful, trust-
ing, equitable model of female-male relationships and sexuality. End the sex
war and replace it with an equitable female-male sexual team model (McCarthy
& McCarthy, 2019b).
Sadly, same-gender friends reinforce the war. There are a myriad of stories
and jokes about the opposite sex. People have overlearned these and hate to
give them up. These narratives are unhealthy, but fit like an “old shoe”. It is
easy to maintain destructive behaviors and values. The media, internet, and
friends reinforce self-defeating beliefs. There is no freedom or wisdom in the
sex war, just overlearned habits with destructive themes. It would be funny
if it didn’t do such damage to men, women, couples, and the culture. Even
well-educated, thoughtful men fall into the traditional double standard trap.
It’s simple and easy, but scientifically wrong and personally destructive. “Pop
psych” and “pop sex” books, articles, and blogs reinforce the sexual war. This is
especially true of male peer groups and sexually oriented materials. In female
groups and on-line sites, there is significant male-blaming and shaming. How
long will it take to end the sex wars? The dialogue about female-male sexual
equity is strongly supported by scientific data and clinically relevant individual
10
T he S exual W ar between M en and W omen
and couple experiences. In contrast, there is little empirical support for the
double standard (Baumeister, 2000). There is a plethora of clinical data and case
studies which point out the negative impacts of the double standard. The double
standard negates the sexual growth of men and women.
People worry about sexual change because they fear that it will lead to con-
fusion and chaos. The female-male sexual equity model provides a road map and
guidelines for change. Identify your “authentic sexual self” from which you cre-
ate an intimate sexual relationship. Men have the freedom to break away from
rigid gender roles and stereotypes. Engage sexually rather than be controlled
by anxieties and shame. A common fear is that sexual awareness and openness
will lead to scary revelations and destabilize the person and relationship. This,
like most fears, is irrational. People can become comfortable with who they are
sexually and value an intimate sexual relationship. It is normal to have sexual
feelings and preferences that are different than your partner’s. You are not sex-
ual clones. In the great majority of cases, differences can be integrated into your
couple sexual style. In fact, differences spice up and enhance couple sexuality.
Sexuality need not be feared nor be subverted by shame. Sexuality is about en-
ergizing you and your bond.
When there are personal or relational issues which interfere with being your
authentic sexual self, we urge you to consult a therapist. A self-help book is not
an adequate resource to deal with these complex issues. Appendix A provides
guidelines for choosing a sex, couple, or individual therapist. Seeking therapy is
a sign of good judgment, not weakness. You deserve sexuality to have a positive
role in your life and relationship.
A New Sexual Dialogue

Female-male sexual equity sounds easy and straight-forward; it’s anything
but. Creating a new psychological, relational, and sexual dialogue is challeng-
ing. Meeting this challenge is worthwhile to enhance relational and sexual
satisfaction.
The easier part is confronting the double standard. It is fun challenging myths
and emphasizing freedom from oppressive demands and expectations. However,
you can’t stop there. Engage with your partner to develop a strategy for ending
the war between the sexes. The core of the dialogue is to treat each other as re-
spectful and trusting partners who share emotional and sexual intimacy. It’s easy
to say, “Stop the war”, but when there are differences or conflicts, people fall into
old attitudes and habits. Resist this. Healthy relationships are based on a positive
influence process. The dialogue about female-male sexual equity and being inti-
mate and erotic allies is based on a positive influence process.
Set aside time to talk about your perspective on desire/pleasure/eroticism/
satisfaction. A crucial conversation involves accepting responsive sexual desire
11
as healthy, not inferior to spontaneous desire. In fact, we argue (discussed in

detail in Chapter 9) that responsive sexual desire is a key for the man and couple
with aging. Sexuality is not a “zero sum game”. Accept similarities and honor
differences. This empowers the man, woman, and couple.
First, focus on shared meanings and values. For example, the benefit of a
relationship where you are intimate and erotic friends. Then address differ-
ences like spontaneous vs. responsive desire. Don’t make it a “right-wrong”
argument, but a discussion where you accept differences while being aware that
with aging, these differences lessen. An example is that after age 50, responsive
sexual desire becomes the norm for both men and women.
An example of the new dialogue is a discussion of masturbation and erotic
fantasies. Acknowledge that the majority of men and women (married or part-
nered) occasionally masturbate, especially when the partner is not available or
interested. The majority of both genders utilize erotic fantasies and materials.
By its nature, erotic fantasies are not “socially desirable”. What makes the fan-
tasy erotic is that it’s different than real-life sexuality. It is normal to have “ab-
normal” erotic fantasies.
Sexuality, including erotic differences, can be openly discussed. Start with
common ground and then explore differences. Some males (less than 15%) and
some females (less than 3%) masturbate in a compulsive manner, misusing porn
or other erotic materials. Rather than demonizing male sexuality or shaming
him, discuss the healthy and unhealthy uses of masturbation and fantasy. This
can be a difficult dialogue, but need not be adversarial, and certainly not turn
into a war.
A healthy dialogue affirms your shared humanity. The war between the sexes
sacrifices respect for yourself and your partner. Dialogue as respectful friends
who embrace similarities and honor differences. An example involves relational
sex (a spouse, partner, lover) vs. non-relational sex (hook-up, anonymous). In
the war, the message is that men have sex wherever they can, while women can
only have sex with an intimate partner. Is that the basis of your relationship?
Simplistic myths fire the war between the sexes.
There are major differences in the meaning of intimate partner sex in
contrast to high opportunity-low involvement sex. This is also true for
women. Rigid gender roles rob you of humanity and complexity. By its na-
ture, sexuality is complex with a range of roles, meanings, and outcomes.
Your dialogue needs to be personally meaningful. Focus on your relational
and sexual values.
Let’s examine another contentious issue in the war between the sexes –
contraception and children. Traditionally, contraception was the woman’s do-
main. If she became pregnant, it was her decision whether to have the child.
The man had a minimal, if any, role. In the new dialogue, contraception,
abortion, childbirth, children, and parenting involve both partners. In the great
12
majority of cases, it is the woman who is responsible for contraception. From a

bio-medical perspective, the most effective contraceptives are for women (iuds,
injections, birth control pills). The exception is sterilization – vasectomy is just
as effective as tubal ligation and with less risks. However, the majority of steri-
lizations are performed on women.
The science is clear; the best situation is when both partners agree on ef-
fective contraception. When a child is planned and wanted, both partners are
involved in the birth process and parenting. Achieving this requires a major
change in the dialogue and the roles of men and women. A daunting but worth-
while challenge.
It is normal for men and women to have differences and disagreements on
important issues. Contrary to war talk that all women want children and men
don’t care, there are more similarities than differences between genders. Some
women are not interested in children. Some men feel being a father is the most
important thing in their lives.
A crucial dialogue involves the role of sexuality in your lives. Sex differences
are a core conflict in the war between men and women. Simplistic myths and
misunderstandings dominate. There are biological differences – pregnancy, ac-
cessibility of the penis, nocturnal emissions, vulnerability to STI/HIV. How-
ever, the underlying mechanisms for sexual desire and response are similar.
There are clear differences in adolescent and young adulthood sexual sociali-
zation, but greater similarities in adulthood, especially with married and part-
nered couples. With aging, psychological and relational similarities increase.
When you reject the double standard and embrace female-male sexual equity,
the dialogue promotes acceptance and encourages development of your couple
sexual style. Ideally, both partners have the freedom to initiate sensual, playful,
erotic, and intercourse scenarios. Both have the power to say no to sex and their
veto is honored. The foundation for the dialogue is pleasure and consent. Sex is
not a shameful force which negates a person or subverts a relationship. Sex is a
small, integral part of life and your relationship. Sex energizes your bond and
promotes feelings of desire and desirability. This reinforces healthy sexuality for
you and your relationship.
Aliza and Marshall

Aliza 29 and Marshall 32 were socially active. Both played in sports teams,
were involved with community projects, had large extended families, and
were part of a religious community. They enjoyed hanging out and joking
with friends. A frequent source of jokes were sex roles and the foibles of the
opposite sex. They had a foot in both camps – they knew and shared all the
stereotypes from the double standard. On the other hand, they were aware
and well-educated. They worked with colleagues of the opposite sex and had
13
friendships with both genders. Aliza was particularly supportive of transgender

people and advocated for gender fluidity.
What appealed to Marshall about the double standard were expectations that
men worked harder, made more money, were freer to travel, and were not sex-
ually harassed. He had empathy for Aliza when she told him of friends who had
been hassled or mistreated, but his attitude was this was the way of the world.
Aliza saw Marshall as a good man, but felt that he indulged in male sport and
drinking habits and took advantage of male privilege.
They became engaged after three years. The clash of the double standard vs.
the female-male equity model became apparent as they talked about the wed-
ding. In following the traditional male role, Marshall felt that wedding planning
was Aliza’s domain, not his role. His input was the music and alcohol – the rest
was up to her. Arguments about the size of the wedding and who to invite were
stressful.
The most disruptive issue was Aliza’s wedding dress. She had a friend
who made an elegant white dress which Marshall’s mother and aunts ob-
jected to since, like most of their friends, Aliza and Marshall were cohabi-
tating. Aliza turned to Marshall for support, but he wanted to avoid being
in the middle of the controversy. He saw this as a silly woman’s argument.
Aliza felt abandoned by Marshall, especially that her sexuality was not val-
idated. Marshall did not understand the emotional significance of Aliza’s
right to be sexual and to wear a white dress for her wedding. Aliza wanted
to be treated as a first-class person, not subjected to the judgments of the
double standard. This was a couple issue, not just Aliza’s. Marshall needed
to be her intimate ally, not avoid the conflict. Did Marshall “walk the walk”
or hide behind the traditional male role?
Would this marriage begin by affirming the female-male sexual equity model
or start under a cloud of misunderstanding and blaming caused by double stand-
ard judgments?
Sadly, the advice from male friends was for Marshall to not get caught in the
conflict. A sign of a healthy relationship is working together to deal with dif-
ferences and conflicts. Could Marshall go against the male tradition and show
Aliza that “I have your back”? Aliza wanted Marshall to support her choice of
a white wedding dress. He didn’t need to attack his mother and aunts, but did
need to clearly state his love and support of Aliza and affirm being a sexual cou-
ple. This reinforces female-male equity where sexuality is honored rather than
the double standard of blaming and shaming women.
In a healthy marriage, you are proud of yourself, each other, and being a sex-
ual couple. You don’t need to fight others or be “holier than thou”. You do need
to affirm respect, trust, and intimacy. Starting with the female-male equity
model provided Aliza and Marshall a solid foundation for a satisfying, secure,
and sexual marriage.
14
Navigating the Details of Female-Male

Sexual Equity
The female-male equity model presents challenges and opportunities. Like
other worthwhile changes, it requires awareness, thought, and dialogue to
make a genuine difference.
Sexual issues can be the most challenging. The rules of the double stand-
ard are very easy to understand. Sex initiation is the man’s domain, sex fre-
quency is most important, sex = intercourse, and eroticism is the driving
force. The female-male sexual equity model has a very different approach
with a set of complex guidelines (not rules). Guidelines require awareness
and communication – sexuality is not simple. A crucial guideline is that
couple sexuality is about sharing pleasure, not counting intercourse events.
Either partner can initiate a sexual encounter. Either partner can say no
without feeling blamed or guilty. In the double standard, the woman is the
sexual gatekeeper. She feels pressured to not say no too frequently. In the
equity model, the man learns to feel comfortable saying no. This gives him
flexibility, but means challenging the tradition that men never say no to sex.
Men take this as a joke – not a healthy response. It does not reduce your
masculinity to accept that for whatever reason you do not want to be sexual
at a specific time or situation. You have a right to say no to sex whether
at 20, 40, or 60. Freedom to use your no is key to enjoying sexuality in
your 60s, 70s, and 80s. Embrace desire/pleasure/eroticism/satisfaction
throughout your life. Let your partner be your intimate and erotic ally.
Even more important than the power to say no is your ability to stay
physically and emotionally connected rather than turning away. In an eq-
uitable relationship, willingness to turn toward your partner is crucial. An
example is when you initiate intercourse and your partner says no, rather
than turning away with you feeling rejected and she feeling punished for
saying no, turn toward each other. She could suggest cuddling, going for a
walk, asking whether you would like a back rub or body massage, offering
to pleasure you to orgasm, make a pot of coffee, or say she wants to be sex-
ual the next day or two. There are a number of ways to feel connected; it
isn’t intercourse or nothing. The positive message is I love you, value you,
prioritize our relationship, and recognize that there are many ways of being
together.
Power struggles about intercourse initiation and frequency reinforce the war
between men and women. Breaking this struggle requires two changes. First,
redefine sexuality to include sensual, playful, and erotic scenarios in addition
to intercourse. Second, intercourse is a shared domain rather than the man’s
domain. A key is to transition to intercourse at high levels of erotic flow and
utilize multiple stimulation before and during intercourse.
15
Exercise – Implementing the Female-Male

Dialogue
It is easy to say, “End the sexual war”. It is challenging to establish and
maintain communication as intimate and erotic friends. Each partner
agrees to stop at least one and up to three defensive or angry behaviors.
Examples include the woman stop saying, “Men are control freaks”, “An
erect penis has no conscience”, or “Sex has to be his way”. A behavioral
example is insisting that only man-on-top intercourse is acceptable. Ex-
amples of destructive male comments include “Why can’t you have a real
orgasm during intercourse”, or “Sex takes too long and too much work
to give you an orgasm”, or “You have too many excuses for saying no”. A
behavioral example is refusing to do multiple stimulation during inter-
course. Rigid beliefs and communication patterns reinforce the war and
undermine being a sexual team.
The challenge is to establish a new dialogue about female-male equity and
being sexual team. The dialogue must be genuine in creating new attitudes,
behaviors, emotions, and values. This is not a politically correct exercise. A
genuine dialogue recognizes personal strengths and vulnerabilities. Don’t be
idealistic and overemphasize love and sexual ecstasy. Make a realistic com-
mitment to trust your partner and act in a respectful and intimate manner.
Genuine respect involves knowing your partner for who he is, not an
idealistic image. She accepting you with strengths and vulnerabilities is a
sign of genuine love and respect. Our culture focuses on extremes – “the
perfect man” or the “dysfunctional man”. Love is not blind; love involves
an emotional commitment to a real person and real relationship. Accept-
ance of your partner makes self-acceptance easier.
Trust is an example of the importance of a genuine dialogue. The
romantic love, idealized extreme is “Love means never having to say
you’re sorry”. The cynical extreme is “You can never trust a man, espe-
cially sexually”. A genuine dialogue focuses on the theme of intention-
ality. You trust your partner would not intentionally do something to
harm or undercut you, especially with friends, relatives, and children.
Trust doesn’t mean that you won’t be disappointed, angry, or frustrated
with your partner. Trust includes being able to say you are sorry – even
if not intentional you hurt your partner. Perfectionism on one extreme
and cynicism on the other extreme undercut your relationship.
Emotional and sexual intimacy are different but related. In the war,
men believed that sexual intimacy was key while women elevated emo-
tional intimacy.
16
In the new dialogue, you speak as intimate and erotic friends. Explore
similarities and differences based on personal attitudes and feelings, not
cultural stereotypes. What are shared emotional needs? How important
is feeling close? Feeling accepted? Feeling understood? What is true for
you, regardless of cultural expectations? Be who you are, not governed
by fears of partner judgment.
Sexual intimacy is a complex, challenging dimension. How do you feel
about sensual, playful, and erotic touch? Are these genuine ways of shar-
ing sexuality or is intercourse the definition of sex? Do you prefer mu-
tual, synchronous sexual experiences? Be clear and specific about your
attitudes, emotions, and values regarding asynchronous sexuality. What
makes an asynchronous sexual encounter healthy for you? What makes
it unhealthy? This can be the most difficult component of your sexual
intimacy dialogue.
Be honest – how important is sexual intimacy in your relationship?
Does it have a 15–20% role or do sex problems and concerns stress you
and undermine your relationship? If the latter, do you blame yourself,
your partner, or your relationship? Are you motivated to change yourself
and your relationship? What do you need to do and/or request your part-
ner do to implement female-male sexual equity?
What have you learned from this exercise? Are you ready and able to
end the war between men and women? Are you able to dialogue about
issues based on sexual equity? Can you be intimate and erotic friends who
are open to changing sexual attitudes, behaviors, emotions, and values?
Can you honor differences? Does sexuality have a positive role for you
individually and as a couple?
From Theory to Implementation

Throughout this book, we emphasize the importance of confronting male sex
myths and creating a new dialogue about male, female, and couple sexual-
ity based on a scientific foundation and personally relevant guidelines (Metz,
Epstein, & McCarthy, 2017). Reading and discussion is of value, but the real
change occurs when you implement the equity model. Barry remembers a cli-
ent who was shocked when his very traditional father told him how much he
admired that he treated his wife as an equitable partner, was affectionate with
her in public, and changed the baby’s diapers. The father had not done any of
those things, but was proud that his son did. Both spouses worked and they
lived on one salary – saving for their daughter’s college and starting a retirement
fund. They did not talk about their sexual equity bond with anyone else, but did
17
dialogue with each other. Sex was more predictable for him, but he accepted
her desire and orgasm pattern as right for her. Implementing the sexual equity
model early in the marriage made it easier to maintain a variable, flexible couple
sexual style with aging.
The real measure of the new dialogue occurs when dealing with sexual dif-
ferences, especially desire discrepancies. Rather than the belief that more sex
is better, the focus of the equity model is sharing pleasure as an intimate sex-
ual team. This is more important than intercourse frequency. The woman’s
acceptance of her sexual voice as first class makes the couple sexual dialogue
meaningful. Intimacy, pleasuring, and eroticism bring you together rather than
splitting you. Accepting that you are not clones of each other facilitates couple
sexuality. Intimacy, pleasuring, and eroticism are a shared experience.
Summary
The traditional gender war is destructive for men, women, couples, and the
culture. It has caused pain for people across generations and cultures. The rules
of the war are simplistic and easy to follow, but totally wrong. The war is the
basis for the male-female double standard which burdens couple sexuality. With
the aging of the man, the double standard causes loss of erectile confidence, re-
sulting in stopping sex. When couples stop being sexual, especially after age 50,
it is almost always the man’s choice because he cannot meet the performance
demands of the double standard.
Stopping the war between men and women is necessary, but not sufficient.
Replace it with a genuine dialogue based on the female-male sexual equity
model. A respectful, trusting, and emotionally intimate relationship promotes
well-being. Establish and maintain an equitable relationship which integrates
intimacy, pleasuring, and eroticism. Be intimate and erotic friends. Sexuality
energizes your bond and reinforces feelings of desire and desirability.
18
3
CONFRONT I NG CONTEMPOR ARY
M ALE SEXUALI T Y
Breaking the Abusive Cycle
The theme of this book is to promote healthy male and couple sexuality. This
chapter focuses on the necessity of confronting toxic male sexuality, especially
child sexual abuse, rape, and incest (the big three “poisons”). In addition, it is
crucial to confront sexual harassment, intimating and shaming women, sexual
coercion, sexual entitlement, use of prostitutes or massage parlors, compulsive
use of porn and cyber sex, and using sex as a weapon to impress male peers.
Toxic sexuality involves destructive attitudes, behaviors, emotions, and values.
Confronting does not mean “shaming”. Shaming makes the toxic behavior
worse by reinforcing negative feelings about being a man. This tears at sexual
self-esteem and makes you more likely to repeat toxic behavior. It is neces-
sary to confront sexual attitudes, behaviors, and values which harm women and
poison relationships. Eliminating sexual poisons is crucial but is not enough.
Adopt an understanding of couple sexuality which affirms intimacy, pleasure,
and eroticism in the context of a respectful, trusting, and emotionally equitable
relationship.
Toxic sexuality is not integral to being a man. The majority of men do not
indulge in toxic sexuality. However, toxic attitudes are part of traditional male
sexual socialization. Toxic sexuality impacts a significant number of men, not
a small minority. Issues of toxic sexuality need to be exposed and confronted
not just to protect women, but to change men and the culture. Exploration of
healthy and toxic sexual attitudes, behaviors, emotions, and values is crucial.
The core sexual values are pleasure and consent. Sexuality is about giving
and receiving pleasure-oriented touching. It is not about individual sex perfor-
mance, nor proving yourself. Sexuality is voluntary, not coerced, pressured, or
demanded. Without consent, sex is toxic. These values need to be reinforced in
the culture. This is true for men as well as women. Pleasure and consent are not
prime topics for men, especially in peer groups. This needs to change.
The double standard assumes that sex is the man’s domain. The belief is that
“pure” women cannot be sexually abused or raped. Destructive or traumatic
sexual experiences are blamed on women (being provocatively dressed, putting
19
C onfronting C ontemporary M ale S exuality
herself in harm’s way, choosing the wrong man, enjoying being a sex object, be-
ing promiscuous, leading men on, and a large range of rationalizations). Let us
be clear, the responsibility for toxic behavior lies with the man, not the woman.
The Big Three Toxic Behaviors – Child Sexual

Abuse, Rape, and Incest
Almost all agree that child sexual abuse, rape, and incest are destructive. Unfor-
tunately, this is an example that sexuality involves more than objective, scientific
information. Child sexual abuse is the most common toxic sexual behavior. The
best estimate is that by age 18, 35–40% of females have had an abusive sexual ex-
perience. The mistaken assumptions are that child sexual abuse involves a stranger,
force, and intercourse. In reality, abuse incidents involve a man the child knows.
Most do not involve physical force. In fact, half of abusive incidents do not involve
touching (voyeurism, exhibitionism, harassment). The most common sexual abuse
incidents do not involve intercourse, but rather manual or oral stimulation.
The core of child sexual abuse is that the man’s (or adolescent male) sexual
wants override the child’s emotional needs. Female children are much more
likely to be sexually abused than male children. Sadly, male children and adoles-
cents are unlikely to disclose abuse to anyone; instead, you feel shameful. Vic-
timized males experience more hands-on abuse. Although female adolescents
and adults do perpetrate abuse, the great majority of abuse of male children is
perpetrated by men or male adolescents.
Rape or attempted rape is quite common, especially between ages 15 and 25
(although 1- and 71-year-olds are raped). In addition to intercourse, rape can involve
manual, oral, or anal sex. Coercion and sexual pressure are common as well as
forced penetration. Acquaintance rape is much more common than stranger rape.
Date/acquaintance rape is the double standard taken to its illogical extreme. The
man says, “Sex was consensual, she said yes to kissing and touching, and that turned
me on”. The destructive rationale is that an erect penis has no conscience. Women
who say no to intercourse are labeled “cock teasers” and blamed for the rape. Of-
ten, alcohol or drugs are involved. Rape is a toxic sexual behavior which cannot be
justified but is viewed as “natural” in the heat of sexual arousal. The adage “rape is a
crime of power, not sex” is widely accepted, but has little empirical support (Daigle,
Evier, & Cullen, 2008). Males who would not beat up a woman even if drunk will
commit rape, especially when drinking. Rape is driven by both sex and coercion/
force. Like other toxic sexual behaviors, rape is never justified or acceptable.
Incest is the third toxic sexual behavior. Most writing about incest involves
father-daughter or step-father-stepdaughter incidents. The reality is that the ma-
jority of incest involves cousins, in-laws, uncles, siblings, and live-in boyfriends.
The reason that father-daughter is highlighted is that it is such a violation of trust
and a shameful secret. She has a right to feel safe in her home – psychologically,
20
physically, and sexually. Incest is surrounded by stigma and silence. Incest is a

shameful secret that needs to be confronted, processed, and stopped.
Dealing with a History of Sexual Trauma

Negative sexual experiences are very common and very challenging. In addition
to the big three traumas, there are a range of experiences, including dealing
with an STI, an unwanted pregnancy, being sexually harassed or humiliated,
sexual guilt, sex dysfunction, caught masturbating, being sexually manipu-
lated. Over 90% of 25-year-old men and women identify at least one negative
sexual experience. This is a sad reality but makes it clear that you are not alone.
Destructive sexual incidents happen to good people.
The message is clear that toxic sexual behavior needs to be confronted and
stopped. It cannot be explained away, tolerated, or worked around. Toxic male
sexuality is not just harmful to women, children, and families; it is harmful to
men and the culture. The assumption that male sexuality is superior and that
the double standard is the norm is the underlying rationale for toxic sexuality.
The essence of healthy sexuality is consent and pleasure – the opposite of
toxic sexuality. Men and women as intimate and erotic friends are negated by
toxic sexuality. The mantra of desire/pleasure/eroticism/satisfaction has no
role in toxic sexuality. Once toxic sexuality has been eliminated, it is necessary
to build healthy male and couple sexuality. We usually advocate for a “both-
and” approach to change, but with toxic sexuality, you have to stop the “poison”
before addressing healthy sexuality.
Male Peer Influence

A major source for creating and maintaining toxic sexuality is the influence of
male peers. There is nothing inherently toxic in men or male sexuality. Toxic
sexuality involves a learned set of attitudes and behaviors which is reinforced by
peers as well as the media and culture.
A core poison is male sexual privilege. Barry remembers as a child hearing,
“If she’s old enough to bleed she’s old enough to butcher”. At the time, he did
not understand what that meant, but the laughter of male peers meant that it
must be okay. Barry grew up with the double standard and the message that
“A real man never says no to sex”. Sex was a source of jokes at the expense of
women. Adolescent and young adult men are exposed to hundreds of examples
of toxic male sexuality which are seldom challenged. In addition, the pervasive
messages in porn celebrate toxic sexuality. Most men accept porn for what it
is – an erotic fantasy dimension to promote masturbation. However, it is too
easy to fall into the trap of accepting a porn narrative as normal male sexuality.
Porn reinforces toxic male sexual behavior.
21
In adolescent and young adult male sexual socialization, there is no mention

of female-male sexual equity, consent, pleasuring, or integrating intimacy and
eroticism. The messages are that masculinity and sexuality are closely linked,
that men never say no to sex, and it is your role to convince or seduce the
woman to have sex. These messages are fertile ground to develop toxic attitudes
and values. Male authority figures – fathers, uncles, teachers, older brothers,
and ministers – do not present a clear message which confronts toxic sexuality.
Nor do they offer a clear message in support of healthy sexual attitudes, behav-
iors, emotions, and values. The usual message is don’t get a woman pregnant
or contract an STI or HIV. Few males receive an explicit message that sexual
coercion is wrong. The destructive learning is that there are “good girls” and
“bad girls”. The implicit message is bad girls get what they deserve.
These crazy-making learnings do not justify toxic male sexuality nor does
it change the need to confront and stop destructive behavior. Rather than de-
monizing the man and male sexuality, focus on increasing awareness of toxic
sexuality and your responsibility to break this poisonous pattern. Recognize the
harm this causes to women. It is easier to change individual and couple sexual
attitudes and behavior, especially in the context of an intimate relationship. It
is crucial to confront and change cultural norms from tolerating toxic sexuality
to a realization that this is poisonous and must be stopped. The hardest issue in-
volves male peer groups. It takes courage to confront toxic male sexuality. Peers
are likely to counterattack or make a joke of it and you. Confronting toxic sex-
uality is a task for the individual man, the couple, the family, and the culture.
Intimate Partner Violence and Toxic Sexuality

Intimate partner violence is a common problem. The traditional belief was that
violence always involved a male perpetrator and female victim. His agenda was
control and dominance. Although this is true of some men, the more common
pattern is an interactive couple process which signifies being emotionally out of
control (Stosny, 2017). Part of the pattern is sex to “make-up” or “compensate”.
This misuse of sex reinforces intimate partner violence. You need to confront
and stop intimate partner violence. A strategy is a clear agreement that there is
no affectionate or sexual touching for 72 hours after a partner violence incident.
It is crucial to break the association between partner violence and sexuality.
Toxic sexuality needs to be confronted in all its forms.
Confronting the Man, Not Shaming the Man

Toxic sexuality is destructive for the woman, couple, family, and culture. In
addition, it is emotionally and physically unhealthy for the man. It leaves you
isolated and vulnerable to rejection and legal and social consequences.
22
Confronting the man involves two themes. First, you need to take responsi-
bility for the hurt/harm inflicted on others. Don’t deny or minimize. What you
did caused damage. Your sexual wants are met at the expense of the emotional
needs of others. This is harmful and cannot be justified. Second, you are better
than this toxic sexual behavior. Sex is bringing out the worst in you. Toxic male
sexuality meets short-term sexual wants at the expense of long-term psycho-
logical and relational well-being. Toxic sexuality is destructive for you and the
people in your life. The three to ten seconds of orgasm is not worth the reality
of hurting others. Toxic attitudes and behaviors cannot be accepted. This sexual
pattern brings out the worst in you.
What is the difference between confronting and shaming? Confrontation mo-
tivates you to change. Shaming reinforces that you are bad, sex is bad, and makes
it almost certain that toxic sexuality will continue. Shame is destructive. Shame
makes you feel bad about yourself as a person (rather than confronting the destruc-
tive behavior) and keeps you stuck in the cycle. Confrontation, regret, and guilt
motivate change. Shame keeps you stuck in toxic attitudes, behaviors, and emotions.
Shaming the man feels good at the time, but serves to reinforce the self-
defeating pattern. Shame undercuts motivation for change. Shame is the most
destructive of human emotions, leaving you clinging to toxic sexuality.
It is your responsibility to confront and change your sexual attitudes, behav-
ior, emotions, and values. The more you feel shame or are shamed by others, the
less able you are to change.
Brad
Twenty-nine-year-old Brad would not have identified himself as a sexually toxic
man. His narrative was that he is a regular guy who likes sex and women. He
was proud of his masculinity and felt accepted by male peers. Brad bragged that
he had a strong sex drive and needed at least one orgasm a day. Brad had a girl-
friend of two years, but was negative toward her, especially when talking with
friends. Although she earned more money, Brad said she was not as smart as he
and had to work too much. He labeled her “sexually slow” and complained she
gave “bad head”. Brad was the dominant partner, and she clung to him. When
asked if he was in a relationship, Brad said no.
The social/sexual scenario he found most erotic was going to bars with
friends and “hooking-up”. Brad bragged that he had a large penis which made
women want to “suck him off”. Just before orgasm, he pulled her hair so she
would insert more deeply. About once a month after midnight and drinking
heavily, Brad would “accidently” urinate on the woman who had just given him
a “blow job”. This was highly erotic scenario for Brad.
Brad never asked a woman’s age, but was particularly attracted to very
young women. He later learned that some were younger than 16. Brad found
23
“breaking the cherry” erotically charged. For Brad, sex was about illicitness and
dominance. He believed that this was the way male sexuality should be.
Brad’s friends knew women who became pregnant and said the friend was
the father. Brad claimed that he and others had sex with this “promiscuous”
woman and anyone could be the father.
Although Brad claimed to have many sex partners, the truth is that most
of his orgasms involved masturbation to porn videos. Brad resonated with
the porn themes of domination, sexually crazy women, pain as a turn-on for
women, the eroticism of double penetration, and ejaculating on the woman’s
face. Porn themes reinforce toxic male sexuality. Brad did not differentiate
erotic fantasy from real-life couple sexuality.
His toxic sexual pattern continued for years before he was arrested for a
forced sexual incident at a bar with an underage woman. Brad claimed to all
who would listen that he was innocent. His expensive attorney made him stop
talking. Although some continued their friendship, most peers avoided Brad.
The arrest and investigation was reported in the newspaper and on the internet.
The girlfriend’s peer group and her parents convinced her to end contact with
Brad. He was feeling increasingly isolated and besieged.
The attorney counseled Brad to accept a plea bargain to a lesser charge which
allowed him to avoid being placed on the sex offender registry. Brad was sentenced
to two years probation, community service, and court-ordered group therapy for at
least six months. In the individual session before the group therapy began, the male
therapist used the term “toxic male sexuality” to describe Brad’s sexual pattern.
This was the first time Brad has been confronted with this concept.
The group consisted of male-female co-therapists and six men. Three of the
group members had served jail time for sexual offenses. Listening to their sto-
ries was sobering for Brad, especially the legal consequences and impact on
their lives.
When Brad described his sexual history and the sexual incident with the
underage woman, a veteran group member bluntly told Brad that he was “full
of b.s.”. Brad minimized the incident and “sugar-coated” his history. The male
co-therapist focused on Brad not taking responsibility for toxic sexual attitudes
and behavior. The female co-therapist said that for a smart man, Brad was obliv-
ious to the damage he had caused women throughout his life. Brad was shaken
by these confrontations. If the therapy were not court-mandated, he would have
dropped out.
Brad admired one group member, a man in his 50s who had turned around
not just his sexual life, but also his career and relational life. This man spoke
of the impact of toxic sexuality, including being sexually humiliated and made
fun of by peers. He described the process of increasing awareness of the impact
of toxic attitudes, behaviors, and emotions. The major breakthrough involved
confronting his destructive sexual values. He’d only had sex with women he
24
thought were over 18, so he felt that this was a private matter. He realized that
he had been coercive, manipulative, and harassed women. He’d used drugs and
alcohol to make it easier to dominate. In retrospect, he realized that he had
“hurt-harmed” over 30 women.
The group member told Brad that change was a 1–2 process. First, Brad
needed to take responsibility for toxic sexual behavior and commit to getting
the “poisons” out of his life. Second, to learn and implement healthy sexual atti-
tudes, behaviors, emotions, and values. A major component of the group mem-
ber’s change process was establishing an intimate relationship with a divorced
woman in her forties. He told her the sexual history and his commitment to an
equitable, pleasure-oriented sexual relationship. She had the power to veto a
sexual scenario, and he would honor her veto.
The group member’s story was motivating. Brad’s toxic approach to sexuality
had a number of life consequences. Brad had dropped out of college and was
working in unstable, marginal jobs. Part of his life change process was entering
a three-year electrician apprenticeship program. The issue was not his intellec-
tual capability, but motivation to finish the apprenticeship and take pride in his
new career. It was crucial to ensure that toxic behavior and sexual shame do not
subvert his life plans.
Brad hoped that a new sexual relationship would save him. The therapists
and group members told him that at this time he was not healthy enough to
establish an intimate relationship. He needed to focus on breaking the toxic
sexual pattern. This surprised Brad and left him unsure of how to proceed,
especially regarding sexual expression. He needed to stay away from partner
sex because it would reinforce the toxic pattern. Intellectually, this made sense,
but emotionally, it was very hard to accept. The therapists and group members
encouraged Brad to work on himself psychologically, to change values and atti-
tudes toward women, and to adopt a new understanding of sexuality generally,
and couple sexuality specifically.
What could Brad do sexually in the present? The logical next step involved mas-
turbation and erotic fantasies. There is no shame regarding masturbation. Masturba-
tion is a normal, healthy behavior for adolescents, young adults, and adults.
Brad accepted that masturbation was normal, but realized that his pattern of
masturbation was compulsive. The first issue was sexual motivation. Brad had
masturbated for negative reasons – anxiety, depression, isolation, embarrass-
ment, boredom, anger. Brad needed to masturbate with positive motivation
because he felt sexual. He would not masturbate for negative reasons. This pro-
vided a crucial insight. So much of Brad’s sexual behavior was driven by nega-
tive motivation, especially feeling he wasn’t “man enough”.
There was a lot of hard work ahead for Brad, but toxic sexuality no longer
controlled him. Brad was looking forward to a healthy relationship. He wanted
desire/pleasure/eroticism/satisfaction to have a positive role in his life.
25
Being a Proud Sexual Man

Toxic male sexuality poisons your self-esteem and relationship. Even if toxic sex-
uality has not had negative life or social repercussions, it undermines respect for
yourself. You cannot be a proud man if your attitudes and behavior cause damage
to others. Men who engage in toxic sexual behavior deny its destructiveness.
However, at some level, they realize it’s harmful. They joke and rationalize with
other men or in “one-up” bar conversations. They do not try to justify toxic sexual
behavior, especially child sexual abuse and incest. These are “shameful secrets”.
The best self-help resources, including this book, are not enough to confront and
change toxic sexuality. You need therapeutic help, whether group therapy, individ-
ual therapy, or a therapy group focused on out of control sexual behavior. There is no
shame in seeking professional help. The shame is living a life of toxic sexuality which
harms you and others. You cannot establish genuine pride in being a man until you
have confronted and ended toxic sexuality (McCarthy & Metz, 2008).
Exercise – Confronting Toxic Male Sexuality
Almost all the psychosexual skill exercises in this book involve couples,
but this exercise is for the man alone. Engage in this exercise in an honest
manner. Your partner makes it clear that she cannot be in a relationship
with you if you maintain toxic sexual attitudes, behaviors, and values.
Confronting toxic sexuality is daunting, but worthwhile. You can do
this exercise with a trusted friend, therapist, counselor, or minister, al-
though some men do it on their own.
Begin with a comprehensive assessment of your negative/toxic sexual
learnings from family, peers, neighborhood, media, and porn. Be honest
about toxic learnings and sexual experiences.
Many men were sexually abused by an adult man or older adolescent.
Typically, this is not disclosed, much less processed. This exercise provides
the opportunity to break the shameful silence. Write a letter to yourself
about your experience. How old were you, how old was the man (or ad-
olescent), what happened sexually, were you coerced or threatened, how
did you feel about the experience at the time, were you manipulated and
told it was your fault? How did you understand your sexual response? A
common sexual abuse experience involves being fellated to orgasm. Abuse
can also involve giving and receiving manual and/or anal stimulation. The
boy/adolescent says how could it be abuse because you were aroused and
orgasmic. It was abusive/toxic because the older male met his sexual wants
at your emotional expense. It was a shameful secret which could not be
discussed or processed, yet controlled your sexual self-esteem.
26
Just as important as your personal sexual history is your history of en-

gaging in destructive sexual behavior with others. Sexual harassment and
sexual coercion are the most frequent toxic sexual behaviors. When was
the first time you engaged in sexual harassment or pressured a woman
sexually? Was it just you or a group of males? Did the woman say no ver-
bally or physically? Did you stop when she said no or did you ignore it and
pressure her? Did this involve manual, oral, anal, rubbing, or intercourse
sex? Did it include shaming or blaming the woman?
What was the most physically violent sexual activity you ever en-
gaged in? How did you justify it at the time? Was it just you or were
others involved? Have you ever been involved in a physical incident which
required the woman to seek treatment at an emergency room or doctor’s
office?
Has anyone ever accused you of child sexual abuse, rape, or incest?
What happened and what was the outcome? Have you ever had a woman
say you harassed her, coerced her, or were emotionally or sexually abu-
sive? Do not be defensive or counterattack; carefully examine your ex-
periences and emotions. Identify what was harmful. An important adage
is you can learn from the past, but you cannot change the past. Confront
your past so you eliminate toxic attitudes, behaviors, emotions, and val-
ues. Your power for change is in the present and future.
When you have completed this exercise, turn toward the woman in
your life and ask her support in ensuring that you remain free of toxic
sexuality. You can build a healthy sexual relationship.
Summary
This was a difficult chapter to write and a difficult chapter to read. Yet, it is
necessary to confront toxic sexuality. You cannot be a healthy man in a healthy
relationship if toxic sexual attitudes, behaviors, emotions, and values remain in
your life.
Sadly, much in traditional sexual socialization and in our culture (subtlety
and not so subtlety) reinforce toxic male sexuality. The woman’s role is not to
rescue you or force you to change. Her role is to be clear that toxic and destruc-
tive sexual attitudes, behaviors, and values are not acceptable. Toxic sexuality
cannot be explained away or tolerated. Assume responsibility for change – she
cannot do it for you. You have the ability to be a good man emotionally, relation-
ally, and sexually. She will support your growth. Change so that sexuality has a
positive 15–20% role in your life and relationship.
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4
FEM ALE-M ALE SEXUAL
EQUI T Y
Confronting the Double Standard
Throughout the world, even in 2020, the great majority of people grow up
with the traditional male-female double standard. The double standard holds
that men and women are very different psychologically, relationally, and es-
pecially sexually. Sex is the man’s domain. Men are sexually superior with the
male model of desire, arousal, intercourse, and orgasm natural and best. The
negative consequences of sex – unwanted pregnancy, STIs, failed relationships,
sexual trauma, rape, sexual harassment, and child sexual abuse – are problems
for women, not men. A positive thing about the double standard is that the
rules are simple and clear, although almost totally wrong. The rigidity of the
double standard is particularly harmful for younger women and older men, sub-
verting sexual pleasure and satisfaction. Rather than bringing out the best in
people, it keeps men and women stuck in rigid roles which lead to conflict and
low satisfaction. The couples are trapped in the “intercourse or nothing” power
struggle. When it’s intercourse or nothing, the result is usually nothing. You
feel rejected and she feels pressured, if not coerced. The key to healthy sexuality
is consent and pleasure. The double standard does not promote either consent
or pleasure.
Female-male sexual equity is the new, healthy model. You are intimate and
erotic friends. The equity model affirms that the essence of couple sexuality
is giving and receiving pleasure-oriented touching (McCarthy & McCarthy,
2019a). You give up sexual dominance and control, but gain much more than
you lose. You experience genuine sharing of pleasure and eroticism with her
as your intimate ally. The double standard keeps the woman in the passive role
as a second-class sexual citizen who struggles to keep up. The double standard
is based on you being an autonomous sex functioner who has totally predicta-
ble erections. Each sexual encounter must end in intercourse and orgasm. You
need nothing from her except to show up. This works for men in their teens,
20s and 30s (although not a healthy learning), but becomes more difficult with
aging, especially after 50. The double standard sets the stage for you to develop
erectile dysfunction (ED). When you have a sensitizing experience (lose your
28
F emale - M ale S exual E quity
erection and cannot perform intercourse) whether at 25, 45, or 65, you do not
return to autonomous function. The double standard does not provide a role
for her to help you regain erectile comfort and confidence. You do not have the
space to reach out for sexual help nor engage her in sharing pleasure and eroti-
cism. She is not in a position to support you. In contrast, the female-male equity
model promotes being intimate and erotic friends. This is particularly valuable
for couples in their 50s, 60s, 70s, and 80s. Implementing the sexual equity
model in your 20s is an example of primary prevention. Being a sexually equi-
table couple before you need to promotes good feelings and good sex. Usually,
the woman is open to sexual equity. When men talk to peers about sex, there is
a strong impulse to brag and “one-up” each other.
It is a challenge to give up the double standard and accept female-male sexual
equity. You need to do more than accept – embrace sexual equity. Her enthusi-
asm for sharing sexuality allows you to join in affirming sexual equity.
When men speak to other men about sex, there is a lack of honesty and a
strong tendency to brag and exaggerate. This reinforces clinging to traditional
male power and the double standard. Men fear being labeled a “wimp”, “not man
enough”, or “weak”. You struggle to win the approval of male peers and maintain
the dominant sex role. The double standard treats sex as a competitive sport.
The female-male equity model emphasizes sexuality as a team sport. This is not
accepted by male peers, but is healthy for you and your intimate relationship.
Embracing the female-male sexual equity approach is good for the man, cou-
ple, and culture. This affirms psychological, relational, and sexual similarities.
Similarities are more common than differences, especially in a married or part-
nered relationship. The equity model serves as the basis for a respectful, trust-
ing, and emotionally committed relationship. Sexuality has a 15–20% role of
energizing your bond and reinforcing feelings of desire and desirability.
Exercise – Confronting the Double Standard

and Replacing It with the Female-Male
Sexual Equity Model
This is a crucial exercise. You go first – describe what you learned grow-
ing up about masculinity and sexuality generally and the double standard
specifically. Be honest and specific, not defensive nor give a “politically
correct” narrative. Discuss what you learned from peers, family, religion,
the media, and teachers. Although you might feel embarrassed, when and
how did you first use porn and what was your reaction to porn videos and
themes? Did porn strengthen your belief in the double standard? What
other factors reinforced the double standard?
29
Were there people or learnings which challenged the double standard or at

least caused you to question it? Was there personal, family, educational, reli-
gious, or relational support for the female-male equity model? In male peer
groups, there is no support for sexual equity. There is more support among
female peer groups. There is often a generational split with older people justi-
fying the double standard even if they do not advocate it. Younger people are
open to exploring this issue, especially college-educated women and men.
There is nothing “natural” about the double standard. It is a rigid cul-
tural legacy whose time has passed. Have you heard objections to the dou-
ble standard from the media, peers, minister, or family members? What do
you think about this? Have you heard support for the female-male equity
model? Don’t be surprised if you did not hear anything (or even thought
about it). If you heard about the equity model, what was your reaction?
Next, examine your present attitudes, behaviors, emotions, and val-
ues about the double standard vs. female-male sexual equity. Be honest,
not say what you think your partner wants to hear. Most men have not
given this much thought. If there is a discussion, it is likely to be abstract
rather than a personally relevant discussion. In this exercise, we want
you to dialogue about the double standard vs. female-male sexual equity
as a personally relevant issue.
Now it is the woman’s turn to disclose her learnings from the double
standard. What were the assumptions you grew up with – whether from
family, religion, school, peers, media? Was the double standard assumed or
was it challenged? What were the advantages of the double standard? Did
the double standard cause problems in your emotional and sexual develop-
ment? Women learn that they are very different than men – the message is
that she is inferior. A hidden message is that men are stronger physically,
emotionally, and sexually. The world is a dangerous place for women. Is
that what you learned, even if sub-consciously? Growing up, what was the
best thing about being a female and what was the worst thing? Are women
strong or weak? What were your sexual learnings from childhood and ad-
olescence? A core component of the double standard, especially for ado-
lescents and young adults, are differences in sexual socialization. Men are
encouraged to be sexual to reinforce masculinity – to “sow their wild oats”.
Women are cautioned to not become pregnant, contract an STI, be labeled
a “slut”, or let sex undermine her life. Did double standard learnings hurt
your psychological, relational, and sexual development? What can you do
now to adopt healthy attitudes, behaviors, emotions, and values?
When did you first hear about the female-male equity model? Who
did you hear it from and what was your reaction? Most males do not
30
take female-male sexual equity seriously nor do they feel it is relevant.

Some give the “socially desirable” response, but the majority blow it off,
especially in the context of male friends. This is her issue, not his issue.
Many men (especially college-educated) think of themselves as pro-
gressive, but don’t discuss sexual equity as a personally relevant issue.
In mixed-sex groups, it is women who advocate for change. It is hard to
give up power and entitlement, especially when you don’t believe that it
is a personally relevant issue. You make fun of traditional double standard
men and take pride in being a sexually liberated man who is sensitive to
women’s issues, especially female orgasm.
Talk about these learnings. Don’t fall into simplistic and adversarial ar-
guments with charges and countercharges. No one wins a power struggle.
As you wrap up this exercise, be honest with yourself and your part-
ner about the effects of the double standard on your attitudes, behav-
iors, emotions, and values. Discuss the effects of the female-male sexual
equity model on your attitudes, behaviors, emotions, and values. Most
important, what do you need to do to confront the double standard and
replace it with the female-male sexual equity model?
The Context for an Emotionally

Meaningful Dialogue
A core strategy is a personal dialogue about the individual and cultural legacy
of the double standard. Be honest and forthcoming, not blaming, adversarial,
and certainly not shaming. Sharing personal learnings makes it easier for your
partner to share. Focus on awareness, not blaming. A core understanding is that
you can learn from the past, but cannot change the past. The power of change
is in the present and future.
What does female-male sexual equity mean to each of you? It is easier to say
what sexual equity isn’t. It does not mean that you are clones of each other. It
does not mean that every sexual experience must be mutual and synchronous. It
does not mean that you have to compensate for past sexual inequality.
The essence of female-male sexual equity is recognition that both partners are
first-class sexual people whose attitudes, behaviors, emotions, and values matter.
Embrace sexual similarities and honor sexual differences. Value intimacy, pleasur-
ing, and eroticism – there is not a split or competition. Celebrate mutual synchro-
nous sexual encounters and enjoy asynchronous sexuality. Turn toward each other
as an intimate sexual team whether the experience was wonderful, very good,
okay, dissatisfying, or dysfunctional. Confront self-defeating gender and cultural
stereotypes. Embrace your uniqueness as sexual individuals and a sexual couple.
31
Marcella and Jose

In many ways, Marcella, 38, and Jose, 39, were a typical American couple with
typical sexual problems. In other ways, they are challenged by a growing aware-
ness of female-male sexual similarities and gender equity. This was a second
marriage for both. They have a five-person blended family, including a four-
year-old son from this marriage. Marcella was a college graduate whose career
as a human resource manager was thriving. Jose had an associate degree in law
enforcement and was a police detective. He had a nine-year-old son from his
first marriage whom he had custody of two weekends a month and six weeks
during the summer. Marcella had a 19-year-old daughter from a non-marital
relationship whom she raised as a single parent. The daughter was three years
old at Marcella’s first marriage and six when Marcella divorced.
When Marcella and Jose married, they were aware that the odds were against
them, but were committed to creating a satisfying, secure, and sexual marriage.
They wanted to be a cohesive, flexible family. Before marrying, they attended
a skill-oriented 12-session blended family psychoeducational program. Jose had
been anti-therapy due to his negative experience in couple therapy. He felt that
the therapist sided with the ex-wife and unfairly characterized him as a blue-collar
man who was an emotional neanderthal. Jose feared that therapy would be
anti-male and blame him for marital and family problems. He was pleasantly sur-
prised by the structure of the group and that the co-therapists were respectful
and non-judgmental. Marcella had positive experiences with therapy, finding it
challenging yet supportive. Her first experience was individual therapy dealing
with the pressures of being a single mother balancing work, school, and parenting.
Her second therapy experience was as a couple during her first marriage. Marcella
had been hopeful about the marriage, but through couple therapy realized that it
was a fatally flawed relationship. Her husband would show up for sessions, but he
made promises he had no intention of keeping. His answer to Marcella’s discovery
that he was having an ongoing affair was to propose having a baby to shore up the
marriage. She was disappointed in both her husband and herself, but realized that
this was not a relationship worth saving.
When Jose came into her life, Marcella felt open to a relationship, but no
longer believed that romantic love and sexual attraction were the core compo-
nents of marriage. The blended family group program increased confidence and
commitment to each other and their family.
Both Marcella and Jose grew up with the traditional double standard from
their families and culture. Marcella’s experiences as a single mother and in a
college class challenged the double standard. Her first husband assumed the
double standard, especially the right of men to have affairs and the “naturalness”
of women having a child to validate the marriage. Marcella was proud she re-
jected those models. She wanted more for herself and her daughter than those
repressive assumptions. She and Jose created female-male equity for themselves
32
and their family. She felt like a first-class sexual woman in a first-class marriage.
Marcella could not do this alone. She trusted that Jose would be her intimate
ally and join in establishing an equitable bond, including sexually.
A key factor was accepting desire/pleasure/eroticism/satisfaction. Both val-
ued intimacy and eroticism. They enjoyed sexual similarities while honoring
sexual differences. An example of honoring differences is that Jose’s sexual
response was reliable and predictable, while Marcella’s was variable and flex-
ible. Jose was turned on by Marcella being turned on. Both enjoyed partner
interaction arousal. Jose reliably had one orgasm during intercourse. Marcella
was usually orgasmic before intercourse, although she could be orgasmic during
intercourse. The keys for orgasm during intercourse were feeling erotic flow
(subjective arousal of eight) before beginning intercourse, giving and receiving
multiple stimulation during intercourse (especially giving testicle stimulation
and receiving clitoral stimulation), utilizing private erotic fantasies, and using
her orgasm triggers of verbalizing “I want to come” and Jose increasing speed of
clitoral stimulation. Jose enjoyed her being orgasmic during intercourse (more
than Marcella did). A crucial factor was turning toward each other whether
the sex was wonderful or disappointing. Afterplay was an integral part of their
lovemaking. Most of the time, afterplay was warm and caring; other times
playful and creative. Afterplay enhanced feelings of satisfaction and secure at-
tachment. Marcella was embarrassed to be more sexually responsive than Jose.
Both the female-male sexual equity model and the Good Enough Sex (GES)
model with emphasis on the multiple roles, meanings, and outcomes of couple
sexuality were appealing to Marcella. Her enthusiasm won Jose over. Jose was a
well-educated, third-generation Hispanic-American, but the cultural narrative
of sexually dominant men and modest women still influenced him. Marcella
was committed to rid herself and her family from those oppressive stereotypes.
One of their most difficult dialogues involved monogamy. Jose expected
Marcella to be faithful, but as a Latin man, he wanted freedom to be sexual with
other women as long as there was no emotional relationship – “just sex”. Marcella
was proud of being a “new woman”, including feeling sexually free and expressive.
The old myth that pro-sexual women would be vulnerable to affairs did not scare
Marcella, although it did Jose. She assured him of her commitment to marital sex-
uality. She asserted her right to sexual daydreams, erotic fantasies, and “crushes”.
She did not fear that this would cross a line and result in an affair.
Marcella would not accept monogamy as a one-way agreement. Jose assured
Marcella that he too was committed to a secure marriage. However, he would
feel silly and less of a man if he committed to monogamy. For example, if he
went on a weekend trip with male peers and there was an opportunity for sex,
how could he say no? Part of Jose’s learning was that “real men don’t say no
to sex”. He did not want to embarrass himself, have Marcella feel hurt by his
sexual “dalliances”, or misunderstand his intentions. This is an example of how
deep the double standard runs.
33
Rather than giving in or demonizing Jose, Marcella was clear that the dou-
ble standard wasn’t right for their marriage, especially not in regard to affairs.
They needed an agreement that applied to both spouses, not one which meets
his wants at her expense. If he had affairs, she had the right to have a sexual life
apart from the marriage. A “sex only” affair would not fit her values. She did
not want an affair, but if she had an affair, it would be a sexual friendship. This
made Jose anxious. He didn’t want Marcella to have an emotional or sexual
involvement with another man. Marcella said, “Why should we have one set of
rules for you but not for me. I thought we agreed on sexual equity?” She didn’t
need to beat Jose in an argument. She wanted an agreement both were com-
mitted to. She wouldn’t accept him saying one thing but meaning something
else. This was a very important dialogue, but not an easy one. Jose didn’t want
to give up the traditional masculine privilege of the right to an affair. He feared
being the target of jokes by male peers. Who did he want acceptance from –
Marcella or male friends? The traditional unspoken norm was that men were
allowed “high opportunity/low involvement” affairs as long as it did not subvert
the marriage or family. Jose’s belief was that an affair was harmless male sexual
fun, while her sexual friendship could subvert their marriage. She advocated
for female-male equity. The traditional male approach to affairs treated her as
a second-class citizen. In her experiences before marrying Jose, Marcella was
aware that affairs could take on sexual and emotional meanings that were not
intended. She did not want marital intimacy and family security disrupted. Jose
agreed, but worried about pressure from friends.
Marcella and Jose had a dialogue about what to say to others. Jose was sur-
prised to learn that on occasion Marcella felt pressured by female peers and by
men coming on to her. Marcella told female friends that she was proud of her
monogamy agreement. She enjoyed feeling attractive to men – this increased
her sense of desirability and for her served as a bridge to sexual desire for Jose. If
the man persisted or she felt pressured, Marcella was assertive in telling him he
was being a bore and to stop. Jose admired her clarity and coping strategies. He
affirmed monogamy, but this would require different coping strategies for him.
It was Jose who suggested that they establish a yearly ritual of going away as
a couple for a long weekend. Marcella’s daughter or a relative would watch the
younger children. They set aside at least two hours to talk about their marital
bond of respect, trust, and intimacy and their sexual bond of desire/pleasure/
eroticism/satisfaction. They discussed what went well in the last year, what had
been problematic, and each spouse’s goals for the next year.
These were not easy conversations, but were worthwhile. Marcella and Jose
realize that they cannot treat their relationship with benign neglect. Marriage
is a challenging process that they were committed to for themselves and their
family. They wanted a better quality of life than their backgrounds and for their
children to thrive in a loving, cohesive (although non-perfect) family.
34
The Challenges of Female-Male Equity

It is easier to confront the double standard than meet the challenges of the
female-male sexual equity model. Each person is responsible for yourself. It is
challenging to share your life emotionally, practically, and sexually.
In the double standard, the assumption was that the man’s career came first –
he made money; she was the homemaker and mother. If the economy changed
or he got a better job offer, they moved. In equity relationships, both people
work and sometimes the woman’s career and income is greater than the man’s.
Is this acceptable? Negotiate agreements that work for you, your relationship,
and your family. The rules of the double standard were clear. It did not promote
psychological, relational, or sexual well-being, but received social and family
support. The equity model requires more thought and dialogue as well as using
all your resources so each person and your relationship thrive. Sexuality has
a 15–20% role of energizing your bond and reinforcing feelings of desire and
desirability. Sexuality provides energy to deal with life issues. An example is
if both have work obligations and there is an ill child, who takes time off or
works from home? You need flexibility and adaptability. If your wife makes
more money, how do you integrate this into your self-esteem and relationship?
If one of you is a caretaker for a family member, how does that impact your
relationship?
The decision of whether to have children is the factor which most impacts
your relationship. Can you be an emotionally and sexually equitable couple
when going through the complex challenges of balancing parenting with au-
tonomy, relationship, career, household, and sexuality? Equity does not mean
splitting everything 50-50 nor should you expect perfection.
Traditional roles and functions continue while adding flexibility and adapt-
ability. Within this complexity, sexual equity energizes your bond so that you
are open to new roles and challenges.
The equity model involves respect, trust, and intimacy as you deal with the
vicissitudes of life. This is considerably more of a challenge than assuming the
traditional roles dictated by the double standard. It takes more thought, time,
dialogue, and negotiation. However, the outcome will be more satisfying. Fam-
ily relationships and children thrive with the female-male equity model.
Relational Equity and Sexual Equity

Although this book focuses primarily on sexual issues, the foundation of an
equitable relationship is psychological and relational. Sexual equity cannot
substitute for a relationship struggling with a power imbalance. There is a
positive, reciprocal association between relational and sexual factors. The tra-
ditional belief about causality is that relational factors come first and sexuality
35
naturally follows. The new understanding supports an interactive (both-and)

process (Byers & McNeil, 2006). Desire/pleasure/eroticism/satisfaction as an
equitable team promotes individual and couple growth. Relational and sexual
equities reinforce each other in a reciprocal rather than hierarchical manner.
In the traditional view, female sexuality was contingent on everything being
in order. The new view of female sexuality allows her to express intimacy and
eroticism to affirm her worth and energize your bond (McCarthy & McCarthy,
2019a). Sexuality is not contingent on everything being positive – she has a
right to her sexual voice during stressful and difficult times. Sexuality energizes
you in promoting psychological and relational equities. This helps navigate the
complexities of a shared life.
Summary
Female-male sexual equity is a cornerstone of your understanding of male, fe-
male, and couple sexuality. It confronts and ends the traditional double stand-
ard which has oppressed couples over generations and across cultures. Equity
redefines the core connection between the man, woman, and couple. This fa-
cilitates being intimate and erotic allies. Confront myths about male dominance
and eroticism as your domain. The empowering guideline is sharing desire/
pleasure/eroticism/satisfaction.
A core message of the equity model is that female sexuality is first-class, not
inferior and not contingent on everything being perfect. Each partner deserves
to have a sexual voice and value pleasure. Relational and sexual equities are
different dimensions, but reinforce each other. The double standard limits and
oppresses you. The female-male sexual equity model affirms and energizes you,
your relationship, and your sexuality.
36
5
THE SEXUAL DEV ELOPMENT
OF BOYS A ND A DOLESCENTS
Healthy and Unhealthy Learnings
In our culture, boys learn about sex in a very different way than girls. Some
learnings are positive, but most are harmful. Understanding the complexity
and confusing nature of childhood sexual socialization increases empathy as
well as motivation to confront sexual issues as an adult.
An important learning is the prominence of the penis as opposed to the “hid-
den” nature of the clitoris. Insecurities about penis size are not discussed with
anyone. Sexual jokes and name-calling are a negative legacy. A particular nega-
tive learning is that males do not admit weakness or ask sexual questions. This
is driven by fear of being made fun of or belittled by peers.
The average male experiences first orgasm between ages 10 and 14. This is
a result of masturbation or nocturnal emissions. First experiences with ejacu-
lation/orgasm can be affirming, but often are confusing or even frightening. A
powerful negative learning is that in our culture (and most cultures), males do
not have the opportunity to process negative experiences or failures. Above all,
boys are not supposed to have sexual questions or doubts.
For most males, childhood (up to age ten) is a happy time with few sexual
stresses. Intellectual, athletic, and social growth are encouraged. Healthy de-
velopment is supported by family, school, and community. The exception is
sexual development. Health educators believe that sex education for children
should be an integral component of human development. Unfortunately, this is
not true in our culture.
There are two major problems with sexuality in childhood and adolescence.
First, rather than a comprehensive sexuality education involving family, school,
and religion, sex topics are ignored or treated with benign neglect. Second,
male and female children are treated as if they were a different species. This
increases with adolescence (ages 13–17). The notion that “boys will be boys”
is the common approach. Sexual questions or concerns are avoided. Sex prob-
lems, especially in adolescence, are viewed as a female concern.
37
H E A LT H Y A N D U N H E A LT H Y L E A R N I NG S
Sexual Identity for Boys

By age three, the great majority of children identify as either male or female.
This means the boy accepts he has a penis which makes him different than girls.
This gender acceptance is congruent with the biological reality of his body.
Congruence and acceptance are crucial. There is a growing literature on gender
dysphoria and gender fluidity which is an important topic (Chivers, 2017), but
involves a small proportion of male and female children. For the great majority,
gender acceptance sets a healthy foundation for sexual development.
What is unhealthy is the contentiousness and put-downs about the opposite
gender. As is true in much of psychology and sexuality, healthy attitudes and
development begin with acceptance. Conflict with girls, put-downs, or dis-
crimination against sexual minorities interferes with healthy development. The
cultural trap is to emphasize rigid differences between the genders, a trend
which accelerates with adolescence. This mistaken belief is reinforced by fam-
ily, adults, peers, and the culture.
There is a good deal of empirical and clinical evidence to support that among
adults, especially in married and partnered relationships, there are many more
similarities than differences between men and women (Hyde, 2005). A healthy
developmental trajectory would create a foundation of similarities during child-
hood and adolescence. Unfortunately, traditional male socialization emphasizes
a very different developmental trajectory. This is driven in large measure by
fear. As boys enter adolescence, the emphasis on competition increases. An
example is the “circle jerk” where the adolescent who ejaculates fastest and
farthest is the most masculine. Fears about delayed physical development, not
being athletically or socially skilled, and unsure of masculinity subverts male
development.
Far and away, the chief fear involves penis size. Over 80% of males believe
that their penis is smaller than average. In addition to the statistical unreality,
this fear is illogical. There is no evidence that penis size has an impact on the
man’s, woman’s, or couple’s sexual function. Yet, this mistaken belief is a major
theme for boys, adolescents, young adults, and adults. It reinforces feelings of
not being “good enough” sexually. This is one of the most destructive learnings
for adolescents.
Child Sexual Abuse

The paradox is that although sexual abuse in childhood and adolescence is less
frequent for males (7% vs. 25% for females), male victims treat this as a shame-
ful secret. This has a powerful impact on adult sexual relationships. There are
four major factors in this paradox. First, female sexual abuse is a better-known
problem, more written and talked about. Second, the myth is that abuse should
not happen to males. If abused, this means there is something wrong with
38
you – you are weak, vulnerable, or easily taken advantage of. Females who ex-
perience sexual abuse are also stigmatized, but stigma and secrecy are greater
for males. Third, the great majority of perpetrators are adult males or male
adolescents, so there is the guilt-inducing question of why it happened to you.
Fourth, a common form of sexual abuse is being manually or orally stimulated
to orgasm. How could it be abuse if you were aroused and orgasmic?
The best way to understand child sexual abuse is that the older man’s sexual
wants are met at the expense of the boy or adolescent’s emotional needs. Abuse
is the shameful secret that cannot be disclosed or processed. You disavow an im-
portant part of your sexual history. You have a “contingent sexual self-esteem”
believing if your partner knew your sexual history, she would not love or re-
spect you. The fear is she would be disgusted.
Two other factors have a major impact. First, the relationship with the per-
petrator. Although it can be a stranger, most of the time it is someone the child
knows, including a teacher, cousin, neighbor, uncle, mother’s boyfriend, min-
ister. Often, the perpetrator manipulates or threatens the boy. He says that no
one would believe you and disclosure would cause great conflict and disruption.
Second, the issue of physical force. Sex associated with force is psychologically
destructive and a powerful negative learning. Secrecy and shame multiply the
impact of child sexual abuse. The most painful issue is feeling you cannot share
your abuse history. Rather than the woman being a “partner in healing”, she
feels left out and frustrated by your emotional distance. In the majority of cases,
she is willing and eager to have a role in processing the abuse history and de-
veloping couple sexuality. When dealing with sexual trauma or negative sex-
ual experiences, the theme is being a “proud survivor” not an anxious, angry,
shameful, or depressed “victim” (Maltz, 2012).
In a healthy culture, sexual abuse would not occur – an example of primary
prevention. If sexual abuse did occur – secondary prevention involves facing it at
the time, processing it in an empathic, respectful manner (not engaging in vic-
tim blaming), emphasizing positive sexual information, and becoming a proud
survivor. What usually happens is tertiary intervention. This involves dealing
with trauma as an adult. The core strategy is processing abuse in a non-shaming
manner and being a proud survivor who values consensual sexuality involving
desire/pleasure/eroticism/satisfaction.
Healing occurs in the context of an intimate sexual relationship. Healing
begins with the courage to share your psychological/relational/sexual history,
including abuse and trauma. Can your partner be your emotional and sexual
ally, responding in an empathic and respectful manner? You need her respect
and empathy; you do not want sympathy or for her to “freak out”. She cannot do
it for you, but can be your partner in healing. The abuse was not your fault. You
coped as well as you could with the resources you had at the time. As an adult
in an intimate relationship, you have greater awareness, insights, and resources.
39
The most important awareness is that you deserve sexuality to have a positive
role in your life. A specific strategy is the power to veto 1–3 sexual scenarios
with confidence that she will honor your veto. This frees you to enjoy intimate,
pleasure-oriented sexuality. That is the opposite of abusive experiences. You
are a proud survivor who embraces desire/pleasure/eroticism/satisfaction. A
favorite adage is “Living well is the best revenge”.
When the Woman Has an Abuse/Trauma History

The same strategies and guidelines apply in the more common case where it is
the woman with a history of child sexual abuse, rape, or incest. A major guide-
line is “Don’t blame the victim”. This is particularly important because in our
culture, the norm is to blame women for acquaintance rape, sexual harassment,
unplanned pregnancy, or incest. Blaming and shaming multiply the trauma. No
one deserves to be raped or abused.
Be sure your partner is on your side and is trustworthy. Barry remembers a cou-
ple where the woman’s abuse history involved an uncle rubbing his penis against
her breast. Her veto involved any breast stimulation. Her partner described him-
self as a “breast man” but said, “Your emotional needs are more important than my
sexual wants”. They created and maintained an intimate sexual bond.
When you feel desire/pleasure/eroticism/satisfaction in the context of an in-
timate relationship, you have taken back your body and sexuality; it is no longer
controlled by trauma.
Special Issues in Childhood Sexuality

You are a sexual person from the day you’re born until the day you die. Male
children have erections in utero. It is normal and healthy to enjoy touching and
being touched, including children exploring and touching their genitals. Accept
this rather than slap the child’s hands. The child learns proper words for penis
and vagina. Unfortunately, this is not the norm. Don’t be harsh on your parents
or culture. Developing sexual comfort is not easy for either adults or children.
Did you learn that genital touch in private (your bedroom or the bath-
tub) was acceptable, but not genital touch in public? Curiosity is normal and
healthy. Hugs and affection are integral to healthy development. Did you learn
the model of good touch/bad touch? What do you remember from elementary
school? Were you encouraged to interact with both genders? Was touch and
exploration accepted?
Acceptance of genital differences in childhood is an important learning. Did
your family, school, and neighborhood promote healthy developmental learnings?
Health educators advocate for educational programs beginning in first grade,
including parental involvement (although in reality this is rare). The theme of
40
health/sex educators is to begin with positive sexual learnings. Unfortunately,

educational programs begin with topics like sexual abuse, fear of strangers, bad
touch, and negative consequences of sex. Negative sexual messages target females,
not males. Start with positive sexuality education for both males and females.
There are substantial age differences in physical development (height, genital
hair). Male children fear being behind. A significant event is first orgasm whether
with nocturnal emission or masturbation. Few children are educated about what
to expect or what orgasm means. There are jokes and bragging, but no real discus-
sion about orgasm/ejaculation. Feeling frightened or ashamed is unnecessary. Ide-
ally, a father, father figure, or older sibling would reassure the child that orgasm/
ejaculation is normal and healthy. First orgasm serves as a cue for sex education.
Adolescents complain that school and family sex education was too little, too late.
The “sex talk” is usually uncomfortable, uninformative, vague, and judgmental.
Ideally, both your father and mother were “askable parents”? A crucial guide-
line is “Never lie to your child”. This is especially true for sex issues.
By the time the boy reaches adolescence (age 13), he has heard confusing and
often contradictory information about sexuality from peers, family, religion,
boy scouts, athletic teams, teachers, and the media. The number of 13-year-olds
who are satisfied with their sex education is very small. Most of their education
was informal – on the street or from the internet. A surprising number have
been exposed to porn (without a context about the differences between the
reality of sex and the erotic fantasy world of porn). Few had a serious discussion
of sex issues with an adult. One of the most negative childhood legacies is that
males are not supposed to ask questions or have sexual problems.
Sexual Issues for Male Adolescents

Scientists believe that ages 13–16 are the most confusing and disruptive in life.
Much of this is attributed to sexual confusion and pressure. Adolescent males lie
about their sexual experiences. No one admits that they are a virgin, although
most are. They brag about what a wonderful sex partner they are, how strong
their erections are, and their lasting power. In reality, most adolescents begin
their sex lives as premature ejaculators with some experiencing orgasm before
the penis enters the vagina. This is nothing to be ashamed of – sex like any
other human skill requires practice and feedback. Ideally, your first relationship
is a sexual friendship with an adolescent girl where you treat each other well
and the relationship ends in a kind manner. A first relationship can involve a
“hook-up” or a paid sex experience. On the other extreme, some men have a
three-year relationship or marry their first partner. For the majority, the re-
lationship lasts weeks or months. Most men remember their first intercourse
positively, but not all. Be aware that first partner orgasm usually occurs with
manual, oral, or rubbing stimulation rather than intercourse.
41
The question is whether sexual learnings were helpful or not. For most ado-
lescents, there was a mixture of good, mediocre, and bad sexual experiences.
This is the norm and is true with most learnings whether academic, athletic,
or social. Two questions Barry asks when conducting a sex history, “What
was your best psychological, relational, or sexual experience before you left
home?” Then, “What was your most confusing, negative, g uilt-inducing,
or traumatic psychological, relational, or sexual experience before leaving
home?” Most males (and females) had both positive and negative experiences.
The most common positive experiences were feeling attractive and cared for,
being in a healthy sexual relationship, confidence you can navigate life and
relationships, enjoying personal freedom, feeling good about your body and
sexuality, growing appreciation of women and sexuality. The most common
negative experiences were feeling sexually rejected and put down, contract-
ing an STI, causing an unwanted pregnancy, caught masturbating and made
fun of, fearing that there is something sexually wrong with you, sexual abuse
and feeling it had to be kept secret, feeling guilty for sexually harassing a
woman. Remember the core adage, you can learn from the past, but cannot
change the past. Your power for change is in the present and future.
Issues for Female Adolescents

The message for adolescent women is “don’t”. Don’t get pregnant, don’t contract
an STI, don’t be raped, don’t be sexually harassed. Although not clearly stated,
a common parental fear is don’t become obsessed with the wrong man and let
your life be sidetracked. There is little to no emphasis on growing as a female,
valuing pleasure, enjoying arousal and orgasm, or assuming responsibility for
yourself and your sexuality. The double standard is bad for females at any age,
but especially during adolescence. It is hard to identify a healthy developmen-
tal trajectory psychologically, relationally, and sexually. Almost no one would
choose to return to adolescence, even if they knew then what they know now.
Exercise – Healthy and Unhealthy Sexual

Learnings
This is not an easy exercise, but is motivating and empowering.
List as many positive learnings as you can – be sure you have at least
five. Then, list negative learnings. Most men find it easy to list many
more than five negatives and some have to be reminded to stop at 20.
Make the positive and negative learnings as specific and personal as pos-
sible; don’t give vague or socially desirable responses.
42
Positive learnings include:
1 Pride in being a man, including your penis

2 Enjoying orgasm
3 Freedom to be sexual and enjoy intercourse
4 Feeling attractive to females
5 First partner orgasm
6 Learning to touch and kiss
7 Enjoy being orgasmic with manual or oral stimulation
8 Feeling good about being a sexual man
9 Joking with male friends about sex
10 A close relationship with an older sibling or cousin who provided
sexual guidance.
Make your list personal and concrete, and acknowledge positive experi-
ences and learnings.
Examples of negative learnings include:
1 Being made fun of by an ex-girlfriend and her friends

2 Caught masturbating and shamed for it
3 Fear your penis is small or oddly shaped
4 Being sexually abused by an uncle
5 Forced to be passive in anal intercourse
6 When 12-years-old having your pants pulled down by a group of males
7 Watching porn with fear you are addicted
8 Fear that you might be gay
9 Believing you must have a spontaneous erection to impress a woman
10 Fear that you can’t live up to double standard demands.
Be honest. What adolescent learnings interfere with your adult sexuality?

We encourage the woman to do this exercise about her positive and
negative adolescent learnings.
The real test is willingness to share your lists/learnings with your
partner, especially the negative learnings. Doing so increases your
vulnerability. More importantly, it builds a respectful, trusting, and
intimate bond because it invites your partner to be your ally in con-
fronting and changing destructive attitudes and values. The man who
is vulnerable and open to his partner’s positive influence is a better
man, better sex partner, and better life partner.
43
Adolescence to Adulthood
Adolescence is a crucial developmental time in the lives of both males and fe-
males. The traditional approach to adolescence brings out the worst in people,
especially sexually. The destructive learnings of the double standard are rein-
forced. Fears about negative sexual consequences are much higher for females.
The learnings for males, especially fears of not being good enough and shameful
secrets, subvert sexual self-esteem. The sad reality is that many men have a
contingent sexual self-esteem and are in a contingent relationship. You fear if
your partner or male peers knew about your sexual past they would not respect
you. This is a very hard way to live. Self-acceptance involves acknowledging
strengths and positive learnings as well as accepting and processing vulnera-
bilities and sensitive issues. Acceptance is the key to healthy sexuality. This
gives you courage to confront toxic male sexuality and the oppressive double
standard. Affirm a new model of male sexuality which allows your sexual rela-
tionship to thrive.
Daniel and Rachel

Rachel and Daniel met in their mid-twenties – they were an idealistic limer-
ence couple. This was a wonderful way to begin, but not a healthy way to es-
tablish an intimate relationship. It was Rachel who pushed the importance of
processing each person’s psychological, relational, and sexual past. She could
not commit to Daniel until she understood who he really was, including vul-
nerabilities from childhood and adolescence. Male friends warned him against
self-disclosure. They said Rachel wanted to know this so she had leverage to
force him to change.
Daniel prided himself on being a “regular guy” who valued a girlfriend and
sexual relationship. Daniel knew that they were a special couple, and felt ready
for a marital commitment. However, he was fearful of Rachel’s motives – did
she love him or was she searching for reasons to back away? Self-disclosure and
vulnerability can strengthen the man and intimate relationship or it can be used
in a destructive manner.
Rachel assured Daniel that she did not have a manipulative or hidden agenda.
She disclosed two major vulnerabilities from her adolescence – an abortion
when she was 17 and being sexually abused over a period of months by an older
cousin when she was 13. Rachel regretted both experiences, but was not shame-
ful nor did she allow these to subvert her sexual self-esteem. Daniel felt closer
to Rachel after those disclosures and open to sharing his life with her. However,
he felt that his “shameful secret” was much worse and feared that she would
not accept him. Daniel wrote a four-page letter to Rachel describing his expe-
riences of being fellated to orgasm two to three times a week at ages 14–16 by
a married man who lived in the neighborhood. Daniel had never spoken about
44
this to anyone. The man told Daniel that this was just harmless fun which he
enjoyed because he was so easily orgasmic. The neighbor said that if Daniel’s
parents found out, they would be ashamed of Daniel. The neighbor had young
children and told Daniel that disclosure would destroy the neighbor’s family.
As an adult, Daniel had no contact with this man who had moved to another
state. Daniel still could not make sense of these experiences. At the time, Dan-
iel feared that he was gay. His adolescent, college, and young adult sexual expe-
riences were driven by the need to prove that he was straight. Although Rachel
enjoyed giving and receiving oral sex, Daniel strongly preferred intercourse. He
was much more comfortable giving oral sex than receiving.
After reading the letter, Rachel invited Daniel to dinner at her apartment.
She was appreciative that he shared this traumatic experience. Daniel broke
into tears – he had never labeled those experiences as traumatic, but she was
right. He was the victim, not responsible for the abuse. The neighbor’s sexual
wants were met at the expense of Daniel’s emotional needs. It was the burden of
keeping these experiences secret that caused Daniel the most harm.
They discussed the difference between regret and shame. They did not want
their adolescence defined by negative incidents. Rachel wanted Daniel to know
that he could veto oral sex, but that for her giving oral sex was a loving, erotic
experience. Again, Daniel cried. He associated fellatio with being sexually ser-
viced, not loved. It reminded him of the way fellatio is shown in porn videos –
oral sex had nothing to do with intimacy or pleasure.
As Daniel and Rachel processed healthy and unhealthy learnings, they didn’t
get stuck on the details but did process themes. Daniel felt pride in being a sex-
ual man intermixed by a great deal of regret and guilt over abusive experiences.
Rachel urged him to commit to intimate, pleasurable, and erotic sexuality. This
was not a conversation that Daniel was used to, but was crucial. It was the oppo-
site of fears and shameful secrets. Ultimately, Daniel became comfortable and
turned on by receiving fellatio in the context of synchronous erotic scenarios.
Daniel was not interested in asynchronous fellatio.
Just as important, Rachel and Daniel processed positive sexual learnings and
experiences. Rather than making jokes or one-upping, they spoke as sexual
allies highlighting what each needed if they were to maintain healthy couple
sexuality. A prime task in the first two years of marriage is to transition from
the limerence relationship phase to develop a couple sexual style with strong,
resilient desire. Sexuality has a 15–20% role in their lives. Both Daniel and
Rachel were committed to a satisfying, secure, and sexual marriage.
Summary
Childhood and adolescence are when males (and females) develop a foundation
for adult sexuality. Few people have the benefit of comprehensive sex education
45
involving the school, family, and religion. Sex education typically emphasized
child sexual abuse, STIs, and unwanted pregnancy. The message to female chil-
dren is don’t be sexual and be afraid of negative sexual consequences. The mes-
sage to male children is don’t ask questions or appear uncertain. The message
of gender sexual socialization is that boys and girls are very different. This rein-
forces the traditional double standard.
Males are encouraged to be sexual with masturbation and taking sexual risks
with girls. Sex is the man’s domain and sexual problems are the woman’s issue.
Females are taught sexual avoidance. Sexual abuse is a problem for girls, not
boys. If boys are abused, it must stay a “shameful secret”. The negative effects of
splitting by gender are multiplied during adolescence.
The sexual socialization of males and females is very different. Sexual issues
are a prime cause of the drama and struggles so many adolescents experience.
Negative psychological, relational, and sexual learnings from adolescence in-
terfere with adult sexuality. You need to confront these attitudes, behaviors,
emotions, and values.
A crucial reality is that sexual differences are the greatest in adolescence
and young adulthood. These negative learnings have to be challenged so that as
adults, men and women are intimate and erotic allies.
46
6
YOUNG A DULT SEXUALI T Y
Time for Change
Major gender differences in sexual socialization and experience dominate young

adulthood (ages 18–25). As adults, especially in marriage and partnered rela-
tionships, there are many more similarities than differences between men and
women. This is true psychologically, relationally, and sexually. However, this is
not true with young adult sexual experiences.
There are three major factors contributing to male-female sexual differ-
ences in young adulthood: (1) double standard learnings and expectations, (2)
autonomous vs. intimate, interactive sexuality, and (3) negative sexual conse-
quences (which have a greater impact on women). Be aware of psychological,
bio-medical, and social/relational factors which subvert young adult sexuality.
Male-Female Double Standard

There is nothing natural or inherent in the male-female double standard. It is
a socially learned set of rules passed down culturally as if the double standard
was based on fact. The double standard subverts sexual desire and satisfaction
for adults. It is unhealthy not just for the woman, but also for you. The double
standard emphasizes that you are the “sex expert”. Sexual initiation is your role,
with intercourse frequency the prime focus. You are in charge of foreplay to get
her ready for intercourse. Intercourse is “real sex”. With the double standard, the
woman’s role is inhibited – she is passive and follows your lead. This is viewed
as “normal” and even celebrated. In the double standard, negative sexual conse-
quences are her fault and burden – whether pregnancy, contracting an STI, being
sexually abused, raped, labeled a “slut”, or being mistreated in a relationship.
The only advantage of the double standard is that the rules are clear, wrong
but clear. In the double standard, sex is your domain with sexual problems
her fault and burden. Your male pattern of sexual response is the norm –
spontaneous desire and erections, highly predictable intercourse and orgasm,
with freedom to be sexual in a guilt-free manner. Sex is a performance to prove
yourself to the woman and to male peers.
47
Y oung A dult S exuality
The rules of the double standard mimic the concept that there is a totally
different set of gender attitudes, behaviors, emotions, and values. The double
standard makes it clear that males are the sexually dominant gender; females
are submissive and second class. You are ready to “have sex with any woman,
any time, any place”. Foreplay is to get her ready for intercourse – she is in the
one-down position, trying to catch up.
Autonomous Sex vs. Intimate, Interactive Sexuality

The second major negative learning from young adulthood is that male autono-
mous sex response is superior to female variable, flexible sexual response. You
obtain an easy, spontaneous erection and proceed to intercourse and orgasm on
your first erection. Sexual response is in your control and is highly reliable. The
most important factor is that sexual response is autonomous. You experience
desire, arousal, and orgasm, needing nothing from her.
The great majority of young adult women learn sexual response as interac-
tive rather than autonomous, variable and flexible rather than totally reliable.
The “common sense” notion is that the man’s sexual response is the norm. The
message is that male sex is totally predictable and superior. This is a prime cause
for you to feel embarrassed and stop being sexual whether at 45, 65, or 75. The
flexible, variable, pleasure-oriented Good Enough Sex (GES) approach (Metz &
McCarthy, 2012) is compatible with female sexual socialization. The challenge
for you is to adopt GES. GES promotes sexual desire and satisfaction, especially
after age 50 in married and partnered relationships.
Negative Sexual Consequences

The third powerful, destructive learning from young adulthood is that the
negative consequences of sexuality are the woman’s burden. One reason that
35-year-old women are much healthier sexually than 15- or 25-year-old women
is that they feel free to express themselves sexually with less fear of negative
consequences or judgments. She feels increased sexual self-acceptance. She
owns her sexual voice and values a satisfying, secure, and sexual relationship.
Her partner is an intimate ally rather than someone she has to prove something
to or meet your expectations.
Her body image is more accepting and positive than at 25, even though by
media/social desirability standards she is no longer viewed as “hot”. Ads, me-
dia depictions, and movies focus on beautiful, thin, erotic women between 18
and 25. These images are intimidating, not empowering. The message is she’s
not “good enough sexually”. Anxieties about STI/HIV, unwanted pregnancy,
and gossip dominate young adult female sexuality. A common way to deal with
this stress is to use alcohol and/or drugs to reduce sexual self-consciousness.
48
This risks creating more emotional, behavioral, and sexual problems. Too many
young adult men and women associate sex with being drunk or high. There is
nothing wrong with one or two drinks to reduce self-consciousness, but as-
sociating sex with alcohol ultimately subverts sexual self-esteem and couple
sexuality. From a biological perspective, alcohol is a central nervous system de-
pressant so lessens sexual response. That is not the reality for young adult men
and women. Alcohol “greases” the social and sexual milieu. Psychosocial factors
override negative biological effects. However, this changes for middle years and
older men (and women). Alcohol abuse is a major cause of sexual dysfunction.
Positive motivation promotes sexuality. Pressure to sexually prove yourself
subverts sexuality. Few men want to return to their young adult years. This is
even truer for women.
Sexual Development and Growth

Rather than demonizing young adult sexuality or feeling intimidated by it, a
healthy approach is to accept this as a developmental phase which will require
personal and sexual growth as he (and she) enter adulthood. Rather than en-
vying or demonizing young adult sexuality, understand and process this in the
context of development in the same way that you proceed through other devel-
opmental stages. For both men and women, psychological well-being improves
after age 25. This is due, in part, to having a better sexual self-esteem. In adult-
hood, you have fewer social and sexual fears. You have a healthy sexual voice
(autonomy) so you make better sexual decisions. Adults say that if they knew
now what they should have known at 25, they would do things very differently.
Almost no one would choose to return to adolescence and few would want to
return to young adulthood. There is too much angst and drama, much of which
is driven by relational and sexual issues.
The core concept is that healthy sexuality has a 15–20% role in a person’s
life and relationship. This is true whether you are male or female, 16, 26, 46,
66, or 86. The paradox is dysfunctional, conflictual, or avoidant sexuality has
an inordinately powerful negative role, a 50–75% factor, subverting you and
destabilizing your relationship. The most disruptive time is during adolescence
and young adulthood. This includes issues such as STIs, HIV, and unwanted
pregnancy. Psychological factors include low sexual self-esteem, sexual trauma,
poor body image, and confusion about the roles and meanings of sexuality. Re-
lationships are unstable during this period, including conflicts about intimacy
and sexuality, feeling emotionally or sexually betrayed, dramatic break-ups,
feeling unloved, fears of not being able to maintain a sexual relationship, and
cynicism about sex and relationships.
Knowledge is a powerful resource. You learn to make wise psychological, re-
lational, and sexual decisions. Young adulthood is a challenging time for sexual
49
health and psychological well-being. Yet, it can be a time of psychological, rela-

tional, and sexual growth.
A motivating strategy is to view positive and negative sexual learnings dur-
ing young adulthood as less important in themselves and more important from
the perspective of what you learned about yourself, sexuality, and relationships
(O’Sullivan, Cheng, Harris, & Brook-Gunn, 2007). A prime issue is setting the
stage for adult sexuality. Does sexuality have a positive role in your life and re-
lationship? The journey was a bumpy one, with positive and negative learnings
and experiences. Are you a healthy adult in a healthy relationship?
Healthy Sexual Learnings from Young Adulthood

The core learning is that sexuality is a good thing in life, not bad or evil. Second,
sexuality is a positive, integral component of your personal identity. Third, the
experiences you had, especially dating and sexual, are lessons about becoming
a healthy sexual adult. Positive learnings include owning your sexual story with
its strengths and vulnerabilities, affirmative and difficult experiences. The ma-
jority of young adult men (and women) engage in masturbation. Accept your
body, enjoy sexual touch, and through masturbation learn your unique desire/
pleasure/eroticism/satisfaction pattern. The great majority of males learn to be
orgasmic through masturbation. However, they negate the value of these learn-
ings by associating masturbation with secrecy and shame. In contrast, empha-
size an open approach to body exploration, sensual touch, playful touch, erotic
touch, and orgasm as a whole-body experience. Learning sexual response and
orgasm through masturbation makes it easier to enjoy partner sex.
A positive learning is to value yourself in the context of an intimate relation-
ship. Even during the romantic love/passionate sex/idealization phase, do not
lose your sense of self. Your sexual self-esteem is not governed by the partner
and her judgment. A healthy relationship allows you to feel desire and desirable,
contributing 15–20% to life satisfaction. Sex should not dominate your life.
This is easier to accept and implement at 25 than 18. This involves psychologi-
cal, relational, and sexual growth.
Another healthy learning is to value integrated sexuality – intimacy, pleas-
uring, and eroticism. Unfortunately, at this life phase, male sexual socialization
focuses on sexual performance and eroticism to the exclusion of intimacy and
pleasuring.
We urge you to value female sexuality. Female sexual response is more varia-
ble, flexible, complex, and individualistic than male response, especially during
young adulthood. Complex and different does not mean worse. A theme is that
female sexual socialization emphasizes intimate, interactive, variable, and flexi-
ble sexuality. This is compatible with the GES approach which is a better fit for
couples than the autonomous male individual performance approach.
50
Debbie and Scott

Scott and Debbie became a couple their sophomore year in college. Six years
later, they married. The marriage was supported by both family and friends.
Debbie and Scott were committed to a satisfying, secure, and sexual marriage
based on emotional and sexual equity.
Coming to this point required a great deal of psychological, relational, and
sexual growth. Scott grew up in an intact family, but his parents were a poor
marital and sexual model. There were chronic marital conflicts over a number
of issues. As an adolescent, Scott realized that sex was an underlying problem
in their marriage. His father drank with male friends, and the hidden agenda
often involved paid sex or “hook-up” sex with women at bars. Mother attacked
father as acting like an adolescent and he counter-attacked calling her “frigid”.
He blamed her for all marital and sexual problems. Scott and his younger
brother attempted to shut out these conflicts. Scott tried to prove his manhood
by “hooking up” starting at age 13. Scott and his friends joked that they would
never need paid sex. Scott felt that he treated girlfriends well and believed that
“hook-up” connections were consensual.
Scott’s world view dramatically changed freshman year at college when he
was forced to withdraw based on accusations of sexual harassment issued by two
sophomore women. In Scott’s view, these incidents were nothing more than
sexual hook-ups. This was strongly confronted by the dean of students and the
two women, with powerful negative consequences. Scott’s mother encouraged
him to learn from this experience and be resilient. She urged Scott to apply to
a new college, and more importantly focus on life lessons, especially emotional
and sexual boundaries. Scott needed to learn the red line between coercive sex
and sexual consent. A problem with Scott’s hooking up experiences was that
those boundaries were blurred. Adding to this was that most of Scott’s sexual
experiences, including with the two sophomore women, occurred when he was
drunk or high. This further confused boundaries, especially in light of sober
reflection the next morning.
Scott was proud that he was resilient. He enrolled in a college which was a
better fit for him and where he established a relationship with Debbie. This had
been a painful learning, but a valuable outcome. A mature Scott valued inti-
macy, touching, and sexuality in the context of healthy boundaries.
Debbie had a very different life story and sexual socialization. She was 8
when her parents divorced and 13 when her mother remarried. Debbie was
fortunate in that her parents were in the minority of couples – they had a “good
divorce”. The prime factor was her father accepting his sexual identity as a gay
man. Instead of blame or shame, her parents sadly realized that the marriage
was fatally flawed because of sexual orientation. The good divorce involved
wishing each other well and not being involved in the ex-spouse’s emotional, re-
lational, or sexual decisions. Mother was the prime custodial parent, but father
51
was an involved co-parent who maintained financial and emotional responsibili-

ties. He reinforced a loving father-daughter relationship and encouraged Debbie
to develop a positive relationship with her stepfather. Both parents supported
Debbie’s emotional and sexual development.
Debbie’s first intercourse was as an 18-year-old high school senior. She in-
troduced her boyfriend to her parents after they’d been dating for six months.
Debbie obtained birth control pills and used condoms to guard against STIs.
This relationship ended during her freshman year of college. The strain of a
long-distance relationship and her desire to date at college motivated her to ter-
minate the relationship. Debbie continued to utilize safe sex and birth control
even when she was having sex on an irregular basis. She did not want to risk a
pregnancy.
Debbie and Scott met sophomore year. They began as friends and two months
later had their first official date. After three months, they became a sexual couple,
but not before going to the student health center for an STI screen and HIV test.
Debbie and Scott were free of STIs. They used birth control pills, but there was
not a need for condoms. If either was sexual with another person, this was a cue
to resume condom use. This occurred twice over the six years they dated. When
they returned to being a monogamous couple, they were again jointly tested. Both
felt good about following their agreement and being a safe sexual couple.
They married when Scott was 27 and Debbie 26. Like over 60% of American
couples, they cohabitated before marriage. They didn’t just slide into marriage,
but made an affirmative decision to share their lives as a respectful, trusting
couple. They were committed to a satisfying, secure, and sexual marriage. Less
than one in four couples discloses and discusses sensitive psychological, rela-
tional, and sexual information before marrying (McCarthy & McCarthy, 2004).
Debbie insisted that she and Scott have that conversation. She wasn’t worried
that Scott had a major secret, but wanted to be aware of personal and relational
vulnerabilities. Although this was an emotionally difficult series of conversa-
tions, it was valuable. They were not burdened by negative sexual learnings
from adolescence or young adulthood. The hardest issue for Debbie was Scott’s
belief that the man should be the initiator because sexual desire and function
is easy for him. She enjoyed Scott’s obvious attraction and sexual response, but
insisted that he treat her as a first-class sexual person. Intimacy and pleasuring
were not just to please her, but a valued part of their couple sexual style. Scott
was not comfortable talking about sexual issues, but Debbie said she wanted to
be sure they would be a healthy couple throughout their lives. Establishing this
foundation was a wise emotional investment. When Debbie told him she’d read
that it was men who stopped couple sex in their 50s or 60s because they’d lost
sexual confidence, Scott didn’t believe it or want to talk about it.
One day while watching football on TV, Debbie asked Scott how old he
thought the couple in the Viagra commercial was. Scott guessed the man was
52
60, the woman 35. Debbie said they were in their 50s. Debbie didn’t want to
be like that couple – she wanted Scott to turn toward her, not to a pill. Scott
was a certified physical therapist who advocated for primary prevention which
made sense when thinking about sexual desire and function. Sexuality which
integrates desire/pleasure/eroticism/satisfaction is the best primary prevention
strategy. Scott had come a long way since adolescence and felt very lucky to have
a pro-sexual wife to share his journey.
Eroticism: The Most Controversial Issue

In young adult male sexual socialization eroticism is the focus. This has always
been true whether traditional Playboy centerfolds or the plethora of erotic pic-
tures and videos on the internet. One of the core themes of porn is the crazier
the woman, the more erotic she is. What is the best way to understand the
erotic dimension of couple sexuality? Is it to be as sexually dramatic as possible?
To reject eroticism as anti-feminist? To view porn and eroticism as unhealthy
male sexuality? To hope you will outgrow this fixation on eroticism?
We suggest a very different strategy. Accept the mantra of desire/pleasure/
eroticism/satisfaction as relevant for both men and women. Eroticism is an in-
tegral component of each partner’s sexual voice. Eroticism is not the domain of
male sexuality; eroticism is important for women. That does not mean that she
adopts the male approach. Be sure eroticism is integrated into her sexual voice
(McCarthy & McCarthy, 2019a). Integrated eroticism is much superior to the
traditional porn version. Eroticism is a core component in the desire/pleasure/
eroticism/satisfaction mantra for both women and men.
Let’s be specific about what integrated eroticism means (whether at 20, 40,
or 60). It is very different than a porn version. Eroticism is compatible with
intimacy and pleasuring. Eroticism is not at the expense of the partner or rela-
tionship. Eroticism can include partner interaction arousal, self-entrancement
arousal, and/or role enactment arousal. Eroticism involves creativity, mystery,
unpredictability, lust, taking emotional and sexual risks, not being politically
correct, and sharing vibrant, vital sexuality.
How is this different from porn eroticism? The porn message is that the best
sex is dirty, kinky, out of control – totally divorced from intimacy and pleas-
uring. The crazier the scenario, the more erotic and the crazier the woman,
the more erotic. Porn eroticism knows no boundaries; it’s about sexual risks
with no reality consequences. Porn eroticism lives in a world where the man
is dominant, the woman submissive. Sex is about power and control, used to
subjugate and humiliate women. There is no boundary between fantasy and
reality – eroticism is controlling and has no conscience.
With integrated eroticism, there is a clear boundary between erotic fan-
tasy and real-life sexual behavior. By its nature, erotic fantasies are about
53
unacceptable sexual behaviors – violent sex, watching people having sex, sex
with an inappropriate partner, orgies, double penetration sex, sex with two
women, sexually humiliating the woman, being sexual in front of a group. Is
this the behavior you want with a real-life partner? No, erotic fantasies (whether
his or hers) are a totally different realm than real-life sexual behavior. Integrated
eroticism recognizes that distinction.
Women want the freedom to enjoy erotic fantasies whether at 15, 25, 45, or
75. The best-selling book series “Shades of Gray” vividly illustrated that. The
sales reflect the power of women’s freedom to enjoy erotic sexuality, specifi-
cally socially unacceptable fantasy themes.
The split of eroticism by gender is an example of the importance of the need for
you to confront the destructive learnings that occur in young adulthood. These
destructive learnings have more negative impact on men than women. You mistak-
enly believe that “first class male sex” is controlled by autonomous sex response and
porn eroticism. This limits and inhibits male sexuality. In contrast, the challenge
for women is to incorporate eroticism into their sexual lives and couple sexuality.
Exercise – Assessing Healthy and Unhealthy

Male Sexual Learnings in Young Adulthood
Do this exercise with a person you like and respect – a spouse, partner,
sibling, minister, good friend, counselor – who is thoughtful and offers
honest feedback about your sexual learnings (whether similar to or dif-
ferent than traditional learnings).
Start with positive learnings. Be as specific and concrete as possible.
What were your psychological, relational, and sexual learnings as a young
adult which promoted male and couple sexuality. Examples include val-
uing sexuality, seeing sex as a positive dimension in life, learning sexual
response and orgasm through masturbation, enjoying a range of erotic
fantasies, learning from sexual problems rather than feeling burdened or
shameful, enjoying dating, seeing sexuality as an integral component of
masculinity, admiring female beauty and sexuality, enjoying intercourse
and orgasm, learning about women and relationships, using condoms and
practicing safe sex. Don’t talk just about socially desirable or politically
correct learnings. What were your positive learnings?
The second part of this exercise is more challenging and difficult, but
equally important.
What are the negative learnings from young adult sexual socializa-
tion which interfere with male and couple sexuality? Be specific and
concrete – not the traditional war between men and women with attacks
and counter-attacks.
54
Common negative male learnings include avoiding serious conversa-

tions about sexuality, feeling your penis is smaller than average, pressure
to perform for the woman or to impress male peers, not be tested for an
STI, avoid responsibility for an unplanned pregnancy, not use condoms in
an effective manner, brag and lie about sexual experiences, label women
as “sluts” or “whores”, insist that you are the sex expert, put down the
woman for not being as desirous or orgasmic as you, labeling other men
as “wimps”, engaging in coercive or forced sex, putting down gay men,
stalking or harassing an ex-girlfriend, putting down women and telling
sexist jokes, feeling that it is your job to be sure that she has an orgasm
each time, insisting that a real woman must orgasm during intercourse,
believing that men are better than women – especially sexually, believing
intimacy and affection are for the woman, feeling that giving oral sex is
a chore, insisting she swallow semen as a sign of submission, preferring
porn to couple sex, pretending to enjoy a sexual scenario but in reality
disliking it, having sex questions or doubts but not raising them, lying
about whether you’ve had an STI, splitting intimacy and eroticism, treat-
ing “relationship women” different than “erotic women”.
Once these lists have been created, focus on what it means to be a
sexual man. What are the problematic legacies from young adult so-
cialization? How can you deal with these negative learnings? Even more
challenging is dealing with your partner regarding disparate sexual and
relational learnings. A crucial guideline is to avoid “right-wrong” power
struggles. Each partner is responsible for your sexuality, but ultimately
sexuality is a team sport. As adult partners, process healthy and un-
healthy, common and different, sexual learnings. The challenge is inte-
grating these learnings in your intimate sexual relationship.
Looking Back Fondly, Resentfully, or in an

Empowering Manner
You can learn from the past, but can’t change the past. Take responsibility and
enjoy sexuality in the present and future.
Many men (and some women) look back fondly at sexual experiences in
young adulthood. That is fine as long as you acknowledge negative learnings and
be open to sexual change. The trap of fond memories is that it makes it too easy
to deny or minimize problematic experiences. Carefully process positive and
negative learnings from young adulthood.
The problem with resentful processing is that you stay stuck in the “victim
role”. You are caught in the angry, anxious, or shameful victim cycle which
55
subverts your sexuality. It is crucial to process hurt, angry, and abusive feelings
about past sexual experiences. Recognize and grieve psychological, relational,
and sexual losses. You cannot allow these experiences to control your sexuality.
It is women who commonly fall into depressive, angry, or resentment traps.
It is men who fall into the shameful secret trap (especially in regard to sexual
trauma).
Process young adult sexual experiences and learnings in an empowering
manner. Be open. Recognize both healthy and unhealthy learnings. Processing
all your experiences allows you to increase understanding. Address male and
couple sexuality to promote desire/pleasure/eroticism/satisfaction.
Summary
Major differences in sexual socialization occur in young adulthood. The chal-
lenge is to confront and learn from the disparities in psychological, relational,
and sexual socialization. A key to healthy couple sexuality is an equitable
female-male model which emphasizes respect, trust, and emotional and sex-
ual intimacy. You are intimate and erotic allies who value desire/pleasure/
eroticism/satisfaction. When you engage in the traditional war between the
sexes – for example, intimacy is the woman’s domain, eroticism the man’s
domain – couple sexuality is the loser. The male-female double standard is
strong in young adulthood. A challenge of adult sexuality is to confront these
self-defeating learnings. Adopt female-male sexual equity which promotes a sat-
isfying, secure, and sexual relationship.
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7
THE NEW SEXUAL M A NTR A
Desire/Pleasure/Eroticism/Satisfaction
In the traditional approach to sexuality, the mistaken assumption was that erot-
icism, intercourse, and orgasm were the man’s domain; intimacy, pleasuring,
and stability were the woman’s domain. “Foreplay” involved the man stimulat-
ing the woman so that she would be ready for the “real thing” – intercourse. The
traditional view was “sex = intercourse”.
There is a new mantra in the sexuality field – desire/pleasure/eroticism/
satisfaction (Foley, Kope, & Sugrue, 2012). This empowering mantra is appli-
cable to both men and women. The great majority of young adult men learn
that sex is easy, highly predictable, and in their control. Male sexual response is
autonomous – he experiences desire, erection, intercourse, and orgasm need-
ing nothing from his partner. This learning backfires with aging. When couples
stop being sexual – whether at 50, 60, 70, or 80 – it is almost always the man’s
choice – made unilaterally and conveyed non-verbally (McKinlay & Feldman,
1994). He has lost confidence with erections and intercourse. Sex is filled with
anticipatory anxiety, intercourse as a pass-fail performance test, leading to frus-
tration, embarrassment, and eventually avoidance.
Typically, the woman feels confused, abandoned, and unsure whether to
blame herself, you, or the relationship. Approximately one in three couples
stops being sexual between 60 and 65 and two in three between 70 and 75. This
is preventable if you adopt the mantra of desire/pleasure/eroticism/satisfaction
in your 50s (ideally in your 30s).
Male sexual socialization emphasized that a “real man is able to have sex with
any woman, any time, in any situation”. What made a man a man was sponta-
neous erections and perfect intercourse performance. This mistaken notion has
oppressed men across generations and cultures. Those who challenge this de-
mand are belittled as “wimps”, “inadequate”, “not man enough”. Few men have
the awareness and courage to challenge the perfect individual sex performance
model, especially not with male peers. The psychologically healthy man accepts
broad-based couple sexuality. This is especially true if you are committed to a
satisfying, secure, and sexual relationship.
57
T he N ew S exual M antra
Sex as a Team Sport

A core concept is that the essence of couple sexuality is giving and receiving
pleasure-oriented touching. Sexuality is a team sport, not an individual perfor-
mance. Sexual desire involves intimacy, pleasuring, and eroticism. Sex is best
when you approach it as intimate and erotic allies. Why is sexuality as a team
sport so hard to accept? In part, it’s because as adolescents and young adults,
sexual socialization is so different for males and females. A major reason is the
oppressive and destructive male-female double standard. As people age, espe-
cially after 40, and in a married or partnered relationship, there are more psy-
chological, relational, and sexual similarities than differences. The over-learned
double standard damages the sexuality of women, men, and couples. Yet, it is
difficult to confront and change. The adolescent/young adult learning must be
challenged as you grow as intimate and erotic friends.
Desire
Desire is the core dimension of healthy sexuality. The key to desire is positive
anticipation and that you deserve for sexuality to energize your relationship.
Desire is facilitated by freedom, choice, pleasure, and unpredictable scenarios
and techniques.
Males learn about sexual desire in a very different way than females. Sexual-
ity is an integral component of being a man. Sex is associated with spontaneous
erections, intercourse, and orgasm. Most males begin masturbating between
10 and 14 and are orgasmic daily or every other day. The typical male will ex-
perience orgasm during couple sex between 15 and 21 whether through manual
stimulation, intercourse, or oral stimulation. Men have less fear of pregnancy,
contracting an STI, and don’t worry about their reputation – it is women who
are labeled “sluts”. A sexually active man is a “stud”.
This works for adolescent and young adult males, although we do not believe
that it is a healthy developmental learning. It does not serve the adult man, es-
pecially after age 40 and in a relationship.
Rather than pretending that gender stereotypes are true of all males, let
us examine common positive and negative learnings about desire/pleasure/
eroticism/satisfaction. Remember the crucial gender guideline – there are
more psychological, relational, and sexual similarities than differences. It is not
true that men and women are a different species.
Desire is the core factor in healthy sexuality. Women experience more de-
sire problems than men. Sexual dysfunction, especially erectile dysfunction
and ejaculatory inhibition, causes secondary low desire. This results in avoid-
ance of partner sex. When couples stop being sexual whether at 55 or 75, it is
almost always your choice, made unilaterally and conveyed non-verbally. You
have lost confidence in erections, intercourse, and orgasm. Sex is frustrating
58
and embarrassing. You are stuck in anticipatory anxiety, performance anxiety

focused on intercourse as a pass-fail test, and frustration and shame eventually
leading to sexual avoidance. You say to yourself, “I don’t want to start some-
thing I can’t finish”.
Desire is the focus of the new mantra, specifically desire for pleasure-oriented
touch. For both men and women, touch and emotional awareness lead to
sexual desire. Rather than male spontaneous arousal (erection) driven by fan-
tasy and visual stimuli, the new understanding is “responsive male sexual
desire”. Unlike the focus on spontaneous erection as the “right’ or “natural”
way to experience desire, this sophisticated, nuanced approach to desire re-
flects similarities between men and women and recognizes the multiple roles
and meanings of sexuality. With aging, “responsive male sexual desire” is an
empowering strategy.
Desire includes psychological, bio-medical, and social/relational factors.
You can promote or subvert desire. Desire is an active, complex process which
waxes and wanes, but is resilient.
Desire is facilitated by positive anticipation, intimacy, and touching.
A core psychological factor that promotes desire is feeling that you deserve
sex to be positive in your relationship. Desire is facilitated by choice, freedom,
and unpredictable scenarios and techniques. Unfortunately, desire is easy to
kill. Psychological factors that negate desire include performance pressure, co-
ercion, fear of negative consequences, anger, guilt, anxiety, routine, and the
demand that all touching result in intercourse. It is a challenge to keep desire
vital and resilient as well as being sure sexual poisons stay out of the system.
Bio-medically, this includes that anything which is good for your physical
body is good for your sexual body. In addition to good health, this includes
behavioral habits of sleep, exercise, eating, no smoking, and moderate or no
drinking. It is not aging which subverts desire, but the side-effects of medi-
cations (especially hypertensive and anti-depressant medications). Poor behav-
ioral health habits – loss of sleep, lack of exercise, unhealthy eating, obesity,
smoking, alcohol or drug abuse – interfere with sexual desire and function (this
is true for both men and women). Illness and disability do not stop desire, but
do alter sexual function.
Socially and relationally, attitudes, values, and expectations have a major im-
pact on sexual desire. A core factor is whether you value a satisfying, secure,
and sexual relationship. For example, movies seldom feature marital sexuality;
“hot sex” involves pre-marital or extra-marital couples. Hot sex is new, dra-
matic, illicit, and idealized. Marital sexuality where intimacy and eroticism are
integrated in a secure bond is ignored. It is crucial for maintaining desire to
turn toward each other as intimate and erotic allies. Sexual desire cannot be
taken for granted nor treated with benign neglect. Maintaining strong, resilient
desire is an individual responsibility and a couple challenge.
59
Communication, loving feelings, and intimacy are emphasized with the false
assumption that these automatically generate sexual desire. In relationships,
whether married or partnered, straight or gay, the challenge is integrating in-
timacy and eroticism. Traditionally, there has been a gender split where men
valued eroticism and women valued intimacy. This split subverts sexual de-
sire. Strong, resilient desire is facilitated when both partners value intimacy
and eroticism.
Pleasure
The second component of the new mantra is nondemand pleasuring. This in-
volves sensual and playful touch both inside and outside the bedroom. Pleasur-
ing is a crucial dimension of sexuality whether it proceeds to intercourse or not.
This is a core concept in the broad, flexible approach to couple sexuality. Of
course, pleasuring can be a path to arousal, intercourse, and orgasm. However,
intercourse is not the sole or even chief function of pleasuring.
Sensuality is the foundation for sexual response and a facilitator of sexual de-
sire. Sensual touch involves non-genital massage, cuddling on the couch while
watching a DVD, touching when going to sleep or on awakening, giving and
receiving back or foot rubs. On a 10-point scale of sexual pleasure where 0 is
neutral and 10 is orgasm, sensual touch involves 1–3 levels of sensations and
feelings.
Playful touch involves both genital and non-genital pleasuring, 4–5 on the
subjective pleasure scale. Examples of playful touch include whole-body mas-
sage, touching while bathing or showering, romantic or erotic dancing, and
games like strip poker or Twister. Playful touch is seductive and energizing. It
has value in itself as well as a bridge to arousal and intercourse.
Nondemand pleasuring validates the role of touch for both attachment and
sexuality. Pleasuring reinforces touch as a core component of desire as well as
promoting unpredictable sexual scenarios. Touch can have a number of roles,
meanings, and outcomes.
Pleasure (as opposed to performance) validates touch. Sex is not a pass-fail
test of erection or orgasm; sexuality is sharing pleasure-oriented experiences
with a range of outcomes. Foreplay is a one-way experience of preparing the
woman for intercourse. Performance-oriented foreplay subverts desire. A
pleasure-orientation involving giving and receiving touch is a bridge for desire.
Eroticism
Erotic scenarios and techniques can be a confusing and controversial aspect
of couple sexuality. On the pleasure/arousal scale, erotic touch involves feel-
ings and sensations in the 6–10 range. A crucial strategy is to transition to
60
intercourse at 7 or 8 rather than rushing to intercourse as soon as you are erect

or she begins lubrication. You can enjoy the erotic flow of manual, oral, or rub-
bing stimulation, allowing it to culminate in orgasm.
Eroticism is different than pleasuring, complementary, not oppositional.
Eroticism involves taking personal and sexual risks, creativity, intense emotions
and sensations, mystery, unpredictability, and vitality. Nondemand pleasuring
is sensual and playful, warm and sharing. Eroticism is explicitly sexual-intense
and lustful, embracing erotic flow, intercourse, and orgasm.
Eroticism involves three arousal styles:
1 partner interaction arousal

2 self-entrancement arousal
3 role enactment arousal.
These are three very different ways of experiencing eroticism (Mosher, 1980).
Partner interaction arousal is the most common. This involves giving and
receiving erotic stimulation. It is the arousal pattern shown in R-rated movies.
It is an erotic extension of the “give to get” pleasuring guideline. One partner’s
arousal plays off the other’s erotic responsivity. Partner interaction arousal is
illustrated by the adage “an aroused partner is the major aphrodisiac”. Some
couples only use partner interaction arousal; others also use self-entrancement
and/or role enactment arousal.
The second most frequent pattern, especially as people age, is self-entrancement
arousal. The key to self-entrancement arousal is taking turns – one is the giver,
the other the receiver. Self-entrancement arousal is very different than you doing
foreplay (where she is passive and dependent). In self-entrancement arousal, you
are mindful and focused on feelings and sensations. Couples, especially with ag-
ing, utilize self-entrancement arousal on a regular basis.
Self-entrancement arousal emphasizes the receiver (whether the woman or
man) being relaxed, taking in pleasure, being open to and mindful of erotic
feelings, allowing you to enjoy erotic sensations with the freedom to let go and
orgasm. Some couples switch roles during an erotic encounter, others transition
to intercourse at high levels of erotic flow, and still others enjoy an erotic, asyn-
chronous orgasmic experience. Self-entrancement arousal is positive for the
giving partner even though less erotically intense. Self-entrancement arousal
confronts the “tyranny of mutuality” – not all sex has to be serious, intimate,
and mutual. Self-entrancement arousal is an integral component of your sexual
relationship.
Role enactment arousal receives by far the most attention in sexuality books
and internet sites. The essence of role enactment arousal is bringing some-
thing external to your sexual repertoire. This can involve sex toys (blindfold,
vibrator, paddle, dildo, handcuffs), x-rated videos, playing out an erotic fantasy,
61
being sexual in front of a mirror, taping a sexual scenario, using fetish material,
or sex while cross-dressed. The Emotionally Expressive couple sexual style is
most amenable to role enactment arousal. The couple sexual styles where it is
not a good fit are Traditional and Best Friend (couple sexual styles are described
in Chapter 11).
Some couples find that role enactment arousal enhances their sexual rep-
ertoire. It spices up your relationship and adds an unpredictable, vital di-
mension. However, we are concerned that the way role enactment arousal is
promoted intimidates rather than empowers couples. For example, porn vid-
eos can serve as a bridge to sexual desire or an erotic charge to orgasm. Porn
works best when both partners recognize that erotic fantasy is very different
than real-life couple sexuality. Erotic fantasies and scenarios are charged be-
cause they are different from real-life couple sexuality. In the great majority
of cases, what charges an erotic fantasy is totally different than your actual
sexual experience. In many cases, playing out an erotic fantasy results in a
sexual “dud” rather than an erotic high.
The message of porn is the crazier the scenario, the more erotic it is and the
crazier the woman, the more erotic she is. This causes women to fear eroti-
cism whether from a video or on the internet. She worries that this is what her
partner wants and she cannot measure up to this crazy, erotic woman. What is
the reality? Erotic fantasies, images, videos, and scenarios are all about fantasy
and not about what the man wants from a real-life woman with whom he has
an intimate relationship. It is worth repeating – erotic fantasies/videos are a
totally different dimension than real-life couple sexuality. This is true for men
and couples. It is an “apples-oranges” comparison which has no real meaning or
importance.
What is the essence of eroticism and what is its importance? Eroticism is
an integral dimension of couple sexuality. Eroticism allows you to experience
arousal, erotic flow, intercourse, and orgasm. Sexual pleasure naturally flows
to eroticism and orgasm whether with partner interaction, self-entrancement,
or role enactment arousal. Eroticism enhances sexual vitality and energizes
your bond.
Satisfaction
Does orgasm = satisfaction? No, satisfaction is much more than orgasm. You
can have a satisfying sexual experience even when you and your partner are not
orgasmic.
The essence of satisfaction is reinforcing feelings about you as a sexual person
and feeling bonded and energized as a sexual couple. Orgasm is an integral com-
ponent of healthy male, female, and couple sexuality. However, when orgasm is
a pass-fail individual performance test, this subverts satisfaction.
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The essence of satisfaction is feeling good about yourself personally and as

a couple. Pleasure, eroticism, and orgasm are positive, integral components
which enhance satisfaction.
Satisfaction is a complex phenomenon involving cognitive, behavioral,
physical, emotional, and value components. Satisfaction involves different
dimensions – from highly satisfying and meaningful to good to okay. It is pos-
sible to be orgasmic yet feel alienated. More commonly, you do not have an
orgasm yet feel emotionally bonded. In fact, sometimes the sexual experience is
more satisfying for the non-orgasmic partner than the orgasmic partner.
One of the most neglected components of sexuality is afterplay. Afterplay is
an integral component of couple sexuality. Afterplay facilitates satisfaction. You
have just shared an intense physical experience; satisfaction is enhanced when
you share an involved afterplay experience.
The most common afterplay scenario is warm and cuddly. There are a range
of possible emotions and scenarios. Afterplay can be playful or intimate, serious
or light-hearted, verbal or non-verbal, involve a glass of wine or a snack, lying
together, sitting and reminiscing, or your unique way of sharing.
Can or should afterplay be a prelude to a second sexual encounter? Yes, but
only if both partners are open to an erotic or intercourse scenario. One reason
people avoid afterplay is the fear that it will be misinterpreted as a sexual ini-
tiation. The majority of afterplay experiences are to share, bond, and enhance
satisfaction, not a second sexual encounter.
Is sex sometimes better for one partner than the other? Not only is that nor-
mal, but it is true for the majority of sexual encounters. Almost all couples pre-
fer mutual, synchronous sexual experiences where both enjoy desire/pleasure/
orgasm/satisfaction. However, among happily married, sexually functional
couples, this ideal scenario occurs less than half the time (Frank, Anderson, &
Rubinstein, 1978). This does not mean that the sex wasn’t satisfying (more than
85% of sexual experiences are positive). Asynchronous sex means that it wasn’t
equally positive. A key to sexual satisfaction is awareness that it is normal for
sex to have different roles and meanings (including in the same encounter) for
each partner. The foundation for sexual satisfaction is positive, realistic expec-
tations. Often, there are differences in psychological, physical, and relational
satisfaction – that too is normal and healthy.
Exercise – Implementing the New Mantra

This exercise asks you to make personal and concrete the mantra of desire/
pleasure/eroticism/satisfaction. This is both an individual and couple exer-
cise. Whether your relationship has existed for 1 or 40 years, each person
describes when each dimension was most positive. Usually, it is different
63
for each dimension. Often, the partner has a different remembrance. For
example, people remember desire being highest in the first few months,
pleasuring best in the present, eroticism best when on vacation, and satis-
faction best when you feel emotionally understood and accepted.
Be specific and concrete; share attitudes and feelings. Some find it easier
to write about sexual dimensions and others to speak about sexuality. The
important thing is to own your experience and share it with your partner
so she “gets it”. What do you value sexually and what makes a sexual ex-
perience satisfying for you? This exercise requires courage to be transpar-
ent and vulnerable. Don’t be vague, politically correct, shy, or inhibited.
Allow yourself to be sexually known by your partner. This enhances trust
in yourself, your partner, and your relationship. It is especially important if
your sexual feelings and experiences are atypical or “socially undesirable”.
One of the most interesting and challenging aspects of being a sex ther-
apist is listening to the range of people’s feelings and experiences about
what makes a sexual experience special. Let us explore examples from
the pleasuring dimension. There are common scenarios such as being in a
bath with a glass of wine, receiving a whole-body massage with a sensual
lotion, mutual stroking while dressed in a sexy outfit, a 20-minute back
massage while listening to your favorite jazz tape. Examples of atypical
erotic experiences include being on a nude beach with people admir-
ing your bodies as you seductively play with each other; going to a sex-
themed motel where there are mirrors and scented candles; being sexual
at 2 am under the Christmas tree; “making out” for an hour in a car
parked by the lake as the sun goes down.
Identify special experiences for each dimension. This is not a matter
of “right-wrong” or proving something to yourself or your partner. Be
open in sharing sexual feelings and experiences. Perhaps the most val-
uable learning is that the desire/pleasure/eroticism/satisfaction dimen-
sions were experienced at different times and in different ways. Another
critical learning is that your partner’s experiences and what she prefers
are different than yours. Sexuality is complex and individualistic. You are
not clones of each other, a motivating and empowering concept.
The second part of this exercise is even more important. What are
positive, realistic goals to enhance desire/pleasure/eroticism/satisfac-
tion? Do not set romantic, Hollywood goals or crazy, porn goals. What
goals are you committed to personally and as a couple? Desire is the core
dimension. A common desire goal is to increase the frequency of sen-
sual and playful touching with the hope that these become a bridge to
sexual desire. This makes personal and concrete the concept that touch
64
(nondemand pleasuring) is the key for responsive sexual desire. Does this
work in your relationship? Do you enjoy nondemand pleasuring for itself
as well as a bridge to intercourse?
Do these strategies and techniques facilitate your desire? If not, find
sources for desire which are a good fit for you.
Let’s explore atypical sources for sexual desire. An example is planning
a special erotic date. It can involve you watching the children in the after-
noon so she can get a pedicure or a massage. Instead of going home, she does
something she enjoys whether a swim, kayaking, shoe shopping, meeting a
girlfriend for a drink, reading a romance or erotic novel. If it’s she who usu-
ally arranges for a babysitter, you contact the sitter and take care of logistics.
Instead of the usual dinner, movie, and home for sex, do something different.
Rent a hotel room from 7 to 10 with sex before and/or after dinner. Go danc-
ing and later be sexual in the car in a safe, secluded place. Go to a sex store
and purchase a sex toy to use after taking the babysitter home. Some couples
find these scenarios elicit desire, others find only one does (the others are
turn-offs), while other couples design their unique scenario.
Whether focusing on desire/pleasure/eroticism/satisfaction, this exercise
encourages you to implement scenarios and techniques to promote vibrant,
satisfying sexuality that has a 15–20% role in your life and relationship.
Arousal, Intercourse, and Orgasm

People read this chapter and find it interesting, but come back to a basic
question – What about arousal, intercourse, and orgasm? Isn’t that the essence
of sexuality (especially for you)? Are desire/pleasure/eroticism/satisfaction just
the politically correct words? Doesn’t it all come down to whether sex works or
not? Meaning old-fashioned arousal, intercourse, and orgasm.
Let us be clear – we are in favor of arousal, intercourse, and orgasm. And,
yes, most sexual experiences involve those components. But, no, this is not the
essence of couple sexuality. Couples have functional sex which neither energizes
your bond nor promotes desire. The new mantra, with its emphasis on desire
and satisfaction, is motivating and reinforcing. Pleasuring often transitions to
arousal, intercourse, and orgasm. Yet, nondemand pleasuring has value in itself.
Erotic sexuality is vital and energizing whether it leads to intercourse or not.
Asynchronous (including one-way) eroticism can enhance desire and satisfaction.
Let us explore this from a different perspective. Mutual, synchronous sexuality
involving arousal, intercourse, and orgasm is the most highly valued. However,
if that is the only acceptable sex, it will subvert desire. By its nature, couple sex-
uality is variable and flexible, with a number of roles, meanings, and outcomes.
Couple sexuality is much more than arousal, intercourse, and orgasm.
65
Rebecca and James

James and Rebecca were a religious, socially conservative couple in a 32-year
marriage. For the first time in 26 years, they were a “couple again” after they
launched their last child into college. The “empty nest” phase is a myth for most
couples. The majority find the “couple again” phase an impetus for personal,
relational, and sexual satisfaction. For 70% of couples, sexual satisfaction goes
down at the birth of a first child and does not go up again until the last child
leaves home. This does not mean that Rebecca and James regretted having three
children. Although stressful at times and reducing opportunities for couple and
sexual time, they enjoyed parenting and were proud of their five-person family.
In the couple again phase, James and Rebecca had an opportunity to em-
brace desire/pleasure/eroticism/satisfaction after 32 years of marriage. Like
many couples in their 50s, they had fallen into the pattern of sex once a week,
usually late on a Saturday night. Sex was functional but not special. The sexual
encounter was a routine of five minutes of foreplay, five to seven minutes of
intercourse, and two to three minutes of afterplay. Good, but not vital.
Rebecca lobbied James to come to a session with her individual therapist (she
hoped that this would lead to couple therapy). James agreed to meet Rebecca’s ther-
apist (he wanted to see who she was as well as give the therapist a better idea of
who he was as a person and spouse). During a subsequent session, the therapist told
Rebecca that meeting James was valuable. He was much different than the image the
therapist had of a “closed down” man. James suggested that he and Rebecca commit
to a six-month effort to enhance their emotional and sexual relationship. If that was
not helpful, he was open to couple therapy. One effect of that consultation was Re-
becca’s therapy refocused on her individual issues. The therapist encouraged Rebecca
to value James, their marriage, and couple sexuality. The trap for a woman in indi-
vidual therapy is to blame the husband and marriage for most, if not all, problems.
James and Rebecca were committed to improving their relational and sexual
lives. She missed feelings of attachment and sexual desire. James had largely ig-
nored these issues because of worry about not having spontaneous erections and
concern about maintaining his erection. He feared a humiliating intercourse fail-
ure. Rather than enjoying the pleasuring/eroticism process, James rushed inter-
course because he worried that he would lose his erection and let Rebecca down.
James and Rebecca had a predictable sexual pattern. She had been orgas-
mic during intercourse, especially when they used manual clitoral stimula-
tion with his or her fingers. With decreased foreplay, rush to intercourse, and
worry about erection, sex was less fun. Rebecca was orgasmic less than a third
of the time. James saying “what’s wrong” made the situation more tense and
performance-oriented. Although erectile failures were infrequent, fear hung
over their sexual relationship. Neither was having fun sexually.
Unknown to Rebecca, James had consulted their internist to obtain a Viagra
prescription with the hope that this would restore reliable erections. When
66
James was subjectively aroused and in an erotic flow, Viagra did ensure main-
taining his erection. However, he subverted the positive Viagra vascular effect
by rushing intercourse. Negative motivation (fear of erectile dysfunctional or
female genital pain) subverts couple desire and pleasure.
Rebecca wanted to focus on intimacy and nondemand pleasuring. James wor-
ried that this would decrease sexual frequency and increase erectile anxiety – a
fear that was not verbalized and Rebecca was unaware of. This is a common
dilemma for couples regardless of age.
Rather than falling into the traditional intercourse power struggle, Rebecca
made an insightful suggestion. Each read the same material (a short article)
about desire/pleasure/eroticism/satisfaction. They shared feelings and ideas
about how to enhance their sexual relationship. This reading and discussion
helped James and Rebecca speak the same language about intimacy, touching,
and sexuality.
A crucial factor was their commitment to rekindle sexual desire. They built
anticipation, felt they deserved to enjoy sexuality at this time in their lives, took
advantage of the freedom of when and how to be sexual, and moved away from
the performance pressures of erection and intercourse. They put fun, pleasure,
and unpredictability into their sexual relationship. Rebecca wanted James to
turn toward her as his intimate sexual ally rather than feel that he had to per-
form for her and fear disappointing her.
The nondemand pleasuring encounters included a commitment to not rush
intercourse. Rebecca would initiate the transition to intercourse when she felt
subjectively aroused and into an erotic flow. James was open to multiple stimu-
lation during intercourse. Rebecca liked giving and receiving stimulation, espe-
cially clitoral stimulation. He valued kissing and testicle stimulation. The entire
sexual encounter, including intercourse, was engaging and vital. Pleasuring and
erotic flow enhanced orgasmic response.
Afterplay had been routine. Now afterplay was involving, meaningful, and less
predictable. Sometimes, it was warm and cuddly, other times fun and silly, and
occasionally intimate and bonding. Not all sexual encounters had to be mutual.
The vibrancy of desire/pleasure/eroticism/satisfaction was markedly improved.
Rebecca and James were committed to couple sexuality in their 60s, 70s, and 80s.
Summary
The new mantra of desire/pleasure/eroticism/satisfaction is valuable to men,
women, and couples. You speak a common language about sexual feelings and
scenarios as well as the roles and meanings of sexuality. Especially important is
the recognition of female-male sexual similarities. Although not clones of each
other, both value desire/pleasure/eroticism/satisfaction. Desire is the core di-
mension and is best approached as a couple issue.
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8
A DULT SEXUALI T Y
A New Model of Masculinity
This is one of the most important and challenging chapters. What does it mean
to be a healthy sexual man in 2021?
The dual challenges are to build your sexual self-esteem and develop a couple
sexual style which integrates intimacy and eroticism. Maintain sexual auton-
omy while being an intimate sexual team.
It is crucial that you confront the traditional model of masculinity which
emphasized perfect sex performance, total control, and sex as a pass-fail test.
The challenge of the new male sexuality model is to embrace a positive, realistic
approach which affirms the value of pleasure, consent, and sharing as intimate
and erotic allies. Sexuality is a couple process of sharing pleasure. Value erec-
tions, intercourse, and orgasm, but you do not need to prove that you are a man.
A core concept is being a “wise man” who makes psychological, relational, and
sexual decisions which promote pleasure and satisfaction. Your partner is your
intimate and erotic friend whether sex was wonderful, good, mediocre, or dys-
functional. The wise man adopts the Good Enough Sex (GES) model and rejects
the individual perfect performance approach.
In adopting the new model of male sexuality, it is necessary, but not suffi-
cient, to confront the traditional double standard. It is a one-two combination
of confronting the old model based on control and performance and creating a
new model of masculinity based on acceptance and pleasure. This is healthy for
men, women, couples, and the culture.
Confronting and Changing the Traditional Model

of Male Sexuality
Why is it so hard to change the traditional male model? Traditional roles
are easy to understand and there is tremendous pressure from male peers
and the culture to prove that you’re a “real man”. This is particularly true
sexually. Male sexual socialization reinforces the message that male sex is
natural and superior. Masculinity and sexuality are closely associated. The
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A dult S exuality
emphasis on testosterone, spontaneous erection, easy intercourse, reliable

orgasm, and meeting performance demands is a given. The most important
factor is “autonomous” sexual response. You need nothing from your part-
ner in order to function sexually. The message is that sex is simple and to-
tally predictable. Women are complex, but not men. This simplistic belief
is scientifically wrong and harmful to men, relationships, and the culture
(Zilbergeld, 1999). Yet, it is widely accepted. Men are afraid to challenge the
traditional view because they will be labeled weak, wimps, not man enough,
or “feminized”. The truth is just the opposite. It takes courage to say to peers
that the traditional approach to masculinity is oppressive and unhealthy. It
requires self-acceptance to advocate for a new model of masculinity based on
the diversity of men rather than a rigid performance approach. Feel genuine
pride in being a self-accepting man rather than maintain a contingent sexual
self-esteem based on a false sense of power and control.
Genuine sexual self-esteem is based on the belief that sex is a good thing in
life, that sexuality is an integral dimension of being a man, and you accept your-
self with your sexual strengths and vulnerabilities rather than denying vulner-
abilities and not questioning sexual demands. It is very important to not allow
shameful sexual secrets.
We advocate core guidelines for being a proud, self-accepting sexual man.
Accepting yourself as a first-class man allows you to accept your partner as a
first-class woman. You are intimate and erotic allies rather than adhering to
the traditional split between intimacy and eroticism. You honor intimacy and
pleasuring in addition to eroticism and intercourse. Intimacy and pleasuring
are valued, not seen as “feminine”. This model of male sexuality is humanistic
and comprehensive, not subverted by a narrow definition of masculinity. This
approach motivates and empowers you to be an accepting, healthy human being.
Challenges to Implementing the New Model of

Male Sexuality
The biggest challenge to implementation is overcoming fears of change. The
traditional model was clear and simplistic. The new model is complex, individ-
ualistic, and requires awareness and acceptance. The new model is healthy for
men, women, couples, and the culture. It promotes psychological, relational,
and sexual well-being. It recognizes gender similarities, affirms pleasure, inte-
grates intimacy and eroticism, and accepts the multiple roles, meanings, and
outcomes of couple sexuality. You are proud to be a sexual man. Rather than
male sexuality as superior, accept the female-male sexual equity model. This
requires dropping the double standard. The biggest challenge is giving up the
need for autonomous sexual performance and replacing it with awareness of
variable, flexible couple sexuality with a focus on pleasure. Totally predictable
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A dult S exuality
erection, intercourse, and orgasm were the basis of the myth of male superior-
ity. Men fear giving up control and superiority.
The fact that GES ensures being sexual with aging has little appeal for a
30-year-old man who enjoys sex without self-consciousness. The majority of
men will not transition to GES until they have a “sensitizing” sexual experience.
This means that he does not get or maintain an erection sufficient for intercourse.
Typically, this occurs in his 30s or 40s, but can occur in adolescence or not until
his 60s. This does not mean that he has erectile dysfunction (ED). After a sensi-
tizing experience, you become more aware and a better lover. You enjoy couple
sexuality more. Most men do not return to autonomous sex performance. You
learn to value variable, flexible couple sexuality. The joke is that if sex was
only about arousal and orgasm, men (and women) would masturbate and avoid
couple sex. Sexuality becomes intimate, interactive, pleasure-oriented, and
couple-oriented with aging. Your partner’s stimulation and arousal is arousing
for you. She is your intimate and erotic friend. The essence of the new male and
couple sexuality is sharing pleasure, not individual performance.
This sounds inviting and liberating, so why is it so fearful? It is different than
the way you learned to be sexual in adolescence and young adulthood. You
give up control and total predictability for a more human and satisfying couple
sexuality.
A good example is dealing with erectile anxiety. The bio-medical approach
is in keeping with traditional male sexuality. You turn to a stand-alone medical
intervention whether Viagra, penile injections, or testosterone. You are search-
ing for a miracle cure which returns you to autonomous sex performance. This
is self-defeating. In the new model of male sexuality, you are open to using all
your resources to build erectile comfort and confidence. Your major resource
is your partner who is your intimate and erotic friend. If you use medical inter-
ventions, these are integrated into your couple sexual style. You adopt GES ex-
pectations rather than sex as an individual pass-fail performance. GES attitudes,
behavior, and emotions confirm the new male sexuality.
These challenges are also true in the psychological and relational realms.
Your self-esteem is not based on being superior to the woman. Self-esteem
is based on owning your authentic sexual self with vulnerabilities as well as
strengths. Roles are not split by traditional gender rules, but are determined
by your interests and skills. It is not a hierarchy where men are in control – the
new model advocates equitable sharing. It is okay if she is more mechanical than
you. It is okay if she is a better financial manager. It is okay for you to get on
your hands and knees to play with your child. It is masculine to change diapers.
Implementing these changes requires awareness and dialogue.
A particularly sensitive issue is money and decision-making. In the tradi-
tional double standard, the man made more money and had the power to make
major decisions. A core guideline in the new model is that power, money, and
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A dult S exuality
decision-making are shared based on interests, skills, preferences, and reality

factors. Themes include complexity vs. simplicity and dialogue vs. assumptions.
The fear is that men (and women) will feel confused and overwhelmed, result-
ing in poor decisions, poor relationships, and chaos.
The new model of masculinity emphasizes finding the “right fit”. We suggest
personally relevant “guidelines” not simplistic “rules”.
These concepts are particularly challenging in regard to sexuality. Most
men under 40 choose to stick with the male performance model, although we
strongly believe that the new model is superior whether at 25, 35, or 55. Ac-
cepting yourself as a man who values your partner is important even when your
sex function is autonomous. Accept the complexity of GES, including meanings
and outcomes of couple sexuality, even when your sexual response is highly
predictable. The new model of masculinity and sexuality is healthier and more
human. Ideally, it is adopted as a young adult rather than waiting for a problem
to occur. Primary prevention is always preferable. This is in your best inter-
est psychologically, relationally, and sexually. Adopt a self-acceptance model of
male sexuality.
Ian and Alexa

Ian was the first member of his family to earn a graduate degree. He grew
up in a working-class family in a small city. He was proud of his family and
community roots. His father was a factory worker who, like his peers, expe-
rienced a great deal of economic turmoil. Father told Ian and his siblings that
to maintain a good standard of living would require advanced education and
skills. Ian’s older brother was trained as an electrician and older sister was a
college-educated nurse.
Ian was nine years old when his mother was killed in an accident caused by a
drunk driver. Memories of his parent’s marriage were positive, but their mari-
tal and parental roles were governed by a strict double standard. Father was not
prepared to be a single parent or manage the household, especially cooking for
the family. Unfortunately, he quickly remarried a woman who had her agenda
which did not include being a nurturing parent for Ian. Ian planned to be a fully
functioning adult, not trapped in the rigid male role. This included learning to
cook and manage a home.
Sexually, Ian was eager to date and be involved with girls. His older brother
married at 21 because of a pregnancy. They worked hard to establish a secure
marital bond and family. His sister took advantage of her nursing training to
be a successful IUD user and had a four-year relationship before marrying. Ian
appreciated the guidance and advice of both siblings, but had to be his own per-
son. As a college junior, Ian enrolled in a human sexuality class. There were 35
females and 5 males in the class. Male friends teased him about why he needed
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A dult S exuality
to take the class. Ian was the only cisgender heterosexual male with mainstream
values in the class.
Ian felt supported by the academic material and by female peers. He wanted
to do more than question the traditional male role; he wanted to carefully
and comprehensively explore what it meant to be a “new man”. He affirmed
the female-male sexual equity model. Ian appreciated the emphasis on female
empowerment, but did not like that class members of both genders engaged
in “male bashing”. Relationships are not a “zero-sum” game. Men do not have
to lose for women to win. Both genders benefit from the female-male equity
model. You join forces in confronting unwanted pregnancy, STIs, sexual abuse,
rape, and sexual harassment. There is nothing inherent in the male role which
is destructive for women or relationships. This generated dialogue and conflict
which challenged Ian to be a strong spokesman against toxic male sexuality.
More important was to be a spokesman for healthy male and couple sexuality.
The foundation for healthy sexuality is consent and pleasure, a value shared by
both genders.
A measure of psychological well-being is integrating healthy attitudes, be-
haviors, and emotions. Academic learnings made it easier to implement this in
his life. This class was a turning point in Ian’s young adult development.
Ian had a double major in economics and computer technology. He wanted to
be successful professionally and economically. Being successful psychologically,
relationally, and sexually was also a high value. Ian was a diligent student who
was involved in internships and special projects. During college, he avoided
the “hook-up” culture, preferring sexual friendships which lasted one or two
semesters. He took his sister’s advice about establishing his life before consid-
ering marriage.
Ian was 26 when he began dating Alexa who was 27. They met during a
volleyball tournament. Alexa came from a college-educated upper-middle-class
family. She was ambivalent about her life organization. She wanted a work-life
balance and worried that being a litigation associate in a large law firm was
not the right fit for her. She eventually wanted marriage and children, but first
needed to decide on a career path.
The group went on a weekend hike followed by a beer and pizza party (Ian
and Alexa chose to skip the party). Instead, they went with two friends to a
small bistro. As they talked about careers, they realized that although in dif-
ferent fields, they had a lot in common. Feeling proud and successful was im-
portant for both as was defining self-esteem as more than job and money. Ian
enjoyed the field of economic analysis and wanted a career where he was in
control of the type and quantity of work. He knew people who had 80-hour
work weeks – Ian wanted a career with a 50-hour work week. At this point,
Alexa worked 80 hours. Although intellectually stimulating, she did not feel
passionate about the litigation field.
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A dult S exuality
There was a clear attraction. They didn’t want to immediately have sex, de-
ciding to proceed in a conscious manner. During the next three weeks, they
communicated by phone and text. They scheduled a hike close to Ian’s favorite
small town and made reservations at a B&B. This was a romantic, sexual week-
end. Both Ian and Alexa had experienced the limerence phase in earlier rela-
tionships. From the beginning, Ian knew that this relationship was special. Sex
is not the most important dimension in their relationship, but sexuality was
vital and energizing. Alexa owned her sexual voice and was enthusiastic about
sharing intimacy and eroticism. She didn’t expect Ian to make her orgasmic.
She joyfully shared eroticism and orgasm with him. If she didn’t like something
in a sexual scenario (for example, Ian had always enjoyed playing with a wom-
an’s hair), she let him know and shared what she did find pleasurable.
After the limerence phase, it takes most people three to six months to de-
velop a couple sexual style of desire/pleasure/eroticism/satisfaction. Ian knew
that this was a healthy relationship – it was easy to talk sexuality while hiking
and to play out sexual scenarios whether in the bedroom or camping under the
stars. This integration of intimacy, pleasuring, and eroticism was the goal he
established in his college class.
A healthy relationship brings out healthy parts of each person. It gave Alexa
the courage to leave her law firm and join a quality boutique firm focused on
business succession planning. This was an appealing area of law and a good way
to help clients avoid litigation. Ian was pleased that they would be a two-career
couple. The marriage limited his ability to transfer cities, but allowed him to be
a successful economic consultant.
Their hardest decision involved children. In marriage, there are many is-
sues couples need to negotiate. The three core issues are children, money, and
where to live. Of all the decisions, the child decision is the hardest to change.
It is easier to switch jobs, houses, even marital partners. When the child is five,
you can’t decide not to parent. Children are a couple’s decision. In the double
standard, it was the woman’s decision because child-rearing was her domain. In
the new model of masculinity, contraception, pregnancy, and raising children
(including sex education) are a shared domain.
Both Alexa and Ian wanted children. Sex with the goal of pregnancy is an
aphrodisiac. She was glad to be free of the IUD. They were fortunate to become
pregnant after only three months. They enrolled in prepared childbirth classes.
Ian was present at the birth of their daughter (and four years later the birth of
their son).
For the majority of couples, sexual frequency and satisfaction goes down at
the birth of the first child and doesn’t rebound until the last child leaves home.
The “empty nest” syndrome is a misnomer. The “couple again” phase heralds an
increase in sexual satisfaction. Ian and Alexa committed to “beating the odds” –
balancing parenting, careers, marriage, and sexuality. This is an example of the
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anti-perfectionism, GES approach which requires dialogue, flexibility, and emo-

tional problem-solving. It is a complex, challenging life organization compared to
his father, brother, and peers, but Ian was committed. He was a “wise” man will-
ing to adopt flexible roles which worked short and long terms, emotionally and
practically. Life is less predictable than in the traditional male role, but facilitates
personal, parental, relational, and sexual satisfaction. He valued his career, but
unlike many of his colleagues, life was not defined by his career. Ian was glad that
they had two careers rather than being the primary income earner. Alexa was in
charge of investments, Ian in charge of household expenses and bills.
Ian and Alexa created a very important couple tradition. They vacationed with
friends and extended family, but the most valued time was a four-day-three-night
yearly couple hiking trip. This was Ian’s time to check in with Alexa about per-
sonal, career, family, marital, and sexual issues. Was he maintaining a balanced,
quality life? Was he living out his values as a new man? Ian relied on Alexa to be
honest and confront him if he was falling into psychological, relational, or sexual
traps. There were two hard issues for Ian. First, accepting himself and GES. Ian
was seduced by movies and tv shows which featured dramatic sex. Alexa affirmed
the value of intense sex, especially on their couple weekend, but felt that sexuality
was more genuine and satisfying at home. They felt good about the range of roles,
meanings, and outcomes of marital sexuality. Ian knew that Alexa masturbated
one to two times a month; she treated this as her special sexual time. In contrast,
Ian’s masturbation was for tension reduction.
The second challenging issue involved career and money. Ian’s income was
somewhat less than Alexa’s. He felt ambivalent about this role reversal. He
knew that he could earn considerably more if he committed to a 60-hour work
week, but this would unbalance his life and parenting. He liked the luxury of
two successful careers but was uneasy about passing up prestige and money. Ian
realized that he couldn’t have a “perfect life” and celebrated his balanced life.
He was committed to the female-male equity model. Alexa accepted and valued
Ian and their marriage which made these challenges easier for him to accept.
Vulnerabilities and the New Man

All people have strengths and vulnerabilities. This is a core issue in the new
model of masculinity. Can you be both strong and vulnerable? The message of
the traditional male model was clear – be strong, admit no vulnerabilities. The
message of the new model is emphasize your strengths and accept your vulner-
abilities. Some vulnerabilities can be resolved and turned into strengths. Most
vulnerabilities can be modified. Other vulnerabilities are neither changeable
nor modifiable, accept these and work around them. The wise man implements
the acceptance model and is healthier for it. Barry cites his personal example. A
vulnerability I resolved was fear of public speaking. Now a favorite professional
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activity is presenting all day workshops. A modifiable vulnerability was inability

to cook. When Emily is away, I have two to three dishes I prepare, enjoy going
to ethnic restaurants, and make salads, scrambled eggs, and English muffins at
home. Not great, but functional. An example of a vulnerability I have to accept
and work around is my perceptual-motor learning disability. Although I love to
write, I cannot type nor use computers. This is a major problem and makes me
very inefficient. I regret this vulnerability/disability, but am not ashamed of it.
This vulnerability does not make me less of a man.
The issue of strengths and vulnerabilities is especially important sexually.
In the double standard, the man was not allowed to have a vulnerability (or at
least admit to one). In reality, every man has sexual vulnerabilities. It could
be sexual shyness, premature ejaculation, an idiosyncratic masturbation pat-
tern, a misshapen testicle, uncomfortable talking about sex, feeling unsure of
self sexually, poor at using condoms, embarrassment about genital hair, sexual
anxiety, taking a medication which interferes with sexual response, guilt over
erotic fantasies, overweight, history of sexual trauma, fears about penis size, a
body scar, discomfort looking at partner’s vulva. Should these vulnerabilities
be a shameful secret causing you to have a contingent sexual self-esteem? Abso-
lutely not. Process your vulnerability whether with your partner, best friend,
counselor, physician, or minister. Is it resolvable, modifiable, or do you need to
accept and work around it? Don’t allow your sexual self-esteem to be controlled
by a vulnerability. Play to your relational and sexual strengths, but be aware of
your vulnerabilities. Be sexually self-accepting. Do not be controlled by perfor-
mance-oriented myths about male sexuality.
Exercise – Establishing a New Male Sexual

Model
Psychosexual skill exercises are meant to make concepts real and con-
crete. Exercises challenge you to create new attitudes, behaviors, emo-
tions, and values. This exercise focuses on developing a positive, realistic,
sexual self-esteem.
Do you have a role model for what it means to be a healthy sexual
man? Most of us don’t, but if you do, that’s a great resource. Whether
or not you have a model, your challenge is to clearly and specifically list
what being a new man involves psychologically, relationally, and sexu-
ally. This is not a socially desirable/politically correct exercise, but what
it means to be a proud man with a positive, balanced view of yourself.
Focus on self-awareness and self-acceptance. Psychologically, what is
it about you, your job, home, and values which promote being a proud
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man? Relationally, what is it about your relationship with your spouse

(life partner), friends, children, community which enhance your life?
Sexually, are you pro-sexual and proud of being a sexual man? Do you
value the female-male equity model? Do you value intimacy, pleasuring,
and eroticism? Do you accept GES? Do you turn toward your partner as
your intimate and erotic friend whether the sex was great, good, medi-
ocre, or dysfunctional? Do you accept the mantra of desire/pleasure/
eroticism/satisfaction?
Be sure your answers are truthful and comprehensive, including prob-
lematic and vulnerable components. Choose at least one issue (three at the
most) to change which would enhance your sexual self-esteem? Set a pos-
itive, realistic goal.
Ask your partner to review your answers. Don’t be surprised if your per-
spectives are new to her. This is an opportunity to dialogue about masculin-
ity, sexuality, and your relationship. It is particularly important to get her
input on change plans and how she can support you in reaching those goals.
She has the opportunity to suggest at least one and up to three changes
that would be healthy for you and your relationship. She is your respect-
ful, trusting, and intimate friend who wants to help. Listen respectfully
to her observations and suggestions. You have the option of agreeing,
modifying, or saying no and developing a different strategy or goal. Re-
member, a key to masculinity is valuing your partner and being open to
her positive influence.
The Poison of Male-Female Power Struggles

This chapter, and the entire book, emphasizes a positive approach to men, cou-
ples, and sexuality. A healthy relationship and healthy sexuality enhance your
well-being. Conversely, people caught in power struggles – whether relational
or sexual – find this demoralizing and emotionally painful. Negative emotions –
hurt, anger, anxiety, depression, alienation – subvert you. If your relationship
is controlled by power struggles, our recommendation is sex, couple, or indi-
vidual therapy (suggestions for finding a therapist are in Appendix A). Power
struggles undermine the strategies and techniques we advocate. Seeking ther-
apy is a sign of strength.
Summary
A new view of men and male sexuality is growing in the United States and
throughout the world. You have opportunities for psychological, relational,
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sexual, and physical health that your grandfather and father did not. Yet, with
opportunities come challenges. It is necessary, but not sufficient, to confront
and rid yourself of the individual male performance model and the double
standard. The challenge is to adopt a model based on genuine pride in being
a man, self-acceptance with awareness of strengths and vulnerabilities. Many
men have a contingent self-esteem and a contingent relationship based on a false
sense of control centered on perfect sex performance. The wise man embraces
the female-male sexual equity model and turns toward your partner as your
intimate and erotic ally. The essence of sexuality is sharing pleasure rather than
individual sex performance. The new male sexuality embraces variable, flexible
GES. Create positive, realistic expectations rather than demand perfect per-
formance. A wise man realizes the range of roles, meanings, and outcomes of
male and couple sexuality. If there is a sexual problem, rather than hoping for
a stand-alone medical intervention (Viagra, penile injections, testosterone) to
return you to perfect performance, your partner is your primary emotional and
sexual resource. Celebrate erection, intercourse, and orgasm while realizing
that couple sexuality is inherently variable and flexible. With the new male
sexuality, you need not panic or apologize. The essence of being a healthy man
is acceptance and pleasure.
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9
DESIR E
The Core of Sexuality
The traditional understanding of what makes you a sexual man is erec-

tion, intercourse, and orgasm. The new sexual mantra is desire/pleasure/
eroticism/satisfaction (Foley, Kope, & Sugrue, 2012). Desire is the core
dimension for male and couple sexuality. This is very different than the
traditional approach. Men learn desire as autonomous, manifested by a
spontaneous erection. Desire is easy, predictable, in your control, and most
important – autonomous (needing nothing from the woman). Traditionally,
desire was driven by erotic fantasy, visual stimuli, testosterone, and the
promise of totally predictable sex.
The Masters and Johnson sex therapy model (Master & Johnson, 1970) took
male sexual desire for granted. Therapy focused on premature ejaculation and
erectile dysfunction (ED). Male desire was assumed to be simple and robust,
totally different than female desire.
Low sexual desire and desire discrepancies are the most common sexual
problem couples bring to therapy (McCarthy & McCarthy, 2020). One in three
adult women complains of secondary low desire, i.e. she once felt desire, but
has lost her “sexual voice”. What few health professionals or the public realize is
that when couples stop being sexual, it is the man who causes the relationship to
become non-sexual. The most common cause is loss of confidence in erections
and intercourse. You feel frustrated and embarrassed and say to yourself, “I
don’t want to start something I can’t finish”. Stopping sex is a unilateral choice,
conveyed non-verbally. You unfairly blame the partner which compounds the
relational damage.
Secondary low sexual desire is a common problem for both men and
women, shrouded in secrecy and shame. Its impact is worse for males
because men are not supposed to experience desire problems. The great
majority of male desire problems are secondary. You don’t admit desire
problems to friends, physicians, a minister, and certainly not your partner.
It is easier to admit to premature ejaculation, ED, or ejaculatory inhibition
than low desire.
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Primary Male Desire Problems

Primary sexual dysfunction means that the man has a life-long history of the
problem. Total lack of sexual desire for anyone or any sexual scenario is very
rare. Asexuality is a sexual orientation which impacts less than 1% of males.
The man might want to marry and/or be a parent, but does not value sexuality.
Sadly, he does not tell his partner about his sexual orientation. The woman
deserves to know that asexuality is the core problem. When she learns this, she
usually feels relieved.
Most cases of primary low desire involve a sexual secret. The most com-
mon secret is a variant (atypical) arousal pattern. This includes approxi-
mately 4% of men. The most common secret is a fetish arousal. Sex desire
is very high with fetish materials and fantasies, but low or non-existent
for intimate, interactive couple sexuality. The novelty of a new relation-
ship provides a temporary sexual impetus, but it disappears after weeks or
months. This dramatic change in desire is very confusing for the partner.
The great majority of men do not disclose anything to their partner. The
combination of high secrecy, high eroticism, and high shame controls the
man’s sexuality. Other variant arousal patterns involve cross-dressing and
BDSM (bondage and discipline/sadomasochism). You have a secret sexual
world. Chapter 15 describes the phenomenon of variant arousal more com-
pletely. Unlike asexuality, there is strong desire, but not for couple sex. The
three strategies for dealing with variant arousal are acceptance, compart-
mentalization, and necessary loss. We encourage you to share the sexual
secret so that you can dialogue about how to deal with this problem. The
partner feels relieved to know that she is not the cause of low desire and has
a voice in deciding how to approach the issue.
A second pattern is that you have a high rate of masturbation (20–40 times
a month). You feel sexually confident with masturbation (you are a “A” mastur-
bator), but anxious and uncomfortable with couple sex (you are a “D”). This
is misunderstood as a “porn addiction” because you masturbate using porn.
The core issue is low desire for couple sex and high desire and confidence with
masturbation.
A third pattern is that you have a “shameful secret” involving abuse and
trauma. Few men share this with the partner because you fear her judgment.
Like other sexual secrets, this needs to be disclosed and processed. Most
women are accepting and supportive, willing and able to be your “partner in
healing” (Maltz, 2012).
Sexual orientation issues are another cause of low desire. This is discussed in
detail in Chapter 16.
Primary low desire is usually tied to a sexual secret. Disclosing and process-
ing with your partner and/or in therapy is crucial to address these sexual desire
issues.
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Secondary Male Low Sexual Desire

The great majority of adolescent and young adult men find sexual desire easy
and robust. You experience first orgasm through masturbation or nocturnal
emissions. This builds desire and anticipation for partner sex. The symbol of de-
sire is a spontaneous erection. Although a source of jokes and embarrassment,
it reinforces masculinity. First partner orgasm whether occurring with manual,
oral, rubbing stimulation, or intercourse reinforces desire. Masculinity is tied
to easy and predictable desire. A crucial understanding is that for the great ma-
jority of young men, desire, erection, intercourse, and orgasm are autonomous.
You need nothing from the woman.
Unfortunately, expectations of totally predictable sexual response set you
up to develop secondary low desire, especially after age 40. Spontaneous
erections, visual stimuli, eroticism, and predictable sexual response are not
a solid foundation for male sexual desire. Friends, male physicians, and drug
company reps mislead men into believing that a medical intervention will
magically return you to an intense desire you experienced in adolescence. It
can’t.
The new model of male sexuality is motivating and empowering, but chal-
lenging. The core concepts are valuing your partner as your intimate and erotic
friend; being open to touch to elicit desire rather than depending on visual
stimuli; accepting variable, flexible Good Enough Sex (GES) not sex as a pass-
fail individual performance; expanding your definition of sexuality to include
sensual, playful, and erotic scenarios in addition to intercourse; openness to
his, her, and our bridges to sexual desire; and valuing both synchronous and
asynchronous sexuality. The essence of desire is positive anticipation, feeling
deserving of sexual pleasure, freedom to embrace pleasure-oriented touching,
and unpredictable sexual scenarios and techniques.
Desire is both an individual and couple concept. Rather than returning to
autonomous desire, desire is a couple process focused on touch and pleasure.
The breakthrough concept for women was “responsive sexual desire”. Rather
than expecting desire to be spontaneous and autonomous, when the woman
is receptive and responsive to sensual and playful touch and aware of her (and
your) feelings, she experiences subjective arousal of two, three, or four. That
is when she feels desire. Desire flows from touch and receptivity rather than
desire being the initial cue. Responsive sexual desire is a motivating and em-
powering concept.
“Responsive male sexual desire” is a new and empowering concept, espe-
cially for men over age 50. Responsive desire is not inferior to spontaneous
desire. It reinforces couple sexuality as intimate and interactive. GES and
responsive desire is the foundation for sexuality in your 60s, 70s, and 80s.
Embracing responsive desire is a core strategy for changing male (and female)
low desire.
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Causes of Secondary Low Sexual Desire

The major cause of male secondary low desire is sexual dysfunction, especially ED.
The cycle of positive anticipation, easy and totally predictable erection, and tran-
sitioning to intercourse and orgasm on the first erection, is replaced by the cycle
of anticipatory anxiety, performance anxiety, rush to intercourse caused by fear of
losing the erection, frustration, embarrassment, and eventually sexual avoidance.
ED can be caused by psychological, bio-medical, or relational factors. Commonly, a
combination of factors are in play. Your low desire is controlled by the cognition “I
don’t want to start something I can’t finish”. Over time, ED becomes chronic and
severe. Desire is no longer associated with pleasure; it is controlled by frustration
and failure. Sexual self-consciousness dominates and destroys desire.
A second cause is intermittent ejaculatory inhibition (delayed ejaculation). This
increases with aging, up to 15% of men over 50. You maintain an erection but
are unable to establish erotic flow and reach orgasm. This is misdiagnosed as ED
because eventually you lose your erection. When intercourse lasts more than two
minutes before your erection dissipates, the problem is ejaculatory inhibition, not
ED. You have intercourse the way you did as a young adult focused on thrusting.
If you want sex to be satisfying, you need to increase involvement and stimulation,
specifically multiple stimulation before and during intercourse. Intercourse thrust-
ing is important but is not enough. Multiple stimulation involves receiving (testicle
stimulation, buttock stimulation, and kissing) and giving (clitoral stimulation, anal
or buttock stimulation, and breast stimulation). The most common form of multiple
stimulation for both men and women is private erotic fantasies. Fantasies serve as
a bridge to arousal and orgasm. The majority of men utilize erotic fantasy during
couple sex to enhance erotic flow.
Other causes for secondary low desire include alcohol abuse, side-effects of
medications, fatigue, conflict regarding parenting, routine and mechanical sex,
poor eating and sleep habits, job and financial distress, depression and boredom,
and not valuing marital sexuality. Desire is easy to kill. The good news is that
desire can be revitalized, especially if you adopt GES and a broad-based approach
to intimacy, pleasuring, and eroticism. Identify psychological, bio-medical, and
relational factors which inhibit desire. Schedule a consultation (ideally as a cou-
ple) with your internist or specialist. Use medications which have fewer sexual
side-effects. Improve sleep patterns so you have more energy to be sexual. Have
sex in the afternoon or early evening rather than late at night.
Exercise – Rekindling Sexual Desire

Rekindling sexual desire is one of your best investments to improve psy-
chological and physical well-being. Sexuality energizes your bond and
reinforces feelings of desire and desirability.
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Rather than hoping that your partner will give you desire, a testosterone
patch will restore desire, or something magical will happen – take an emo-
tional problem-solving approach. You are responsible for your desire. This
requires a one-two approach. First, confront and change the factors that “poi-
son” desire. Second, build bridges to desire and use all your psychological,
bio-medical, and social/relational resources to promote desire and pleasure.
Identifying and changing poisons is the easier task. An example of con-
fronting a psychological poison is to masturbate only when your partner is not
receptive rather than masturbating in a secret, compulsive manner. Another
example is identifying thoughts, fantasies, or erotic material which serve as
sexual cues; drop narrow, compulsive, and shameful fantasies. Erotic fanta-
sies are normal and healthy. By their nature, erotic fantasies represent non-so-
cially desirable sexual behavior such as being sexual with a forbidden partner
or engaging in triadic sex. Illicitness provides an erotic charge. Fantasies
which are narrow, compulsive, and shameful poison desire for couple sex.
An example of a bio-medical poison is needing to be drunk or high in
order to feel sexual. Another example is depending on a pill or injection
for desire. Confront bio-medical poisons and break the self-defeating cycle.
Relationally, what subverts sexual desire? One poison is a secret
arousal pattern such as a fetish involving long fingernails. This results
in walling off your partner. You are not sexually present. You need the
fingernails rather than her. A common relational poison is de-erotizing
your partner. She is not your intimate and erotic friend, but a woman
robbed of her sexuality.
Discuss poisons with your partner. What is your partner’s perspec-
tive? Does she have concerns about psychological, physical, or relational
poisons? Be clear and specific about what poisons desire. What can she do
to help you in the change process?
The second phase of this exercise is more challenging. What psycho-
logical, bio-medical, and relational factors can help build desire?
Psychological examples include developing a new initiation scenario
such as joining your partner for a shower or bath or mixing non-genital
touch with a request to “get together”. Another example is buying a pil-
low saying “tonight” on the one side and “rain check” on the other. You
can create a new bridge to sexual desire involving a self-entrancement
arousal scenario where she receives first.
An example of a bio-medical intervention to facilitate desire is you
taking Cialis and she using a Vylessi injection an hour before being sex-
ual. Use that hour to talk and share nondemand pleasuring. Another ex-
ample is being sexual after a nap where you wake to genital stimulation.
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Examples of relational interventions to facilitate desire include tak-

ing a two-mile walk as a couple followed by a shower so you are
fresh for oral sex. Another scenario is coming home to a beer and as
you sit watching the sunset, she stimulates you to orgasm. Meet at
a funky hotel and pay the day rate so you can have an “afternoon de-
light”. Sit and talk for 30 minutes about your intimate relationship.
Make couple sexuality inviting so desire has the space to thrive.
As you review this list with your partner, are the strategies and tech-
niques clear and can you implement them? Do they allow you to feel
desire? Your partner has her perspective and suggestions. Do you ap-
proach desire as a couple issue? Can you work together to rekindle and
strengthen desire?
Is Sexual Desire Really a Couple Issue?

Each person has a right to sexual desire. You partner is not responsible for your
desire. Desire involves a combination of personal responsibility and being an
intimate sexual team. Remember, sex is a team sport.
The traditional male model of spontaneous erection and autonomous desire
confuses the issue and creates the intercourse or nothing power struggle. This
eventually leads to low desire. Desire as a couple issue is empowering for the
man, woman, couple, and culture. You are an intimate and erotic team. Sexu-
ally, you win or lose as a team. You cannot make your partner desirous, but you
can facilitate your desire and your partner’s desire by touching, sexual open-
ness, and responsivity (Nobre, Carvalho, & Mark, 2020).
Be intimate and erotic allies in keeping poisons out of the system and building
bridges to desire. This is even more important when the man is the low desire
partner. She cannot force or cajole you to be sexual. She can help you confront
the poisons which subvert desire and be your sexual friend in rekindling desire.
Do not expect to return to autonomous sex or spontaneous erections. Develop a
new approach to male and couple sexuality. Focus on pleasure and turn toward
your partner rather than hoping a stand-alone medication or a porn video will
restore desire. Be sexually aware, emotionally and physically open, and focus
on giving and receiving touch. Be open to broad-based sexuality which includes
sensual, playful, and erotic scenarios in addition to intercourse. From this foun-
dation, it is easier to be an intimate team who revitalize desire. Men who cling
to the old model stay stuck in a low sex or no sex relationship. The wise man ac-
cepts desire as a couple issue and is ready and able to create vital, resilient desire.
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Henry and Brianna

Forty-seven-year-old Henry had a very common name, but a unique life story.
He came from a working-class double standard family. He was the first to grad-
uate college, earn an MBA, and be an amazingly successful entrepreneur. Three
years ago, he sold his company and is now a semi-retired multi-millionaire.
Henry had been married to 43-year-old Brianna for three years. This was
Henry’s second marriage and Brianna’s third.
Although financially and professionally successful, Henry thought of himself
as a failure. He was the youngest and shortest of three brothers. His brothers
were a “man’s man” – strong and athletic who bragged about sexual prowess.
The oldest brother experienced a pregnancy, marriage, and divorce before age
20. He joined the military and was disabled in a training accident. He has been
divorced twice more and lives on disability payments and part-time work. He
still thinks of Henry as the weak little brother. Sex is his favorite topic for jokes,
often at Henry’s expense. Henry’s middle brother is a heavy-duty driver of con-
struction equipment. He is in a first marriage with three children, but brags
that he’s a “sexual player”. He belittles Henry, saying even though Henry has
more money, he has more sex. Henry’s ex-wife left after nine years and blamed
Henry for the divorce. Brianna feels that Henry was taken advantage of. He still
pays alimony to the ex-wife (even though they had no children). In many areas
of life, Henry was a successful man, but not relationally or sexually.
The problem which brought Henry and Brianna to therapy was his fear that
she would divorce him because of his sexual failings. They had a very different
way of handling conflict. Brianna was vocal with her complaints. When she felt
that Henry was avoiding issues, she would accelerate her emotional demands.
The cycle was clear – Henry ignored conflict which served to increase Brianna’s
emotional intensity. After arguments, Henry would give her a gift as a peace
offering. This further agitated Brianna. She felt that he was trying to placate her
rather than deal with problems.
When they began as a couple, sex was a strength. Brianna fell in love and was
impressed with Henry’s success and financial generosity. She had been very dis-
appointed with both of her husbands, especially ignoring their daughters (one
from each marriage). In contrast, Henry was a solid stepfather, especially to the
19-year-old. He was generous with tuition and college costs, and encouraged
her to be a successful young adult.
Henry viewed Brianna as smart, attractive, and pro-sexual. This was his health-
iest and most satisfying relationship. When she initiated sex, Henry was receptive
and responsive. Brianna was puzzled why 90% of the sexual initiations were hers. In
one way, she found that refreshing but made her wonder what was wrong. Her his-
tory was very different than Henry’s – the only thing the ex-husbands would show
up for was sex. Brianna’s experiences were the opposite of the stereotype – good
sex, bad relationships. She felt that Henry and she had a good marriage and good sex.
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Brianna was pleased that Henry was open to therapy and glad that he valued
her and their marriage. However, Henry’s approach to relational and sexual
problems made no sense to her. How could such a nice, generous man be such
an emotional and sexual avoider? When they started talking about desire issues
two years ago, Brianna had been patient and empathic, but at this point she was
blunt and confrontative.
At the first session, the therapist asked Henry what he wanted relationally and
sexually. He tried, but what came out were not his desires, but his fears. He was
overwhelmed by fear that she would leave him because of sexual failures. Brianna
fought her impulse to attack. She followed the therapist’s guidance in trying to
understand why he was so negative about masculinity and sexuality. A core issue is
that he didn’t feel he deserved sexual pleasure. Henry enjoyed arousal and orgasm –
his problem was desire and pleasure. He felt that she deserved pleasure, but not he.
Henry was controlled by the fear that sexually he was not a real man. Brianna could
not convince him that he deserved to feel good about himself sexually.
What Brianna could do was understand Henry’s vulnerabilities and help him
challenge and change these. His view of masculinity was defined by his broth-
ers’ view of him rather than Henry’s view of himself. He gave others, including
the ex-wife and Brianna, power over sexuality. Henry had a contingent sexual
self-esteem. He was afraid of other’s judgment. Henry was hyper-vigilant about
any negative feedback. This is what drove sexual avoidance and his inability to
initiate or take sexual risks.
As this pattern became clear, Henry realized that he would never allow this
in his professional or financial life. Masculinity and sexuality brought out the
worst in Henry.
The therapist suggested five individual therapy sessions and then couple sex
therapy. Henry needed to develop a positive sexual self-esteem, including find-
ing his “sexual voice”. This would affirm him as a sexual man and create a posi-
tive rather than fearful view of couple sex.
Henry found individual therapy (including readings about male sexuality,
psychosexual skill exercises, and erotic fantasy exercises) of great value. His
view of masculinity and sexual desire was controlled by performance myths,
intimidating expectations, and fear of harsh judgment. Henry had the right to
own his body, sexual experiences, and pleasure. For the first time in his life,
Henry accepted himself as a first-class sexual man.
Henry could turn toward Brianna rather than see her as someone he needed
to prove something to. He need not fear her judgment and rejection.
Henry’s newfound sexual autonomy was appealing. Brianna was open to his
sexual voice, especially sexual initiations. She had the freedom to say no with-
out worrying about intimidating him. She initiated sexual scenarios with confi-
dence that he would tell her if it wasn’t right for him. The power to say no to sex
is crucial in creating desire. Henry’s ability to initiate, play, experiment, and
say no made him an attractive sexual partner. Their sexual experiences were
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D esire
genuine, with each present and involved. They had vital, energizing sex. Just as
important, when the sexual experience was a “dud”, Henry did not apologize.
Brianna no longer felt that she had to tiptoe around Henry. She could say “that
was a bummer” and laugh without fear that he would be devastated.
Henry had a good life and a good marriage. Now he had a good sexual life,
feeling open to a range of feelings and experiences. For the first time in his life,
masculinity and sexual desire had a 15–20% positive role.
The Reality of Adult Sexual Desire

Male sexual desire is complex, not simple. Don’t be intimidated by the myth of
sex with any woman, any time, any situation. You are a proud man who values
your sexuality, not controlled by oppressive performance myths and demands.
A crucial understanding is that male sexual desire is resilient. You don’t need
desire 24 hours a day, 7 days a week. When you feel anxious or sad, fatigued
or experience medication side-effects, have a conflict with your partner or
exhausted from attending children’s events, low desire is normal. The key to
desire resiliency is receptivity and responsivity to pleasure-oriented touch. An-
other key is awareness of sexual stimuli such as a sexy outfit, an erotic fantasy,
an attractive person you see on the street, an R-rated movie, dancing, taking a
shower together. Other keys for desire are being on vacation, the children out
of the house, camping under the stars, taking your partner on a business trip
and enjoying an upscale hotel room. Rather than depending on spontaneous de-
sire, create bridges to desire. Sexuality is an integral part of your life. Be open
to a range of roles, meanings, and outcomes of couple sexuality.
Summary
Men are prone to take sexual desire for granted. This is both a strength and
a vulnerability. Sex is not just for young men, but for middle-years and older
men. Welcoming your partner as your intimate and erotic friend, being open
to her touch, and accepting responsive sexual desire facilitate strong, resilient
desire. The traditional double standard demands male desire; in the long run,
this subverts desire. The new model of masculinity reinforces desire/pleasure/
eroticism/satisfaction. By its nature, couple sexuality is variable and flexible
with a range of roles, meanings, and outcomes.
A key for genuine male desire is to approach sex as a team sport and turn toward
your partner in giving and receiving sensual, playful, and erotic touch in addition
to intercourse. Don’t fall into the trap of demanding spontaneous erection with to-
tally predictable intercourse. That ultimately leads to low desire and giving up sex.
Embrace GES and turn toward your partner whether the sex was wonderful or dis-
appointing. Don’t apologize for sex. Resilient desire is based on openness to touch,
creating bridges to desire, and accepting a range of sexual experiences.
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10
I NTEGR AT I NG I NT I M ACY,
PLEASUR I NG, A ND EROT ICISM
Broad-Based Sexuality
Traditionally, intimacy and pleasuring were the woman’s domain, with eroti-
cism and intercourse being the man’s domain. An easy to understand split, but
destructive for the man, woman, couple, and culture. An important sexual de-
cision is to adopt an integrated intimacy, pleasuring, and eroticism approach to
male and couple sexuality. Being an intimate sexual team promotes desire and
satisfaction. Rather than splitting by gender, value intimacy and pleasuring as
well as eroticism and intercourse. This is crucial for the growth of male sexual-
ity. You are a fully functioning man psychologically, relationally, and sexually.
Broad-based sexuality is healthy for you and your relationship.
Intimacy, pleasuring, and eroticism promote the desire/pleasure/eroticism/
satisfaction mantra. The myth that men don’t need or value intimacy is one of
the most destructive learnings from the double standard. The fear that inti-
macy will “feminize” you is an example of the destructive role of rigid gender
stereotypes. Intimacy is integral to being a sexual man. Needs for intimacy
are core to your sexuality. In a cross-cultural study of couples from six coun-
tries who had been together for more than 20 years, what men most valued
was confidence that the partner “has your back” and feeling secure with your
intimate bond (Heiman et al., 2011). What women valued most was a vital
sexual relationship. This is the opposite of traditional gender stereotypes. Inti-
macy, pleasuring, and eroticism are not split by gender, but are integrated and
shared. Intimacy is about feeling close and secure. You feel accepted for who
you are with psychological, relational, and sexual strengths and vulnerabilities.
Intimacy is a foundation for your relationship and promotes desire, but is not
enough. The old view was the more intimacy, the better the sex. The trap is that
too much intimacy and closeness cause you to “de-eroticize” your partner and
relationship. The challenge for couples, married or partnered, is to integrate
intimacy and eroticism. Find a comfortable level of intimacy which facilitates
rather than smothers sexual desire. How to balance intimacy and eroticism is
a challenging issue for both couples and mental health professionals. Couple
therapists advocate intimacy, while sex therapists advocate eroticism. Women
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BROA D-BASED SEX U A L I T Y
advocate intimacy; men advocate eroticism. This splitting is bad for couple sex-
uality. The issue is finding the right balance and integration. Find the level of
intimacy which allows you to feel open and receptive as well as affirm being a
sexual team.
The second dimension is nondemand pleasuring. In addition to affectionate
touch, pleasuring involves sensual and playful touching. Traditionally, this was
the woman’s domain, not the man’s. Nondemand pleasuring involves subjective
arousal in the 1–5 range. This is valuable for itself. You don’t need erotic stim-
ulation or intercourse to enjoy being a sexual man. Sensual massage and genital
play are affirming. The woman can enjoy pleasure without having an orgasm.
This is a crucial learning for you – value pleasure for itself. Erection is a sign of
pleasure, not a demand for intercourse or an orgasm. Women avoid sexual play
because of the pressure felt when you have an erection. The answer to this par-
adox is simple, enjoy your erection for what it is – a sign of pleasure. Your erec-
tion and her vaginal lubrication is a natural response to pleasure. The core of
nondemand pleasuring is accepting pleasure. This reinforces a major concept –
the essence of couple sexuality is giving and receiving pleasure-oriented touch-
ing. Of course, pleasure can lead to arousal, intercourse, and orgasm. However,
this is not the chief function of pleasure.
The third dimension, eroticism, is the most contentious and can cause con-
fusion and alienation. Eroticism involves intense sensations and feelings in the
6–10 range. Traditionally, eroticism is the man’s domain; the woman’s role is to
promote male eroticism. What nonsense. Like intimacy and pleasure, eroticism
is a shared domain. The issue is how to integrate eroticism into couple sexuality
(McCarthy & McCarthy, 2020). The woman’s role is not to sexually perform
for you, but to find her “erotic voice” and integrate it into couple sexuality.
Integrated eroticism is very different than the porn depiction or the focus on
illicitness and drama. Eroticism is integral to the desire/pleasure/eroticism/
satisfaction mantra. Erotic scenarios are often asynchronous, better for one
partner than the other. As long as the erotic scenario is not at the expense of the
partner or relationship, enjoy it. If it’s a 10 for you and a 3 for her, this is fine.
What is not healthy is if it’s a −3 for the partner.
As with other dimensions of sexuality, mutual, synchronous eroticism is the
ideal. An aroused, orgasmic partner is a powerful aphrodisiac. Eroticism is a
natural extension of the “give to get” pleasuring guideline. Eroticism belongs as
much to the woman as the man.
The Whole Is More than the Parts

Intimacy, pleasuring, and eroticism are three different dimensions. When in-
tegrated and implemented, the whole is more than the parts. It is not a hier-
archy; all three dimensions enhance your sexuality. Not all dimensions need
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to be present at each encounter. For example, you experience a high level of

eroticism, so there is no time for pleasuring. More common is an intimate en-
counter focused on pleasure where eroticism follows. The most satisfying sex
integrates intimacy, pleasuring, and eroticism, but if that were necessary for
each encounter you would have much less sex. This is a complex message, but a
very important one. When all three dimensions are valued, it is easier to accept
a sexual experience where one or two dimensions are missing. A healthy couple
embraces the variability and flexibility of sexuality. Couples with the traditional
intimacy/eroticism split are vulnerable to sexual conflicts and low desire. Each
partner valuing all three dimensions provides a solid sexual foundation. You
have confidence in yourself and your partner. If a dimension is missing from
an encounter, you accept this rather than overreact. An example is the woman
who has two drinks and has a strong reaction to pleasuring which leads to a
powerful erotic response. He enjoys this, but feels strange. He thinks, “Does
she respond more to alcohol than me”? She is confused by your reaction be-
cause she assumes that all men are turned on by female erotic response. Gender
assumptions and misunderstandings subvert the best-intentioned couple. It is
normal to have sexual encounters which are more or less intimate, more or less
pleasurable, more or less erotic. You are not a perfectly functioning sexual ma-
chine nor are you clones of each other. Be aware that intimacy, pleasuring, and
eroticism is not a recipe you need to follow each time nor does it need to be the
same for each partner. Asynchronous sexual encounters (positive but better for
one partner than the other) are the norm, not the exception. There are times
the man craves more intimacy and there are times the woman craves more erot-
icism. This is normal and healthy. Both partners valuing intimacy, pleasuring,
and eroticism is the basis for variable, flexible couple sexuality.
Jeremy and Emma

Jeremy met Emma when he was 32. They have been a couple for more than five
years. He identifies as a non-traditional man both in his job and approach to
women and relationships. He works four to six months at a job site, returning
to his one-bedroom apartment in their small city on occasion. He likes this
lifestyle and saves a significant part of his salary (including travel bonuses). He
does not plan to marry nor have children. When he was 27, Jeremy had a va-
sectomy so did not have to worry about an unwanted pregnancy. Jeremy had
sexual friendships but was not interested in a serious relationship. Sometimes,
the sexual friendship lasted the whole time he was at the job site, but more often
there were a series of short-term relationships – from one night to two months.
Emma was a dental hygienist in a thriving dental practice. She enjoyed her
two-bedroom condo where she had solid friendships and community ties.
Emma valued economic stability and like Jeremy was a saver. She came from a
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chaotic family where her parents, two siblings, and four half-siblings had mul-
tiple divorces. Emma had an eight-year-old niece she was close to, but kept dis-
tance from other relatives. Like Jeremy, Emma had no interest in marriage and
children. Unlike Jeremy, Emma valued a serious intimate relationship. She had
no interest in multiple relationships. She had friends, both married and part-
nered, who engaged in consensual non-monogamy, but that was not for Emma.
She viewed Jeremy as a sexual friend, not as a life partner. Emma was pleased
that Jeremy had a vasectomy.
Relationships change over time. For most dating couples, satisfaction is low-
ered eventually leading to ending the sexual friendship. A sign of a healthy re-
lationship (whether a marriage or life partnership) is that it becomes better over
time, including sexually. Jeremy and Emma felt that their relationship, especially
their sexual friendship, was healthier after five years. Integrating intimacy, pleas-
uring, and eroticism made their relationship more satisfying than in the limerence
phase. Jeremy enjoyed the limerence phase with a new woman, but over time
felt that he was letting her down because their relationship wasn’t moving in the
direction she wanted. With Emma, he found a partner who shared his values of a
sexual friendship, engagement when he was in the city, and willing to travel to his
work site. Emma shared his life organization and not having children.
Jeremy thought of sexuality as a strength. He had good ejaculatory control
which he believed was the key for female sexuality. Jeremy used the woman’s
orgasm as his measure of being a good lover. Emma valued orgasm, but for her
the issue was not length of intercourse. Like many women, Emma could be
orgasmic during the pleasuring phase, during intercourse, or during afterplay.
Like the majority of women, her orgasmic response was variable. She was or-
gasmic in 70–80% of partner experiences.
The intimacy, pleasuring, eroticism model was more easily accepted by
Emma. They were more in synch on eroticism than the other dimensions.
Both enjoyed giving and receiving erotic stimulation. Emma enjoyed mutual
oral sex, while Jeremy preferred taking turns. Emma went with his preference.
When receiving oral stimulation, she wanted two things. First, begin with
manual stimulation and intermix oral stimulation when subjective arousal is a
7. Second, his openness to her touching and moving rather than being passive.
When she is the giving partner in oral sex, she prefers the position where she
is kneeling, him standing, with her setting the rhythm of oral pleasuring. She
enjoys Jeremy verbalizing sexual feelings and saying when he is about to “come”.
She finds ejaculation in her mouth a turn-off, so switches to manual stimulation
before orgasm. This is not a rigid set of rules, but variable guidelines.
The issue of intimacy was challenging. Jeremy’s sexual experiences followed
the traditional role of the woman emphasizing intimacy. Jeremy did not want
to be sexually selfish, but felt no need for intimacy – intimacy was to placate
the woman. Emma disliked feeling that she was being placated; she does not
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want to be viewed as “emotionally needy”. She wants a genuine emotional con-

nection. This meant being a sexual team with intimacy as a shared dimension.
Finding the “right fit” for emotional and sexual intimacy is a couple challenge.
This is not about marriage; it’s about feeling emotionally attached and sexually
valued. When they are sexual, whether at her condo, his apartment, or on a
trip, Emma wants to feel that they are genuinely sharing themselves. Jeremy
saying, “What can I do so you don’t complain”, was the opposite of emotional
intimacy. She wanted a genuine emotional dialogue. For Emma, genuine is the
operative concept. Jeremy had viewed intimacy as a foreign idea; it was a reason
the woman felt hurt and demanding. Ideally, emotional intimacy bonds the cou-
ple; sexual intimacy energizes the couple.
When Jeremy is on a job site, they speak by phone two to three times a week.
They meet for a long weekend once a month. She wanted to know whether that
level of intimacy fit for Jeremy. This was a question he had never asked himself.
What was the right balance of autonomy and intimacy for him? He was so used
to feeling controlled by the woman’s intimacy needs that he ignored his own inti-
macy preferences. He did not want a marital commitment, but now felt open to a
genuine intimate relationship. He particularly valued that “Emma has my back”.
Jeremy was proud to balance autonomy and their relationship. He respects that
Emma has a life of her own – career, friends, condo, financial independence. The in-
cident that strengthened their relationship was her support when he injured his back
in a work accident. Emma urged him to return home and consult a rehabilitation
medicine specialist rather than the general practitioner the company wanted him to
see. Emma accompanied him to the appointment and picked him up after physical
therapy. She urged him to use all his resources to ensure a full recovery. Jeremy
trusted Emma to listen and give feedback on the rehab program. Jeremy feels he is
a better, healthier person with Emma in his life. In addition, they developed a new
sexual scenario so that he could enjoy sex without back stress.
The hardest dimension for Jeremy was nondemand pleasuring. This was not
part of his sexual socialization. Women focused on pleasure, not men. Jeremy
viewed foreplay as strictly for the woman. Pleasuring made no sense to him and
had no role in his approach to sex.
Learning to value pleasuring for himself as well as a couple was a major
breakthrough. Emma had a central role in advocating for nondemand pleasur-
ing. Emma disliked “foreplay” where she was passive. A key to Emma’s recep-
tivity and responsivity is giving and receiving touch. She wants Jeremy to be
actively involved in the pleasuring process rather than the controlling partner.
A benefit of nondemand pleasuring was that it confronted routine, predict-
able sex. Emma enjoyed playful scenarios without the demand that it end in
intercourse. She enjoys his erection rather than feel pressured by it. Emma sug-
gested that at least once a month, they have a playful date with a prohibition on
intercourse and orgasm. At first, Jeremy felt that was silly and unnecessary, but
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found this a special experience. Nondemand pleasuring is something Jeremy

has learned to value.
Jeremy and Emma committed to a life partnership. They emphasize a satisfy-
ing and sexual relationship as more important than relational security. Jeremy
knows too many married men who complain about the spouse and marriage.
Emma has too many friends with “stable” relationships, but did not feel “secure”.
Secure means you value your partner and the intimacy of your relationship.
Stable means you stay together for convenience, continuity, children, finances,
social norms, but do not feel valued relationally or sexually.
Jeremy was proud that he and Emma had grown as a couple. They value
intimacy, pleasuring, and eroticism. Sex has a 15–20% role of energizing their
bond and reinforcing feelings of desire and desirability.
Integrating Intimacy, Pleasuring, and Eroticism

into Your Couple Sexual Style
We emphasize guidelines rather than sexual rules. This is particularly true for
the integration of intimacy, pleasuring, and eroticism. Each couple develops their
unique way to integrate these dimensions, often changing over time. Intimacy and
pleasuring take a more important role as the couple mature. You want eroticism to
be vital whether you’ve been a couple for 1 or 50 years. Some couples emphasize
intimacy, others emphasize eroticism; some emphasize pleasuring. Be sure all three
dimensions remain present. The traditional male trap is downplaying pleasuring.
The traditional female trap is downplaying eroticism. The most common trap is the
gender split between intimacy and eroticism. This split is overlearned in adolescence
and young adulthood. It does damage to men, women, couples, and the culture.
An advantage of integrating intimacy, pleasuring, and eroticism is having a shared
language and a shared value. It allows you to confront the “intercourse or nothing”
myth. It provides three distinct ways to feel connected and be present. Men and
women are not clones of each other, but are allies who embrace intimacy, pleasuring,
and eroticism. The challenges are different by gender. The goal is finding common
ground so you experience enhanced humanity and sexuality. Intimacy, pleasuring,
and eroticism are particularly challenging for men, but also particularly rewarding.
They facilitate male sexuality which is more human and genuine. In addition, they
promote a broad-based approach to desire and satisfaction, especially with aging.
Exercise – Implementing Intimacy,

Pleasuring, and Eroticism
This exercise asks you to take responsibility for your sexuality and clearly
define what you value about intimacy, pleasuring, and eroticism. This is
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a challenge because intimacy and pleasuring have traditionally been the

woman’s domain, not yours. Let’s begin with intimacy. What type and
degree of intimacy fit your needs (rather than your partner’s)? For you, is
emotional and sexual intimacy different? Does sexual intimacy enhance
emotional intimacy? Does emotional intimacy enhance or inhibit sexual
desire? Be clear, specific, and genuine; do not give socially desirable an-
swers. Does it matter if you are the one initiating an intimate encounter?
Next, focus on your preferences for nondemand pleasuring. This in-
cludes affection, sensual, and playful touch. Is your preference mutual
touching or taking turns as giver and receiver? How often do you want
pleasuring to be a bridge to arousal and intercourse – 20%, 40%, 60%,
80%, or 95%? If you have an erection during pleasuring, do you rush to
intercourse or can you accept the erection for itself? Do you enjoy pleas-
uring clothed, semi-clothed, or nude? What is the meaning of pleasure
for you? What are your partner’s preferences for pleasure?
What does eroticism mean for you? Is eroticism valuable for itself or as
a bridge to intercourse? Do you prefer partner interaction arousal/erot-
icism, self-entrancement arousal/eroticism, or role enactment arousal/
eroticism? What is your favorite synchronous erotic scenario? What is
your favorite asynchronous erotic scenario? Does your partner know
what you value about integrated eroticism?
Share learnings with your partner. What is her feedback about your ap-
proach to intimacy, pleasuring, and eroticism? What are her perceptions
and suggestions to enhance intimate, pleasurable, and erotic sexuality?
This exercise illustrates that what initially sounds like an easy concept
is in fact multi-dimensional and challenging. It is such a different approach
to being a sexual man than the traditional double standard. Be sure that
intimacy, pleasuring, and eroticism fit personally and relationally.
Broad-Based Masculinity vs. a Narrow

Approach to Masculinity
This new model of being a sexual man and broad-based masculinity opens you
to a human, genuine understanding. It promotes acceptance and valuing male
and couple sexuality. The disadvantage is that it’s more complex and challeng-
ing than the old model and is not supported by male peers. The old model was
simple and required little thought or dialogue. In truth, it was narrow, unrealis-
tic, and oppressive. You kept doubts, questions, and fears to yourself. Barry re-
members a client saying, “What matters in life is making as much money as you
can, having as much sex as you can, and being strong and independent-I know
93
who I am”. This narrow view of masculinity negates your humanity and choice
in expressing who you really are. The traditional approach leaves no space for
doubt, vulnerabilities, doing something non-traditional, or the courage to say
no. It gave fears and stereotypes inordinate power, especially in regard to sex-
uality. Sex was a simple pass-fail performance that left no room for intimacy
and pleasuring.
The new model of masculinity is based on acceptance of the reality and com-
plexity of being a man. An example is receiving fellatio. The myth is that all
men love being fellated to orgasm, want to ejaculate in the woman’s mouth,
and want her to swallow your semen as a sign of submission. Fellatio is viewed
as erotic sexuality with the man dominant and the woman subservient. Is that a
turn-on for all men? Absolutely not. We estimate that one in five men does not
enjoy fellatio to orgasm, but would never say that to the woman and certainly
not to male friends because you fear being judged. The traditional view of mas-
culinity does not give you the right to your sexual feelings and preferences. You
are trapped in an intimidating, rigid role.
The challenge of the new masculinity is to be your authentic sexual self. This
includes your approach to intimacy, what you value about nondemand pleasur-
ing, and preferred erotic techniques and scenarios. When you are open about
who you are, your partner is likely to be open about who she is. Women feel
pressured by traditional masculinity which treats her as a second-class citizen.
She is blamed for any and all sexual problems. The new masculinity frees men,
women, couples, and the culture. This is especially true of integrated eroti-
cism. Both value the integration of intimacy, pleasuring, and eroticism.
Summary
Intimacy, pleasuring, and eroticism are separate dimensions, but are best when
integrated and valued by both partners. The whole is more than the parts. The
challenge is to identify for yourself what degree of intimacy promotes sexual an-
ticipation and desire. Contrary to cultural myths, more intimacy is not better.
A key is to balance intimacy and eroticism. Another key is to confront the tradi-
tional male (eroticism)-female (intimacy) split. Men have a need for an intimate,
secure relationship. Women have a right to enjoy integrated eroticism and her
“erotic voice”. Nondemand pleasuring is a core factor in a healthy relationship.
You and your partner decide what type of pleasuring and what type of eroticism
are the right fit.
Both partners valuing intimacy, pleasuring, and eroticism promote strong,
resilient sexual desire and couple satisfaction.
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11
DEV ELOPI NG YOUR COUPLE
SEXUAL ST YLE
The Autonomy/Couple Balance
Sex therapy brings two major contributions to the relationship field. First,
psychosexual skill exercises to enhance sexual comfort and confidence. Second,
the importance of creating a couple sexual style (which is often different than
your relational style). This chapter focuses on your couple sexual style.
There are two components of your couple sexual style. First, maintain your
sexual autonomy (“sexual voice”) while being an intimate sexual team. Second,
how you integrate intimacy and eroticism into your relationship. This is dif-
ferent than your relational style which focuses on dealing with differences and
conflicts. Your relational style involves how you organize your life as a couple,
while your sexual style focuses on the 15–20% role of healthy sexuality.
The primary couple sexual styles (by frequency) are:
1 Complementary (mine and ours)

2 Traditional (conflict minimizing)
3 Best Friend (soul mate)
4 Emotionally Expressive (fun and erotic).
Each sexual style has strengths and each has vulnerabilities (traps). We urge
you to adopt a sexual style that meets his, her, and our needs and preferences.
Reach a mutual agreement on which couple sexual style is the best fit and then
modify the style so that it meets your needs and preferences (McCarthy &
McCarthy, 2009).
A common power struggle is that the man wants the Traditional sexual
style and the woman wants the Best Friend style. The Complementary sexual
style is the choice for the majority, but not all, couples. Sexually, one size
never fits all.
We describe each couple sexual style focusing first on strengths and then
vulnerabilities. Choose the sexual style which is the best fit for your feelings,
preferences, and values. Enjoy the strengths of your chosen style while moni-
toring traps so they don’t subvert couple sexuality.
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D eveloping Y our C ouple S exual S tyle
Complementary Couple Sexual Style

The reason this is the most common sexual style is that it fits the therapeutic
model of each person taking responsibility for your sexuality while being an in-
timate sexual team. Both the man and woman value intimacy and eroticism.
In addition, you have “his”, “hers”, and “our” bridges to sexual desire. Comple-
mentary couples are not clones of each other. Both value pleasuring, eroticism,
intercourse, and afterplay. You affirm the value of both synchronous and asyn-
chronous sexual scenarios. Acknowledge the multiple roles and meanings of sex,
including a shared pleasure, a means to reinforce attachment, a tension reducer,
and to conceive a planned, wanted child. In addition, sex affirms attraction, a
“port in the storm” when dealing with difficult parenting or financial issues, en-
ergizes your bond so you can deal with emotional conflicts, or provides comfort
after the death of a sibling. Your sexual style acknowledges the inherent variabil-
ity and flexibility of couple sexuality. The Good Enough Sex (GES) approach is
easily compatible with the Complementary couple sexual style.
There are several potential vulnerabilities (traps) of the Complementary sexual
style. The major one is treating your sexual relationship with benign neglect. This
results in lowered desire and satisfaction even if sex remains functional. Another
vulnerability is too much routine and predictability. The Complementary sexual
style welcomes partner interaction and self-entrancement arousal scenarios. Role
enactment arousal is more challenging to incorporate. A vulnerability is feeling re-
sentful that the promise of an equitable sexual relationship was not met.
A satisfying sexual relationship requires continual awareness and energy.
Don’t treat your Complementary sexual style with benign neglect – sexuality
cannot rest on its laurels.
Traditional Couple Sexual Style

This is the most stable sexual style. You adopt traditional roles. Initiation is the
man’s domain with an emphasis on intercourse frequency. Intimacy and affec-
tion is the woman’s domain. There is little sexual fighting and no need for sexual
dialogue – each partner is clear about your very different roles. Traditional sex-
ual couples tend to be religious, family-oriented, and benefit from community
support. Same-gender friends make jokes about the foibles of the opposite sex
but are supportive of marital security. Paradoxically, this is the couple sexual
style which most easily accepts a non-sexual relationship with aging, especially
if you maintain an affectionate attachment.
There are several vulnerabilities with the Traditional couple sexual style.
The most common is that sex roles become rigid, causing isolation and alien-
ation. You believe that she does not value sexuality, especially intercourse. As
you age and deal with illness, including side-effects of medications, you are not
able to be sexually functional without her stimulation. Sadly, you turn away
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rather than toward her. The trap for the woman is resentment because your
need for intercourse overrides her need for intimacy and affectionate, sensual,
and playful touch. She loves you and feels loyal to the marriage, but does not feel
that you’re an intimate spouse nor does she value couple sex.
Another trap is dealing with infertility. Rather than seeing infertility as a
medical issue where you support each other, infertility is viewed as god’s pun-
ishment for past sexual transgressions. Even though religious Catholics, Jews,
Protestants, and Mormons are not supposed to have extra-marital affairs, this
occurs, including to happily married couples. Traditional couples find it hard to
recover from an affair (especially the woman’s affair).
In dealing with difficult issues such as infertility or affairs, you are urged to
seek professional help and stay away from the traps of shame or feeling that this
is god’s punishment.
Best Friend Couple Sexual Style

When we wrote about couple sexuality years ago, we said that the Best Friend
sexual style was superior. This is what mental health professionals believed at
the time. We thought the Best Friend style would be the best fit for most cou-
ples. How wrong we were. The Best Friend (also called soul mate) sexual style
has great strengths, but even greater vulnerabilities. The Best Friend relational
style is usually the best fit, but not the Best Friend sexual style.
The biggest strength of the Best Friend sexual style is that you share intimacy
and eroticism. Your partner knows your strengths and vulnerabilities and loves
and accepts you. This is affirming. If something goes wrong sexually, you trust
your partner “has your back”. You enjoy mutuality and support. You reinforce
the value of intimacy and touching.
The Best Friend sexual style has major vulnerabilities. There is so much in-
timacy that you de-eroticize each other. Mutuality is so crucial that you don’t
take personal or sexual risks. Thus, there is less sexual initiation and frequency.
It is easier to be warm and cuddly than erotic and sexual. Best Friend couples
experience the most difficulty recovering from an extra-marital affair. They
stay stuck in feelings betrayal. Couples fall into the Best Friend sexual style be-
cause they mistakenly believe that if this style fits relationally, it should fit sex-
ually. The Complementary couple sexual style is a better fit for most couples.
Emotionally Expressive Couple Sexual Style

This is the fun and erotic sexual style. People envy Emotionally Expressive sex-
ual couples because they make their own rules, are filled with sexual energy,
and have the most resilient sexual relationship. For example, they bounce back
from an affair – they cry, yell, and have sex. They are the couple most likely to
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have a non-traditional life organization, enjoy role enactment arousal, and have
a consensual non-monogamy agreement.
The Emotionally Expressive sexual style has the largest number of potential
vulnerabilities, especially being less secure. Even though they are resilient, after
recovering from the fourth affair, you feel emotionally worn out. The biggest
vulnerability is breaking emotional and sexual boundaries. People are vulnerable,
especially when fighting about sex, nude, in bed, lying down, after a negative
sexual experience. When hurt, angry, or drunk, people say harmful things that
are long remembered. An example is the man saying, “You pulled a sexual bait
and switch-if I knew who you really were, I never would have married you”. Or
the woman saying, “If you can’t keep it up why do you bother to stay alive”? The
partner apologizes the next day, but this does major harm to self-esteem and your
relationship. The best time to talk about sex is dressed, sitting, the day before
being sexual, and a clear request of what you want to sexually try the next time.
The guideline is to play to the strengths of your chosen sexual style and be
sure to not fall into traps. Your chosen couple sexual style allows sexuality to
have a 15–20% role in your relationship – energizing your bond and reinforcing
feelings of desire and desirability.
Mitch and Sarah

When they married four years ago, Sarah and Mitch were a loving, enthusiastic
couple. After four years and one child, it was unclear whether they would be
able to stay married. Rather than sexuality having a positive role, it was a major
problem, a 50–75% draining role which threatened the marriage.
Mitch and Sarah had a wonderful beginning as a romantic love/passionate sex/
idealized (limerence) couple. Sex was special and energizing. Both sexual quality
and frequency were excellent. This began to change after six months of living to-
gether, occurring five months before the wedding. As they shared their lives and
negotiated emotional and practical details, including wedding planning, “magical”
sex disappeared. The biggest issue was a common struggle – initiation patterns
and intercourse frequency. Rather than a fun coming together, Mitch pushed sex
almost every day. Sarah felt pressured and did not like being in the role of saying
no. She did not want to be the sexual gatekeeper. She hoped that this pattern
would change after the wedding, but instead the cycle intensified. Was it Mitch’s
fault, Sarah’s fault, or was there something wrong with them as a couple?
Sarah looked forward to the honeymoon in Hawaii, hoping that it would
break the problematic sexual cycle. Sadly, the honeymoon made the intercourse
frequency problem worse. They argued every day. The two times they had in-
tercourse, it was fine for Mitch, but not for Sarah, and both felt disappointed.
Sex with the goal of becoming pregnant was fun, but the conflict over inter-
course frequency continued during the pregnancy and became worse after the
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baby was born. Mitch and Sarah were excellent parents and valued many aspects
of their lives, but were not an intimate sexual team.
Over the past eight months, Sarah was thinking more about divorce. Mitch did
not want a divorce, but tired of daily masturbation being his sexual outlet (in the
past year, they’d had intercourse three times and no other sexual touch). Sarah
did not feel sexual desire with Mitch, but was increasingly attracted to other men.
Sarah’s sister did an extensive internet search and found a well-respected,
pro-marriage sex therapist. They e-mailed the therapist who responded that she
was willing to meet with Mitch and Sarah.
At the initial session, it was clear that Sarah and Mitch were a demoralized cou-
ple who turned away from each other. This is typical for couples in a non-sexual
marriage. The clinician was not discouraged. She empathized with them about
how demoralizing it was to go from being a loving, sexually vibrant couple to a
non-sexual, alienated couple. She recommended that they commit to a six-month
therapy contract with the goal of creating a marital bond of respect, trust, and
emotional commitment. A crucial issue was developing a new couple sexual style.
Sarah was motivated by the therapist’s willingness to see them and especially
her optimism that like three of four couples they could rebuild couple sexuality.
Mitch was hopeful because the clinician was experienced and suggested realistic
goals rather than promising a return to the magical sex of the first year.
Sex therapy requires focus and energy by both the couple and the clinician.
There are five clients (dimensions) for the therapist to attend to: (1) Sarah,
(2) Mitch, (3) their relationship, (4) their sexual relationship, and (5) the most
difficult client – their emotional and sexual history.
A major challenge in working with Mitch was his anger at Sarah for blaming
him for the sexual problem. The clinician noted that Mitch couldn’t change the
past, although he could learn from the past. Mitch needed to focus on the pres-
ent and future and realize that low desire was the joint enemy. In her individual
session, Sarah committed to focus on the marriage rather than allow herself to
be diverted by an affair – including an emotional, unconsummated affair.
The challenge for Sarah was to find her sexual voice and rebuild positive
anticipation – the core of sexual desire. A particularly empowering psychosex-
ual skill exercise was Sarah having the power to veto a sexual scenario. Mitch
honored her veto. Rather than go away and sulk, Mitch and Sarah developed a
trust position where she put her head on his heart, he stroked her hair, and they
were mindful of feelings of safety and attachment. This was a powerful healing
experience, especially for Sarah.
An important understanding is that you do not have the freedom to say yes
to sex unless you have the power to say no. You trust your partner will respect
your veto. Her emotional needs are more important than your sexual wants.
Rather than turning away, Mitch and Sarah would turn toward each other in an
affectionate, sensual, or erotic manner.
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The majority of couples in therapy choose the Complementary couple sex-

ual style. Sarah and Mitch read about sexual styles, took a self-administered
questionnaire, and discussed their sexual attitudes, experiences, feelings, and
values. In retrospect, they understood the conflict – Mitch assumed that they
would have a Traditional sexual style, while Sarah assumed that they would have
a Best Friend sexual style. This misunderstanding and difference in assumptions
almost guaranteed a power struggle. The “good-bad” struggle about sexual de-
sire and frequency was unintended. The desire problem had not been caused by
negative motivations or hidden agendas.
Sarah and Mitch (with the therapist’s guidance) approached the issue of their
couple sexual style from a positive knowledge base. Both were committed to
finding a sexual style that fit them.
Sarah made it clear that she valued both intimacy and eroticism and realized
how important it is to have her sexual voice. Mitch committed to intimacy and
nondemand pleasuring. Each partner had preferences for sensual, playful, erotic,
and intercourse scenarios. They developed afterplay scenarios which increased
emotional and sexual satisfaction, even when the sexual encounter was mediocre.
Mitch and Sarah embraced the Complementary couple sexual style and in-
tegrated that with the Best Friend relational style. This provided a solid foun-
dation for a respectful, trusting, intimate marriage from which to welcome a
planned, wanted second child. Sex with the goal of pregnancy is an aphrodisiac.
Rather than taking their marital bond and sexual relationship for granted,
Mitch and Sarah committed to a relapse prevention program. They agreed to
attend six-month follow-up sessions for two years to be sure that changes were
maintained and generalized. In addition, they set a new couple sexual growth
goal for the next six months. If the relationship ran into a problem or they were
concerned about a relapse, they would call for a “booster session”. They had
come too far psychologically, relationally, and sexually to allow a relapse.
Couple Discrepancies in Sexual Desire

You are not clones of each other, especially not sexually. There will be differ-
ences in what you value about intimacy, pleasure, and eroticism. Contrary to
popular belief, these are not governed by traditional gender stereotypes. There
are many men who value intimate sexuality. There are many women who value
sexuality generally and erotic sexuality specifically.
Focus on yourself and your partner – your attitudes, behaviors, emotions,
and values are more important than gender stereotypes. Be clear and specific
about sexual feelings, especially what promotes desire.
An important guideline is don’t fall into the pursuer-distancer trap. A sexual
power struggle over intercourse or nothing is in no one’s best interest. One of
the reasons American couples have intercourse only a bit more than once a week
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is that they only have two dimensions (gears) – affection and intercourse. They
ignore sensual, playful, and erotic touch.
In dealing with differences, focus on sexuality as an intimate team experi-
ence of sharing pleasure. Discussing the value of touch and attachment opens
partners to affectionate, sensual, playful, and erotic touch in addition to inter-
course. Touch is an invitation to connection rather than a demand for inter-
course. An empowering guideline is to enjoy touch both inside and outside the
bedroom without the expectation that touching must lead to intercourse. Many
women dread the man’s erection because the erect penis is viewed as a demand
for intercourse or at least an orgasm. Welcome your erection as a sign of pleas-
ure rather than a sexual demand.
Sexual desire is enhanced by freedom, choice, and unpredictability. Implement
this into your couple sexual style. It is easiest for the Complementary style. For the
Traditional and Best Friend styles, this needs to be explicitly stated and behaviorally
implemented. This results in more sexual experiences because it allows her freedom
to enjoy intimacy and touching rather than being afraid of turning you on unless she
wants intercourse. The key to implementing this guideline with the Emotionally
Expressive couple is to celebrate playfulness and unpredictability.
Exercise – Discovering Your Couple Sexual

Style
Choosing the right sexual style is a very important decision. It will affect
your relationship and couple sexuality for years. Be honest with yourself
and your partner. Discuss the following questions:
1 How important is sex in your life? How important is having a satis-

fying, secure, and sexual relationship?
2 What is your preferred way to express affection – hand holding,
kissing, or hugging?
3 What is the difference between affectionate touch and sexual touch?
4 Do you value sensual, non-genital touch? Do you prefer taking turns
or mutual touching?
5 What is the meaning and value of genital pleasuring? Do you ex-
perience this as playful or is it always oriented toward arousal and
intercourse? Do you have a favorite playful scenario? Do you enjoy
mixing sensual and genital touch?
6 Do you value erotic scenarios and techniques that do not lead to inter-
course? Do you prefer manual, oral, or rubbing stimulation? Do you
enjoy multiple stimulation or one focused stimulation? Taking turns
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or mutual stimulation? Using external stimuli (sex toys, erotic videos,

playing out a fantasy)? Do you enjoy erotic sex to orgasm or is eroticism
a prelude to intercourse?
7 Do you view intercourse as a natural extension of the pleasuring/
eroticism process or a pass-fail performance test? Do you transition
to intercourse as soon as possible or wait until you experience erotic
flow? What is your preferred intercourse position? What types of
thrusting do you enjoy? Do you value multiple stimulation during
intercourse?
8 How much do you value afterplay? What afterplay scenarios and
techniques enhance sexual satisfaction?
9 What is the preferred balance of your sexual voice (autonomy) with
being an intimate sexual team?
10 How do you integrate intimacy (closeness, loving feelings, warmth,
security, predictability) with eroticism (creativity, mystery, intense
sensations, taking emotional and sexual risks, unpredictability)?
Share your feelings and preferences. Discuss areas of agreement and dis-
agreement. In developing a comfortable, pleasurable, erotic, and satis-
fying couple sexual style, you need to take personal responsibility and
share sexuality.
In choosing among the four couple sexual styles – Complementary,
Traditional, Best Friend, and Emotionally Expressive – which affirms
your sexual voice and allows you to be intimate and erotic friends?
Each partner states the one or two couple sexual styles which would
be a good fit as well as one or two which are not right for you. This is not
an analytic problem-solving process, but an attitudinal/behavioral/emo-
tional commitment of who you are as a sexual person and a sexual team.
Ideally, both partners choose the same couple sexual style. When
there is no agreement, engage in an exploration of why the couple sexual
style you prefer would be a good fit. Do not fall into the demand/attack
mode. Share the key dimensions of your sexual voice, what you value
about being a sexual team, and your preferred way to integrate intimacy
and eroticism. Listen empathically and respectfully to your partner’s
emotional and sexual preferences. This process increases understanding
and empathy. Your intimate relationship is based on a positive influence
process, with a commitment to not engage in power struggles. Find a
genuine common ground, so sexuality has a 15–20% role in energizing
your bond. Individualize components of your chosen couple sexual style
so that sexuality uniquely fits your relationship.
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Monitoring the Vulnerabilities of Your Chosen

Couple Sexual Style
Each couple sexual style has vulnerabilities (traps). Individually and as a couple,
commit to not failing into traps. An advantage of having chosen a sexual style
is that you don’t have to monitor all the traps, only the ones relevant for your
sexual style.
The Complementary couple sexual style has many strengths which is why
it’s the most chosen. The biggest vulnerability (trap) is complacency – you take
sexuality for granted and “rest on your laurels”. Rather than devoting thought,
energy, and communication so that your sexual style remains vital, sex becomes
routine and stale. To address this vulnerability, each partner commits to in-
troducing one new scenario each year. It could be a new pleasuring lotion or
sequence, a new erotic scenario or technique, a new pattern of multiple stimu-
lation during intercourse, a new intercourse position or thrusting rhythm, or a
new afterplay scenario. Each partner initiates something new (at least two new
sexual scenarios a year). This ensures that couple sexuality remains vital and
satisfying.
The prime vulnerability for the Traditional couple sexual style is that the
roles become rigid. Specifically, as the man ages and your ability to function
autonomously is lessened, you become self-conscious and anxious. The trap for
the woman is she resents that her needs for intimacy and touch are overridden
by your need for intercourse. The suggested intervention is that once every six
months, you initiate an intimacy date with a prohibition on intercourse. Every
six months, she initiates a playful or erotic scenario and it’s her choice whether
to transition to orgasm or intercourse. Honor traditional roles while “spicing
up” your relationship.
The Best Friend couple sexual style’s major vulnerability is that with so much
emphasis on intimacy, you “de-eroticize” your partner. A second vulnerability
is that with so much emphasis on mutuality, you take few personal or sexual
initiations, which results in low sexual frequency. The suggested intervention
is that every six months, each partner initiates a “selfish” asynchronous erotic
scenario. Own your sexual feelings – it is normal and healthy to have different
sexual preferences. This confronts the “tyranny of mutuality” allowing you sex-
ual freedom (as long as it’s not at the expense of the partner or relationship).
Another intervention is to initiate a playful sexual scenario – not all sex needs to
be intimate and serious. Playfulness is a sign of healthy couple sexuality.
The vulnerability of the Emotionally Expressive couple sexual style is that
you wear each other out with emotional and sexual drama. When hurt or angry,
the partner drops a “sexual atomic bomb”. The suggested intervention is to set
boundaries. Each partner shares one to three “sexual atomic bomb” issues. You
make an emotional commitment that no matter how hurt, angry, or drunk, you
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will not launch a sexual attack. A specific suggestion is to not talk sex when
lying in bed, nude, after a negative sexual experience. In that situation, people
say and do things which cause great damage.
The core guideline is to enjoy the strengths of your couple sexual style and
monitor the traps so they do not subvert your sexuality.
Gender Issues with Couple Sexual Styles

The simplistic belief that women value intimacy and men value intercourse has
done great damage to men, women, and couples. A core concept in choos-
ing a couple sexual style is to speak the same intimacy and sexuality language.
Each partner has their sexual voice and values being a sexual team. Each couple
decides what is the right integration of intimacy and eroticism for you. The
Complementary couple sexual style affirms female-male sexual equity. Each
partner has the right to initiate, say no, and value both intimacy and eroticism.
A key element of the Complementary sexual style is to disarm the male-female
power struggle over intercourse frequency. The Traditional sexual style is or-
ganized along gender roles but affirms the importance of sexuality. The Best
Friend sexual style emphasizes female-male equity, mutuality, and centers on
intimacy. The Emotionally Expressive sexual style emphasizes both partners
enjoying eroticism and taking sexual risks.
The issue is which couple sexual style fits your approach to sexual roles and
expectations.
Summary
A major contribution the sexuality field brings to the relationship field is the
importance of developing a couple sexual style which promotes and maintains
sexual desire. There is not “one right” way to be a sexual couple. Choose the
sexual style which is the right fit for you. Your couple sexual style breaks the
power struggle over intercourse as the measure of sex, instead promoting
desire/pleasure/eroticism/satisfaction.
Play to the strengths of your chosen couple sexual style as well as be aware
of the vulnerabilities so you don’t fall into those traps. Individualize your sexual
style so it uniquely fits your feelings and preferences. Be sure your sexual style
facilitates the 15–20% role of sexuality in your life and relationship.
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12
GOOD ENOUGH SEX (GES)
Positive, Realistic Expectations
Traditional men stop being sexual in their 50s or 60s. “Wise” men can be sexual
in their 60s, 70s, and 80s. A key strategy is to embrace the Good Enough Sex
(GES) model. This empowers male sexuality, especially with aging.
Women find GES inviting and easy to accept because it is congruent with
female sexual socialization and lived experiences. The great majority of women
learn sexuality as an interactive, variable, flexible experience. In contrast, the
great majority of men learn sexuality as easy, highly predictable, and in your
control. You learn that sexual response is autonomous, i.e. you get a sponta-
neous erection and go to intercourse and orgasm on your first erection. You
experience desire, arousal, and orgasm without needing anything from your
partner. The traditional belief is that male sexuality involves the ability to have
sex with any woman, any time, and in any situation with the expectation of
perfect sex performance.
Male sex focuses on individual performance with total control and predict-
ability. This might work for men in their teens, twenties, and thirties, but not
for men in their forties and older, especially not in married or partnered rela-
tionships. The female model of intimate, interactive, variable, and flexible sex-
uality is superior to the male autonomous sex performance model (McCarthy &
McCarthy, 2019b). Sadly, when men talk sex with peers, they brag, lie, and
one-up each other. Male peers do not affirm GES.
Acceptance of GES in the Context of an intimate

Relationship
What does GES mean? GES affirms that couple sexuality is inherently varia-
ble and flexible. The core of sexuality is giving and receiving pleasure-oriented
touching. Couple sexuality is a team sport not an individual performance. The
traditional sex performance approach demands predictable erection from you
and predictable orgasm (during intercourse) from the woman.
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G ood E nough S ex ( G E S )
The best sex is mutual and synchronous where both partners feel desire/
pleasure/eroticism/satisfaction. We advocate for arousal, intercourse, and
orgasm as well as mutual, synchronous encounters. Research indicates that
although the great majority of sexual experiences are positive, even among
happily married, sexually functional couples less than 50% are synchronous
(Frank, Anderson, & Rubinstein, 1978). Couple sexuality is inherently var-
iable, involving a range of motivations, roles, and outcomes. This is true for
both men and women. For example, you view the sexual encounter as a means
to reconnect and feel attachment, while for her, sex is driven by the desire for
orgasm as a tension reducer. A sexual encounter later that week is better for you
than her – sex is a celebration of your job promotion while she “goes along for
the ride”. The next week, a sexual encounter results in your orgasm, but is not
particularly satisfying, while she feels warm and attached even though she is not
orgasmic. These examples illustrate that GES is much more than sex function.
GES involves roles, feelings, and meanings. Desire and satisfaction are more
important than arousal and orgasm.
GES is a couple process focused on sharing pleasure, not an individual per-
formance. GES becomes more important with the aging of the individuals and
relationship. GES is particularly important for sexuality in your 60s, 70s, and
80s. The challenge is to embrace GES as first-class sexuality.
A key concept is that not all touching can or should proceed to intercourse.
Perhaps 85% of sexual encounters will flow from pleasure to arousal to erotic
flow to intercourse and orgasm. When sex does not flow, do not panic or apol-
ogize. There is nothing more anti-erotic than sexual self-consciousness and
apologizing. Be open to a seamless transition to an erotic scenario or a sensual
scenario. It is normal for 5–15% of sexual encounters to be mediocre, dissat-
isfying, or dysfunctional. GES is based on positive, realistic expectations. Ro-
mantic love and perfect sex demands ultimately subvert desire. GES allows you
to thrive with positive, realistic sexual expectations.
GES Experiences and Expectations for Women

Most, although certainly not all, women find GES inviting. Perhaps the easiest
concept to adopt is valuing sensual, playful, and erotic scenarios rather than
all touching leading to intercourse. Most women, including those who are not
orgasmic during intercourse, enjoy intercourse. However, the belief that all
touching must end in intercourse promotes sex as a mechanical routine rather
than as an anticipated pleasure. Alternative scenarios and erotic unpredictabil-
ity put spice into your sexual life. Sensual scenarios are different than playful
scenarios which, in turn, are different than erotic scenarios. Reinforce sensual-
ity, playfulness, eroticism, and unpredictability in couple sexuality. In addition,
freedom to enjoy both synchronous and asynchronous scenarios is empowering.
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An example is pleasuring your partner to orgasm rather than having intercourse

when you are not interested. Freedom to broaden your sexual repertoire builds
comfort and reinforces pleasure. A particularly powerful scenario is requesting
him to orally stimulate you to orgasm (or multiple orgasms) without the ex-
pectation that it must be reciprocated at that time. GES recognizes that not all
sexual experiences need to be serious, mutual, or have the same meaning for
both partners.
Positive, realistic expectations are particularly important in regard to in-
tercourse. Sex involving desire/pleasure/eroticism/satisfaction is most valued.
In addition, you can say, “This won’t be an intercourse night-can we cuddle,
play erotically, or take a rain check?” Celebrate sexual variability and flexibility.
Even the 15% of women who are only orgasmic during intercourse welcome
sensual and playful scenarios. Manual, oral, or rubbing stimulation can facili-
tate her (or his) orgasmic response. Variable, flexible scenarios are an important
addition to couple sexuality.
GES Experiences and Expectations for Men

Men find adopting GES is a major challenge and welcome the woman’s support
and enthusiasm. Reading and talking about variable, flexible GES is necessary,
but not sufficient. You need to experience the transition to a sensual, playful,
or erotic scenario and the pleasure that comes from non-intercourse sexuality.
Her sexual involvement and enthusiasm is good for your couple bond and helps
you embrace GES. Be open to GES not to please her, but because it facilitates
male and couple sexuality.
Carolyn and Ian

Ian and Carolyn had been a couple for 16 years. This was 44-year-old Ian’s
first marriage and 45-year-old Carolyn’s second. Ian being a confident, in-
volved lover was attractive for Carolyn. He was sensitive to Carolyn’s emo-
tional, touch, and sexual needs unlike her ex-husband who was a “meat and
potatoes” sex man.
The first husband’s sexual scenario involved breast and vaginal foreplay to
get Carolyn ready for intercourse (as soon as possible). Sex was a source of
contention. He would push intercourse four to five times a week, and she would
reluctantly go along once or twice a week. At first, sex was functional, but after
the second year, Carolyn’s desire was low. Intercourse was a way to placate him
with little pleasure for her. The marriage ended eight months after their daugh-
ter was born because Carolyn found him a disappointment as a person, spouse,
and father. He further disappointed her by having marginal contact with the
daughter and making irregular child support payments.
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In the three years before meeting Ian, Carolyn found a renewed sexual in-
terest with dating. She had two romantic love/passionate sex/idealized rela-
tionships, each lasting less than a year. The relationship with Ian started in that
manner, but with time intimacy grew rather than burning out. Carolyn and Ian
were open to a committed relationship.
At 38, Ian wanted more from life than a six-month to two-year relationship.
He wanted a life partner. He had grown fond of Carolyn’s daughter. Ian told
Carolyn that the daughter deserved love and stability. Carolyn found this touch-
ing. It increased her attraction and desire for an intimate, secure relationship
with Ian.
Almost all sexual touching led to intercourse, but it was a very different expe-
rience for Carolyn than with the ex-husband. Ian enjoyed touching both outside
and inside the bedroom and sensed her feelings and needs rather than constantly
pushing intercourse. Intimacy, touching, and sexuality had a 15–20% role in
their relationship and continued to do so for 13 years, including Ian adopting the
daughter and their having a son.
Ian had his first experience with erectile difficulty when he was 61. Carolyn
realized that the cause was fatigue and alcohol. He tried twice more that night,
but Carolyn lacked desire and Ian was sexually frustrated. The next night, in-
tercourse went fine and Carolyn thought nothing about it. She had experienced
low desire and low arousal many times. Like most women, Carolyn was orgas-
mic in many, but not all, sexual encounters. She was not aware of the negative
impact of the erectile failure on Ian. He no longer felt sexually confident and
unselfconscious. Although he continued to enjoy pleasuring and eroticism, Ian
rushed intercourse because he feared losing his erection. Over time, erectile
anxiety increased and the number of unsuccessful intercourse experiences also
increased.
Carolyn and Ian did not speak directly about sexuality. Carolyn developed
a pattern of manually stimulating Ian to orgasm if he wasn’t aroused enough
for intercourse. For a number of months, this worked fine, but Carolyn began
resenting Ian’s “sexual selfishness” and noticed a decline in her desire. She loved
Ian, but sex was no longer fun. Ian’s making sure Carolyn was orgasmic before
intercourse had the paradoxical effect of increasing her orgasmic response but
decreasing her sexual desire.
With the internet flooded with Viagra ads, Carolyn encouraged Ian to ask the
internist for a prescription. The doctor was glad to do so, although he gave Ian
no guidance about how to use it other than not to drink alcohol before taking
Viagra. Pro-erection medications have two major effects. First, increase effi-
cacy of the vascular system so that once aroused the erection is firm and lasting.
Second, a psychological effect – Viagra reduces anticipatory anxiety. In the next
four months, fun was back in their sexual relationship. Ian’s sexual enthusiasm
increased Carolyn’s sexual desire. However, this came to a crashing halt when
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Viagra failed to produce an erection sufficient for intercourse. Ian lost all sexual
confidence and returned to avoidance. Carolyn begged him to try again and
offered to stimulate him to orgasm, but to no avail.
After four months of a total sexual shutdown, Carolyn insisted that they
make an appointment with a couple sex therapist. Ian literally had to be dragged
to the session. Couple sex therapy is more effective than a stand-alone erection
medication (Althof & Rosen, 2007). Ian was relieved that the therapist was em-
pathic and respectful rather than berate or shame him. The therapist was clear
that regaining erectile comfort and confidence was a couple challenge. Carolyn
had an important role in the change process. The most important thing the
clinician said was that Viagra would not return Ian to the autonomous, totally
predictable erections of the past. The therapist introduced the GES approach,
giving them materials to read and discuss. This offered guidance and positive
expectations, rather than hoping for a “magic pill” which guaranteed perfect
erections.
The next step in the therapeutic process was to schedule individual ses-
sions for a psychological/relational/sexual history. Carolyn had a chance to
voice her confusion, anxiety, and anger about what had happened relation-
ally and sexually. The clinician was supportive and empathic, normalizing
Carolyn’s feelings as well as making clear her role in the change process.
Carolyn valuing desire/pleasure/eroticism/satisfaction was a crucial factor
in the success of sex therapy. She had an opportunity to ask questions and
clarify feelings about sensual, playful, and erotic scenarios. The guideline
that 85% of encounters would flow to intercourse was realistic. When sex
did not flow, Ian and Carolyn could transition to an erotic or sensual sce-
nario so that the experience ended in a positive manner. The therapist en-
couraged Carolyn to value mutual erotic scenarios in addition to pleasuring
Ian to orgasm. Carolyn was hopeful that this would be a satisfying chapter
in their sexual life.
Ian’s individual session allowed him to develop a narrative about psycholog-
ical and sexual strengths and vulnerabilities. The challenge was to give up the
traditional male model of perfect erection and intercourse and embrace the
“wise man” role which facilitates sexuality and erections. Ian liked the concept
of “beating the odds” and valuing variable, flexible, pleasure-oriented GES. The
therapist advised Ian to ask his internist for a prescription for Cialis rather than
Viagra. Cialis was easier to integrate into their couple style of intimacy, pleas-
ure, and eroticism, especially the daily low dose regimen. Cialis allows free-
dom of when to initiate sex (30 hours rather than 4). Ian was warned against
expecting 100% predictable erections and strongly encouraged to accept GES
as first-class male sexuality. Turning toward Carolyn as his intimate ally was
integral to successful therapy. A major new learning was for Ian to “piggy-back”
his arousal on hers.
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In subsequent therapy sessions, these themes were discussed, modified, and

implemented. Change is seldom easy or problem-free; it’s a matter of “2 steps
forward, 1 step back”. GES was easier for Carolyn to accept. Ian wanted a re-
turn to predictable erections and intercourse. Carolyn’s desire was enhanced
by the variety and unpredictability of sexual scenarios. Choice, freedom, and
unpredictability enhance sexual desire.
Ian made it clear to Carolyn that he preferred to transition to intercourse
and orgasm on his first erection. The therapist affirmed this and added two
suggestions. First, do not transition to intercourse until you are into an erotic
flow and utilize multiple stimulation during intercourse. Second, practice tran-
sitioning to erotic and sensual scenarios so that you don’t panic if sex did not
flow to intercourse. Ian was positive about the first suggestion, but ambivalent
about the second. Carolyn’s enthusiasm about sensual and erotic scenarios won
Ian over. Reading and talking about alternative scenarios are important, but
the real learning occurs with practicing these scenarios. Ian enjoyed their new
sexual style. Variable, flexible GES was good for Ian, Carolyn, and their bond.
Woman’s Sexual Self-Acceptance

Traditionally, the woman felt that she had to catch up with your spontaneous
erection and readiness for intercourse. New scientific findings and clinical in-
sights establish that female sexual desire and orgasm are first-class (McCarthy &
McCarthy, 2019a). Female sexual response is more complex, variable, flexible,
and individualistic than male sexual response – different, not better or worse.
Embracing desire/pleasure/eroticism/satisfaction is empowering. A prime
guideline is to own your unique sexual voice.
GES recognizes that female desire and orgasm is healthy. Female sexual
socialization and lived experiences reinforce the value of variable, flexible,
pleasure-oriented GES. The male individual perfect performance model is in
contrast to GES. Accept the core concept – couple sexuality is a variable, flex-
ible, pleasure-oriented experience of sharing intimacy and eroticism. Orgasm
is not a pass-fail test for her (and erection is not a pass-fail test for you). Inter-
course is valued as the natural continuation of the pleasuring/eroticism process,
not a pass-fail test. Desire and satisfaction are more important than arousal
and orgasm. Self-acceptance of your body and touching is more important than
performance. GES empowers you to embrace healthy sexuality rather than feel
intimidated by performance demands.
The psychological challenge is to accept variable, flexible sexuality as healthy.
Biologically, accept your body and adopt healthy behavioral habits of sleep, ex-
ercise, eating, moderate or no drinking, and no smoking. Relationally, turn
toward your partner as your intimate sexual friend. You don’t need to prove
anything to him or yourself. Accept GES as first-class.
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Male Sexual Self-Acceptance

Traditionally, your sexual self-acceptance was contingent on perfect perfor-
mance. You were afraid of failing your partner and even more afraid of male
peers knowing about your sexual anxieties and vulnerabilities. That’s a hard
way to live. If your penis could speak, it would say, “Treat me better, I am al-
ways one failure from feeling humiliated”.
GES builds a new foundation for sexual awareness and self-acceptance. You and
your penis are human, not a performance machine. GES emphasizes your right to
sexual pleasure and approaching your partner as your intimate and erotic friend
rather than someone to perform for. GES allows you to be self-accepting rather
than afraid or shameful. You will not receive support for GES from male friends;
you need it from your intimate partner. Her acceptance reinforces your acceptance.
Why is GES so hard for men to accept? The male performance model is pow-
erful and oppressive. Adolescents, young adults, and adult men over learn the
message that a “real man is willing and able to have sex anytime and anywhere”.
Is this really human? You are afraid to challenge this model because you fear be-
ing labeled a “loser”, “wimp”, or “not man enough”. GES is viewed as “settling”
because you can’t “perform like a real man”.
This irrational thinking and peer pressure subverts sexual self-esteem. She can’t
do it for you, but can urge you to embrace GES and increase self-acceptance. Be
a healthy man in a healthy relationship. The challenge is to take the risk – show
her you value variable, flexibility couple sexuality. Don’t be a traditional man who
falls into the trap of anticipatory anxiety, rushes to intercourse, experiences frus-
tration, embarrassment, and sexual avoidance. A wise man anticipates intimacy,
pleasure, and eroticism; enjoys giving and receiving sensual and playful touch; is
open to erotic scenarios and techniques; transitions to intercourse at high levels
of erotic flow; enjoys giving and receiving multiple stimulation before and during
intercourse; lets erotic sensations naturally culminate in orgasm; and enjoys the af-
terplay experience. It is an involving, multi-dimensional sexual scenario, different
than sex in your 20s. This is all to the good. When there is not an erotic flow rather
than trying to force intercourse, seamlessly transition to a mutual erotic scenario,
pleasure her to orgasm with your mouth or hand, or ask her to pleasure you to
orgasm. Another option is saying that this won’t be a sexual night – you can enjoy a
sensual, cuddly scenario. Be sexual in the next few days when you feel comfortable
and receptive. Women welcome and enjoy erotic and sensual scenarios as long as
you are involved. GES is empowering for the man, woman, and couple.
Use of Pro-Erection Medications, Penile Injections,

and Testosterone
Wise men are open to psychological, bio-medical, and relational resources to pro-
mote sexuality. Pro-erection medications, penile injections, and testosterone are
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compatible with GES. The reason medical interventions are not as successful as ad-
vertised is that no one (doctor or counselor) sits with the couple (or you alone) and
discusses how to integrate the medical intervention into your couple sexual style. A
major flaw in the medication/marketing approach overpromises easy, predictable
erections. The GES 85% guideline for intercourse is applicable to men using Viagra
or Cialis. Few men return to totally predictable erections and intercourse.
What are guidelines for using medical resources to improve sexual confidence
and function? The ideal guideline is you meet as a couple with the internist, urol-
ogist, nurse practitioner, endocrinologist, psychiatrist, or sexual medicine spe-
cialist. The first doctor to consult is your primary care physician who will assess
factors such as high blood pressure, cardiac problems, diabetes, depression, a pitu-
itary tumor, alcohol or drug abuse among other bio-medical problems to consider.
In exploring pro-erection medications, many couples prefer Cialis to Viagra
because it provides greater freedom of when to initiate sex. The crucial factor
is feeling desire and subjective arousal before the vascular effects of the medi-
cation kick in.
A crucial psychosexual skill is not to rush to intercourse, driven by fears of
losing your erection. Intercourse driven by fear increases the likelihood of ED.
A positive strategy is to begin intercourse when you (as well as she) are into an
erotic flow. Another technique is for the woman to guide intromission. Rather
than being distracted by performance concerns, enjoy giving and receiving
erotic stimulation. Multiple stimulation during intercourse facilitates the erotic
experience for both partners.
The more intrusive the medical intervention, the more likely it will produce
an erection. An example is penile injections. The reason injections have been
disappointing, with a high dropout rate, is that the sex feels mechanical. You
have difficulty ejaculating because you are not subjectively aroused. Your part-
ner does not enjoy intercourse because she does not feel aroused. The sexual
experience is not satisfying for either partner. If you use penile injections, do
so in a manner which enhances involvement and subjective arousal. Schedule a
couple consultation with the urologist or internist. Both partners learn to do
injections in a safe and comfortable manner. Many couples prefer the woman
administer the injection. The medical intervention can’t be expected to pro-
vide everything sexually. A crucial psychosexual skill is to engage in pleasur-
ing/eroticism to enhance your (and her) subjective arousal rather than assume
that you are subjectively aroused because you have an erection. Remember the
guideline – integrate the medical intervention into your couple sexual style.
This is a couple challenge – the injection can’t do it all.
Hormone enhancement is popular for both men and women. Although tes-
tosterone is sold at drug stores and on the internet, we recommend seeing a
physician and obtaining a prescription. Consult a competent endocrinologist
with a sub-specialty in hormonal and sexual function. The trend to overuse
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testosterone is one of the worst in our culture. Testosterone is usually pre-

scribed in the gel form, but can be administered through patch or injection.
Seldom is oral testosterone advised. From the psychobiosocial perspective, tes-
tosterone is a resource to enhance desire for those with severe testosterone
deficit. In those cases, testosterone is a necessary, but not sufficient, resource.
Psychological and relational factors are addressed to promote sexual receptivity
and responsivity. With the impetus of testosterone, you find it easier to reestab-
lish anticipation and feel receptive to sexual pleasure.
Exercise – Accepting and Implementing the

GES Approach
This couple exercise asks you to read, discuss, and, most importantly,
implement the GES approach. Very few couples begin their sexual rela-
tionship with GES. Commonly, you begin as a romantic love/passionate
sex/idealized (limerence) couple. This provides special memories. How-
ever, by its nature, limerence fades after 6–24 months. Replace it with a
couple sexual style which promotes strong, resilient sexual desire. Ide-
ally, you adopt the GES approach in your 30s. However, most couples do
not until there are sexual problems, especially ED. Prevention is always
superior, but the majority of men do not adopt GES until they experience
a problem. The good news is it’s never too late. Adopting GES is a wise
choice for the man, woman, and couple.
Knowledge is power. Read about GES. Even more important is a couple
dialogue about the role and meaning of GES. The best time to talk about
sexual issues generally, and GES specifically, is the day before being sexual.
Talk over a glass of wine or cup of tea, at the kitchen table or on the porch
(clothed and sitting up). The worst time to talk sex is in bed, nude, lying
down, after a negative experience. Agitation or anger causes people to say
and do things which are hurtful and destructive. Sexual communication
involves sharing information/attitudes, requesting sexual scenarios, and,
most importantly, disclosing sexual feelings and values. Don’t be politi-
cally correct or give the socially desirable response. Share psychological,
relational, and sexual desires as well as vulnerabilities. What is inviting
about GES? What are your fears and concerns about GES? The suggested
format to implement GES involves practicing three sexual scenarios:
1 Transition to a mutual or asynchronous erotic scenario

2 Transition to a sensual, cuddly scenario
3 Practice an intimate, interactive sexual scenario which promotes inter-
course as a natural continuation of the pleasuring/eroticism process.
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Transition to intercourse at high levels of erotic flow and enjoy multiple

stimulation during intercourse.
Most couples (especially men) prefer the third scenario. This is fine as
long as it is not a performance mandate.
Practice each scenario at least twice, and preferably three or more
times. Ideally, develop comfort and confidence with all three scenarios.
Having a variable, flexible sexual repertoire is a great relational resource,
especially with aging.
It is common for one or both partners to reject a scenario or part of
a scenario. An example is choosing to “take a rain check” rather than
engage in a sensual scenario. Another example is a woman who prefers
pleasuring her partner to orgasm than a mutual erotic scenario. Be hon-
est with yourself and your partner about preferences and feelings as well
as what does not fit. You can repeat this exercise in the future – reading,
talking, and implementing.
Guidelines for Asynchronous Sexual Scenarios

Couples have a strong preference for mutual, synchronous sex involving inter-
course and orgasm. In addition, be open to asynchronous scenarios (both in-
tercourse and erotic experiences). Accepting asynchronous sexuality is crucial
for GES.
A core guideline is that the asynchronous scenario cannot be at the expense
of the partner or relationship. Said positively, the partner finds the scenario a
2, 5, or 8 on the pleasure scale. At a minimum, the asynchronous scenario is
neutral. If it’s negative, resentment will grow, and desire will be inhibited.
A common example is that you value intercourse, while she finds it pleasant –
whether a 4 or 7. For couples over 60, female arousal and orgasm is often easier
than for you. She enjoys being pleasured to orgasm – the experience is a 7 or 3
for you. A different example is that you find rear entry intercourse highly erotic,
where she finds it a 1 or 3.
If you experience conflict regarding asynchronous sexuality, we suggest
seeking couple sex therapy (Appendix A has guidelines for choosing a com-
petent therapist). Sexual power struggles are destructive. Rather than share
pleasure, the issue is not feeling like the loser. Asynchronous scenarios enhance
your couple repertoire and are compatible with GES. However, some couples
decide not to engage in asynchronous sex.
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Summary
GES validates the reality of your relationship. Flexible couple sexuality
recognizes that the essence of a sexual encounter is giving and receiving
pleasure-oriented touching. GES acknowledges the multiple roles, meanings,
and outcomes of sexuality for the man, woman, and couple. Intercourse and
orgasm is highly valued, but not as an individual performance demand. Sexual-
ity is much more than intercourse. Satisfaction is more than orgasm. Touching
(affection, sensual, playful) is valued both inside and outside the bedroom. Not
all touch leads to intercourse.
Her acceptance and enthusiasm for GES is affirming for you. Acceptance of
GES promotes sexuality in your 60s, 70s, and 80s. GES helps rid you of the
oppressive pass-fail performance demands of erection, intercourse, and orgasm.
GES is valuable for both partners, and thrives as an intimate team experience.
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13
M ALE SEXUALI T Y I N THE 60 s,
70 s, A ND 80 s
Being a Wise Man
The good news is that there is solid scientific evidence that men (and women)
can enjoy sexuality in their 60s, 70s, and 80s (Lindau et al., 2007). The bad
news is that one in three couples stop being sexual by age 65 and two in three
by age 75. In the great majority of cases, the choice is the man’s, made unilat-
erally and conveyed non-verbally. It isn’t that he wants to stop sex, but he has
lost confidence with erections and intercourse. He feels frustrated and embar-
rassed, saying to himself “I don’t want to start something I can’t finish”. This is
a destructive choice for the man, woman, and couple.
One of your best emotional investments is reinforcing a broad-based,
pleasure-oriented sexual relationship. With aging, you need each other in a
manner you hadn’t when younger. Sexuality is more human, genuine, and
satisfying.
Rather than the “show-up” erections of youth, you need her touch and stim-
ulation to develop “grown-up” erections. The essence of couple sexuality is
giving and receiving pleasure-oriented touch. Sexuality is a couple process of
sharing pleasure rather than an individual pass-fail performance test of erection
and intercourse.
It surprises most people, including physicians, to learn that it is men who
choose to stop sex. It is the opposite of the traditional gender belief about men
having a stronger sex drive. It is another example how the double standard
misleads men, women, couples, and the culture. Two mistaken beliefs lead to
ceasing sex. First, the emphasis on erection as a measure of desire. Second, that
intercourse is the only real sex. Adolescent and young adult sexual socialization
“poisons” sexuality with aging. Sexuality in your 60s, 70s, and 80s is promoted
by a focus on pleasure and being intimate and erotic friends. The Good Enough
Sex (GES) model emphasizes sexuality as a couple issue with a variety of roles,
meanings, and outcomes. GES facilitates acceptance of the variability and flex-
ibility of sexuality after 60.
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M ale S exuality in the 6 0 s , 7 0 s , and 8 0 s
Confronting Myths about Sex and Aging

In dealing with sex and aging, you are confronting two stigmatized topics –
aging and sexuality. Some cultures honor aging – sadly, the United States
is not one of those. Traditionally, people over 60 were viewed as “over the
hill”. Their emotional and sexual needs were treated with benign neglect.
They were thought to be living in the past rather than having a vibrant
life. The belief was that sex belongs to the young and beautiful with a fo-
cus on exploration, breaking boundaries, illicitness, and drama. The fear is
that sex disrupts people’s lives and relationships rather than be a source of
bonding and security. When Barry asks college students “How many of you
believe people of your grandparents age are sexual”, it is 1 in 13. That is a
terrible cultural message.
A prominent myth is that the key to sexual desire is visual stimuli. This ne-
gates aging bodies. In truth, the key to sexual desire is touch, not visual cues.
Enjoy giving and receiving pleasure-oriented touch throughout your aging.
Another prominent myth is that illness and disability, which becomes more
common with aging, destroys desire and the ability to be sexual. Sexual func-
tion does change, but sexual desire continues no matter what the illness or
disability. The challenge is to accept the “new normal”, valuing sexual pleasure
rather than sex performance.
Another myth involves menopause – that after menopause women lose their
ability to enjoy sex. In reality, a fascinating role reversal with aging is that fe-
male arousal and orgasm is easier than for the male. An important learning is to
“piggy-back” your arousal on hers. Another gender challenge is accepting GES –
variable and flexible sexual response is easier for women to accept. Women can
and do enjoy sexuality after menopause.
Anther myth is that “natural” male sexual response of predictable erection
and intercourse without needing anything from the partner is superior. We
are proponents of erection and intercourse, but not as an individual pass-fail
performance. With aging, you need partner genital stimulation and to accept
that erections are not totally reliable. This is normal male sexuality with aging,
not a sign of ED. The experience of variable, flexible response is healthy for the
man, woman, and couple.
A core myth is that “spontaneous sexual desire” is better than “responsive
sexual desire”. You can begin a sexual encounter at 0 (neutral). As you give
and receive affectionate, sensual, and playful touch, your responsivity increases
(2–4) which results in sexual desire. An involved, receptive partner is your ma-
jor source of desire. You need each other to enjoy sexuality with aging.
There are many more myths regarding sexuality and aging. The good news is
that there are clinically relevant, scientific guidelines about the value of broad-
based male and couple sexuality with aging.
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The Good Things about Sexuality Come to Fruition

with Aging
Healthy sexuality comes into focus in your 60s, 70s, and 80s. Sexuality is more
human and genuine. Sexual satisfaction increases, partly because you know you
have beaten the odds. You enjoy sensual, playful, erotic, and intercourse touch.
You need each other sexually in a way you didn’t 20 years ago. Be intimate and
erotic friends who turn toward each other whether the sexual encounter was
wonderful or disappointing. Adopting GES and accepting the multiple roles,
meanings, and outcomes of sexuality is freeing. Aging couples accept asyn-
chronous sexual experiences. Mutual, synchronous sex is highly valued, but
variety in sexual encounters is the norm. Most couples prefer partner interac-
tion arousal, although with aging there is an increased use of self-enhancement
arousal. A key to sexuality and aging is acceptance of a range of sexual experi-
ences and the recognition of female-male sexual equity. You are freed from the
constraints of rigid roles and gender restrictions. Enjoy the sexual experience
for what it is. With a decrease in parenting responsibilities, you have greater
freedom when to be sexual. Rather than late night sex, you can have sex in the
morning, before or after a nap, before dinner (sex as an appetizer), or after din-
ner (sex as dessert). You need not be constrained by sex in the bedroom. With
greater privacy enjoy sexuality in your living room, den, guest room, or on
the secluded porch late at night. Be open to responsive sexual desire and touch
rather than longing for spontaneous, dramatic, swept away sex. Sexuality be-
longs to you and is integrated into the reality of your lives. Freedom from myths
and stereotypes allows you to enjoy self and partner acceptance.
Defining Sexuality as More than Intercourse

Whether age 25 or 75, most couples define sex as intercourse. Intercourse is
highly valued, but recognize that sexuality is much more than intercourse. An
empowering concept is that sexuality entails five dimensions (gears) of touching –
affection, sensual, playful, erotic, and intercourse. This is crucial for sexuality and
aging. Rather than counting number of intercourse encounters, accept that sen-
sual, playful, and erotic experiences are integral to couple sexuality. Sensual and
erotic scenarios have been a back-up if the experience did not flow to intercourse.
Value sensual, playful, or erotic scenarios for themselves, not just if intercourse
fails. This is a challenge for both men and women, although more easily accepted
by women. Traditional men cling to “sex = intercourse”. “Wise” men embrace
awareness that sexuality is more than intercourse. The GES concept is that 85%
of sexual encounters flow from comfort to pleasure to arousal to erotic flow to
intercourse and orgasm. No matter what the reason that sexuality does not flow to
intercourse, the optimal response is to enjoy sensual, playful, or erotic scenarios.
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There is no need to apologize or panic (this is anti-erotic). Variable sexuality adds

to your couple repertoire. Couples who embrace broad-based, flexible sexuality
enjoy sex into your 60s, 70s, and 80s.
Be aware of psychological, medical, relational, and psychosexual skill factors
which facilitate intercourse. Psychologically, the key is to view intercourse as
a natural continuation of the pleasuring/eroticism process, not a pass-fail test.
Medically, if you use resources such as a pro-erection medication, penile injec-
tions, medications to promote desire, or vaginal lubricants, you need to inte-
grate this into your couple sexual style rather than expect it to be a stand-alone
intervention (Althof, 2006). Relationally, you are sexual allies who share pleas-
ure and eroticism which flow to intercourse. Psychosexually, the most impor-
tant skill is not to transition to intercourse as soon as you can, but transition at
high levels of erotic flow. A major cause of failed intercourse is rushing to intro-
mission because you fear losing your erection. Negative motivation interferes
with sexual pleasure and arousal. One strategy is that the woman decides when
to transition to intercourse and guides intromission. This allows you to give
and receive multiple stimulation before and during intercourse rather than be
distracted by performance anxiety. This includes giving manual clitoral stim-
ulation, oral breast stimulation, and buttock or anal stimulation, and receiv-
ing testicle stimulation, buttock stimulation, and kissing. The most common
form of multiple stimulation is private erotic fantasies which serve as a bridge
to erotic flow and orgasm.
In younger days, intercourse involved just thrusting. An advantage of sexu-
ality and aging is increased involvement and simulation. Almost 15% of older
men struggle with ejaculatory inhibition (delayed ejaculation). Thrusting is
not enough stimulation to facilitate erotic flow. Women are also more likely to
benefit from multiple stimulation before and during intercourse. A significant
number of women find it easier to reach orgasm with manual, oral, or rubbing
stimulation than during intercourse.
Perhaps the most valuable strategy for both men and women is not to transi-
tion to intercourse until you are into an erotic flow (subjective arousal is an 8 or
at least a 7). The major cause of failure with pro-erection medications is rushing
to intercourse as soon as you get an erection (subjective arousal 4 or 5). Rushing
disrupts the sexual experience. The strategy is to experience intercourse as a
natural extension of the pleasuring/eroticism process and engage in multiple
stimulation during intercourse. This reinforces intercourse as a pleasurable,
erotic, and satisfying experience.
Being Sexual When Intercourse Is Not Possible

Intercourse (insertive sex) has been an integral part of your sexual experi-
ence. If insertive sex is not possible due to ED or female sexual pain, does
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that end couple sex? Absolutely not. Although intercourse is highly valued,
it is not the essence of couple sexuality. Manual, oral, rubbing, and vibrator
stimulation are ways to share pleasure and eroticism. Although you mourn
the absence of intercourse, it opens opportunities to share sensual, playful,
and especially erotic sexuality. For many couples, arousal and orgasm is eas-
ier with erotic sexuality. This is especially true for women, but men find
erotic sexually to orgasm satisfying. Couples feel emotionally connected with
sensual scenarios. Others find that playful scenarios are a great addition to
your sexual life and wish you had added this in your 30s instead of waiting
until your 70s.
Ideally, couples value broad-based, flexible sexuality in addition to inter-
course. It is the reality of stopping intercourse that challenges you to value sen-
sual, playful, and erotic sexuality.
The Value and Traps of Asynchronous

Couple Sexuality
An empowering insight is that asynchronous sexuality – whether involving in-
tercourse or erotic scenarios – is normal and healthy. The sexual experience
being better for one partner than the other is the norm. If all sex had to be
mutual and synchronous, you would have a low sex relationship or give up sex
altogether.
Accepting asynchronous sexuality is easier for the woman. Intercourse typ-
ically was better for the man. With aging, you spend more time and focus on
sensual, playful, and erotic stimulation. Broad-based flexible sexual expression
is healthy for men and women.
Are there potential traps with asynchronous scenarios? The core guideline is
that asynchronous sexuality is healthy as long as it is not at the expense of the
partner or relationship. On a ten-point scale of subjective arousal, one partner
experiences a 10, while the other’s experience might be a 6, 4, or even 1. This
is acceptable. It is not acceptable if the partner experiences a −2 or −7. Another
trap is pressure that the person must perform a specific scenario or technique
to prove love or sexual openness. Sexual demands are harmful to your intimate
relationship.
A common trap with asynchronous sexuality is that the partner settles for
routine or mediocre sex. “Going along for the ride” becomes the norm. When
this occurs, the partner gives up her “sexual voice” and no longer enjoys desire/
pleasure/eroticism/satisfaction. Asynchronous sexuality reinforces the positive
functions of sex. Each partner’s sexual pleasure and responsivity is acknowl-
edged. Sexuality is a shared pleasure, with you accepting different levels of
pleasure.
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Exercise – Enhancing Sex and Aging

An important adage is that you can learn from the past, but cannot
change the past. In this exercise, as in your lives, the power for change
is in the present and future. What are your attitudes regarding sexuality
and aging? Do you affirm the value of desire/pleasure/eroticism/satisfac-
tion? What do you value about affectionate, sensual, playful, erotic, and
intercourse touch? Is your partner your intimate and erotic friend?
The most important question is whether you are motivated to remain
sexual as you age. Hopefully, your answer is yes. List at least two and up
to five specific advantages of sexuality and aging. What are you willing to
explore to keep sexuality vital and satisfying?
Do you accept the variable, flexible GES model of sexuality? For many
people, sex is dichotomous, if it doesn’t involve intercourse, it’s a bad ex-
perience. That is not healthy, especially not for couples over 60. Embracing
the multiple roles, meanings, and outcomes of sexuality is the wise deci-
sion. You need more than socially desirable words. Attitudinally, behav-
iorally, and emotionally, do you turn toward your partner whether the
sexual encounter was wonderful, good, okay, or dysfunctional? Can you
celebrate mutual, synchronous sex as well as enjoy asynchronous sexuality?
Have an honest dialogue about incorporating GES. Even more im-
portantly, consciously practice GES. Create two playful scenarios and
implement them. Are they a good fit for you? Then do this with two
sensual and two erotic scenarios. Find ways of sharing sexuality which is
pleasure-oriented and satisfying.
Now, the hardest challenge. When touching does not lead to arousal
for one or both partners and/or you are unable to have intercourse, how
do you feel and what can you do? These experiences become more com-
mon with aging. The issue is whether you and your partner can accept
that it is normal to not have intercourse. Do not panic or apologize.
There is nothing more anti-erotic than apologizing for yourself. It has no
value for you or your relationship.
When arousal, erection, and intercourse do not flow which strategy
are you comfortable with: (1) transition to a mutual or one-way erotic
scenario, (2) transition to a sensual scenario, or (3) take a “rain check”
and try again in a couple of days when you are open and receptive? Ide-
ally, you would be comfortable with all three scenarios. What is not ac-
ceptable is avoidance. Avoidance reinforces sexual anxiety. You lose your
sexual voice. Reading and talking has great value, but the key to change
is trying out the three scenarios to see whether it fits for you.
121
Typically, 5–15% of sexual encounters are dissatisfying or dysfunc-

tional. With age, these percentages are likely to increase, especially re-
garding intercourse. Contrary to the advice “just do it”, which is likely to
cause problems because it treats intercourse as a pass-fail performance,
you need a pleasure-oriented engagement strategy. Find pleasurable and
erotic ways to be with each other.
When sex is a performance, you are always one experience away from
feeling like a failure. Sexuality is about sharing pleasure with multiple
ways to enjoy your partner. Expand your sexual repertoire so you cele-
brate intimacy, pleasuring, and eroticism.
The last component of this exercise involves use of your veto power. An
advantage of aging is you feel free to say “no” to sex (this is true for men and
women). Unless you have the power to say no, you don’t have the freedom to
embrace sexuality. To promote this concept, each partner vetoes one, two,
or three sexual scenarios you no longer (or never) found appealing. The veto
can involve a single technique (rubbing your penis between her buttocks,
use of a body lotion, having sex while standing) or a major change in sexual
scenarios (no longer having anal or oral sex, stopping erotic talk in the bed-
room, no longer using man on top intercourse). Your veto is honored (not
debated – you do not feel pressured to give in). In addition, you commit to
stay connected, so intimacy, pleasuring, and eroticism are reinforced. When
you avoid touching, sexual anxiety increases and sexual desire is lowered.
Maintaining Positive Motivation

The reason we advocate for the psychobiosocial model of assessment and treat-
ment is the focus on motivation and desire. More than physical health, medical
interventions, love, or erotic scenarios, the key to sexuality with aging is desire
and motivation. “Beat the odds” – enjoy giving and receiving pleasure. Positive
motivations include reinforce intimacy, touch as a refuge, a message of personal
worth, challenge stereotypes, validate physical attachment, deal with illness or
disability, a positive model for adult children and grandchildren, share erotic
vitality, enjoy cuddling, grow and experiment, and fully live your life. In ad-
dition to psychological and relational benefits, there are medical and physical
health benefits for sexuality with aging. Touching and sexuality are good for
your physical body. Sexual activity is a plus for your heart, lungs, and limbs. It
keeps you invested in quality of life – emotionally, physically, and relationally.
The Negative Consequences of Stopping Sex

Stopping sex is one of your worst life choices. You not only give up arousal, inter-
course, and orgasm, but you give up desire, pleasure, playful touch, and intimacy.
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The most common reason to stop sex is ED – you feel sexually frustrated and embar-
rassed. Barry says to clients, “You can be a traditional man who demands problem-free
intercourse and eventually give-up sex because you no longer feel in control or you
can be a wise man who embraces Good Enough Sex (GES) and enjoys sexuality in
your 60s, 70s, and 80s”. For quality of life, staying sexual is a better investment than
putting $200,000 in your retirement fund. The insistence on traditional penis-vagina
intercourse drives the choice to give up sex. Stubbornly clinging to a narrow defi-
nition of sex is very costly in terms of emotional and relational consequences. One
client lamented, “More than anything, I miss the intimacy of afterplay”. You sacrifice
pleasure for performance. A great loss for the man, woman, and couple.
Evan and Ophelia

Seventy-six-year-old Evan is in a 24-year second marriage to 77-year-old
Ophelia. Ophelia was divorced and Evan had been a widower for three years
when they met. They take pride in creating a satisfying, secure, and sexual mar-
riage. Their adult children had not been in favor of the marriage, but Ophelia
and Evan celebrated beating the odds and persevering. Their grandchildren are
very fond of them as a couple.
Evan suspects that the majority of male friends and relatives have stopped
being sexual. Sex and aging was a taboo topic in his peer group. He didn’t brag
to anyone, but was proud that he and Ophelia had a genuine sexual relation-
ship. Evan was grateful that Ophelia was his “cheerleader” in embracing GES.
They had fond memories of sex in their 50s – there was plenty of pleasuring,
eroticism, and intercourse. Sexuality energized their bond as well as served as
a “port in the storm” when dealing with conflicts, especially extended family
problems. Ophelia appreciated Evan being an involved, giving lover. Although
she enjoyed intercourse, arousal and orgasm was easier with manual stimula-
tion. She would usually orgasm before intercourse and sometimes during inter-
course (which Evan particularly valued).
Ophelia embraced her sexual voice and did not compare her sexual response
to anyone else. She appreciated that he accepted the variability and complexity
of her sexuality and did not pressure her to respond the way he did. Ophelia had
a variable sexual response pattern. Sometimes, she would be multi-orgasmic,
sometimes non-orgasmic, and other times have one orgasm. She enjoyed being
the giving partner in asynchronous scenarios – especially mixing manual and
oral simulation as she pleasured Evan to orgasm. Ophelia understood that Evan
preferred intercourse. She enjoyed intercourse, although orgasm during inter-
course was not a valued scenario for her.
Evan was aware that Ophelia’s approach to desire/pleasure/eroticism/satisfaction
was a better fit for them in their 70s than the traditional intercourse scenario. How-
ever, he felt particularly satisfied when both were orgasmic during intercourse.
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In their 70s, each was dealing with health and medical concerns. The biggest is-
sue for Ophelia was arthritis. She uses hearing aids (she takes them off when being
sexual). Evan took medications for blood pressure, cholesterol, and gout. His big-
gest concern was adult onset diabetes and keeping his blood sugar in control. The
illnesses and medications had a negative impact on erectile function. Evan took
a daily low dose Cialis which was helpful, but erections were slower, less firm,
and less predictable. The most important psychosexual skills were using multiple
stimulation before intercourse, enjoying private erotic fantasies, piggy-backing his
arousal on Ophelia’s, and she guiding intromission. He didn’t need a firm erection
for intercourse. They continued multiple stimulation during intercourse.
At this point, about 50% of sexual encounters flowed to intercourse. If sex-
uality did not flow, it was counter-productive to try forcing intercourse. Their
strategy was to seamlessly transition to a sensual or erotic scenario. Typically,
Evan opted for a mutual sensual scenario which he found calming and pleas-
urable. Typically, Ophelia opted for a mutual erotic scenario, but enjoyed an
asynchronous erotic scenario whether she was the receiving or giving partner.
Unless Evan felt really turned on, he preferred being the giving partner and
enjoyed her erotic responsiveness. This was a new scenario for them (adopted in
the last four years). Evan was pleased that asynchronous scenarios added to vital
sexuality. Ophelia feeling sexually satisfied was satisfying for Evan.
They were pleased that the number of dissatisfying sexual experiences was
low, about once a month. If Evan apologized, Ophelia would tickle him until he
stopped apologizing. Ophelia was accepting of the range of sexual experiences
and outcomes – she embraced GES.
Ophelia and Evan hoped to enjoy sexuality into their 80s, including after 85.
The key was to reinforce his, hers, and our bridges to sexual desire and accept
sexual experiences with a range of roles, meanings, and outcomes. Ophelia
particularly valued playful and erotic sexuality which could be synchronous or
asynchronous. Evan enjoyed a range of sensual and sexual encounters.
Summary
Sexuality and aging is genuine and human. All the good things about couple sex-
uality come to fruition with aging, especially sharing pleasure. Embrace GES
rather than view intercourse and orgasm as an individual pass-fail performance.
When the man gives up intercourse, the couple usually stop sensual, playful,
and erotic sexuality. The variable, flexible approach to sexuality and aging affirms
erection, intercourse, and orgasm as well as emphasizes a range of sexual scenarios.
Enjoy pleasuring and eroticism with or without intercourse. The essence of couple
sexuality is giving and receiving pleasure-oriented touching. GES recognizes the
multiple roles, meanings, and outcomes of male, female, and couple sexuality.
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14
DEALI NG W I TH SEXUAL
PROBLEMS
PE, ED, HSDD, and Ejaculatory Inhibition
Male sex dysfunction is more common than either men or women recognize.
Ideally, sex dysfunction is dealt with as a couple issue. The woman did not cause
the problem, but as your sexual ally she has an integral role in helping you re-
gain sexual comfort, function, and confidence. Typically, men are embarrassed
about sex dysfunction, minimizing or denying the problem. The most destruc-
tive reaction is to blame the woman for your sex dysfunction. Be honest with
yourself and take responsibility for resolving the problem. Turn toward your
partner as your sexual friend.
You hope that a pill (or other medical intervention) will guarantee perfect
performance. You are disappointed and frustrated that a stand-alone medical
intervention won’t resolve sex dysfunction. Like most in our culture, you have
been misled by the ads and overpromises of the drug industry. You need to use
all your psychological, medical, behavioral, and relational resources to facilitate
sexual change. This includes confronting the myth of perfect sex performance.
Replace this with positive, realistic expectations based on a new model of male
sexuality and adopt the Good Enough Sex (GES) model (Metz & McCarthy,
2012) with positive, realistic sexual expectations.
The Four Most Common Male Sex Dysfunctions

There are four common male sex dysfunctions. These affect approximately
40% of men. By order of frequency, they are:
1 Premature Ejaculation (PE)

2 Erectile Dysfunction (ED)
3 Hypoactive Sexual Desire Disorder (HSSD)
4 Ejaculatory Inhibition (Delayed Ejaculation)
Sex dysfunction is categorized as primary (life-long) or secondary (acquired).

With the exception of PE, most male sex dysfunction is secondary. Over the
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D ealing with S exual P roblems
course of your life, the majority of men experience sexual dysfunction which
lasts a month or longer. Sex problems need not be stigmatized or a shameful se-
cret. Approximately 40% of men experience chronic sexual dysfunction which
is lower than for women, but a significant number.
The most important message is that your sexuality need not be defined by the
sex dysfunction. You and your sexual relationship are much more than the sex
problem. Sexual self-esteem is not contingent on perfect performance.
Most sex dysfunction is resolvable or at least modifiable. The key is motiva-
tion and persistence. Do you turn toward your partner as your sexual friend in
addressing the problem and building a new couple sexual style? You can change
the sexual problem and enhance desire/pleasure/eroticism/satisfaction. Create
a couple sexuality that is special, not just functional. A key is that your partner
is your intimate and erotic ally. Her sexuality is as important as yours. You win
or lose as a sexual team.
The sex problem robs both partners of sexual pleasure. The best time to
address a sexual problem is when it’s acute, but most male sex dysfunction is
chronic. Embarrassment has caused you to minimize and avoid. A legacy of the
old model of masculinity is unrealistic performance demands and avoidance
of dealing with sex problems. The new model of male sexuality urges you to
accept your sexual strengths and vulnerabilities. Accept responsibility for sex-
uality, but do not feel pressure to change on your own. You are not a “rock and
an island”. You are a sexual man who turns toward your partner. As an intimate
team, you build sexual comfort, skill, and confidence.
Success is more likely if you consult a couple sex therapist (Appendix A pro-
vides resources for choosing a therapist). Therapy provides a structure and helps
you deal with the inevitable frustrations inherent in the change process. Ther-
apy helps you stay focused on building pleasure-oriented sexuality.
Premature Ejaculation
The most common male sex dysfunction is premature (rapid) ejaculation (PE).
The majority of young men begin their sex lives as premature ejaculators. With
practice and continuity, men learn ejaculatory control and enjoy intercourse.
Twenty to thirty percent of men experience PE as a chronic problem. Most PE
is primary, but can be secondary.
Contrary to braggadocio, claims on the internet, and bar talk, the average
length of intercourse is three to nine minutes. Few couples engage in inter-
course longer than 12 minutes no matter what you hear. There are many defi-
nitions of PE (intercourse lasting less than one minute, less than 20 strokes,
ejaculation before female orgasm). These rigid criteria are not helpful. Ejac-
ulation before the woman is orgasmic is particularly self-defeating since one
in three women never or almost never experience orgasm during intercourse.
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Learning ejaculatory control is not about performance; it is about sharing pleas-

ure and enjoying intercourse. Our definition of PE is intercourse lasting less
than two minutes where you are not in control of when you ejaculate. You
learn ejaculatory control not to prove anything to yourself or your partner,
not to reach a 12-minute performance goal, not to “give her an orgasm”, but to
increase enjoyment of intercourse and couple sexuality (Althof, 2020).
There are many causes of PE, including a hyperresponsive physiolog-
ical system, side-effects of medications, a goal-oriented masturbation
pattern, and anxiety (Metz & McCarthy, 2003). Sometimes, additional ther-
apeutic or bio-medical resources are necessary, but in the majority of cases, a
cognitive-behavioral ejaculatory control program is effective. There are two
core psychosexual skills. First, identify the point of ejaculatory inevitability.
There is an orgasmic difference between men and women. Women can stop
mid-orgasm (for example, a child crying or coming in which interrupts love-
making). However, once you pass the point of ejaculatory inevitability, orgasm
is no longer under voluntary control. You could be totally turned off, but still
ejaculate. Orgasm and ejaculation are different physiological processes, but
most men experience them as the same. Learn to identify the point of ejac-
ulatory inevitability. On a scale of arousal with 0 neutral, beginning arousal
5, erotic flow 8, and orgasm 10, be aware of sensations and feelings between
6 and 8. Don’t “test the limits” and reach 9.5. When masturbating, most men
find it relatively easy to identify the point of ejaculatory inevitability. This is the
beginning of orgasm and in one to three seconds, you begin to ejaculate.
The second step is to practice ejaculatory control with either masturbation
or partner manual stimulation. Focus on stimulation lasting three to nine min-
utes before letting go and enjoying orgasm. When you reach the 6–8 arousal
level stop stimulation. Then resume stimulation. Enjoy sensations of moderate
arousal without moving toward orgasm. Some men use the “squeeze” technique
as a clear differentiation, but most prefer the “stop-start” technique. If you use
the squeeze, you or your partner squeezes the top of your penis with two fingers
and thumb and hold for three to five seconds until the urge to ejaculate dissi-
pates. With “stop-start”, you stop stimulation for 30–60 seconds.
Learning ejaculatory control is a gradual step-by-step process which is prac-
ticed over weeks. It is not a fun exercise. You increase awareness, understand-
ing your body’s sexual response, and build sexual comfort and confidence.
The next step is the most challenging – ejaculatory control during inter-
course. This requires working as a sexual team. Most couples find that it takes
three to six months to develop ejaculatory control during intercourse. Key
changes involve intercourse positions and movements. It is difficult to gain
ejaculatory control using the man-on-top position with fast, short thrusting.
Use the woman-on-top, side-by-side, or woman sitting-man kneeling positions.
Experiment with slower, longer thrusting or circular thrusting. Typically, the
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learning process is “2 steps forward, 1 step back” as you engage in new ways of
sharing pleasure-oriented intercourse.
Your goal is not perfect ejaculatory control. It is to enjoy the entire sexual expe-
rience, including intercourse. The GES model emphasizes that 85% of the time you
feel control of when you ejaculate and intercourse is an enjoyable experience. Occa-
sionally, when you rapidly ejaculate, enjoy your orgasm; do not panic or apologize.
Embrace the variability and flexibility of intercourse and couple sexuality.
Sex does not end when you ejaculate. Whether it was a highly enjoyable in-
tercourse, a good intercourse, a so-so intercourse, or a PE intercourse, turn
toward your partner. Afterplay is an integral component of couple sexuality.
Afterplay is not just for the woman, it is for you and your bond. Afterplay has
a crucial role in promoting sexual satisfaction. This is especially true when in-
tercourse involves PE. You could offer to pleasure her to orgasm, be sexually
playful, or cuddle and enjoy intimacy.
Some men use a medication to promote ejaculatory control (a low-dose
anti-depressant taken daily or two to four hours before sex). Other couples
focus on the woman being orgasmic before intercourse. Still others focus on
afterplay. PE is a changeable problem, especially if you focus on intercourse as
sharing pleasure rather than an individual performance.
Erectile Dysfunction (ED)

When the public thinks about male sex problems, the focus is on ED. The great
majority of ED is secondary. The demand for spontaneous and totally predicta-
ble erection is self-defeating and sets you up for ED. Your penis is human, not a
perfectly functioning machine.
Rather than approaching ED as a bio-medical problem and turning to a stand-
alone medical intervention (Viagra or Cialis, penile injections, or testosterone
enhancement), adopt the comprehensive psychobiosocial approach which involves
using all your resources, especially your partner as your sexual friend, and practic-
ing erection psychosexual skill exercises (Kalogeropoulos & Larouche, 2020).
ED can have a number of causes:
1 psychological – anticipatory and performance anxiety, unrealistic expecta-

tions, sexual secrets, history of sexual trauma, depression
2 bio-medical – side-effects of medications, illness (especially poorly con-
trolled diabetes and cardiac problems), vascular or neurological disease,
extremely low testosterone, alcohol or drug abuse, poor sleeping and eat-
ing patterns
3 social/relational – angry or alienated relationship, resentment toward
partner, afraid to make sexual requests, intimidated by partner’s sexuality,
poor psychosexual skills, routine and boring sex.
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ED is multi-causal and multi-dimensional. Treatment usually requires psy-

chological, bio-medical, and relational changes. As in other types of sex dys-
function, our suggestion is to consult a couple sex therapist. In conjunction,
schedule a medical assessment with your internist or a sexual medicine spe-
cialist. The sexual tipping point model (Perelman, 2009) describes the range
of factors that can cause ED and the need to address them in a comprehensive
manner. Learn to maintain erectile comfort and confidence.
The comprehensive GES model is of great value. It provides the man and
couple with a scientifically validated approach to ED (Metz & McCarthy,
2004). Women are supportive of integrating GES in treating ED. Her enthu-
siasm for GES is crucial for the man who insists on a medical intervention to
return you to totally predictable erection and intercourse. This is an unrealis-
tic, self-defeating goal. It ensures that you will stay in the cycle of anticipatory
anxiety, tense performance-oriented intercourse, frustration, embarrassment,
and eventually sexual avoidance. Replace this with the cycle of positive sexual
anticipation, pleasure-oriented touching, enhancing subjective and objective
arousal, transitioning to intercourse at high levels of erotic flow (8 or at least 7),
and multiple stimulation before and during intercourse. A positive, realistic ex-
pectation is that 85% of sexual encounters will transition to intercourse. When
sexuality does not flow, transition to an erotic or sensual scenario without pan-
icking or apologizing. You don’t need an erection or intercourse in order to feel
good about a sexual encounter. The core message is that sexuality is a couple
experience of sharing pleasure, not an individual performance test. The second
core message is that subjective arousal (feeling turned on) is as important as
objective arousal (erection). Neither you nor your partner needs a firm erection
to enjoy sexuality, including orgasm.
The most important psychosexual skill exercise is “waxing and waning
of erection”. Almost all men prefer to transition to intercourse on their first
erection and reach orgasm during intercourse. This is fine as a preference, but
poisonous as a performance demand. The wax and wane exercise directly con-
fronts this performance myth. When you obtain an erection, stop stimulation –
your erection will naturally wane. If you remain comfortable and receptive to
sensual and playful touch, your erection will wax again. Stop stimulation and
your erection will wane a second time. As long as you remain mindful of sen-
sual and playful touch, your erection will return. Then proceed to intercourse
and orgasm. Few men (or women) enjoy this exercise, but you learn a crucial
lesson – erections wax and wane. You need not panic if you lose your erection.
The major reason men fail with Viagra or Cialis is that as soon as you become
erect (subjective arousal 4–5), you rush to intercourse because you fear los-
ing your erection. Negative motivation subverts sexuality. Do not transition
to intercourse until you are into an erotic flow. This is promoted by giving and
receiving multiple stimulation before and during intercourse.
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A key concept when you utilize a bio-medical intervention is to integrate it

into your couple style of intimacy, pleasure, and eroticism as opposed to treat-
ing it as a “magic pill”. The more invasive the medical intervention (for example,
penile injections), the more effective in obtaining an erection. The challenge is
to integrate the medical intervention into couple sexuality. Your partner being
actively involved in the pleasuring/eroticism process is crucial.
The good news is that dealing with ED as a couple and adopting GES set the
stage for sexuality in your 60s, 70s, and 80s. You didn’t want to experience ED,
but you can use ED to learn a new respect for your penis and pleasure-oriented
sexuality.
Hypoactive Sexual Desire Disorder (HSDD)

Male sexual desire was explored in detail in Chapter 9. The great majority of
HSDD is secondary, but primary HSDD occurs with 10% of men. Total lack
of desire for anyone or anything is very rare, less than 1%. In this case, a man’s
sexual orientation is asexual. This is not changeable – it is who he is.
Both primary and secondary desire issues are changeable. This is good news.
However, you are so embarrassed by HSDD that you do not disclose it to any-
one, especially your partner. When couples stop being sexual, especially after
age 50, it is almost always the man’s choice – made unilaterally and conveyed
non-verbally (Lindau et al., 2007).
In primary HSDD, the issue is a sexual secret that you are too embarrassed or
ashamed to share with your partner. This can involve a variant arousal pattern
(fetish, cross-dressing, or bondage and discipline), preference for masturbation
because you experience anxiety and discomfort with couple sex, a history of
sexual trauma which has not been processed, a sexual orientation issue, or sex-
ual shame.
The most common cause of secondary HSDD is ED. There are a number
of other causes, including side-effects of medications, anger, partner aliena-
tion, boredom with routine sex, de-eroticizing your partner and relationship,
an affair, alcohol or drug abuse, illness, depression, and belief that older people
should not be sexual. Desire problems need professional intervention, specifi-
cally couple sex therapy.
Identify and address factors which inhibit desire. Some are resolvable, most
modifiable, and others need to be worked around. You cannot return to the
romantic love/passionate sex/idealization (limerence) phase. You can develop
a new couple sexual style which integrates intimacy and eroticism, the basis
for strong, resilient sexual desire. A key is openness to “responsive sexual de-
sire” rather than hoping for a return to easy desire driven by spontaneous erec-
tions. Enjoy giving and receiving sensual and playful touch which reinforces
responsive sexual desire. Pleasurable and orgasmic sexuality promotes desire.
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The core of desire is positive anticipation, sense of deserving pleasure, freedom

and choice, and erotic scenarios which are inviting and unpredictable. Use all
your resources to facilitate sexual desire, especially turning toward your part-
ner as your intimate and erotic ally.
Ejaculatory Inhibition (Delayed Ejaculation)

This is the least known and discussed male sex dysfunction, but has a negative
impact on male and couple sexuality. Primary ejaculatory inhibition is rare (less
than 2%). This means that you have never ejaculated intravaginally. Most are or-
gasmic with masturbation as well as partner manual or oral stimulation, but not
intercourse. Typically, male peers and female partners view you as a “stud” – you
have a strong erection and last forever. Men with PE are envious. However, they
are missing a crucial point – you are performing for the woman rather than en-
joying sexuality. The reason you don’t ejaculate is that your subjective arousal is
low – you are not into an erotic flow. Intercourse is for the woman, masturbation
for you. This is not healthy for you or your relationship, but can continue for years.
The impetus to address ejaculatory inhibition is fertility issues – your wife cannot
become pregnant because you do not ejaculate intravaginally. That’s sad because
ejaculatory inhibition is a changeable problem (Perelman, 2020).
Intermittent secondary ejaculatory inhibition is more common, effecting as
many as 15% of men after age 50. If not addressed, it becomes chronic and
severe. Like other sex dysfunctions, ejaculatory inhibition is multi-causal and
multi-dimensional. Causes include side-effect of medications and alcohol abuse,
but by far the most common cause is following the same sexual routine you used
for 20–30 years. For sex to remain functional with aging, you need new inputs
and energy. Routine sex – predictable foreplay and intercourse with man on top
focused on thrusting – is boring rather than vital. There are three strategies to
change ejaculatory inhibition:
1 Do not transition to intercourse until you are into erotic flow (subjective
arousal of 8)
2 Utilize multiple stimulation before and during intercourse
3 Consciously employ “orgasm triggers”.
These strategies enhance your sexual repertoire. Spend time and be creative with
pleasuring and erotic techniques so you are subjectively aroused before begin-
ning intercourse. Utilize multiple stimulation before and during intercourse.
Give clitoral, buttock, and breast stimulation and receive testicle, buttock, and
kissing stimulation. The most common type of multiple stimulation is private
erotic fantasies. Identify orgasm triggers by recognizing what you think about
and do to transition from 9 to 10 during masturbation. Give yourself permission
131
to use orgasm triggers – speed of movement, pressure of movement, type of

movement, self-talk (“I’m going to come”), or using fantasies to reach orgasm.
Overcoming ejaculatory inhibition is not only good for you; it enhances the
experience for your partner and makes couple sex fun and involving. Reinforce
the desire/pleasure/eroticism/satisfaction mantra.
Exercise – Confronting and Changing Male

Sex Dysfunction
Do this exercise on your own and then share with your partner. Examine
each dimension of sexual function:
1 Sexual desire vs. HSDD

2 Arousal vs. ED
3 Enjoying orgasm vs. PE
4 Erotic flow to orgasm vs. ejaculatory inhibition
Are all four dimensions of sexual function positive or is there a problem?

Be honest; don’t fall into the traditional male trap of exaggerating sexual
prowess and denying problems. Male sexual function is not about per-
fection; it is about sharing pleasure and enjoying your experience. Don’t
be embarrassed about sex dysfunction. Most men begin as premature
ejaculators. By age 40, most men have an experience of not maintaining
an erection sufficient for intercourse. By age 50, many men have the ex-
perience of not reaching orgasm during intercourse. Although you won’t
admit it, the majority of men have experienced low or no desire whether
caused by fatigue, alcohol, anxiety, depression, or distraction. Occa-
sional sex problems are normal. This is part of male sexuality. Variable
sexual function is normal, very different than chronic sex dysfunction.
Discuss your perspective on sex problems of PE, ED, HSDD, and ejac-
ulatory inhibition. Does your partner agree with your assessment or does
she have a different perspective? Discuss her approach to couple sexual-
ity. Is this new to you?
Half of couples experience sexual dysfunction or dissatisfaction. What
is the best way to address these problems? Our recommendation is cou-
ple sex therapy. How do you (and your partner) want to address sexual
problems? Do you deserve sex to have a 15–20% role in your life and
relationship? Create a change plan and check-in with your partner in six
months to see whether your sexual relationship has improved.
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Is Good Enough Sex Acceptable?

What men dislike about GES is that it sounds like you’re “settling” because you
can’t have perfect sex. GES motivates and empowers you to accept yourself,
your partner, and the complexity of couple sexuality. GES encourages you to
play to your sexual strengths while being aware of your sexual vulnerabilities.
It allows you to celebrate outstanding sexuality, accept good sex, and not over-
react to problematic sex. Adopt a variable, flexible sexuality rather than sex as
a pass-fail intercourse test. Broaden sexuality to include sensual, playful, and
erotic scenarios. Most importantly, sexuality is an intimate team experience of
sharing pleasure rather than a pressured individual performance. GES allows
you to enlist your partner as your intimate and erotic ally rather than someone
to perform for and fear her judgment. GES promotes acceptance of the complex
humanity of sexuality. It allows for the multiple roles, meanings, and outcomes
of couple sexuality. Not only is this not settling, GES promotes understanding
what it means to be a sexual man and accepts healthy masculinity.
Case: Geoff and Seraphina

When 34-year-old Geoff married 31-year-old Seraphina, he did so with great
anxiety. His first marriage ended in a bitter divorce three years ago. His ex-wife
demonized him because he was unwilling to have a baby with her. As well, she
bitterly complained about his PE.
Geoff viewed Seraphina as totally different – empathic, kind, and committed
to a satisfying, secure, and sexual marriage with two planned, wanted children.
Family and friends were supportive (they viewed Seraphina as the opposite of
the judgmental, self-centered ex-wife).
Geoff’s major concern was sexual. He feared that PE would cause her to be
so disappointed that like his first wife she would leave. Seraphina reassured
Geoff numerous times that she loves sex with him, he is a sophisticated lover,
he celebrates her orgasmic pattern with manual and oral sexuality, and she
enjoys their short, intense intercourse. He was not convinced. He obtained a
prescription for a fast-acting anti-depressant and took two pills before inter-
course to ensure ejaculatory control. Trying so hard not to ejaculate caused
a decrease in involvement and arousal leading to erectile anxiety and ED.
Seraphina urged him to not overreact. Although well-intended, it had the
effect of making him even more self-conscious and accelerated fears that she
would give up on him.
Geoff scheduled an appointment at a men’s sexual health clinic where they
gave him testosterone enhancement pills, porn, and taught him to do penile
injections. Bio-medically, the injections worked fine, but Geoff and Seraphina
found it very awkward. His reaction to testosterone was heightened agitation
133
and irritability. She reacted negatively to the porn – feeling intimidated by the
type of erotic sexuality portrayed. She feared this was what he wanted sex-
ually. Their sexual lives were a mess. This dramatically impacted their emo-
tional relationship. His worst-case scenario was in danger of becoming the
reality. It is amazing how sexual problems can undermine the man, woman,
and relationship.
Seraphina consulted her minister who blamed the problem on Geoff’s use
of porn (not a good understanding), but did something very valuable – he re-
ferred them to a couple therapist with a specialty in sexual desire problems. At
the first session, the therapist met a very demoralized couple. Seraphina felt
confused. Geoff was in a full-blown panic, apologizing for himself sexually,
and desperately afraid that Seraphina would leave. The clinician was empathic
and respectful, but gave a clear message to Geoff – stop catastrophizing think-
ing, stop penile injections, stop testosterone pills, and stop watching porn. The
second message was that desire is best addressed as a couple issue – they could
rebuild sexual comfort and confidence as an intimate team. The clinician sched-
uled an individual session with each spouse. In his session, Geoff talked about
his fragile sexual self-esteem and how hopeless he felt. He feared his sexual
failures had destroyed his kind, loving wife. The clinician noted that Geoff’s
lack of sexual self-acceptance made it impossible to accept Seraphina and her
sexuality. The therapist’s message to Geoff was that he had dug himself into
a hole. The first thing to do was stop digging. He needed to accept his wife as
his intimate and erotic friend and begin developing a new couple sexual style
focused on comfort and pleasure, not performance. The therapist assured Geoff
that the marriage had a solid foundation, they had an excellent prognosis, that
time was on his side, and to listen to Seraphina and her sexual feelings and re-
quests. He needed to banish male performance myths and his ex-wife from his
life. Geoff cried – which the therapist assured him was normal. Geoff had put
tremendous pressure on his penis. He needed to let go of the self-defeating per-
formance demands and embrace desire/pleasure/eroticism/satisfaction. Geoff
could schedule an individual session if needed, but couple therapy was the pri-
mary approach.
When the therapist saw Seraphina three days later, it was clear that this
would be an easy couple to work with. Geoff went home after his session and
initiated a sexual date. Seraphina was open and responsive, including enjoying
orgasm. When she pleasured him, he was responsive and they had intercourse.
She enjoyed his rapid, intense orgasm. Seraphina liked the idea of creating a
new couple sexual style. She accepted the therapist’s assurance that she had not
caused Geoff’s sexual melt-down.
At the couple feedback session, the therapist suggested a six-session contract
beginning weekly and switching to bi-weekly. They liked the idea of focused,
time-limited therapy. It reflected the clinician’s optimism about their capacity
134
for change. The therapist said that past sexual experiences need not control
them. They practiced resiliency skills, which was particularly important for
Geoff’s sexual self-confidence. Geoff and Seraphina were conscientious clients,
engaging in psychosexual skill exercises between sessions. Psychologically,
relationally, and sexually, Geoff had a lot going for him – he needed to heed
Seraphina’s feedback. She saw no need to engage in the ejaculatory control ex-
ercises. Seraphina enjoyed her arousal/orgasm pattern using erotic sexuality.
Just as important she enjoyed Geoff’s rapid, intense intercourse. The message
is don’t compare yourself with a rigid performance model – find your unique
couple sexual style.
Summary
Male sex dysfunction is a hidden, stigmatized problem which is very com-
mon and is changeable. Each dysfunction – PE, ED, HSDD, and ejaculatory
inhibition – has a different set of causes and different interventions. Success is
more likely when treated as a couple issue. Confront the self-defeating tradi-
tional male performance model, adopt the GES approach, establish positive,
realistic expectations, and use all your psychological, relational, and sexual re-
sources to maintain healthy male and couple sexuality.
In dealing with sexual problems, do not deny or minimize. Establish a desire/
pleasure/eroticism/satisfaction pattern rather than stay stuck in dissatisfying or
dysfunctional sex. You deserve sexuality to have a 15–20% role in your life and
relationship.
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15
VA R I ANT A ROUSAL
What Fits Your Relationship
Women assume that all men want sex. Like most assumptions, “all men” is
wrong. Over 90% of men value intercourse and intimate, interactive couple
sexuality. However, approximately 4% of men have a variant arousal pattern.
Less than 1% have a deviant arousal pattern. He almost never shares this infor-
mation with his partner.
Variant arousal refers to a sexual pattern that is powerful, narrow, and very
different from intimate, interactive couple sexuality. The most common type
is a fetish arousal. Variant arousal also includes cross-dressing and bondage and
discipline (BDSM) scenarios.
There is major scientific and clinical controversy about the meaning and
treatment of variant arousal. There are three major approaches: Acceptance,
Compartmentalization, and Necessary Loss. Be aware of what you want as well
as what fits your partner’s feelings and values.
Development of Variant Arousal

Learning that her partner has a secret sexual life is a major shock for the woman.
She blames herself or feels that she’s a fool. In fact, for the great majority of
men, the variant arousal developed in childhood or adolescence, before you met
your partner. The poisonous cycle involves high secrecy, high eroticism, and
high shame. This is a powerful, destructive combination which controls your
sexual desire. Variant arousal has been reinforced by thousands of masturbatory
experiences.
For men in a new relationship, the romantic love/passionate sex/idealization
(limerence) phase can override the variant arousal pattern for weeks or months,
and in some cases, years. You naively hope that this will continue, so don’t
share the reality of the variant arousal with her. In the majority of cases, variant
arousal returns to dominate your sexual desire and response. Variant arousal
controls your relationship leading to avoidance of couple sex. Embarrassment
takes over and variant arousal remains a shameful secret. She did not cause the
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variant arousal and had no reason to believe that this was the factor causing your
low or no sex relationship.
When consulting a couple therapist, you typically blame the problem on re-
lationship issues or on your partner. This distracts you from the core issue.
The therapist is emphatic and respectful, but confronts the issue of your secret
sexual life. Being truthful will not solve the problem, but pretending that there
is not a major sexual secret is unfair and makes the problem worse (Scorolli
et al., 2007).
The woman’s reaction to the disclosure varies from shock, dismay, or anger
to relief at finally understanding the core problem. You fear her response: that
she will shame and abandon you. Although this does happen, in a majority of
cases the woman is surprised and hurt, but does not want to destroy you or the
relationship. The ideal situation is that she commits to being your intimate and
erotic ally in choosing a strategy to deal with the variant arousal. It can’t remain
a secret. Sexual issues need to be addressed with a strategy both partners are
committed to.
Strategies for Addressing Variant Arousal

There are three strategies to address the issue of variant arousal:
1 Acceptance
2 Compartmentalization
3 Necessary Loss.
These are not compatible strategies; you need to decide what is the right fit for
your relationship. There is a tendency to give the socially desirable answer, but
not mean it or be able to implement it. We promote the guideline suggested for
parents when speaking with children about sensitive issues – no “sins of com-
mission”. Do not lie to your partner. Do not say things which are not true or
you don’t mean. This is disrespectful and destructive for you, your partner, and
your relationship. A secret sexual world focused on variant arousal is a serious
issue. The trap for the woman is to assume responsibility for the variant arousal
and feel that it is her job to resolve the problem. The trap for you is to minimize
the erotic intensity of the variant arousal and pretend that it’s not a major prob-
lem. Variant arousal is a major sexual and relationship issue. Lying to yourself
and your partner makes it worse.
Acceptance
The new trend is to advocate for the Acceptance strategy. The premise is that
variant arousal is your “authentic sexual self”. Asking you to deny your variant
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arousal is like asking a gay man to not have sex with men. Variant arousal is a
challenge for the woman not just to accept, but to embrace. Acceptance is not
at her expense nor does it compromise her sexuality. She doesn’t lose anything
and hopefully gains a special sexual experience.
Many women and some men reject the Acceptance strategy as not genuine.
Playing out a fetish scenario, being sexual when you are cross-dressed, or as-
suming the dominant role in a BDSM scenario can be a turn-off and alienating
for her. Seeing you erotically charged by something which is anti-erotic for her
is unhealthy. Rather than sex bringing you together, it serves to separate or
even alienate you. As one woman said, “I tried to please him, but bad sex is
bad sex”. A key to the Acceptance strategy is that you enjoy the erotic charge
without feeling guilty. The key for the woman is to accept good sexual feelings
and that it is okay for the scenario to be asynchronous (better for you). If the
variant arousal scenario is at her expense or is destructive for the relationship,
the Acceptance strategy will backfire. Usually, you advocate for the Acceptance
strategy.
Compartmentalization
Compartmentalization is the traditional and most common strategy. It sounds
like the sensible compromise. You use variant arousal fantasies during partner
sex to facilitate erotic response. In addition, you act out the variant arousal
whether weekly, monthly, or quarterly. You can do this on-line, with a different
partner, or by utilizing paid sex.
The crucial question is whether this strategy is acceptable for the man,
woman, and couple. Too often you are dysfunctional or dissatisfied with couple
sex and avoid or are sexual to placate your partner. The woman does not feel
desire or desirable. She develops low desire and resents partner sex. Does the
Compartmentalization strategy have a positive role in energizing your bond?
Does each partner feel desire and desirable? Or does it have a negative, draining
role? If so, you need to adopt a different strategy.
Necessary Loss
The Necessary Loss strategy is utilized when the variant arousal cannot be suc-
cessfully integrated into your couple sexual style. This is the most challenging
strategy. It asks you to give up the powerful erotic charge of variant arousal and
adopt a new couple sexual style which integrates intimacy and eroticism. It is
the strategy most advocated by the woman. Erotic intensity in the new couple
sexual style provides an erotic charge of 85 for you rather than 100. The payoff
is that couple sexuality has a positive rather than conflictual role in your life and
relationship. The challenge for the woman is to embrace the new sexual style
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and not feel guilty that your erotic response is less intense. Her enthusiasm for
intimacy, pleasuring, and eroticism is motivating for you. Accepting the Nec-
essary Loss strategy requires courage and is a symbol of genuinely valuing your
relationship.
The danger with the Necessary Loss approach is when it’s not genuine. You
agree to eliminate the variant arousal, but you’re not being honest with your-
self or your partner. Eliminating variant arousal is a challenge. You need to
use all your resources to succeed, including her emotional and sexual support.
Unfortunately, you feel guilty and embarrassed and stop the sexual dialogue.
You regress to a secret sex life where masturbation is much preferred to couple
sex because during masturbation you use fetish materials and fantasies. During
couple sex, you wall her off by using fetish fantasies to produce an erotic charge
which allows you to have intercourse and reach orgasm. Couple sex is unsatis-
factory for her because you are not there emotionally. You focus on stimulating
her rather than sharing erotic feelings. For you, sex is a chore which becomes
less frequent. You resume acting out the variant arousal whether in-person or
on-line. This illustrates the failed strategy of Necessary Loss. For Necessary
Loss to be successful, both partners value their new couple sexual style and
share desire/pleasure/eroticism/satisfaction.
Choosing the Best Strategy for the Man,

Woman, and Couple
There is not one “right” strategy for all couples. Relational and sexual success
requires a genuine commitment to a shared strategy. This involves a good faith
effort to implement the strategy whether Acceptance, Compartmentalization,
or Necessary Loss. Of course, there are no guarantees, but is likely to succeed
if you are an intimate team. Keep your agreement of “no sins of commission”.
What each says at home and in therapy will be honest, no emotional or sexual
lies. Trust what your partner says. For example, she agreed on the Acceptance
strategy, but it’s not working because she experiences your variant arousal as
an erotic turn-off. Don’t pretend she’s enjoying sex if it’s not true. Or you find
that acting out the fetish is not erotically satisfying (it is barely sexual). Don’t
pretend you’re satisfied. Each partner needs to be honest. A different example
is that you agree to the Necessary Loss strategy and the Complementary couple
sexual style. This is good for her, but you are unable to reach orgasm because
there is no erotic charge. Pretending you had an orgasm is counterproductive.
A different example is that you enjoy the new couple sexual style and feel de-
sire/pleasure/eroticism/satisfaction, but your erotic charge is 75. Accept this.
It is a healthy “sin of omission”. It will not help to argue about erotic intensity.
Disclosure and processing is valuable when trying to change a problem. It is not
valuable if the agenda is complaining, manipulation, or punishing the partner.
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Case – Margaret and Steven

When 28-year-old Margaret met 32-year-old Steven, she felt her prayers had
been answered. Steven was a good person who loved her and wanted marriage
and a family. They began as a romantic love/passionate sex/idealized couple.
Margaret was especially pleased that Steven was a caring and skilled lover who
accepted Margaret’s orgasmic pattern with erotic sexuality. She was concerned
that since she was orgasmic before intercourse that he didn’t feel sexually ful-
filled. Steven assured her that wasn’t true – he was a sophisticated man who
accepted that she came first (Kerner, 2005). She didn’t need to change anything
for him.
After the birth of their first child, Margaret was pleased that Steven was an
involved father and they were an affectionate, cuddly couple. However, they
had not resumed erotic play or intercourse. After several gentle hints, Steven
still did not initiate, so Margaret got up her courage. She made sure that their
eight-month son was asleep and initiated sex. Steven was willing to stimulate
her to orgasm, but when it came to intercourse, he was more than hesitant. He
was not aroused and had no interest in intercourse. Margaret felt that she was
on an emotional roller coaster. She loved being stimulated to orgasm, but felt
bewildered by Steven’s lack of sexual interest and arousal.
Steven minimized the problem, saying that he didn’t want to physically
hurt her. Margaret was reassured, but still concerned. This concern turned
to agitation when the pattern continued for the next few months. When
Margaret initiated, Steven was responsive to her sexual needs, enjoying giv-
ing manual and oral stimulation. He was pleased by her orgasmic response,
but did not want intercourse. Margaret offered to pleasure him to orgasm,
but he declined.
Margaret was very worried – they had not had intercourse in over a year.
Steven responded that most new mothers would be pleased rather than hassle
their husbands. Steven said that she had no basis to complain. He began a pat-
tern of initiating erotic stimulation once a week. Afterward, he let her nap as
he took the child for a walk.
When Margaret asked if there was anything wrong, Steven was reassuring
that in every way he felt their marriage and three-person family were doing very
well. He had no complaints.
Four months later, Margaret glanced at their credit card bill (Steven was an
excellent financial manager who paid all their bills) and was stunned by a charge
of over $500. When she asked Steven about this, he was flustered and irritated
stating that it must be a mistake and he would take care of it. Next month,
Margaret checked the bill and found a charge of $300. In querying Steven, he
turned it around and asked whether she wanted to do the bills because she
feared he wasn’t competent. Margaret was on the defensive, saying that she
admired his handling of finances. With that Steven walked away. Margaret felt
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confused and agitated. She knew something was wrong, but had no idea what it
was or what to do about it.
This state of affairs continued as weeks turned to months. Steven still ini-
tiated erotic sex weekly, but Margaret was less enthusiastic. One-way sex had
become stale. Routine and predictability inhibit desire.
Their son was almost two. Margaret told Steven that she had always hoped to have
two children, ideally a son and a daughter. To Margaret’s surprise and joy, Steven
was enthusiastic about a second child. He promised they’d have intercourse three
times during the high probability week. The resumption of intercourse was easier
than Margaret expected. Steven had a firm erection and intercourse was pleasura-
ble. Steven seemed to be enjoying himself, and joked that they should do this more
often. However, during the rest of the month, they continued the pattern of Steven
stimulating Margaret to orgasm, but not interested in anything for himself. By the
third month of trying to become pregnant, sexual enthusiasm waned as did his erec-
tions. As soon as he became erect, he rushed to intercourse so he could ejaculate
before losing his erection. Margaret had enjoyed intercourse, but rushed sex was
not fun. Both persevered because they wanted a child. To their relief, Margaret
became pregnant during the fifth month. Once they achieved pregnancy, sex totally
stopped. They avoided sexual touch, although Steven was affectionate and solicitous
of Margaret’s feelings in all other areas.
After the first trimester, Margaret was feeling healthy and missed sexual
contact. She asked Steven to pleasure her to orgasm. However, Margaret found
it hard to feel turned on. Steven was a distant, reluctant lover. Eventually, she
achieved orgasm, but it was hard work – like swimming against the tide. The
next day, she asked Steven what was wrong – this time he responded with a
harsh put-down. He noted how hard it had been to become pregnant. Steven
didn’t want to do anything to endanger the pregnancy. Margaret felt attacked
for being sexually selfish. On the next visit to the obstetrician, Margaret asked
her opinion about sex during pregnancy. The doctor reassured Margaret that
it was perfectly safe. When conveying this information, Steven’s response was
“You can never be too safe when it comes to a baby”. His message was clear “I
don’t want sex with you”. At this point, Margaret had no interest in sex with
Steven – she felt humiliated.
They were fortunate to have a healthy baby girl and Steven was active in
parenting. However, by this point, it was clear to Margaret that something was
happening sexually that needed to be addressed. She carefully examined the
credit card bills for the previous three months and found unexplained charges
from three different companies totally more than $700 per month. When she
called the number on these accounts, she found that all three sold leather boots.
Neither she, Steven, nor the children wore these types of boots.
After the children were asleep, Margaret confronted Steven with these facts.
He tried to distract and blame, but this time Margaret was having none of it.
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She was very surprised when Steven broke down in tears and begged her not to
abandon him, saying they have a wonderful family. Margaret wanted the mar-
riage and family, but needed to know what was happening sexually. Were the
boots tied to sex? Once she said that and saw the look of shock and humiliation
on Steven’s face, she realized that he had a hidden sexual life involving boots.
This was a pivotal moment. Margaret could have shamed and punished Steven.
Although hurt and confused, she wisely chose to turn toward him and say “I
love you. We can deal with this together”.
It was Steven who called for an appointment with a couple sex therapist and
asked Margaret to join him. In the first session, Steven said that he was com-
mitted to Margaret and their four-person family. He felt very badly about the
sexual problem and didn’t know what to do. Margaret was confused, but val-
ued Steven’s commitment to their marriage and family. She wanted to be his
emotional and sexual ally, not his critic or judge. The therapist said he’d en-
countered this problem several times and was optimistic that their concern for
each other and their family would make it easier to address these sexual issues.
Margaret was surprised when the therapist asked whether she had consulted a
divorce attorney and saw the relief on Steven’s face when her answer was no.
The next step in the therapeutic process was individual histories. The therapist
began the session by saying “I want to understand your psychological, relational, and
sexual strengths and vulnerabilities, both before you met your spouse and since. I
appreciate you being honest and forthcoming. At the end, you can red-flag sensitive
or secret information. I will not share it without your permission, but I need to
know as much as possible in order to help you deal with these difficult issues”. If the
clinician conducts the history with the spouse present, there will be a “sanitized”
version, not the genuine narrative (Metz & Epstein, 2002).
The complexity of Steven’s variant arousal became apparent in his individ-
ual interview. The clinician was empathic and respectful, but clear that Steven
needed to be honest about his sexual history and the boot fetish. Steven was
caught in the cycle of high secrecy, high eroticism, and high shame. He’d never
spoke with anyone about the fetish. The variant arousal existed from childhood
(which is a common pattern). He hoped that once married, the fetish would lose
its controlling power (a typical self-defeating wish). Steven was afraid to share
his variant arousal history with Margaret, but with the therapist’s urging real-
ized that there was no reason to keep it secret. The fetish history was processed
in a therapeutic manner at the couple feedback session.
The couple session was a turning point. The clinician carefully reviewed each
person’s strengths and vulnerabilities, especially sexually. The key to under-
standing Steven was his shame regarding the boot fetish. Negative motivation,
especially shame, subverts the change process. The therapist outlined three
strategies (Acceptance, Compartmentalization, Necessary Loss) to deal with
the boot fetish. The clinician emphasized that Steven and Margaret needed to
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make and implement a decision based on what would make a difference in their
lives. Margaret agreed wholeheartedly.
Steven was orgasmic 25–35 times a month by himself, always using fetish
materials or fantasies. Over the years, he had purchased hundreds of pairs of
boots – he would fondle the boots during masturbation, sometimes rubbing his
penis on the boots. During couple sex, he would fantasize about the boots with
the hope that he would become aroused enough for intercourse.
It was Margaret who suggested trying the Acceptance approach. She was
willing to wear boots during sex. At first, Steven was very excited, but by the
third time admitted to Margaret and the therapist that it did not have an erotic
charge. For Steven, secrecy and enacting the fetish in a ritualistic manner was
the key for erotic response. Paradoxically, Margaret’s openness and willingness
de-eroticized the boot experience for him. They realized that the Acceptance
strategy was not viable. Was Margaret willing to accept the Compartmentali-
zation strategy where Steven would masturbate using the boot fetish and later
would pleasure Margaret to orgasm?
Margaret said that perhaps now that she understood Steven’s variant arousal,
she could live with the Compartmentalization strategy. She wanted to feel inti-
mate and share sexuality. The therapist asked Steven about the Compartmental-
ization strategy. Steven didn’t believe that it would fit their needs for intimacy
or eroticism.
The therapist asked if they were willing to commit to a six-month good
faith effort to adopt the Necessary Loss strategy and create a new couple sex-
ual style. The therapist’s belief that there was a good possibility of success
was motivating – a couple sexual style was what Margaret really wanted. This
would be a major challenge for Steven – giving up the boot fetish and being
open to intimate, interactive sexuality with Margaret as his sexual ally. Steven
viewed couple sex as for Margaret, not a shared pleasure that involved his sexual
feelings and needs. The therapist was clear that Necessary Loss required each
partner being genuine. It was not a punishment for Steven’s sexuality or a po-
litically correct exercise. Steven agreed to not use fetish fantasies or materials.
He brought all the boots (four large bags) to the therapist’s office as a safe haven.
Steven agreed to not visit internet boot sites. They set up a weekly five-minute
check-in to ensure that Steven did not regress to a secret fetish world.
In terms of a couple sexual style, they read material, took a self-assessment
questionnaire, and discussed which sexual style was the best fit for them. At the
same time, they began the sexual desire psychosexual skill exercises of comfort,
attraction, trust, and playing out each person’s preferred sexual scenario (Mc-
Carthy & McCarthy, 2012).
The process of sex therapy is challenging. Changing sexual attitudes, behav-
ior, and emotions is seldom easy and straightforward. The role of the therapist is
to keep the couple focused and motivated and to process difficult issues.
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Margaret’s sexual responsiveness was crucial to the change process. She al-
lowed herself to enjoy intimate, interactive sexuality rather than second-guessing
Steven’s sexual feelings. The therapist was empathic and respectful of Steven’s
struggles, encouraging him to meet these sexual challenges. At first, Steven found
it hard to be sexually responsive to non-fetish fantasies. He was genuinely pleased
(and surprised) that he was able to masturbate to orgasm without the fetish (it
took five attempts). The erotic charge was less powerful, but masturbation was
enjoyable. This learning was transferable to couple sexuality.
In the second month, Steven had his first orgasm during intercourse with-
out using fetish fantasies. With that breakthrough, couple sex became genuine
and satisfying, although less erotically intense. Key strategies and techniques
included multiple stimulation throughout the pleasuring/eroticism process
(including non-fetish erotic fantasies), Steven piggy-backing his arousal on
Margaret’s, using self-stimulation during partner sex, waiting until he felt
erotic flow before transitioning to intercourse, and use of multiple stimulation
during intercourse. Margaret provided testicle stimulation, while Steven used
erotic fantasies and orgasm triggers to facilitate letting go. If Steven was not
orgasmic during intercourse, they transitioned to her manual stimulation or his
self-stimulation to orgasm. Steven and Margaret found that the Complementary
couple sexual style was the right fit. The most important factor was that Steven
valued couple sexuality which integrated intimacy, pleasuring, and eroticism.
He felt desire and desirable. Sex was intimate and genuine, although less erot-
ically charged.
Margaret and Steven continued six-month couple check-in sessions for two
years after the termination of therapy. At the yearly follow-up session, Steven
gave the therapist permission to donate the four bags of boots. This was a sym-
bolic gift to Margaret (as well as a substantial tax write-off). Steven fully ac-
cepted the Necessary Loss strategy.
Therapy vs. a Self-Help Approach

This is one of the few chapters that does not contain a psychosexual skill ex-
ercise. The reason is that the secrecy/shame around variant arousal requires
professional intervention. If the man and couple try to do this on their own,
a likely outcome is an anti-therapeutic power struggle. The woman accuses
you of lying and betrayal, and you counterattack saying that she is controlling,
neurotic, or it’s her fault. Approach this sensitive/secret issue in a respectful,
non-shaming manner using the help of a therapist. Variant arousal subverts cou-
ple sexuality. It needs to be addressed as an intimate team. Engage in emotional
problem-solving. Trying to address sexual issues as a self-help project is likely
to increase alienation and blaming which is demoralizing and makes sexuality
more difficult.
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Deviant Arousal
Less than 1% of men have a deviant arousal pattern. Deviant arousal involves
illegal sexual behaviors that harm others. This includes exhibitionism, vo-
yeurism, frotterism, obscene phone calls, child sexual abuse, and pedophilia.
Deviant sexual behavior needs to be confronted and stopped. This requires pro-
fessional intervention (with the support of your partner). Deviant sexual behav-
ior involves a powerful compulsive sexual life controlled by secrecy and shame.
Confronting you is necessary; shaming you is self-defeating and inadvert-
ently reinforces deviant behavior. The more shameful you feel, the more likely
you are to be controlled by the impulsive, compulsive sexual pattern.
You cannot moderate deviant behavior; it needs to be stopped because it
harms others. Use all necessary resources, including individual therapy, couple
therapy, medication, a self-help group, religious/spiritual support, and sexual-
ity education. The woman has a crucial role in the change process, but cannot
do it for you. Contrary to popular belief, treatment has a high probability of suc-
cess with a low relapse rate as long as there is a clear, specific relapse prevention
plan and couple accountability (McCarthy, 2015).
Summary
One of the most difficult sexual issues for women to understand is the man’s
secret world of variant arousal – whether a fetish, cross-dressing, or bondage-
discipline scenarios. Approximately 4% of men have a secret sexual life cen-
tered on variant arousal. For most men, this remains a sexual secret, although
some men unfairly blame the partner. This causes confusion, hurt, anger, and
demoralization. She wonders if it’s her fault, your fault, or a symptom of a love-
less marriage.
Variant arousal typically begins in childhood or adolescence. You hope that a
loving relationship will cure the problem. Although couple sex is functional in
the short term, it does not resolve the variant arousal pattern. Variant arousal
is driven by high secrecy, high eroticism, and high shame – a poisonous combi-
nation. You need professional intervention to deal with variant arousal. Decide
whether to adopt the Acceptance, Compartmentalization, or Necessary Loss
strategy. The woman did not cause the problem and cannot change the problem.
What she can do is be your intimate ally in understanding and dealing with the
variant arousal. Deviant arousal must be confronted and stopped.
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16
GAY MEN AR E FIRST CLASS
Validating Sexual Diversity
Sexual orientation involves an emotional and erotic commitment to someone

of the same sex (homosexual) or someone of the opposite sex (heterosexual).
Traditionally, the culture has viewed homosexuality as pathological and unac-
ceptable. There has been a dramatic change in the past 50 years, especially the
last 10 years. The scientific and clinical evidence is clear; homosexuality is a
normal sexual variation. Approximately 3–4% of males are gay. For the great
majority of men, sexual orientation is “hard-wired”; it is not changeable (Janni,
Blanchard, Camperio-Clanis, & Bancroft, 2010).
Your spouse “did not make you gay” nor can she make you straight. Accept
yourself and feel loved as a gay man. For most couples, when there is a differ-
ence in sexual orientation, the wise decision is a “good divorce”. In the tradi-
tional American divorce, the ex-spouses argue for years whose fault it was that
the marriage failed. The primary emotion is anger. In the good divorce, the pri-
mary emotion is sadness. You wish each other well and agree to not be involved
with the ex-spouse’s psychological, relational, and sexual decisions. Acceptance
of the divorce allows you to be respectful, cooperative co-parents.
In the past, a large self-help group was gay married men. You married with
the hope that marriage would “cure” homosexuality or that the marriage and
family would shield you from discrimination and stigma. You had a hidden sex-
ual life. A “double life” is unhealthy for the man, woman, and family. The wife
felt misused and betrayed. You felt caught in a dilemma. You were in a marriage
where you did not have a genuine erotic bond. Your secret sex life often had a
compulsive component. This is a very hard way to live.
The Core of Being a Gay Man

The culture (including mental health professionals) believed that sexual orien-
tation was determined by who you fantasized about and who you had sex with.
Simple, but wrong. There are two core components of sexual orientation. First,
who you genuinely emotionally bond with. Second, who you genuinely share
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G ay M en A re F irst C lass
eroticism with (Ramirez & Brown, 2010). It takes many men years to accept
your sexual orientation, but the truth is there for most gay people by age 16. A
man who experiences a limerence phase with a woman is not lying to her. The
problem is that over time the strength of your sexual orientation overwhelms
the emotional attachment to the woman. Barry has sat with couples where the
woman said, “I felt you loved me and we had good sex, was it all a lie?” It
wasn’t a lie; it was an unrealistic hope that because you loved her and she was
pro-sexual that it would “cure” being gay. You don’t cure sexual orientation.
Sexual orientation involves accepting your genuine erotic charge and emotional
attachment. The challenge is to embrace your authentic sexual self.
An important effect of accepting being gay as normal is that fewer gay men
are entering heterosexual marriages. The gay married men self-help groups are
much smaller. Acceptance that sexual orientation is about who you love and
who you want to have sex with is a major step forward for both gay and straight
people. Being gay is not the most important part of being a man but is integral
to who you are and your psychological, relational, and sexual well-being. Being
gay is not just normal but is your authentic sexual self and optimal for you.
Are There Other Sexual Orientations?

In addition to homosexual and heterosexual, there are at least two other sexual
orientations – asexual and bisexual +.
Asexual is very rare (less than 1% of men), but is real. The asexual man
does not value sexual touch. Asexual men have no attraction to sexual stim-
uli or being sexual with another person. Some asexual men are interested
in marriage and parenting, but cannot create a genuine sexual relationship.
Our strong recommendation is that you tell the woman about your asexual
orientation early in the relationship. This allows her to make an informed
decision about whether to commit to a marriage or life partnership with
you. Asexuality also occurs with women, although the number is small (less
than 2%). Respect individual differences and the complexity of people and
relationships. Most asexual people decide against marriage. In dealing with
asexuality, we encourage consulting a sexual health professional to process
feelings and make wise life decisions.
Bisexuality + (also called pansexuality) has many definitions. The core is
openness to being sexual regardless of your partner’s gender. A significant
number of bisexual + men advocate consensual non-monogamy relationships
whether open, swinging, or polyamorous. Some value marriage and children,
but a significant number do not value a traditional pair-bonded relationship.
Do not assume that bisexual + orientation means the same thing to every man.
Be clear about your self-definition regarding sexual attitudes, behaviors, emo-
tions, and values. We urge you to disclose your orientation and what that means
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to your partner(s), whether female or male. Be aware that more women are
bisexual + than men and that more women identify as bisexual + than lesbian.
Bisexual + men experience a genuine emotional and erotic bond with both
a male and a female partner. It does not mean exact 50-50, but there is a desire
to be emotionally and sexually involved with both genders. Unfortunately, gay
men belittle bisexual + as you not having the courage to admit you are gay.
Others believe that bisexual + people are controlled by ambivalence and in-
decisiveness. This is not respectful of the man who has genuine emotional and
erotic feelings with both genders. In deciding how to successfully implement
bisexual +, our recommendation is individual and/or couple therapy to help
decide what is the right fit for you and people in your life.
The Most Common Situation – Acceptance

of Being Gay
Acceptance is the key for healthy individual and couple sexuality. Identifying your
authentic sexual self is crucial. Gay men have more resources and greater cultural
acceptance than at any time in the U.S. culture. You cannot expect others to accept
you unless you accept yourself. Be a first-class gay man psychologically, relationally,
and sexually. A challenge is that unlike your heterosexual friends, you don’t have
a “socially desirable” path to follow. That can be an advantage because you don’t
have to confront the traditional traps of the old, repressive approach to masculinity.
Commit to psychological, physical, sexual, and relational health. Affirm that being
gay is optimal for you. You deserve sexuality to have a positive role in your life and
to make wise personal and relational decisions.
In the past, the message to gay men centered on negative consequences – being
harassed or harmed, acquiring HIV, alcohol and drug abuse, depression, suicide,
losing a job, being rejected or shunned by family. These issues are real and need to be
dealt with, but this is not where to start. Start with a commitment to live a healthy
life as a gay man. A good life doesn’t mean perfect. Unlike past generations, ho-
mosexuality is now accepted. Homosexuality has existed in almost all cultures and
over thousands of years. Attempts to wipe out or punish homosexuality have failed
because it is inherent in the person, not a lifestyle choice. Treating sexual orientation
as a deviant behavior makes no scientific sense. Being gay is integral to who you are.
It is much more than sexual behavior. You have a right to love who you love. Sex is
important, but is not the essence of being gay. Use your resources and opportunities
to be a fully functioning gay man.
Heterosexually Married Gay Men

Traditionally, gay men married as part of the denial process. It makes no sense
to blame or demonize a gay man for marrying. Often, you married with the
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hope that this would resolve the sexual orientation issue which it never does.
You hoped that being married and having a family would make you “normal”.
Gay men are normal; you don’t need a woman to feel normal. Being gay is op-
timal for you.
It takes courage to disclose to your partner that you are gay (or bisexual +).
It is hard to predict her response. Often, it is relief that the real issue is now
clear. Other times, it is a shock – she had no idea. Sometimes, it is self-blame;
she let you down and you had to turn to men for sex. Often, it is anger driven
by feelings of rejection. You cannot control your partner’s reaction, but be clear
about yourself and what you feel. Start with an affirmative recognition that
emotionally, relationally, and sexually, your attachment is to men not women.
Your partner didn’t make you gay nor did you mean to hurt her. Ideally, you
would have acknowledged your sexual orientation before marrying, but you
can’t change the past. If you have children, you want to continue being their
father, and ideally co-parent.
It is important to carefully consider individual and reality factors. For exam-
ple, some married for practical reasons, but that’s not true for most gay men.
Most want to have a positive role with their children, but not all gay men. Most
women eventually accept that their ex-spouse is gay, have a good divorce, and
co-parent, but certainly not all. Be honest with yourself and deal with reality;
do not expect a best-case scenario. Most of the time, the couple divorce because
of a difference in sexual orientation. Yet, other gay men stay married and be-
lieve that this was the right decision.
The crucial issue is being true to your authentic sexual self. Accept being
gay as optimal. It is healthy for you and your wife to process why you did
not disclose this before marriage. Apologizing for the hurt and confusion
caused facilitates the healing process. Be clear what you are asking. She
probably won’t give you everything you ask for, but you have a right to your
requests.
Be open to her feelings, reactions, and requests. What you cannot allow is
being blamed or shamed. Do not apologize for being gay – it is your authentic
sexual self. In dealing with your partner, realize you have had time to process
your feelings and values. She needs time to process her attitudes, emotions, and
values. We encourage use of competent, non-judgmental therapeutic resources
(guidelines in Appendix A) to help in this process. She can benefit from a sup-
portive, gay-affirmative therapist. The woman has a right to establish her own
agenda. As well, both of you need to address the feelings and needs of your
children.
Each partner has the power to make a wise decision. A wise decision makes
sense emotionally and practically and works in the short and long terms So
much of “common sense” is simplistic and judgmental. It encourages dramatic
emotional choices which sound easy, but are often self-defeating. The first issue
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is whether both spouses can accept the reality that you are gay. Being gay was
not caused by the woman and she cannot change your sexual orientation. A
crucial issue is whether to continue the marriage. This is not a simple decision
that fits all people. Barry knows gay men, personally and professionally, with
healthy marriages and families.
The wise decision for the majority is the “good divorce”. The emotion is sad-
ness, not anger. You genuinely wish each other well and agree to not be involved
in the ex-spouse’s psychological, relational, or sexual decisions. Be respectful,
cooperative co-parents. Children want and deserve cooperative parents. Is this
too idealistic? Sometimes, it does not work, but is successful in a number of
families to the benefit of both the adults and children.
These guidelines are relevant if it is the wife who ends the marriage because
she determines that her genuine sexual self is lesbian or bisexual +. Accepting
this reality is healthy for her, you, and your children.
Marriages survive when there is a difference in sexual orientation, including
being polyamorous. Some couples maintain an emotional, although not sexual
bond. Most couples decide to divorce. Being lesbian was not caused by you,
but the realization that her genuine emotional bond and erotic charge is with a
woman needs to be accepted. Some couples find it is easier to accept a sexual
orientation difference as the reason to end the marriage. Acceptance facilitates
moving on with your lives.
Relational Decisions
For a gay man, a major decision is whether to share your life with a partner or
choose sexual friendships. If the latter, we suggest not trying to integrate new
men with your ex-spouse and children because there is too much change. When
you establish a life partnership or gay marriage, the challenge is establishing a
positive role for your partner. The usual recommendation is to create a cor-
dial relationship with the ex-spouse and a “favorite uncle” relationship with the
children. We have seen relationships where on one extreme the partner is like
a second parent and on the other extreme is stuck in the role of the “bad guy”.
What is the right fit for your real situation?
The overarching theme is to reorganize your life as a first-class gay man.
Ideally, this is supported by friends (both gay and straight) as well as family
members. Some people are accepting, others maintain distance, and some are
rejecting. Don’t give power to the rejecting people whether family, friends, or
neighbors. A particularly important resource is a religious community. Many
religions are now accepting of gay men. Others are affirmatively pro-gay, in-
cluding gay-majority congregations. Use all your resources to enhance your life
and relationship.
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Specific Issues of Sexual Behavior

The old view of gay sex was high frequency, multiple partners, focus on eroti-
cism, downplay intimacy, and never say no to sex. The sexual theme was any-
thing goes. A negative message was the dangers of gay sexuality, especially HIV
but also STIs, manipulative and destructive relationships, rejection of older gay
men and men with disabilities, and stigma about high-risk, anonymous sex. In
this view, gay sex was for the young, beautiful, adventurous, experimental, and
foolish. Another negative stereotype is that the passive partner in anal inter-
course was a second-class man. What an unscientific, simplistic, and prejudiced
view of gay sexuality. It negates what it means to be a healthy gay man relation-
ally and sexually.
In most ways, gay sexuality is similar to straight sexuality. Healthy gay sex-
uality is integrative, not driven by eroticism. Gay relationships can vary from a
traditional monogamous commitment to anonymous sex. Gay sexuality can be
healthy and satisfying or it can be high risk and destructive. Gay sexuality in-
volves a variety of scenarios, not a simple stereotype. Although anal intercourse
is valued by many gay couples, a significant number prefer manual, oral, and/
or rubbing stimulation. Many gay men and couples value intimacy, pleasur-
ing, and eroticism, but certainly not all. Contrary to cultural myths (including
among gay men), you can be sexual in your 60s, 70s, and 80s. In the shame-
based relationships of the past, older gay men formed “sugar daddy” connections
where younger men were manipulative in return for sex. In the new model of
gay sexuality, unhealthy relationships are not tolerated. The ex-wife urges her
former husband to create a healthy gay relationship. The core issue is accepting
being gay as optimal. You deserve sex to have a 15–20% role in your life and
relationship.
What are the core sexual differences for gay men? Other than loving and be-
ing sexual with another man, there are few core differences. There are individ-
ual differences in preferences, patterns, and feelings. Be aware these differences
are not true for all gay men or all gay relationships.
A common pattern is having more partners over a lifetime than straight men.
Another difference is lower levels of marriage (life partnership) and higher
levels of sexual friendships and casual sexual experiences. In addition, various
types of consensual non-monogamy are accepted, including “monogamish” on
one extreme and “fuck buddies” on the other. Gay men typically emphasize
eroticism and downplay nondemand pleasuring. In oral and anal sex, a signifi-
cant number take either the active or passive role, while others pride themselves
in being versatile. Masturbation and use of porn are accepted. There is evidence
of higher rates of impulsive/compulsive sexual behavior in the gay community
(Braun-Harvey & Vigorito, 2020).
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Gay men and straight men are not a different species. On most dimensions,
there are more similarities than differences. Contrary to cultural myths, this
includes sex problems. There are lower rates of PE, but higher rates of ED (es-
pecially with anal intercourse), HSDD, and ejaculatory inhibition. Sadly, there
are higher rates of mental health problems, including drug and alcohol abuse,
depression, intimate partner violence, and stress caused by prejudice and har-
assment. As a culture, we have come a long way, but have a long way to go to
promote the psychological, relational, and sexual well-being of gay men. A ma-
jor issue is not feeling deserving of love and acceptance. There are few positive
models of gay men, healthy relationships, and gay families.
Nathaniel, Katharine, and Kris

Nathaniel is a 29-year-old married man who is in the process of divorcing
Katharine, his 28-year-old wife. They had been a couple for almost ten years
(four of them married) and have a two-year-old son. Nathaniel met Katharine
when he was a sophomore in college and she a freshman. They enrolled in a class
on literature and gender. They were attracted to each other’s progressive ideas,
united against traditional gender values, and opposed to the double standard.
They did not become a sexual couple until the next year, but Katharine was
aware of a strong attraction. When they began as a couple, Nathaniel felt swept
away by her sexual enthusiasm. He was aware of conflicting sexual feelings.
When he masturbated, beginning at age 13, he had a range of erotic fantasies
about boys, girls, and group sex. This pattern continued throughout college,
although the predominant fantasy was giving oral sex to young men. His first
partner experience to orgasm was at age 16 – a girl stimulated him through his
pants while they were watching a movie. Each time he had a sexual experience
with a girl, he felt encouraged, but his sexual ambivalence continued. The first
time Nathaniel fellated a man to orgasm was age 17. It provided a powerful
erotic charge.
Katharine was a vibrant and erotic woman. Nathaniel knew she loved him
and felt love in return. He particularly valued giving and receiving oral sex. He
was functional during intercourse, but sensations and feelings were less intense.
About once a month, especially when drinking, he would have oral sex with a
man, experiencing powerful feelings. When Nathaniel was a senior and making
plans to apply to medical school, Katharine encouraged him to attend in the
city they lived. Nathaniel received a generous financial package and decided to
stay. Medical school and residency were stressful. Nathaniel valued Katharine’s
support and the continuity of their relationship. After graduation, she enrolled
in a two-year medical administration program where she excelled. Their life
was progressing and Katharine felt ready for marriage. Nathaniel loved her
and was enthusiastic, but did not bring up his sexual ambivalence or concerns.
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Their social/political stance was progressive and pro-gay, but they did not have
a discussion about his sexual orientation conflicts. They attended a ten-session
marriage preparation program which focused on communication and prob-
lem-solving, but ignored sexual issues. Theirs was a celebratory wedding and a
year after became pregnant.
The first sexual crisis occurred during the pregnancy. Nathaniel was enjoy-
ing his residency and felt that there was much good in his life, but was sleep
deprived. One night, he was in the break room at the hospital with an older
gay nurse who Nathaniel fellated to orgasm. The next day, the nurse accused
Nathaniel of sexual harassment. Nathaniel felt panicked and thought he should
tell Katharine rather than her hearing it through gossip. Unfortunately, he felt
shamed and could not disclose his sexual ambivalence. Katharine was very as-
sertive with the nurse who dropped the accusation. Katharine felt great and
Nathaniel felt terrible. He was living a lie – Nathaniel had a contingent sexual
self-esteem. He was afraid of sharing his sexual struggles with Katharine. Sex-
ual harassment was a bogus issue, but his sexual attraction to men, especially
giving fellatio, was very real. Nathaniel obtained a referral to an individual ther-
apist who was empathic, but not trained in sexual therapy and certainly not
sexual orientation assessment. The therapist believed that fellating men was a
symptom of an obsessive-compulsive disorder. Nathaniel attended individual
therapy for five months, terminating just before their son was born. Nathaniel
knew that the therapist was trying to help, but was not able to address his con-
flict over sexual orientation. This remained a “shameful secret”. He loved his
wife and was excited about the birth of their son, but felt like a sexual charlatan.
Two months after the birth, balancing medical practice and sleep depri-
vation, Nathaniel initiated a fellatio encounter with an intern. This man was
proud of being gay and wanted to pursue a sexual friendship with Nathaniel.
He urged Nathaniel to confine in him as a supportive friend. As a proud gay
man, the intern made it clear that there was nothing shameful about being gay.
He suggested that Nathaniel attend a meeting of the gay married men self-help
group and offered to accompany him. This was a breakthrough in terms of
self-acceptance.
Unfortunately, Nathaniel did not have the courage to disclose his growing
awareness to Katharine. He was involved with the baby, but stopped being sex-
ual with Katharine unless she insisted. He functioned sexually, especially in
the giving role, but his heart was not in it. Three months later, Nathaniel met
Kris, a 27-year-old gay man. Nathaniel fell in love. Kris strongly encouraged
Nathaniel to disclose his sexual orientation to Katharine rather than her hearing
it from others.
When he finally told Katharine, she was shocked. She asked how could
he be gay since their sex had been so good before the pregnancy and he was
a father. Katharine insisted that they consult a couple sex therapist. Nathaniel
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was ambivalent but agreed. The therapist employed a four-session assessment

model beginning with a joint session, then seeing each person for an individual
psychological/relational/sexual history. The therapist saw Nathaniel for a second
individual session to ensure that this was his genuine sexual narrative. As well,
the clinician had a second session with Katharine to assess her ability to deal with
Nathaniel being gay. At the 90-minute couple feedback session, the therapist was
empathic and respectful but clear in affirming that Nathaniel was gay. The ther-
apeutic challenge was accepting this reality and making a wise decision of how
to proceed. Nathaniel felt that a 500-pound weight was lifted from him. When
Katharine cried, they held each other without blaming or shaming.
Therapy gave them the time and space to process their new reality. They
decided to proceed with a good divorce. Katharine’s concern was that Kris not
replace her as a parent. They scheduled one session where Kris was invited to
discuss his role as a “favorite uncle”. Katharine and Kris established an emotion-
ally distant but cordial relationship.
Nathaniel embraced his new life, including creating a first-class relationship
with Kris with the hope that this would lead to a satisfying, secure, and sexual
marriage. Nathaniel, with Kris’s support, expanded his sexual repertoire to
include manual and anal stimulation. He also expanded his medical practice as
a gay-friendly physician. Nathaniel’s life was a busy, multi-dimensional one as a
first-class gay man.
Accepting Being Gay Is Necessary, But Not

Sufficient
In the early years of the gay liberation movement, the naïve belief was that when
the man accepts being gay, everything else would easily follow. Psychologically,
medically, and relationally, you need to attend to the issues and problems in
your life to ensure that you maintain a genuine sense of well-being. All men,
gay, straight, bisexual +, or non-binary, have strengths and vulnerabilities. In
assessing vulnerabilities and problematic areas, you need to determine which
are resolvable, which modifiable, and which have to be accepted and worked
around. You deserve to experience life as a healthy gay man. Don’t blame your
problems on other’s prejudices (it is true that anti-gay people and institutions
are a source of stress). An example is attending to physical and mental health.
Alcohol and drug abuse is higher in the gay community and gay men (even more
than straight men) are reluctant to consult a primary care physician. You owe
it to yourself and those who care about you to take care of your health. Alcohol
and drugs are misused as self-medication, especially for trauma. Don’t hide or
avoid; deal with difficult issues. An important decision is whether to organize
your life around a pair-bonded relationship, a consensual non-monogamy re-
lationship, sexual friendships, or casual sexual connections. What is the right
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fit for you emotionally and sexually? An important issue is work and finances.
Many gay men have flexibility since they are less likely to have children or a
mortgage. Organize your life so it’s functional and fits your values. Barry had a
gay client whose boss took advantage of his life flexibility to give night and week-
end assignments. Some gay men are underpaid because they have fewer financial
obligations. Gay men complain that their extended families take their flexibility
for granted compared to siblings who have a conventional life organization.
Be aware of health, personal, career, and life organization issues that are
challenges to being a first-class gay man.
Exercise – Assessing Strengths and

Vulnerabilities
Be honest with yourself and share your relational and sexual issues with a
trusted partner, friend, counselor, minister, or family member.
The first issue is acceptance as a gay man. Do you deserve a quality
life? What aspects of your life are you proud of? How do you organ-
ize your relational life – gay marriage (life partnership), lover, sexual
friendship, hook-up sex, anonymous sex? Do you attend sex parties, go
to hook-up bars, engage in triadic or group sex? Do you practice safe sex
or take the PreP medication? Are there high-risk people or situations in
your life? In what ways do you feel most accepted as a gay man? Are these
situations where you feel stressed or rejected?
If you were married and/or had children, have you processed sexual
orientation issues with your wife or ex-wife? Depending on their age and
maturity, have you discussed sexual orientation issues with your chil-
dren? Are you actively involved as a father?
Set goals for the next year. Don’t accept stereotypes or give socially
desirable responses. What are your personal goals? Set at least one and up
to three change goals. Examples include introducing nondemand pleas-
uring with your lover, writing a letter to your brother that acknowl-
edges he can’t affirm you being gay but he’s family and you want to feel
comfortable at family events, changing jobs to a gay-friendly employer,
introducing an erotic oral sex scenario, reassuring your parents they did
nothing wrong – being gay is optimal for you, planning a trip with your
child, having a consultation with a gay-friendly minister, joining a ther-
apy group for gay men, creating a retirement savings account.
Ask your partner, friend, or counselor for their perspectives. Remem-
ber, it’s your life, you are not asking for approval. Seek inputs and per-
spectives that would add to your understanding and quality of life.
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Summary
A book about men and sexuality needs to address the issue of homosexuality,
other sexual orientations, and gender expression. The old belief was that homo-
sexuality was a deviant behavior that had to be changed. Scientific findings re-
veal that this is a myth. For the great majority of gay men, sexual orientation is
“hardwired”. Being gay is optimal for you. Lead your life in a first-class manner.
Traditionally, gay men married with the hope that marriage and family would
change sexual orientation. For most couples, a “good divorce” is the wise de-
cision. However, respect individual differences. You have a range of emotional
and sexual options to deal with a mixed sexual orientation marriage. Be aware
of your attitudes and values as well as your spouse’s. Find the right fit for you,
preferably with the help of an individual and/or couple therapist.
Accept that your authentic sexual self is gay. This allows you to organize
your psychological, relational, and sexual life so that sexuality has a 15–20%
positive role. A major decision is whether to organize your life around a gay
marriage (life partnership). Another decision is whether you value monogamy
or you choose consensual non-monogamy.
Our culture has made major changes in the past 50 years, especially the
past 10 years. Accept homosexuality, bisexual +, and alternative sexualities.
Be aware of challenges and stresses and make wise decisions. Use all your re-
sources to establish a first-class life as a gay man.
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17
MONOGA MY VS. CONSENSUAL
NON-MONOGA MY
Developing a Genuine Commitment
Traditionally, couples assumed monogamy. Unfortunately, few couples have a

clear, specific discussion about the role and meaning of monogamy. In reality,
infidelity is common, especially among men. The most common type of affair is
a male High Opportunity-Low Involvement affair. When discovered, the cou-
ple fall into a gender power struggle where the woman feels hurt and betrayed
and you counterattack saying that this is normal male sexual behavior and she is
overreacting. Usually, the affair did not involve an emotional connection. The
affair might involve oral sex, intercourse, an on-line sexual experience, a one-
night stand, or going to a massage parlor and paying extra for a “happy ending”.
She feels you broke the trust bond. You counterattack saying that this was a
“sexual fling” that all men have, and she is being neurotic and causing a crisis.
No one wins power struggles. It is about not being the “loser”.
As a culture, our understanding of affairs and monogamy is sadly lacking. Affairs
are treated in a simplistic, black-and-white manner. Treatment is simplistic –
the “perpetrator” has to apologize and compensate the “victim”. The affair ends
the marriage because trust is destroyed. The assumption was that the cause of the
affair was either a relational or sexual problem. The affair controls your lives and
relationship. You are blamed for the affair and for the divorce.
Like so much in the sexuality field, the traditional approach to monogamy
is not scientifically supported. The traditional approach harms men, women,
couples, and the culture.
Affairs are multi-causal, multi-dimensional, with large individual, couple,
cultural, and value differences. Although well-intentioned, concepts about af-
fairs are iatrogenic (the attempt to help makes the problem worse and causes
greater damage). In truth, there are many causes of affairs, many dimensions,
many meanings, and many outcomes. Although the science regarding affairs is
weak because of lack of research and value conflicts, there is clinically relevant
scientific information which can facilitate understanding and help you make a
“wise decision” (makes sense emotionally and practically, short and long term).
A valuable guideline is never end a marriage because of an affair. This gives the
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M onogamy vs . C onsensual N on - M onogamy
affair more power than it deserves. The best assessment and treatment program
(Snyder, Baucom, & Gordon, 2007) urges individuals and couples to not make
impulsive choices. Do not “listen to your gut” when you discover an affair. In-
stead, engage in “self-care”. Do not assume that you know the meaning of the
affair or that the affair was caused by something you did or did not do. Do not
listen to the advice to kick the spouse out of the house, call a lawyer, or tell
her mother and friends what a terrible person you are. Self-care means engag-
ing in healthy coping using exercise, sleep, prayer, or meditation. Don’t drink,
demand to know all the affair details, post on Facebook, or hire an aggressive
divorce attorney. Slow down the process and take care of yourself. Don’t do
anything harmful to you or your family. This is especially true if you learn about
your wife’s affair.
A crucial strategy is to make genuine meaning of the affair. Create a narrative
that makes sense to the “injured partner” and the “involved partner”. Be sure
you understand the meaning of the affair for your marriage and sexual relation-
ship. We strongly recommend a marital or sex therapist who approaches affairs
as a couple issue rather than a simplistic, adversarial approach. Like intimacy
and sexuality, affairs are best understood and treated as a couple.
In understanding the affair, was it the most common type of male affair, a
High Opportunity-Low Involvement, Compartmentalized/Ongoing, or Com-
parison affair? What is the meaning of the affair from the perspective of the
involved partner, injured partner, and your relationship?
A common conflict is over what constitutes an affair and whether this was
really an affair. The involved partner says that it’s not an affair because they did
not have intercourse. The injured partner counters that it involved manual, oral,
or paid sex so of course it was an affair. Or in a Comparison affair, the involved
partner says that we never even kissed. Yet, the reason you avoid sex in the mar-
riage is that you’d be betraying the affair partner who you are in love with. Affairs
have different emotional and sexual meanings and are different for the involved
and injured partners. This is an example of the multi-dimensional role of affairs,
especially in terms of your marital bond. The traditional belief is that an affair is
always a symptom of a relationship problem. It is very important to assess that, but
don’t assume it because it’s usually not true. The majority of affairs occur with the
involved partner feeling fine about the marriage and sex in the marriage.
It is crucial to understand gender, cultural, and value dimensions when ex-
ploring the role and meaning of an affair. The traditional gender assumption
is that male affairs are “normal” as long as it didn’t threaten the marriage or
family. This difference in meaning is particularly significant in young marriages
and when there is a female Comparison affair. The gender split in behavior and
meaning exists across generations and cultures. Traditionally, male affairs are
treated with less judgment.
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A common fight after the discovery of an affair is whether or not the couple
had an agreement about monogamy. The injured partner insists that they have a
clear understanding and the affair is a major betrayal. The involved partner says
that they did not have a specific agreement and she is “making a mountain out
of a mole hill”. No one wins this argument; it is a charge-counter charge fight
which generates much heat but little light. It’s about whose fault it is, not about
understanding the role and meaning of the affair and how to move forward.
There is more bad advice in the media about affairs than almost any other area
of sexuality. A dramatic, extreme reaction to an affair is destructive for you,
your relationship, and your family.
The issue of monogamy is very important. It requires thought, awareness,
dialogue, and making a wise decision, not a simplistic, cookie-cutter approach.
Sexually, one size does not fit all. This illustrates the need for a wise decision
rather than an emotional choice based on simplistic gender assumptions.
The Importance of Having a Clear Agreement

Monogamy is something to dialogue about and decide on, not assume. A prime
question is whether both partners are committed to a satisfying, secure, and
sexual marriage (life partnership). Do not assume; have an honest, personal,
and clear discussion. For you, how important is sexuality and how important
is monogamy? Be honest; don’t give the socially desirable answer. Explore your
family, cultural, and religious beliefs and values. A crucial issue is whether there
are gender differences or are the values the same for both genders. Tradition-
ally, affairs were “normal” for men, but not for women. People are surprised
to discover that personal assumptions and values are different than traditional
gender assumptions.
Affairs are an example of sexuality being multi-causal, multi-dimensional
with large individual and value differences. Is an affair always a threat to the
marriage? Does an affair have to involve intercourse? Do you believe that high
opportunity is the major cause of affairs, especially for men? What constitutes
an affair – is it intercourse, use of porn, paid sex, betrayal, lying, kissing and
touching, trading sex pictures or erotic stories, acting out a secret arousal pat-
tern, sharing sexual texts or stories, oral or anal sex, fantasies about another
person? Do you have an explicit agreement covering these dimensions? Or do
you prefer the “don’t ask, don’t tell” approach? It is dangerous to have very dif-
ferent understandings and values. This sets you up for hurt, betrayal, and crisis.
Types of Affairs
The possible types of affairs are endless. We focus on three major types. First,
the High Opportunity-Low Involvement affair, the most common type for men.
159
It could involve one affair partner or a hundred partners. The important charac-
teristic is that it is primarily about sex with little to no emotional involvement.
Women do engage in High Opportunity-Low Involvement affairs. The belief
that a woman would not have this type of affair is an example of a false gender
stereotype. This is the easiest affair for the involved partner to give up and for
the injured partner to forgive.
Second, the Compartmentalized/Ongoing affair. This can be in-person or
on-line, choice or paid, someone from work or the neighborhood, involve elab-
orate planning or impulsive encounters. The affair can last six weeks or six
years. It begins as a sexually focused affair, but can take on emotional dimen-
sions which were unplanned. An example is the classic movie “Same Time Next
Year” that features a couple who meet for a sexual weekend each year for 25
years. The affair took a meaning very different than originally intended. Com-
partmentalized/Ongoing affairs are easier to get into than get out of.
Third, the Comparison affair which meets emotional and sexual needs more
than your primary relationship. Because of the mixture of emotional and sexual
dimensions, the Comparison affair is the most challenging to deal with. Unlike
other affairs, people do not plan to have a Comparison affair – you “fall in love”.
Comparison affairs are the most common female affair. Interestingly, women
seldom marry the affair partner. Marrying the affair partner is a male pattern.
These marriages have a high risk of a second divorce. What makes for an excit-
ing affair is different than what makes for a healthy second marriage.
Men react very strongly to finding that your wife had an affair partly because
it is a reversal of the double standard and partly because of the emotional com-
plexity of the affair. It violates a common guideline “Don’t fall in love with the
affair partner”. A Comparison affair has a major impact on the involved partner,
injured partner, and affair partner.
Don’t Give the Affair More Power than It Deserves

Affairs are an important issue, but when it is the defining issue for your rela-
tionship, you are giving the affair more power than it deserves. Your marriage
is more than the affair. An important guideline is to not end a marriage because
of an affair. Whether it was your partner’s affair or your affair, the wise strat-
egy is to take the time to make genuine meaning of the affair so you make the
best decision moving forward. Sometimes, the message of the affair is that this
is a fatally flawed marriage. More commonly, the message is that you ignored
important psychological, relational, or sexual issues that need to be addressed.
In other situations, the affair was a high opportunity that your partner or you
stumbled into. Other possible meanings are that the affair is a product of lone-
liness, depression, a secret arousal pattern, to prove something sexually, or
revenge.A common theme is the affair caused you to feel desire and desirable.
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The affair was not about wanting to leave the marriage, but to feel better about
yourself.
The affair has a message. Do not assume that you know the message. Explore
its meaning for you, your partner, your relationship, and your sexuality. Engage in
disclosure and discussion so that the message makes sense to the involved partner
and the injured partner. This puts you in a position to make a healthy decision
about your marriage. Don’t go with your gut; make a wise decision. The decision
to recommit to your marriage (partnership) or to end it isn’t “right-wrong”, but
what is the right decision for the present and future. The reality of marriage is that
it takes both to commit, and the reality of divorce is that it only takes one to leave.
In the United States, different than other cultures, it is the woman who decides to
divorce. The decision is based on the understanding that this is not a healthy mar-
riage in the present and won’t be in the future. It needs to be a thoughtful decision
based on an exploration of attitudes, behaviors, emotions, and values – including
sexuality. The decision to recommit is based on you revitalizing your relationship
and developing a bond of respect, trust, and intimacy. You can learn from the
past, but cannot change the past. You don’t get a “do-over” for the affair. Your
power for change is in the present and future. The decision should not be based on
the fact that an affair occurred.
Affair Statistics
The science of affairs is quite weak. The best estimate is that some type of
emotional or sexual incident, in-person or on-line, choice or paid, occurs in
35–45% of marriages. Contrary to popular belief, affairs are most likely to oc-
cur early in the marriage (the first five years). Married couples have lower rates
of affairs than cohabitating or dating couples. The majority of couples survive
affairs, especially the male High Opportunity-Low Involvement affair (Allen
et al., 2005).
Most couples do not have a clear agreement about monogamy, and do not
create an agreement even after an affair has been discovered. Contrary to pop-
ular belief, those in couple therapy do not repeat the affair pattern. The saying
“Once a cheater always a cheater” is not empirically supported. The important
issue is how the affair is processed and whether you create a clear agreement
about monogamy in the future. Our theme whether discussing primary preven-
tion or recovery from an affair is the importance of a clear, personally relevant
agreement. The majority of couples commit to monogamy after an affair. The
difference is that both partners are clear about personal and couple vulnera-
bilities and what to do in a high-risk (in terms of person, mood, or situation)
environment (McCarthy & Wald, 2013). The monogamy commitment is not
“holier than thou” or about being perfect, but based on genuinely valuing your
partner and marriage.
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Consensual Non-Monogamy (CNM)

Some couples reject monogamy, instead experiment with consensual non-
monogamy (CNM). Couples (perhaps 5–12%) adopt CNM as their sexual value.
A clear agreement regarding the boundaries of CNM is even more important.
There are three dimensions to a CNM agreement. First, what you value about
your marriage (partnership). Second, what type of CNM is right for you. Third,
what are the red lines which would destabilize or destroy your relationship.
There is probably a higher rate of affairs in CNM than in monogamous relation-
ships. Be aware that CNM agreements are often revised or revoked.
With CNM, one or both partners value adventure, exploration, testing
boundaries, making your own rules, and sexual flexibility.
There are all kinds of CNM, but we focus on three types – Open, Swing-
ing, and Polyamorous. Open relationships involve one or both partners being
sexual with others. This usually involves High Opportunity-Low Involvement
or Compartmentalized/Ongoing affairs. Open relationships are the most com-
mon CNM pattern, especially for men. Seldom do partners share information
about their affairs, although for others talking about the affair details enhances
erotic response.
Swinging involves being sexual with other couples. It can be “open swinging”
which means that your partner is present while you are sexual or “closed swing-
ing” where you know your partner is sexual, but you are not present.
Polyamorous relationships are the most discussed, but least practiced, type
of CNM. Polyamorous people have a range of emotional and sexual connec-
tions (often in the context of a Polyamorous community). These are complex
relationships – an alternative lifestyle.
These brief descriptions point out the complexity of CNM. CNM has differ-
ent roles and meanings for each partner and relationship. In many CNM agree-
ments, the partner’s roles are different rather than equitable.
Exercise – Your Couple Agreement about

Monogamy or Consensual Non-Monogamy
We urge you to have an open dialogue and create a clear agreement about
monogamy or CNM. Be honest with yourself. What is the right fit for
you? Do not give the “socially desirable” response. You cannot expect
your partner to be honest if you are not honest.
Most couples affirm the value of a satisfying, secure, and sexual mar-
riage (life partnership). They decide on monogamy to promote intimacy
and security. Monogamy is much more than good words or good in-
tentions. Create a specific monogamy commitment which is personally
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meaningful. Be aware of the type of person, situation, or mood which

would make you vulnerable to an affair. All people and all relationships
have vulnerabilities. Honesty about vulnerabilities is a crucial step in pre-
venting affairs and strengthening your monogamy commitment. It is very
rare that both partners have the same vulnerability. For example, your
partner might be vulnerable in a group setting where alcohol is flowing,
while you might be vulnerable in a situation where you feel isolated and
marginalized. Share vulnerabilities with your spouse. Rather than feel-
ing badly about yourself or your vulnerability, turn toward your partner
and discuss what an affair would mean for you and your relationship.
Affairs thrive on secrecy and impulsivity. Treat affairs as you would any
major life decision (having a third child, switching careers, buying a
house). Dialogue about the impact of an affair on you, your spouse, and
your relationship.
If there were an incident (in-person or on-line, intercourse or touching),
make an emotional commitment to disclose it within 72 hours. Do not keep
it secret. The cover-up adds to feelings of betrayal which is more impactful
than the sex itself.
A monogamy commitment is not based on fear, being a sexual detec-
tive, or feeling you are better than others. The foundation is valuing the
intimacy and security of your relationship. Monogamy is an emotional
and sexual commitment based on a positive influence process.
If you and your partner decide on CNM, an agreement is even more
important. You want sexuality to have a positive role in your life. Your
CNM agreement has three components. First, be clear what you value,
emotionally and sexually, about your marital (partnered) relationship.
Be sure that CNM does not subvert this. Couples choose CNM to eroti-
cize their lives, create their own sexual rules, add sexual drama, explore
emotional and sexual boundaries, and reinforce sexual adventure and
vitality.
Second, what type of CNM is the right fit for you – Open relation-
ships, Swinging, Polyamory, or something else? For example, open and
closed Swinging is very different, with different types of arousal and dif-
ferent sources of vulnerability. Think this through by yourself and with
your partner. Be personal and specific, not abstract or vague. People are
clear about what they don’t want. Be clear about what would work for
you. Don’t let yourself be blindsided by emotional or sexual factors you
did not consider.
Third, deal with difficult issues – “red flags”. What factors and bound-
ary violations would destroy your CNM relationship? Examples include
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falling in love with the affair partner, becoming pregnant, contracting an

STI, being manipulative, feeling set up, realizing you can’t accept your
partner being sexual in public, or pressure to incorporate the partner’s
variant arousal pattern. Rather than CNM having a positive role, it has a
destabilizing or destructive role.
Do people “cheat” on their CNM agreement? Yes. Be sure your CNM
agreement is clear, functional, and fits your emotional and sexual values.
This exercise is not a “politically correct” game. It involves a thought-
ful dialogue to promote a wise decision. Create an emotional agreement
which reinforces your sexuality and values.
A significant majority of couples commit to a monogamy agreement
because they put high value on intimacy and security. Does this guaran-
tee that neither partner will have an affair? No, affairs happen for a num-
ber of reasons, especially emotional factors and high opportunity. What a
monogamy commitment does ensure are the traditional gender assump-
tions about affairs and the secrecy/betrayal pattern is confronted. As a
client said to Barry “Two affairs over a 40-year marriage does not negate
the value of monogamy or our marriage”. A clear monogamy commit-
ment reduces the frequency of affairs, especially High Opportunity-Low
Involvement affairs. It confronts the traditional gender wars regarding
affairs.
For couples who decide on a CNM agreement implement this so sexu-
ality has a positive, rather than destabilizing role in your life. CNM needs
a positive agenda, not just a rejection of monogamy. Like much in life,
positive motivation is likely to result in a successful outcome. Couples
who decide on CNM value individuality, emphasize eroticism, and en-
courage experimentation with boundaries and sexuality.
Fears Behind the Monogamy Dialogue

Change is a given in individual and relational life. We are in a 54-year mar-
riage. Personally and relationally, we have experienced many changes, some
planned others totally unexpected. The mantra of a satisfying, secure, and sex-
ual marriage was not in vogue in 1966. Like most couples of our generation,
we did not engage in a clear dialogue about marriage, sexuality, or monogamy.
We, especially Barry, were aware of traditional sex roles and hypocrisy about
monogamy. Barry ignored the destructive role of traditional gender conflicts
until he began teaching a human sexuality class in 1970. Teaching causes you
to confront hypocrisy. You don’t want to teach one thing and practice another.
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Conservatives fear that if you challenge one sexual boundary, you wind up
challenging all sexual boundaries and eventually are caught in sexual chaos.
Contrary to those fears is the challenge to develop an integrated view of sexual-
ity which affirms that sex is a good thing in life, integral to you as a person, with
sexuality having a 15–20% role in your relationship. This includes attitudes,
behavior, emotions, and values. The decision about monogamy vs. CNM is a
crucial personal and relational decision. Be sure sexuality has a positive role in
your life.
Bethany and Alberto

Bethany and Alberto were a bi-cultural and bi-racial couple whose marriage
was thrown into crisis over the issue of affairs. They had been a romantic love/
passionate sex/idealized couple who were strongly supported by friends but
in conflict with their families. They met as young professionals. Alberto was
a Ph.D. economist from South America who worked for an international con-
sulting firm. He was determined to have a better quality of life than his family.
His parents were a conservative, traditional couple where mother managed the
family and looked the other way at father’s long-term Compartmentalized/
Ongoing affairs. Alberto’s sexual learning was totally different than his sister’s
who married at 18 because of a pregnancy.
Bethany was raised by her African-American single mother and had little
contact with her wealthy Caucasian father who had a traditional marriage and
family that Bethany never met. One thing her parents agreed on was the im-
portance of education. The major contact with her father involved academic de-
cisions. He would not pay tuition at Howard University, a Black college where
she had been accepted, instead insisted that she attend Georgetown University.
Bethany had planned to major in sociology, but father insisted that she major in
either business or pre-law. She became a lawyer with a specialty in civil rights
enforcement which thrilled her mother. Bethany’s mother was a proud Black
woman who embraced activism and sexuality. Mother supported Bethany’s
marriage, but her father did not attend the wedding because he did not believe
Alberto would value Bethany and their marriage, including monogamy. Beth-
any loved her father, but felt that he was a hypocrite.
It was easy for Bethany and Alberto to attack traditional norms and feel spe-
cial as a couple. Unfortunately, they avoided a personally meaningful conversa-
tion about their marriage, including monogamy.
Two years into the marriage, their careers and reputation as a non-traditional
couple were thriving, but intimacy and sexuality were problematic. When he
was home, Alberto was monogamous, but on business travel, especially inter-
nationally, he had High Opportunity-Low Involvement affairs. He made sure
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the woman used effective contraception and he always used condoms. He found
paid affairs with women he met at a hotel bar particularly erotic.
Bethany’s affair pattern was quite different. She valued being a sexually
expressive woman and was attracted to lawyers and sociologists active in the
civil rights movement. These were Compartmentalized/Ongoing affairs. She
fell in love with a high-profile, charismatic lawyer who claimed to be separated
and moving toward divorce. This was Bethany’s Comparison affair. She was
shocked to open an e-mail from the affair partner’s wife informing Bethany that
the affair was undermining their family and children and begging her to end it.
Bethany felt betrayed. This was compounded when she learned that the wife
had e-mailed Alberto – a painful way to learn of Bethany’s affair.
Bethany and Alberto felt drained by the drama. They needed to address ques-
tions of what affairs meant for each spouse, their marriage, and their sexual
relationship. They had seen friends engage in highly emotional, attack-counter-
attack reactions to discovered affairs. They did not want to go that route.
They scheduled a session with a couple therapist whose sub-specialty was
affairs. The therapist utilized a four-session assessment beginning with a couple
session which reinforces that like intimacy and sexuality, affairs are a couple
issue. The message of the first session was to slow down the process, not do
anything to make it worse, and engage in self-care. They were advised not to
compare each other’s affairs nor use friends to complain about and demonize
the spouse. Sessions 2 and 3 were individual psychological/relational/sexual
history sessions to start the process of making meaning of their affairs as well
as reaction to the spouse’s affairs. Each was given the homework assignment to
write a therapeutic letter to the spouse. Take responsibility for the affairs, dis-
cuss the themes (not the details) of the affairs, apologize for the hurt you caused,
own your positive and negative learnings from the affairs, and say what you
want going forward. The therapist’s role is to ensure that the letter is genuine
and comprehensive. Each letter is read aloud in the therapy session. The injured
partner can ask questions and clarify information and perceptions. The involved
partner apologizes for the pain caused. When the apology is accepted, you con-
tinue to process the meaning of the affair, but not use the affair as a weapon to
punish the involved partner.
This process was helpful for Bethany and Alberto. You can learn from the
past, but cannot change the past. A core issue was whether to rebond their
marriage. This would involve creating a new couple sexual style and a new trust
bond, including discussion about monogamy vs. CNM.
There was much that Bethany and Alberto respected and loved about each other.
Although they were sexually functional, sex did not energize their bond. The drama
of the affairs interfered with intimacy and marital sexuality. Neither Alberto nor
Bethany had a good marital or sexual model. Their affair pattern served to keep
them from developing a healthy marital bond and couple sexual style.
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Bethany and Alberto committed to a satisfying, secure, and sexual marriage,

including having two children. Would a monogamy commitment or a CNM
agreement facilitate those goals? Bethany was clear about wanting a marriage
where sexuality was vital and energizing. She valued a monogamy commitment
for herself as a first-class woman in a satisfying and secure marriage. Alberto
would have to give up the male privilege to have affairs, but the rewards of a
genuine bond made this worthwhile. They agreed to a relapse prevention plan
and consulted the therapist once a year to stay accountable to their commit-
ment. If a problem or conflict occurred, they would call for a “booster session”.
Summary
The issue of monogamy is very important – it needs to be carefully explored,
not assumed. Deal directly with monogamy issues. Couples (married or part-
nered) routinely endorse monogamy, but do not make a clear commitment.
Treating monogamy with benign neglect is a major cause of affairs and feelings
of betrayal. If you commit to monogamy, be sure it is a clear, specific, and
personally relevant commitment. This includes being honest about personal,
relational, and sexual vulnerabilities. Your agreement identifies high-risk situa-
tions, moods, and people.
For couples who choose CNM, it is even more important to have a clear,
specific agreement. Implement CNM so that sexuality has a positive role in your
life and does not subvert your relationship.
The commitment to monogamy or to CNM is a core relational decision.
Make it thoughtfully and wisely. Implement your agreement so that it promotes
sexual desire and satisfaction.
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18
CR EAT I NG A ND M A I NTA I NI NG
A SAT ISF Y I NG, SECUR E, A ND
SEXUAL BOND
A valued goal is to create and maintain a satisfying, secure, and sexual marriage
(life partnership). Marriage meets needs for intimacy and security better than
any other relationship. A healthy couple bond is very different than a perfect
relationship. You feel loved and respected for who you really are with your
strengths and vulnerabilities. You feel secure in your relationship with its dif-
ficulties and challenges rather than pretending you have an ideal relationship.
A healthy relationship is based on a positive influence process. This brings
out the best in you. You value a respectful, trusting, and intimate commitment.
Sexuality has a 15–20% role in energizing your bond and reinforcing feelings of
desire and desirability (McCarthy & McCarthy, 2019b).
Sexuality has a paradoxical role in your life and relationship. Sex is a small, inte-
gral factor in sharing pleasure, reinforcing your intimate bond, and serving as a ten-
sion reducer to help cope with the stresses of life, including sharing your lives. The
paradox is that dysfunctional, conflictual, or avoidant sexuality has an inordinately
powerful negative impact, demoralizing you and threatening relational stability. Bad
sex can kill a good relationship, but good sex cannot save a bad relationship.
This chapter is especially important. Traditionally, men were supposed to be
loyal to the marriage and support the family, but it was women who valued in-
timacy and the relationship, not men. For you, sex was the payoff for marriage.
This gender split is scientifically untrue and destructive for the man, woman,
couple, and culture. It is true that women enjoy and celebrate healthy marriages
and families more than men, but you need a healthy marriage more. One factor
which is different in the United States compared to other countries is that it is
women (especially college-educated) who leave marriages (Amato, 2010). The
most common reason is that she is disappointed in the man and relationship.
Divorce is hard on you and your role with your children.
You benefit from a healthy relationship. Creating a respectful, trusting,
emotionally committed marriage is one of your best life decisions. Even more
important, and more challenging, is to maintain a healthy bond, including sex-
ually. Traditionally, men valued sex, but not intimacy, nondemand pleasuring,
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A SAT I SF Y I NG, SECU R E, A N D SE X U A L BON D
or emotional bonding. Rigid stereotypes about men and masculinity are op-
pressive. You are discouraged from being a fully functioning human being.
Valuing your strengths is important but denying or minimizing vulnerabilities
is destructive. Many men have a contingent self-esteem and/or a contingent
relationship. You fear that if people, especially your partner, knew your history
or anxieties, they would not accept or love you. That is a very hard way to live.
The old model of masculinity based on the double standard was unhealthy
for the man, couple, and culture. We present a humanistic, accepting model
of being a man and a cooperative, pleasure-oriented approach to masculinity
and sexuality. The core sexual issue is a broad-based couple approach rather
than sex as a pass-fail individual performance. Good Enough Sex (GES) em-
powers you to accept a range of sexual roles, meanings, and outcomes rather
than a narrow, rigid approach to masculinity. The mantra of desire/pleasure/
eroticism/satisfaction is motivating. Perhaps the most important concept is to
value the woman as your intimate and erotic ally rather than the traditional split
of men valuing eroticism and women valuing intimacy. Female-male sexual eq-
uity reinforces the integration of intimacy, pleasuring, and eroticism.
The new approach to masculinity generally, and sexuality specifically, is
challenging yet worthwhile. The model of the strong man who is always in
control with no questions or doubts was simple and seductive, but wrong. Like-
wise, the traditional model of totally predictable performance with the demand
that a real man be able to have sex with any woman, anytime, and any situation
was oppressive. Men are complex and male sexuality is complex. Sexually, one
size never fits all. Focusing on giving and receiving pleasure is the essence of
the new model of male and couple sexuality. Share desire/pleasure/eroticism/
satisfaction. You do not need to perform for the woman or impress male peers.
Satisfying Is a Crucial Dimension

Traditional men undervalue their intimate relationship. Valuing a satisfying rela-
tionship is crucial. A satisfying relationship includes sexuality as an integral com-
ponent, but not the most important. A satisfying relationship involves accepting
your strengths and vulnerabilities, your partner’s strengths and vulnerabilities,
and strengths and vulnerabilities of your relationship. A satisfying relationship is
anti-perfectionistic, the opposite of the idealized limerence phase. Your relationship
is based on a positive influence process. You are a better person because you are in
this relationship. The relationship brings out healthy parts of you. You feel respected
and loved for who you really are – with your flaws as well as positives.
Satisfying involves positive, realistic goals for change. Healthy marriages
change; they do not stagnate. A key to the change process is the realization
that only 30% of relationship problems are resolvable. It is very important to
address and change those. The majority of relationship problems are modifiable.
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It is worth your time and effort to make realistic changes even though the prob-
lem is not totally resolved. The hardest issue is that even for the most loving,
well-intentioned couples, 10–20% of problems are not changeable or modi-
fiable. Satisfied couples accept this and work around problems so they do not
subvert your marriage (Gottman & Silver, 2015).
Positive, realistic goals are especially important in terms of sexual issues.
“Pop sex” would have you believe that with enough love, communication, erot-
icism, and willingness sex can be wonderful every time. This sets you up for
sexual dissatisfaction if not alienation. Play to your strengths as a sexual man
and couple, but don’t expect all sex to be wonderful, powerful, and swept away.
The best sex is mutual and synchronous. Both partners experience desire/
pleasure/eroticism/satisfaction. Most sexual experiences are asynchronous,
positive but better for one partner than the other. Even among loving, sexually
aware couples, 5–15% of sexual encounters are dissatisfying or dysfunctional.
Maintaining positive, realistic expectations is key to sexual satisfaction. Satis-
fied couples accept a range of meanings and outcomes rather than demanding
that all sex be mutual and wonderful.
Secure vs. Stable Marriage

In many cultures, the key to marriage is stability and children, not emotional or
sexual satisfaction. The underpinnings of a stable marriage were community norms,
family, religion, finances, and the stigma of divorce. A secure marriage is much
more than stability. In a secure marriage, you value your spouse and celebrate your
relationship which meets needs for intimacy and security. Yes, family, community
norms, and religion are important resources but genuinely valuing your relationship
and feeling loved and accepted is the foundation for a secure bond. For men and
couples, secure is much healthier than stable. A secure bond speaks to a high-qual-
ity relationship, while stable accepts a marginal or even destructive relationship. In
Barry’s clinical practice, he was saddened to see how lonely and disconnected men
feel in an unsatisfying, but stable marriage. Don’t settle for a marginal marriage.
Stability does not promote sexual desire or satisfaction; security promotes vital
and satisfying couple sexuality. A secure bond frees you to take risks and strive to
eroticize your relationship. A secure bond facilitates sexual exploration which invites
playful and erotic scenarios. A secure bond promotes male and couple sexuality.
The Paradoxical Role of Sex

One of the most interesting and controversial concepts is the paradox that healthy
sexuality has a 15–20% role in the man’s and couple’s lives, while dysfunctional,
conflictual, or avoidant sexuality has a powerful destructive role. Healthy sexu-
ality energizes your bond and reinforces feelings of desire and desirability. Don’t
take sexuality for granted. Put time, energy, and creativity into couple sexuality.
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The paradox is that sex problems destabilize you and your relationship. Sex can-
not save a bad relationship, but sex problems, secrets, dysfunction, and avoidance
can destroy a loving relationship. Rather than blaming your partner or denying
problems, turn toward your partner as your intimate and erotic friend. Secrecy
and shame subvert sexuality. Being an intimate sexual team promotes pleasure
and bonding. Respecting and trusting your partner is critical, but not enough.
Sharing intimacy, pleasuring, and eroticism ensures that sexuality remains vital.
Eric and Vivian

No couple is perfect, but Eric and Vivian were a model of a satisfying, secure,
and sexual marriage. Eric took great pride in his life and relationship. Sadly,
his family and cultural history did not promote healthy relationships. Eric was
proud he’d beaten the odds and their marriage promoted psychological, rela-
tional, and sexual well-being.
Eric’s parents were deceased. He does not blame them nor is he ashamed of
his background. Eric’s mother was murdered when he was 13 – it was a case
of being in the wrong place at the wrong time. She was a bystander in a fight
involving male gangs and was killed by a wayward bullet. Eric’s father quickly
remarried because he was unable to care for the older sister, Eric, and younger
sister. That tumultuous marriage lasted less than five years. Eric’s father became
an angry man who hated anyone different than himself. It was the sister, not the
father, who encouraged Eric to complete high school before joining the Navy.
The structure of the military was a foundation for Eric’s life. He learned
a valuable skill set involving technology. Refining job skills elicited a love of
learning and provided Eric opportunities for mastery and promotions. After he
left the military, Eric used veteran’s benefits to complete a college degree with a
double major in technology and business. He was 27 when he met Vivian. They
were a couple for three years before marrying. Both Eric and Vivian lacked a
positive model for a healthy relationship, but were committed to creating a sat-
isfying, secure, and sexual marriage. Eric told friends that developing a loving,
secure bond with Vivian was the best decision that he ever made. The concept
of “beating the odds” was highly motivating for Eric.
Vivian had taken advantage of Pell grants to finance her education, begin-
ning at a community college and finishing at a state university. She majored in
digital communication which she chose in part because it gave her flexibility of
where and how to work. Having a career and income was crucial. Watching her
mother struggling financially and without an independent identity motivated
Vivian to organize her life with greater autonomy.
Early in their relationship, Vivian made clear that the double standard was
not acceptable. She wanted more for herself and expected more from Eric. As
an adult, Eric no longer accepted the rigid male role regarding relationships
and sex. He looked back at adolescence and young adulthood relationships with
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regret. He was ready to meet the challenges of a healthy life and relationship.
Eric was a “new man” and Vivian supported Eric’s growth.
Eric and Vivian enjoyed the limerence phase. Most importantly, they dis-
cussed how to create a healthy bond. They had serious discussions on walks
after a sexual encounter. Sex was energizing and set the stage for explorations
about life, marriage, and family. Rather than splitting by traditional gender
roles, Eric was committed to creating and maintaining a life he was proud of.
They were honest about their family backgrounds. Eric was saddened by his
mother’s murder but did not feel shameful about this. He was frustrated that
he knew so few details about his mother and her life. Vivian encouraged him to
speak with an aunt who was outspoken in her antagonism toward Eric’s father,
but was willing to fill in important details about his mother’s life. Eric tried to
reestablish contact with his two sisters – he established a good relationship with
the older sister, but the younger sister resented Eric’s successes and they had a
marginal relationship. Vivian made the helpful comment that perfect endings
only happen in movies and novels.
The concept of “beating the odds” was empowering and motivating. Vivian
emphasized couple friendships to provide support for their goals. A particularly
hard realization was that one of Eric’s best friends from the military was now
a negative force in his life. The ex-friend’s motto was “Never trust a woman”.
Vivian encouraged Eric to establish male and couple friends who supported his
life values, especially female-male equity. Eric wanted people who were friends
of the marriage, not those who negated women and marriage.
Most of their friends were childless or had one child (one and done). Vivian
supported their decisions, but she wanted two or three children and for Eric
to be an involved father. This was a difficult challenge since Eric was not ex-
perienced with babies or young children. Fortunately, a couple friend had two
young children and Vivian volunteered them to watch the children for a three-
day weekend, while the parents went on a canoeing trip. This “test of fire”
opened Eric to enjoying parenting (not just surviving it).
The decision of whether to have children and how many is one of life’s most
important and one of the hardest to reverse. Vivian didn’t want to coerce Eric.
She wanted them to make a joint decision. Eric needed Vivian’s assurance that
he wouldn’t be treated as a second-class parent. She was more experienced and
skilled, but parenting is not a competition. Eric brought up the issue he was
concerned about – would they stay a sexual couple while parenting or was be-
ing a mother more important than being an intimate and erotic woman? Vivian
had talked about this with female friends – she wanted to be a good mother
and a first-class sexual woman. If Eric shared in parenting – both routine and
fun activities – this would allow Vivian the time and energy for pleasuring and
sexuality. This was a new and empowering concept. What Eric remembered
before her death is that mother did 95% of the parenting. When Vivian asked
him whether they were a good sexual model, Eric said that he had no idea, but
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assumed that they had the traditional role of the man initiating sex and the
woman saying no – then he laughed. Vivian was put off; this was not going to
work for their marriage. Vivian was enthusiastic about sex. She wanted Eric to
be open to her sexual scenarios. If something didn’t fit, Eric could say no. Eric
looked very uncomfortable and Vivian pushed him to be honest. Finally, Eric
said that it wasn’t a big deal, but he found her wearing cowboy boots a turn-off.
Vivian laughed and couldn’t stop. An old boyfriend had asked her to wear cow-
boy boots as an erotic charge and she assumed that was a common male turn-on.
It was funny but demonstrated how important it is to be honest about sexual
turn-ons and turn-offs. Remember, you are not clones of each other.
The advantage of having a good marital and sexual model is that it provides
a pattern to follow. However, most of us don’t have that advantage, especially
about sexual issues. The challenge is to create a couple sexual style that allows
you to be responsible for yourself sexually and be a sexual team who integrate
intimacy and eroticism. This takes time, energy, dialogue, trying out scenarios,
and feedback. You can get it right, but you can’t get it perfect. Nor can you
rest on your laurels. We have been married 54 years, and still put thought and
energy into couple sexuality.
Maintaining a satisfying, secure, and sexual marriage is an ongoing chal-
lenge. Eric and Vivian developed a couple ritual. Every six months, they took
a two-night trip to their favorite small town and reserved the same room at a
boutique hotel. They had two favorite hikes, two favorite breakfast places, and
one fancy restaurant for dinner and one funky place for their second dinner.
One night, Eric initiated his favorite sexual scenario and the next night, Vivian
initiated her erotic scenario with a prohibition on intercourse. The most impor-
tant dimension of their weekend was sitting by the lake, reviewing the past six
months and setting a goal for the next six months. This was particularly impor-
tant for Vivian who saw too many couple friends coast until there was a crisis.
For Eric, the important thing was to reinforce the quality of their lives and be
sure that their marriage is a core focus rather than their lives controlled by work
and parenting. He looked forward to the “couple again” phase. Eric and Vivian
were committed to a satisfying, secure, and sexual marriage.
How Much Is Enough?

A theme throughout this book is that traditional male expectations for inti-
macy and satisfaction are too low, while expectations for sex performance are
oppressive and dehumanizing. We advocate positive, realistic psychological,
relational, and sexual expectations. The GES model is empowering for men
whether 30, 50, or 70. So how much is enough?
Begin with acceptance of yourself as a sexual man. Accept yourself with psy-
chological, relational, and sexual strengths and vulnerabilities. Healthy male
sexuality is anti-individual sex performance. Confronting the double standard
173
and the rigid male sex role is necessary, but not sufficient. Just saying you are a
new man who affirms female-male sexual equity is not enough. Attitudinally,
behaviorally, and emotionally implement these concepts.
When you have a dissatisfying or dysfunctional sexual experience, do you turn
toward your partner without apologizing? Is she your intimate and erotic friend?
Do you end the experience in a sensual or erotic manner? This confronts the myth
of total predictability and performance. GES is an empowering concept, not com-
pensating or settling. GES is important for male sexuality, especially after age 40
and is crucial after age 60. Embracing GES allows you to enjoy sexuality in your
60s, 70s, and 80s. GES promotes a satisfying sexual relationship which enhances
the quality of your life, especially with aging. GES is about sexual acceptance and
dropping oppressive, performance-oriented demands.
Exercise – Implementing a Satisfying, Secure,

and Sexual Relationship
This couple exercise ensures that the new model of masculinity and sexu-
ality is successfully implemented. It requires you to value satisfaction and
security, not just sexuality. Satisfying is the key to a healthy relationship.
What does satisfaction mean to you and your partner? Each person lists
three relational components which enhance satisfaction. Don’t be misled
by idealization or perfectionism; focus on what allows you to feel good
about yourself, your partner, and your relationship. Examples include
feeling listened to in a conflict situation, supporting each person’s career
goals, feeling accepted as a desirable sexual partner, valuing a variety of
touching experiences from affection to intercourse, feeling accepted for
who you really are, being a healthier person because of your relationship.
Secure means feeling loved and valued, knowing that your partner has
your back. Secure is much different than stable – secure means you are a
valued person in a valued relationship. Although children, home, finances,
joint experiences are important, it is your emotional bond which is the core
of relational security. Security is about feeling respected and loved with
your vulnerabilities as well as strengths. Secure is much more than stable.
Problems need to be addressed, but not be driven by fear. A secure
bond promotes confidence that you can process feelings and emotionally
problem solve. You trust that your partner will make a good faith com-
mitment to deal with issues. If there are experiences which undermine
relational security, process these and do what is necessary to rebuild a
secure bond. You cannot treat your relationship as a done deal – you need
to reinforce satisfaction and security.
174
Sexuality is integral to your bond. The energizing role of couple sexuality

cannot be underestimated. Set aside time and energy for vital and satisfy-
ing sexuality. You cannot take sexuality for granted nor treat it with benign
neglect. Strategies to reinforce healthy sexuality include every six months
each partner initiates something new in terms of pleasure, eroticism, or in-
tercourse; every two months have a sexual date with a prohibition on inter-
course; each year schedule a couple weekend without children; when you
have a disappointing or dysfunctional sexual experience, turn toward your
partner rather than apologizing or avoiding; once a quarter, create an asyn-
chronous sexual scenario; develop a new afterplay scenario; surprise your
partner with a sexy outfit; be sexual somewhere other than your bedroom.
The goal is not an erotic performance, but to spice up your sexual
life – sharing intimacy, pleasuring, and eroticism. A key is acceptance
of the inherent flexibility and variability of couple sexuality, including a
range of outcomes.
We suggest engaging in this exercise on a yearly basis. Maintaining a
satisfying, secure, and sexual relationship is a challenge which requires
awareness and commitment.
Summary
Writing this book has been a joy, especially this chapter. Establishing realistic
goals for an intimate relationship is especially important for men. A traditional
male trap is to take the relationship for granted and have low expectations of
the marriage, including marital sex. Adopt the female-male equity model; em-
brace desire/pleasure/eroticism/satisfaction; integrate intimacy, pleasuring,
and eroticism; accept GES; and view the woman as your sexual ally.
Sexuality facilitates a respectful, trusting, intimate relationship. Sex does not
dominate you or your relationship, but has a positive, integral role in energizing
your bond and feeling proud as a sexual man. Unlike the double standard or the
individual pass-fail performance approach, this model centers on acceptance,
sharing pleasure, female-male equity, and GES expectations and experiences.
You are responsible for yourself sexually while recognizing that the essence of
sexuality is sharing intimacy, pleasuring, and eroticism. Being a proud sexual
man involves owning your vulnerabilities as well as strengths. Unlike the past
where men had a contingent sexual self-esteem or a contingent relationship,
male sexuality is based on acceptance.
A satisfying, secure, and sexual relationship brings out the best in you as a
man. This is true psychologically, relationally, and sexually. Good luck in your
journey to healthy male and couple sexuality.
175
Appendix A
CHOOSI NG A SEX, COUPLE,
OR I NDI V IDUAL THER APIST
This is a self-help book, but not a do-it-yourself therapy book. Many individuals
and couples are reluctant to consult a therapist, feeling that to do so is a sign
of weakness, a confession of inadequacy, or an admission that your life and
relationship are in dire straits. Unfortunately, this is even truer for men who
are fearful that the therapist will blame them for individual, couple, and sex
problems. In reality, seeking professional help means that you are a wise man
who realizes that there is a problem. You have made a commitment to address
the issues and promote individual, couple, and sexual growth.
The mental health field can be confusing. Sex therapy and couple therapy are
clinical subspecialties. They are offered by several professionals: psychologists,
marriage therapists, pastoral counselors, psychiatrists, social workers, and li-
censed professional counselors. The professional background of the clinician is
less important than his competence in dealing with sexual, couple, and individ-
ual problems.
Many people have health insurance that provides coverage for mental health;
thus, they can afford the services of a private practice therapist. Those who have
neither the financial resources nor insurance can consider a university or medi-
cal school mental health clinic, a family services center, or a local mental health
clinic. Most clinics have a sliding fee scale program.
When choosing a therapist, be direct in asking about credentials and areas
of expertise. Ask the clinician about the focus of therapy, how long therapy is
expected to last, and whether the emphasis is specifically on sexual problems or
on individual, communication, or relationship issues. Be especially diligent in
asking about university degrees and licensing. There are poorly qualified indi-
viduals – and some outright quacks – in any field.
One of the best ways to obtain a referral is to call or search on-line for a
professional organization such as a state psychological association, marriage and
family therapy association, or a mental health organization. You can obtain a re-
ferral from a family physician, minister, imam, rabbi, or a trusted friend. If you
176
APPENDIX A
live by a university or medical school, call to find what specialized psychological

or sexual health services are available.
For a sex therapy referral, contact the American Association of Sex Educa-
tors, Counselors, and Therapists (AASECT) at aasect.org. Another resource is
the Society for Sex Therapy and Research (SSTAR) at sstarnet.org.
For a couple therapist, check the website for the American Association for
Marriage and Family Therapy (AAMFT) at therapist locator.net.
If you want to see a psychologist who can provide individual or couple ther-
apy for anxiety, depression, behavioral health, and other issues, we suggest the
Registry of Health Service Providers in Psychology at findapsychologist.org.
Feel free to speak by phone with two or three therapists before deciding with
whom to see. Be aware of your level of comfort and degree of rapport with the
therapist as well as whether the therapist’s assessment of the problem and ap-
proach to treatment seems right for you. Once you begin, give therapy a chance
to be helpful. There are few miracle cures. Change requires commitment; it is
a gradual and often difficult process. Although many people benefit from short-
term therapy (fewer than 10 sessions), most find that the therapeutic process
will require four months or longer. The role of the therapist is that of consultant
rather than decision-maker. Therapy requires effort on your part, both during
the session and between sessions. Therapy helps you change attitudes, behav-
iors, and feelings. It takes courage to seek professional therapy. Therapy can
be a tremendous help in assessing and changing sexual, couple, and individual
problems. Therapy allows you to be a healthier person, couple, and sexual man.
177
Appendix B
SUGGESTED R EA DI NGS
Readings on Male Sexuality

Bader, M. (2008). Male sexuality. Lanham, MD: Rowman & Littlefield.
McCarthy, B. & Metz, M. (2008). Men’s sexual health. New York: Routledge.
Metz, M. & McCarthy, B. (2003). Coping with premature ejaculation. Oakland,
CA: New Harbinger.
Metz, M. & McCarthy, B. (2004). Coping with erectile dysfunction. Oakland, CA:
New Harbinger.
Murray, S. (2019). Not always in the mood. Lanham, MD: Rowman & Littlefield.
Zilbergeld, B. (1999). The new male sexuality. New York: Bantam.
Readings on Couple Sexuality

Kleinplatz, P. & Menard, A. (2020). Magnificent sex. New York: Routledge.
McCarthy, B. & McCarthy, E. (2009). Discovering your couple sexual style. New
York: Routledge.
McCarthy, B. & McCarthy, E. (2012). Sexual awareness (5th ed.). New York:
Routledge.
McCarthy, B. & McCarthy, E. (2019). Enhancing couple sexuality. New York:
Routledge.
McCarthy, B. & McCarthy, E. (2020). Rekindling desire (3rd ed.). New York:
Routledge.
Perel, E. (2006). Mating in captivity. New York: Harper-Collins.
Snyder, S. (2018). Love worth making. New York: St. Martin’s.
Readings on Female Sexuality

Brotto, L. (2017). Better sex through mindfulness. New York: Greystone.
178
APPENDIX B
Foley, S., Kope, S., & Sugrue, D. (2012). Sex matters for women (2nd ed.). New
York: Guilford.
McCarthy, B. & McCarthy, E. (2019). Finding your sexual voice. New York:
Routledge.
Mintz, L. (2018). Becoming cliterate. New York: Harper.
Nagoski, E. (2015). Come as you are. New York: Simon & Schuster.
Readings on Relationship Satisfaction

Doherty, W. (2013). Take back your marriage (2nd ed.). New York: Guilford.
Finkel, E. (2017). The all or nothing marriage. New York: Dutton.
Gottman, J. & Silver, N. (2015). The seven principles for making marriage work (2nd
ed.). New York: Harmony.
Johnson, S. (2008). Hold me tight. Boston, MA: Little, Brown.
Markman, H., Stanley, S., & Blumberg, S. (2010). Fighting for your marriage (3rd
ed.). San Francisco, CA: Jossey-Bass.
McCarthy, B. & McCarthy, E. (2004). Getting it right the first time. New York:
Routledge.
McCarthy, B. & McCarthy, E. (2006). Getting it right this time. New York:
Routledge.
Other Sexuality Readings

Maltz, W. (2012). The sexual healing journey (3rd ed.). New York: William
Morrow.
Snyder, D., Baucom, D., & Gordon, K. (2007). Getting past the affair. New York:
Guilford.
179
R EFER ENCES
Allen, E., Atkins, D., Baucom, D., Snyder, D., Gordon, K., & Glass, S. (2005). In-
trapersonal, interpersonal, and contextual factors in engaging in and response to
extra-marital involvement. Clinical Psychology: Science and Practice, 12, 101–130.
Althof, S. (2006). Sex therapy in the age of pharmacotherapy. Annual Review of Sex Re-
search, 17, 116–132.
Althof, S. (2020). Treatment of premature ejaculation. In K. Hall & Y. Binik (Eds.)
Principles and practice of sex therapy (6th ed., pp. 134–154). New York: Guilford.
Althof, S. & Rosen, R. (2007). Combining medical and psychological interventions for
the treatment of erectile dysfunction. In S. Leiblum (Ed.) Principles and practice of sex
therapy (4th ed., pp. 157–186). New York: Guilford.
Amato, P. (2010). Research on divorce. Journal of Marriage and Family, 72, 650–666.
Baumeister, R. (2000). Gender differences in erotic plasticity: The female sexual drive
as socially flexible and responsive. Psychological Bulletin, 126, 347–374.
Braun-Harvey, D. & Vigorito, M. (2020). Out of control sexual behavior. In K. Hall &
Y. Binik (Eds.) Principles and practice of sex therapy (6th ed., pp. 269–293). New York:
Guilford.
Byers, E. & McNeil, S. (2006). Further validation of the interpersonal exchange model
of sexual satisfaction. Journal of Sex and Marital Therapy, 32, 53–69.
Chivers, M. (2017). Gender. In C. Pukall (Ed.) Human sexuality (2nd ed., pp. 232–259).
New York: Guilford.
Daigle, L., Evier, B., & Cullen. (2008). The violation and sexual victimization of col-
lege women. Journal of Interpersonal Violence, 23, 1296–1313.
Doherty, W. (2013). Take back your marriage (2nd ed.). New York: Guilford.
Foley, S., Kope, S., & Sugrue, D. (2012). Sex matters for women (2nd ed.). New York:
Guilford.
Frank, E., Anderson, C., & Rubinstein, D. (1978). Frequency of sexual dysfunction in
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Gottman, J. & Silver, N. (2015). The seven principles for making marriage work (2nd ed.).
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Heiman, J., Long, J., Smith, S., Fisher, W., Sand, M., & Rosen, R. (2011). Sexual
satisfaction and relationship happiness in midlife and older couples in five countries.
Archives of Sexual Behavior, 40, 741–753.
Hyde, J. (2005). The gender similarities hypothesis. American Psychologist, 60, 581–592.
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Kerner, I. (2005). She comes first. New York: William Morrow.
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183

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“Barry and Emily McCarthy continue to produce high-quality, highly rele-

Confronting Myths and Promoting Change

Barry McCarthy and Emily McCarthy

1 Men Are Not Simple: Promoting Male and Couple Sexuality 1

2 The Sexual War between Men and Women: Changing

3 Confronting Contemporary Male Sexuality: Breaking

4 Female-Male Sexual Equity: Confronting the

5 The Sexual Development of Boys and Adolescents:

6 Young Adult Sexuality: Time for Change 47

7 The New Sexual Mantra: Desire/Pleasure/Eroticism/

8 Adult Sexuality: A New Model of Masculinity 68

9 Desire: The Core of Sexuality 78

10 Integrating Intimacy, Pleasuring, and Eroticism:

11 Developing Your Couple Sexual Style: The Autonomy/

We explore healthy and unhealthy components of male sexuality to increase

The Myth of Male Sexuality

Healthy Male, Female, and Couple Sexuality

a first-class woman. Healthy sexuality is a one-two combination of personal

Special Issues for Men

degradation of female sexuality must be confronted. Demonizing and shaming

Special Issues for Women

Respect, Trust, and Intimacy

Sexual intimacy is particularly challenging. Sexual intimacy involves integrating

The Challenge of Couple Sexuality

Who We Are and the Format of This Book

harmful effects of the double standard which emphasizes male-female differ-

A New Sexual Dialogue

as healthy, not inferior to spontaneous desire. In fact, we argue (discussed in

majority of cases, it is the woman who is responsible for contraception. From a

Aliza and Marshall

friendships with both genders. Aliza was particularly supportive of transgender

Navigating the Details of Female-Male

Exercise – Implementing the Female-Male

From Theory to Implementation

The Big Three Toxic Behaviors – Child Sexual

physically, and sexually. Incest is surrounded by stigma and silence. Incest is a

Dealing with a History of Sexual Trauma

Male Peer Influence

In adolescent and young adult male sexual socialization, there is no mention

Intimate Partner Violence and Toxic Sexuality

Confronting the Man, Not Shaming the Man

Being a Proud Sexual Man

Exercise – Confronting Toxic Male Sexuality

Just as important as your personal sexual history is your history of en-

Exercise – Confronting the Double Standard

Were there people or learnings which challenged the double standard or at

take female-male sexual equity seriously nor do they feel it is relevant.

The Context for an Emotionally

Marcella and Jose

The Challenges of Female-Male Equity

Relational Equity and Sexual Equity

naturally follows. The new understanding supports an interactive (both-and)

Sexual Identity for Boys

Child Sexual Abuse

When the Woman Has an Abuse/Trauma History

Special Issues in Childhood Sexuality

health/sex educators is to begin with positive sexual learnings. Unfortunately,

Sexual Issues for Male Adolescents

Issues for Female Adolescents

Exercise – Healthy and Unhealthy Sexual