SEXUAL HEALTH: psychedelics and sex therapy

In recent years, medical research into the therapeutic use of psychedelic drugs has cautiously re-emerged after decades of being shut down by War on Drugs rhetoric. Major medical centers are now participating in multi-stage trials of MDMA (ecstasy) for treatment of post-traumatic stress disorder (PTSD) and psilocybin (the active ingredient in magic mushrooms) for treating depression, cancer anxiety, and alcoholism. In South America, the Amazonian plant medicine ayahuasca has been used to manage a variety of ailments, especially alcohol and drug addiction.

Like a lot of people, I caught wind of this renewed research into psychedelics from reading an article by Michael Pollan called “The Trip Treatment” that was published in the New Yorker two years ago. Pollan noted:

Beginning in the nineteen-fifties, psychedelics had been used to treat a wide variety of conditions, including alcoholism and end-of-life anxiety…Between 1953 and 1973, the federal government spent four million dollars to fund a hundred and sixteen studies of LSD, involving more than seventeen hundred subjects…Psychedelics were tested on alcoholics, people struggling with obsessive-compulsive disorder, depressives, autistic children, schizophrenics, terminal cancer patients, and convicts, as well as on perfectly healthy artists and scientists (to study creativity) and divinity students (to study spirituality)…

By the mid-nineteen-sixties, LSD had escaped from the laboratory and swept through the counterculture. In 1970, Richard Nixon signed the Controlled Substances Act and put most psychedelics on Schedule 1, prohibiting their use for any purpose. Research soon came to a halt, and what had been learned was all but erased from the field of psychiatry.

It’s taken decades for conditions to shift so that research into the therapeutic use of pyschedelics can pick up where it left off in 1970. The bulk of Pollan’s article focused on participants in clinical trials at several universities, including N.Y.U., in which psilocybin was being administered to cancer patients in an effort to relieve their anxiety and “existential distress.”

One of the researchers was quoted as saying that, under the influence of the hallucinogen, “individuals transcend their primary identification with their bodies and experience ego-free states . . . and return with a new perspective and profound acceptance.”

Naturally, as a sex therapist, I was intrigued to attend a presentation last December called “Reclaiming Ecstasy: An Exploration of the Therapeutic Use of Psychedelics and Sacred Plant Medicines in the Treatment of Sexual Trauma and Dysfunction” given by my friend and colleague Dee Dee Goldpaugh. The presentation took place as part of the Sexuality Speakers Series, hosted by Dulcinea Pitagora and Michael Aaron, creators of the AltSex NYC Conference.

reclaiming ecstasy

image by Alex Grey

In her talk, Goldpaugh laid out some basic pharmacological information about the two classes of psychedelics (the hallucinogens such as psilocybin, LSD, and ayahuasca/DMT and the empathogens such as mescaline, 2cb, and MDMA) and the difference between therapeutic use (pure substances in measured doses) and self-administration. She shared the distinction that clinicians make between big-T trauma (rape, incest, assault, molestation) and little-T trauma (being catcalled, medical exams, being belittled, punished for masturbation, boundaries not respected by caregivers). And she explained the numerous ways in which sexual abuse has lasting effects on those have been sexually abused: PTSD, depression, dissociation, substance abuse, distrust, dysfunction, shame, self-blame, body image issues, sexually transmitted infections.

Citing the work of Friedericke Meckel Fisher (Therapy With Substances) and Bessel van der Kolk (The Body Knows the Score), Goldpaugh then laid out some of the explorations researchers are conducting to use psychedelics to treat trauma, especially in the area of sexuality, intimacy, and relationships. MDMA, for instance, was first patented in 1914 and until it was outlawed in 1985 was used for couples therapy, among other things, because of its effectiveness in treating symptoms of PTSD and because it seemed to activate long-term memory and allow subjects to reprocess traumatic material safely. Because it induces pleasurable sensations, MDMA allows users to feel fully embodied, increases empathy, and reduces shame.

Psilocybin studies suggest that it increases openness and facilitates mystical experiences by helping the brain bypass habitual thinking. Goldpaugh proposed that psilocybin could be useful in sex therapy to reduce body anxiety and to be present with pleasure. Similarly, ayahuasca enables users to override old responses and write new stories of their own experience. Goldpaugh suggested that these substances have potential to enhance a spirituality often neglected in sex therapy. She gave examples of using guided visualizations with trauma survivors who experience intrusive images during sex, helping them identify non-sexual images they can connect to in an embodied way during sexual activity (including masturbation).

Goldpaugh was very upfront in saying that she doesn’t give psychedelics to her clients or refer them to “underground” practitioners who do. At the same time, she does advocate working to legalize the use of these medicines and to support further research through organizations such as MAPS (Multidisciplinary Association for Psychedelic Studies). Her website introduced me to the term “psychedelic integration therapy,” indicating that she helps clients process their experiences with psychedelics, as I have begun to do in my own work.

I consider Goldpaugh a kindred spirit in many ways, including how she describes a “psychedelic” approach to working with clients. This approach, she said, is based on strengths, not pathology; engages spirituality, “whatever that means for the client,” as an aspect of identity; embraces radical sex-positivity; sees all people as capable of change and growth; and views sexual pleasure as a sacred human right.




SEXUAL HEALTH: sex therapy for wounded veterans

In an article by Joseph Jaafari posted online May 12, The Atlantic covered creative therapies that are teaching veterans with genital injuries alternative ways to be intimate. “While all Veterans Affairs hospitals offer Occupational Therapy, which includes sexual therapy, the VA Long Beach Healthcare System in southern California and Walter Reed Medical Center in Bethesda, Maryland, are unique in that they have introduced courses and counseling focused on this issue. The programs offer guidance as veterans recover from genital wounds, and are part of an increasing effort by the military to both address these injuries and protect soldiers from them in the future.”

The article focuses on the treatment of a former U.S. Marine Corps staff sergeant named Timothy Brown. “Post-recovery, Brown has taken a different approach to sex than he had before—shifting the emphasis from his personal satisfaction to insuring that his partner enjoys the experience. ‘I went from being self-centered to trying to encompass everything for the both of us,’ he says. ‘Simple things like feeling [his partner’s] body, feeling their muscles when you hit the right spot.’ While he developed this outlook on his own, he notes that the program enabled him to feel more secure in his sexual life.”

Army Spec. Chris Smith, a soldier from the 10th Mountain Division stationed at Fort Drum, sits in The Different Drummer Internet Cafe in Watertown, New York April 16, 2008. The Different Drummer is a place where soldiers both active and discharged can go for support, counciling or just to socialize. Soldiers of the 10th Mountain Division are among those who've spent most time in Iraq and Afghanistan, making its base at Fort Drum a "canary in a coal mine" for a looming crisis of post-traumatic stress disorder.  Picture taken on April 16, 2008.     To match feature USA-MILITARY/ and USA-MILITARY/MARRIAGE         REUTERS/Mark Dye          (UNITED STATES) - RTR208HV

Army Spec. Chris Smith, a soldier from the 10th Mountain Division stationed at Fort Drum, sits in The Different Drummer Internet Cafe in Watertown, New York April 16, 2008. The Different Drummer is a place where soldiers both active and discharged can go for support, counseling or just to socialize. Soldiers of the 10th Mountain Division are among those who’ve spent most time in Iraq and Afghanistan, making its base at Fort Drum a “canary in a coal mine” for a looming crisis of post-traumatic stress disorder. Picture taken on April 16, 2008. Photo by Mark Dye

The article notes that “Brown’s approach is exactly what occupational therapists at Walter Reed have tried to teach other injured soldiers. Within the hospital there is a sexual health and intimacy service that focuses on education and therapy. According to Brown, therapy sessions were de facto sex classes that included sex toys aimed at stimulating different parts of the body. Officials at Walter Reed wouldn’t comment on what products were used during the sessions. In addition to funding classes like this one, the Department of Defense spent more than $84 million on erectile dysfunction drugs in 2014.”

Check out the whole story online here and let me know what you think.

SEXUAL HEALTH: sensible talk about herpes

Researching medical conditions online is always a dicey proposition. Dr. Google almost always offers too much information (e.g., statistics without context), focuses on worst-case scenarios, and scares people to death, sometimes intentionally. All of that is especially true when it comes to the subject of herpes. “I have seen herpes make more people cry than a positive hepatitis-C result,” says my friend Brett, a veteran sex educator who recently graduated from nursing school. “Doctors really do the world dirty by how they present this.”

I have had conversations with numerous clients who were concerned (“freaking out” is not too strong an expression) to learn they themselves have herpes or that a partner has herpes, based on either a blood test coming back positive or experiencing an outbreak of herpes lesions. Because it is true that once you’ve acquired the herpes virus it stays in your nervous system forever and that herpes is sometimes transmitted through sexual contact, it’s not uncommon for someone in the throes of freaking out to leap to the conclusion that “OMG my boyfriend has given me an incurable disease and/or I can never have sex again!” Neither of those statements is accurate. Active herpes infections are something to take seriously, and of course conscientious people make every effort not to pass sexually transmitted infections on to their sex partners. But herpes is treatable, not tragic. I would like to take this opportunity to offer some calm practical information about the realities of living with herpes.


What we’re talking about is the herpes simplex virus, of which there are two types, HSV I and HSV II. HSV I affects the mouth and face and causes crusty cold sores on the lips or chancre sores inside the mouth. Almost everyone has HSV I; it’s usually acquired as an upper respiratory infection during early childhood. HSV II causes genital herpes, which can manifest as small clusters of itchy blisters on the penis, vulva, or anus. “There is some evidence of crossing over (HSV I causing genital herpes and HSV II causing oral herpes),” says Brett, “but the numbers don’t support the freakout.”

Guys usually learn they have herpes when they find tiny blisters on their dicks that turn into painful sores. It can take a couple of weeks for the sores to run their full cycle of scabbing over and then healing. (Anal and vaginal herpes can take longer to heal because of the moist environment in which they occur.) The first outbreak is always the worst. It can be treated with the antiviral medication acicyclovir (Zovirax) and its variations, famciclovir (Famvir) and valacyclovir (Valtrex). Taking this medication daily can reduce the severity of symptoms and frequency of recurrence. You can expect outbreaks to occur at unpredictable intervals, triggered by a cold or stress or friction. Recurrences usually get less severe and less frequent over time. If you have HIV or hepatitis-C, your immune system may be more susceptible to herpes outbreaks and so requires extra care and attention.

It’s possible to acquire the herpes virus without experiencing any symptoms. “How would you explain to someone what it means when a blood test returns positive for herpes simplex with no symptoms?” I asked Brett. He said, “It’s probably a mild or previously acquired infection, newly detected. If you discover you have it and you aren’t covered in lesions, rejoice, because it will continue to fade.” Another sex educator I know tells the people he counsels that a blood test that comes back positive for herpes most likely means that you’ve had sex with more than four people in your life.

How do you avoid passing genital herpes to a partner? That’s easy. You know when you have a herpes sore on your dick because it hurts and you don’t want anyone messing around with it in that condition anyway. Herpes is most infectious when there’s an open sore; once the skin has healed over, it’s safe to engage in sex with a partner. You may read online scary language about “viral shedding” that suggests that you’re infectious whether you have a visible sore or not. I don’t mean to be cavalier about this, but if it’s not measurable there’s no point in making yourself crazy about it, anymore than it makes sense to stay home all winter to avoid seasonal airborne colds.

How do you avoid contracting herpes from a partner? That’s also pretty easy. All sexually transmitted infections can be prevented by using condoms for insertive sex – there’s a reason that condoms used to be referred to as “prophylactics.” And let’s be honest, not everyone uses condoms for insertive sex. (Almost no one uses condoms for oral sex.) If you don’t, it’s common sense to take some other precautions, which can include having an honest and detailed conversation with your partners about possible infections (a conversation that does not limit itself to the offensive question “Are you clean?”) and/or visually examining the apparatus for suspicious bumps or rashes. I know it’s awkward to talk about these things, so try to make it fun and safe for yourself and others. For helpful suggestions on that front and a rational perspective on herpes from a woman’s point of view, check out the website of Ella Dawson, who has written numerous brave, informative, personal, mythbusting blog posts about many different aspects of herpes.

If you’re sexually active, it’s wise to get tested on a regular basis for sexually transmitted infections. If you know that you’re the kind of person who’s prone to hysteria and runs to the doctor to get tested after every sexual encounter that poses some risk, you might want to seek help and support from friends, peers, or professionals to scale back the behavior that causes you to freak out. Life is too short to let exaggerated fears get in the way of the pleasures of sex.