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Dear Intimacy Dr, The holidays are coming up and my mom is asking me to “keep the peace” with all the older family members. They are high-key racist, transphobic, and homophobic and will rail on endlessly. The rest of my family say it’s stressful enough, and not to respond. Do I need to stay silent for civility’s sake? Queer and Tired Dear Queer and Tired, Fuck no. Sincerely, Dr. Faith 
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I have a newsboy cap. Actually I have two of them. One is black and one is green because I like options as much as I love hats. When I say newsboy cap you probably totally know what I’m talking about. They were ubiquitous among the young men who delivered and/or sold newspapers on street corners. At least as seen in black and white photos of the 30s. They are soft and comfortable and keep the sun out of my eyes. They are brilliant for hiding a bad hair day. I also have zero desire for becoming a newsboy. I like being a therapist. And I think it generally pays better, at least most days, then selling newspapers curbside. Human beings have a unique capacity to “try on” (whether literally or figuratively) multiple ways of expressing who we are. It helps us define not only who we are, but also who we are not. Freud Is famous for saying “Sometimes a cigar is just a cigar.” And it is equally true that sometimes a newsboy hat is just a newsboy hat. And sometimes a fantasy is just a fantasy. Fantasy Does Not Define Reality The Diagnostic and Statistical Manual (DSM-V) is the manual that clinician use to assign a diagnosis. It refers to “anomalous” fantasies. As a licensed clinician with a post-doc in sexology I realize I have very wide margins of “normal” but I can’t be the only one who wonders what anomalous is supposed to mean in this context. More than 30 years ago, the Masters and Johnson research team started releasing their findings about sexual fantasies. About 75% of our sexual fantasies are “normal” sex. Which means the other 25% is about things that have some level of intrigue for us but isn’t something we necessarily want to try out. For example? The researchers noted that among homosexual and heterosexual men, both groups fantasized about having sex with a person not of their traditional orientation. That was as high on the list as BDSM fantasies, group sex fantasies, and all the other common fantasy behaviors that people experience. In fact, more recent research, published in the Journal of Sexual Medicine, tried to parse out what fantasies are “normal” and what are “atypical.”
And guess what? Sexual fantasy is so complex and diverse that the study authors found it exceptionally difficult to define anything as either typical or rare. A rich fantasy life is just an integral part of being human. Dr. Adrian Warren, a licensed clinician in private practice in San Antonio, TX notes that sometimes fantasies can represent what Jung referred to as the shadow self, the darker part of our human nature. He relates to fantasies as symbolic ways of exploring the shadow aspects of human nature, which is far different from presuming they are indicative of being a terrible or evil human being. He states “Like all shadows they are only 2-dimensional objects of light and dark. The outlines probably do, to one degree or another, represent a truly dark side of us. But they are filled in by thoughts, fantasies, nightmares, and dreams that rarely take form. The details hidden inside the shadow are incredibly intimate and vulnerable.” The sexual inventory checklist I use with clients about sexual activities has four options: yes, no, I don’t know, and fantasy only. This stems from the fact that I’ve had clients tell me, with great horror, that after sharing a fantasy with a partner, their partner went to great trouble trying to fulfill it for them…and they had no genuine interest in making it real. Being intrigued by an idea or turned on by it isn’t the same thing as being interested in trying it out in real life. Human beings are storytelling animals. They may be a reflection of our true desires, or our shadow selves. Only the person having the fantasy knows for sure. Fantasy is Not Obsession (2/3rds of Women Don’t Actually WANT to Be Raped) A 2015 study of women published in the Archives of Sexual Behavior found that that up to 62% of women in the study had experienced rape fantasies. Do 62% of women secretly harbor a desire to be raped? Maybe some losers on 4chan think so, but I seriously doubt it. This is the important part.  The researcher looked at how often the fantasy occurred. And the respondents essentially said “hardly ever.” As in once a week, maybe once a month. And when the researchers unpacked the “why” behind the rape fantasy? It wasn’t tied to the idea of not having to take responsibility for a sexual encounter but was actually tied to a younger generation being experientially open and fantasy allowing them to express that without actual violation. The women who reported this particular fantasy had HIGHER self-esteem overall, more positive attitudes about sex overall, and a general wider variety of sexual fantasy overall. Rape fantasy was a small part of a much larger picture. Dr Jacqueline Parsons, a licensed counselor and neurofeedback practioner with offices in Marble Falls, TX and San Antonio, TX agrees, noting “There’s no such thing as a normal sexual fantasy-topics include BDSM, same sex encounters, rape fantasies, etc. Individuals often get more adventurous in their heads than in their bedrooms.” She goes on to state that Freud was just dead wrong when he proclaimed that a happy person never fantasizes. In reality, it’s a sign of an active and healthy imagination. Fantasy and Role Play Can Allow an Authentic Identity to Be Present I’ve seen a far greater number of clients in my private practice who are into sexual role play. The internet has made it so much easier to find people with similar interests and engage in a sexual relationship with them setting up elaborate stories and settings in which they can enact certain roles that would be otherwise impossible. I’ve seen this be especially true of my clients who are trans* or otherwise gender non-conforming. If you feel uncomfortable in your physical body presentation, role playing as someone else allows you a new level of freedom. Many younger clients have told me that role playing games were their first self-awareness of the gender identity. That starting in puberty they found themselves picking characters of their authentic gender instead of birth assignment. A lot of people are just big fans of certain characters and really enjoy cosplay. Bringing that cosplay into their sexual relationships simply enhances the experience. Whether you are dressing up as your favorite Marvel character, wearing a firefighter’s uniform, or even just a newsboy cap, you don’t need to hate you body to enjoy being someone else now and then! So When IS It A Problem? Things To Watch Out For
While I am totally the queen of “you do you and let your freak flag fly,” sexual fantasy and role play can end up being problematic. Here are some warning signs:
 Myth One: Only Certain Types of Sex Are Real Sex There is a ridiculous idea that certain types of sex are real. Or, at least, more valid and preferable to others. When we think of “real sex” we usually think partnered penetrative intercourse. DO YOU KNOW HOW MANY PEOPLE HAVE ACTIVE AND FULFILLING SEX LIVES THAT DO NOT ENGAGE IN PARTERNED PENETRATIVE INTERCOURSE? Or, for that matter, all the people who have a lot of partnered, penetrative intercourse who have epically miserable sex lives. So what actually IS sex?
Myth Two: Sex is Intuitive and Natural We have this idea that sex should be all spontaneous. And we just sort of “get” what our partner wants. That we are going to run across a field of flowers in slow motion to each other. What complete bullshit. That everything should be spontaneous. And free flowing. And it will be amazing all the time forever with the right person. Oh, please. I can vouch for all my years of clinical experience (never mind all my years of, um, experience) that that kind of sex generally happens with the people that are the worst possible matches and in relationships that are completely unsustainable. As in…relationships where you are hanging on for the ride as long as you can, but this ain’t someone you bring home to momma. Sustaining an enjoyable and long-lasting sex life with long term partners takes fucking WORK, y’all. And communication. And effort. And yes, calendar management. You don’t spontaneously run into the dentist to get your teeth cleaned right? You make a plan. Making space for sexual intimacy is often also going to require some planning for execution. Not having a slow-motion field of daisies experience doesn’t mean your relationship is a sexual failure. When I did my TedXSanAntonio talk “Sex, Shame, and Silence” back in 2013, someone complained on Twitter about my definition of sex (the same one I used above). They were upset that I didn’t include the word “natural” in my definition. Now sexual interest may be natural (unless your ace/demi/grey, which makes it definitionally unnatural) but how we have sex? NOT THAT NATURAL. We are inventing ways to make it weird, and interesting, and complicated, and technologically advanced all the time. Even professional perves like Kinsey (who was known for tying up his nutsack with a cord and jamming a toothbrush up his dick) would be all “Damn, y’all” if he saw what we were up to now. Sexual desire may be natural. Expecting sex itself to fit some category of natural means we are setting up ourselves for a lot of stigma and shame. Ain’t nobody got time for that.
Myth Three: Sex Education Isn’t A Universal Necessity We are the most sex obsessed country that never talks about sex in pragmatic ways. It’s everywhere. Every car ad is PervyAF. Your steak dinner. Sex was used to sell it in some way, shape or form. But sex education itself? Not acceptable. Just writing this column for the past three years has gotten me in hella trouble with the academic establishment. If there is so much out there that isn’t so natural and isn’t so intuitive, then we need to have those conversations. And you know who we need to have these conversations with? EVERY-FUCKING-ONE. People with intellectual disabilities. People with physical disabilities. People with severe chronic mental illness. Kids. Parents. Older people with changing bodies. LGB people. Trans folx. Poly peeps. Kinksters. We all need access to the information about safe, healthy, and fun sex that meets our needs and our desires. Myth Four: Sex Is Not That Important In The Grand Scheme of Things Ok, actually it isn’t. IF EVERYTHING IS GOING WELL. If the sex is good, it’s 10% of your relationship. If it’s bad, it’s like 90%. Is sex the most important thing in the world? Of course not. People in Flint, Michigan are still in need of clean water. But I bet they also still care about their sex lives and don’t like it when things aren’t going well. Sex is important to most people. It’s an important part of how we connect. And communicate. And it often operates as the sparkly glitter-glue that helps keep relationships together. If it’s important to you, it’s empirically important. Don’t let anyone diminish that for you.  Myth Five: Certain People Are Fundamentally Undesirable (And You Are Probably One of Them)
Thank you, media for continuing to perpetuate the myth that there is only one kind of attractiveness. And everyone else is just destined for misery and solitude. Unless you’re an epically unbearable asshole, there’s someone out there for you. Your quirks and flaws (whether real or perceived) do not make you unworthy of great sex and wonderful love affairs. I don’t care how long you have been under the impression that you are an ugly duckling. I promise you that there a decent number of people out there with a duck fetish. And there is nothing sexier than someone who loves their life and is out there enjoying it. That’s how all us regular, flawed people find their partners. Or on OKCupid. Semantics. My mission in life is to battle these myths in all the ways, shapes, and forms they show up in my clients lives and in society. Kinsey was with me. We may have differing opinions about where a toothbrush goes (FFS DUDE, IN ONE’S MOUTH) but whatever. Opinions differ. Sex lives differ. And that’s what makes it all sex fascinating and so fun.  I’ve read a couple of really good thought pieces on what it means to have a non-cisgender identity. And while it is far more common than not, the idea that dysphoria is a requirement Is totally shitty. Like there is a requirement of fundamental brokenness in your experience of your assigned gender before you are accepted for your true gender. A form of colonization of people with lived experience by the medical establishment. I agree with that sentiment with 100% of my being. You know who you are. That is not for me as a clinician to decide. Individuals with lived experience have written about the no-dysphoria phenomenon, and you should read their pieces if you haven’t already. Sam Dylan Finch wrote a piece for Everyday Feminism. And this piece on FTM Magazine is an equally thoughtful and beautiful analysis of why dysphoria isn’t a requirement. Then add to the mix this post by Zinnia Jones about her own experience with starting gender confirmation treatments without experiencing dysphoria…or so she thought. She started knowing that the aging process would likely cause physical changes that would trigger dysphoria in the future. But she also realized later that she did have symptoms of dysphoria that she didn’t well read at the time. I absolutely agree with the idea that we need to de-stigmatize, de-medicalize, and de-colonize gender identity. But I think that Ms. Jones’ nuanced understanding of dysphoria is an important part of a conversation I endeavor to add to today. My role is that of a cisgender, ally clinician who serves to support individuals undergoing confirmatory treatment. In English, this means I’m one of the people in town who will write the letter that will allow individuals to receive gender confirmation treatments (hormone therapy and/or various surgical interventions). Of course, the WPATH Standard of Care does not require a letter for many of these treatments, instead encouraging an informed consent dialogue with the treating professional. But all doctors have their own requirements, as do all insurance companies that provide coverage for confirmatory treatment. In short, many docs and all insurance companies are going to require a diagnosis that establishes medical necessity. So whether you are seeking a letter or you are a clinician who is figuring out how to assign a diagnosis without breaking the law, this post is for you. The Criteria for Diagnosing Gender Dysphoria The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults. We are using the adolescent and adult criteria in this piece to keep things simple. Know that trans* children have very similar responses to gender mis-assignment, it just presents in more age-appropriate ways. F64.0 [302.85] Gender Dysphoria in Adolescents and Adults In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:
First of all, is Gender Dysphoria the only viable diagnostic option? The short answer is no. Your other options include:
Obviously, these are the same codes, just different interpretations. If it says “other specified” this could mean a multitude of things that a clinician would then elaborate on. This code is used when the dysphoria has not persisted more than 6 months, for example. It is also regularly used for individuals who have an intersex condition with accompanying dysphoria or for people who have a desire for a penectomy without wanting any other markers/characteristics of the female gender. You could also make the argument that these are entirely appropriate codes for individuals who are trans* but do not experience dysphoria. Above when I said the short answer is no? The longer answer is an insurance company will likely not accept one of these diagnosis for gender confirmation treatments. A doctor might. Though, if I sent this diagnosis in to one of the docs I work with in the area I would likely get a “Faith, WTF is this about?” text from them. If I am forced to serve as a gatekeeper for someone else’s identity, the gender dysphoria diagnosis is the magic key for getting services. And this brings us back to the original question. If someone doesn’t endorse dysphoria are we fucking liars for using that diagnosis? And maybe it took me a minute to get to this point, but we need to look at how we operationalize clinical terminology when making these determinations. If we unpack the verbiage, I think we can come to terms with a diagnosis that fits a variety of lived experience without feeling that we are making a demeaning or unethical choice. And this is where I go into board supervisor and counselor educator mode. Bear with me.  "You keep on using that word. I do not think it means what you think it means." — Inigo Montoya
Let’s start with defining dysphoria as a state of unease or generalized dissatisfaction with life. It’s a mid-19th century term, coming from Greek word dusphoros meaning ‘hard to bear.’ This is a far different explication of dysphoria than we have been led to believe, isn’t it? It is more like Miss Clavell in the Madeline books by Ludwig Bemelmans who has a habit of saying “Something is not right!” Identity and assignment do not match, and I recognize this situation. But hey, you’re saying. What about those few words from the DSM 5 that really change everything??? You know. The “significant distress or problems functioning” part. Are those five words forcing people into mis-diagnosis and forcing clinicians into a ethical conundrum? After a lot of research and thinking about the issues, I have to say I don’t think so (though I am certainly open to and even welcome more dialogue on the topic). And I came to this conclusion again through defining and unpacking the words being used. The common usage of the word distress has only vague similarities to the clinical definition of distress. And clinical definitions are what we are talking about here, after all, right? Diagnoses are really intended for a pretty singular purpose: a shorthand conversation between treatment professionals about presentation, symptomology, life domain functioning, and treatment needs. I understand that we have weaponized and bastardized diagnoses to no end, which is a whole other conversation. But in the service of people, all the diagnosis is meant to represent is me (PhD) telling another doc (MD) that certain treatment protocols are appropriate for someone because there is something impacting their ability to be healthy and happy. And we are having a conversation between the two of us about how we can help fix that. Back to a clinical definition of distress. The term “stress” has lost all logical meaning, hasn’t it? Everything is considered stressful nowadays. And it’s entirely probably that everything IS fucking stressful nowadays. But in a clinical sense, stress means an event that requires an output of resources. Stress can be good (output of resources to create art, or run a race, or finish school) or it can be bad (coping with a car accident or an illness or being terminated from a job). Whether the situation is good or bad, we can hit a point where we run out of the resources that we need to cope with the situation. And that is what distress is. The point of resource depletion. The point where we need support. Whether you are suffering enormous amounts of emotional pain over a mismatch between your gender and your birth assignment, or you are simply aware that it is incorrect and there are things that can be done to bring you into alignment, you could be said to be experiencing psychological distress. You’ve hit a point where you need resources. It isn’t something you can do on your own. It isn’t a term that identifies someone as tragically fucked up. It’s a term that treatment professionals understand to mean this person needs some help, and that’s your job. We have resources to assist in aligning a person’s gender with their physical body in ways that they can’t achieve on their own. And if we are operating with that intent, and the true spirit of what a diagnosis is designed to communicate, our work is accurate and ethical in both a legal and moral sense. I believe the move in the DSM V to category of Gender Dysphoria (instead of DSM-IV’s Gender Identity Disorder) is an appropriate one. We are acknowledging a misalignment that may require resources to correct. We are acknowledging distress. Now let’ get to work.  No one ever made Kirk madder than Khan. And Khan had that whole open-chest thing going. Hmm... Man. It’s kind of a dick move when you think about it. Our partners see the absolute worse side of us when they are the people we love best and who love us best. We are nicer to the bratty toddler running through the aisles at Target than we are to Boo, who has seen us upchuck at 3 o’clock in the morning, smelled our morning breath, and cleaned our pee off the toilet seat. And to be fair, Boo does the same to us. It’s human nature to be toughest on the people we are closet to. This is why we tend to pick fights with our mate more than anyone else. Not that Boo is perfect. Or that you are the epitome of grace, elegance, and sweet-smelling morning breath. But we do tend to fuck with each other way more than necessary. Of course when someone is your partner, you are having to constantly negotiate and navigate boundaries. Of course. And it’s an ongoing process as relationships are fluid entities that are always morphing and reshaping themselves as we live in them. But what really needs to be navigated? And when can you just let Boo be Boo? Is it Intentional? Is Boo intentionally fucking with you? Like deliberately disrespecting your time, resources, needs, and desires? Like “I know we had dinner plans but I went out drinking instead because fuck you”? Ok, sweet pea. You have every right to be mad. But also? What the ACTUAL, LITERAL HELL ARE YOU DOING WITH THIS PERSON? If they have no fucks to give about what’s important to you? Get OUT. Believe what they are showing you about who they are. Call your bestie to request sofa surfing privileges, pack up your pooch, polish your tiara, and move ON. Fighting is worthless here. Because you are being treated like YOU are worthless here. Don’t fight if Boo has made it clear that they don’t care. Grown ass people are not intentionally dicks. Well, there are a few…and they sometimes become president. But if you wouldn’t vote for someone, you sure as hell shouldn’t get them the privilege of seeing your naked, FFS.  Sometimes a cigar is just a Cuban dildo. Who You Really Mad At, Cupcake? Remember learning about Freud’s defense mechanisms in Psych 101? Ok, he was a crazy motherfucker who snorted too much coke. But he was right on about that shit. Displacement is a defense mechanism where we attack the safe target rather than the real cause of distress. Of course you can’t tell your boss that his mother was a hamster and his father smelt of elderberries. So you are already riled up and ready to rumble. Boo tells you they forgot to pick up your dry cleaning and you find yourself spewing venom like a champ. If you know you are ripe to rumble, after a hard day, do what you need to do to decompress that doesn’t involve sniping at Boo. And warn them that you are wound tight. What’s The Cost Analysis? We all have our idiosyncrasies. It doesn’t mean we are intentionally fucking with our mate, it means we have years of behavior patterns that are really hard to change. Ever tried to give up tacos for Lent? You feel me, right? Mr Intimacy Dr and I are pain- in-the-assess in a million different ways, but battle stations are only activated when there is a cost beyond irritation involved. For example, Mr Intimacy Dr has dish duty here at the Underground Headquarters of Sexitimes. I cook, he cleans. Modern romance. He has a tendency to put off the hand-washables like my kitchen knives and cutting boards because they are a pain in the ass. This makes me nuts, because I like to head into a clean kitchen to start my next day of oven sorcery. Bleh, irritating. But not the end of the world. However, he got in a habit of leaving them soaking for a couple DAYS at a time (My fellow culinary types? Are you feelin’ me on this?) I had to get all the knives resharpened and had to completely toss a few of the cutting boards. So yeah, that was worth a different kind of discussion. I growled and stomped and muttered and griped. Mr. Intimacy Dr has worked really hard at not leaving dishes hanging around near as long since that episode. And if he doesn’t get to the handwashables, he puts them up behind the sink so they don’t soak and get ruined. And if I need them in the meantime, I wash them myself. Another example? Mr. Intimacy Dr is a writer. His lair is a pit of despair, as you can imagine. I go through and collect trash sometimes, but mostly close the door and ignore. I only fuss when we are getting to the point that I see a huge-ass roach sitting at his laptop, editing his current screen play, and eating the popcorn he left out. Then it’s “Dude. You’re grounded till you clean your room. Now tell the roach to go do the dishes.” What tends to be your relational sticking points? How money is spent? Create free money allowances for yourself. Or come up with an amount that each can spend without checking in with the other based on what you can afford and your financial goals as a couple. Sex? Come see me at my office, we can work that out. Parenting teenagers? Ugh, good luck on that one. But no matter big or small, look at what the actual cost of the issue is before you decide how to proceed. It’s amazing how much can be let go when you do that. Humor Rather Than Snipe I suck at hanging towels up to dry. I tend to leave them sitting in the sink. I’m trying to be better at that but I had years of living alone and not sharing that bathroom with anyone. And it doesn’t bother ME. I’m probably gonna use that towel to mop up the floor before I throw it in the laundry, anyway. Which also grosses him out. If I forget to hang up the towel, he will tease me into remembering rather than yell. “Who HATES to hang up towels?” And I’ll waive my hand in the air and say “Me! MEEEE!” It’s obnoxiously cute, but it is way preferable to a stupid fight over a stupid thing, right? I remember to go hang up the towel and neither one of us feel irritated in the process. Negotiate on Things That Are Straight Up Preferences I have a toilet paper roll holder than hangs over the side of the toilet tank. Mr. Intimacy Dr hates the thing because he has to twist around to reach the roll. First world problems. He prefers it sitting on the counter next to the toilet. I don’t like that because it gets damp there. Again, first world problems. Guess what? We have two rolls of toilet paper in the bathroom. One sitting on the counter and one handing on the holder. Boom. We are all set in our ways and have our preferences. They aren’t worth fighting about. Is it Netflix and chill night and you want pizza and Boo wants Chinese? Just get both. Mr Intimacy Dr would wear basketball shorts to the White House. I just got a white Cruella streak in my hair that he hates. But we allow each other to be who we are. Let your partner have their idiosyncrasies. They are the things you fell in love with, after all. Honestly? My goal in life is to have my house be a peaceful abode. I want it to be my favorite place in the world to be. My spouse feels the same, so we work hard at setting up our relationship so we maintain that peace. Try it at YOUR home. It’s a pretty nice way to live.  The evil Mrs Doubtfire. Or something. (Since People Gotta Act As Stupid Online As They Do IRL)
 2. Speaking of pictures? Use accurate ones. Like recent ones. From the past year. That show what you really look like. Right now. Full body. Not the head shot with the hands tucked under the chin to hide extra. Or the “in the shadows” shot. Or the Snapchat flowers and dog tongue shot. Look your best, sure. But be HONEST. Seriously, tho. Do you really think that someone is honestly going to say “Oh, it’s ok that you are actually 6 inches shorter and 50 pounds heavier than you implied now that I’ve met you in person and am bowled over by your sparkling personality”? No. They may have been totally fine with a shorter, chubbier you. But now you’ve already marked yourself as a fucking liar. So what else are you lying about??? And that’s a plural. Have a few photos. Head shot, body shot, you doing interesting things in your life shot. Pictures with cute dogs or cats shots. You know. And if they DON’T want to go out with a shorter, chubbier you? Then fuck THEM and find someone who respects your cuddly ass for the excellence it is. 3. Be honest in general. Are you looking for a LTR? Or just a bit of strange? Are you separated but not actually divorced yet? Are you poly and have other partners already? Do you have an STI? Are you moving at the end of the year? We all have shit that may limit our options out there. But be honest NOW. Let people self-select out of the process rather than wasting time. Don’t have sex of the first date? Totally cool. Tell people that and weed out the hook-up artists. 4. Be interesting. “I love tacos and music.” Good. That makes you human. It also makes for a really boring profile. Could you at least talk about the KINDS of music y”ou like and your favorite taco dive? Ask your friends what makes you interesting and fun. And use THEIR answers to shape your profile. This also goes for the messages you send others. “Hey.” “Sup?” “Nice pics.” “Cool profile” etc., are really boring openers that will likely get you very little response. Show you actually read their profile and comment on THAT. Like “I noticed that you said your blood type is coffee. I was super excited to read this, because now I have a blood donor match if I ever need one.” Or “You say Taqueria Jalisco is the best in town. I will fall on my sword over Chella’s Tacos downtown. Shall we investigate both side by side and see which one is clearly better? By which the answer is clearly Chella’s?”
5. Be humble. But not falsely humble. Enough bragging to show that you’re secure is a good thing. So much bragging that you look like Donald Trump isn’t. Saying that you are pretty sure that you make the best chocolate chip cookies in town is appropriate. Saying that your “hands” are so big you can’t find “gloves” in your size isn’t. But also don’t go looking for ego strokes with false humility. “I’m no good at this” or “You probably won’t be interested in someone as lame as me” etc are gag-inducing cries for attention that are icky and gross. 6. Put down the scorecard. Y’all I went out with a guy who had just been burned pretty bad. The girl he was dating actually went into her therapist’s office and they rated him out on his positives and negatives. He almost made the cut but he “didn’t have a Crossfit body.” And I’m not even saying he was a big dude. He just wasn’t a Crossfit dude. And that was a deal breaker. And of course, that saved him the trouble of being with someone critical, and awful, with a literal checklist of what she wanted from others. But the real bummer was she missed out on dating a REALLY nice guy. There are some things that are deal breakers. It may be smoking. Or them being married. Or unemployed. Or way older or younger than you. Whatever. That’s fair. But once you start going in with a wishlist for Santa, you are setting yourself up to miss out on meeting some great people. 7. Have a reasonable response window. Or if you can’t, explain that. Respond within a day if you’re gonna respond. If you legit can’t because you work crazy swing shifts or some shit, tell people that upfront. Like “I’m a line cook. I don’t even check my messages when I’m on the line. My days off are Tuesdays and Wednesdays, so I will HYU by then, promise!” Dating site research shows that responding in a timely fashion increases your chance of keeping the conversation going. On the flip side? Settle the fuck down and give people time to respond back to YOU. It’s creepy as fuck to get a message then a few hours later another one “Guess you aren’t interested in me then, bye” when, damn son, I was at the movies and my phone was off. Dating site research also shows that people who do that decrease the chances of getting a response as well. 8. Be a little suspicious. And be careful. For example, they only talk to you on KIK? Won’t meet you in public? Vague about every damn thing? Something may be up there. Do your research. A Google Fu may show you that the person you are chatting with is VERY married and their partner is not hip to their shenanigans (You aren’t poly if your partner doesn’t know, y’all. You’re just CHEATING.” Coffee dates are good first dates. Not a lot of money or time spent, and escape is easy. And don’t park places you can get boxed in. And don’t be left without a way home. And let people know where you are and who you are with. And have a friend check in on your so you can claim emergency and jet if need be.  9. Go out with them or move on.
Don’t spend weeks and weeks chatting online and not actually meeting. Set a DATE. If they aren’t interested in anything but online flirting but you are looking to actually go out, then move on. Otherwise you create this whole relationship with tons of investment that may not withstand real life. Now if you are long distance, and there isn’t much choice, at least try to have phone and video chat dates and the like so you get more of a handle on each other’s communication styles and conversational interactions (without the ability to edit). 10. Remember it’s just DATING. Not RELATIONSHIPPING. It may take a while. And if it is wearing you out, take a break. It’s supposed to be (at least relatively) FUN. If you aren’t interested, move on. And let them know politely. (And as an aside? If they fuck with you about it, block them. Don’t respond and keep up the dialogue. If they are fucking with you in real life, get legal help.) And if you are interested, get back in contact with a day after your date. “Hey, I had fun! If you did too let’s go out again!” is super simple. And if you are interested, don’t assume the feelings are at the same level unless you’ve had that conversation. They may be dating other people. They may think of you as a time filler. So don’t plan your wedding just yet. And if they end up ghosting out pretty quickly? That’s so much about them. I’ve written about this before. They don’t know you near well enough to be rejecting you the person. Just your offer at this time. And someone else out there is gonna think you hung the moon. So keep looking for THAT person. You’re fabulous and they’re out there. Dear Intimacy Dr.: Heyyy, so I'm at a conference with my good friend, and randomly she got a dick pic sent by text. It's a wrong number. Still.. ewww. So doc, what's the deal with dick pics? Why do guys think any woman is going to enjoy this???  Some ladies out there do love a good ween photo. And that’s cool. Most of us ladies who like the penis-havers far prefer the IRL experience during sexitimes, rather than a photo popping up (I SAID POPPING UP! GET IT???? YOU SO GOT IT!) when they are sitting in a staff meeting at work. I like dick in context only. Sounds like you and your friend are with me on this. So why soooo many dick pics out there? All kinds of reasons, actually. Not every guy out there is in power-over dominance mode with the women in their lives, like Louis C.K. Most of us appreciate some good visual stimulation (after all, they show endangered species porn in zoos to encourage mating, both their own species and even human porn) and see it is a display of the tail feathers, just like the showmanship of a male pea-cock (YOU SO GOT THIS ONE TOO, RIGHT?). Grindr is full of dick pics, after all. Men who dig dick also seem to dig dick pics…at least at higher numbers than their female counterparts. Men are also far more likely to feel comfortable in that kind of exchange...at least that’s what personal experience has told me. I think the problem is, so many women don’t feel safe in saying “Dude. No.” if sent an unsolicited photo. And we unintentionally give the message of “Dude! Yasss!” when we don’t. Or as my friend Mark chimed in: It’s like the guy is the cat bringing the dead bird and no owner is never happy to see that and does not want it. Men get a clue, NO ONE WANTS TO SEE YOUR DEAD BIRD!  Did somebody say dead bird? My Dudes and other Penis-Havers? So many women have been socialized to not throw down a hellnaw when they need to. Setting a boundary does not always feel safe for us. Even if you are an excellent boundary respecter and we would be entirely safe with YOU, we may not know that based on past experiences of having our boundaries NOT respected. And it might seem easier to just politely accept a dick pic then end up with a death threat. Or actually dead. And that shit happens.
So ask. And ask nicely. And ask in a way that lets us know we are safe with saying “No thank you!” and being respected. Like “Hey, I know unsolicited dick pics are the bane of most women everywhere, but some women don’t mind seeing a wee bit o’ peen when in the flirt zone. Do you dig such shenanigans or would you rather see pictures of tacos and panda bears? Or panda bears eating tacos? Do panda bears even eat tacos? If not, how do we convince them that they should?” Perv with respect, y’all. We thank you for your support. Besitos, Dr. Faith P.S. I know you didn’t ask how to respond to that kind of text message but I still use the line my dad taught me to throw out when I was 16. “Hey! That looks just like a penis! Only smaller!” Buddha bless feminist fathers!  Dear Intimacy Dr., My new partner is kinkier that I expected. I’m not complaining, tho! She likes the choking a lot and I’m scared I’m not doing it right. She says its great but she’s so much smaller than me, so I don’t know if I’m applying too much pressure. She won’t tell me to stop but I swear that gasp of air she takes in sounds like someone who’s just been revived. I don’t want to kill her! Can you help me out???? Considerate Choker Dear Consider Choker: So. Erotic asphyxiation. This is, simply, the deprivation of oxygen to the brain. Induced cerebral anoxia, if you’re nasty. That lack of oxygen can cause an extra sense of exhilaration (wheeeeeee!) that makes the orgasm more intense. You mentioned her breathing after you release, and that’s totally normal. And the reason that people who like erotic asphyxiation are called “gaspers.” First of all, good on you. You’re down with what your partner likes and you want to make her happy. But you don’t want to, you know, actually murder her. Wikipedia points out that people have been charged when that’s happened. And the numbers aren’t as small as you’d think. MedicineNet.com notes that about 1000 people a year die from erotic (or autoerotic) asphysixation. So its bad for the relationship. And for future dating opportunities, I imagine. So when people actually die from this, it usually NOT because their windpipe was crushed. It’s for the same reason that the Vulcan death grip (nerve pinch) is kinda legit. You’re targeting the vagus nerve through a point on the neck called the carotid body. The carotid artery runs down both sides of the throat, and the point where it forks (the aforementioned carotid body) has a cluster of chemoreceptors. These are specialized sensory receptor cells that respond to biological signals. Pressure there causes a discharge from the vagus nerve that makes you pass out like Spock knocked out Captain Kirk to fool the Romulans into thinking he was dead.  And THEN going unconscious makes you go limp, right? So that actually makes your chokehold TIGHTER so circulation is decreased even MORE. It’s the lack of blood flow that causes death. Just ask David Carradine. So is there any fail safe way of not killing Bae? Nope. Choking someone out is inherently dangerous. But there are things you can do to be a lot safer. You said she doesn’t ever tell you to stop. To be fair, talking probably doesn’t work so well at that time. She may also not have a good handle on what her limits are. Being a gasper is actually addictive as fuck. So first of all you need a non-verbal signal. Tap on the shoulder, whatevs.  I’d also suggest keeping a wedge of lemon or lime in her mouth. Autoerotic asphyxiators do the same thing. As she starts to pass own, her jaw will relax down and she will bite on the sharp citrus. That will help wake her up enough for her to safe signal you to release.
And let me know how that works for y’all! Besitos y Limon, Dr. Faith Hey there, fancy doctor lady! Got a question for ya. I dig my sex toys. Like a lot. Am I gonna start over relying on them? Are they gonna ruin me for regular sex? I don’t wanna break my junk…HELP!  Have you ever noticed that almost anything can become suggestive if it's associated with sex? Hey there back atcha, my Babe in Toyland! Short answer? Nah, you cool. Toy play away! Longer answer? This is a really common question I get. You are not alone in your concern. So let’s talk about what toys do and don’t do and how all that fits into the context of a healthy sex life. Sex toys provide stimulation and sensation: Vibration, movement, warmth, etc. All the stuff we create for each other and ourselves for the purpose of sexual pleasure. And yes, sex toys can provide a more intensive version of those sensations for sure. But that isn’t gonna BREAK anything. You called it “regular” sex, but which I think you mean sexual activity, with a partner or not, that doesn’t involve any accoutrement. Just whatever body parts you might be using. Think of it this way: You can walk to the store or drive, right? If you walk it might take you awhile longer but you’re still gonna get there. Walking has its benefits. You slow down, you connect to the world around you, you enjoy the view. Walking can be a ton of fun. But sometimes you just need to run into H-E-B and grab a bag of chips before the party, you know? Nothing wrong with driving, is there? So the other question you may have is “what if walking ISN’T getting me there and I only get the chips from H-E-B if I drive?” That totally does NOT make you broken, Babe. It just means you need more stimulation than other people. The toy didn’t create that, that’s just how you’re wired down there. If that kind of bums you out, the question I would ask is what exactly does the driving do for you that the walking doesn’t? For example, if you are a clitoris-having person, you may have a clitoral hood that blocks a lot of sensation. The toy provides the extra sensation you need to get the job done. And you might be able to get a similar effect if you or your partner push back your clitoral hood during sex. Some people also have that hood pierced so the piercing provides the stimulation and some people have a clitoral hood reduction if it’s really getting in the way. So a toy may be solving a problem you didn’t really know existed until you investigate a bit further. So many people born with penii have had circumcisions (or at least gotten decent information about pushing back their foreskin for stimulation) that it’s less an issue. But it can show up in other places, too. Maybe your g-spot (which are not limited to vagina-having people, BTW!) is getting stimulated in just the right way by a certain toy, and that can be replicated with yours or your partners fingers (finding the G spot should be its own article, but in the meantime you can use your Google Fu). Or maybe it’s your perinium (taint, durf, gooch, etc….and yes, the perineum is not limited to penis-having people) that is getting hit the right way.  OK, yeah, these are toys, but this isn't suggestive at all. I mean, just...no. Pay attention to what the toy is actually doing for you, not just the final outcome. Erm, bag of chips. Whatever. Toys can be lifesavers for both solo and partnered sex, PERIOD. And are nothing to be ashamed about. Some people have mobility issues that would make masturbation impossible without them. Sometimes toys allow people to participate in sex in a way they couldn’t otherwise. Individuals who struggle to maintain an erection, might find using a hollow core strap helpful in still allowing them penetrative intercourse with their partner. Sometimes toys allow people to be authentically who they are. A traditional strap-on can allow someone to participate in penetrative intercourse if they don’t have a penis, for example. Another great example of the market catching up to the need is Buck Angel’s new Buck-Off, an FTM stroker which was designed specifically to allow transmen the stroking sensation that other men enjoy, while taking into account that they have larger genitilia due to gender confirmation hormone treatment. In short? Sex toys are meant to enhance, not replace. And technology is letting many of us experience the sexual pleasure that we wouldn’t have access to otherwise. You interested in going to explore? We have many awesome shops in town. I teach classes at The Love Shack Boutique, and it’s no state secret that it’s my favorite (and Current readers seem to agree, the store has won as many “best of” titles as the Spurs!). If you head out in that direction, mention you read this article. Amy and her crew will give you 20% off your purchase. SCHWING! Because doesn’t everyone deserves to be all that AND a bag of chips?  Now you're just being disgusting.  (TRANSCRIPTION - TALK GIVEN ON MAY 4, 2017)
Back in 1955, the National Cancer Institute started funding research for cancer treatment. Results weren’t great so in 1960 they expanded their search for cures into natural plant and animal products. Between 1960-1981, 30,000 samples were collected from nature. One such sample came from a USDA botanist named Arthur Barclay in 1962. Now, we move as slow in science as we do in society in general. So it wasn’t until much later (the 1990s through 2013) that the FDA first approved Taxol for the treatment of breast cancer, ovarian cancer, pancreatic cancer, among others. Today, Taxol is listed by the world health organization on their Model List of Essential medicines. This is the official list of the most necessary and most important medicines needed to support a basic health care system. Taxol was produced from the bark of the Pacific Yew Tree. So as life tends to do, this is where it gets more complicated, and more interesting. The yew tree is considered a trash tree by the logging industry. The wood isn’t appropriate for building, so when forests are being clear cut, it is dumped in the slash and burn pile by loggers. Even in the 1990s, when we KNEW what value these trees had, clear cutting practices meant that 75% of the life saving yew bark was lost as trash. About ten years ago, the Forest Service moved the yew tree from the vulnerable list to the endangered list. But small groups of dedicated people are not having it. We have conservationists out there fighting for the yew trees. Protecting the old growth and defending the new saplings. These individuals know and value the truth. The yew trees contain something sacred. Something integral to the well being of humanity. Although it’s a fight that feels overwhelming, the movement is growing. We cannot toss aside, slash and burn, and otherwise treat that which is sacred like so much garbage just because it doesn’t fulfill our immediate desires. The yew tree is a literal example that all life holds a piece of our collective survival. That everything is sacred. Our LGBTQ youth today are our yew trees. And we are their protectors. Like all protectors, all conservationists, we are hugging tree trunks and facing down bulldozers. It’s overwhelming. I currently sit on four different not for profit boards. So fundraising is like breathing in and out for me. I keep telling people I need a million dollars and a building. Of course what I’m really asking for is a ten dollar a month commitment from enough people to help us fund our next family event. But I really need a million dollars and a building. My friend Brett told me recently that if he had a million dollars to fund a program, it would totally go to me. He said “I’ve seen the magic you work with zero dollars, so I can only imagine what you’d do with a million.” And all of us here today are in the same boat. And one day, I’ll have that million dollars, but in the meantime, I will keep my arms wrapped around my yew trees, facing down bulldozers. Because I know their value and worth, even if I have nothing in my pocket but my determination. And everyone in this room is in the same boat. My husband, out of curiosity, recently looked up the suicide rates of inmates on death row. We all know, that being in prison doesn’t stop anyone from committing suicide if they are so committed, anymore than being in prison doesn’t stop someone from using drugs. He told me that the rate of suicide among death row inmates is 4 times higher than that of the general population. Oh, I said, that’s interesting. It’s the same rate as it is for LGBQ folk. Of course that number doubles to 8 times higher if they have unsupportive families. And it’s 44 times higher if they are transgender or gender nonconforming.
Every year on the transgender day of remembrance, we host a march and memorial service for the individuals lost to hate crimes. We carry their names and photos on tombstones with us as we march. Every year, we add more tombstones to the walk, rather than take some away. And let’s talk about our schools for a moment, our so-called bully free zones. Nine of out ten LGBTQ youth experience harassment at school. Eight of ten students had been verbally harassed at school;
But we don’t do that, right? Except we do. Or our colleagues do. LGBTQ persons experience similar forms of discrimination from mental health professionals as they do in the general public. A study that was just published this week by the Williams Institute found serious health care disparities for LGBTQ adults and youth in Texas along with economic disparities and discrimination in employment, housing, and public accomodations. Additionally, there is still movement towards techniques termed “therapeutic” that focus on sexual orientation change efforts. In 2014, the Texas Republican Party Platform added language supporting “reparative therapy” as an appropriate counseling modality. Therapy to make you straight. Just last week, someone asked me “Wait, isn’t that illegal???” No, it’s not. Not in Texas. And not only is it legal, it was just publicly sanctioned and encouraged by the individuals whose salaries we pay. I was training in Beaumont last year, on election day. When the results came in, every single one of my trans or gender nonconforming clients called me or texted me in the middle of the night in a panic. I got a call the next day from a colleague at the LGBTQ youth shelter in San Antonio. The kids were LITERALLY hiding under their beds. Sucide hotlines around the country reported that the number of calls that evening tripled. Staff at Equality Texas reported 8 reported suicides in the United States by LGBTQ individuals 24 hours after the election. The new legislative session, currently in progress in our state, has already seen a flurry of bills that would strip away the rights and protections of LGBTQ Texans. This is not a political position statement on my part, and it is not intended as a criticism of yours, if we happen to differ. Nor is it a criticism of your spiritual belief system or your religious or cultural practices. I have the utmost respect for whatever you bring to the table, because I want the same respect in return. This is said as a statement about the reality of existence as an LGBTQ individual in this state and in this country. Our responsibility is to the health, well-being, and life span development of those we serve. And when it comes to LGBTQ folx… we are failing. They are our yew trees. Despite their immeasurable value to the whole of society, and no matter how we in this room recognize the truth in that statement, they are still being treated like trash trees…left in the slash and burn pile. One of the things I was asked to address this morning was the importance of language. Here I am talking about bullying. And access disparities. And violence. And homicide. And suicide. And yew trees. So why the huge focus on language today at this conference? Two reasons:
I grew up in a time where most people were straight. As far as I knew. There were a few gay kids in the drama club and if you watched Donahue, you might have seen someone who was transgender on the show. The language we have today, and the space that now exists for different identities is wildly different. I train on this topic, and I still run into words that I’ve never seen before. Urban Dictionary is my best friend. And for those of us who grew up during gay-straight-or-Donahue times, it can feel overwhelming. But learning and respecting language is one of the most powerful things we can do as mental health advocates. Franz Boas published the Handbook of American Indian Languages in 1911. He was one of the first cultural relativists and he discovered something interested when studying these languages with an eye as to how they function within their communities. There is a bi-directional flow between thought and verbal expression. That is, what we think influences how we speak. And how we speak starts to change how we think. If we want to change the world, and we don’t have a million dollars and a building? We start with our language. The language we use in service. In direct care. In advocacy. Our language declares our allyship. Our bravery. Our intent for change. And that language changes the dialogue and changes minds. And when I’m feeling hopeless in the face of bulldozers, this is something I can do. One of my favorite writers, Clarissa Pinkola Estes, said it with far more eloquence than I ever could: What is needed for dramatic change is an accumulation of acts, adding, adding to, adding more, continuing. We know that it does not take everyone on Earth to bring justice and peace, but only a small, determined group who will not give up during the first, second, or hundredth gale. One of the most calming and powerful actions you can do to intervene in a stormy world is to stand up and show your soul. Soul on deck shines like gold in dark times. The light of the soul throws sparks, can send up flares, builds signal fires, causes proper matters to catch fire. To display the lantern of soul in shadowy times like these - to be fierce and to show mercy toward others; both are acts of immense bravery and greatest necessity. This is how we protect your yew trees. And I am deeply grateful that you are with me in this fight. Thank you for being here today. |
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