Brand Names: GlucaGen
Generic Name: Glucagon Hydrochloride

GlucaGen, glucagon hydrochloride, full prescribing information

Uses For Glucagen

Glucagon belongs to the group of medicines called hormones. It is an emergency medicine used to treat severe hypoglycemia (low blood sugar) in patients with diabetes who have passed out or cannot take some form of sugar by mouth.

Glucagon is also used during x-ray tests of the stomach and bowels to improve test results by relaxing the muscles of the stomach and bowels. This also makes the testing more comfortable for the patient.

Glucagon also may be used for other conditions as determined by your doctor.

Glucagon is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, glucagon is used in certain patients with the following medical conditions or undergoing certain medical procedures:

• Overdose of beta-adrenergic blocking medicines
• Overdose of calcium channel blocking medicines
• Removing food or an object stuck in the esophagus
• Hysterosalpingography (x-ray examination of the uterus and fallopian tubes)

Before Using Glucagen

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

---

continue story below

---

Pediatric

This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems than it does in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of glucagon in the elderly with use in other age groups, it is not expected to cause different side effects or problems in older people than it does in younger adults.

Pregnancy

Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acenocoumarol
• Anisindione
• Dicumarol
• Phenindione
• Phenprocoumon
• Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes mellitus—When glucagon is used for test or x-ray procedures in patients with diabetes that is well-controlled, a rise in blood sugar may occur; otherwise, glucagon is an important part of the management of diabetes because it is used to treat hypoglycemia (low blood sugar)
• Insulinoma (tumors of the pancreas gland that make too much insulin) (or history of)—Blood sugar concentrations may decrease
• Pheochromocytoma—Glucagon can cause high blood pressure

Proper Use of glucagon

This section provides information on the proper use of a number of products that contain glucagon. It may not be specific to Glucagen. Please read with care.

Glucagon is an emergency medicine and must be used only as directed by your doctor. Make sure that you and a member of your family or a friend understand exactly when and how to use this medicine before it is needed .

Glucagon is packaged in a kit with a vial of powder containing the medicine and a syringe filled with liquid to mix with the medicine. Directions for mixing and injecting the medicine are in the package. Read the directions carefully and ask your health care professional for additional explanation, if necessary.

Glucagon should not be mixed after the expiration date printed on the kit and on one vial. Check the date regularly and replace the medicine before it expires. The printed expiration date does not apply after mixing, when any unused portion must be discarded.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• As an emergency treatment for hypoglycemia:
  
  • Adults and children weighing 20 kilograms (kg) (44 pounds) or more: 1 milligram (mg). The dose may be repeated after fifteen minutes if necessary.
  • Children weighing up to 20 kg (44 pounds): 0.5 mg or 20 to 30 micrograms (mcg) per kg (9.1 to 13.6 mcg per pound) of body weight. The dose may be repeated after fifteen minutes if necessary.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Glucagen

Patients with diabetes should be aware of the symptoms of hypoglycemia (low blood sugar). These symptoms may develop in a very short time and may result from:

• using too much insulin ("insulin reaction") or as a side effect from oral antidiabetic medicines.
• delaying or missing a scheduled snack or meal.
• sickness (especially with vomiting or diarrhea).
• exercising more than usual.

Unless corrected, hypoglycemia will lead to unconsciousness, convulsions (seizures), and possibly death. Early symptoms of hypoglycemia include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.

Symptoms of hypoglycemia can differ from person to person. It is important that you learn your own signs of low blood sugar so that you can treat it quickly. It is a good idea also to check your blood sugar to confirm that it is low.

You should know what to do if symptoms of low blood sugar occur. Eating or drinking something containing sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse, and will probably make the use of glucagon unnecessary. Good sources of sugar include glucose tablets or gel, corn syrup, honey, sugar cubes or table sugar (dissolved in water), fruit juice, or nondiet soft drinks. If a meal is not scheduled soon (1 hour or less), you should also eat a light snack, such as crackers and cheese or half a sandwich or drink a glass of milk to keep your blood sugar from going down again. You should not eat hard candy or mints because the sugar will not get into your blood stream quickly enough. You also should not eat foods high in fat such as chocolate because the fat slows down the sugar entering the blood stream. After 10 to 20 minutes, check your blood sugar again to make sure it is not still too low.

Tell someone to take you to your doctor or to a hospital right away if the symptoms do not improve after eating or drinking a sweet food. Do not try to drive yourself.

If severe symptoms such as convulsions (seizures) or unconsciousness occur, the patient with diabetes should not be given anything to eat or drink. There is a chance that he or she could choke from not swallowing correctly. Glucagon should be administered and the patient's doctor should be called at once.

If it becomes necessary to inject glucagon, a family member or friend should know the following:

• After the injection, turn the patient on his or her left side. Glucagon may cause some patients to vomit and this position will reduce the possibility of choking.
• The patient should become conscious in less than 15 minutes after glucagon is injected, but if not, a second dose may be given. Get the patient to a doctor or to hospital emergency care as soon as possible because being unconscious too long can be harmful.
• When the patient is conscious and can swallow, give him or her some form of sugar. Glucagon is not effective for much longer than 1 ½ hours and is used only until the patient is able to swallow. Fruit juice, corn syrup, honey, and sugar cubes or table sugar (dissolved in water) all work quickly. Then, if a snack or meal is not scheduled for an hour or more, the patient should also eat some crackers and cheese or half a sandwich, or drink a glass of milk. This will prevent hypoglycemia from occurring again before the next meal or snack.
• The patient or caregiver should continue to monitor the patient's blood sugar. For about 3 to 4 hours after the patient regains consciousness, the blood sugar should be checked every hour.
• If nausea and vomiting prevent the patient from swallowing some form of sugar for an hour after glucagon is given, medical help should be obtained.

Keep your doctor informed of any hypoglycemic episodes or use of glucagon even if the symptoms are successfully controlled and there seem to be no continuing problems. Complete information is necessary for the doctor to provide the best possible treatment of any condition.

Replace your supply of glucagon as soon as possible, in case another hypoglycemic episode occurs.

You should wear a medical identification (I.D.) bracelet or chain at all times. In addition, you should carry an I.D. card that lists your medical condition and medicines.

Glucagen Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

• Dizziness
• lightheadedness
• trouble in breathing

Symptoms of overdose

• Diarrhea
• irregular heartbeat
• loss of appetite
• muscle cramps or pain
• nausea (continuing)
• vomiting (continuing)
• weakness of arms, legs, and trunk (severe)

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

• Skin rash

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common or rare

• Fast heartbeat
• nausea
• vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.

Last Updated: 11/05

GlucaGen, glucagon hydrochloride, full prescribing information

Detailed Info on Signs, Symptoms, Causes, Treatments of Diabetes

back to:Browse all Medications for Diabetes

 

Dr. Marlene Shiple is a certified sex counselor. Dr. Shiple's areas of expertise include sexual dysfunction, sexual addiction, sexual relationships, and intimacy issues.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

---

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Sexual Issues and Questions". Our guest is Marlene Shiple, Ph.D., certified sex counselor. Dr. Shiple became interested in the specialization of sex therapy because she recognized how many people are fearful or nervous about their sexual interaction, when this should be a normal and enjoyable process of the human experience. She is here to give information and practical ideas on the topic of sexuality. Click here for more information about Dr. Shiple.

Good evening, Dr. Shiple. Thank you for being our guest tonight and welcome to HealthyPlace.com. Can you tell us a little more about yourself?

Dr. Shiple: Good evening, David and everyone out there who was able to join us tonight. I am certified with the American Association of Sex Educators, Counselors & Therapists (AASECT) as a Sex Counselor, and with the American Board of Sexology as a Sex Therapist. I have been interested in sexual issues for all of the twenty-four years that I have been in private practice. I found early in my practice that clients were fearful and uncomfortable with their sexual being. I was struck by how this held them back in their personal growth with sex being such an important area to our well-being.

David: Have you found that in the new millennium people are more or less comfortable talking about sex?

Dr. Shiple: Actually, no, I've not found most people more comfortable talking about sex, and that to me, is surprising. With all of the sexually transmitted diseases, which are of concern to many people, I was hoping that potential partners would become more verbal, more easily and more quickly. This does not seem to be happening.

David: Also, in this day and age of easy availability of sex sites over the internet, you would think more people would feel comfortable discussing it. What is it that keeps many people from feeling comfortable about expressing themselves about sex?

Dr. Shiple: I think it is lack of practice and the sex-is-bad ideas that still persist. I find in working with clients that we role play them being open and honest about sexual issues. It takes them some time to begin to feel at ease with this. Then, once they get going, they have so much to say that they have not said in so long, that it is hard to get them to stop.

David: Since we are a mental health site, I want to get directly to several issues. The first issue is sex after sexual abuse. How difficult is that, and can one expect to have "normal" sexual relations after being sexually abused?

Dr. Shiple: In my experience, it is possible to have satisfying sexual relations after being sexually abused. However, the beginning experiences in this direction require considerable awareness on the part of the person who was abused. What am I feeling, am I safe to go on, can I say hold it here? It requires a very sensitive partner, who is willing to listen and understand these requests, not take them personally, and respond according to what is being requested. With this, patience, and focused therapy working on releasing any abuse issues, I have found clients able to resume very satisfying personal and sexual relationships.

David: Here's an audience question on the subject:

punklil: Thank you for coming here to talk to us, Dr. Shiple. My question is how do you stop flashbacks in the middle of sex?

Dr. Shiple: First, I would ask if you had worked through the issues contained in the flashbacks. If not, that would be procedure number one. If you have worked through these issues, then I would suggest practice on focusing on the present, on what you are experiencing RIGHT NOW, on how you feel within you RIGHT NOW. I would suggest you take the time to remind yourself, "This is NOT the past, this is the present. I want to be here with this partner, enjoying one another."

David: What makes for great sex?

Dr. Shiple: So many ideas flooded my mind to answer your question. Actually, that is such a personal experience, that it is hard to create an answer that would fit for each person. Elements of great sex would include feeling a sense of harmony and oneness with one's partner. Freely expressing and hearing what each partner wants and doing one's best. As long as each party is comfortable to provide it. Taking the time to let it be good. Giving each partner focus for being pleasured and satisfied. Including the elements that each partner finds GREAT!

David: Here's an audience question:

slowdown: How do you get your partner to feel sexier about herself.

Dr. Shiple: Do not be distracted by the simplicity of this, consider it seriously. Does she WANT to feel sexier about herself? If not, there is not a way. If so, ask her what she thinks it would take for her to feel sexier about herself and listen carefully to what she tells you. Ask for clarification if anything is unclear about what she thinks would make her feel sexier. Then create a plan together, if she is willing, to begin to address whatever she has said. Compliment her on each step, or any beginning step she is able to make. Recognize that this is probably very, very difficult for her. After all, she has spent all of these years, however old she is, not feeling all that sexy. Ask her what she needs to help her feel more comfortable with this.

David: Why would someone see a sex therapist and when is it time to consider that you need to see a sex therapist?

Dr. Shiple: There are many reasons that clients see sex therapists. Some of these include sexual dissatisfaction, sexual dysfunction (the inability to attain an erection and/or have an orgasm if the person wants to), disagreements in frequency of sexual interaction, painful intercourse when all physical and medical reasons for this have been eliminated. These are just a few.

When it is time? That would be when you and your partner are dissatisfied with some aspect of what is going on between you two in your sexual relationship. Oftentimes, we find that the real issues may not be sexual. They may be in some other areas of communication, or, more often still, LACK of communication. Seeing a sex therapist can help you sort this out. Then, together with the therapist, you both create a strategy for solving the difficulties.

rtn12760: I am thirty-nine and have had one encounter with one female twelve years ago. What if a fear of sex has removed all desire for it, except for occasional pornography and masturbation?

Dr. Shiple: You would be surprised at how often a fear of sex, or some aspect of the sexual encounter, is EXACTLY what prevents someone from having satisfying sexual interaction. I would suggest that you find a good, sensitive sex therapist in your area and outline for him/her what you have said above.

The first step in dealing with this, would possibly be, to go back to that event and discover the dynamics that created the outcomes you experienced. Then, awareness of the thoughts that you have used over time, that have kept these dynamics active and present, would be in order. Having a sex therapist's guidance, in this case, would be very beneficial. I would expect that, in clearing up what was going on in the past, you would be in the position to create new sexual directions in the present. This would be the goal and focus of sex therapy.

David: Would you say that you, generally, have to feel good about yourself to have satisfying sex?

Dr. Shiple: In general, it certainly is a help! That, and knowing what you find to be satisfying and pleasing, so you CAN relate this to your partner.

Silvie: What number of women can achieve an orgasm through intercourse?

Dr. Shiple: There have been several research studies to quantify this. In general, somewhere in the fifty percent range. There is a false belief in vogue that the only satisfying sex is having orgasms together. This is not only not necessary, but it happens rather infrequently. It can be a problem to limit the ways that you are willing to "accept" or allow yourself pleasure. This can also limit the pleasure that you have

nett: Is it okay to have anal sex, and does it have any lasting ill effects? I'm in a heterosexual relationship.

Dr. Shiple: In terms of human sexual practice, anal sex is OK. In terms of some religious proscriptions, there are differing opinions. The problem with anal sex can be tearing the lining of the anus. If the man's penis is really large and you do not use ample lubrication this can happen. Why is that a problem? Because you will be using your anus for other purposes later on (when you defecate, this carries bacteria). If the lining of the anus is torn, you can get the infection in your body. So, you would want to use plenty of lubrication and if your partner is very large, get him to enter you before he is fully erect. If that is not possible, you might want to forego the experience.

jullian: I was wondering if you know about how medications affect sex life? I am on Paxil and it has changed my sexual experience. Is this common and do you know of any meds that do not have this effect?

Dr. Shiple: Oh, Jullian, you are entering touchy territory. Yes, many medications affect your sexual interaction. In my experience, Paxil is certainly one of them. One difficulty in answering the "any meds that do not" question, is that people experience different results from different medications. As a general rule, I would refer you back to your doctor. She or he better knows your history and can make recommendations. One word of encouragement: do not give up your quest. Keep working to find a medication that does not adversely affect your sexual interest and/or pleasure until you find one. Having satisfying sexual relations is worth it!

David: How do you broach your sexual "desires" with your partner. For instance, for some, the idea of asking for anal sex might be difficult to bring up?

Dr. Shiple: Timing would be important. Choose a time that you are relaxed and your partner is relaxed. Then set the stage. By this, I mean to say something like, "I have something that is important for me to ask you, but I am embarrassed (if you are) or nervous (if you are) about it." This lets your partner know to be appropriately ready. If you need your partner's encouragement at this point, ask for it by saying something like, "I would really like you to say it is all right, that you want to know, that you are listening." Then give your partner time to respond to this. If she/he does not respond appropriately to this, it probably is not time yet to go on to something more sensitive like stating that you would really enjoy experiencing having anal sex with her/him.

Questions: Hi Dr. S :) Here is a brief summary: I don't think I know how a "healthy" sexual relationship starts. Can you give me general ways of knowing when I'm ready? I know I'm either the "aggressor" or the "passive" participant. I don't feel sex as an emotional extension, but almost separate of "love". I can't "feel" sex as necessarily emotional, just physical.

Dr. Shiple: Is that OK with you? Or does it cause you problems? If what you are doing is satisfying to you, and to your partner, it may not be necessary to change it. However, let's presume that you are saying that you want to change it. First, you would want to take plenty of time to get to know your partner and not rush the physical, sexual interaction. Then, in that time, you would begin to experience other emotional responses with your partner. Emotional feelings that are not just sexual. This will get you on your way. Then be sure to ASK your partner what she wants. See if her expression of her desires, and how she feels, can spark some emotional response in you. These are beginnings.

TheArtOfBeingMe: Is it impossible to get out of the "sex is bad" frame of mind after sexual abuse as a child?

Dr. Shiple: YES. Let me repeat that because it is so important: Yes! With work. You would want to find an excellent and skilled cognitively-oriented sex therapist, because what you are dealing with, is how concepts and ideas affect your behavior. Then really dedicate yourself to WORK with this therapist.

Other issues, which would be a part of this, would be accepting and loving yourself as good and beautiful! Yes, you can!

ladyofthelake: In times of extreme stress, when I least want sex, my husband seems to need it the most. Is this a normal reaction?

Dr. Shiple: Absolutely, and it is not just a male-female thing. It is the difference in personal expressions. Sex provides incredible tension release. So, at a time of extreme stress, this element alone can make sex desirable for some people. For other people, as you so well point out, it is just the opposite. The stressful event takes center-stage in your mind, with all lights focusing on it. Who can think about having sex?

In a relationship, the difficulty with these differential ways of responding, is how you resolve the two poles. Does one of you look at what benefit the other partner might see in his/her approach, and get in the other person's shoes, as it were? Or does it become an argument as another way of diverting the stress-filled energy?

David: In terms of a relationship, where you have been with your partner for some time, is part of the "deal", whether you are a man or woman, to have sex when your partner wants it -- even though at occasional times you may not want to have sex at that moment? Or maybe a better phrasing of the question is, is that part of having a good relationship?

Dr. Shiple: Sometimes, and sometimes not. What I mean by that is, I think there have to be three modes of interacting:

1. we both want to have sex and we do
2. one of us wants to have sex and the other of us has no serious problem/objection with that. Maybe she or he is tired and not up to generating the energy herself or himself, but if the desirous partner can get the action going, the other party is amenable; and
3. it's just NOT the right time.

I would add that I think (c) needs to be used sparingly. But, by not having a (c), it sets up the circumstance in which one partner might feel forced, or create resentment. This resentment can undermine and destroy a relationship fast!!

rtn12760: I have a therapist who works with me on my pornography issues but doesn't touch on the fear of intimacy. Should I get a new therapist? This one was supposed to specialize in sexual addiction.

Dr. Shiple: Have you brought up to your current therapist that you want to work on fear of intimacy? Do you want to work on fear of intimacy (rather than to presume this from your question.)? If your current therapist feels competent to deal with intimacy fears, I would certainly stick with this therapist. It takes a considerable amount of time to build a therapeutic relationship, one of deep trust and benefit. I would not be looking to have you throw that over too quickly.

However, if you have asked to deal with your fear of intimacy, and the therapist is just not doing so, I would ask if she or he could refer me to someone capable in this area. Intimacy is such a crucial area to sexual satisfaction that I encourage you to take the steps to pursue this.

David: When I hear the term sexual dysfunction, I, maybe because I am a man, think about "inability to get an erection." What other categories does that cover?

Dr. Shiple: Sexual dysfunction for a male can also include what used to be called premature ejaculation. It can include problems with sexual desire. It can include not being able to sustain the erection long enough for mutual satisfaction and pleasure.

For a female, sexual dysfunction can also be inhibited sexual desire. It can include the condition of vaginismus -- in which the mouth of the vagina tightens up so fiercely and so strongly that it can prevent penetration. Even if penetration is possible, this condition creates incredible pain in the female partner, and, in her partner.

punklil: I have DID ( dissociative identity disorder, multiple personality disorder) and when I say "no" to my partner, he would call out another alter that would say "yes". Is this wrong, or does he have a right to do this?

Dr. Shiple: That would depend on the relationship between the alters. Is it OK with you that what you requested is not listened to? Is it a relief to you that one of the others would be able to please your partner when this is not possible for you? As I mentioned above, if a dynamic is going on that creates resentment for one of the partners, including the main personality, this will be a serious problem to the relationship. Does he have the right? I would seriously consider, outside of the sexual interaction, having the two of you define what you need from your partner and what you are willing to do about your partner requests. If this is absolutely unacceptable to you, Punklil, you would need to help your partner understand, and together, create other options to use when this situation comes up. If you cannot do this yourselves, I would advise you to seek a good relationship therapist for assistance.

Dawnie3: I have diabetes and get splits in the skin, which really hurt. Is this normal and what helps to relieve them and prevent them? I think it's caused from dryness.

Dr. Shiple: Dawnie3, I think that this is an excellent question, but it is out of my area of expertise. Have you asked your medical doctor about this? If not, I encourage you to do so. I would tend to bet that there is some medical treatment that could help you. I just do not know what it might be.

David: What is the best way of "complaining" about your partner's sexual habits or preferences? Some people have trouble communicating in general, but in sexual matters "tact is critical."

Dr. Shiple: Once again, timing is of the essence in this area. Choose a time when you and your partner are relaxed together. Then set the stage I mentioned above. You do this by saying something along the lines of, "I have something I need to talk to you about that is very important to me; yet I am concerned that you might get upset, angry, hurt (whatever fits). I absolutely do not want that result, yet I still need to talk with you about this."

Then proceed to talk in terms of I-messages: "I would feel so much more aroused if you ...", "I would be willing more often to initiate sex and be an active partner if we did more ...", "Sometimes I need a light touch and sometimes a need a harder touch. Would it work for you if I put my hand over yours to show you which I would enjoy most when?" If your partner says, "no" to this. Ask him/her what works for them. Get your partner actively involved in creating solutions that are helpful pleasing to him/her. You have great expertise between the two of you. You are an expert on yourself and your partner is an expert on his/her responses and inclinations. Don't miss out on the opportunity to use these areas of expertise for your mutual benefit. By all means, however, avoid "You always ..." kinds of messages; or, "You never ..." messages. These tend to create defensive responding, the very opposite of what you are looking for when you and your partner could be focusing on one (or several) solutions. As always, timing and "how you say what you say" are crucial.

spudrn: My question is that I was sexually abused as a child, and now, for me to have a successful orgasm, I have to hurt myself sexually to the point of bleeding to release my tension. How can I heal myself from this need of self-injury?

Dr. Shiple: Spudrn, that is a courageous question! Have you worked with a therapist on this? Let me assure you -- you are not alone! I have worked successfully with many, many clients with the "need" to hurt themselves physically (self-injury). This is a treatable condition. However, it requires some basic psychotherapy in the areas of increased positive self-esteem, learning self-love, developing ways of kindness with yourself. These are important skills to learn. Working with a skilled therapist to develop them is step number one. And let me say again, this condition is treatable. So, I encourage you to do the work to get this resolved.

David: For everyone's information, Dr. Shiple's website is: http://www.sexualtherapy.com/therapists/shiple.htm.

Thank you, Dr. Shiple, for being our guest tonight and sharing your expertise with us. And I want to thank everyone in the audience for coming and participating. I hope you have found the information helpful.

Dr. Shiple: Thank you, and good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

In the beginning of a relationship, coming to work sleepy often means that your sex life is going well. But surveys, experts and common sense suggest that people who are chronically sleep-deprived actually have less sex.

"Sleep and sex is not a topic on which a lot of research has been done," says J. Catesby Ware, MD, the chief of sleep medicine at Eastern Virginia Medical School and the director of the Sleep Disorders Center at Sentara Norfolk General Hospital. "But there are a lot of ways that sleep affects one's sex life."

Some people may be skimping on sleep and sex because of an overly hectic schedule. After all, when you're working long hours and doing your grocery shopping at 10 pm, you probably feel like sleeping when you hit the pillow. Even on the weekends, couples sometimes prefer catching up on their sleep to having sex.

People who do shift work at night may find it especially hard to obtain both sleep and sex. Not only is it is difficult for shift workers and their partners to find a time when they're both free to have sex, but sleep-deprived shift workers are also often too irritable to get in the right mood. Being awake at night also throws off the body's internal body clock, or circadian rhythms, which Dr. Ware says can impair sexual functioning.

Others may have psychiatric or medical problems that interfere with their ability to sleep well and perform well sexually. For example, symptoms of depression and anxiety can include both insomnia and a diminished sex drive. And many antidepressants, which can sometimes cause erectile dysfunction and/or a loss of libido, further complicate matters.

The medical condition most commonly associated with problems with sleep and sex is sleep apnea, in which the airway is sucked shut during snoring. People with sleep apnea may wake up as many as 400 times a night in order to breathe again, and this can cause severe daytimes sleepiness, and irritability. According to Dr. Ware, men with sleep apnea tend to have lower levels of testosterone, which can lower libido.

Other medical conditions that affect sleep and sex include diabetes, lung conditions and heart disease. And as with depression, some medications that treat these conditions don't help one's sex life. For example, medications for high blood pressure-which itself may cause erectile dysfunction in men may affect sexual performance in men by inhibiting blood flow to the penis.

As Dr. Ware explains, "Sometimes the complexity of the interaction among the medication, the disease and the disturbed sleep can all gang up on a patient."

If you think your lackluster sex life is due to poor sleep, try to figure out why you're sleepy, and seek the help of your physician if necessary.

Improving your sleep behaviors, which are known as sleep hygiene, may also help. Good sleep hygiene involves practices such as going to sleep and waking up at the same time each day. Regular exercise and limiting sleep-disturbing substances such as caffeine, alcohol and nicotine can also make it easier to get some sleep-and hopefully some sex.

A third of those with ADHD also suffer from depression, but it can be difficult to diagnose and studies indicate that ADHD and depression should be treated separately.

ADHD does not often come alone. There are many other comorbid conditions that are commonly associated with ADHD. Depression, Bipolar Disorder, Oppositional Defiant Disorder, Conduct Disorders and Learning Disabilities are just some of the conditions that can appear with ADHD. Some studies have indicated that between 50% and 70% of individuals with ADHD also have some other condition. The presence of co-morbid conditions can interfere with treatment, render some treatments ineffective and seems to have a direct correlation on whether ADHD symptoms will continue to cause impairment into adulthood. The positive response to treatment is lower in patients with co-morbid conditions. Patients with at least two co-existing conditions are also more apt to develop conduct disorders and anti-social behavior. Early diagnosis and treatment can many times prevent problems later.

Many with ADHD Also Suffer with Depression

According to studies, anywhere from 24% to 30% of patients with ADHD also suffer from depression. In the past it was thought that depression may have been the result of constant failures due to ADHD symptoms. Therefore, if ADHD was successfully treated, the depression should disappear. Based on this assumption, ADHD was considered to be the primary diagnosis and the depression was ignored. However, a study by the Pediatric Pharmacology Department at Massachusettes General Hospital in Boston, MA indicated that depression and ADHD are separate and both should be treated.

Diagnosis can be very difficult. Stimulant medications, commonly used to treat ADHD, can sometimes cause side effects that mimic depressive symptoms. These medications can also increase symptoms of depression and bipolar disorder, making it hard to distinquish what are the true symptoms and which are caused from medication. Many physicians will, therefore, treat the depression first, and, once that has been controlled will begin to treat ADHD. Depression becomes the "primary" diagnosis and ADHD becomes the "secondary" diagnosis. Other physicians will argue that treatment must be simultaneous, with treatment occurring at the same time. Arguments for this method of treatment say that in order to have either condition under control, both must be under control.

Some of the risks of co-existing conditions (especially undiagnosed and untreated) are:

• Substance abuse
• Development of conduct disorders
• Development of Bipolar Disorder
• Suicide
• Aggressive or Anti-Social Behaviors

Some experts recommend that all individuals receiving a diagnosis of ADHD should also have a complete and thorough psychological evaluation to determine the presence (or absence) of any co-existing disorders. Once this has been completed, a treatment team, sometimes consisting of family physician, psychologist and psychiatrist, can work together to create a treatment plan geared specifically for that individual. If you suspect that you, or someone you know suffers from depression, please consult your physician for referrals to a mental health professional in your area for further evaluation and treatment.

---

---

next: What To Do About Depression
~ adhd library articles
~ all add/adhd articles

Return to text

Table I. Height, Weight, and BMI by Gender and Age Group
Height (cm)			Weight (kg)			Body mass index (BMI)
Age Group	M	SD	M	SD	M		SD
Women
18-29	165.24	7.26	63.08	12.01	23.24		4.35
30-49	164.28	7.42	71.32	17.28	26.43		6.23
50-86	162.54	7.56	69.72	13.29	26.46		5.22
Overall	164.00	7.44	68.63	15.13	25.60		5.63
Men
18-29	179.68	8.03	74.87	12.48	23.18		3.55
30-49	180.45	7.22	83.72	14.14	25.75		3.84
50-86	175.69	7.66	82.26	12.66	26.65		3.30
Overall	178.34	7.87	79.84	13.56	25.13		3.86

 

Table II. Body Image Scores by Gender and Age Group
Physical attractiveness				Body image satisfaction
Group	M		SD	M	SD
Gender
Women	18.57	3.51		31.23	8.56
Men	18.51	3.57		35.46	7.21
Age
18-29	19.80	3.68		33.41	7.56
30-49	18.11	3.49		31.73	8.82
50-86	18.00	3.24		34.80	7.95
Body Image Importance				Body concealment
Group	M	SD		M	SD
Gender
Women	32.00	7.44		15.40	5.72
Men	30.94	7.61		9.77	4.73
Age
18-29	30.83	7.93		12.12	5.12
30-49	31.60	7.03		14.07	6.39
50-86	31.93	7.77		11.91	6.07
Body improvement				Social physique anxiety
Group	M	SD		M	SD
Gender
Women	9.22	3.74		34.50	9.46
Men	8.70	3.70		27.68	8.11
Age
18-29	9.40	3.41		32.47	9.27
30-49	9.05	3.38		32.92	9.95
50-86	8.62	3.45		28.25	8.45
Appearance comparison
Group		M		SD
Gender
Women		10.98		3.29
Men		9.17		3.35
Age
18-29		11.00		3.48
30-49		10.64		3.25
50-86		8.76		3.18

 

---

continue story below

 

 

---

---

Table III. Unique Body Image Predictors From Regression Equations That Significantly Increased the Prediction of Psychological Functioning at Step 2 Among Men and Women of Different Age Groups
Unique body
Outcome variable	Group	image predictors	[sr.sup.2]
Self-esteem	Women 18-29	None	--
Women 30-49		Social physique anxiety	.06
Body Image Importance			.05
Women 50-86		Physical attractiveness	.13
Men 18-29		Physical attractiveness	.07
Body image importance			.07
Men 30-49		Body concealment	.10
Men 50-86		Appearance comparison	.08
Body image satisfaction			.07
Depression	Women 50-86	Social physique anxiety	.08
Anxiety	Women 50-86	None	--
Men 50-86		Appearance comparison	.11

 

Table IV. Unique Body Image Predictors From Regression Equations That Significantly Increased the Prediction of Social and Sexual Functioning at Step 2 Among Men and Women of Different Age Groups
Unique body
Outcome variable	Group	image predictors	[sr.sup.2]
Social anxiety	Women 50-86	Social physique anxiety	.08
Body improvement			.07
Men 30-49		Appearance comparison	.08
Same-sex relations	Men 30-49	Physical attractiveness	.13
Opposite-sex relations	Men 18-29	Body concealment	.09
Sexual self-efficacy	Men 30-49	Body satisfaction	.09
Sexual satisfaction	Men 30-49	Appearance comparison	.12
Body concealment			.10
Body satisfaction			.08
Sexual optimism	Women 30-49	None	--
Men 30-49		Social physique anxiety	.18

 

 

SOURCES:

Abell, S., & Richards, M. (1996). The relationship between body shape dissatisfaction and self-esteem: An investigation of gender and class differences. Journal of Youth and Adolescence, 25, 691-703.

Allaz, A. F., Bernstein, M., Rouget, P., Archinard, M., & Morabia, A. (1998). Body weight preoccupation in middle-age and ageing women: A general population survey. International Journal of Eating Disorders, 23, 287-294.

Allgood-Merten, B., Lewinsohn, P. M., & Hops, H. (1990). Sex differences and adolescent depression. Journal of Abnormal Psychology, 99, 55-63.

Australian Bureau of Statistics. (1998). How Australians measure up. Canberra, Australia: Australian Bureau of Statistics.

Banfield, S. S., & McCabe, M. P. (2002). An evaluation and clinical implications of the construct of body image. Adolescence, 37, 373-394.

Beebe, D. W. (1995). The Attention to Body Shape Scale: A new measure of body focus. Journal of Personality and Assessment, 65, 486-501.

Bemben, M. G., Massey, B. H., Bemben, D. A., Boileau, R. A., & Misner, J. E. (1998). Age-related variability in body composition methods for assessment of percent fat and fat-free mass in men aged 20-74 years. Age and Ageing, 27, 147-153.

Ben-Tovim, D. I., & Walker, M. K. (1994). The influence of age and weight on women's body attitudes as measured by the Body Attitudes Questionnaire (BAQ). Journal of Psychosomatic Research, 38, 477-481.

Berscheid, E., Dion, K., Walster, E., & Walster, G. W. (1971). Physical attractiveness and dating choice: A test of the matching hypothesis. Journal of Experimental and Social Psychology, 7, 173-189.

Boggiano, A. K., & Barrett, M. (1991). Gender differences in depression in college students. Sex Roles, 25, 595-605.

Coakes, S. J., & Steed, L. G. (1999). SPSS: Analysis without anguish: Versions 7.0, 7.5, 8.0 for Windows. Brisbane, Australia: Jacaranda Wiley.

Davison, T. E. (2002). Body image and psychological, social, and sexual functioning. Unpublished doctoral dissertation. Deakin University, Melbourne, Victoria, Australia.

Denniston, C., Roth, D., & Gilroy, F. (1992). Dysphoria and body image among college women. International Journal of Eating Disorders, 12, 449-452.

Drewnowski, A., & Yee, D. K. (1987). Men and body image: Are males satisfied with their body weight? Psychosomatic Medicine, 49, 626-634.

Eklund, R. C., Kelley, B., & Wilson, P. (1997). The Social Physique Anxiety Scale: Men, women, and the effects of modifying item 2. Journal of Sport and Exercise Psychology, 19, 188-196.

Faith, M. S., & Schare, M. L. (1993). The role of body image in sexually avoidant behavior. Archives of Sexual Behavior, 22, 345-356.

Feingold, A. (1992). Good-looking people are not what we think. Psychological Bulletin, 111, 304-341.

Feingold, A., & Mazzella, R. (1998). Gender differences in body image are increasing. Psychological Science, 9, 190-195.

Halliwell, E., & Dittmar, H. (2003). A qualitative investigation of women's and men's body image concerns and their attitudes toward aging. Sex Roles, 49, 675-684.

Harmatz, M. G., Gronendyke, J., & Thomas, T. (1985). The under-weight male: The unrecognized problem group of body image research. Journal of Obesity and Weight Regulation, 4, 258-267.

Hart, E. A., Leary, M. R., & Rejeski, W. J. (1989). The measurement of social physique anxiety. Journal of Sport and Exercise Psychology, 11, 94-104.

Harter, S. H. (1999). The construction of the self: A development perspective. New York: Guilford.

Holmes, T., Chamberlin, P., & Young, M. (1994). Relations of exercise to body image and sexual desirability among a sample of university students. Psychological Reports, 74, 920-922.

Hoyt, W. D., & Kogan, L. R. (2001). Satisfaction with body image and peer relationships for males and females in a college environment. Sex Roles, 45, 199-215.

Koenig, L. J., & Wasserman, E. L. (1995). Body image and dieting failure in college men and women: Examining links between depression and eating problems. Sex Roles, 32, 225-249.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-343.

Mable, H. M., Balance, W. D. G., & Galgan, R. J. (1986). Body-image distortion and dissatisfaction in university students. Perception and Motor Skills, 63, 907-911.

Marsh, H. W. (1997). The measurement of physical self-concept: A construct validation approach. In K. R. Fox (Ed.), The physical self: From motivation to well-being (pp. 27-58). Champaign, IL: Human Kinetics.

Marsh, H. W. (1989). Age and sex effects in multiple dimensions of self-concept: Preadolescence to early adulthood. Journal of Educational Psychology, 81, 417-430.

Martin, K. A., Rejeski, J. W., Leary, M. R., McAuley, E., & Bane, S. (1997). Is the Social Physique Anxiety Scale really multidimensional? Conceptual and statistical arguments for a unidimensional model. Journal of Sport and Exercise Psychology, 19, 359-367.

McCarthy, M. (1990). The thin ideal, depression, and eating disorders in women. Behaviour Research and Therapy, 28, 205-225.

Mintz, L. B., & Betz, N. E. (1986). Sex differences in the nature, realism, and correlates of body image. Sex Roles. 15, 85-98.

Mitchell, K. R., & Orr, F. E. (1976). Heterosexual social competence, anxiety, avoidance, and self-judged physical attractiveness. Perceptual and Motor Skills, 43, 553-554.

Monteath, S. A., & McCabe, M. P. (1997). The influence of societal factors on female body image. Journal of Social Psychology, 137, 708-727.

Montepare, J. M. (1996). An assessment of adults' perceptions of their psychological, physical, and social ages. Journal of Clinical Geropsychology, 2, 117-128.

Motl, R. W., & Conroy, D. E. (2000). Validity and factorial invariance of the Social Physique Anxiety Scale. Medicine and Science in Sports and Exercise, 32, 1007-1017.

Nezlek, J. B. (1988). Body image and day-to-day social interaction. Journal of Personality, 67, 793-817.

O'Brien, E. J., & Epstein, S. (1988). MSEI: The Multidimensional Self-Esteem Inventory. Odessa, FL: Psychological Assessment Resources.

Paxton, S. J., & Phythian, K. (1999). Body image, self-esteem, and health status in middle and later adulthood. Australian Psychologist, 34, 116-121.

Petrie, T. A., Diehl, N., Rogers, R. L., & Johnson, C. L. (1996). The Social Physique Anxiety Scale: Reliability and construct validity. Journal of Sport and Exercise Psychology, 18, 420-425.

Pliner, P., Chaiken, S., & Flett, G. L. (1990). Gender differences in concern with body weight and physical appearance over the life span. Personality and Social Psychology Bulletin, 16, 263-273.

Powell, M. R., & Hendricks, B. (1999). Body schema, gender, and other correlates in nonclinical populations. Genetics, Social, and General Psychology Monographs, 125, 333-412.

Ricciardelli, L. A., & McCabe, M. P. (2001). Self-esteem and negative affect as moderators of sociocultural influences on body dissatisfaction, strategies to decrease weight, and strategies to increase muscles among adolescent boys and girls. Sex Roles, 44, 189-207.

Rodin, J., Silberstein, L., & Striegel-Moore, R. (1985). Women and weight: A normative discontent. In T. B. Sonderegger (Ed.), Psychology and gender: Nebraska symposium on motivation, 1984 (pp. 277-307). Lincoln, NE: University of Nebraska Press.

Rosen, J. C., Srebnik, D., Saltzberg, E., & Wendt, S. (1991). Development of a Body Image Avoidance Questionnaire. Psychological Assessment, 3, 32-37.

Rosenberg, M. (1965). Society and adolescent self-image. Princeton, NJ: Princeton University Press.

Rosenberg, M. (1979). Conceiving the self. New York: Basic Books.

Sarwer, D. B., Wadden, T. A., & Foster, G. D. (1998). Assessment of body image dissatisfaction in obese women: Specificity, severity, and clinical significance. Journal of Consulting and Clinical Psychology, 66, 651-654.

Scheier, M. F., & Carver, C. S. (1985). The Self-Consciousness Scale: A revised version for use with general populations. Journal of Applied Social Psychology, 15, 687-699.

Silberstein, L. R., Striegel-Moore, R. H., Timko, C., & Rodin, J. (1986). Behavioral and psychological implications of body dissatisfaction: Do men and women differ? Sex Roles. 19, 219-232.

Snell, W. E., Jr. (1995). The Multidimensional Sexual Self-Concept Questionnaire. In C. M. Davis, W. L. Yarber, R. Bauseman, G. Schree, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 521-524), Newbury Park, CA: Sage.

Snell, W. E., Jr. (2001). Measuring multiple aspects of the sexual self-concept: The Multidimensional Sexual Self-Concept Questionnaire. In W. E. Snell. Jr. (Ed.), New directions in the psychology of human sexuality: Research and theory. Cape Girardeau, MO: Snell. Electronic book retrieved December 2004 from: http://cstl-cla.semo.edu/snell/books/sexuality/sexualtity.htm

Stormer, S. M., & Thompson, J. K. (1996). Explanations of body image disturbance: A test of maturational status, negative verbal commentary, social comparison, and sociocultural hypothesis. International Journal of Eating Disorders, 19, 193-202.

Stowers, D. A., & Durm, M. W. (1996). Does self-concept depend on body image? A gender analysis. Psychological Reports, 78, 643-646.

Thompson, J. K., Heinberg, L., & Tantleff, S. (1991). The Physical Appearance Comparison Scale (PACS). Behavior Therapy, 14, 174.

Tiggemann, M. (1994). Gender differences in the interrelationships between weight dissatisfaction, restraint, and self-esteem. Sex Roles, 30, 319-330.

Walster, E., Aronson. V., & Abrahams, D. (1966). Importance of physical attractiveness in dating behavior. Journal of Personality and Social Psychology, 4, 508-516.

Wiederman, M. W., & Hurst, S. R. (1997). Physical attractiveness, body image, and women's sexual self-schema. Psychology for Women Quarterly, 21, 567-80.

Tanya E. Davison (1) and Marita P. McCabe (1,2)

(1) School of Psychology, Deakin University, Melbourne, Australia.

Ritalin is not addictive when taken as prescribed by doctors. But there is a high level of Ritalin abuse. 30-50% of adolescents in drug treatment centers report abusing Ritalin. (Source: University of Utah Genetic Learning Center)

Methylphenidate (Ritalin) is a medication prescribed for individuals (usually children) who have attention-deficit hyperactivity disorder (ADHD), which consists of a persistent pattern of abnormally high levels of activity, impulsivity, and/or inattention that is more frequently displayed and more severe than is typically observed in individuals with comparable levels of development. The pattern of behavior usually arises between the ages of 3 and 5, and is diagnosed during the elementary school years due to the child's excessive locomotor activity, poor attention, and/or impulsive behavior. Most symptoms improve during adolescence or adulthood, but the disorder can persist or present in adults. It has been estimated that 3-7 percent of school-age children have ADHD. Ritalin also is occasionally prescribed for treating narcolepsy.

Health Effects

Methylphenidate is a central nervous system (CNS) stimulant. It has effects similar to, but more potent than, caffeine and less potent than amphetamines. It has a notably calming and "focusing" effect on those with ADHD, particularly children.

Recent research at Brookhaven National Laboratory may begin to explain how Ritalin helps people with ADHD. The researchers used positron emission tomography (PET—a noninvasive brain scan) to confirm that administering normal therapeutic doses of methylphenidate to healthy, adult men increased their dopamine levels. The researchers speculate that methylphenidate amplifies the release of dopamine, a neurotransmitter, thereby improving attention and focus in individuals who have dopamine signals that are weak.¹

Methylphenidate is a valuable medicine, for adults as well as children with ADHD.^{2, 3, 4} Treatment of ADHD with stimulants such as Ritalin and psychotherapy help to improve the abnormal behaviors of ADHD, as well as the self-esteem, cognition, and social and family function of the patient.² Research shows that individuals with ADHD do not become addicted to stimulant medications when taken in the form and dosage prescribed by doctors. In fact, it has been reported that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.^{5, 6} Also, studies have found that individuals with ADHD treated with stimulants such as methylphenidate are significantly less likely than those who do not receive treatment to abuse drugs and alcohol when they are older.⁷

Because of its stimulant properties, however, in recent years there have been reports of abuse of Ritalin by people for whom it is not prescribed. It is abused for its stimulant effects: appetite suppression, wakefulness, increased focus/attentiveness, and euphoria. Addiction to methylphenidate seems to occur when it induces large and fast dopamine increases in the brain. In contrast, the therapeutic effect is achieved by slow and steady increases of dopamine, which are similar to the natural production by the brain. The doses prescribed by physicians start low and increase slowly until a therapeutic effect is reached. That way, the risk of addiction is very small.⁸ When abused, the tablets are either taken orally or crushed and snorted. Some abusers dissolve the Ritalin tablets in water and inject the mixture; complications can arise from this because insoluble fillers in the tablets can block small blood vessels.

Trends in Ritalin Abuse

Monitoring the Future (MTF) Survey *
Each year, MTF assesses the extent of drug use among adolescents and young adults nationwide. MTF 2004 data on annual** use indicate that 2.5 percent of 8th-graders abused Ritalin, as did 3.4 percent of 10th-graders and 5.1 percent of 12th-graders.

Other Studies

ADHD has been more frequently reported in boys than in girls; however, in the last year, the frequency among girls has greatly increased.⁹

A large survey at a public university showed that 3 percent of the students had used methylphenidate during the past year.¹⁰

Other Information Sources

Because stimulant medicines such as Ritalin do have potential for abuse, the U.S. Drug Enforcement Administration (DEA) has placed stringent, Schedule II controls on their manufacture, distribution, and prescription. For example, DEA requires special licenses for these activities, and prescription refills are not allowed. The DEA web site is www.usdoj.gov/dea/. States may impose further regulations, such as limiting the number of dosage units per prescription.

---

* These data are from the 2004 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan's Institute for Social Research. The survey has tracked 12th-graders' illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

** "Lifetime" refers to use at least once during a respondent's lifetime. "Annual" refers to use at least once during the year preceding an individual's response to the survey. "30-day" refers to use at least once during the 30 days preceding an individual's response to the survey.

---

---

---

Sources:

1 Volkow, N.D., Fowler, J.S., Wang, G., Ding, Y., and Gatley, S.J. (2002). Mechanism of action of methylphenidate: insights from PET imaging studies. J. Atten. Disord., 6 Suppl. 1, S31-S43.

2 Konrad, K., Gunther, T., Hanisch, C., and Herpertz-Dahlmann, B. (2004). Differential Effects of Methylphenidate on Attentional Functions in Children With Attention-Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry, 43, 191-198.

3 Faraone, S.V., Spencer, T., Aleardi, M., Pagano, C., and Biederman, J. (2004). Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J. Clin. Psychopharmacology, 24, 24-29.

4 Kutcher, S., Aman, M., Brooks, S.J., Buitelaar, J., van Daalen, E., Fegert, J., et al. (2004). International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): Clinical implications and treatment practice suggestions. Eur. Neuropsychopharmacol., 14, 11-28.

5 Biederman, J. (2003). Pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) decreases the risk for substance abuse: findings from a longitudinal follow-up of youths with and without ADHD. J. Clin. Psychiatry, 64 Suppl. 11, 3-8.

6 Wilens, T.E., Faraone, S.V., Biederman, J., and Gunawardene, S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 111, 179-185.

7 Mannuzza, S., Klein, R.G., and Moulton, J.L., III (2003). Does stimulant treatment place children at risk for adult substance abuse? A controlled, prospective follow-up study. J. Child Adolesc. Psychopharmacol., 13, 273-282.

8 Volkow, N.D. and Swanson, J.M. (2003). Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am. J. Psychiatry, 160, 1909-1918.

9 Robison, L.M., Skaer, T.L., Sclar, D.A., and Galin, R.S. (2002). Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs, 16, 129-137.

10 Teter, C.J., McCabe, S.E., Boyd, C.J., and Guthrie, S.K. (2003). Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors. Pharmacotherapy, 23, 609-617.

---

---

next: Parenting an ADHD Child is Exhausting
~ adhd library articles
~ all add/adhd articles

Trust takes years to develop and only a moment to destroy. Ronn Elmore, Psy.D., explains how trust works and how to rebuild trust in your relationship

Carol had always known Melvin was passionate about cards. The two first met at a bid-whist party, where the host teamed them up. But she had no idea how obsessed Melvin was with gaming until the night she woke up from a sound sleep to find her husband of ten years slumped over the edge of their bed. When she asked what was wrong, he confessed that he'd messed up--really bad. In a series of lunch-hour visits to a nearby casino, Melvin had blown nearly $8,000 of the college fund they'd set up for their three children.

In that moment, Carol* felt as if her world had caved in. Losing the money was bad enough. But what stopped her cold was the realization that if the man she thought she knew inside out could do something like this, then who was he? Carol wasn't sure she could ever trust him again.

The Nature of Trust

Over the years, many women and men have sat on my counseling couch and shared their stories of violated trust. Their reactions seldom vary: "It felt as if he ran me over with a truck--I never saw it coming 'til it was too late." "Now I wonder if loving somebody is too dangerous to let happen again." "I've pretty much gotten over the hurt feelings, but I honestly don't know if I'll ever be able to trust my own judgment."

For trust to flourish, you have to believe that you know your partner's character and conduct intimately. The two should match and be consistent over a significant period of time. Trust isn't an investment blindly made but, rather, is a natural response to another's trustworthiness. Trust follows trustworthiness--not the other way around.

Doling out your trust before it's earned is often a recipe for disaster. Take the story of my client Nicole, a successful 38-year-old graphic designer who used her good credit standing and the equity in her home to launch a consulting business with her new boyfriend Jared. Though she'd only known Jared for a few months, she'd fallen for him in a big way. Nicole couldn't imagine that such a sweet-natured and hardworking man could deceive her, so she gave him full access to everything--including her home.

It proved to be a tragic mistake. Jared was a scam artist with a string of criminal convictions. Nicole lost both her impeccable credit and her house. Five years after incurring huge financial losses, Nicole says, "1 prided myself on being able to read a person's character instantly. Now I know that judging someone based on an instant read is just plain dumb."

On the other hand, it's unhealthy to approach every relationship with your guard up. Far too many of us have been raised to believe that we shouldn't trust anyone, even if that person has proven himself to be trustworthy. When every move your partner makes is filtered through a lens of suspicion, the relationship never really has a chance to grow.

So much in life is unpredictable. That's why we all need to know with some degree of certainty that we can count on the people we keep close to us. When your partner repeatedly makes choices that are consistent with his promises--keeping appointments with you, showing up on time, handling his share of the financial responsibilities--your confidence in the relationship grows. Conversely, when a mate's behavior is marred by selfishness, broken promises, chronic irresponsibility, infidelity or, as in Melvin's case, financial deception, trust is eroded. Can a relationship rebound from such a breach? The answer is a resounding yes, but only with a sincere commitment from both parties to rebuild what has been damaged.

When Trust Is Lost

No two stories of shattered trust are alike. But as these examples (based on real couples I've counseled) illustrate, one principle is universal: It takes time--and lots of hard work--to learn to trust again.

John and Vivian: Undercover Addiction

The situation: John and Vivian met at an Alcoholics Anonymous meeting. She had been clean and sober for more than nine years, he for just more than a year. Vivian first caught John's eye when she stood at the podium to share the gritty story of her troubled life and past addiction to alcohol and prescription drugs. "She was so gorgeous, I couldn't take my eyes off her," he recalls. "But what hooked me was her incredible honesty and the commitment she had to her sobriety." They soon became best friends, and after Vivian supported John through a bout with clinical depression--and the serious threat of a relapse into drinking--romance bloomed. "I thought of her as my perfect angel," he says.

Two days after the couple announced their engagement, John's neighbor, who had just gotten a job at a drugstore on the other side of town, called him and dropped a bombshell: On her first day on the job, she had spotted a poorly disguised Vivian trying to fill a prescription for codeine by using a fake name and ID. With a little more investigation, he learned that his "perfect angel" had been getting drugs there for months. Vivian was using again.

The aftermath: When John confronted Vivian she denied everything. She eventually came clean, tearfully vowing that it would never happen again. John asked her to publicly confess her relapse to their AA group and go to counseling. Vivian agreed to the counseling but persuaded John that the public confession was a bad idea "that would discourage others who looked to her as a role model." John didn't push her. "As usual, when it came to AA stuff, I always went along with what Vivian said," he says.

The turning point: As serious as Vivian's drug use was, it was only a symptom of more deeply rooted issues, as she learned during the counseling process. "I was really addicted to being perceived as perfect and maintaining the approval--from John and everyone else--that comes with it," she explains. John's baggage had also played a part in the couple's drama. "I hadn't owned up to the pressure I put on Vivian by treating her like she was my spiritual guru instead of my girl," he says. "I didn't even want to know that she might struggle with some fears or weaknesses just like anybody else. Who wants to admit that their guru has clay feet, too?"

The road to recovery: For Vivian and John, moving forward meant starting over. They put their wedding plans on hold and, with counseling, worked to build a new, mutually honest relationship. Vivian committed to being more open about her moments of self-doubt and her struggles with perfectionism. John said he would strive to be more attentive to Vivian, even when she revealed things about herself that he didn't want to hear. He also resolved to be more assertive about holding Vivian--and himself--accountable as they worked to rebuild their relationship.

Dina and Lee: Serial Infidelity

The situation: Dina had a gut feeling something was wrong. It was similar to the one she had had when her husband, Lee, stepped out on her for the first time. There had been too many last-minute business trips and too many nights without a call to say he'd made it safely to his destination or simply to see how things were holding up on the home front. And that's not all that was unusual: "I had noticed that we hardly ever argued anymore and that we weren't having sex quite as much as before," she says.

Dina finally followed her hunch and hired a private investigator to check up on her husband's suspicious behavior. Two weeks later he confirmed her fears: Lee, Dina's husband of 17 years and father to their four children, wasn't leaving town as much as he said; he was checking into local motels--and not alone. Dina actually knew Lee's new mistress. It was Celeste, the marketing specialist Lee had hired away from another software firm to help turn his company around. After she came on board, business was booming and Celeste made partner.

The aftermath: When Dina confronted him, Lee was contrite and immediately ended the affair. He agreed to go to couples counseling for as long as she thought necessary. But he refused to fire Celeste. Getting rid of her at that point, he insisted, would leave a gaping hole in the company. To Lee, firing Celeste would be financial suicide.

Dina made vague threats of divorce but never acted on them. Instead, she insisted that her husband recount the minute details of the sordid affair. On more than one occasion she became physically violent toward him. He called her hysterical and tried to stay out of her way.

The turning point: Their tug of war went on for nearly a year until the day Dina realized she was as angry with herself for her passivity as she had been with Lee for his infidelity. She wasn't sure she could rally herself to take necessary action on her own, so she rejoined the women's prayer group that she had abandoned after Lee's affair had become known. "I started feeling my confidence come back after one of the sisters in the group who'd been through this herself looked me in the eye and said, 'If you don't expect your husband to treat you with respect, then why should he?' "Dina summoned her courage and calmly but firmly issued an ultimatum: Either Lee would send Celeste packing, or he'd have to pack his own things and find a new place to call home.

The road to recovery: Lee wanted a business that included Celeste, but he decided that if he had to make a choice, his marriage and family came first. He negotiated a buyout settlement with Celeste and helped her find a position out of state. For a time the business faltered, but it didn't collapse. Within a year Lee's company--and marriage were afloat again.

Whenever Dina began to obsess about Lee's transgression, she reminded herself that most of their time together had been good. I value my marriage, she told herself. Then Lee jump-started his recovery by participating in an intensive therapy group for men with a history of sexual infidelity. "I discovered that my struggle was about selfishness, thinking I had worked so hard that I deserved to have whatever I wanted," he says. And day after day, month after month, Lee did everything Dina asked and more in order to prove to her that having her in his life meant more to him than anything else.

Making Up and Moving On

At first, getting beyond a loss of trust, to have a relationship that feels normal again, may seem impossible. But with time, relationships can and do recover. After Melvin's late-night confession that his gambling had gotten out of control, he and his wife separated briefly but eventually chose to reconcile. "We had had ten great years together," Carol says. "We know we can't ignore what happened, but we just couldn't go out like that." Melvin adds, "I did have to work a lot of overtime to put back what I took, but I did what I had to do." He was probably talking about the balance of their bank account, but he could just as well have meant the level of trust in their marriage. In the end, it's important to take your mate's entire history into account, not merely one dark chapter. Consider that if the situation were reversed, you'd hope he or she would do the same. Rather than wallow in the past, resolve to envision an intimate, trusting future together--and to rise each day focused on your pursuit of it.

* All names and identifying information have been changed.

---

STEPS TO RESTORE TRUST

How do you begin again after the confidence you've placed in a relationship has been betrayed? These guidelines can help you regain your faith and get your relationship back on track

1. Expect an apology. You deserve it. It can be difficult for someone to own up to what they've done. But in order to move on, the offending party has to admit guilt and sincerely apologize for the harm they've caused. I'm sorry I squandered our money and deceived you about it. I regret I was unfaithful and put our relationship at risk. An apology won't dissolve the hurt or guarantee a breach of faith won't happen again. But it is a critical first step.

2. Try to understand why it happened. If you focus only on the "dirty deed," you'll find yourself caught up in a whirlpool of debilitating emotions: anger, guilt, withdrawal, depression. Both you and your partner must try to figure out what led to the transgression. Character flaws and bad conduct may not tell the entire story. Inattentiveness, poor communication and misplaced priorities can also lead to behaviors that trigger a breakdown in trust.

3. Get some help. The more devastating the incident, the less likely you'll be able to handle the fallout on your own. Seek the support of professional counselors, a spiritual adviser or a few trusted friends who can help you sort things out in a way that's productive, not punitive.

4. Spell out your expectations. For example, ask that he cease all visits to X-rated Web sites, or that she make no credit-card purchases over $50 without mutual agreement. It may seem as if you're keeping your mate on a short leash, but in fact, his freedom and credibility will grow as he consistently proves by his actions that he can be trusted.

5. Make your commitment clear. Show your mate that you, too, are willing to make some concessions as you work together to reconcile the relationship. Your mutual accountability reinforces your commitment to developing a long, stable future together in spite of what has happened in the past.

Ronn Elmore, Psy.D., is a relationship therapist, ordained minister and author. His latest relationship book is An Outrageous Commitment: The 48 Vows of an Indestructible Marriage (HarperResource).

Phillip Sharp Ph.D. has spent the past 5 years developing a specialty in the field of Sexual Addiction counseling, including incest and sexual perpetration issues. He works with sex addicts, their spouses or partners, and families. Dr. Sharp is our guest speaker tonight.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

---

David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Sexual Addiction". Our guest is psychologist, Dr. Phillip Sharp, who is a specialist in the field of sexual addiction counseling. Dr. Phillip Sharp's early training included work with families dealing with incest and sexual perpetration issues. Over the past 5 years, Dr. Sharp has developed a specialty in the field of Sexual Addiction counseling, working with sex addicts, their spouses or partners and families. We'll be talking about treatments for sexual addiction as well as the impact it has on family members -- and more importantly, what can be done to help.

Good Evening, Dr. Sharp and welcome to HealthyPlace.com. We appreciate you being here tonight. I know our audience members have different levels of understanding, so briefly, can you define sexual addiction. Then we'll get into deeper issues.

Dr. Sharp: The definition varies depending upon what expert you talk to. Generally, it is a pathological relationship with a mood altering experience. In this case - sex.

David: How does a person develop sexual addiction?

Dr. Sharp: There are various paths by which a person can progress down the road of sexual addiction. Most people have some pain or injury that they seek to heal, numb or medicate. The sexual behavior becomes their primary coping mechanism.

David: And just so everyone knows, does sexual addiction only involve sex with other individuals, or does it cover pornography and other sexual activities?

Dr. Sharp: It covers any activities related to the theme of sex. It is not simply acting out with another person. It includes, pornography, fantasy, masturbation, 900 numbers, etc. The important point to remember is that it is a pathological relationship. Out of the ordinary.

David: When you spoke of "pain" or "injury" a moment ago, I'm assuming you are talking about emotional or psychological pain. Can you explain further?

Dr. Sharp: Yes. The pain usually has to do with some experienced or perceived injury, which the person may or may not be consciously aware of. It can include things such as emotional neglect in the family of origin, rejection from peers or even childhood abuse.

David: What kind of treatment is involved in dealing with sexual addiction?

Dr. Sharp: It depends on the persons underlying issues (pain) and the level of their addiction. Some folks can do fine in a general weekly therapy session with an appropriately trained professional. The therapy will likely need to be supplemented by participation in a 12-step recovery group. Other folks who have a deeper level of addiction may need to go away to an inpatient treatment center.

David: Does a person who has a sexual addiction usually have other addictions (drug, alcohol) as well?

Dr. Sharp: That is often the case. I would say it is more the norm that they will either have another addiction or abuse some other substance or process.

David: We have a few audience questions Dr. Sharp:

lostforwords: Can depression/anxiety bring on sexual addiction?

Dr. Sharp: It can help to trigger it. Usually, depression and anxiety are due to other underlying issues. The underlying issues, such as unresolved trauma often fuel both sex addiction and depression/anxiety.

David: Like other addictions, I imagine there is "no cure," but rather sexual addiction is managed on a day-by-day basis. Is that true?

Dr. Sharp: Yes, that is true. A person is typically in recovery for the rest of their lives.

David: And what about the ability of a sex addict to have close personal relationships?

Dr. Sharp: When the sexual addiction is active, it usually severely hampers and disturbs truly intimate relationships. It is hard to spend all of the time that the addict puts into their acting out behaviors and still maintain the level of attention that a personal and close relationship requires. In recovery, the person has the best chance of maintaining close relationships.

David: Here's another audience question:

iaacogca: I have heard it said that not all love addicts are sex addicts but all sex addicts are love addicts. Comments?

Dr. Sharp: I disagree. Sex addiction has nothing to do with love really. It's really about loneliness, the inability to connect intimately and an attempt to deal with the pain of the real loneliness. At the heart of it, sex addicts, although some are extremely sociable and outgoing, are truly lonely people who feel disconnected.

mrlmonroe: Being new to this, what is "acting out". In other words, what types of behaviors would be considered acting out - besides the obvious?

Dr. Sharp: A person can act out or act in. Acting out refers to behaviors external to the self, such as careless and senseless sex, masturbation, pornography, chat rooms and 900 numbers. A person can act in with fantasy and distorted perception of reality.

Rhino1: What can a person do to help their spouse understand the addiction?

Dr. Sharp: I suggest that first of all, you educate yourself by reading some of the books written on the issue. For instance, Patrick Carnes, PhD has authored a number of good books. His original work was entitled Out of the Shadows: Understanding Sexual Addiction, he also wrote: Contrary to love: Helping the Sexual Addict, Don't Call It Love: Recovery From Sexual Addiction, and Sexual Anorexia: Overcoming Self-Hatred.

Once you get an understanding of the addiction, then you need to think about confronting your partner with the unhealthy behaviors that you have observed. If you find this difficult, you may want to consult with a professional. It's just as important for the partner to get support and assistance.

David: I'm sure it is very difficult on spouses and partners of addicts too, especially since fidelity is the cornerstone of most marriages. How is a spouse or partner supposed to "understand" this type of behavior?

Dr. Sharp: It's a sickness, a disease, and it usually doesn't appear out of nowhere. The disease has been growing for a long time. It may have taken a while to manifest, or your partner may have not been honest with you about past behaviors and struggles.

dreamer1: Has Dr. Sharp ever worked with a married couple where both were sex and love addicts?

Dr. Sharp: Yes. It is a fairly common scenario to have sex and love addicts partnered together. It is a little more common to see women who are sex and love addicts, versus men.

David: Here's a question from someone with Multiple Personality Disorder:

TSchmuker: I am wondering how does Dr. Sharp handle a person with Multiple Personality Disorder, that has an alter who is sexually addicted?

Dr. Sharp: I don't do much work with MPD. To date, I have not worked with an alter that was a sex addict. I would think that a therapist would need to treat that alter for sexual addiction while attempting to continue the integrative therapy.

fm3040: What are the chances of achieving a healthy relationship with a sex addict?

Dr. Sharp: It depends on so many things. For instance, how far into recovery is the addict and how much progress has he/she made on their underlying issues.

FaPiRDaniel: Dr. Sharp, what would you say the percentage is of adult male sex addicts in America today, dealing with homosexual desire for preteen aged children?

Dr. Sharp: I don't know that we have good data available to definitely answer that question. It also depends on what and how you define desire. Many sex addicts who consider themselves heterosexual will occasionally "cross the line" in the service of their addiction. Sexual addiction covers all sexual orientations, and all homosexuals or bisexuals are not sex addicts.

Rae1: Is it odd for a co-sex addict to change her mind about the relationship and decide to leave even after the sexual addict has worked toward recovery?

Dr. Sharp: No. not at all. Often, when one person in the relationship or system starts to get recovery, the other person leaves, because they don't want to give up their co-dependence of the sex addict. If she or he can't have the sex addict the way the person used to be, he/she may look for a replacement.

David: Does that go along the same lines as "misery loves company?"

Dr. Sharp: Yes.

panzena: Do most sex addicts really change?

Dr. Sharp: I can't really answer that, because I don't know most of them. I can tell you it is possible to change. The journey is a difficult one for most people, however, and there is a tendency to experience many relapses, as with other addictions, before a person commits to and stays in recovery.

LAS1027: What level of sex addiction warrants inpatient treatment?

Dr. Sharp: Usually a person who has a significant loss of self-control and the addiction is interfering in a major way with one or more significant parts of their lives, such as family, career, health, etc.

David: Is sex addiction more or less difficult to treat than substance abuse and why?

Dr. Sharp: I would say it is at least as difficult, and at present a little more difficult. I believe that the continuing denial of our society and lack of education makes identification difficult. Identification of and/or diagnosis of the problem is the first essential step that many professionals, partners, and addicts never reach.

David: Is it because they don't see having a lot of sex as a "problem" vs. drugs and alcohol?

Dr. Sharp: I believe that is part of it for many people. Our culture tends to overlook high levels of sexual activity for certain groups such as males, college students, and homosexual men.

fm3040: Isn't it better to just leave the sexual addict if there is such a high rate of relapse?

Dr. Sharp: Please clarify your question. What do you mean by leave?

David: I think what fm3040 is saying, if you are a spouse or partner of an addict, and there's a significant chance of relapse, why stick around for more pain?

Dr. Sharp: That is a decision that each person has to make for themselves. I can't tell you whether it is better to stay or to leave. Some of it may depend on the person's level of addiction and the seriousness/risk of their acting out behaviors. A person with a lower level of addiction who primarily fantasizes and masturbates may be more easily treated and have better prospects for the future.

David: Is that because a person who has sex with many different partners in an addictive environment has a difficult time with personal attachment?

Dr. Sharp: Yes. And the deeper you go into acting out behaviors, the farther you have to come back.

dreamer1 What do you mean the deeper you go into acting out, the farther you have to come back?

Dr. Sharp: Patrick Carnes, PhD., the acknowledged worldwide guru writes about different levels of addiction and acting out behaviors. The types of behaviors, the frequency, the legal and other consequences as well as longevity of the addiction can all influence the course of recovery. "The farther you've fallen into it, the harder it is to get out."

JamesLaws: What groups or organizations are available to people with sexual addictions?

Dr. Sharp: There are several. Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addictions Anonymous, Co-Sex Addicts Anonymous. Sexual Compulsives Anonymous, to name a few.

David: James, these groups are usually listed too in the local phone book or you can call your local psychological association to guide you in the right direction.

paulv54: Doctor Sharp, you mentioned the propensity for relapse in the early stages of recovery. From what I hear at meetings, this is true. However, this should not deter the addict from participating fully in a recovery program, working the twelve steps, etcetera, should it?

Dr. Sharp: Not at all. Every relapse is not a full slide back into all of the previous behaviors. If you don't start your recovery, it will never happen for sure. Don't be put off by the possible enormity of the task. Rather, avail yourself of the many resources such as Mental health professionals, 12-step groups, in town and online. There are increasingly more self-help materials to supplement all of this and aid your recovery.

Rosebud: I'm a recovering addict and I want to know, is it normal to have memory loss of your childhood? I can't remember any, except for bits and pieces.

Dr. Sharp: That suggests that you experienced some abuse or trauma in your past. Most sex addicts have experienced some level of abuse or trauma as children or teens.

Deirdre: What about this scene "Dominance and submission" that I have been seeing with "humiliation". Does it look like a sexual addiction in a new package?

Dr. Sharp: It often is. Sex addicts differ in their preferences or "modus operandi."

David: But Domination and other forms of "sexual play" can be covered under sexual addiction, correct?

Dr. Sharp: Yes. I would not assume that all games of dominance play are Sex Addiction. But, in contrast, it often is a symptom of people's addiction.

David: By the way, are the terms "sexual addiction" and "sexual compulsion" synonymous?

Dr. Sharp: Yes. Different people use slightly different terms that mean basically the same thing. There is some dispute in the professional community as to whether this is an addiction or compulsion, according to guidelines placed in the APA's Diagnostic and Statistical Manual. For the layperson's purpose (and most of the rest of us) they are synonymous.

MikeS: Are there any non-12 Step related recovery programs that have been effective?

Dr. Sharp: There are some religious programs that don't specifically use the 12-step approach, but very similar principles, that are having success.

David: How about approaches that don't deal with a "higher power?"

Dr. Sharp: I believe some programs such as the Masters and Johnson treatment centers may not specifically rely on 12-steps or higher power. They do a lot of work with Trauma Recovery.

David: With substance abuse addictions, there's speculation that in some people, at least they are "organically based" or a person is genetically predisposed to a substance like drugs or alcohol. I'm assuming that isn't so with sex addiction, that it's more of a psychological issue. Is that true?

Dr. Sharp: Again, we do not have sufficient scientific evidence to suggest one way or another. Although I doubt if there is a Sex Addiction gene, it may be fair to guess that some people are neurologically predisposed to sexual addiction.

David: Is there any medication available that helps the sex addict?

Dr. Sharp: Some physicians are finding success with the anti-depressants, SSRIs. These are Selective Serotonin Reuptake Inhibitors, such as Paxil, Prozac. Medication alone is not sufficient treatment, however.

David: If a partner of a sex addict could do one thing to aid in the addict's recovery, what would you suggest?

Dr. Sharp: Avoid enabling. Don't overlook or excuse the behavior, but also be supportive and encouraging of recovery.

Charcy2000: Do they ever recover and lead healthy lives?

Dr. Sharp: Yes. Many do. There are thousands of people who recover from sex addiction and lead healthy lives.

FaPiRDaniel: Dr. Sharp, Are there any really good programs available to assist recovery pedophiles?

Dr. Sharp: I know that there are. I cannot name them off the top of my head. Contact your Sex Addicts and Sex Addicts Anonymous organizations as well as your community mental health system. They frequently can give you leads. I could research that further and have information available at a later date.

iaacogca: Is there anything the spouse can do, such as being more sexually responsive in order to help the addict avoid acting out?

Dr. Sharp: Being more sexually responsive will not typically curb the acting out for long. Sex addiction is about a fantasy relationship, it is not reality oriented. Consequently, the Sex Addict often looks for an excuse to get angry with their spouse or partner. This gives them an excuse to go act out through their unhealthy behaviors.

mrlmonroe: Do you think it is ever possible to have a "kinky" sex life with a sexual addict. My fiance who is a Sexual Addict and I, have had a good sex life, and now that I know of his illness, I am afraid to even venture to places we used to go?

Dr. Sharp: You need to be careful. Although I don't condemn people's sexual peculiarities, it's important to try to find out what significance this behavior has for the sex addict partner. Would your partner ever have non-kinky sex with you and be OK with it? Also, are you OK with it, or does it make you feel used? I would want to know how much of the kinky sex is about loving you, versus simply acting out and getting the high. I guess what I am wondering is, is your partner fully present with you or in some fantasy.

mrlmonroe: Yes, we do vary our sexuality a lot - and it is very fulfilling for both of us. That's why the acting out has me so baffled.

David: By the way, are you saying that having kinky sex with an addict is dangerous, like let's say, putting alcohol before an alcoholic?

Dr. Sharp: It can be. It may simply be part of that person's ritualized behaviors and may lead to other things that you don't know about.

paulv54: What about the sex addict for whom sex has such negative connotations, history, and feelings, that he has almost an impossible time envisioning having a sexual relationship with someone he loves and respects?

Dr. Sharp: That suggests trauma and really requires treatment. That is assuming your goal is, to one day have a healthy sexual relationship. Of course, people can concentrate on having healthy, non-sexual relationships. The important thing is to take care of yourself and not force yourself or let someone force you to do something you are not ready for. Obviously, if you are in a marriage or partnered relationship, that partner may or may not be willing to settle for a sexless marriage.

David: Well, it's getting late. I want to thank everyone for coming tonight. I want to thank Dr. Sharp for coming tonight, sharing his knowledge and expertise. And I want to thank everyone in the audience for participating. If you are interested in conferences like this one, please sign up with the community mail list that interests you. Our homepage is www.healthyplace.com.

Any closing comments Dr. Sharp?

Dr. Sharp: Thanks for inviting me. 

David: Thanks again and good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Dr. Linda Savage is a licensed sex therapist and the author of "Reclaiming Goddess Sexuality: The Power of the Feminine Way." We discussed why so many women are apparently disinterested in sex in their long-term relationships, being sexually unhappy, sexual dysfunction, inability to achieve orgasm, sexual side effects of antidepressant medications, abuse survivors and sex, satisfying sex, and more.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

---

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Reclaiming Your Sexuality." Our guest is sex therapist, Linda Savage, Ph.D. Dr. Savage is a licensed sex therapist and author of the book, "Reclaiming Goddess Sexuality: The Power of the Feminine Way."

According to statistics, large numbers of women are reporting that they have little desire for sex in their long-term relationships. Our guest says a surprising number of women are plagued with varieties of sexual dysfunction and unhappiness.

Good evening, Dr. Savage and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Why are so many women apparently disinterested in sex in their long-term relationships?

Dr. Savage: There are a variety of reasons that go from bad relationships to health issues and life problems. The most important thing women say is, they feel something is wrong with their sexuality.

David: And what, exactly, do they mean by that?

Dr. Savage: Most women have been raised to believe that sex equals intercourse and the goal is an orgasm. That's a male model of sex. Since many women enjoy other types of stimulation besides intercourse and may take a long time to achieve orgasm, we have a situation ripe for dissension between partners.

David: One thing I'd like you to clarify. Sometimes we hear that in long-term relationships, the "magic" isn't there anymore or sex isn't that important in the relationship anymore. But when you say "women are unhappy," you're not referring to the relationship just "tiring," are you?

Dr. Savage: No, not necessarily. Many women feel that they love their partners but they do not respond well to the conditions under which sex occurs in their relationships.

David: Are you saying, that still in the year 2000, where men are supposedly more sensitive to their partner's needs, many women still are sexually unhappy? Or is it because women aren't speaking up enough and letting their partners know what they want?

Dr. Savage: Both. Most couples still do not know enough about what is truly satisfying and their sexual options, and they also do not talk about their needs. It's truly amazing that in the year 2000, most people do not talk frankly about sexual needs. They hint at it, and that's the worst think you can do because your partner guesses the worst.

David: But the other thing I noted on your website was that the statistics were also showing that women have "little desire" for sex? To me, that means they don't really want to have sex within, at least, their long-term relationship.

Dr. Savage: The women who report low desire would like to have satisfying sex within their long-term relationships. They are just as frustrated about it.

Men often think their partners will be looking for guys outside the relationship. Their jealousy just compounds the issue. What women want, is to feel the intimate connection before physical sex.

David: We have some audience questions, Dr. Savage, then we'll continue with our conversation:

Aporpoise: Can depression play a part in not wanting sex?

Dr. Savage: Depression is an important factor in low sexual desire. However, often the antidepressant medications given (which are important for recovery) make it more difficult to orgasm.

There are lots of options that will rebuild the intimacy in the relationship and, in fact, address some of the issues that lead to depression. I recommend that women never give up on their sexuality. There are always ways to reawaken the "coiled serpent."

David: We've had many medications chats here at HealthyPlace.com where the doctor states "sexual dysfunction" is a side-effect of certain psychiatric medications. Is it possible to achieve orgasm while taking antidepressants or other medications?

Dr. Savage: First, you can talk to your doctor about giving you a different medication that is less likely to have the sexual side effect.

There are also wonderful ways to experiment with your partner to achieve orgasm: vibrators, new oral sex techniques, finger play. All of it requires spending the time and communicating about it.

Keatherwood: I am an abuse survivor and taking several antidepressants. I've been happily married for 23 years, but have zero interest in any type of sex. I've tried changing medications with no luck. I find myself staying up until early morning to avoid sex. Is it normal to have no sex drive? I also had a total hysterectomy about 12 years ago and I am on estrogen.

Dr. Savage: You have several of the known sex drive depressors in your life. But I am a great believer in the miracle of sexuality, as a way to tap into your life force. Once you find the motivation for yourself to reawaken your sexuality, then the journey begins.

Do not assume that the ways you and your mate have approached sex are the ways you will continue using. It will take lots of communication and many of the techniques in my book are self-directed as well as couple directed. There is hope, however. Please believe me.

David: How does one go about "reawakening" your desire to have sex?

Dr. Savage: First, women need to find within themselves the will to begin. Then you must Practice the Principle of Readiness with your partner (as well as yourself). This means taking the time to tease the energy with erotic massage, non-demand touch and playful time spent together.

David: I need you to define some of these terms. What does "tease the energy with erotic message" mean?

Dr. Savage: Okay, in a nutshell, women need to feel that the touch they are receiving is a little bit behind their pace. That means that the partner must stay with a type of touch until she is ready to move on to a more intense type of touch. Let me give you an example:

If you touch your partner's neck gently and play with her hair lovingly, she will begin to arch her neck and move into the touch, then you may move to her shoulders. But stay with the gentle touch until she wants more.

David: And what is, "non-demand touch?"

Dr. Savage: Non-demand touch is different from erotic message. It came from Masters and Johnson's work in the '70s. It is touching the partner for the pleasure of touch, without the erogenous zones. Erotic message moves into the erotic zones after stimulating the whole body in very pleasing ways. Its intent is to arouse. I have very specific instructions in my book.

David: For women who have lost the desire to have sex, are you saying

• first - reconnect with your partner
• re-establish intimacy
• and then take things slowly in terms of having sex again?

Sort of build up to it.

Dr. Savage: Yes, but even before that, many women must understand the context of a culture in which their desire has not been given the chance to develop. We have only, in the last 30 years, given women permission to explore their sexuality, let alone represented the feminine way of sex. So many women must first get a history lesson. That's why I've written about the ancient Goddess cultures.

David: Here are some more audience questions, Dr. Savage:

waiting: Dr. Savage, in this age of cyber relationships, do you feel that the feelings of love that develop are real, and if so, do you think that because the relationship is based more on conversation at first, i.e. more time to get to know each other, that they have a better chance of becoming a long-term "real relationship" than the standard meeting at a party and sex soon type of relationship?

Dr. Savage: The issue of relationships that begin on the internet is very complex. Yes, I believe getting to know someone's "soul" by many talks is great. But many women have told me when they meet the man, there's no chemistry. So it's tricky.

bubbaloo: Dr. Savage, one of the greatest turn-ons is the challenge of keeping a new partner. How do you keep that interest going in a long term relationship?

Dr. Savage: There is a great difference between the sparks of a new relationship and the passion of a long term relationship. In fact, it's like apples and oranges.

Sometimes, you must let the myth of the early sparks die and mourn the loss of the adventurous chase energy of the new relationship before you can really go deeper to find the passion from a long term partner.

hopedragon: I have no desire for having sex. I don't like it. And when I do have sex, after about 5-10 minutes, I get very bored. If I don't stop, sometimes I freak out. Do you have any idea what may be causing this?

Dr. Savage: If by "sex" you mean intercourse, you may be saying you don't really like this because it does not feel good to you. If you go to a banquet many times but cannot enjoy the food, why would you continue to go?

The feminine paradigm for "erotic encounters" (a different word for sex) is: Pleasure is the goal rather than orgasm, sensual touch is the vehicle, not genital performance and orgasm is multidimensional. So you may find you enjoy a lot of touch and stimulation but not heavy frictional intercourse.

David: Here's an audience member response:

Keatherwood: I understand what hopedragon is saying. I don't enjoy any type of sexual activity and feel like screaming when I'm just being touched. My husband is patient but I mostly just bite my tongue and put up with it when I have to. I don't see how I can get motivated to change when it is so repulsive.

seven: What about lesbian relationships, where one woman is more "aggressive" (like a man) and the other woman has a hard time meeting up to those expectations? Is it the same as a heterosexual situation?

Dr. Savage: Yes, whenever you are accommodating a partner, whether male or female, when you feel uncomfortable (more than a little) you are dousing your sex drive even more. But remember, your sexual desire is not gone, it just became dormant.

There are wonderful ways to get it back. Sometimes you may need to leave a partner who is so insensitive as to push you into unwanted situations. But in the case where there is loving partners, begin with communicating what you'd like to change (I have some scenarios that take you step-by-step in the book). Then you will need to find your own way to sexuality for you. You may need the help of individual and couple therapy, specifically for sex.

David: Are there some people out there, Dr. Savage, who just don't enjoy sex? And is that okay?

Dr. Savage: Of course its okay, if the person is happy with their life. BUT keep in mind, many people who say this, also enjoy self sex, which is another enjoyable sexual outlet. So you see, we must broaden our understanding of the word to include lots of other pleasuring.

David: A couple of site notes here, and then we'll continue with the questions:

Here's the link to the HealthyPlace.com Sex - Sexuality Community Sitemap. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Dr. Savage's website is here: http://www.goddesstherapy.com.

And now, here are some more questions:

MaggieMae: What can help in the case of premature ejaculation in a 32-year-old male with an average sex drive?

Dr. Savage: Rapid ejaculation, as we now call it, is one of the most treatable male dysfunction. The "Stop, Start" techniques can be practiced alone, so that he gets the control. It consists of stimulating self until you feel the urge to ejaculate (point of inevitability) and then calming down until the urge subsides. This can then be practiced with the partner. Anxiety is often a component of Rapid Ejaculation, so sometimes anti-depressant medications can be helpful, so consult your doctor or a urologist about this.

Finally, men can return to pleasurable touching after one orgasm and enjoy pleasuring their partners and get turned on again. Remember, the erotic encounter need not end with the man's first ejaculation. There's lots more fun to be had.

nattygee: I'm a woman, Dr. Savage. So what does it mean when you can't cum? Why can't I achieve orgasm?

Dr. Savage: You certainly can, you are just pre-orgasmic, If you've never had an orgasm with self-stimulation, the best way to learn about what feels good is to pleasure yourself. I have some specific suggestions in my book. You can also experiment with vibrators (the Hitachi magic wand is the best to start with) and find the feelings that are best. Then you can try it with a partner.

R2mny2nm: Being a survivor of extreme sexual abuse, I can't see how it is possible for me to have a healthy sexual relationship. I have never had an intimate moment that didn't end up in a flashback.

Dr. Savage: This is a very difficult situation for you and I have no easy answers. I hope you have considered therapy. If you have done a significant amount of work on the abuse issues, then you may be ready for a sex therapist. You can find a competent one in your area on aasect.org.

David: Dr. Savage's book is "Reclaiming Goddess Sexuality: The Power of the Feminine Way." You can view and purchase the book by clicking on the link.

bubbaloo: How does a woman slowly build intimacy back into a relationship when she is consistently pressured to move at a faster pace? His actions and attitude tend to kill the mood, and then just more complaints arise. Is there any way to avoid this conflict of interest?

Dr. Savage: Your must build your "guardian self" which will stand up for you and stop your partner's insensitivity, even in the face of his anger. If he is behaving like a bully or pouting, tell him so and withstand the urge to give in.

Men have gotten away with bad behavior and demanding sex for a long time. Now it is time for women not to give up on themselves (remember, sex is your life force) but to represent the feminine way of sexuality.

You must discover this for yourself and then make it clear to your partner that you want only the touch that feels pleasurable to you.

David: Thank you, Dr. Savage, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Dr. Savage: Thank you for having me.

David: Thank you again, Dr. Savage. Have a good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Marriage and family therapist and licensed hypnotherapist Randy Chelsey, discusses alternative sexual practices, sex outside of straight heterosexual intercourse, including bondage and being a submissive, fantasies of being raped, the desire to be spanked, foot fetishism, and more. We also talked about people's feelings surrounding sexual fantasies, acting out our sexual fantasies, and living with unfulfilled fantasies and how those things affect our relationships.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

---

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Alternative Sexual Practices." Our guest is therapist, Randy Chelsey. Ms. Chelsey is a marriage and family therapist and licensed hypnotherapist located near Monterey, California. She says that every one of us has sexual fantasies. However, many of us end up repressing them. Ms. Chelsey also has a rather unique method of working with her clients and we're going to be discussing that also.

Good evening, Randy, and welcome to HealthyPlace.com. Thank you for joining us tonight. When you use the phrase "alternative sexual practices," what exactly are you referring to?

Randy Chelsey: I am referring to almost everything other than straight heterosexual intercourse.

David: Why is it that most of us have difficulty acting out our sexual fantasies?

Randy Chelsey: It's a sense of shame, I think. Our fantasies, those middle of the night thoughts, quite often differ from the way we like to think of ourselves acting.

David: I was wondering about the shame aspect of it, but also I think many of us are afraid we can't find a willing partner.

Randy Chelsey: Most of us can't, I think. We don't meet people we want to date with those criteria in mind. We don't find a community of people interested in foot fetishism, or spanking or leather when we are seeking a mate. We find a "vanilla" person we care about and then hope they'll like what we like, or else, we are so ashamed of these urges that we never expect anyone else will share them.

David: So are you suggesting that maybe seeking a "vanilla" person isn't all it's cracked up to be?

Randy Chelsey: I think it's a set up for disappointment not to ensure the person you are interested in being sexual with enjoy what you most enjoy. We make sure they're from our own social class, want children or not, share our religion, but we don't check on the fantasy level.

David: Asking someone to share a fantasy or lifestyle, for instance, involving bondage or some sort of fetish, is pretty difficult. It sort of reminds me of the pressure that guys in high school face when it comes time to ask a girl out and the fear of being rejected. Only in this case, the price you might have to pay for rejection could be rather high -- being branded a deviant. How would you address that?

Randy Chelsey: Absolutely. Unless that is a priority and you explore bondage communities for sexual partners. The internet has really made these communities a lot easier to locate. And being branded as a deviant is exactly what happens when someone asks his/her partner to act out their fantasy.

David: We have a few audience questions, Randy, on what we've been talking about so far, and then I mentioned that you have a unique way of working with clients in therapy and I want to address that. Here's the first question:

Love_and_care: I don't have difficulty with acting out my fantasies, but I am branded a "slut" for doing so. Do you think that people who act on their fantasies are "sluts?"

Randy Chelsey: I don't believe anyone is a "slut." I am sorry that with your opening up to who you really are, you were treated that unkindly. Perhaps the key to avoiding that in the future might be to approach a community who share your interests.

pia: So are you suggesting maybe instead of "vanilla person," which could be boring, seek "a rainbow" person.. :)

Randy Chelsey: Vanilla people are interesting to vanilla people. Few of us are the entire rainbow. Maybe we're red or green or yellow instead.

David: As we continue on here, I want to mention that when we are talking about sexual fantasies and acting them out, we are talking about consensual sex, an agreement between partners, NOT unwanted sexual advances. Just wanted to make that clear.

Randy Chelsey: I want to underline that.

GaryS: Is sex more important to marital or relationship stability than social class, children, or religion? I do not think so.

Randy Chelsey: I agree with you Gary. However, it's easier to find people who are middle class or who share child raising ideas than it is to find someone who appreciates the fact that you like to wear diapers.

David: Here's the link to the HealthyPlace.com Sex - Sexuality Community Sitemap. You can click on the link and sign up for the newsletter, so you can keep up with events like this.

Randy, how can we open up to our own sexual fantasies? How do we get to the point where we can accept it within ourselves as being "okay?"

Randy Chelsey: That's an extremely important question. Most of us judge our fantasies as wrong. It takes creating the time and space to sit with ourselves in our entirety. Our fantasies don't make sense. They don't "mean" anything. They emerge from a deep shadow side of ourselves. If you take the risk to act out any part of the deepest fantasy you have, I think you'll be surprised. Our fantasies are one of the "keys" to unlocking huge parts of ourselves. The part before thought. Our creativity is tied up with these fantasies.

David: I mentioned at the beginning of the conference that you have some unique methods for working with clients in therapy. Can you go into more detail on that?

Randy Chelsey: Yes. I've done a lot of work on myself, explored our cultures and worked with clients for years. During that time, I became aware that traditional therapy just doesn't work. People rush in and out of their therapist's office from a busy day, stay for 50 minutes talking off the top of their head, then they rush back to the lives they just left.

I work with people on a residential basis. They travel to see me and stay at a beautiful Bed and Breakfast across the street from my office. This is in a small ocean village in the Monterey Bay area of California. I work with them on one issue only. We meet for 3 two-hour sessions in 2 days on that one issue. Most of the work is done in trance. Between sessions, clients draw, watch the ocean or sit and think outside of their usual lives. I'm excited to say that I am often astounded by the work people do.

David: One observation, and I've received several emails today on this, is that some therapists, when told by their patients that they enjoy spanking, for instance, tell the patient they are suffering from low self-esteem. In other words, the therapist tells them there's something wrong with having a fantasy or experience like "that." After that, how can anyone walk out and think that what they are doing is alright or healthy?

Randy Chelsey: It's difficult. Therapists are members of society, and society holds a value that unless a sexual activity has to do with procreation there's something immoral, evil, sick, or unhealthy about it. Please don't believe that. Many women (and men) experience fantasies of being raped. That's a hard one to come to terms with. Often, they're powerful people who in their ordinary lives, would never stand for any mistreatment. Yet, in order to orgasm, they play out the rape fantasy. Now, that's not rape. With real rape, there is no control. We don't get to chose our attacker or what he does to us. It's our own fantasy, and it's okay to act it out.

David: We have a lot of audience questions, Randy. Let's get to some of those:

Randy Chelsey: Great.

barb_c: What if you don't have a fantasy, but your partner does. Do you try and fulfill it? He likes two girls to one man. I'm not sure I can do that without getting really jealous of someone touching my man.

Randy Chelsey: It's a part of my value system that says that I will not participate in anything I am not comfortable with. Yes, it's great to stretch and try new things. If you feel excited, or even neutral about what your partner wants, go for it, but if it's not comfortable for you, please respect yourself.

That's why it is often useful to meet people who already enjoy what you do before you become sexual and look at a life together.

steve d: I have been single now for a year. I had some wild times with my ex. Now I am starting to consider dating. Should I tell the person I am dating that I like a variety of sex and have unfulfilled fantasies, or should I just be like a perfect gentleman?

Randy Chelsey: Why do you think one option negates the other? Please be honest from the start. I get a lot of clients who are frustrated that their life partner isn't interested in what they crave day and night. Well, it's not their fault if you didn't ask.

David: I think that's a great point, Randy. If you aren't honest with potential partners, there's a huge chance that things won't work out in the long run.

steve d: Well, in today's society, I do not want to offend another person. Would it be ok to talk this over with a prospective life partner?

Randy Chelsey: Yes, Steve. This is your life. I think it's important to be sexually compatible. But, Steve, if you haven't found your partner in a community of like-minded people, chances are you are not compatible.

brianna_s: I am a submissive and have been involved in the D/s lifestyle. "Vanilla" is not fulfilling for me sexually, and trust is just as important as love in any alternative lifestyle. I feel our fantasies cannot become real without both people finding someone to share love and trust with, although this can be very difficult.

Randy Chelsey: Good for you, Brianna! You've taken this very big step. Everyone needs things sexually. You know that you enjoy being a submissive and you also need a loving relationship. That's true for you. We all have things that we need. I find that there are an infinite variety of desires. Within the D/s community, you have a billion preferences.

David: Here's the next question:

billthecat: What happens if we open up to a long-time partner about our fantasy and it turns them off so much that the relationship can't be saved?

Randy Chelsey: That's a very real risk. The fact that so many people, often after years in a relationship, begin to share their fantasies is an indication of how strong a craving they can be. We lie awake nights wishing for what we want - and need. This is something like the "life force," I think. It's our path, our own myth. And it has nothing to do with reason.

David: Just out of curiosity billthecat, what is your fantasy that you are hesitant about sharing?

billthecat: I pretty much fulfilled my fantasies already. I was just wondering if it would be worth opening up to a partner and risk losing something good.

dash_chance: I was under the impression that the desire to be spanked, in some people, was in a sense how the subject associated spanking with love (from childhood experiences). Is that a falsehood?

Randy Chelsey: Who knows? None of it makes any sense. It also makes it an unhealthy urge. Most people have spent years trying to figure out why they crave what they do. They buy the pornography, and then they throw it away, vowing never to think those sick thoughts again.

mayoz1950: I'm a bisexual, and I've known since high school that I've been attracted to women, too. The only problem is that I don't know how to meet another bisexual woman. I am 50 and I've had a few short relationships with women in my twenties. I don't feel weird; I feel blessed being a bisexual, but I wish I would meet some others.

Randy Chelsey: For every fantasy any of us have, there are thousands, millions, who share it. Use the computer to explore sites. The Internet is a great tool for people to find others who share their fantasies.

mayoz1950: I'm at the time in my life when I finally want what I want, and I think that is female companionship. The man in my life died 6 years ago with cancer and I feel I don't want another man now; I want female friends and companions.

Randy Chelsey: A great place to start - knowing what you want. You can have it if you commit yourself to finding this.

mayoz1950: Yes, the Internet is ok. Almost no one ever lives near where you are though.

Randy Chelsey: People can travel or move. It depends on how high a priority this is for you.

David: You might want to try some lesbian groups or organizations in your community or nearby. Here's the next question:

mschristy: I just found out that my boyfriend is gender confused. I try to accept it but I feel like it's just about him or her. During the day, he is a man but at night he is all women. I try to understand but it seems, sexually, it's all about her.

Randy Chelsey: I would support you in taking care of yourself and your own needs, first of all. Then, you might talk to your boyfriend about your concerns. Sounds like he might have something to tell you about himself.

David: In our fantasies and sexual experiences, is there anything that you would classify as not being "alright and healthy," besides forcible sex with an unwilling partner?

Randy Chelsey: Sex with children, who I consider unwilling partners. Also, sex that has you feeling bad about yourself in any way.

David: Here's an audience comment:

Tink: I am here as a virgin who hopes to stay that way and have a sex life without oral sex.

Randy Chelsey: I support you in your desires. However, I am hearing what you don't want rather than what draws you.

David: Thank you, Randy, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thanks again, Randy, for being our guest tonight.

Randy Chelsey: Thank you, David.

David: Good night everyone and I hope you have a good weekend.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.