Some Shit About Relationships

(Syllabus Weeks 5 and 6)



Relationships, man. Shit.  Credit: Keith Haring

Here’s some shit about relationships. I named this section of the syllabus “Some Shit About Relationships” well before reading any of the chapters, and I assumed I’d title the blog post something less flippant.  After all, relationships (sexual, romantic and otherwise) are the foundations of human society— heck, they’re the building blocks of humanity itself!— and they deserve serious consideration. Alas, these chapters (Patricia Hill Collins, as always, excluded) are not considerate. They are exactly what I had intuited: some shit.

Specifically, they are devotional texts to the sanctity of blissful, lifelong, sexual, monogamous relationships (BLLSMR, pronounced ball-smear, because why not?) This is the 21st Century and these are liberal texts, so BLLSMR aren’t just for cisgender heterosexuals: LGBT people can and should and, like, probably must have them, too. What a wonderful world, where LGBT people can kill for US imperialism and have their relationship issues medicalized in the same ways as cisgender heteros.

The medicalization— if not pathologization— of everything that isn’t blissful, lifelong, sexual, monogamous relationships is what disturbed me while reading these texts. It’s one thing to hold up BLLSMR as the only functional option; it’s another to assert that those who don’t meet the standards of BLLSMR must choose between dysfunction and treatment of the medical variety; if you need counseling, well, other than religious counseling, medical counseling is your only option. I’m sure I’ve known that for quite some time, but it hasn’t really bothered me until now: you’re supposed to see a medical professional to address infidelity!

The chapter on infidelity in Principles and Practice begins by stating that, “Infidelity is not a sexual dysfunction. In fact, it is not a mental disorder” (399). In fucking fact?! And yet, it is being treated by a medical professional, with a medicalized approach to therapy, and this medical approach feels like fingernails on a chalkboard. There are two researched and recommended medical treatment models for infidelity: “the intersystems approach, [which] asserts that infidelity is a relationship issue: partners suffer together and must heal together,” and “the integrated approach, [which] describes three phases of recovery: 1) dealing with the initial impact 2) developing a shared understanding of the contributing factors and 3) reaching an informed decision as to how to move on— separately or together” (italics mine) (405) . For a profession that values neutrality to the point of upholding white supremacy, it’s pretty striking that there isn’t even an attempt at considering infidelity in a value-neutral way.  The word ‘infidelity’ itself has been selected over ‘nonnegotiated non-monogamy’ because “it is easier to employ” (408). There is zero explanation offered for this choice, so forgive me for speculating: it’s easier to employ a word with negative connotations when you mean to impose the medical value of healing or recovering from suffering. 

I might be willing to grit my teeth and shrug this off if the healing options were useful. But, again, they elevate blissful, lifelong, sexual, monogamous relationships as the gold standard, from which the major deviation is being miserable and/ or alone. There is little discussion of non-sexual romantic relationships (not just a Tumblr thing!; actually quite common among older, long-term partners), casual romantic relationships, multiple relationships, poly communities, serial monogamy, and various kinds of non-romantic relationships. There isn’t even an attempt to clarify what the values of BLLSMR are, let alone to help the individuals in such a relationship identify what their own values are and whether these values conflict with those of BLLSMR. Other questions that remain unanswered: what if an individual has internally dissonant values that are causing distress—  can they be resolved? If the partners have conflicting values, might they be mediated in a way that could result in a compromise, and could that compromise open up other options in the relationship like consensual non-monogamy? Silence. The only discussions are of healing or relationship death. No possibilities open up after death; it is implied that the subsequent events are limited to another BLLSMR or eternal loneliness.



The advice to heal or to kill a relationship purports to be supported by research, which should clue us in that there are some experiences— say, alternative lifestyles or particular intimate arrangements— that academic and clinical knowledge production can’t approximate the wisdom of. Instead, the conventional wisdom is confirmed through bias in the construction, implementation, and interpretation of academic and clinical studies. This false wisdom is passed down from one accredited professional to another and from all to their peon patients. It is certified with the seal of approval from an endless chain of doctors who don’t have one single relevant personal experience among them to know that you can be something other than alone or in a BLLSMR.

Knowing better isn’t limited to relationship options. There are some things you’d think any sexuality professional— and certainly a psychiatric doctor— would know better than to do—  like, say, surprise his clients with a guided visualization of a sexual fantasy of child gang rape. (!?!?!!???!!!) But this is exactly what David Treadway, Ph.D. does to a couple in a sexless marriage in the New Directions chapter, “Hearts’ Desires.” He is attempting to get the couple to talk about taboo fantasies. Instead, he triggers one half of the couple into silence and then sobbing. The poor man eventually reveals he’s a survivor of child sexual abuse and— of course!— this leads to a breakthrough for everyone. Lessons are learned! How any therapist could learn that child sexual abuse survivors exist through triggering one and not express any shame about his dangerous ignorance, I don’t know. Is there anything that shitty old white people with doctorates won’t pretend to know best about?

No, there isn’t. However! This is slightly less infuriating when their knowledge is accurate. Only about half of the official information on sexual relationships is incorrect conventional wisdom; the other half appears to be the sort of accurate wisdom most of us possess but can’t always identify or articulate on our own. To whit: the importance of communication and the various kinds of love. These were the major take-aways of Janell Carroll’s two chapters this week, and if we ignore her intimations that love and communication occur mostly in BLLSMRs, we can actually learn to articulate a few things we may already know. I break down these lessons about communication, love, and intimacy in the notes, where I also detail Patricia Hill Collins’ sociological discussion of  Black love relationships, the DSM‘s bizarre categorizations of issues affecting relationships, Principles and Practice’s surprisingly insightful chapter on body image and sexual relationships, and New Directions strange model of ‘good enough’ sex in long-term relationships.

First I want to end this summary on this point, about wisdom we learn from living versus wisdom that is received. Ultimately, helping people identify and articulate what they’ve learned from relationships and sex is one  major purpose of radical sex education.  Its underlying principle is that people are the experts of their own lives, and from this same principle we draw a second purpose: sharing the wisdom from our unique experiences with other people who haven’t experienced the same things. This is especially important where the commonly received wisdom about the experience diverges sharply from the lived reality, and doubly so where the reality is oppressed and criminalized: for sex workers, for queer people, for transgender people, even for Black people in ‘opposite’-gender BLLSM relationships, who, in Collins’s words, are resisting white supremacist notions of gender and sexuality by “loving the unlovable and affirming their humanity” (250). These are the things we so often cannot learn from professionals.



There is a third and final purpose of radical sex education: taking what we can learn from professionals and de-professionalizing it. We should widely disseminate medical facts about things like genital function and appearance, puberty, menopause, safer sex, pregnancy, abortion, birth and STIs. These are common sexual or sex-related physical experiences we may not understand without better access to information that has been unfairly tucked away in medical textbooks and hidden in ivory towers. Medical professionals obviously have incredible value— I have not gone full ‘anarcho-primitive’ here— but when they extend their professional realm past their expertise and hoard the knowledge they do have, their dominance should be resisted.



I’ve been brainstorming better ways to present the notes. I want to make them accessible for three different purposes: for my own future reference, for the reference of casual readers interested in gauging the temperature of undergrad and grad-level sex ed. and therapy programs (i.e. figuring out how much of the information imparted therein is worthwhile and how much is bullshit), and for the reference of other people interested in getting deeply involved in sex ed. who wouldn’t otherwise have the time or money to access this raw information. (In my daydreams I envision a number of self-taught educators learning from this information before organizing into DIY sex ed collectives and forming a loose international network… uh, but I digress.)

Keeping all that in mind, I’ve re-organized the notes by tackling one text at a time and color-coding the information to denote how true and useful it is. A quote in black denotes that it ‘seems fine and good, perhaps even great’; orange quotes are ‘profoundly questionable’ and red quotes mean ‘pants on fire/ extreme bullshit alert’. [If you are Blind or vision-impaired and would like a more accessible version of this blog post, please hit up the contact page and I will make one available]. So, if you want to scroll to the blatant lies, you can easily do that, and if you want all the notes on certain chapters, you can easily do that, too. Finally, Ive put the really key bits in bold, if you just want to browse those.

Sexuality Now: Chapter 3: Communication and Sexuality; Chapter 7: Love and Intimacy

  • Much of Chapter 3, “Communication and Sexuality” and Chapter 7, “Love and Intimacy” is information-free pablum designed to take up enough space to satisfy a publishing contract. How do you even critique something as vague as, “Communication has changed drastically over the last few years” (60) or as wide-sweeping as,  “One of the characteristics of love is that we often believe that the intensity of the emotion is unique to us…”(159)? I’m skipping most of the questionable parts this time around for everyone’s benefit, including Janell Carroll’s, because she can’t honestly want to stand behind this crap.
  • One of those things we all probably know but wouldn’t necessarily be able to articulate: when communication in a relationship is poor, communication problems often compound. “Misunderstandings, anger, and frustration can all lead to a downward spiral in which communication becomes less and less effective” (60).
  • A few other things we might need help articulating are the three major goals of communication: 1) To convey information, 2) to maintain or improve a relationship, and 3) “to project a certain image of ourselves” (62). Often times these goals conflict. Linguist Deborah Tannen— who has the garbage belief that ‘gender’ means ‘biological sex’ and so should be taken with a garnishing from Salt Bae— researched the communication styles of men and women and found that men are more focused on goal #1 (“report talk”) whereas women are more focused on goal #2 (“rapport talk”) (63).
  • Communication skills can be broken down into two categories: affective communication and instrumental communication. “Affectively oriented communication skills are comforting and involve a significant amount of listening, whereas instrumentally oriented communication skills are more persuasive and narrative” (63).
  • Men and women (or, male and female college students, if we’re being honest about the design and implications of this study) both use around 16,000 words every day (63).
  •  “Research has found that women’s informal talk includes gossip, complaining, ‘troubles talk,’ and ‘bitching’ (Softinin, 2000). Although at first glance these types of talk might seem similar, each appears to have its own structure and function. The focus of gossip is on an absent target and includes contributions from several participants … Complaining is usually brief and to the point. ‘Bitching,’ in contrast, relates an in-depth account of events, usually about an injustice or something


    negative that has happened to the speaker… In ‘troubles talk,’ there is one ‘troubles teller,’ and the focus of the conversation stays on the teller the entire length of the conversation” (65). That’s a fascinating typology of complaint, and I’m even willing to assume there’s a
    decent reason for officially labeling something women do as ‘bitching’ (like, perhaps that’s what the study participants called it, as indicated by the quotations). But how the fuck can you act like all women do is complain? Hell, I manage to do things other than complain, and I fucking love complaining.

  • Like heterosexual couples, conversational styles in gay and lesbian relationships have been found to reflect power differences in the relationship more than the biological sex of the communicator” (65). Presumably, ‘heterosexual couples’ means ‘male-female couples’ and ‘gay and lesbian relationships’ means ‘relationships between people of the same gender,’ although it’s certainly possible that bisexuals were excluded from this study.
  • The majority of communication is nonverbal. (This is implied for in-person communication as it references body language and positioning in physical space.) (66).
  • Whether or not online relationships can be a form of infidelity depends on how one defines intimacy (and, I’d add, what boundaries or expectations for exclusivity of intimacy have been set) (67).
  • Because of the perception (accurate or not) that computer-mediated communication is lower-risk, relationships can become more intimate more quickly online (68).
  • “It’s true that before anyone else can accept us, we need to accept ourselves” (71). This is not true at all. It’s just an effective way to convince people with mental illness, abuse histories and various other forms of ‘baggage’ that they’re worth less or even worthless in what Patricia Hill Collins identifies as “marketplace models  of relationships” (254) . In reality, people learn to accept themselves and cope with their issues through building relationships and definitely should not self-isolate.
  • Important components of sexual communication includea positive self-image, self-disclosure, trust, and listening” (70). Kindly ignore the first one (this is where Carroll pulls out the ‘no one will love you if you don’t love yourself’ crap); after all, men manage to do it all the time. Self-disclosure means communicating what you want and do not want; trusting your partner means “that you have confidence in them and feel secure in the relationship”, and listening should be active listening, meaning “using nonverbal communication to let your partner know that you are attentive and present” (71- 72).
  • Look at these competing accounts of a sexual encounter from a man and a woman (from p. 71)( Possible trigger warning for sexual assault). fullsizerenderCarroll used these passages to illustrate what the woman was doing wrong, placing them under the subheading “Self-Disclosure and Asking for What You Need.” Carroll goes on to comment, “Communication is key here, because whereas the man thinks he is doing exactly what his partner wants, the woman is wondering why he’s doing what he’s doing! … If this couple could have self-disclosed more, they might have been able to work through these issues.” What a perfect example of blaming the woman when communication goes wrong. She seemed to use plenty of nonverbal cues, and her male partner refused to pay attention to them because doing so would disrupt his sexual enjoyment. In that assessment, Carroll’s comment comes very close to victim-blaming; it’s not possible to tell from these excerpts alone, but there are hints that this encounter may have been rape. Even if it isn’t, Carroll’s analysis uses the same logic as victim-blaming, asserting that it is the responsibility of the passive and receptive partner to constantly verbalize what is and is not okay even though their nonverbal communication is being trampled over and speaking up could prove even more dangerous. The fact of the matter is that it’s the active partner’s responsibility to slow down, pay attention to nonverbal communication, and if still confused, ask for clarification.
  • Later, Carroll lists “embarrassment and concerns about sexual terminology” as the major obstacles to sexual communication (72), but she leaves out fear and intimidation, which are just as influential, especially for assault survivors.
  • How to receive (hopefully constructive) criticism: avoid blanket denial, avoid making excuses instead of taking responsibility, and avoid deflecting onto the other person’s behavior (74).
  • How to avoid non-constructive communication: don’t engage in overgeneralization (“making statements that tend to exaggerate a particular issue”), don’t go for overkill (“a common mistake that couples make during arguments, in which one person threatens the worst but doesn’t mean what he or she says”), don’t try to address too many issues at once, don’t dig up the past, and (fucking obviously) don’t name-call or yell (75).
  • Health is not a virtue. Wellness might be, but health is not, and yet Carroll opens Chapter 7 by saying that “Love and the ability to form loving, caring, and intimate relationships with others are important for both our physical and emotional health… Many studies… have found that social support and love are related to stronger immune systems and lower levels of illness” which means what exactly for the chronically ill (158)?
  • What is love? (Baby don’t hurt me.) Here are the o-freaking-fficial definitions of various kinds of love, plus passion, intimacy, and commitment:
  1. Romantic love (aka passionate love)– “Idealized love, based on romance and perfection” (159).
  2. Companionate love (aka conjugal love)– “An intimate form of love that involves friendly affection and deep attachment based on a familiarity with the loved one”(159).
  3. Passion– “sparked by physical attraction and sexual desire; drives a person to pursue a romantic relationship” (161).
  4. Intimacy– “feelings of closeness, connectedness, and bondedness in a loving relationship” (162). “Intimacy requires reciprocity” (167). Further, while passion and romance can be effortless, intimacy “always requires effort” (ibid).
  5. Commitment-” the determination to maintain love; commitment builds slowly and is often related to relationship length” (162).
  • Two models of love are John Alan Lee’s “Colors of Love” and Robert Sternberg’s “Triangular Theory.”
  • Lee gathered panels to analyze “statements about love from hundreds of works of fiction and nonfiction, starting with the bible” and determined they can be classified into six different styles: 1) Eros, the romantic lover; 2) ludus, the lover who enjoys the ‘game’ of seduction; 3) storge, the lover who prefers calm love that builds over time; 4)mania, the possessive lover consumed by thoughts of the beloved; 5) pragma, the lover that has a certain list of qualities they want their partner to meet and attempts to “make the best ‘deal’ in the romantic marketplace”; and 6) agape, the altruistic lover who doesn’t demand reciprocity (160).
  • Sternberg believed that the three qualities of passion (P), intimacy (I), and commitment (C) could combine (or fail to combine) in 7 distinct, implicitly hierarchical ways:  


  • Four indications that a relationship may be better described as infatuation, rather than love: 1) when it involves compulsion (rather than desire); 2) when there is a lack of trust; 3) when there are emotional extremes; 4) when there is “a willingness to take abuse or behave in destructive ways” (162).
  • Regarding love and human development: We form attachment styles as babies with our caregivers, and in adolescence we form role repertoires behavioral patterns we call on in our interactions with others. It’s in our adolescent relationships we also “experiment with different intimacy styles… and develop an intimacy repertoire, a set of behaviors that we use to forge close relationships throughout our lives” (166).
  • More on intimacy and gender differences: “Men and women report equally desiring and valuing intimacy, but many men grow up with behavioral inhibitions to expressing intimacy” (168).
  • Three things that can help you through a break-up: high self-esteem, a secure attachment style, and time (172). At least you can work on your self-esteem?
  • A quick break from useful info to address a particularly bad bit of pablum: “[T]he blues is a whole genre of music built on the experience of losing love” may just be the whitest thing a white person has ever said, Janell (172).
  • Back to useful info. To make sure you’re initiating a positive sexual relationship, clarify your values to yourself and then to your potential partner (173).
  • How to develop intimacy with a partner: develop a thorough self-knowledge (self-intimacy), demonstrate you’re receptive to learning about your partner and connecting with them on a regular basis, demonstrate affection, establish trust, and show respect for their needs (174).
  • How to cope with jealousy:


    recognize that we are most jealous when we consider losing our partner to people who have traits that we want, then work on building your own self-regard and also building trust with your partner.

  • Abusive love relationships exist when one partner tries to increase his or her own sense of self-worth or to control the other’s behavior by withdrawing or manipulating love” (176).

Black Sexual Politics: Chapter 8: No Storybook Romance

  • Laws against interracial relationships served several purposes beyond the eugenicist fear of ‘diluting’ racial purity. In the era of slavery they were obviously necessary to legally determine who could be a slave. Following emancipation they maintained social inequality by a) ensuring white wealth remained in the hands of white people and b) “mystifying segregation and keeping people alienated from one another,” which helps reify white supremacist beliefs about Black inferiority (249).
  • Although these laws were struck down several decades ago, it’s difficult to say that people are “really free” to pursue interracial relationships, since “contemporary intimate love relationships are influenced by a convergence of factors… political, economic, and social conditions of the new racism” (249).
  • These factors aren’t limited to persistent social taboos; they include material realities of institutionalized racism. Consider, for example, how a quarter of African American men are controlled by the criminal justice system at any one time, or, as Collins puts it, “How can heterosexual African American men marry and raise families when 25 percent are arrested, incarcerated, or on parole?” (249)
  • “Oppression works not simply by forcing people to submit… but also by rendering its victims unlovable” (250). In this context, “loving Black people (as distinguished from dating and/ or having sex with Black people)… constitutes a highly rebellious act” even between and among Black people themselves (250). This rebellion can still “uphold prevailing hierarchies of race, class, grender, and sexuality… But rebelling not simply against the rules but against what the rules are designed to do creates space for a very different set of individual relationships, and a more progressive Black sexual politics” (251).
  • The notes for this chapter contain a lot of statistics and detailed information about Black marriage rates. One that’s worth highlighting shows the decline in Black marriage rates across the early period of neoliberalism in America: “In 1970, 57 percent of Black men and 54 percent of Black women were married. By 1980, 49 percent of Black men and 44 percent of Black women were married” (340).Collins gives a number of psycho-sociological reasons for the decline in Black marriage rates over the 20th Century, ranging from the more urgent need for Black women and men to support each other during the era of Jim Crow to the effects of growing rates of incarceration and unemployment on Black men’s sense of masculinity. She also mentions the higher divorce rate for well-educated Black women, but she leaves unspoken the very obvious economic reasons: when women don’t gain financially from marriage, they’re less likely to get and stay married.
  • Another useful bit of info on Black marriage rates: “Because African Americans and White Americans constitute numerically large population groups, Black-White intermarriages represent the greatest number of relationships. Statistically, however, African Americans remained the least likely group to marry interracially with Whites” (italics in the original) (340).
  • On the double-standard for Black male-white female relationships and white male-Black female relationships: “For African American women, acquiring legal rights meant freedom from White male persecution… [whereas] African American men were [previously] forbidden to engage in sexual relations with all white women, let alone marry them.  In this context, any expansion of the pool of female sexual partners enhances African American men’s standing… [whereas] African American women… face the stigma of being accused of being race traitors and whores” (262).
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    Credit: J. Robinson, via

    Black women are the most devalued in the racial ‘marketplace model’ of relationships, “overlooked in a political economy that erases its own workings and appears to be much more concerned to protect the rights of individuals to ‘love who they want'” (263).

  • [T]he politics of ‘coming out’ have a different consequence for Black Americans than for Whites… in the context of a racialized history that constructs homosexuality as white” (269).
  • This goes a way toward explaining Black men who are Down Low, but Collins elaborates that “for many men on the Down Low,  the label is both ‘ an announcement of masculinity and a separation from white gay culture. To them, it is the safest identity available…'” (274, quoting Benoit Denizet-Lewis).
  • Finally, on why there is homophobia within Black communities: “[It] is one consequence of [white supremacist] ‘sexual humiliation’ that has left Black men and women vulnerable to adopting dysfunctional perceptions of masculinity and femininity… In this situation, the politics of respectability that suppress discussions of Black sexuality in general operate to police Black LGBT sexualities that are seen as being a threat to the integrity of the entire African American community” (273). But of course, as Collins discusses earlier in the book, respectability politics cannot successfully challenge white supremacy.

DSM-5:  Relational Problems; Educational and Occupational Problems, Housing and Economic Problems, Other Problems Related to Social Environment

  • The actual code for sex therapy is “V65.49 sex counseling,” which for some reason is much funnier-sounding than ‘sex therapy’ (716).
  • “Other Conditions That May Be a Focus of Clinical Attention” include Relational Problems as well as Educational and Occupational Problems,Housing and Economic Problems, and Other Problems Related to the Social Environment, which I’ve grouped together here because it seems clear they can all affect relationships (Abuse and Neglect is its own category and will be addressed in future weeks). None of these are disorders that can be diagnosed, nor will they appear as ‘axes’ of diagnosis; rather, these are contextual factors that should influence treatment and can be listed with V-codes on the insurance form. It’s hard to imagine any shrink bothering to code these for insurance, especially since so many of the housing and economic problems indicate the client is probably on Medicaid, and clinicians who take Medicaid (usually LCSWs) aren’t going to have the time to list all of these codes.  My main interest in these codes isn’t in how they’re (not) used clinically, but in what they reveal about psychiatric conceptualization of interpersonal and social problems. The major take-away? The classifications indicate a skewed professional view of the impact of non-physical forms of abuse like emotional abuse and sexual harassment. Sexual harassment and emotionally abusive behaviors are classified under Occupational Problems and Relational Problems respectively, rather than Abuse and Neglect.  Regarding emotionally abusive behaviors, the DSM includes “arguments that escalate to threats of physical violence” under Parent-Child Relational Problem. It also lists “hostility, emotional overinvolvement, and criticism directed toward a family member who is an identified patient“under High Expressed Emotion Level Within Family (an amazing euphemism in and of itself!) (715- 16).  Further, verbal abuse by peers is considered Social Exclusion or Rejection, not abuse, even though it is expressly identified as “verbal abuse” (724).
  • Similarly troubling? The DSM-5 definition of homelessness does not include couch surfing or long-term motel stays even though most governments, NGOs and service organizations do (723).



  • Housing and Economic Problems include Problem Related to Living in a Residential Institution, (724) which is separate from Imprisonment or Other Incarceration (725) presumably because the American Psychiatric Institute does not have a critical lens when it comes to the vast and various forms of medical incarceration.
  • There is a category under Other Problems Related to the Social Environment called— I shit you not— Discord With Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker (725). Imagine the conversation that went into designating this bullshit as a specific problem, and then imagine the asshole who was like, “Seems great, but aren’t parole officers really social service providers, too?” Then imagine the asshole in chief who said yes.
  • I ironically appreciate the general disapproval for all things non-normative conveyed by Problem Related to Lifestyle, for everyone who fucks too much (“high-risk sexual behavior”), sleeps too little (“poor sleep hygiene”), and eats ALL GODDAMN WRONG (“inappropriate diet”) (726).

Principles and Practice: Ch. 16: Body Image and Sexuality; Ch. 18: Infidelity

I’m only going to speak here about “Body Image,” the chapter I didn’t angrily address in the summary.

  • Why is body image important for sex therapists to know about? Because body image-based distractions during sex may be as common as performance anxiety (359) and these issues are related to a number of sexual problems.
  • Sexual problems related to body image issues include greater aversion, less desire, decreased arousal, increased anxiety, and less frequent orgasm (361).
  • “Wiederman and Sarin suggest that evaluating body image concerns while taking a sexual history should be standard as available research clearly shows that body image is only weakly correlated with attractiveness as judged by others” (359). This statement isn’t wrong in and of itself but what it implies is super fucked-up: that clinicians only screen for body image issues in patients they think are ugly!!
  • Body image includes “[an] individual’s perceptions, thoughts and feelings” about their body as a whole, in parts, in appearance, and in function. When assessing a person’s body image, it’s crucial to determine what these perceptions/ thoughts feelings “mean  to the person, or how invested the individual is in his or her body image” (italics in the original) (360).
  • Research on body image is mostly limited to female college students, and this almost certainly means it focuses on white and cisgender young women (360).
  • “Body image as experienced during sexual activity and measures assessing perceptions of those body parts most relevant to sexual activity or sexual appeal” are the relevant aspects of body image to sexual functioningnot overall satisfaction with physical appearance (361). 
  • Prevalence (among college women): “approximately one-third of women have reported experiencing such concerns at least some of the time” (361).
  • There is a lack of data on genital and breast body image perception but the most common concerns related to genital appearance are as follows: for (cis) males, size and appearance of nonerect penises, and for (cis) females, vaginal odor and type and amount of pubic hair. “Males indicated more positive genital body image overall compared with females” (362).
  • Other interesting facts about male vs. female sexual body image: men who are dissatisfied with the size of their penises are more likely to want bigger penises than women who are dissatisfied with their breasts are likely to want bigger breasts (363), probably because size is not the only metric of breasts women are concerned with. Also, “men’s desire for a larger penis did not translate into shame or partner dissatisfaction,” keeping with the trend that men are less sexually impacted by sexual body image (362). This is thought to be the case because male sexual appeal is culturally believed to revolve more around “confidence, achievement, status, and experience” (364).
  • Women’s reasons for desiring labiaplasty are about evenly split between the functional and the cosmetic: “32% [underwent labiaplasty] strictly to correct functional impairment, 31% because of both functional impairment and aesthetic concerns, and the remaining 37% indicated strictly appearance-related concerns” (364).
  • Special shout-out to Michael W. Wiederman and Sabrina Sarin, the authors of this chapter, for mentioning sex work in a respectful way— and for acknowledging that sex workers might be patients! “An individual’s body image also may be influenced by current life circumstances aside from his or her sexual partners.  For example, particular occupations such as modeling, dancing (erotic or otherwise), athletics, and sex work may facilitate either body confidence or anxious self-consciousness, depending on numerous factors” (365). 
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    by Rachele Cateyes. Order prints and merchandise at

    Treatment possibilities for patients/ clients who experience sexual body image issues include

  1. Educating clients! Educate them about sexual response cycles (369) and about what bodies usually look like, by giving them a ‘homework’ assignment to look up amateur erotica or medical images (370). 
  2. “Addressing thoughts experienced by the client during sexual activity” (367) by helping them make these thoughts explicit OR by “seeking explicit feedback from the client’s sexual partner” (368), which can be risky if the partner reinforces the negative thoughts. Remind the client that undoing negative thoughts is a process and will not happen instantly (368).
  3. Assign ‘homework’ in which the client describes their body in neutral or positive terms and/ or draws their body. If possible (and applicable) have them share this drawing with their partner (369).
  4. Assign ‘homework’ in which the partner verbalizes positive thoughts and feelings to the client while engaging in sensual touch, like massage (368). This sensual massage can help with “systematic desensitization” if it focuses on the areas of the patient’s body they have issues with (368).
  5. Pair sensual massage (or the general viewing/ touching  by the partner of the parts of the patient’s body with which they have issues) with relaxation techniques (369).
  6. Try other forms of body work like exercise that can increase body competence (370).
  7. Present ‘alternative models of sexuality,’ like “one based on valuing intimacy and pleasure rather than goal-directed sex” (369).
  • I love that the authors of this chapter advocate education and value re-assessment (as of intimacy-based sexuality in place of goal-directed sexuality), and I generally like the treatment options presented. However, it’s worth noting that the case studies included in the chapter showed that the goals of these treatment options are quite different depending on whether the ‘client’ in question is single or partnered. The married woman was directed toward and expected to engage in sex with her husband even when she expressed anxiety about sex; the single woman was directed toward and expected to engage in celibacy when she expressed anxiety about sex. This indicates a profound lack of regard for women’s real desires. The continued, unquestioned valuation blissful, lifelong, sexual, monogamous relationships, to the extent that if BLLSMR doesn’t exist then nothing else should, is obviously misogynist.  In short, this chapter is pretty useful but I still want to set fire to it.

New Directions: Ch. 13: The Good Enough Sex (GES) Model;  Ch. 15: Hearts’ Desires

I’m only going to speak here about “The Good Enough Sex Model,” the chapter I didn’t angrily address in the summary.

  • Sexual problems are “multi-causal (biopsychosocial), multidimensional (psychological and interreactional), and [have] multiple effects on the person, the partner, and their relationship”  (213).
  • The authors propose that effective treatment for sexual problems can’t just address the specific dysfunction but should present a whole different model of sex in relationships. Their model is the ‘Good Enough Sex’ Model, which is so unfortunately named that they feel the need to clarify that it “does not promote accepting ‘mediocre,’ ‘boring,’ ‘unenthusiastic,’ or ‘lackluster’ sex” (italics in the original) (214). Rather, it promotes “realistically vibrant and relationship-sustaining sex that serves a number of values and purposes— pleasure, affirmation, tension release, couple cohesion, self-esteem, lust, emotional intimacy, excitement, comfort and/or reproduction” (214).
  • “The ultimate purpose of the multiple medical and psychological treatments now available to address sexual dysfunction should be the well-being of the couple” (214). BLLSMR or death!
  • The indispensable variable for sexual satisfaction (emotional dimension) is the ‘meaning’ (cognitive dimension) of the sexual interaction (behavioral dimension)” (215). You’re going to have to read that about five times, but it’s worth it because it’s actually pretty legit.
  • Eroticism is a very different component of sexuality from intimacy” (217).
  • There are three ways to achieve arousal: “partner-interaction arousal, self-entrancement arousal [fantasizing], and/or role enactment arousal” (217).
  • Here it is, the Good Enough Sex Model and it’s 12 features, which vary tremendously in utility from excellent to majorly questionable to fuckin’ lies. These are all direct quotes:
  1. Sex is a good element in life, an invaluable part of an individual’s and couple’s long-term comfort, confidence, intimacy pleasure, and eroticism. Eroticism is an intentional feature and the responsibility of each partner (216).
  2. Relationship and sexual satisfaction are the ultimate developmental focus and are essentially intertwined. The couple is an “intimate team” and together promote a vibrant balance of emotional intimacy and eroticism (217).
  3. Accurate, realistic, age-appropriate physiological, psychological, relationship, and sexual expectations are essential for sexual satisfaction (218).
  4. Good physical health and healthy behavioral habits are vital for sexual health.  Each individual values, respects, and affirms his/ her and the partner’s sexual body (218).


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  5. Relaxation is the foundation for pleasure and function.
  6. Pleasure is as important as function (218). [I’d say it’s more important but your mileage may vary.]
  7. Valuing variable, flexible sexual experiences and abandoning the ‘need’ for perfect performance inoculates the couple against sexual dysfunction by reducing performance pressure, fears of failure, and rejection (219). [Maybe they mean it inoculates about as well as the flu vaccine (efficacy depends entirely on what strain you catch) rather than the small pox vaccine].
  8. Five basic purposes for sex (pleasure, intimacy, stress reduction, self-esteem, reproduction) are integrated into the couple’s sexual relationship. Sex for only one purpose for extended periods of time (e.g. fertility) undermines flexibility and creates a risk of sex dysfunction and distress (219). Partners may pursue different goals at different times. [Important side-note about dysfunctional relationships“In dysfunctional relationships, the purpose [of having sex] may be negative, such as manipulation, control, proving something to self or partner, hurt or revenge, or a chronic demand for one purpose” (219).]
  9. Integrate and flexibly use the three basic sexual arousal styles (sensual self-entrancement, partner interaction, and role enactment) (220). [Counterpoint: do whatever the fuck you want.]
  10. Partner gender differences and preferences are respectfully valued and similarities mutually accepted. Partners cooperate as an intimate team for relationship and sexual pleasure and satisfaction (220). [Idek what this means but sure, okay.]
  11. Sex is integrated into real life, and real life is integrated into sex. Partners ensure a ‘regular’ frequency of sex. Sexuality is developing, growing, and evolving throughout one’s life to create a unique sexual style. Regularity ensures an emotional ‘intimacy blender’ (221). [Counterpoint: this does not work for me as a survivor of sexual abuse; I need to act on desire, not obligation. Also, lol, ‘intimacy blender.’]
  12. Sexuality is personalized: Sex can be playful, spiritual, special.




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