‘Empathy’s the antidote to shame. The two most powerful words when we are in a struggle: me too.” Brene Brown
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For readers of a certain age the title above will bring to mind an angst-ridden song made famous by Nazareth in the ‘80s. But what follows is not so much about love as about sex, which is the physical expression of romantic love. Usually when people use the word ‘sex’ they are talking about penetrative sexual intercourse. This is actually a very narrow (and heterosexist) view of what sex is. But more about that later.
So to sex. (And the discussion which follows is largely limited to female sexual pain and heterosexual relationships). In an ideal world, sex is enjoyable, and so memories of past experiences of sex are pleasurable and positive. Thus when a person thinks about sex, pleasurable memories and expectations are brought to mind. This person will anticipate sex as they might a mouth-watering meal; they expect to experience pleasure.
But what if sex hurts? What if the person’s expectation is of pain rather than pleasure? Unfortunately this is the reality for many people. More commonly women, but men can also experience pain during sexual intercourse. The information that follows is more applicable to the issue of female sexual pain, although many of the comments are also relevant to men.
When pain, rather than pleasure, is anticipated, the person’s emotional response is obviously very different. The expectation of pain creates anxiety, and the natural physical response is to tense up. This can become a self-fulfilling prophecy, as being very physically tense will increase the chance that sex will be painful. This is especially true for women, as to allow comfortable penetration of the vagina by their partner’s penis, the muscles at the entrance of the vagina need to be relaxed.
When considering sexual pain, it is useful to separate the cause of the pain, from the factors that are maintaining the pain. The causes of female sexual pain can be due to both physical and psychological factors. Some of the common physical causes are skin conditions that cause pain and inflammation of the vulva (the area around the entrance to the vagina). Conditions such as endometriosis can lead to deeper pain within the vagina during penetration. Hormonal factors, particularly around menopause, can also be a factor. Very tense pelvic floor muscles are also a common cause of pain during sex.
In terms of psychological factors which cause sexual pain, the most obvious is a history of negative sexual experiences such as sexual abuse. Other possible causes are relationship problems, anxiety, stress, and depression. Negative attitudes about sex can also lead to sexual pain problems.
So there are a number of potential physical and psychological causes of sexual pain. However once the pain problem persists and becomes chronic, psychological factors are always part of the maintenance of the problem. Thus a psychologist or sex therapist experienced in working with sexual pain can help with addressing the avoidance, and negative thoughts and expectations that inevitably develop when sex hurts over and over again. Psychological treatment will also involve a broadening of the definition of sex to include sensuality and non-penetrative ‘outercourse’, with a focus on pleasure from various sources apart from penetrative intercourse. This will take the pressure off sex, and allow physical intimacy to be restored.
If you are experiencing pain during sex, you should also consult your doctor and seek a specialist opinion from a gynaecologist, as accurate diagnosis of the issue will allow you access to the most appropriate treatments from the large range available. Other health professionals that may be useful include a physiotherapist who specializes in pelvic pain problems, and a dietician, who will be able to suggest dietary changes that can reduce inflammatory problems.
So, although deeply personal, sexual pain is not untreatable. There is a great deal that can be done to reduce suffering and improve physical intimacy. Seek help if LOVE HURTS for you.
Computer and video gaming is huge. As well as the home PC there are a range of dedicated gaming consoles with serious computing grunt. Game development companies boast budgets rivalling those of the big movie studios, producing games with very high production values and sophisticated back stories. This level of investment reflects the money that gamers are prepared to pay for good products, and the large number of gamers that are out there. Along with all the excitement generated by the emergence of a new entertainment medium is growing concern that for some gaming is getting out of control. Gaming addiction is increasingly recognised as a genuine phenomenon.
How common is it? Well that all depends on what you mean by “it” and what definition is used. Because there is no widely agreed definition and no well recognised measure, we are in the situation of wildly varying estimates, from virtually no one up to around half of all gamers, depending on which study you look at. The manual used by the American Psychiatric Association (sometimes referred to as the “bible” of psychiatry) released its fifth edition in 2013, 19 years after the release of the 4th edition. Whilst the only behavioural addiction formally recognised is Gambling Disorder, the manual has a final section to list conditions that warrant further study, where there is enough evidence to justify the research that would be necessary to include the condition in the 6th edition.
One such new condition is Internet Gaming Disorder, which is characterised by a pre-occupation with internet games, symptoms of irritability, anxiety or sadness when unable to game, need to spend increasing amounts of time gaming, and deceiving others about the extent of this, difficulty controlling use, loss of interest in other activities, continued use despite knowledge of psychosocial problems, using gaming to escape or relieve negative moods, and significant impact on relationships, work or education. A person would need to meet most, but not all of these criteria. Readers won’t be surprised to learn that this problem is most common amongst males, in the 12-20 age range. It is certainly not exclusive to males and heavy internet gaming does occur in older age groups, and this may prove to be increasingly the case as a generation exposed to modern games, and less focussed on the passive experience of TV viewing continues to age.
It is this generational change that may underlie much of the conflict within homes and uncertainty that surrounds the emergence of computer games as a major focus of adolescent and young adult entertainment time. Like it or not gaming is a legitimate hobby for millions of people. Older generations are not familiar with these games. Whilst very heavy TV watching will often be seen as an unhealthy choice, it is seldom thought of as an addiction or compulsion. What is it about computer games that makes them more prone to compulsive use, as captured by the concept of Internet Gaming Disorder? Unlike watching TV or reading a book, gaming is an interactive experience and it appears that the more interactive a game is the more popular it is and the more likely it is to become problematic. Acronyms such as MMO and MOBA refer to games that are online, involve large numbers of people, sometimes interacting with a small group of people and sometimes in an environment or world with hundreds or even thousands of other players. Games may be played as one off battles or ongoing campaigns. Players usually have the ability to achieve higher status levels that provide them with the opportunity to purchase better equipment.
The global nature of these games means a New Zealand player could be interacting with people from anywhere in the world. As a result usual circadian rhythms and conventional sleep patterns can become blurred. As well as finding these games exciting, players are attracted by the ability to compete, challenge themselves, acquire online possessions, achieve status and the experience of group membership. Like all entertainment, computer gaming can be a way to relax and unwind, but also has the potential to become an escape from worries and can lead to avoidance of responsibilities. They can also be seriously expensive, with more committed players spending thousands on equipment, games, upgrades and other optional content.
How much time is too much? A person who is identified as having internet gaming disorder typically spends 8 or more hours a day gaming when possible, with a least 30 hours accumulated per week. By their nature these games make it very easy for players to lose track of time. Amount of time gaming on its own isn’t a good way to identify problematic use however. More important is the impact this is having on a person’s life. Probably the most pronounced impacts of gaming addiction are social isolation, family conflict, neglect of sleep and diet, and neglect of work/study responsibilities. Social isolation is difficult to evaluate in this group however as gaming is often very interactive. A person can spend a lot of time engaging with others, either random strangers or a regular group of people they will team up with. At one level this does constitute social interaction, but if it is occurring at the expense of at least some contact with family and face to face contact with friends then this would be a concern.
As a newly emerging problem, treatment options are poorly evaluated, however the general approaches taken with other addictive behaviours are likely to be relevant. These include enhancing motivation, dealing with underlying mood and anxiety difficulties, agreeing on whether significant reduction or complete abstinence is required, environmental change, social support, and encouragement to engage in alterative activities.
Over recent years scientists and health practitioners have been interested in the health benefits of mindfulness meditation,
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You’ll never plough a field by turning it over in your mind ~ Irish Proverb
Rumination is derived from the Latin for chewing the cud. The term applies to the process of turning something over and over in our minds. Rumination involves reflection and brooding. Reflection can be helpful, as it can lead to solutions or help identify and process what we feel. But when reflection is associated with ongoing and repeated negative thoughts this is unhelpful.The tendency to dwell on negative thoughts can impair thinking, problem solving and drive away social supports.
To ruminate is common. We all have the experience of ruminating on personal losses, and trying to understand what happened to us. For most, the rumination is brief. It’s when the frequency increases and influences our enjoyment of life that this process becomes destructive. The negative thoughts are often related to past upsetting events, unresolved concerns, or perceived inadequacies.
States of anxiety and depression affect our sense of self- confidence, enjoyment of relationships and life. To help negotiate these states it helps to understand factors that contribute, allow emotional healing, and identify and regain a balanced sense of self. This is the basis of ‘talking’ therapies. Many who experience ongoing rumination report that the negative thoughts have a ‘life of their own’ and can be viewed as habitual or compulsive. The talking therapies help treat the complexity of depression and anxiety, but a more direct approach is likely to help change the habit of rumination. A habit is defined as a behaviour performed automatically when there is a repetition between a situation (cue) and the behaviour (negative thoughts). The cues linked to sustaining the habit over time become resistant to change.
There are several evidence based self-management approaches that help break the rumination habit. Firstly commit to a goal. Be clear that reflecting and pondering on an issue may have helped initially but this process is not serving you well now. Visualise success i.e. what life would be like with reduced levels of rumination e.g. being more engaged in the moment, less stressed. Be your own researcher and self-monitor your behaviour, and trial strategies to break the habit. For a week, keep a record of when you ruminate and what triggers this. There will always be a pattern. The triggers may be the time of day (more common early morning and late evening), a location e.g. the bedroom, a prior action e.g. talking about someone, a piece of music. The trigger can also be a change in body sensation or feeling e.g. sensations of heat, tension, abdominal churning or feeling tired or low. Once the cues have been identified aim to alter or remove them. If the cue is being inactive, aim to do something e.g. walk, Sudoku, Zentangle. If sad music triggers the rumination, play something different. And if tension leads to the rumination learn ways to relax. Just the ability to relax and distract has been shown to be effective in changing the pattern. Identify what action is most effective in modifying the trigger and practice this daily. It usually takes four months to change a habit and to sustain the change, so be patient. Any reduction in negative rumination is a plus.
Utilising and developing our capacity to be Mindful is also recommended. Mindfulness involves focusing attention in the present moment and in a non-judgemental way. We all have regular ‘Mindful’ moments. Examples are watching leaves fluttering in the wind, the feeling of a light breeze on our faces, the awareness of the sensations as our bodies begin to relax. Repeated Mindfulness awareness helps us learn to focus in the moment, to observe sensations and thoughts and ‘let them pass.’ With practice this awareness helps to change the rumination habit.
The ploughing metaphor from the Irish proverb suggests that dwelling on an issue doesn’t get the job done. Understanding ways to manage and change the rumination habit allows us to get on with what we choose to do, and boosts our positive emotional energy and well-being.
Having a sneaky peek at a naked person without their being aware of this is reported as far back as biblical times, when King David watched a beautiful woman bathe from the refuge of his roof.
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Most of us are concerned about how we are perceived by others. It is part of being human to want to be accepted by others and to fit in with the group. We are social animals after all. Our perception of ourselves as sexual partners is part of this broader sense of self.
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To live both passionately and reflectively, we need to integrate both our heads and our hearts. Rather than attempting to control, interrupt, change or avoid the experience of emotion we need to learn to live in harmony with it.
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‘ Be yourself, everyone else is taken’
– Oscar Wilde
Love that quote. Just like our fingerprints, each of us has a unique ‘self’. Accept what we have.
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