The Fundamentals of Sex

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Sex education should include consent, sexual pleasure, masturbation, and how to develop emotional intimacy.

The media portray sex in ways that increase our own self-consciousness and inhibition.

Combat shame by changing self-talk from criticism to connection, without making orgasm the primary goal.

“Tell me your sexual history,” I say. My new 48-year-old client looks at the oriental rug between us. This is our third session, and she’s complained of anxiety, trouble sleeping, and feeling distant from her husband. Gently, I say, “Your sexual experiences are an important part of your life.” Now she glances around my office and brushes imaginary lint off her pants. I wait. Finally, she looks at me and shakes her head, her cheeks developing high color. “I’ve never had an orgasm,” she says. “I’ve faked it with my husband for 20 years.” As her eyes fill with tears, I’m sad for her, yet hopeful, because for the first time, she’s confessed this private heartache to someone who cares.

For 30 years, I’ve been doing psychotherapy with individuals and couples. Unless I ask my clients how they feel about their bodies, their sex life, or their level of satisfaction with partners, most of them don’t bring up those subjects. Even my friends struggle to talk about it. In America, where the media is full of sexuality, and sex education in schools is encouraged, the prevalence of secrecy and shame is remarkable.

It starts early. According to a worldwide study about sex education, adolescents often grow up surrounded by cultural silence, taboo, and discomfort regarding conversations about sexuality, relationships, and power.

In American homes, a child is likely to have the “sex talk” with a parent who focuses on the biology of reproduction and the risk of sexually transmitted infections and unwanted pregnancy. What is often omitted are the relationship aspects of sex---power dynamics, sexual pleasure, masturbation, worries about one’s body or genital appearance, and the emotional intimacy required for a truly satisfying sexual relationship.

Adolescents are left to learn from internet scrolling, social media, or friends. We learn to keep experience to ourselves and often develop negative beliefs about our bodies or inaccurate ideas about how we’re supposed to behave in bed. Men tend to focus on the size and shape of their genitals and how long they can maintain an erection. Women harbor an internal critical voice that berates them in the mirror and creates fear of body judgment from their partners.

Images of perfect bodies on social media, TV, and print reinforce feelings of never being able to measure up. We’re afraid we’re not perfect enough, the way we reach orgasm isn’t right, or that we must perform to please our partner. These worries fuel our self-consciousness and sexual inhibition.

Emily Nagoski, in her book Come as You Are, points out that there’s a wide degree of variation in the shape and size of genitalia, and it’s all within the normal range. Still, there are women who have genital plastic surgery to conform to some idea of perfection, and more commonly now, many women wax away their pubic hair, a practice inspired by porn films that require the camera to create revealing close-ups.

Women fear not reaching orgasm with a partner, and men fear not being able to retain an erection long enough to please their partner. These are performance anxieties, fueled again by stereotypes portrayed in TV and film of women reaching orgasm only through intercourse and men who are ready all the time and can go as long as necessary.

We can do better. What will shift the culture for us, and change the relationship with ourselves and our partners? You cannot rewrite your own history, but you can choose to start an honest conversation with your partner and move toward that. Hiding shame and anxiety gets in the way of deeper connection.

The Fundamentals of Sex

Take our Sexual Satisfaction Test

Find a sex therapist near me

If you don’t feel safe to ask for what would please you and haven’t done so sometimes for years, you might be afraid that if you reveal your truth now, your partner will be shocked or hurt or disappointed. What you don’t know is whether your partner has also been afraid to be entirely open and perhaps might be relieved or grateful for this opportunity to be more authentic and close.

Here are my recommendations:

Change your self-talk from criticism over body shape and performance to self-acceptance and connection. For example, say to yourself, “I’m grateful I can reach orgasm however it happens, and how it happens for me is just as good as how it happens for other people." For men, it means saying, "Everyone's body is different. And sex is not about performing; it’s about being connected and pleasing my partner in whatever way works for both of us."

Stop thinking of orgasm as the goal. Instead, think of exploring each other for what feels good, showing curiosity about both of your bodies, and going with what feels good with no end goal in mind.

Educate yourself. Read Nagoski’s book, or Peggy Orenstein’s Girls and Sex, and visit this website, which has documented research, videos of what real people look like, and samples of dialogue that will help you interact in a healthy way with a partner.

The less we allow the media to define our relationship with our bodies and our partners, the better off we’ll be. And my client who’d never had an orgasm? All she needed was a gentle vibrator and a partner who was willing to try something new.

Neelam Punjani and Amber Hussain. “Unspoken Sexuality: The Mental Health Impact of Missed Sex Conversations in Youth” Adolescents 2025, 5(4), 79; https://doi.org/10.3390/adolescents5040079

Nagoski, Emily. Come as You Are: The Surprising New Science That Will Transform Your Sex Life. Simon & Schuster, 2015.

Orenstein, Peggy. Girls & Sex: Navigating the Complicated New Landscape. Harper, 2016.

Website: http://OMGyes.com

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