James W. Hicks, M.D.

Archive for the ‘Ask the Doctor*’ Category

Feedback on the Test

In Ask the Doctor* on September 1, 2011 at 1:34 pm

Many of you have taken the time to give me feedback on the Flex Test, and I would like to share some of the more interesting comments with readers of the blog.

The following comment points out that sexuality has many dimensions that we might not think about, such as whether one “wants” an experience or would just be “willing to try.” I think this also nicely illustrates a sort of undefensive heteroflexible attitude.

Comment: I believe my concern came up with the questions of threesomes, or sex with the same gender… if I am having sex with my girlfriend and a male friend naked as the day he was born comes in wanting to join in…ok, and if he wants to penetrate me or have me penetrate him…ok I suppose I can try that.  However, your question I thinks asked if I would seek that out or have I ever thought about things like that with the same sex…and the answer is no I have not, but if a situation like that arises, I suppose I will cross that bridge, but I do not think of it or seek it out.  Maybe it is just a matter of wording and I am a big fat dummy, I have been wrong before.

Visit the archives to see all Flexuality posts!


In Ask the Doctor*, Sexual Types on April 8, 2011 at 7:49 am

Q: What if someone is asexual, as in completely uninterested in having sex at all with anyone, not out of fear, but simply out of boredom? Is this a sign of depression? What if said person doesn’t feel the least bit mentally stressed or poorly but, in fact, perfectly healthy?

A: I have received several questions like this, and also several comments expressing dissapointment that “asexual” is not a category recognized on the Flexuality Test. The point is well taken, because asexuality has become a self-defining sexual identity for many people, and not just one end of a dimensional measurement of sexual desire or behavior.

As with other types of sexual orientation, any discussion about asexuality is complicated by a multitude of definitions (does it refer to attraction, desire, behavior, or identity?), and even more so by a lack of research, though a couple of interesting exploratory studies have been published in recent years.

Perhaps the most common and useful definition is the one implied by the question above: you are asexual if you lack sexual feelings. You may find other people attractive in an aesthetic way, but not in a way that triggers sexual arousal or desire. Like many asexuals, you may have engaged in sex, if only out of curiosity or to please a partner, but you wonder, “What’s the big deal?” You are probably able to masturbate, but you may experience orgasm as a relaxing, physical release unaccompanied by sexual fantasy and craving. You may be concerned about your lack of sexual interest, since everyone else is so impressed (if not preoccupied) by sex, but you do not feel you have lost some necessary feeling.

Some people find themselves romantically attracted to others (either men or women or both), but the romantic feelings are not accompanied by a desire to have sex. Some people choose not to have sex, even though they experience some sexual desire, and this might be better characterized as celibacy. But those who choose to be celibate may do so, in part, because they experience less sexual desire or arousal to begin with.

For more information about asexuality, and to make contact with an internet community of asexuals, check out the excellent web site of the Asexual Visibility and Education Network.

As a psychiatrist, I should point out that some people lose interest in sex for medical or psychological reasons, such as depression or hypothyroidism. Some people have learned to fear and avoid sex, sometimes because of painful, coercive, or otherwise distressing experiences, but this seems to be distinct from the more neutral disinterest experienced by those who consider themselves asexual. If you are troubled by your lack of interest in sex, if you dread sex, or if you have experienced a change in your level of sexual desire and functioning, then you should probably consult with your doctor or a therapist.

As some readers have pointed out, asexuality is not explored on the Flexuality Test. Some questions assume that the test taker has some sexual desire (aimed at people of the same or opposite sex, or both). My intention was not to deny asexuality as a type of sexual orientation in an overall scheme. Rather, my project has been to explore only those dimensions that contribute to a spectrum of bisexual feelings and behaviors. I similarly excluded from consideration many other areas of interest, such as age preferences, sexual addiction, and fetishes. Of the categories discussed on this blog, the flexamorous sexual type is probably most likely to overlap with asexuality, in that the gender of the partner may be unimportant for some asexuals who have romantic feelings but little desire.


In Ask the Doctor* on February 24, 2011 at 10:45 am

Q: How can I convince my boyfriend to eat me out? He’s so stubborn.

A: There are several reasons why a partner might be reluctant to administer cunnilingus. He might have a gut feeling of disgust for nether parts in general or for the female genitals in particular. He might have unquestioned beliefs that anything other than procreative sex is immoral. Or he might view going down on a woman as an unmasculine act. I imagine you have tried to engage him on this topic and might have some idea about his reasons.

To address the feeling of disgust, you might consider making your move when you are in a shower together or after you have just stepped out of the shower. Many partners might also find shaved genitals to be cleaner and less frightening than naturally hairy ones. Exposure and knowledge also tend to undermine feelings of disgust, so teach him about your clitoris, vulva, and vagina. Take his fingers on a tour, show him how his touch is arousing, and at some point suggest how excited you would be if he put his tongue where his fingers were. Most partners want to be fair, even if they have strict ideas about what men and women are supposed to do, so you might have more luck if you offer him oral sex from a “69” position. He can hardly ignore the proximity of your genitals when you are servicing his in a reciprocal position. If he licks your thighs or nuzzles you with his nose, that’s a start.

The key is to overcome his reluctance gradually, rather than frighten him off. Make it easy for him, and let him try a little bit at a time. Reinforce his efforts and his confidence by expressing arousal during the act, by turning him on at the same time, and by telling him how much you enjoyed it afterwards. If you watch porn together, you can also express your interest by pointing out how the scenes of cunnilingus look like fun and something you would like to try together.

Many men love cunnilingus, but that simple fact probably won’t convince him. He’ll have to find out for himself. Be careful about stressing how much you have enjoyed cunnilingus in the past (if you have), because that might make him feel jealous and make the whole topic more difficult to approach in the future.

[You can e-mail your questions about sex, sexuality, and sexual relationships to me at flexuality@hotmail.com, or post a question anonymously as a comment. The answers I post are for informational purposes only and do not constitute individual treatment.]

Visit the archives to see all Flexuality posts!


In Ask the Doctor* on February 11, 2011 at 6:54 am

Q: Thanks Doc, I was wondering do you have any advice on a how to cement a commitment between two bisexual married men who wish to enter into an exclusive closed loop relationship? Should we have some kind of private commitment ceremony? I suppose we should have blood tests as with getting married? What other things can you think of that might help ensure the exclusivity and success of the relationship? We have been friends for a couple of years and have had enough private time to know we are sexually compatible. Neither of us is out. Also, we both love our wives and want to protect those relationships. Thank you for any advice.

A: The medical part of your question is the easiest to answer: anyone who has unprotected sex should get tested for sexually transmitted infections. A good time to do so is at the start of a committed relationship, but also periodically thereafter if the relationship is not strictly monogamous, in which case it would also be prudent to use protection, for yourselves and your partners. Obviously there is no need to test for blood type compatibility, since two men can’t impregnate each other.

The part of this question I have difficulty addressing involves the ethics and practicality of committing when you are both already married (I am assuming that your wives do not know about this affair, since you are not “out”). I am suspicious of moral pronouncements that don’t consider individual circumstances; but it seems paradoxical to cheat on one partner in order to commit to another. Generally, spouses should have the opportunity to decide whether they want to stay in a relationship in which they have to share. But presumably you have considered this, and the risks and alternatives, and I think it is a very personal matter between you and your wives.

Condoms for Oral Sex

In Ask the Doctor* on January 16, 2011 at 10:07 am

Q: What percentage of people wear a condom for a blowjob? I’ve seen it advised everywhere, but I’ve only met one person who actually does it, and zie [he/she?] does it for sex work. How important is it in terms of STD’s? How dangerous is it for the reciving and giving partner? Can you give me the skinny? THANKS!

A: Medical professionals urge condom use during oral sex, because potentially infectious fluids are exchanged. Even though the risk of transmitting HIV is low, you can catch gonorhea, syphilis, chlamydia, and herpes. If you have a cut in your mouth, or a sore, then you could also conceivably get HIV. In some anonymous sexual settings (such as a bathhouse or video store), your partner could pass on hepatitis, an intestinal bug, or even the common cold, if he hasn’t washed between sexual acts. Who knows where that penis has been?

Some people try to limit the risk by not letting a partner ejaculate in their mouth, but that can be difficult to control, and you may still be exposed to unclean skin and pre-ejaculatory fluids. If someone has ejaculated in your mouth, it may be relatively safe to swallow, since the acidic juices in your stomach should kill HIV and most bacteria, but spitting out is probably the safer course. It might help to gargle with an antiseptic mouthwash immediately after giving a blowjob, though the practice hasn’t been studied.

If you use a condom during oral sex, you may prefer one that is unlubricated, or one that is flavored. Though you asked about a blowjob, most of the risks described above also apply to cunnilingus. You can use a dental dam, which is a sheet of latex that you lay across the woman’s clitoris, vulva, and vaginal opening.

Returning to your original question, I suspect that condoms are not widely used for oral sex. A condom changes the experience of oral sex, though perhaps more for the one giving the blowjob than the recipient. Some people make it a rule to always use a condom themselves or on their partners, but others make an exception for oral sex. Condoms are almost never worn for oral sex in pornographic movies, but that’s probably not a good place to turn for guidance. Sex workers protect their health (and their clients) by using a condom regardless of the act.

The bottom line: The risks are lower than with unprotected vaginal or anal intercourse. You need to consider what level of risk, if any, is acceptable to you.

[You can e-mail your questions about sex, sexuality, and sexual relationships to me at flexuality@hotmail.com, or post a question anonymously as a comment. The answers I post are for informational purposes only and do not constitute individual treatment.]

Ask the Doctor

In Ask the Doctor* on January 10, 2011 at 7:26 pm

Q: If I had a gay experience when I was a little kid, but I’m horrified about it now, am I straight?

A: Your experiences do not define your sexual orientation. Even if you had a pleasurable gay experience as an adult, you could still be straight. Your orientation is defined by what you desire and enjoy, not by what happens to you. This is especially true of children, who may engage in sexual play out of natural curiosity or because an older person involves them in sexual activities that they are too young to understand. Unfortunately, these experiences can lead children, as they grow up, to feel ashamed and to question their sexuality. You may have reason to feel horrified if you were taken advantage of by someone more experienced, but there is no need to feel ashamed of youthful sexual experimentation, which is quite common. If you are currently only interested in the opposite sex, then you are straight. If you have some sexual interest in the same sex as well, that’s nothing to be ashamed about either.

[This is a new series, answering your questions about sex, sexuality, and sexual relationships. You can e-mail your questions to me at flexuality@hotmail.com, or post a question anonymously as a comment. The answers I post are for informational purposes only and do not constitute individual treatment.]