Sexual Issues

PCOS and Sex

Rhiannon No Comments

PCOS and Sex: Considering Sexuality and Sexual Functioning With a Diagnosis of Polycystic Ovary Syndrome

One of the MOST common endocrine and hormonal issues facing women of reproductive age (it is estimated to affect 4-12% of women) is polycystic ovary syndrome (PCOS).  PCOS is a challenging, symptom-based diagnosis that can greatly impact a woman’s sexuality and sexual functioning.  PCOS is also the most common cause of infertility in the United States.  What we don’t often talk about after a diagnosis of PCOS is how it affects a woman and their partner’s sexuality and sexual functioning.  This blog will go over a brief review of PCOS and how it affects the sexual aspects of a woman and their partner.


women photo

Prevalence and Symptoms

Despite how prevalent the disorder is (1 in 10 women) many women suffer in silence on how PCOS affects them and how it affects the way they feel about themselves sexually and how it can affect their partner sexually.

I have been living with PCOS for approximately 5 years now, but in retrospect perhaps have had some of the symptoms long before my diagnosis.  PCOS is generally a symptoms-based diagnosis, meaning I was diagnosed based on several symptoms I was exhibiting as well as some imbalances in blood and hormonal levels.

The most common symptoms in women with PCOS include:

  • Irregular menstruation: few or no periods, intermittent bleeding, heavy periods, etc.
  • Hair loss from scalp or hair growth (hirsutism) on the face, chest, back, stomach, thumbs or toes
  • Acne and oily skin
  • Fertility Issues
  • Insulin resistance and too much insulin, causing upper body obesity and skin tags.
  • Depression and mood swings
  • Breathing problems while sleeping (linked to obesity and insulin resistance)

The general reason behind PCOS has to do with the body producing more androgens, causing a hormonal imbalance, and the body has trouble using insulin, called “insulin resistance”.  Overall, the cause of PCOS is not readily understood.

You can watch more about my journey with PCOS and why I decided to freeze my eggs last year as well as my experience as a sex therapist diagnosed with Polycystic Ovary Syndrome below.


PCOS and Sex

Not only is PCOS not well known as a major issue for women of reproductive age and the #1 cause of infertility, even more closeted is how PCOS affects sex and sexuality of the woman and their partner(s).  PCOS can have tremendous affects on a woman and their partner and this blog aims at creating more awareness about how PCOS affects the sexuality and sexual functioning of all people involved.

Body Image

The biggest effect I see in clients (and in myself) living with PCOS is how the symptoms of PCOS can change how we feel about our bodies.  Not only did I gain weight mostly in my breasts, abdomen, and upper arms the more the PCOS progressed, but I also grew a white, fine hair on my face that became more and more embarrassing the longer into the diagnosis I went.  No matter what I did, I still gained weight and the hair still grew.  I have always had issues with acne since adolescence, and I noticed that I was getting increasingly more cystic acne on my cheeks, chin, and even my neck.  Painful red bumps on my neck which had never happened before.  There is nothing less sexy than feeling like I don’t even know what my body is doing and feeling super self-conscious on how it looks due to weight gain, hair, and acne.

Body image can greatly affect all aspects of sex and sexuality.  If you don’t feel good about yourself in your own body, why would you want to share it with anyone else?  Having a negative body image about ones body can also really inhibit desire- the better you feel in your own skin, the more desire you’ll have to be intimate and sexual with yourself and partners.

Partners don’t often understand this and I have seen that a partner sometimes doesn’t like the body that their partner has developed because of PCOS.  Self-acceptance is the first to place to start, and then communicating with your partner WHY you might be having these feelings about your body.  Partners often misinterpret a lack of desire for sex or inhibited arousal as something wrong with THEM.  It’s important to talk to your partner(s) about PCOS and how it affects you and to ask for your partner to work to help you and them accept your body for what it IS, not what it isn’t.

How I Manage It:
It sucks.  And its not fair.  But I tried to focus on my body as something that needed my help and love and support, and not something to loathe and despise.  I tried several different very restrictive diets, only to find that the Ketogenic Diet was the most successful.  I lost a little a weight and felt better about my body, but I also mourned the loss of what my life and my body used to be before PCOS.  I’ll talk more about how Keto has helped other aspects of PCOS later in the blog.

I also started waxing my face, which helped, but since then, I have began laser hair removal monthly for all dark, hairy areas of my body (including a brazilian!) and getting my face dermaplaned ever other month (takes care of the hair and also leaves my skin looking fantastic!)  Even though my hair growth was the white, soft hair  on my face and lasering doesn’t work for that kind of hair, feeling good in my body and managing other unwanted hair helped.  I feel like a hairless sexy vixen, which helped my body image.

Another factor was to embrace my curves.  I try to wear clothing that accentuates my body, and doesn’t make me feel self-conscious.  With a bigger abdomen, certain outfits (shorts for example) just didn’t make me feel good about myself.  But dresses looked bomb!  I really tried to find clothing AND lingerie/undergarmets that made me embrace my Marilyn Monroe figure, something that isn’t easy to do when I have been encouraged (societally) to be as skinny as possible.  I also decided that when I needed to wear a swim suit, I would wear the sexiest one piece I can find.  I’m 34 and it might be time to rock the pinup look instead of the bikini look. The feedback has been incredible!  I have found partners CAN eroticize a more full-figured look.  I look like a W-O-M-A-N, and most of them have found that VERY sexy.  And so I have I- because I mean, if I don’t think I’m sexy, how can anyone else?

I was prescribed Spironolactone to manage the acne and some of the other symptoms.  Spironolactone helped right away clear my skin and clear up the hormonal acne that was increasingly getting more severe on my neck and face.  What it also did, however, is cause me to spot bleed more (my doctors denied that this was a thing, but the nurses did not).  So I made sure I kept the dosage as low as I could, since bleeding was a major issue for me.  Overall my skin looks great.

It took a long time and losing 5 lbs. to fall back in love with my body (I gained about 15 lbs after my diagnosis).  I still feel self-conscious at times but body image is something that most people struggle with indefinitely, regardless of health issues.

Depression and Mood Swings

Depression and mood swings, in and of themselves can greatly impact your sexuality and your desire, arousal, and ability to orgasm and experience sex as well as your relationship with your partner.  The hormonal and insulin related nature of depression and mood swings of PCOS can make for a very unstable emotional climate within oneself and interacting with your world (i.e.: partner).  If someone isn’t stable emotionally, due to the side effects of PCOS, or depressed, their sex life will be impacted, with low libido, low desire, low arousal, and difficulty experiencing pleasure and/or orgasm.

And since a lot of the depression caused by PCOS is treated with psychopharmaceuticals like SSRI’s and antidepressants which are CRAZY notorious for impacting desire and sexual functioning, its like a double whammy.  Ultimately, I tell my clients to weigh the benefits vs. the costs of treating their depression:  If you are depressed or have bad mood swings and those are untreated, you aren’t going to want to have sex or enjoy sex.  If you are on antidepressants or mood stablizers, you could feel a lot better but your desire and ability to be aroused or experience orgasm could be inhibited.  Which is better or worse?  Which offers you the best quality of life?  These are decisions to talk about with your doctor and your therapist.

And it is important to keep your partner(s) in the loop.  It can be really confusing to a partner and can impact them as well if depression and mood swings are a part of your life.  Partners can feel blamed, criticized, defensive, and can subsequently develop their own anxiety and depression over their relationship because things aren’t going well or they perceive they aren’t.  Open and honest communication and psychoeducation about PCOS are really important.  No one wanted this- not you, not your partner, not anyone.  Supporting each other and working together is the main goal of dealing with depression and mood swings, no matter what is the cause.

How I Manage It:
diabetes photoSince so much of my mood and emotions were influenced by sugar and my blood sugar and insulin being so imbalanced, when I got the sugar and insulin and glucose reaction under control, this improved a lot, but I’m still prone to some low level depression (its interesting  after I got the diagnosis a lot of things made sense including a long standing low level depression, the acne, and probably irregular periods except I had been on hormonal birth control for so long) I manage it with diet, exercise, nutritional supplements (I work with a naturopath), and a lot of rest.  I can’t overwork like a lot of people without shutting down so self-care is really important.  I’ve also had some success with medicinal foods and supplements such as St. Johns Wort, 5HT-P, SAM-E, and other products, but I don’t advise taking these unless you consult a doctor since they can interact with a variety of other medications (even reducing the efficacy of birth control) so even though you don’t need a prescription for some of them, they should be only taken under the supervision of a medical professional.  If you want to know more about Medicinal Foods, read my blog on Medicinal Foods For Sexual Functioning .

Another thing that a lot of people discuss is Metformin.  I have been prescribed metformin many times but I still resist taking it.  I am not sure why- I think I am stubborn and am trying to manage these things naturally.  But metformin often greatly improves these symptoms for many (as well as various other side effects/symptoms of PCOS).

Sexual Self-Esteem

Body image issues and mood aside, living with PCOS can greatly affect ones sexual self-esteem.  The unpredictability of menstrual cycles and bleeding and fertility issues can cut us at the core of what is often an already fragile sexual self image.  PCOS can make us mistrust our body or feel like we know nothing about it, which can lead to a lack of awareness of ourselves, our sexuality, and what brings us pleasure.  I would not be surprised if a high-level of women living with PCOS also struggle with orgasm and desire issues, as well as other sexual dysfunctions, such as painful sex.  And many of the pharmaceutical treatments for the symptoms of PCOS have the unpleasant side effects of affecting our sexual functioning.

Another factor, PCOS aside, is how high WAS/IS your sexual self esteem?  Sex and the way we feel about ourselves is something we should be exploring indefinitely.  It isn’t a destination, our sexuality and how we feel about ourselves sexually is a JOURNEY.  As a sex therapist, I am constantly learning and growing and reading and journalling and going to conferences about sex.  That is my profession- but what is everyone else doing to feel good about themselves sexually?  To grow sexually?

On my Facebook page, I have tons of links to great books on sex and sexuality.  But two I recommend for all women include Come as You Are (Dr. Emily Nagoski) and a new one Becoming Cliterate (Dr. Laurie Mintz).  But there are so many more.  Our sexuality has been totally neglected for most of us.  Isn’t it time we build our own sexual self-esteem through KNOWLEDGE?

Oh and a brief word about partners- how is their sexual self-esteem?  What are they doing to improve themselves?  Is there stuff rubbing off onto you or vice versa?

How I Manage It:

The biggest factor on this was my irregular periods/bleeding.  There was a time prior to my diagnosis and finding the correct hormonal birth control to be on that I was bleeding every day.  EVERY.SINGLE.DAY.  This really restricted my ability to be sexual with a partner (and since I have been mostly sexually single throughout my journey with PCOS, it made it REALLY hard to be sexual with a new partner).  My sexual self-confidence, even as a sex therapist, plummeted and I felt like I constantly lived in fear of spot bleeding.  It made it really hard to have desire, arousal, and orgasm and made me at times want to avoid sex all together.  I wound up finding a hormonal birth control that helped ease the bleeding and then had to be prescribed a stronger hormonal birth control since I was bleeding through the original after a while.  I also cut back down on the spironolactone and stopped taking a few supplements that I think contributed to the bleeding.  Overall, it took months to figure it out but I’m happy-ish where I am at right now.

As a note- not all birth controls are equal for those of us with PCOS and medications and supplements that we are prescribed MAY VERY WELL have side effects that are distressing as well (like antidepressants on sexual functioning).  Make sure you research yourself what the potential side effects are of a medication and trust your body.  You know yourself better than anyone else.  You can also ask your doctor, but they don’t always have or give you the full information on side effects.  With PCOS, doctors don’t always know a lot about this disorder and they don’t always know all the side effects that will affect us, so make sure you do your homework and be your own advocate.

Glucose/Insulin/Pre-Diabetes/Blood Sugar

This definitely has an impact on your sexual functioning and can range to very little impact to the same affects on your sexual functioning that diabetes has.  Diabetes can greatly affect your sexual functioning, including neuropathy, low sexual sensation, desire issues, issues orgasming and a variety of other issues.  I don’t have the space or time to go into the complete complexities of diabetes and sexual functioning, but it’s worth a perusal of what the internet says…

How I Manage It:

I’ve tried very diets and programs to manage this, and the only thing I really have found that helps me has been the Ketogenic Diet.  Sure, keto is challenging sometimes, but overall, I feel great on it, I feel way more in control of my hunger and appetite, I’m not self-medicating with sugar and carbs (which was pretty much what was happening- my blood sugar was so unregulated I was using sugar and carbs to manage mood swings, emotions, and just generally feeling crummy), and I’ve lost a little bit of weight.  I know Keto is the long game for me, and I just take it a week at a time of making good food choices and learning more about the keto diet.

I’m also considering testing my blood sugar (I already test for ketones) but since I have responded so well to the keto diet, I wonder if I can do even better if I test myself regularly for blood sugar fluctuations.  That might be the next chapter in my management of PCOS.


If you are struggling with a diagnosis of PCOS or think you might have PCOS and are looking for help and guidance with dealing with the symptoms of PCOS, please contact me.  I am a PCOS-knowledegable and PCOS-aware therapist who can help you cope with PCOS and live the best life possible!


More Resources on PCOS

PCOS Awareness Symposium 

In person conference held annually to discuss PCOS developments and research.

The PCOS Summit

Online series of interviews with experts in PCOS available for free for two weeks then for a fee afterwards.

PCOS Diet Support

Online support forums and weekly recipes designed to naturally manage symptoms of PCOS.

There are also a TON of Facebook PCOS groups that can be helpful.  Just type PCOS into your search bar on Facebook and let the joining of the groups begin!

Dealing with Jealousy

Rhiannon No Comments

Jealousy can be so painful and fiery and dealing with jealousy can be even harder than experiencing it.  And jealousy is SO prevalent.  At the recent 50th Annual 2017 American Association for Sexuality Educators, Counselors, and Therapists (AASECT) in Las Vegas, NV, there was a presentation entitled “Coping with Jealousy: Tools for Individuals and Relationships” presented by Erica Marchand, PhD and it was SO popular it had to be held in the main ballroom and had nearly 500 people attend.  And it was just a break out session!  There seemed to be more people than the keynote and plenary sessions!

Why was this presentation so popular?  Because jealousy is one of the most intense and powerful and common emotions in intimate relationships.  And we’ve all felt it, and we are all afraid of it.

Most of this information was reference from the presentation by Dr. Erica Marchand and is credited to her presentation.

So what is jealousy?

Jealousy is an emotional state aroused by a perceived thereat to a valued relationship or position, involving feelings of hurt, anger, anxiety and/or betrayal, which often motivates behavior aimed at countering the threat. Jealousy is different from envy, where jealousy is a fear of losing what you have, while envy is desiring what someone else has.

Theories of Jealousy
There are a variety of theories psychologically on why jealousy occurs and why it occurs is important because it informs us as clinicians on how to treat it.  In the therapy room at SexTherapy- Online, we approach jealousy from an integrated model of all these perspectives.

From a psychodynamic and attachment perspective, jealousy is caused by painful childhood experiences, such as loss of love, loss of parent, or threat thereof and poor attachment with primary caregivers.

From a systems perspective, jealousy arises from relationship dynamics and serves a purpose in the relationship.

From a cognitive-behavioral perspective, jealousy is a learned response that can be unlearned and people can be retrained.  From a social perspective, jealousy is shaped and defined by culture and social norms.

evolution photoFrom an evolutionary perspective, jealousy functions to guard against losing mate and/or associated resources.

Gender Differences
Men experience more jealousy in response to sexual aspects of infidelity, while women experience more jealousy about emotional aspects of infidelity.  Sometimes this is credited to evolutionary psychological factors, but its a little more complicated than that.  When working with clients, Marchand says that the evolutionary explanation washes over a lot of other relevant information and factors.  Sexual and emotional infidelity are overlapping concepts and research on gender differences and infidelity has not been replicated consistently. Jealousy and infidelity overlap a lot, but in this blog, we are really just talking about jealousy, and not aspects of infidelity.

Jealousy has been been reported at higher levers among people who have experienced infidelity, people who have been unfaithful, and person(s) with less power/status in the relationship.

Same Sex Relationships
lesbian photoIn same sex relationships, Marchand says there is not a lot of research out there but a few items to note: gay men in monogamous relationships experience more jealousy than in non-monogamous relationships and that intimate partner violence in same sex couples is more prevalent if jealousy is present.

Consequences of Jealousy

There are significant outcomes and consequences of jealousy.  In individuals, when one or both partners are jealous, individuals experience lower self-esteem, anxiety, anger, betrayal, and hurt. Attempting to address jealousy often threatens the relationship and the person can be prone to seeking reassurance, provoking conflict, exerting control, and investing more time and energy into the relationship in efforts to increase their value in the relationship.

If that doesn’t sound EXHAUSTING, I don’t know what does!

In relationships, jealousy can often lead to hostile, aggressive or abusive behavior.  Jealousy can also mask as a perception of love, caring, and investment in the relationship (this is the argument that if one didn’t love someone, they wouldn’t be jealous).  When jealousy occurs, the partner’s reassurance as a response to jealousy is associated with greater relationship stability (I don’t see this happening ALL that often, but it does occur!)

So if you are struggling with jealousy, and need help getting out of its clutches, I can help.  Feel free to contact me at the form below or check out the Schedule An Appointment page for more information.

But here are some of the things we would be working on.  If jealousy is bothering you as an individual, we would focus on the following:

  • Accepting /tolerating distress
  • Increase self-esteem and perception of value
  • Increase self-awareness about beliefs and experiences that are contributing to jealousy
  • Increase ability to self-soothe
  • Create response flexibility

I also see couples, poly-relationships, and Non-Monogamous relationships which can particularly prone to jealousy.  If you came to therapy for your relationship(s) and coping with jealousy, we’d be working on:

  • Developing a critical awareness of relationship patterns
  • Changing relationship dynamics
  • Improving and Adjusting Communication
  • Reconciliation and healing

Some questions you can get started with for homework on helping you better understand your jealousy:

For the Individual
How do you respond to jealousy?
What are your feelings, thoughts, beliefs?
What did you learn from past experiences?
– About other people and relationships?
– About acceptable or desirable responses to jealous feelings?
What do you fear losing
What do you gut-level want to do?  What do you frontal lobe level want to do?
How can you treat yourself like a valuable person?
Make a list of qualities that make you valuable.
List five affirmations a day of your value and worth.
Make a list of ways to be kind/nice/awesome to yourself
Imagine if…
What do you need to do to take care of yourself?

For the Relationship
– Create space for talking about jealousy
– Take responsibility for own feelings/validate others feelings
Make an inventory of partners relationship experiences and expectations
List how to build trust/express affection/reassurance
– Things your partner can do or say to reassure you when you feel afraid, anxious, jealous (do it for self and other person)

If there is infidelity, you will want to focus on rebuilding relationship security, ethos, self-esteem
– Create space to talk about emotions related to affair- including jealousy
– Complete above lists
– Set new boundaries/agreements
– Hurt partner rebuilding
– Atone/Atune/Attach

[The majority of this blogs content was taken from “Coping with Jealousy: Tools for Individuals and Relationships” presented by Erica Marchand, PhD at the 50th Annual 2017 AASECT Conference in Las Vegas, NV]

Still need help with dealing with jealousy, give me a call.  You don’ have to suffer alone!

Tantra Sexuality: Weaving Spirit and Sex

Rhiannon No Comments

Tantra Sexuality: Weaving Spirit and Sexspirituality photo

Sit or lay down, with your partner or with yourself.  And breathe.  A deep, abdominal breath.  And do it again.  And just by breathing, you have the foundation of improving your sexual experience through tantra sexuality.

An area of interest of mine for some time now has been sex and spirituality, and how to gain a deeper experience of our spirituality, sensuality, and sexuality through the practice of a variety of techniques, and an area of increasing interest of mine has been tantric sexuality.

My colleagues at the Southwest Sexual Health Alliance invited Sally Valentine, PhD, LCSW to present to therapists on deepening the tantric awareness of practitioners and I want to share a little about the day.

So what is Tantra? 

“Tantra is where sex is transformed into Love and Love is transformed into the Higher Self”  Bhagwan Shree Rajneesh, OSHO

“Tantra is the weaving of spirit and sex.  Through an awareness and consciousness of our energies we are able to shift our energy throughout our bodies, which can enhance our depth of connection with ourselves and our partner.  Tantra partnering includes honest communication, eye gazing, and fully tapping into our senses by means of touching, tasting, smelling, seeing, and hearing.  Practices of tantra include fully breathing, breathwork, visualization, and meditation” (Valentine Counseling, 2017)spirituality photo

A lot of the work I do in my practice weaves tantra naturally into couples and intimacy work, but to break it down to the average person, tantra involves four basic principles and four levels:

The four basic tantric principles that I weave into my work as an online sex therapist include:

1. Presence: Being in the moment, this moment

2. Open-Heart: Free of Judgment, unconditional Love

3. Reveres Sex: Vehicle for Higher Consciousness

4. Reveres the Body as Sacred and Divine

Tantra Practice has Four Levels

1. Body/physical: Tune into the senses/embrace the body

2. Mind/mental: Overcome old beliefs/shame

3. Heart/emotional: Let go of fear, open up to trust, giving, and receiving

4. Soul/Spiritual: Activate energy, experience of Self/Spirit

The four levels of tantric practice is exactly what we address in sex therapy at SexTherapy-Online.  All these areas are attended to.  I often get the question- What is Sex Therapy?  What does it look like?.  My answer can vary but you’ll usually hear me say something like “All my clients come to me for a sexual issue, but it is rarely ever really just about sex.  It’s about life.  Sex is just what brought you to me.  Life is what we will work on”.  These four levels are exactly what we address in therapy.  We will address all of these areas.

Why Tantra?

Tantra is a change agent and can facilitate sexual healing and enhance emotional, sexual, and spiritual intimacy.  Tantra promotes healthy communication, honors the self and others, and explores how attitudes and beliefs of sexuality affect sexual satisfaction.   Tantra promotes change by increasing awareness in energy through meditation, eye gazing, and breath work.

“Tantra is a mode of sexual healing and sexual healing takes place when the individual experiences safety and validation for their experiences.  Sexual education may enhance understanding of what had occurred.  Healthy sexual communication enables one to reach into greater levels of intimacy and increase sexual self-esteem.  This may be facilitated by psychotherapy, personal growth programs, and spiritual practices, such as tantra.  Some tantric practices that facilitate sexual heal thing and enhancement of emotional, sexual, and spiritual intimacy are (but not limited to)” (Valentine, 2017):

– honoring self and others

– sacred space

– healthy communication

– breathing

– energy awareness

– eye gazing

– heart connection

– meditation

One of the first and most basic components of of Tantra is Tantric breathing and is fundamental to a lot of our therapeutic work.  It might be annoying when someone says “Take a Deep Breath”, but there is science behind why that works.

Tantric Breathing Yogic Breath

Tantric yoga breath reduces anxiety and mental stress, strengthens cardiovascular system and stimulates the nervous system, improves oxygenation (allowing the lungs to work at full capacity, increasing the amount of oxygen in the blood), helps expel toxins from the body and improves stamina and vitality. Below you will find some instructions on the tantric yogic breath.

“Take a full breath.  Breathe from your belly, concentrating on filing your lungs completely up.  Place your hands over your belly and feel your belly expand on inhalation and return back to normal when you exhale.  This is both mechanical (movement of their body) and visual, imagine that you are breathing all the way down to your perineum, knees, floor, etc.  Start with 2 minutes increase over time.”  (Valentine, 2017)

It might seem silly, but sometimes we need to start our sessions with some deep breathing to change the way our body interacts with our systems.  Deep breathing provides your body what it needs.

Just as important to the practice of tantra that breath is, eye gazing is also another fundamental exercise.

Eye Gazing

eye photoEye gazing is when you face another and look into each others eyes softly and connected and lovingly.  The importance of eye gazing is that it facilitates deeper intimate connection, increases oxytocin, decreases anxiety, in some case may increase anxiety (due to vulnerability, threatened, shyness, intrusive feelings), and may illicit emotions of joy, sadness, calm, and loss.  Here are some instructions below:

“Face each other and look/gaze into each other’s eyes, softly and lovingly.  (Is natural in ‘new’ love but wanes over time).  Poet, Rumi, calls it ‘consciousness of union’.  See/feel the depth and uniqueness of your partner.  Notice what feelings come up, notice what thoughts comes, notice your bodily sensations.  Allow yourself to be present and just ‘be’.” (Valentine, 2017)

Sexual Energy

Sexual energy is life force energy and sexual energy is innocent.  When sexual energy is open: it flows and increases vitality, creativity, healthy boundaries, passion, and sense of well being.  When sexual energy is blocked or closed: one may experience rigidity in the body, pain, emotional distance, and distress.  Tantra is about weaving sexual energy within oneself and others.

Sex is sacred.  Sex is spiritual.  Sex is being connected to oneself and others.  If anything you read interests you, feel free to reach out to me via the form below or give me a call and we can set up an appointment to begin your tantric journey.


STD Testing and Screening Available in Austin, TX

Rhiannon No Comments

What a better way to start off the year than to commit to regular STD Testing and Screening!

Recently, I recorded a podcast episode ( on sexually transmitted diseases and infections.  When the topic was posed by my team, I initially thought “Who is going to want to listen to an hour long podcast about STDs?”  I mean, I could talk about sexual health and STDs all day long (and many days, I talk about them a lot!) but who wants to tune in and listen to us talk about the risks and dangers of sex?

That’s when my producer stopped me and said something along the lines of “I’m not proud of it, but there were many times I abandoned any concern about my sexual safety for pleasure.  If we can just help 10 people practice safer sex, than it would be a success.”

I was speechless: he was SO right.  I guess working in the field of sex sometimes disconnects me to the average persons experience of sex, and safer sex is one of my most FAVORITE topics to talk about, so I probably take for granted how much I talk about it, and maybe how little people talk about it in their regular lives.

Since the podcast is based in Austin, TX, I wanted to make sure that listeners were provided with helpful resources of where they can get STD testing.  Some of these resources can be generalized to all of the areas I work (and beyond), but many are local and aim to provide services to people in the Austin, TX area.

The FIRST thing I will say about getting STD tested is knowing what you are getting tested for.  People will often say “I’ve been tested. I’m clean” (imposing the inherent shame that we feel about our sexual health, as if having a sexually transmitted disease means you are DIRTY).  Fun fact: More than half of all people will have STD/STI at some point in their life (American Sexual Health Association, 2016).  That means having an STD/STI is really common, so common that it seems unnecessary how much secrecy and shame we have out there about having had or currently having a sexually transmitted disease or sexually transmitted infection.  But that’s sex in this country right- riddled with secrecy and shame, often disguised as “privacy” and “modesty”, but let’s be honest- sex in many families is seen as something you don’t talk about and you don’t feel good about- hence the secrecy and shame part.

So back to WHAT you are getting tesedt for- when someone say “I’ve been tested”, they are usually referring to ONLY four diseases they have been screened for:

  1. HIV (shows up as HIV AB/AG Combo or HIV 1 + 2 AB + AG or some variation): Desired result Non-reactive or Negative
  2. Syphilis (shows up as RPR on your lab tests): Desired result: non-reactive or negative
  3. Gonorrhea and Chlamydia, Desired Result: negative

What that doesn’t include is HPV (genital warts and can cause cervical cancer and oral cancer), Herpes, Hepatitis B & C, Trichomoniasis, or any other skin diseases that can be transmitted through blood, semen, saliva, vaginal fluids, or skin to skin contact.

The other thing, is you actually have to ASK to be tested.  And you need to be specific on what you want to have tested.  According to the American Sexual Health Association (2016), in a national survey of US physicians, fewer than one-third routinely screened patients for STDs/STIs.  That means that this is something YOU need to make a priority.  I know, it isn’t right, for something that carries so much weight, shame, and heartache, why don’t our physicians take a more proactive approach in helping us navigate sexually transmitted infections and diseases?  THAT is a great question, and a WHOLE other topic for another blog!

So know that you know what I recommend you getting tested for, here are some places in Austin, TX that will do it for a low-cost or free.

  1.  First, if you have health insurance, MOST, if not all, of the above mentioned tests will be covered.  But you have to ask and you HAVE to be insistent.  In all the years I’ve been a sex therapist and have been getting regularly screened 1-2 times per year, I STILL have to insist to “regular” doctors why I need the tests I need.  Even if some years I am “low risk”, I have to explain to the doctor that my sexual health is a priority and the sexual health of my partner is also a priority.  Because of that, I need to have tests for the following:
    1. HIV
    2. Syphilis
    3. Gonorrhea
    4. Chlamydia
    5. Trichomoniasis
    6. Herpes I and II
    7. Hepatitis B and C
    8. HPV
    9. If symptomatic, yeast culture as well – CHERRY ON TOP!
      Most of these are blood tests (HIV can be a finger prick, which I don’t like).  A couple are a culture from my vagina or in men, their urethra.  I usually get fought by the practitioner (insane, I know) on 1 or 2, generally hepatitis and HPV.  HPV is a REALLY dangerous and common virus, and it isn’t always uniform on testing for it.  Women usually have it done through a pap test- for men, there isn’t an “approved” way of testing/screening unless there is a wart or lesion present.  An anal Pap test is available for those who frequently have anal sex.
  2. Go to a low-cost or free clinic. Generally, my experience has been that these places are WAY more receptive at testing you for whatever you want and many accept your insurance and if you have crummy insurance or none at all, they are often very reasonably priced or FREE!  It’s often easy to get free HIV testing, whereas other tests usually aren’t free.  World Aids Day in December 1 every year is often a pretty easy day to get a free HIV test too, so you could make it an annual thing.  If you go to college or university, you can also take advantages of some of their free and low-cost STD/STI screening programs because each year, one in four teens contracts an STD/STI, one in two sexually active persons will contract an STD/STI by age 25 and about half of all new STDs/STIs in 2000 occurred among youth ages 15 to 24 (ASHA,2016).Here is where I would go (taken from the website):

Austin/Travis County Health and Human Services Department

HIV Prevention & Outreach Program

15 Waller Street (and various other locations)
Austin, TX 78702
FREE HIV testing
See the Mobile Outreach Van testing schedule.

Follow us on Facebook.

RBJ Sexually Transmitted Disease (STD) Clinic

Austin/Travis County Health and Human Services Department
15 Waller Street
Austin, TX 78702
Low-cost STD/HIV Testing

Other Testing Locations

AIDS Services of Austin

7215 Cameron Rd # A
Austin, TX 78752
Call for dates & times

MHMR CARE Program (Community AIDS Resources & Education)

5015 S. IH35, Suite 200-D
Austin, TX 78744
FREE, confidential HIV and Hepatitis C testing
Monday and Wednesday mornings, 8:30 a.m. – 12:00 p.m.
First-come, First-served basis
Rapid test results

Planned Parenthood Downtown Clinic

1823 E 7th Street
Austin, TX 78702
Rapid testing is available.
$0 – $60

Planned Parenthood North Austin Clinic

9041 Research #250
Rapid testing is available.
$0 – $60

Kind Clinic

1101 W 40th St. #102
Austin, TX 78756

Any Lab Test Now

Offer a variety of tests at several Austin area locations


Call 1.800.809.9252 for testing locations and cost.

Fast, private, and affordable STD testing at 10 locations in and around Austin

STD Labs

A professional STD testing service offering fast, private, and affordable STD testing.

And if you are in the Austin area, or Texas, or Maine, Massachusetts, New York or New Hampshire and are looking for some help in dealing with sexually transmitted infections, please fill out the information below and I will be happy to contact you to set up an appointment.

Sex isn’t scary, it just needs to be enjoyed responsibly!


Common Barriers to Good Sex

Rhiannon No Comments

Being nearly 10 years in practice, over the last decade, I have been able to identify some common barriers to good sex within relationships.  Here is a brief blog on some common barriers I have found.  If you have some of these barriers, it’s important to do the work to remove them or help limit the effects that these barriers have on your sex life.

Unresolved and/or complex trauma is a huge barrier to good sex.  It’s also a barrier to general happiness and satisfaction in life and can be one of the main sources of anxiety, depression, and other mental health concerns.  And any type of trauma (even if it is not sexual) can impact your sex life.

Grief and Loss
I see grief and loss as one of the main causes of sexual functioning concerns and sexual disatisfaction in a persons life.  Whether active or unresolved, grief and loss appears to directly affect the sexual functioning system and it would be worth the time to resolve and do work around this.

Fear of anything, nothing, and/or everything can create a barriers to good sex.  We live in a fear based society and fear is instilled inside of us from a very early age.  Fear greatly affects our ability to feel safe with ourselves and partners and in the world and can be huge barriers to good sex.



Lack of Knowledge
Most people don’t feel super knowledgeable about sex and a lack of knowledge about sex can be a barrier of good sex.  I encourage my clients to be “students of sex”, lifelong learners, recognizing that there is no ceiling on how much one can learn about sex.  I will never stop learning about sex, and I sometimes feel like there is so much to learn about sex I will never learn it all, and this is MY profession!  Sex is an never-ending journey- an EXCITING never-ending journey.  Buckle up and enjoy the ride!

Lack of Experience
Experience doesn’t mean competence, but our culture often values more experience as being more competent.  Lack of experience can often create a barrier to good sex, but it doesn’t have to.  As mentioned above, we are lifelong students of sex.  Since we have our whole lives to learn about sex, experience is all relative and quantity is not more important than quality.

Low Sexual Self Confidence
Self-esteem and self-confidence is a huge contributor to whether sex is good or not, and if you have low sexual self confidence and low sexual self-esteem, it can be a great barrier to good sex.

Body Image Issues
I generally believe that you have to feel pretty good about your body in order to want to share it with someone else.  If someone doesn’t feel good about their body, they often don’t feel like sharing it with others.  Body image issues can be huge barriers to good sex.

Closed Mindedness
The most common way I see closed mindness coming up is when people think that they know what sex is supposed to be like, or what their partner is supposed to be like or like.  It’s this closed mindedness to the individuality and nuances of sexuality that prevents good sex from happening.

Human beings and SEX is imperfect.  Having a perfectionistic attitude toward life and sex is a HUGE barrier to good sex.



Marijuana and Sex: Therapeutic Cannabis for Sexual Functioning

Rhiannon No Comments

Marijuana and Sex: My General Thoughts on Therapeutic Cannabis for Sexual Functioning

This November, Maine and Massachusetts, two of the states that I provide online sex therapy to their residents, pass laws legalizing recreational marijuana for consumers over the age of 21 (making the laws similar to alcohol consumption).

I have long had many thoughts about the therapeutic use of marijuana/cannabis/THC for certain sexual functions in certain people but haven’t really had the science or empirical proof to back up anecdotal reports.  But as we start to move into a new era around the use of marijuana, I just want to make a general statement that marijuana is worth researching on its negative and POSITIVE effects for some sexual functioning concerns.  That’s right, positive.

marijuana photo

That isn’t a general statement that I want everyone to think to just use marijuana for sex.  That isn’t what I am saying at all, because some usage can actually harm sexual functioning.  But for certain sexual functions, it has been reported that therapeutic cannabis actually do a lot of good.  But there are a lot of factors, like type of marijuana, dosage, routes of transmission, etc. and sometimes the costs are not worth the benefits.

I particularly like some of the sex specific products that are being developed, such as lube with THC infused in it, so the route of transmission is vaginally or anally.  And for certain issues (like desire, performance anxiety, and pre-orgasmia in women) it has been reported that marijuana has really helped in improving the negative symptoms of these issues.

But like with anything that could be harmful or helpful, or a little bit of both, I like to talk to my clients about staying within the boundaries and balance of what is legal, moral, and ethical and when the benefits outweigh the risks.  We discuss manageable use, just as we would discuss if we were to use any substance for sexual functioning.

Want to talk about this more?  Email me at the contact information below and we can set up an appointment.

The Risks and Benefits of Sexting

Rhiannon No Comments

Sexting didn’t exist when I was an adolescent and young adult, but I am glad it exists now!   Back in the day, sexting for me was as elaborate as a note that asked if someone would go out with me and hlove note photoad a yes and no check box.  Or maybe someone drew a penis on a desk.  That was pretty much it.  But with the increase in texting (starting mid/late 1990’s, actually the FIRST text was sent in 1992 but texting didn’t become popular until a little later), it was only a matter of time before we sexified texting and made it an amazing tool (as well as a tool to use with caution) to accentuate our sexual communication.   In fact “sexting” became an official word in the dictionary not that long ago (2012) so don’t feel bad if you don’t really know what I’m talking about

First off, for consenting adults, in general, I fully support sexting.  Now what is sexting technically?  Sexting is defined by Miriam Webster as “the sending of sexually explicit messages or images by cell phone”, but

sexting has also included emailing, chatting, and other media that is text or image based.


I think there are a lot of benefits to sexting between consenting adults.  I think sexting builds desire, creates excitement, keeps the fire stoked at times when you are away from each other, is a safe way to explore yourself sexually, is a safe and fun way to explore fantasy and sexually explicit content, and in generally can be super erotic.  For partners who are apart from each other during the day or for long periods of time, sexting can keep that fire warm and hot even when they aren’t in the same location.  And sexting doesn’t have to be nude pics, dick pics, or sexually explicit words.  It can be as simple as just texting an eggplant emoji with a question mark to your partner with a kiss (don’t know what I am talking about- check out these links:

A Beginners Guide to Sexting with Emoji

69 Emoji Combinations That Symbolize Sexual Acts

Definitive Emoji-Sexting Glossary

Other benefits- no one ever got an STD/STI or got pregnant from a sext.  (Not to my knowledge… not yet at least). Sexting is a safe way to explore different fantasies, fetishes, and sexual enactments that can be stopped at any time (turn off the phone) and can be creative and artistic and help people develop their authentic sexual selves or try things that they might not in real life that can enhance and improve their sexual lives.

Sexting can often resolve or help reduce the negative symptoms of a sexual functioning concern and be a good tool in sex therapy.  Sometimes people are a lot more comfortable being sexual via images and texts than they are in person, which is a good start in the right direction.

Sexting is a creative and artistic way to express and develop yourself sexually. This is why I think sexting is popular amongst teens and adolescents:  as teens and adolescents develop themselves sexually, sexting is a safe way to explore some themes that might not be super safe in real life (IRL).


The risks are important to mention but I don’t want to nay say what I feel like is a really good tool and resource for consenting adults.  Some of the risks include the fact that you can’t control the information or images that you are sending once you press that send button- so its important that you trust your sexting partner and establish that these thoughts and images are for their eyes only.  Even creating a verbal agreement with that partner won’t protect you from them misusing the content if they want to, so just press send at your own risk.

We often don’t think about this, but be careful sexting on a phone that your company/business pays for or on an account that you share.  Information isn’t TRULY private at all, I think we all know that confidentiality and privacy is an illusion in this day and age.  Don’t send something that you really don’t want anyone ever to see ever.  Know that when you put information, text, or an image out there, it likely won’t disappear…it’s out there.  And many companies have policies against using electronic devices for anything sexual and you could get in deep trouble, fired, and sometimes prosecuted for sending/receiving sexually explicit media on company devices.

Make sure you know who you are talking to and sexting.  It’s super important that you NEVER EVER EVER send a sext to someone that you don’t know for sure who is on the receiving end.  And you really don’t know who is receiving the sext right?  So be very careful.  Sending a sext to someone who is underaged is illegal…even if you didn’t intend to send it to them.  Make sure you keep passwords and locks on your phone, and even set up a setting where the text messages and images don’t come through on the home screen where anyone underaged can see a sext.

As with any and all type of communication, you can’t always really tell the inflection and tone and meaning in a text or image.  So sometimes misunderstandings can occur.  And what is difficult with sexting is that consent gets a little hazy.  It’s important that you have someones consent before being sexual with them, but consent and sexting isn’t always present (we don’t have language in our culture just yet on “is it okay if I send you a dick pic?”) but we need to…


Overall, sexting mindfully and safely can be a very beneficial and creative way of expressing yourself sexually, but use carefully and appropriately with consenting adults.  And HAVE FUN!


Stress, Sex and the Holidays

Rhiannon No Comments

Stress is one of the most common contributors to low sexual desire and the holiday season has proven to be one of the most stressful times of the year!  But don’t let holiday stress affect your sex life!  Sex and the holidays do not need to be mutually exclusive events!  Here are some tips to make sure that this holiday season you have less excuses for why not to have sex and more heat in the bedroom, or in front of a warm fireplace, or under the mistletoe or…

1. Plan Ahead

Try to schedule everything.  Around the holidays, our routine goes out the window and as creatures of habit, that immediately sends us into a stress filled tail spin that can spiral to the point of breaking.  Make lists, schedule your week, fit everything in.  If you aren’t usually an agenda or planner person, use one to stay organized during the holidays.  Put your every day tasks that you might forget in the planner in one color and holiday tasks in another color.  Be creative on keeping your self organized, from shops you need to check out to what you are having for dinner.   Use the calendar option on your smartphone to assist with this. Schedule things in advance and do not wait until the last minute.  The term “waiting until the last minute” is in and of itself stressful- just don’t do it!  Scheduling and planning are huge stress reducers.

If you don’t regularly plan sex with your partner, maybe stressful holiday times are a great time to start intentionally setting aside time for intimacy with your partner.  And just because you set aside some time, doesn’t mean you have to have sex.  In fact, pressure to have sex is another desire killer!  Just set aside some time each week (at least once a week) to have some alone time with your partner.  It doesn’t have to be sexual, just close and intimate.

2.  Blow Off Steam

Whatever you put into your body in stress needs a place to leave your body (and screaming at your family members does not count as stress leaving your body).  If stress can’t or doesn’t leave, it can be manifested in muscle pain, emotional distress, gastrointestinal issues, relationship concerns, sleep disturbances, low sexual desire, and/or complete overload.  Make time to de-stress and blow off steam.  Exercise, meditate, do yoga, read, knit, play a musical instrument, walk your dog, do anything to blow of the steam before the tea pot starts to whistle.

Having sex is another way to blow off steam and provided you do not have issues with compulsive or unhealthy masturbation, taking time to be sexual with yourself is also a great way to blow off steam.  Easy on the pornography, or better yet, use your imagination or read an erotic holiday story for a fun holiday sexual fantasy with (or without) your partner!

steam train photo

3. Nourish Yourself

You can’t expect your body to act in top condition if you aren’t giving it the necessary fuel it needs to run smoothly.  Make sure that you still take time to eat healthy food and snacks.  Not traditionally a healthy eater?  Try to give yourself one healthy snack or portion of your meal a day and pack an apple or carrot sticks in your bag before you leave to provide you with a healthy option.  If you are a stress eater, know that you aren’t “rewarding” yourself when you eat unhealthy.

Being sexual with yourself or with a partner can be very nourishing.  Take the time to go slow and enjoy the sensual experience of nourishing yourself (and your partner) sexually.  A fine meal at a nice restaurant is a wonderful form of foreplay and is made to nourish our sensual needs too.

4.  Play and Laugh

All too often, we forget to enjoy the holidays for what they are for: family and friends.  We get so caught up what we need to do or get, where we need to be (5 minutes ago!), and how we need to act.  Let your hair down a bit, kick off your boots, and play with your cousin’s dog, sit with the kids, and tell funny stories.  Playing and laughter will reduce your stress and give you a good recharge to why the holidays can be fun.

And that goes for times in the bedroom too- have fun with sex and recognize that laughter is VERY sexy.  Don’t take things so serious and try new things.  Most couples wish their sex was less serious and more playful!

5.  Redefine

If you walk in the door thinking your holiday dinner is going to be a disaster, the likelihood of it being something different is reduced.  Redefine the holidays as an opportunity to check in with family members, see babies and kids grow, and catch up on big family milestones.  Even if those “disaster” characteristics are present, it doesn’t cost you anything to say silently to yourself: “At least my daughter-in-law has a brain” instead of critiquing her differing political views.  Redefine how you look at the negative aspects of the holidays and challenge yourself in being more positive.

Redefining sex might be long overdue- do you look at sex as a chore, as something you just do to “get it over with”, or something that is necessary to keep your marriage/relationship together?  If any (or all) of these apply, it is definitely time to redefine how you look at sex.  Sex is an opportunity not an obligation.  If this is how you feel, it might be time to contact a qualified sex therapist for assistance.  See information below.

6. Manage Your Finances

Give only what you can, and be okay with that.  Finances are a major source of stress for people and add the holidays in the mix and it can get overwhelming.  Most of us can understand that gone are the holidays in the thousands, and here (to stay it seems) are the holidays where it is more about family and friends than giant presents and extravagant gifts.  The best gift you can give (to yourself and others) is staying within your budget this holiday.

Finances and sex are two of the most common topics couples argue about.  Consult a qualified financial coach to assist you and your partner with managing everyday finances as well as long-term financial considerations.  Set out a plan and stick to it, and recognize the holidays aren’t the best time to address ongoing financial habits (as this is the most vulnerable time for spending).  If you haven’t come up with a plan yet, and are already way over budget, try to do little things to keep the stress off.  Try not to let stress and worry about finances affect your sex life.

7.  Do Good

Even though this is a very stressful time, volunteering your time, donating items, participating in charity events, and helping out others is a great way to relieve stress.  I would recommend doing it in person (even if you don’t feel like you have one more minute to do anything more, make a minute).  You would be surprised how less stress you feel when you give to others and gain a little perspective.

And when it comes to doing good for others, give your partner some extra attention around the holidays.  Perhaps doing something you both don’t do that often, but you know you/they like.  Give to give, not to receive.  No reciprocal intimacy can be very rewarding (and erotic).

8. Accept and Allow

Holidays are often a time when individuals and families have a lot of stress over a loss.  This can be a loss of a family member, a loss of functioning, a loss of a pet, a loss of a job, a loss of relationship, or any other loss.  Because the holidays are a bench mark for the year, it is easy to get into the habit of thinking “I was doing this last year with so and so, and this year… nothing”.  Accept the fact that the holidays are hard and allow yourself (and others) the opportunity to grieve and express their grief.  If this time of year is especially hard, seek out help either from friends and family or from a counselor.

If you are mourning the loss of your intimate partner or intimate life or any loss at all, don’t use sex to replace the actual feeling.  Just feel and move through the feeling.  Real intimacy isn’t about escaping negative feelings, its about processing them and moving forward with them.

9.  Rebuild

Family dynamics.  What are the first words that come to mind?  Stress, anger, resentment, old memories, money?  If these are some words that come up for you, you are like many other families during this holiday time.  But instead of piling on more words to your destructive family relationship pile of negativity, why not take your shovel and scoop off a few from the top this holiday season.  At the very least, don’t add on any more, but I challenge you to try to let go of some of the old resentments you might hang on to because of stressful family situations.  Why should you be the one that has to?  Well you don’t have to, but you are reading an article on how to reduce stress during the holidays so maybe it is in your best interest to be the bigger person and get that shovel out.

If you are holding out resentments towards your intimate partner around the holidays, try to not let it get in the way of intimate time and rebuilding moments with them.  Sometimes, one can find themselves more committed to the resentment than the relationship.  Let go, if you can.

10.  Relax

The holidays can and are fun.  Make your friends and family and fun and food take priority over anything stressful.  Keep everything in perspective and relax and enjoy yourself.  Allowing yourself to relax is sometimes just as difficult as relaxing so take the time you need, a few deep breaths, and smile.

And there is nothing more relaxing than a steamy, sexy night with your partner (or yourself).  Remember that sex is a GREAT way to relax.  Don’t feel that way about sex?  Then call me and I can help.

Stigma, Shame, and Consent for STD-STI Status

Rhiannon No Comments

I have a bit of a bee in my bonnet.  bee photo

The news of Charlie Sheen’s HIV Status has been circling around tabloid and celebrity media for some time now.  Up until today, it had been very “secretive”, with little teasers here and there of people talking about a mystery celebrity that was HIV positive that had possibly infected many people.  The fact that someone’s HIV status has been sensationalized in this manner is just absolutely disgusting to me!  Our sexual health is a very personal topic and for it to be exploited and publicized in the media is in poor taste and very insensitive.  I will state, for the record, that as of now, I have no idea of what Charlie Sheen’s HIV status is and nor do I think it is any of my business.  And I do not want anyone to interpret my writing this blog as an endorsement of the publicity that this topic has received.  In fact, whether it is true or not, I want this blog to be about how we treat STD-STI status and how its stigmatization leads to more infections and more shame.  I also want to talk about how if your partner doesn’t know your status, you really don’t have their consent to knowingly expose them to a STD/STI.

Stigmatization, Shame, and Consent
It is news stories like this, and locker room gossip, that lead to the greater stigmatization of sexually transmitted diseases (STDs) or sexually transmitted infections (STIs).  And with greater stigmatization leads to shame and greater secrecy: the more something is stigmatized, the more it is likely that someone will try to hide or not share their status, and my opinion is that if you have a STD/STI and you do not share that with a partner, you are victimizing that partner by not giving them the right to choose whether they want to risk their health and wellness and sexual self-image on a sexual relationship with you.  And they might want to take that risk.  Or they might not.  But consent is the name of the game in sex these days.  You need a yes before you can proceed, and that has to do with STD/STIs as well.

So if you knowingly have an STD/STI and do not share that with your partner (no matter how much they do or do not matter to you), you are taking away their right to choose whether to be exposed to a sexually transmitted disease.  And not only does it victimize your partner, it is also in very poor taste.

“I got tested, so I’m all good.”  Really?  What did you get tested for?
News Alert: When you walk into your doctors office and ask for an STD Test, you will likely get tested for the following:

Why only those four you ask?  While I am not COMPLETELY sure, I have an idea it’s because those are the four diseases that are required to be reported to the Center for Disease Control.  So my guess is that the research, testing, and treatment for these diseases have some money tied up into them.  Also, HIV and Syphilis can be very fatal untreated (and chlamydia and gonorrhea is no walk in the park either).  But I don’t want to get into this too much, I am just writing to notify you that this is what likely will occur.   I may be totally off the mark and some testing is WAY better than no testing!

What they WON’T test you for (unless you ask or they determine you to be “high risk”) are as follows:
Hepatitis C
Hepatitis B
HPV (Human Papilloma Virus/ genital warts)
Herpes (HSV I and HSV II)
Vaginitis: Yeast Infections or Bacterial Vaginosis
Molluscum Contagiosum
Crabs (Pubic Lice)
Nongonococcal Urethritis
Pelvic Inflammatory Disease

And to really freak you out, there are new STDs/STIs being discovered that aren’t on this list: read more

So when you say “I’ve been tested” the questions to follow should be:
1) When was the last time you were tested?
2) What were you tested for?
3) How many sexual partners have you had since you have last been tested?
4) Do you regularly use condoms during sex?
5) Since the last time you were tested, did you have sex with someone you knew who had an STD/STI?

It is essential you are your own health advocate in these situations.  And you might need to pay a little money out of pocket, because insurance does not always cover all of these tests (as they deem them unnecessary unless there is evidence of symptoms or risk).  But your sexual health is invaluable (as well as the sexual health of your partners), so I suggest you make the investment to test for as many as you can.

So what are we dealing with?  
While the statistics vary, according to the American Sexual Health Association (,

More than half of all people will have an STD/STI at some point in their lifetime.

Each year, one in four teens contracts an STD/STI.

One in two sexually active persons will contract an STD/STI by age 25.

One out of 20 people in the United States will get infected with hepatitis B (HBV) some time during their lives. Hepatitis B is 100 times more infectious than HIV.

It is estimated that as many as one in five Americans have genital herpes, a lifelong (but manageable) infection, yet up to 90 percent of those with herpes are unaware they have it.

With more than 50 million adults in the US with genital herpes and up to 776,000 new infections each year, some estimates suggest that by 2025 up to 40% of all men and half of all women could be infected.

Over 14 million people acquire HPV each yearand by age 50, at least 80 percent of women will have acquired genital HPV infection. Most people with HPV do not develop symptoms.

It goes on and on, so I won’t get too bogged down.  But you get the point.  It isn’t just about HIV anymore… and the consequences of a positive status on many of these diseases/infections can have devastating consequences due to stigma, shame, and low sexual self-esteem.

Stigma and Shame Around STD/STI Status
Many people these days say “HIV, whats the big deal, it’s basically curable now”.  I’m not going to attest to the medical advances around HIV and other STDs/STIs.  What I do want to talk about is no matter the cure, no matter the treatment, the stigma and shame that surround ANY diagnosis of an STD is there and it is enough to knock you down off your sexual high horse and come back to reality that you are a human being and can get diseases from other human beings, no matter how careful or how careless you are about safe sex.  So even if there are medical treatments and cures for sexual transmitted diseases and infections, they don’t address the stigma and shame you may feel after you receive your first diagnosis of a STD/STI.

And that stigma and shame just might cause you to NOT want to tell a partner about you status.  Not tell your partner that you sometimes get cold sores on your mouth.  Not tell your partner that you had to burn genital warts once or twice or many times.  Not tell your partner that you have had several abnormal PAP smears and you are afraid you have cervical cancer, the third most common cancer among women.

And stories like Charlie Sheen’s HIV Status, and the numerous reports about which celebrities have genital herpes, and the locker room whispers about who has what and who gave what to who, contribute to this stigma and shame.

If you really like your partner, or if you just want to be a good person, tell your partner about your status and let THEM make the choice.  Victimization occurs when you take that choice away from someone.

And if you are struggling with telling your partners about your status, getting tested, or dealing with stigma and shame around a diagnosis of an STI/STD, feel free to give me a call at the information below.  You are not alone, in fact, you are VERY not alone.

No Habla Espanol: Spanish Resources for Sexual Issues

Rhiannon No Comments

No Habla Espanol: It’s difficult to find resources in Spanish for anything to do with sexual issues. Recently, a colleague of mine asked if I had any Spanish resources for sexual issues as she had a client that was looking for resources to assist with some dyspareunia and vaginismus.  Off the top of my head, I didn’t know of any, but felt like it was a great question and in efforts to be culturally competent and inclusive, here is what a short search online resulted in.

(Note: While I do have some basic knowledge of Spanish [seven years and several weeks in Spain should provide that] I don’t have the language skills to review all of these resources so I cannot personally vouch for these resources entirely)
spanish photo

En La Mujer (For the Woman)

Vaginismo (Vaginismus)


Dolor Pelvico (Pelvic Pain)
IBRO: Sana El Dolor Pelvico

Sexualidad para la mujer con cáncer (Sexuality and Cancer)

Disfuncion Sexual Mujeres (Sexual Dysfunction in Women)

El Sistema Reproductor Femenino (Female Reproductive System)

Disfuncion Orgasmica (Orgasmic Dysfunction)

Por Los Hombres (For the Men)

Disfuncion Erectil (Erectile Dysfunction)

Problemas Sexuales Comunes La Disfuncin (Hombres y Mujeres)

Adictos Sexuales Anonimos:


Some additional resources that some colleagues have recommended include: (Mexico) (Argentina)