Patti E. Hard,

M.S., L.M.F.T., C.A.D.C., A.A.S.E.C.T.
Licensed Marriage & Family Therapist, Certified Sex Terapist, Certified Alcohol & Drug Counselor  |  Lexington Kentucky



 Published Articles by Patti E. Hard, M.S., L.M.F.T., C.A.D.C., A.A.S.E.C.T.

Sexuality, Substance Abuse, and Recovery
How to Get Your Desire Back After Pregnancy
How to Have Great Sex
Loss of Sexual Desire
Physical Intimacy and Beyond 

 Sexuality, Substance Abuse, and Recovery

Does the idea of sober sex scare you? Have you used substances to help you feel attractive or aroused, or conversely, to feel numb? It is possible that if you are in recovery from drug or alcohol abuse, you may have little idea what healthy sexuality is. Alcohol or drugs, in the beginning, may have been used to increase desire and to relax inhibitions. Often, over time of active use libido decreases and numbness, or disconnection increases. Orgasm can take longer to achieve and may require more pressure, if it can occur at all. Heavy substance use often leads to more dysfunction. Men may experience erection or ejaculatory problems.

In addition, sex can easily get tangled up with love, abuse, and addiction. Trading sex for drugs, sex for money, or sex for physical comfort is common. A lack of having a positive sense of self combined with substance abuse may lead to poor decisions and poor choices. Further, perhaps substances have led to becoming non-functional sexually. Or the opposite may be true, i.e., perhaps you have become overactive or compulsive sexually. In addition, perhaps substances have helped shut out painful experiences of sexual abuse, or sexual trauma. And, finally, perhaps substances play a part in shutting out the confusion of sexual identity issues.

It is possible that some of these struggles become apparent in sobriety. These issues can be very upsetting and frustrating. They can lead you to feel helpless, and to avoid being sexual at all.

Recovering your sexual self, learning healthy sexuality becomes an important part of the overall recovery process. Developing healthy sexuality includes learning about your body, developing a positive body image, including the sexual parts of your body. Healthy sexuality evolves as guilt, shame and inhibitions associated with sexual thoughts and behavior are overcome. Sexual orientation becomes accepted. Learning tenderness, sensuality, how to give and receive pleasure is important. You will also be learning what is erotically pleasing to you. Learning to approach sex from a place of pleasure rather than performing is an essential attitude shift. Enjoying sexual pleasure also includes learning to relax and play, and has many benefits for healthy sexuality.

Continuing the journey towards sexual health will include learning how to present your own needs, wishes, feelings, and attitudes in the sexual relationship. Equally important will be learning self-protection, so bullying and abuse are not allowed.

Sexual issues can come up at any point in recovery, the beginning, the middle, or in the latter stages. It is important not to neglect your sexual self in recovery, but as in all parts of recovery, not to become overwhelmed with the magnitude of the issues; taking it, as in all stages of recovery, one step at a time, understanding that sexual health is a developmental process that can be incorporated into your general recovery. This shifts back and forth from sexual issues to general issues over a long period of time. It helps to remember that the process of learning and growing sexually is rewarding in itself.

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 How to Get Your Desire Back After Pregnancy

If you feel overwhelmed and exhausted after childbirth you are not alone. Pregnancy and childbirth bring profound physical and emotional changes that can take up to two years to recover and integrate into your overall well-being. Allowing yourself time to recover is important. Having a tuned in and understanding partner ensures success. Here are some tips to help the process:

Wait at least two weeks after delivery to have sex. Before that risks bleeding and infection. Most physicians recommend four-six weeks to allow the body to heal. If you had an episiotomy you could be sensitive for months. Vaginal dryness can last as long as breast feeding lasts. Low desire often continues until breastfeeding ends. Use a lubricant, such as Astroglide, if using condoms; oil-based can weaken latex.

Use condoms. You can get pregnant again before your next period.

Make sex important and protect it by capturing and holding onto sexual thoughts and feelings as they resurface. Try not to give away all your physical attention to your baby. Dress in colors you love. Dress in sexy lingerie for you.

Have an early bedtime for your baby. Bedtimes are really for parents to have time together.

Your partner can help by being tuned in, patient, and share responsibility for the workload. Just as important is continuing to treat you as a romantic partner first, and as a mother second. Signs of readiness for sex are when you are less tired, not as moody, and seem happier. Those are signs your hormones are stabilizing. Keep touch and affection going. Touch the small of her back, pat her on the rear, and kiss her on the neck. Many women find these special touches sexy.

Arrange a date night out away from the baby. Let her know she is beautiful. Compliment her. Body issues are important.

Take it slow; cuddle, kiss, connect with your partner. Share sensuality. Take 15-20 minutes to give her long caressing strokes all over her body. This helps you relax, release oxytocin, and increases desire. Gradually build intensity. Your body may be different. Let your partner know what feels good. Try the woman on top position for intercourse or facing side by side, so you have more control of the pace and depth of penetration. Bring your mind back to the present if it wanders. Having orgasm will not cause any harm.

Early on, inserting fingers in the vagina is not a good idea, but clitoral stimulation is just fine. In addition, oral sex as the receiver is not a good idea in the first few weeks as it could introduce infection. But oral sex given to your partner may be a good option if you are not ready for intercourse. If breastfeeding, caressing breasts may produce jets of milk. If that is bothersome, feed your baby before sex. Orgasm during breast feeding is normal; it is just the effect of hormones after childbirth.

Don’t pressure her.

Don’t forget contraception.

Be open to other sexual activity besides intercourse.

And finally don’t forget to build in time for your relationship on an ongoing basis. It needs continual nurturing just like your baby does.

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 How to Have Great Sex

Many people of all ages struggle to have satisfying sex lives. Many settle for so-so sex because they aren’t sure what to do differently. Many feel shy, awkward, uncomfortable, or uninformed.

The good news is that sexual techniques or variety by themselves will not lead to great physical intimacy. Nor do you have to be sexually functional. Here is what you can do to have memorable sex:

1) Shift your framework from reaching the goal of orgasm to having a good time playing. Remember how you played as a child, or play with your own children. You weren’t performing; you were running, shouting, laughing, getting messy, and not caring about anything else. Great sex has all of those features.
2) Learn to relax and be in the present moment. Good sex is about experiencing the pleasure of sensation in the moment; again, not about focusing on the goal of orgasm. Being absorbed in pleasure is similar to the state of absorption of a good book, good movie, or good music. Everything else fades into the background.
3) Be comfortable in your own skin. Be yourself. Let perfectionist standards about your body and your performance go.
4) Have a warm connection to your partner. Trust and sharing enhance sexual experiences. Controlling behavior is a turn-off.
5) Be tuned in to your partner—listening and empathy especially are turn-ons.
6) Develop an easy ebb and flow of giving and receiving pleasure. Stretch yourself in one of those areas that may be harder. If you give well, but have trouble receiving; gradually develop more ability to receive. If it is harder to give, stretch yourself in that area too.
7) Work on being a healthy person free of addiction, have good boundaries and good self-knowledge.
8) If you have suffered a trauma, stay on the path of healing and learn strategies to have safe and pleasurable intimacy.
9) Kissing is the most important part of great sex. Kissing conveys tenderness and passion. Without it you stop having great sex.

Consider bringing more meaning to your sex life. Many believe great sex involves love, romance, and spiritual connection.

Many find these ideas a relief and more easily attained than focusing on more pressured ways to perform sexually. These ideas encourage personal growth, which leads to more confidence in all areas of life, including success in ones sex life.

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 Loss of Sexual Desire

As an AASECT certified couples and individual therapist I am often asked to help men and women understand why they have lost their libido. I understand the strain that loosing sexual desire may place on a relationship. Often the first step is partnering with a physician who specializes in sexual medicine, obgyn, urologist, or family physician to first rule out the many possible physical causes of low libido. Sometimes even a therapy patient who has plenty of psychological issues has a physical issue that is more relevant to the problem, and maybe more easily solved as well.

After a thorough medical evaluation rules out physical causes, a therapist specializing in sexual dysfunction can help continue the evaluation.

The most common cause of low desire, as many might guess, is that couples are not getting along. Unresolved resentment and anger commonly affects desire. Not being listened to is another. Empathy is a turn-on for women especially; whereas, feeling controlled suffocates desire. Being tuned in to each other is the greatest aphrodisiac.

The second most common reason is that individuals do not anticipate enjoying sex. This may be because they are too tired, too stressed, or depressed. It may be because of past abuse. It may be that one has a sexual dysfunction, such as erectile dysfunction, that affects one or both to also lose desire. Further, religious orthodoxy, ongoing body image and self esteem difficulties, menopausal issues, sexual and gender identity disorders may all be influencing low desire. In addition, personality issues, such as passivity, perfectionism, trouble letting go, trouble playing, or having pleasure are other important considerations. Further, overly intellectual analytical personality styles that lead to being too much in one’s head disconnected from body often leads to lack of sexual desire. And finally, commitment issues, having trouble reconciling and balancing love and security vs. excitement and adventure is a causative area to explore.

With a thorough evaluation physically, psychologically, and systemically, treatment directions can unfold relatively easily. In addition, comfort and skill in talking about sexual issues is necessary. Being certified by AASECT is advantageous. With this knowledge helping patients achieve healthy sexuality is greatly rewarding.

I was richly rewarded by a couple in their 60’s and 70’s who reflected, “we found bliss together in the pleasure of long slow touching, kissing, love talk, talk, talk about sex, and my (woman) learning to have orgasm for the first time.” The man said, “Heaven is getting work done around the house, laughing all day, then being tuned into each other’s body, responsive to sensitive touch. Time stops and everything else stops, and all we know is the moment. And all we did to get in the mood was laugh and clean together.”

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 Physical Intimacy and Beyond

The Possibility of Sex, Heart, Soul, and Spirit Connections

If you asked people in the general population what the meaning of physical intimacy is you would get many opinions. Even within the marriage therapy and sex therapy professions opinions are varied. Some say sex is just sex. Some say it’s just about feeling very good. Even when sex is not great it is still pretty good. Some say it is about love. Some say it is about ecstasy. Some says it’s also being close to God. Some have trouble finding words for the state of being physical intimate that they may achieve. Abraham Maslow said, “There are many paths to heaven and sex is one of them.”

Jim Loehr, personal coach from Orlando, Florida, describes a pyramid for achieving greatness in life. He uses it to coach athletes, musicians, and other performers to greatness. At the ground floor is physical needs, the next rung is emotional needs, the next one is mental-psychological needs, and at the very top is spiritual needs. I believe this pyramid can be applied to also describe the building blocks for great sex. This helps make sense of all the differing opinions about sex. All those opinions are all right. But at the top of the game it is possible when physical, emotional, mental, and spiritual needs meet to converge into what could be considered sex, heart, soul, and spirit connections for great sex.

Building Blocks for Great Sex

We have more research since the Masters and Johnson pioneer days of sex therapy that has attempted to find out what physical intimacy means to people and what qualities define great sex. This is ground breaking, because all we have had before has been about sexual performance; i.e., how many times a week one has sex or if orgasm was achieved or not. Foremost researcher in the field of couple therapy, John Gottman has found that the quality of the affectionate bond is the single greatest predictor of a successful relationship. The sexual relationship as part of that affectionate bond, gives fulfillment, a sense of well-being, and overall enjoyment of life. It enhances one’s sense of self and feeling of happiness.

Gina Ogden’s 1998 survey of 3000 women and 700 men found that 86% said sex is more than physical. It involves love, romance, and mystical union. She summarized that love is a powerful catalyst for meaningful and satisfying sex.

Further brain research studies show that sex lights up the right side of the brain. This is the side that is capable of religious experience. Perhaps that is why women often cry out “Oh God” when they are orgasmic!

What is Great Sex?

Peggy Kleinplatz, University of Ottawa, 2006, has an ongoing wonderful research study of over 35-year-old men and women, with a large group over 65, who are sex therapists. She is attempting to ignore the media and try to learn from mature people who have actually experienced great sex. What she is learning so far is great sex includes:

1. Being Present – Being totally absorbed in the moment, everything seems to be happening in slow motion. Others involved in creative endeavors describe the same experience of being fully in touch with the sensory experience. “The first clue that it is great sex is that you are not wondering if it is, or not. You are not thinking at all.” 
2. Being Authentic – Feeling completely free to be yourself, honestly and openly.
3. Having an Intense Emotional Connection – During the encounter. Some say before, some say while in it. There is trust, sharing, cherishing, and accepting. There is an easy ebb and flow of giving and receiving pleasure. There are also clear boundaries, self-knowledge, a sense of being grounded, and a sense of having a good grip on oneself.
4. There is a relationship of deep caring and respect. The sexual act itself is irrelevant with the one exception of kissing. Many said kissing was key. Kissing is about tenderness and passion. If you stop kissing you stop having great sex.
5. And finally, transcendence is part of great sex. People felt silly talking about this. It seemed too touchy-feely. It seemed, if talked about, sex might lose its “getting down” quality. Transcendence means an expansive state of bliss. We may not have the language for expressing it.

Dr. Kleinplatz summarizes that the good news about her study is that one does not have to be sexually functional to have great sex. That is especially good news for all the over looked population recovering from cancer, heart attacks, chronic illness, disability, or aging. The bad news is that it is not sufficient for great sex to be sexually functional. One has to be comfortable in one’s own skin. All the participants in the study said they did not start out having great sex. They learned over time.

In summary, simplistic solutions, sexual techniques, variety, new positions, new sex toys will not suffice by themselves for memorable physical intimacy. Research is supporting what many have long believed, that meaning is important and heart, soul, spirit connections matter to fulfilling physical intimacy.

Doctor’s Park, 1517 Nicholasville Rd, Lexington, Ky, 40503
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Patti E. Hard, M.S.  |  1517 Nicholasville Road, Lexington, KY 40503  |  859-278-4364