Depression is a treatable mental illness experienced by approximately 9% of Americans at any given time, according to the Centers of Disease Control and Prevention (CDC). Depression can be experienced at any stage of life and similarity in depression symptoms and statistics have been found across countries like the U.S., Canada, Japan, Iran and Switzerland. Depression in women is diagnosed significantly more frequently than in men.¹ (See: Depression in Men: Understanding Male Depression)

While major depressive disorder is the most common, other types of depression also exist based on additional specific symptoms. Clinical depression classifications include:

• Major depressive disorder (MDD) – a period of two or more weeks in a depressed (low or sad) mood episode 
• Depression with melancholic features – depression, as above, but with additional symptoms like waking up two hours earlier than usual. Depression that is worse in the morning. Feeling excessive guilt.
• Depression with catatonic features – depression, as above, but with additional symptoms like extreme negativism or mutism, motor immobility and uncontrollable repetition of words spoken by another
• Atypical depression – depression that includes symptoms like an increased need for sleep, increased appetite, weight gain and feelings of heaviness in the arms or legs (see: What is Atypical Depression? Symptoms, Causes, Treatment)
• Seasonal affective disorder (SAD) – depressions that occur corresponding to a season, generally the winter, in the last two years or more; often atypical depression (see: What is Seasonal Depression Disorder? Symptoms, Treatment)
• Postpartum depression – major depression immediately following childbirth (see: What is Postpartum Depression (PPD), Postnatal Depression?)
• Depressive disorder not otherwise specified (NOS) – depression identified by a clinician but of a type that does not explicitly fit into a defined category

Major depressive disorder is most commonly referred to as simply "depression." Depression is also often termed "unipolar depression" to differentiate it from bipolar depression. Bipolar depression has the same symptoms as unipolar depression during a depressive episode, but bipolar disorder also contains manic or hypomanic episodes.

Depression Definition: What is Major Depressive Disorder?

Major depressive disorder is defined in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DMS-IV-TR). A depression checklist outlining symptoms includes the following:

• Sadness, emptiness, a depressed mood
• Lack of interest or enjoyment in activities previously found pleasurable
• Reduced or increased need for sleep, energy
• Reduced or increased appetite
• Difficulty in concentrating, paying attention, making decisions
• Thoughts of harming oneself or others

Situational Depression vs. Clinical Depression

The causes of clinical depression include both genetic and environmental factors. However, in some cases, people experience an inability to cope with a life change or stressor. People in this situation often experience depressive symptoms too, so this scenario is sometimes informally referred to as "situational depression." Situational depression, however, is not a diagnostic depression classification and normally what the person is really experiencing is an adjustment disorder with depressive features. Adjustment disorders may include depression symptoms, but are short-term and are directly related to an outside stressor.²

article references

Bach and Deutsch (1970) illustrate the deception that occurs early in a relationship, using "Will" and "Carol." These two people have had a couple of dates, like each other, and are trying hard to please and impress the other. After a fun day at the beach and a romantic dinner, Will asks Carol to stay overnight at his place. She agrees. But after a long drive home, both are very tired, have sunburns, and need to go to work early in the morning. Actually, both would rather go home tonight and set aside a special night for making love the first time. However, they are pushed by their own needs to please, to impress, and to deceive the other. Each assumes (without asking) the other is horny. Each wants to give the impression that he/she is highly sexual too. The truth is that both are concerned about their sexual adequacy.

Since neither can say "let's wait," Will and Carol stay together and have intercourse. They utter the right words to each other: "I love you," "You are fantastic," "Yes, I came," "You are a real man," "You have a great body," and so on. But during sex they were thinking: "I'm too tired to come," "I feel miserable," "He will think I'm frigid," "I can't keep this up, I hope she comes soon," "My God, she wants more!" and so on. Will has a climax and Carol fakes one. After telling each other how wonderful it was (while hoping the other is ready to sleep), they struggle to be affectionate and provide a little after play. This leads to more intercourse which neither wants and both fake a climax this time. They weren't honest. The experience was much less satisfying than it could have been. By pretending, they set a high sexual standard to live up to in the future, and they increased their own feelings of sexual inadequacy. If Will and Carol do not become secure enough to be frank with each other, they will become stressed and irritated. Their relationship may be headed for trouble.

Later in marriage a common complaint is "I ain't gettin' enough." But Masters, Johnson and Kolodny (1985) say frequency is almost never the issue. What is the problem then? The complainer may feel neglected or lonely or that something is wrong with the relationship. The partner being complained about may be anxious at work, upset about adding weight, disgusted with his/her lover, or depressed. The tasks of a couple who "ain't gettin' enough" are to recognize what the real underlying problems are, talk about solving those problems, and express loving concern for each other. The freer one can talk to his/her lover about sex and other concerns, the better the sex will be (Levin, 1975). Many books discuss intimacy and communication in marriage (Gottman, Notarius, Gonso, & Markman, 1976; Rubinstein & Shaver, 1982b; Rubin, 1983). Below are guidelines for communicating about sex:

1. Be honest, open, and direct. Don't pretend, be genuine. If you don't know what your partner is thinking, wanting, or feeling (and you probably don't), please ask, don't assume. Don't be overly eager to impress, like Will and Carol.

2. Forget the nonsense that men know or are supposed to know all about making love. No man knows how a woman feels or what she needs to climax; each woman is different. Talk to each other, DON'T AVOID DISCUSSING PROBLEMS. Both the male and the female have to let the partner know what feels good and what doesn't, what acts are appealing and unappealing. If there is a problem, just say "I'd like to talk about our love-making," then find out when is the best time to talk, i.e. after making love, before, or at an entirely separate time.

3. Forget the notions that men should take the initiative, that the man is responsible for making sex good, and that the woman just lies there, letting the man do things to make her feel good. These are outdated Victorian ideas. So are ideas like: "a man never gets enough" or "most women want to be loved but aren't really interested in sex." The best sexual adjustment (80% satisfied) is achieved when each spouse takes the lead equally often. When the initiative is one-sided, only 66% are satisfied (Blumstein & Schwartz, 1983). A wonderful aphrodisiac is an excited, active partner.

4. Try your best to avoid thinking negatively about the partner, especially watch out for blaming the other person for your problems. Examples: "I might have a climax if he were a better lover." "If he loved me, he'd take more time, whisper sweet nothings in my ear, and massage my back." "If she loved me and wasn't such a prude, she'd play with my penis a lot." "He/she never wants sex, he/she must have a problem (gay/lesbian, feels inadequate, ashamed of his/her body)." The stereotypes and negative thinking frequently hide our own feelings of inadequacy: "It's not my fault, he/she is the one to blame." You need to understand what is really going on.

5. Use "I" statements when expressing a concern (see chapter 13). This shows you accept responsibility for your own feelings. It shows that you are hoping to work cooperatively to solve the problems.

6. Use empathy responses when the partner talks about problems (see chapter 13). This helps get the true underlying problems out on the table. Remember nothing kills sexual urges as fast as resentment and depression.

7. Use books as a stimulus for discussing sex. They may help you see the problem from another angle, suggest factors you had not thought of, and offer you a variety of solutions to consider with your partner.

8. Often it is much more effective to show your partner how to do something, rather than trying to tell him/her. If the woman will guide the man's hand as he touches her clitoris, he will more quickly understand what she wants. Likewise, the man can show the woman how he masturbates and then guide her hands so she knows she is doing it just right.

9. Don't expect things to stay the same; how a couple makes love tends to change from time to time. Don't expect perfection--but you do have the right to a good sex life. Talk about trying new things. And don't forget to laugh too.

Dr. Clayton E. Tucker-Ladd is a licensed Clinical Psychologist and author of Psychological Self-Help

Couples in long term relationships often complain of lagging sexual energy. In fact, over half of the people in my "Retreat for Couples" sexuality workshops attend with the hope of increasing their sexual energy, and others want to know they are not perverts for enjoying sex, especially at midlife and beyond. All want passion and they want it with each other. They want to grow old together as lovers, not roommates.

According to sexual older couples, keeping sexual energy is satisfying but not easy. Hidden sexual energy can be found when people know how and where to look. Most couples search for it where it feels comfortable, not where it is. Couples often act like the drunk searching for his keys under a street light because darkness prevents his looking for them where they are.

Comfort, more than anxiety, obstructs sexual passion; yet, comfort is necessary to relationships. It affirms and sustains partners with closeness, familiarity, and predictability. Partners who stay friends for life know how to care about, respect, and complement each other's growth. There is ease in comfort.

Staying exclusively in your personal comfort zone stifles sexual energy. Couples seek comfort (look only under the streetlight) and avoid anxiety (dodge the darkness). Anxiety is hard to bear, but managing it can fuel growth. Relationships without anxiety allow blandness to overshadow intimacy. A "no-growth" agreement prevails when partners avoid tension, discomfort, and knowing each other. The cost of rigidly maintaining comfort is the sacrifice of sexual energy.

Being deeply sexual over time with your life partner produces both joy and anxiety. This means that consciously managed anxiety can promote, even escalate, erotic energy. For example, the ability to soothe your own anxiety instead of expecting your partner to do it for you helps you create a resource for erotic feelings. This is equally true for adult survivors of incest and other traumas.

Anxious tension between partners can push them to develop tolerance, skill, and taste for highly erotic sex: "Am I willing to say how deeply sexual I feel or don't feel, and why?" "Do I say what I really want/don't want,?" "Do I say 'yes' to myself as well as to my partner?" "Do I keep faith with myself when I get upset or disagree?" "Do I have the courage not to fake feelings, not to protect against uncomfortable emotions we both avoid?" "Do I speak the truth about my own experience?"

Managing anxiety in the service of growth means you risk improving yourself in a relationship. You demonstrate integrity when you manage yourself. Integrity helps you judge which anxieties to risk, such as getting to know your hidden self with your partner, and which to forego, such as having an affair. By managing anxiety you deepen your relationship as you stay intentionally connected to your partner. For example, you learn to affirm and sustain yourself; you become self-validating without pushing your partner to be different even when you dislike him/her. You can tolerate your partner's intense emotions and you can accept and regulate your own, even when that feels impossible. You compromise neither yourself, your partner, nor your self-respect, and you promise yourself to do all this in the relationship. Managing anxiety means you can tolerate intimacy. This is different from closeness. Where closeness is usually anxiety-free, familiar, comfortable, and predictable, intimacy can be anxiety-laden, strange, risky, and surprising. Intimacy is the deep experience of self in relation to a partner. With intimacy, you experience yourself in a different, new, and profound way, not necessarily at the same time your partner does.

Intimacy can be profoundly joyful and penetratingly uncomfortable. The latter happens when you presume your partner will either reject you or smother you (they can do both) and you actually believe you are helpless to handle yourself in the face of either event (as an adult you are, in fact, not helpless and will survive both without ado). It is the former when you finally own your thoughts, feelings, and behavior and are willing to share all this with your partner, with and without anxiety.

Intimacy is not negotiable (behavior is negotiable). People who can risk both integrity and intimacy often stay sexually expressive in some manner throughout life. They struggle successfully to be true to themselves and at the same time face the anxiety inherent in a life that will certainly end no matter what else happens in it. This can be a powerful incentive and deterrent to learning to be deeply sexual with the life partner you know you will eventually lose. In a culture that decries death, it takes courage to love a partner for life.

Hers: a female orgasm can be frustratingly evasive. While about 85 to 90 percent of women are capable of having an orgasm, according to Beverly Whipple, Ph.D., vice president of the World Association for Sexology, only about one-third have had one during intercourse. That said, it's important to remember that orgasm should never be the goal.

"In goal-oriented sexual interactions, each step leads to the top step, or the big "O" -- orgasm," says Whipple. "Goal-oriented people who don't reach the top step don't feel very good about the process that has occurred. Whereas for people who are pleasure oriented, any activity can be an end in itself; it doesn't have to lead to something else. Sometimes, we're very satisfied holding hands or cuddling. There would be a lot more pleasure in this world if people would just focus on the process."

Whipple also points out that the psychological ramifications of dissatisfying sexual interactions are not often suffered alone; they can cause distress in both partners. "If one person in a relationship is goal-oriented and the other is pleasure-oriented, and neither is aware of their own orientation, they don't communicate that with their partner," she explains. "A lot of relationship problems can develop. In my workshops with couples, I help them be aware of how they view sexual interactions and then communicate this with their partner."

Types of Orgasm

Clitoral Orgasm

The most common, they result from directly stimulating the clitoris and surrounding tissue. What many people don't realize is that the majority of the clitoris is actually hidden inside the woman's body. Recently, Australian urologist Helen O'Connell, M.M.E.D., studied cadavers and 3-D photography and found that the clitoris is attached to an inner mound of erectile tissue the size of your first thumb joint. That tissue has two legs or crura that extend another 11 centimeters. In addition, two clitoral bulbs -- also composed of erectile tissue -- run down the area just outside the vagina.O'Connell's findings, published in the Journal of Urology, show that this erectile tissue, plus the surrounding muscle tissue, all contribute to orgasmic muscle spasms. With so much tissue involved in a clitoral orgasm, it's no wonder they're the easiest to have.

Pelvic Floor or Vaginal Orgasms

These occur through stimulating the G-spot or putting pressure on the cervix (the opening into the uterus) and/or the anterior vaginal wall. Located halfway between the pubic bone and the cervix, the sensitive G-spot -- named after its discoverer, German physician Ernest Grafenberg -- is a mass of spongy tissue that swells when stimulated. Because it's difficult to locate, experts have developed a few guiding techniques:

o Lying on her back, the woman tilts her pelvis upward so that her vulva presses flat against her partner's pelvic bone. According to the Bermans, this allows the penis to make contact with the G-spot, simultaneously stimulating the clitoris. Putting pillows beneath her buttocks makes angling her pelvis easier.

o Whipple suggests placing two fingers inside the vagina and moving them in a beckoning motion. The fingertips should stroke the frontal vaginal wall, just where the G-spot is located.

The Blended Orgasm

This can be attained through a combination of the first two.

Guys, I'll let you in on a little secret. The weight room is an intensely pleasurable place--and not just because of how good it feels to lift. Despite the musty smell and all that grunting, the gym is a lust den. Think about it: Sweaty bodies move in repetitive unison, each contraction revealing tight muscles and bare skin glowing from the blood pumping beneath.

EXERCISE + OPPOSITE SEX = HEAT

The whole thing started innocently enough. It was back day, and my training partner and I were doing rows. As he touched the area between my shoulder blades, an electric current pulsed through me. Before I knew it, I was in the throes of, well ... let's just say that it wasn't only the exercise that was making me hot and sweaty.

Muscle lust is not an uncommon phenomenon. The American Council of Exercise addressed the topic of trainers coping with unwanted advances from clients in its member newsletter. Newsweek reported the accounts of a personal trainer who slept with many of his clients. Men are arousing women in profound ways inside the weight room. But can hitting the gym really be a warm-up to more exercise in the bedroom?

Quite possibly. In a study of perimenopausal women, Judith Gerber, PhD, found that "people who continued to have good sexual arousal were people who exercised. The more they exercised, the better their sex lives." This is because physical activity stimulates the physiological as well as psychological aspects of sexual arousal. "Blood flow is important," says Gerber, a clinical associate professor of obstetrics and gynecology and psychiatry at the University of Vermont Medical School in Burlington. "Men get erections because of blood flow to the penis," she says. "When women are aroused, there is also an increase in the blood flow to the genital area, so maintaining the health of your blood vessels is very important." Exercise is the best way to do that.

Supporting this point, researchers at the University of British Columbia in Vancouver, Canada, found that exercise increased a woman's sexual arousal. Subjects did 20 minutes of intense exercise before viewing both neutral and erotic films. Sexual arousal was measured by the subjects' own rating and by vaginal probes that measure blood flow. Measurements taken after the subjects watched the erotic flick demonstrated a marginal increase in blood flow to the vaginal area.

THE BODY ELECTRIC

But blood flow isn't the only exercise-related sexual stimulant. "Endorphins also impact sexual arousal," says Gerber. "Runners feel their effects, which influence the brain in much the same way as antidepressants." Overall, this mixture of feel-good body chemistry, which is the result of any good workout, can make women feel sexy.

What does that mean for you, boys? To reap the benefits of exercise on your sex life, plan more active dates with the object of your affection. Don't assume that you'll get lucky, but when the two of you are hiking, biking or even lifting together, notice the glow in her cheeks and the smile on her face. Then touch her lightly between her shoulder blades.

Female sex experts provide 15 can't-miss tips to turn your sex life into a mature-audiences-only flick

You're lying in bed after a job well done, thinking you're at the top of your game. "This couldn't possibly get any better, could it?" you ask. "Of course not," she replies. But there's a look in her eyes that says maybe it could.

Even if she doesn't say there's something missing, she may be thinking it. That's the thing about sex; even when it's great, there's still room for improvement--if not for you, then, just possibly, for her. Sometimes the problem is that she won't tell you what she wants ... or maybe she did tell you but you were a little too involved at the time to pay attention. In the interest of keeping your relationship well heated, we went to four top female "sexperts" to find out what bedroom moves you can make to thrill a woman most--while maximizing your own pleasure as well. Here's what they had to say.

SEXPERT #1

Josey Vogels writes the syndicated sex-advice column "My Messy Bedroom."

1) Take things slow. "Whenever a woman says she wants things to go slower, take what you think is slower and multiply it by 10. Women often complain that guys work too quickly through the stages kissing, hands on boobs, hands on crotch. The time you spend at each stage should be longer--women want to be teased. Which isn't to say we don't still like the occasional 'grab me in the hallway and do me now' session--just not all the time."

2) Change your style. "Don't assume that because something worked last time--or with your last girlfriend--you should stick with it. Variety is the spice of sex. Don't be afraid to try things and ask her how it feels: more or less, faster or slower, softer or harder. Women aren't always comfortable telling men what they want, so ask her directly and encourage her to tell you."

3) Remember that adult films are for entertainment purposes only. "Stop taking tips from porn films... They're not a very good teacher. In most mainstream porn, it's like, a woman enters room, kiss, clothes off, they're doing it. For women, the seductive period leading up to the nakedness is important, and you seldom get that in porn. And forget that tongue-flicking thing they do.... Generally, women want anything you do with your tongue to be long and slow."

4) Give yourself a rest. "It's not always true that the longer you last during sex, the happier we women are. We want things to go on a while, but chafing isn't sexy. And just because you start something doesn't mean you can't stop and go back to it. Don't be concerned you'll lose your erection, because you can get it back."

5) Appreciate her looks--and take care of your own. "Always verbally express your appreciation of your partner's body at any given opportunity. Women are vain; we want to hear all the time how beautiful we are. We're also insecure about our physical presence. But you should also take care of your own body--women love a guy who dresses well and stays well-groomed. Both men and women tend to go into cruise control when they get into relationships, but she'll appreciate you even more if you still put effort into your appearance."

SEXPERT #2

Sex and relationships writer Sari Locker is the author of The Complete Idiot's Guide to Amazing Sex.

6) Sometimes she doesn't want much foreplay. "In the course of a relationship, there will probably be times when a woman is turned on and ready without needing a lot of kissing and touching first. How can you tell? If she's eagerly attending to your happy parts more than the rest of your body or pulling you straight into a sexual position, it's pretty clear. If you aren't sure, ask her."

7) Don't assume she'll request what she wants. "Many women are shy about asking for oral sex, but really do want it. If she doesn't ask, give it a try anyway. Kiss your way from her neck all the way down her chest, stomach, and thighs, then go for it. If she likes it, she'll be happy to let you keep going. In the unlikely event that she doesn't, or if she just isn't in the mood, she'll be sure to stop you. Or she may want you to do it for a while, then move on to regular intercourse."

8) Do it in the dark. "Men often say they like to make love with the lights on, and women sometimes find that adds excitement as well. But because so many women have body-image issues, she may feel more open to letting herself go and trying new things in the dark. Rather than feeling as if you're missing something by not being able to see her, enjoy the pleasures that her sense of freedom can bring both of you. And if you want her to feel totally uninhibited, blindfold yourself and let her go wild. You can create a blindfold from anything that's around your bedroom, from your tie or boxers to her silk scarf or tights."

9) Have fun with mirrors. "If she is secure with her body, having sex in front of a mirror or two can be very exciting for both of you. If you don't have a large mirror that's aimed at your bed, you can buy an inexpensive full-length mirror, prop it up against a wall, and have at it on the floor in front of the mirror. This can be much sexier than videotaping, which often creates a fairly unattractive memento of your sexual experience. With mirrors, you can change positions and angles if what you see is not turning you on--it's easy to move around to find an attractive view."

SEXPERT #3

Sex therapist Rebecca Rosenblat writes advice columns and holds seminars under the name Dr. Date.

10) Put her in the driver's seat. "In general, female-dominant positions will make you last longer and her climax faster. They also make it easier for you to use your hands, touching all the places that aren't as accessible when you're on top. If she's a 'breast woman,' stimulating them up to and including the grand finale can create electricity that will knock your socks off."

11) Be smooth. "Rough hands can be the sign of a manly guy who doesn't mind physical labor, but they're not what she wants when you're stimulating her more sensitive zones. For that, make sure your hands are clean and smooth--use moisturizer if you need to. Any roughness, or even minuscule amounts of sweat, can leave her feeling sore."

12) Make the most of what you've got. "Want your girth to feel twice as huge and her to feel twice as tight? Try positions where she has her legs straight up in the air. Want to feel twice as long to her? Try positions where she pulls her knees back toward her chest. On the other hand, if it's so big that she's uncomfortable, take extra time with foreplay. The more excited she is, the easier it is to fit together just right."

SEXPERT #4

Clinical sexologist Patti Britton, Ph.D., has hosted several videos and DVDs.

13) Get her motor running in different ways. "Remember this: Foreplay can be many things. It can be anticipation--knowing that you're going to have sex at a certain time, later on, can fuel the fire. It can be something that's physical but not overtly sexual, such as stroking her hair. And women tell me that they never get enough kissing. That's what often gets the motor running; it starts the connection between people."

14) Tickle her ears. "Men are more visual, so they often don't realize that women tend to be more auditory--they need to hear things. If you listen to her, and learn how to talk to her, it's not just romantic but sexual as well. For her, there's no greater aphrodisiac than being listened to. It translates into a feeling of being connected, and connectedness is probably the greatest aspect of a woman's ability to engage in sex."

15) Play with her head. "Fantasy can be an important aspect of sex, but my experience has shown that women have a harder time expressing their sexual fantasies. A great way for men to enter foreplay is to tease out her fantasy side. That might include telling stories or reading a sexy book together. Erotic novels, or the 'softer' side of fantasy, are less threatening than hard-core porn, although some women love that, too. When you're in the zone of sexual energy, everything becomes a part of foreplay."

How about talking to her?

Bedroom boredom is a bad, bad thing, and it's totally unnecessary. According to the panel of experts we keep standing by just for these situations, all that's standing between you and the sex life of your filthiest dreams is learning to communicate what you really want. So if you're doing pages 1 through 4 of the Kama Sutra, but not pages 12 through 20--and never page 84--it's time for a little chat with that woman hogging the covers. Here's how three guys were instructed to get past their coital-conversation issues, and how you can too.

PROBLEM #1: YOU WANT SOMETHING, BUT YOU DON'T KNOW HOW TO ASK FOR IT.

John had always been a fan of a certain non-missionary position but was afraid that Lisa would think he had lost respect for her if he requested it. He alluded to it indirectly from time to time, but she never took the hint ... and he never found out if she was willing.

SOLUTIONS

* Go ahead and tell her what you want.

"You'll get the best results by telling her the truth--whether or not she wants to try the same things that you do, she'll be encouraged by your honesty," says Pepper Schwartz, Ph.D., a professor of sociology at the University of Washington in Seattle and author of Everything You Know About Love and Sex Is Wrong. "Say, 'There are certain things I want to include in our sex life,' and tell her what they are. Or get a book of sexual positions and read it together, just to get a discussion going. Talk about things you like or don't like, including specific acts you'd like to try."

* Be respectful. "If you want to discuss changes in the bedroom, bring them up during a non-sexual situation when you can talk about it calmly," says Julian Slowinski, Psy. D., a Philadelphia psychologist and sex therapist and co-author of The Sexual Male: Problems and Solutions. "Do it nicely, with the understanding that you might not get what you ask for. On the other hand, she might be receptive to what you have in mind--but you'll never know until you ask, so speak up."

* Discuss it indirectly. "If you're worried about making her nervous, the easiest way to ask is to use a third-party reference," suggests William Fitzgerald, Ph.D., a sex therapist in San Jose, Calif. "Say, 'I was talking to a buddy who said his girlfriend did this or that to him.... Would you be willing to try it?' Avoid saying, point-blank, 'I want us to try that.' If you phrase it in those words and she says no, afterward she'll be worried that you'll find someone else to do it with. If you phrase it in more ambiguous terms, there's less risk for her."

PROBLEM #2: YOU WANT SOMETHING, BUT SHE DOESN'T KNOW HOW TO DO IT.

Rita had had few sexual partners before Tony and had never done the act that he wanted to try. He was willing to instruct her but was afraid of making her feel inadequate.

SOLUTIONS

* Give her the benefit of the doubt. "Don't hold her inexperience against her.... The fact that she's hasn't tried a lot of different things doesn't mean she isn't willing to learn," Slowinski says. "If she is, try to educate her without being patronizing or putting her down. Watching 'adult sex education' videos together can be very helpful in these situations."

* Don't sound critical. "The words you use are very important," Fitzgerald says. "If there's a specific thing you want to teach her, what works most effectively is to say something like, 'Guys are different in the way they want to be touched.... Let me tell you what my body likes.' That keeps you from sounding as if you're reprimanding her for not knowing what to do."

* Make it easy. "Just play around ... try to keep things light and fun," says Schwartz. "If she's worried that she won't do it right, reassure her that it doesn't have to be done perfectly to feel good. Say, 'If you do this with me, the last thing I'll be thinking is that it's too bad you're not an expert.'"

PROBLEM #3: YOU WANT SOMETHING, BUT SHE SAYS SHE DOESN'T WANT TO DO IT.

When Allen asked Summer to participate in a certain bedroom maneuver, she said, "I've never liked doing that." He didn't want to pressure her and let the matter drop, but felt their sex life had suffered as a result.

SOLUTIONS

* Deal with her issues. "Try to find out what's behind her reluctance," Slowinski says. "If you know what's really going on, in some situations you may be able to change her mind. For instance, if she's had a bad experience with a certain act, you can try to make her feel better about it. If she has a religious background, ask her why she thinks something is wrong'.... It's possible she has a misunderstanding of what her religion really teaches about sexuality. Or if she hasn't enjoyed a certain act in the past, she may be willing to try it again with you if she's comfortable with your relationship in general. Of course, if she isn't, you won't get anywhere by pressuring her."

* Be adaptable. "Break the act down into compound pieces to find out what part she's objecting to," Fitzgerald suggests. "Say, 'Help me understand; what is it about this that you dislike?' You may find that there's only one aspect of it that bothers her, in which case you can deal with that part or do it differently."

* Plead monogamy. "If you're in an exclusive relationship, let her understand that you want to increase your level of intimacy by broadening the scope of your lovemaking," says Schwartz. "If you say, 'I only want to be with you ... but that means you're my only hope for doing this now,' she'll probably be understanding."

In the unlikely event that she still says no even after all this, what can you do? We didn't even have to go to the experts to field that one.... Like so many sexually frustrated men before you, you'll take up golf.

How do you survive an affair? Learn what it takes to rebuild a relationship after an affair.

It takes seconds to destroy trust, and years to rebuild it.

Few people understand how devastating infidelity can be to a relationship. Affairs rape the emotional trust at the core of love. However, there is a way to repair the damage wrought by an affair. Be aware -- it's not for the faint of heart or the uncommitted.

The Four H's

When one partner has an affair, it triggers Four H's in their mate: Hurt, Hate, Hesitation to Trust, and Holding on to Resentment.

If you had the affair, your partner felt hurt by having her emotional trust betrayed. She hated you for taking away that trust -- the most important element for love -- and having to worry over what else you might be lying about.

Your partner is hesitant to trust you only to risk being betrayed again (many people who have been cheated on say that if they made it through one infidelity, they know they wouldn't be able to make it through another).

And finally, she's going to hold on to resentment. She won't want to, but may feel powerless to let it go.

The Four R's

The corrective responses to the Four H's are the Four R's: Remorse, Restitution, Rehabilitation and Request for Forgiveness.

In order to heal the hurt, your partner needs to see and feel your genuine remorse. This means looking her straight in the eye and saying how sorry you are for the hurt you've caused. Your "I'm sorry" must be simple and clear and not followed by excuses or "but it wouldn't have happened if you hadn't . . . "

As much as your partner's hurt needs remorse in order to heal, her anger needs vengeance in order to be expunged. The best restitution is for you to let your partner verbally vent every bit of revulsion, disgust, disappointment and hurt that you caused. She needs to feel completely drained of all the negative feelings your betrayal engendered. And you need to stand there and listen and take it without defending yourself. This outpouring of emotion will help satisfy your partner's need for revenge and help clear the air so you can move on to the next step.

Her hesitation to trust you needs to see you rehabilitating yourself. You need to learn how to cope with upsetting issues in your life or marriage without resorting to an affair. You also need to reach the point where you actually favor your new and improved way of handling issues over resorting to deceit.

Finally, your partner's resentment needs you to request forgiveness. Make this request only after you've built up a track record of remorse, restitution and rehabilitation for at least six months (and perhaps even as long as the length of the affair). Forgiveness is something that must be earned.

Dr. Goulston is the author of The 6 Secrets of a Lasting Relationship (Putman, 2001).

Heavy drinking increases women's risk of sexually transmitted disease

(Aug. 1, 2003) - Many young women are having unprotected sex -- yet they don't realize how risky it is.

In fact, these young women underestimate their risk for contracting a sexually transmitted disease (STD), a new study shows. Binge drinking makes it more likely they will have sex -- minus a condom -- the study adds.

STDs are a significant health problem for young women -- nationally, among women ages 15 - 24, rates of human papillomavirus (HPV), genital herpes, and chlamydia are particularly high, writes researcher Kimberly S. H. Yarnall, MD, with Duke University Medical Center.

STDs can substantially increase risk of infertility, pelvic inflammatory disease, stillbirths, and chronic pain, Yarnall points out. Also, HPV may be a cause of cervical cancer.

"Even though they are having unprotected sex, most young women would say they are at low-risk of contracting an STD," she says in a news release. "Some don't see STDs as a big deal and are desensitized to the risk."

Risky Business

Yarnell's study included 1,210 women -- all sexually active, unmarried, heterosexual women between the ages of 18 and 25; some were students, some were not. During phone interviews, the women were asked about all sorts of risk behaviors, like binge drinking, history of vaginal sex and STDs, how they perceived risk of contracting an STD, and condom use.

Here are some of the findings:

• More than 75% of all the women felt they were at low risk of acquiring an STD.
• Binge drinking was strongly linked with having unprotected sex -- but only among non-students.
• The non-students were older, had more sex partners over the past year, and were more likely to have had STDs.
• Both the students and non-students reported the same rates of unprotected sex in the past three months.
• In both groups, women were less likely to use condoms if they were older, white, on birth control pills or had partners who didn't see condoms as important.

College students were steering away from binge drinking, likely because of special campus programs addressing the issue, Yarnall says.

Non-students in general were more likely to have unprotected sex with someone they did not consider to be a committed partner, she adds.

"Neither group had a great track record as far as safer sex," Yarnall says. "But the college students did a little better overall. Students were less likely to have unprotected sex with someone they met at a party or bar. Non-students were just as likely to have unprotected sex with their boyfriend as they were a man they had just met."

Doctors can help the situation by identifying and counseling young women who may not see themselves at risk for sexually transmitted diseases, she says.

Some things for teenage girls or young women to think about before they have sex. And take our "Are You Ready to Have Sex" test.

As a teenage girl or young woman, you may be thinking about what it means to be involved in a sexual relationship. Deciding to have a sexual relationship is a big deal since it involves both your body and your emotions. You need to make sure that it is the right decision for you. There are many things that you need to think about before you decide to have sex, including whether this is the right person, the right time in your life, and how you will feel if the relationship breaks up. If you do decide to have sex, you definitely need to first think about how to prevent getting pregnant, and how to protect yourself from getting a Sexually Transmitted Disease (STD).

You should talk to your parents, guardian, a trusted adult, or your health care provider if you are thinking about having a sexual relationship. It is a good idea to discuss all of your choices and all of the concerns and worries you may have so that you can make good decisions. This can be a very confusing time for you, and it is always good to have someone to talk to.

What do I need to know if I am sexually active or I'm thinking about becoming sexually active?

Young people have to make lots of decisions about their sexuality, including whether to abstain from sexual intercourse (not have sex) or become, or continue being, sexually active. Other sexuality issues that teens need to make decisions about are the gender of partners, the type of contraception to use, and the intensity of the relationship. You should never let others pressure you into having sex if you don't want to. The decision as to when you want to have sex for the first time (and every time after the first time) is yours, not anyone elses! Remember that it's completely okay to wait until you're older to have sex. You are young and there are risks involved, like STDs and pregnancy. Many young people just don't want to even deal with the possibility of getting an STD or getting pregnant, so they choose to wait.

Before you decide to have a sexual relationship, talk to your partner about whether this is the right decision. Ask about his or her sexual history, including if he or she has had any sexually transmitted diseases (STDs). Talk about whether you or your partner has been, or will be sexually involved with other people. Remember, the risk of getting a sexually transmitted disease or a virus that can cause cancer or AIDS is increased if you or your partner are having sexual intercourse with other people. The more partners, the greater the risk. The only way to absolutely prevent getting a sexually transmitted disease is to not have sex. If you do decide to have sex, the best way to avoid getting any sexually transmitted diseases is to have sex with only one person who has never been exposed to an STD. You should use a latex condom every time you have sex, from start to finish.

If you are in a heterosexual relationship (you are a female dating a male), talk about birth control (latex condom, birth control pill, injection hormones) and what you would do if it failed. If you feel that you cannot talk to your partner about these issues, then you should rethink whether or not you should be having a sexual relationship with him. Talk to your primary care provider about what methods of birth control are right for you. If you are in a serious relationship, it is equally important to talk about how to prevent sexually transmitted infections (STI's).

How do I find a health care provider to discuss birth control and STD protection?

Many teens and young women can talk to their moms, dads, or guardians about these issues, while others need confidential services. You can talk to your primary care provider about birth control or STD protection. You also have the options of talking to a gynecologist, a health care provider (HCP) at a family planning clinic, or an HCP at a student health center or school clinic. You should feel comfortable with your HCP, since it is important to share personal information and any health problems with her/him. You need to find a provider who will listen to your concerns, answer your questions, and take the time to explain things clearly to you.

Make sure you know how to receive confidential, non-judgmental services when talking about your sexual choices and health.   Practice these questions to ask:

• What happens to the bills from my visits here or to a gynecologist in the community?
• If I'm covered by my parents' insurance, will they find out about examinations and tests that are done on me?
• What if I need birth control?
• Can you tell me what happens to my lab test results? Who do you call?
• What if I want to be tested for STDs or HIV?
• What if you find out that I have a STD?
• What if you find out that I am pregnant?
• Is there any information that you are obligated to tell my parents?
• What happens if I have a big problem and need help telling my parents?
• What should I know about emergency contraception?

If your birth control method fails, you do have an option called emergency contraception, also known as the "morning-after pill." Emergency contraception can prevent pregnancy after unprotected sex. Emergency contraception pills are taken in 2 doses. The first dose should be taken within the first 72 hours after unprotected sex, and the second dose should be taken 12 hours later. The sooner you start the medicine after unprotected sex, the more effective the treatment is. You can usually get emergency contraception from your health care provider or family planning clinics, through Planned Parenthood, at: 1-800-230-PLAN, or by calling 1800-NOT2LATE.

What if I'm not sure whether I'm gay, straight, or bisexual?

Many young people may also be trying to figure out their sexual orientation. If you feel like you need to talk to someone or you need more support, your HCP can help you find a counselor or support group for gay, lesbian, bisexual, and transgender teens. If you don't feel comfortable talking to your provider, you can call any of the following to talk to someone and get advice on where you can find a counselor or support group.

• BAGLY (Boston Alliance of Gay, Lesbian, Bisexual, and Transgendered Youth): 617-227-4313
• Massachusetts Gay and Lesbian Youth Peer Listening Line: 1-800-399-7337
• Gay and Lesbian National Hotline: 1-800-843-4564
• LGBT HelpLine: 1-888-340-4528

QUIZ: Are you ready for sex?

Ask yourself the following questions to see if you are ready to have a sexual relationship:

1. Is your decision to have sex completely your own (you feel no pressure from others, including your partner)?
2. Is your decision to have sex based on the right reasons? (It shouldn't be based on peer pressure, a need to fit in or make your partner happy, or a belief that sex will make your relationship with your partner better, or closer. If you decide to have sex, it should be because you feel emotionally and physically ready and your partner should be someone you love, trust, and respect.)
3. Do you feel your partner would respect any decision you made about whether to have sex or not?
4. Do you trust and respect your partner?
5. Are you able to comfortably talk to your partner about sex, and your partner's sexual history?
6. Have you and your partner talked about what both of you would do if you became pregnant or got an STD?
7. Do you know how to prevent pregnancy and STDs?
8. Are you and your partner willing to use contraception to prevent pregnancy and STDs?
9. Look inside yourself. Do you really feel ready and completely comfortable with yourself and your partner to have sex?

If you answered NO to any of these questions, you are not really ready for sex. If you think you should have sexual intercourse because others want you to or you feel like you should since everyone else is doing it, these are not the right reasons. You should only decide to have sex because you trust and respect your partner, you know the possible risks, you know how to protect yourself against the risks, and most importantly, because you really know that you are ready!