I have a particular set of symptoms that make me feel hopeless about ever having a partner again because of how this will interfere with sexual intimacy. I want to talk to someone who can reassure me and tell me I’m wrong. Maybe this someone knows solutions I haven’t heard about yet. I am doing some treatment at Kaiser, but I’m not making much progress.

I’ve tried to talk to conventional therapists, but they don’t have much to say or much real knowledge. Do you know someone who I can discuss this with?

A: We’re sorry to hear that you’re having to struggle with MS and that it’s put such strain on your intimacy. Chronic illnesses of all sorts can impose tremendous difficulties on people’s sex lives–whether directly due to symptoms or from the stress, fatigue and preoccupation that tend to come with the territory. It is possible to continue to have a hot and fulfilling sex life while dealing with chronic illness though, and some people do so successfully. Some of the common keys to success are self-knowledge, working around limitations, and self-advocacy.

Self-knowledge means learning what your body can and cannot do, which just has to be a process of trial and error along with thoughtful observation. Working around limitations means using that knowledge to create relationships and kinds of intimacy that work for you and your body. And self-advocacy means being ready to speak up for your needs with partners and potential partners and seek out partners who will meet them. In conditions like MS that tend to have “good days” and “bad days”, this might look like making clear to a potential partner that you might sometimes have to cancel or modify dates on short notice, and choosing partners who will be sympathetic and supportive of that.

Since you’ve found general therapists not to have the expertise to talk about your situation, you might try looking into MS support groups, where the people you were working with could be expected to know about the disease. You could also try some broader searching online for “chronic illness” or even “intimacy and disability” which might lead to resources from people dealing with similar issues. Also, if you haven’t seen it yet, the National Multiple Sclerosis Society has a pamphlet on their website devoted to MS and intimacy. You may also try the American Association of Sex Educators, Counselors and Therapists to find someone who will be able to talk comfortably about sexual issues.

What I’m actually getting at is how this has evolved to more deeply disturbing sexual fantasies involving the violent deaths of women. After watching particularly violent, gory movies I feel very stimulated and usually masturbate. I have such fantasies on many nights. Now, I’d like to make it clear that I would never, ever hurt anyone, I can’t even kill bugs without a guilty conscious. No part of me wants to commit any of these acts in reality, but I get way too sexually excited thinking about it. I know that fantasies are just fantasies and most of what I’ve read tells me there’s no such thing as sexually “normal”, but I can’t help feeling this is wrong. It’s distressing to have these thoughts and it is to the point where I can’t just dismiss them by thinking about something else. It doesn’t interfere with my daily life, just haunts me anytime I’m alone with my thoughts.

I guess my actual question is… should I seek help, such as therapy? Is it ok just to fantasize about such bad things?

A: Your anxiety is understandable–having fantasies about acts that would horrify you in real life can be seriously disturbing. But it’s also not uncommon. For some people, the wrongness of the fantasy is a big part of what makes it so hot in the first place. From what you write, it’s clear that you have a solid understanding of the difference between fantasy and reality. You don’t seem at all worried that you might ever act out the acts you fantasize about, and you don’t seem to feel dissatisfied with keeping them in the realm of fantasy.

We can’t tell you what you should do–that’s your decision to make. We can say that talk therapy might be helpful in either diffusing the power of the fantasies or easing your distress over having them. But many people in similar situations also just go on having and enjoying violent fantasies without that ever becoming a problem for them.

Of course I want to act upon my desire, but my desire to be wholly normal – and confident in my sexuality, I think – is stronger. I am white, and I’ve noticed that my fetish is really only common in other white people. My boyfriend is not white and not kinky. I love him and I don’t want to make him feel estranged.

Please do not try to reassure me that my fetish is normal or okay. I really want it gone. I would greatly appreciate any advice or insight you can give me.

A: Thank you for your very interesting question. As you have specifically requested, we will not reassure you that your fetish is normal or okay, as it obviously is not for you. We can say that it is very normal not to be comfortable or okay with your fetishes. In fact, a big part of the attraction to most fetishes is that they are taboo in the first place and that adds to the excitement of acting them out.

As a source of information related to sex we are often asked questions about all varieties of fetishes but usually we are asked for resources for the questioner who wants to delve deeper into their particular fetish. In your case there is not much that we can tell you unless you want to learn more about the fetish of spanking to see what it is about this fetish that you find troubling.

If on the other hand you simply want to overcome this fetish that would be a task we would defer to professional counselors or therapist who specialize in CBT (cognitive behavior therapy) or other therapies that are designed to help people overcome behaviors or aspects of their characters they wish to change.

In case you want take this route and would like some referrals we suggest you might try AASECT (American Association of Sex Educators, Counselors, and Therapists) at www.aasect.org.

The trouble is that I was raised a strict Roman Catholic and taught that sex outside the confines of marriage and procreation, masturbation and even having “lustful” thoughts is a sin. I left the church at the age of fourteen, when I started questioning what I was being taught about the role and status of women, the morality of homosexuality etc. I consider myself a feminist and a skeptical agnostic. I am not even sure that I BELIEVE in god, and I feel that the teachings of the church and the bible are demeaning to women. However, while I may know these things on an intellectual level I can not seem to rid myself of the guilt and shame. I was taught that sex was “dirty” and “sinful” and something that women should only do to please their husbands.

I can not afford to see a sex therapist. Most therapists charge upwards of $100 an hour, and I am on a fixed income and can not afford that. Someday I would like to enjoy a healthy and satisfying sexual relationship with my partner (whether we choose to marry or not) and in the meantime I would like to be able to masturbate, fantasize, watch pornography etc without feeling like a “slut” or a “bad person”. That is another thing I was taught. That men do not respect women who like sex and have had partners before marriage. 

To top it all off, I am bisexual which I discovered at a young age. That is the ultimate “sin” according to the church. Having lustful thoughts or engaging in sexual relations with someone of the same sex. I was diagnosed with a condition called vaginismus when I complained that I experienced excruciating pain whenever I attempted penetration. For example, I was unable to use tampons or have an exam. They gynecologist said there is NO physical problem, and that it is psychological. I have still not confided in my partner about this, because I am ashamed and fear he will think I am less of a woman and may not want me.

How can I learn to be more comfortable with my sexuality? I feel very bitter and resentful towards the people who told me sex was “bad”. Isn’t it natural and normal to have “lustful” thoughts? To want to be intimate with someone that you are attracted to and care about (what difference does it make if we are married or not?) If you have any advice for me, or can recommend any web sites, books etc that deal with this I would appreciate it.

A: Thanks for your question.  It sounds like you are processing a lot of emotions regarding your sexuality right now.  It’s probably going to take some time for you to sort it all out.  You say that you can’t afford an expensive therapist right now, but it would certainly be helpful for you to find some therapeutic outlet.  You might try looking around for less expensive counseling options.  In many areas, you can find therapists/counselors that have sliding scale fees, and many therapists offer group counseling sessions that are less expensive than private therapy.  If these options are not available to you, you might try looking for other ways to share with like-minded women – maybe there are local support groups that may help you deal with some of these powerful emotions.  Unfortunately, there’s nothing we can tell you over email that will make these feelings go away.  They are a result of a long personal history, and it will likely take you quite a bit of time and healing to feel more comfortable with your sexuality and move on.  

That being said, I can give you a few suggestions for reading material.  If it would be helpful for you to learn more about sexuality and things you might be going through, then by all means do it.  Since you expressed feeling guilty about having sexual thoughts, it may be helpful for you to check out some basic sexuality books or websites.  The Joy of Sex is a classic and offers a healthy view of human sexuality.  You may also want to check out Our Bodies, Ourselves: For the New Century printed by the Boston Women’s Health Book Collective.  This is a fairly extensive book offering a comprehensive look at the female experience worldwide and may provide you with information, resources, and/or help put topics about sexuality into perspective.

If  you are looking for books discussing bisexuality, it may help to read Bi Any Other Name by Loraine Hutchins and Lani Kaahumanu and Getting Bi: Voices of Bisexuals Around the World edited by Robyn Ochs.  These are both collections of accounts of bisexuals from various backgrounds.  Reading about others that have experienced similar things can be helpful for some people.  You also say you have been diagnosed with vaginismus.  One thing about vaginismus that’s good to keep in mind is that it’s often correlated with psychological issues, so therapy could definitely be beneficial here.  In the meantime, you might want to check out When a Woman’s Body Says No to Sex by Linda Valins.  

While this reading material won’t solve the problems, it may help you jumpstart your own processing of emotions.  It’s good to keep in mind that others have gone through similar struggles, and there is help to be found.  

I also need a reliable and detailed source of medical info, about the process and what’s involved. I really love this person, and want to be the best support person I can be. We’ve been talking about the possibility of having a child before its too late. How does estrogen effect sperm? does it lower sperm counts, and more importantly, can getting pregnant while the male partner is taking hormones cause birth defects? What’s the legal gender status of someone who doesn’t fully transition? I mean, say they live full time as a woman, get implants and feminizing surgery, but don’t get the naughty bits removed. If we were to marry while she’s still male, would the marriage still be binding after a full transition?

Are there therapists that specialize in this sort of thing? Any that work for cheap? Can you send me a bunch of referrals? I can get pretty much anywhere in the Bay Area for meetings. Thanks.

A: In the San Francisco Bay Area, there are many groups for transpeople and their loved ones. There is a good list at TransGender San Francisco.

The legal and medical questions would be best directed to professionals in those fields. One good resource for transgender legal support is the Transgender Law and Policy Institute. This site may help you to find the information you are looking for, particularly in their resources section. We found a resource at TSRoadmap which outlines the process of transition, including some of the medical and legal issues. Once again, the legal and medical questions can be answered in even more depth by talking to a lawyer or a doctor who specializes in serving the trans community.

Taking estrogen will produce a very rapid drop in sperm production, so it is recommended that your partner banks some sperm with a local sperm bank before starting to take hormones.

To find a therapist who specializes in these issues, you can go to AASECT or to SFBACCT. Both of these resources list therapists who can help you. New Leaf Services specializes in therapy and support services for the LGBT community. All of these resources will feature therapists who are willing to work on a sliding scale.