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There are times when the saying "it's the thought that counts" fits. For example, if someone you don't know that well remembers your birthday, but forgets to buy you a gift, you might say "that's okay, it's the thought that counts" and mean it. But what if it's someone you are close to? Or a family member? Or what if it's any old friend and while they remember your birthday they neglect to call or email or even post something on your Facebook wall? They still thought about your birthday, only you never knew about it. Does there thinking count? And does it count as much as their actions?

I was thinking about this while answering a sex question from a reader. And it got me thinking about how these questions translate to sexual thoughts and actions. As a sex educator I'm often reminding people that our sexual thoughts and our sexual activities are different. Sometimes they match up, sometimes they don't. There's no reason they need to, and when it comes to sexual thoughts I'd say they all matter at least a little.

But let's say I really want to give my partner sexual pleasure, I think about it a lot, I may even worry about whether or not they are getting the pleasure they desire. But then when it comes down to it I'm too tired or too into my own pleasure and I don't turn my thoughts into actions. How likely is it that my partner - lying beside me unsatisfied while I drift off into blissful sleep - will say "don't worry, it's the thought that counts"?

In other words, how much does the thought count in bed? And how much of the answer has to do with the people involved as opposed to some philosophical understanding of the meaning of thought and action?

Read more: Sex Question of the Week: Selfish In Bed

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When It Comes to Sex, Is it the Thought That Counts? originally appeared on About.com Sexuality on Thursday, February 2nd, 2012 at 10:50:15.

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Construction metaphors figure prominently in iconic images of erections. Tall objects built on a flat plane, penetrating the sky, standing firm and tall, immoveable and awe inspiring in their stand-out-ness, their pokey-tude.

But real erections aren't constructed from raw materials, they aren't built so much as they are evoked. And the analogy with construction falls apart completely when you consider that no one has complete control over their erections, and erections can disappear as easily as they arise.

A roller coaster car might be a more apt metaphor. One of the few things we can say with absolute certainty about erections is that they go up and the come down. If you have a penis in your life - your own or someone else's - the temptation to obsess over the meaning of a lost erection can be powerful. And while I love an unconscious motivation as much as anyone, in the case of penises going soft I think it's actually better to focus on what might be going on first before you begin to ruminate on the what-it-all-means part of it. After all, even Freud said sometimes a cigar is just a cigar. And sometimes a lost erection is just that.

If you're looking for some help sleuthing your own personal mystery of the missing erection, here are some tips on where to start your search.

Read More - Penis Goes Soft: Reasons Why An Erection May Go Away

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The Penis Roller Coaster originally appeared on About.com Sexuality on Thursday, January 26th, 2012 at 00:01:23.

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In the past, if you had a stroke, a heart attack, or a more minor event that led to a diagnosis of cardiovascular disease and you asked your doctor about your options for having sex, the response wouldn't be very encouraging. Something along the lines of it being better safe than sorry, so why not wait. How long you had to wait, and exactly what you had to wait to do was never clear. But there wasn't much research to guide doctors, and in a society where sex is seen more as a perk and privilege of youth, the prudent advice was to be grateful you're alive, and not push it.

Over the past few decades that advice has changing, thanks in large part to two different but connected research agendas. On the one hand we now have a reasonable amount of data suggesting that sexual activity represents a minor risk to people with stable cardiovascular disease. On the other we have research that points to the many physical, emotional, and psychological benefits of regularly engaging in sexual activity. So doctors not only have some concrete answers about risk, but they also have very good reasons to encourage people to resume sexual activity.

Last week the American Heart Association released a scientific statement (available for free download here) which summarizes the most recent research and advises physicians on the importance of talking with patients about sexuality and supporting their overall health by supporting their sexual health. Here are a few highlights from the statement, and some of the things I most appreciated them including:

Risk of Pain, Heart Attack, and Death Is Very Low
Using a term that is sure to appear on some hipster Valentine's Day cards this year, the authors point out that experiencing coital angina (in other words pain caused by a heart problem during coitus) happens in about 5% of all reported cases of angina. In other words, if you're going to feel pain it's more likely that you'll notice it first while exercises, shoveling snow, or doing any number of other activities before you'll feel it during sex.

Looking at reports of heart attacks, less than 1% were caused by sexual activity. For people who have heart disease and are having regular sex the risk goes down even further.

Sudden death during sex is incredibly rare. Reviewing three studies of autopsy reports where the death was related to a cardiovascular event, around 1% of the deaths were reported to have occurred during intercourse. For whatever it's worth in 75% of those cases, the reported intercourse was of the "extramarital" kind (whatever that means), and was with a younger partner, immediately following "excessive food and alcohol consumption". This is taken from medical reports of course, so there are probably major details being left out. Nonetheless, take out the drinking and the Oysters Rockefeller, and better yet, be honest with your partner about your sexual desires, and your chances of dying should bo way down.

Narrow Focus of Previous Research
It was nice to see the authors highlight how most of the research we have is based on heterosexual men engaging in penile-vaginal intercourse. These men aren't the only ones who get heart disease, and there's more to sex than intercourse.

Counseling Is Needed
The statement advocates for physicians to begin counseling their patients on the general low risk of sexual activity, as well as specific information they need regarding birth control, pregnancy, the use of erectile dysfunction drugs, and more. The authors highlight depression and anxiety as two common experiences that are related to cardiovascular disease which can on the one hand make engaging in sexual activity more challenging, and on the other are experiences that can be to some extent alleviated by pleasurable sexual activity.

More About Sex and Heart Health From About.com:

• Tips on Talking with Your Doctor About Sex and Heart Disease
• Sex and Heart Attacks
• Recommended Sex Positions Following a Heart Attack
• Sexual Dysfunction and Heart Disease
• Sexuality After Stroke

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Calling for Better Care: New Recommendations for Sex and Heart Health originally appeared on About.com Sexuality on Tuesday, January 24th, 2012 at 00:01:06.

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It may be hard to imagine sex without moving, but sometimes it's the moving that makes it hard to imagine ever having sex.

This week instead of answering one sex question in particular I took inspiration from about a half dozen questions I've received over the past year all about whether or not it's "normal" for your sex life to slow down after you move in with a partner.

Of course "normal" is code, and in this case I think it's code for a few things: predictable, okay, understandable, something to worry about.

I tried to write a response using as little code as possible, and to offer some post-moving sex tips for those who are unhappy with the situation, whether it's okay or not.

Read more: Sex After You Move In Together

Related: Sex Tips for the Rest of Us

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When Moving Is Bad for Sex originally appeared on About.com Sexuality on Wednesday, January 18th, 2012 at 00:01:13.

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I'm making one New Year's resolution. I get many great questions by email and I don't have time to respond to them all. This is something I feel bad about. My resolution for this year is to not only reply to a few more questions each week, but to try and publish at least one response a week. And as a sub-resolution I'm going to try and feel less bad about the whole thing. I think I have a good chance of achieving one of these goals.

This week's question comes from a 53 year old who is feeling pressure about ejaculation. Actually he isn't feeling the pressure like he used to, and that's his question.

Read on: Help for Low Pressure Ejaculation

Read More: Your Sex Questions, Answered

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My Ejaculation Situation originally appeared on About.com Sexuality on Tuesday, January 3rd, 2012 at 11:43:25.

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