As a specialist in the field of sexual medicine for over twenty years, I frequently hear people ask “how can you guarantee a satisfying and electrifying sexual experience every time?” Clearly, “silver bullets” to answer this question do not exist because the personal variables are great. However, there may be some basic techniques and truths, which can help many couple’s experience greater sexual satisfaction more often.


            Basically, I have found boiling the mystery of physical intimacy down to 3 C’s for Successful Sex can help couples enjoy greater physical intimacy and sexual satisfaction more of the time. From my perspective, the 3 C’s are: Caring, Communication, and Creativity. Each of these concepts will be discussed and explained in greater detail in future paragraphs. The goal is to develop a better understanding of how they can be used effectively when sharing physical intimacy with a partner.


            The first C-Caring, refers to the interpersonal relationship being shared by two people. This implies they have a friendship, affection, attraction, respect, and fondness for each other. These feelings work best when each person has a solid sense of self, which might allow each individual to feel fully relaxed and flexible with this kind of interpersonal relationship. It also implies they know, trust and respect who they are within their own skin, which allows them to give that to others, and receive it back from others. WHOA….this is a really big prerequisite…Or, they can differentiate and depersonalize--not to personally react to disappointments of others. WOW…another big construct…


Fortunately, or unfortunately, the body is wired to function best when the neural and vascular systems are relaxed. Hence, when we are truly “comfortable in our own skin”-we are more relaxed with our deepest and truest self. Additionally, when we are relaxed during physical intimacy, we are more able to feel good about ourselves and be less critical of ourselves or our partner-the Negative Tape plays less often. And, we are more flexible and compassionate with our partner and able to have a better time sexually! Usually, when there is a sense of self-trust and self-respect, it is easier to give and receive that trust and respect from our partner, AND, have a better time sexually! Yes, there is an echo here! With the 3 C’s--most couples can have some satisfying sexual experiences. I have seen couples with relational conflict, and for some strange reason, they can have satisfying sex because of the understanding provided with the 3 C’s. Somewhere deep within each of them, they truly love, trust, and respect their partner enough to feel “safe” with the physical intimacy, which they share together. Hence, the neural and vascular systems are able to stay relaxed while their emotional system may have recently been fully charged. Some couples say “sex is a great cement in their relationship….and others say it is a wedge in their relationship.”  My goal is to help couples keep the cement in tack, which should help them build confidence they can “weather” whatever storms life may bring their way as they go and grow through this journey called life!


Normally, for good sexual function to work, the neurological and vascular systems need to be relaxed, which is what happens with caring, compassion, and flexibility! In the first phase of the sexual response cycle (SRC)  [1] the desire or caring phase is crucial for good sexual function. Arousal is the next phase in the SRC, and this would also be part of the caring process in physical intimacy [1]. Typically, when someone cares for another in a physical way, they would experience erotic thoughts and sexual desire, which would evolve to become sexual arousal. Sexual arousal progresses through the SRC to culminate in the act of “sex”-whether in the “Clintonian” [2] version or the normal definition of “sex”. Those of us in the sexual medicine field [3], believe that all aspects of “sex” are to be included in “sex”, whether oral, manual, intercourse, or with apparatus. 


One of the physiological prerequisites for good sexual function is relaxation at all levels of awareness within the mind/brain. This means that when one member of the couple has stress or distractions, they are not able to be fully relaxed-physically and emotionally. Unfortunately, sexual intimacy is a dynamic process because it impacts both people. I frequently tell couples that when one person is anxious or distracted, the other person usually picks up the anxiety and amplifies it back to their partner. Hence, both people end up anxious or distressed and distracted and it may be difficult for the couple to have a “good time with physical intimacy”. I often tell couples that “sexual response is the most obvious sign of this inability to be fully relaxed” and it plays out in the connection of the relationship-called intimacy. Thus, it is important for couples to allow themselves to relax prior to and during physical intimacy to encourage good sexual function for both parties. In the second phase of the SRC, many people notice the idea of being relaxed when they are really supposed to be excited [1], seems counterintuitive. However, it is imperative that the neural and vascular systems, fueling the physiological sexual response, be fully relaxed at every level of awareness within the mind/brain. The hormonal system is activated with either the sympathetic (survival-fight or flight) system or the parasympathetic (pleasure and procreation) and these hormones and neurological systems influence the sexual response. When women are relaxed, feel safe (and heard), they are able to secrete _____hormones and this starts the SRC [4]. There was a study with functional magnetic resonance imaging (fMRI) done at the University of Washington in Seattle by Heiman and Maravilla [5] showing that the area of activation in the female brain with sexual arousal is in the prefrontal cortex, related to the executive functioning and judgment. This is why I can say that women “need to feel heard” to feel safe, relax, and become sexually aroused. With young men, we were able to identify their areas of activation in the brain with sexual arousal and the fMRI technology [6]. At the Stanford Medical Center, we found this area of activation was more of the deep dorsal areas and the somatosensory areas, known as the more primal areas of sexual arousal [6]. Hence, women and men have very different methods of sexual arousal when they are young. However, my hypothesis is this all changes when men age, and they also require more “emotional connection” and possibly prefrontal activation for sexual arousal. We won’t know this until we are able to complete the research with more funding. And, this leads us to the next C for Successful Sex, which is Communication.


The second C for Successful Sex is Communication. When I use the word “communication”, I am including a broad range of reasons for this being critically important in good sexual function. First, it is a significant method for many women to get turned on sexually. This is why we have heard for years that the biggest female sexual organ is the one between our ears-the mind [7]. And, this may be part of the reason we believed for many years that most of the sexual dysfunctions were 90% psychological [8]. However, a lot of this thinking may also have been a direct result of the Freudian belief that psychological disorders were sexually based [9]. Regardless, the main reason for men to be aware of the importance of female sexual arousal being a direct result of “feeling heard” is because it IS one of the main methods for sexual arousal for many women. This is a GLOBAL phenomenon, as I have verified this theory with many women from around the world, at international sexual medicine meetings as well as in my private practice in Silicon Valley. History tells us that many famous scenes from movies of old had the classic “silver tongue” hero, sweet-talking to the heroine, and she was sexually aroused in the process. He could “have his way with her”….and, so the story goes….


Additionally, when I refer to the importance of communication in good sexual relationships, I am talking about the communication skills prior to physical intimacy, during, and after a sexual encounter. We have talked about the foreplay aspects of communication, and now I would like to discuss specific sexual talk during sex. This includes the ability for either partner to verbalize their personal preferences, thoughts, and feelings in a positive way during physical intimacy. Unfortunately, many couples have so much negative history with each other, they do not know how to say anything positive anymore. This is especially true during physical intimacy, so it is easier to say nothing at all. For many women, we were conditioned not to say anything that could be construed as negative about sex because that was not appropriate for “good girls”. And, we knew that the male ego was closely tied to the penis. Hence, women wouldn’t say anything that could injure that fragile ego/sexual identity by saying anything remotely critical-or constructive-because it could be taken negatively, and crush or bruise the male ego-the ego of our beloved! Also, many women don’t know how to express their desires from their beloved on the rare occasion he may ask “what can I do to give you pleasure?” Hence, the old saying, “if you have to ask for it, it’s not special anymore”…however, if women could “find their voice in an empowered way”, they would probably have a better chance enjoying themselves in the bedroom.


Sexual roles have changed over the past fifty years and more women are “finding their voice” in the bedroom. However, I feel they still do not know how to speak clearly, and yet lovingly, when they are sexually frustrated. This is part of the reason my research has focused on the importance of having the couple present for sexual counseling together. It IS the couple that experiences the sexual problem regardless of which member of the partnership may be physically demonstrating the stress of the relationship. There is good news and bad news about women finding their voice in the bedroom. My youngest male presenting with erectile dysfunction (ED) was a young man at the age of 16. His history reported that he had successful sex with roughly forty female partners over the course of the previous two years. During this time, he began to hear some disparaging remarks about his size and sexual abilities. These negative comments helped to create performance anxiety, and he was literally afraid to try with women again until he got some information about “normal” sexual functioning. This is an example of what I mean by the bad news about women finding their voice in the bedroom. It can have a negative impact on the male ego, which is one reason we have “kept our mouths closed” for years. The good news about women finding their voice in the bedroom is that it allows them to be clear and empowered with their partner, where they are in the SRC, and then the partner might have a better chance to be closer to the same place with the woman. Clearly, the goal of mutual orgasms is not a realistic goal, and I am not promoting the “come together” desire for some couples! However, I do promote mutually respecting sexual interactions with clear communication, when both people are empowered and confident enough to find their voice in a positive way with their beloved! Again, balance seems to be the order of the day, with the goal of some mutually satisfying physical intimacy shared by two caring and communicative people, done in a way that is respectful and pleasurable for both.       


There is one interesting phenomenon which many men are not aware of that also influences their sexual arousal in the “middle years.” My hypothesis is that they also begin to change their sexual arousal cues within the brain, as I mentioned previously. Instead of being visually aroused, as they have been for most of their lives, many men report after the age of 40 plus, they start to notice a change in their ability to get aroused via erotic pictures or videos (porn). Many men aren’t able to put two and two together to realize that just as women experience menopause, men have a change in their sexual arousal, which impacts their erectile function or dysfunction (ED). As a researcher on this topic for many years, I have certainly seen and documented this phenomenon. Typically, men in the middle years report that they too get more turned on and aroused via emotional connection or most frequently I hear them say that they must feel “connected” to get fully aroused. With clear communication, mutual respect, and flexibility in the relationship, the ability to feel connected is much more likely for most men. Additionally, I hear many men in this age group report that they want to feel desired by their partner. This creates a double bind for women, who were wired to expect the man to be the “pursuer” and “finding their voice”, let alone being the initiator, is very difficult for most women. The double bind comes, especially when their partner has had some difficulty with erectile/sexual function, because they are also afraid to initiate sex and fear his sexual failures. This is also part of the CARING in the three C’s!


As a professional specializing in male sexual function, I frequently hear men complain of rapid ejaculation-coming too quickly-typically, within one to two minutes of intercourse [10]. We can teach them to communicate with their partner during sexual relations, so that each member of the partnership can see where the other person is in the SRC. This can also allow the man to judge, more effectively, his own arousal and excitement responsiveness to learn to last longer. And, the best part is that if he can talk to his partner more during the sexual encounter, he might also help her to get more aroused in the process and help her get closer to orgasm much easier than by not talking to her. Additionally, in this process, he can learn that if he talks more within the sexual arousal process, and even if he had an orgasm sooner than he wanted, typically, he would be able to get another erection and last longer the next time with his partner.  


The final C-Creativity is the most fun, and the one I save for last in sexual medicine treatment. It is more like brainstorming with clients to think about how they can “think out of the box to keep the spark alive” in their sexual relationship. This ability actually helps to fuel the arousal process in the SRC. If we have the same old “meat and potatoes” all the time, the desire for that diet eventually wanes. Hence, the arousal decreases and ED increases. However, if we can mix in some variety, then we would continue to look forward to new taste treats in the process. One of the greatest barriers in helping couples to become creative sexually is their own inner limitation, which is when they allow themselves to be physically and emotionally vulnerable (*) with their partner. This is why it is critically important for each person in the couple to have a solid sense of self and flexibility to try some new sexual interactions, positions, locations, and who knows what else they can think of sexually. I say that we are only limited by our own Creativity!


(*) It is interesting to me that after working in this specialty for so many years, I continue to hear men say “they can never be vulnerable with their partner” because “she would use it against me”. My answer to this statement is that it is a lot more about the woman’s insecurity than the man’s vulnerability if she needs to use something he perceived as “vulnerability” against him at any time in the future. We all need to remember “our vulnerability is our power”. At the end of the day, we are all just humans. Accepting our human vulnerabilities is really the first step in learning to relax, enjoy ourselves, others, and life! More will be said about this theory in future books and articles.


Relationships are supposed to be fun, and it is the ability to feel relaxed, aroused, and loved which often brings two people together in the first place. Many of the people I meet, report that they “used to be able to talk for hours and felt like we were best friends…and now all that has changed for the worse”. Once we have verified that the desire to return to that pleasurable state is there for both members of the couple, then, we can work to bring it back. The fun factor is the last phase of sexual medicine treatment. I usually ask couples to share their sexual fantasies, their most erotic experience, and then I share some of the experiences I have heard or read about as a sexual medicine specialist. One of the first homework assignments I usually give couples is to go dancing because I know that most women enjoy it and find it arousing-with the bodies moving in rhythm and motion. One of my favorite couples took the assignment seriously and reported that they locked their bedroom door after putting their six year old to bed and had a wonderful time dancing in their bedroom without their clothes on-“was that OK?” Needless to say, I said, “you bet!” Then, they gave each other a sensual massage, and by the way, “they had the best sex in their fifteen year marriage…was that OK”? YOU BET!


There are many resources available for couples to explore their sexual intimacy, ranging from erotic books, stores, DVDs, videos, and workshops. Personally and professionally, I prefer the Sinclair Intimacy Institute’s book and video selections because they have a wide array of educational and arousing materials. I have used many of their videos in research projects and daily in my private practice. To date, all of my patients seem quite comfortable with the information and format of these resources.  Ordering materials is simply done via the internet at




[1]  Masters and Johnson, Human Sexual Response. 1966. NY: Little, Brown and Company.


[2] Lacanyo, R. “When is sex not ‘sexual relations’?” Aug 24, 1998. All Politics CNN.


[3] Merriam-Webster Dictionary, 2013. Definition of Sex


[4] ] Brizandine, L. 2006. The Female Brain. Sex: The Brain Below the Belt. New York: Morgan Road Books.


[5] Maravilla KR, Yang CC. Magnetic resonance imaging and the female sexual response: overview of techniques, results, and future directions. J Sex Med. 2008. 5 (7): 1559-71.


[6] Arnow BA, Desmond, JE, Banner LL, Glover GH, Soloman A, Polan ML, Lue, TF, Atlas, SW. Brain Activation and Sexual Arousal in healthy, heterosexual males. Brain. 2002. 125 (Pt5): 1014-23.


[7] Brizandine, L. 2006. The Female Brain. Sex: The Brain Below the Belt. New York: Morgan Road Books.


[8] Zilbergeld, B. 1999. The New Male Sexuality. New York: Bantam Books.


[9] Hartmann U. Sigmond Freud and his impact on our understanding of male sexual dysfunction. J Sex Med. 2009. 6 (8): 2332-9.


[10] McMahon, CG, Waldinger, M, Rowland, D, Assalian, P, Kim, YC, Bechara, A, Riley, A. “Ejaculatory Disorders”. In Porst, H, Buvat, J. (Eds). 2006. Standard Practice in Sexual Medicine. Malden, Mass: Blackwell Publishers.  

© Linda Banner 2012