If you think it’s mainly sexually unconventional or differently wired people – gays, lesbians, queers, kinksters – who naturally will be the most ashamed of their sexual desires, you’re wrong.

      How we feel, personally, about sex acts is certainly impacted by the religious and social norms, of course. We can see the brutal evidence of that in the high rates of suicide among gay and transgendered youth, for example, who feel emotionally overwhelmed by the negative social messages they get about their identities. The pain people experience by feeling socially outcast, rejected or mocked by peers, treated as sinners or mentally ill people, and denied their human rights on the basis of their sexual identity, is enough to destroy anyone’s self-esteem.

      But, interestingly, it’s equally, if not more strongly, influenced by how we feel about ourselves. People with fundamentally positive views of themselves tend to be self-accepting, no matter how quirky, edgy, or sexually radical they are. They tend not only to ask for what they want, but they expect to get it and on the whole get more of what they want out of sex than other people. They don’t believe their sexual interests make them a flawed person or less than others; indeed, it may make them feel more creative and adventurous than others. In other words, people with good self-esteem feel entitled to sexual pleasure in bed and seek it out on their own terms.

      People with a negative sexual self image tend to feel anxious and inadequate. They find it hard to articulate what they want, and harder to ask for satisfaction. They may be their own worst enemies – censoring their fantasies, sublimating all their urges, and sacrificing their needs to please their partners or their parents. They may struggle with shame for wanting what they want, or wish they were more like other people, who they imagine are having better sex lives. In the end, they never get as much sex, or the kind of sex, they need to feel complete.

      Resolving sex issues in relationships isn’t as hard as people believe it to be. I think people are scared that sex will turn out to be too embarrassing or mysterious for them to handle. They’re afraid that opening up about their sexual needs and fantasies to their partners will hurt their relationship. My clinical experience has been the opposite: secrets destroy otherwise supportive, respectful, loving relationships.

      BARBARA was a bio-engineer in her late 40s and married to her high school sweetheart, Jim. She heard me on a Playboy radio show talking about swinging and bisexuality, and wanted my opinion on her marriage. About a year ago, she learned that Jim had been cheating on her for the past 12 years. It was ugly at first. They fought and cried over it, and finally, they reached a place of peace and forgiveness. They still loved each other. They didn’t want to divorce.

      She accepted responsibility for her piece of it: she lost her desire for him about seven years into their marriage. She’d had some infections and had to avoid sex on doctor’s orders for a year. After that, her desire never really returned. First it slumped to once a month, then once every few months and now it had been almost 15 years since they’d had regular intercourse. When he finally confessed about cheating on her, it hurt like hell but it wasn’t a total surprise.

      When Jim told her that he’d been dipping his toes into the world of swinging and group sex, Barbara said her ears perked up. She’d always been curious about it. She made him give her all the details on his experiences. Instead of feeling angry, she felt envious, even turned on by the thought of group sex. She looked at Jim through fresh eyes: it made him seem sexier now that she knew that other, younger women had found him attractive.

      They started making love again and that, too, seemed more exciting to her than she remembered. After thinking about it for a few weeks, she asked Jim how he’d feel about exploring the swinger lifestyle as a couple. She’d always had bisexual fantasies and wished she had the nerve to try visiting a sex club. Jim was amazed and, of course, enthused, and they began looking for an event they could attend.

      On a whim, Barbara visited a psychologist to hear what a professional thought about her situation. Was she crazy for feeling the way she did? The psychologist seemed to think so. She was alarmed by Barbara’s story and felt that Barbara’s sudden interest in swinging must be a symptom of her grief. Or maybe Jim had secretly coerced his wife into enabling his own sex addiction. She urged Barbara to give herself a year, perhaps two, to slowly heal from her husband’s betrayal and come in for weekly counseling to work on her dependency issues. Barbara left that session feeling completely rattled.

      The possibility of an open marriage – something they’d never considered before – was actually exciting to her. She saw it as a way of not just getting back her sex life with her husband, but having a sex life that would never bore her. Was she wrong to want that? Did I agree with the psychologist that she needed to spend more time grieving?

      I understood the psychologist’s concern about the betrayal. In general, yes, people need time to process grief and betrayal. For some, the shock of the betrayal is so overwhelming they end the relationship there and then. Even when partners negotiate a truce, they may still feel hurt and unable to resume intimacy until trust is restored. Sadly, there’s no guarantee trust can be restored after betrayal: that depends on a wide range of factors, from someone’s capacity for forgiveness to his or her attitudes about sex. So when you work with individuals, you have to figure out whether they fit the general pattern or whether they break the mold.

      Barbara and her husband were definitely mold-breakers. Their commitment to their marriage was unshakeable and their attitudes about sex were liberal. Barbara was hurt at first but, practical minded, she did not view sex outside of marriage as a deal-breaker. Her husband was genuinely repentant. They had already come through the worst of it and seemed more solid as a couple than before. All those factors worked in their favor. They only needed one rigid boundary: no more lies. Jim promised Barbara and Barbara chose to believe him.