Sex work and the transactional nature of human relationships

Sonnenschirm_rot_redNew essay in Lancet Psychiatry

My latest piece is called Sex work – society’s transactional blind spot.

In the article I explore the transactional nature of human relationships and how we are encouraged to bargain with others, from a very young age, for social and emotional survival. I have focused on sex work because it is a significant cultural issue that polarises opinion and inspires much clichéd and harmful representation in art and media.

Sex workers also report poor experiences in therapy and within the mental health system as a whole.

The opinions and experience of those who actually do it are often ignored or marginalised

Even if you cannot imagine doing sex work yourself, or think you don’t know anyone who does it, it’s worth reflecting on it as an issue of labour rights, self-determination and consent.

Political support for change

Just after the piece was published, the UK Home Affairs Select Committee declared in a report that there was a very strong case for decriminalisation. Amnesty International reached a similar conclusion in 2015 which has now become policy. This move has also been supported by the Lancet.

If you are affected by any of the issues here and would like to explore them further in therapy, please get in touch.

[The image above is by Usien and can be found at]


Are you stuck on the Sex Escalator?

tg-1-27Today I’m talking about the repetitive sexual conveyer belt that we can find ourselves on if we pay too much attention to cultural influences and not enough to our own needs.

I’m calling it the Sex Escalator because you can sit on it and it will take you somewhere that feels vaguely elevated over and over again – and you need not think about it, ever.

Remember the ‘Relationship Escalator’?

You may well have heard of the ‘relationship escalator’, an idea that originated in non-monogamy research circles and promoted in excellent article about polyamory that I have linked to before. It’s about how relationships are culturally encouraged to follow a tried and tested formula – essentially meeting, dating, becoming a (preferably heterosexual) couple, becoming exclusive and monogamous, moving in together, getting married, buying property and having children.

This model suits many people for many reasons – but it also has a purpose, namely to uphold social cohesion and provide a foundation for a very specific way of having a family. It does not deserve to be rejected outright, but it does deserve examination because many people fall into it before realising it is not what they want or need at all. And this is when relationships can become damaging.

As with relationships, so with sex

Discussing this with friends and colleagues (and working in communities where we talk about these issues a lot), even highly creative sexual adventurers will admit to having sat on the escalator at some point in life. The process goes something like this:

  1. Kissing
  2. Manual stimulation
  3. Oral sex 
  4. Penetration (preferably PIV)
  5. Peak genital orgasm
  6. The End (someone falls asleep)

People base entire marriages around this paradigm. Any deviations from this become treats, exceptions or outliers, or simply never thought of.

And of course, parts of this sequence may be missing altogether because they were never there in the first place.

This is not to judge anyone or criticise this as a way of having a good time together. Over time you may have discovered the most efficient way to orgasm with one person – and after all it’s pleasure and connection you’re after. You may be frequently tired and you may be busy and you may have family to take care of.

The problems start when you’re increasingly unhappy – but you’re not doing anything about it.

Communication as taboo

The problems start when communication ends. For many people, unaccustomed to stating even the simplest needs, useful communication will stop as soon as mutual liking is discovered. For many people this may even come as a relief. In the UK we have a popular trope of two people getting drunk together on a date, waking up in a relationship, and then being delighted that it need never be mentioned again, perhaps for several years.

As with emotions, so with sex.

A package deal of conditioned behaviours and expectations

On the Sex Escalator:

  • Anything else doesn’t really count as sex, or is weird.
  • It’s vital to have a goal, and that goal is ‘full sex’ because the rest is just ‘foreplay’.
  • If you miss out the genital penetration, the sex is incomplete and has failed.
  • If the escalator doesn’t arouse you that much, you should keep quiet about it so as not to create disruption.
  • If the escalator doesn’t arouse you that much, you may need to seek outside help, because the problem is your fault.
  • If the escalator doesn’t arouse your partner that much, you should tell them to seek help, because the problem is their fault.
  • Obviously the penis owner will have an orgasm, because they definitely enjoy penetration. (Go here for a longer discussion on why a number of people actually aren’t into penis-in-vagina sex. Go here for a rather more brutal takedown of this sexual trope from a feminist perspective.)
  • The vagina owner really ought to have an orgasm because otherwise they must be dysfunctional and the penis owner won’t like them any more due to their imperfect functioning. 
  • You dare not discuss any of this with your partner in case they are offended or think you are about to criticise them.
  • Deviating from this pattern in any way is terribly adventurous and needs masses of preparation and expense.

I would like to think that the generations that have grown up with the internet will have found a better way, but looking at what young people seem to be learning, I am not so sure. And although this feels like a strictly heterosexual/cis model, any pairing of genders and sexualities could technically enact this. 

I also have a suspicion that this conveniently boxed scenario keeps people more heterosexually confined than they would ideally wish to be.

If the Sex Escalator isn’t working for you

If you keep on ending up having sex like this, and you’re not enjoying it, or you feel that there’s something missing – ask yourself some questions. If you have a partner, ask each other some questions.

  • Am I or my partner truly consenting to any of this?
  • Have we actually ever discussed it?
  • Do either of us really want it?

And if you’ve said to yourself and/or each other: ‘Well, this is okay enough, and if we don’t do these things it doesn’t feel like we’ve actually had sex – ‘


If you want something different, here are some things to remind yourself about:

  • Sex does not need either a goal or a destination.

  • Genital sensation does not need to have primacy.

  • Specific activities do not have to have primacy over others.

  • There are no rules about which parts of the body should be included or left out.

  • Orgasms are nice but they are not obligatory.

  • Communicating your needs is vital. 

  • Focusing on breathing can add a whole layer of experience.
  • There is a whole world of sensation waiting for you in many areas of your body that you may not have considered.

  • Have you talked about your fantasies? Have you even thought about them?

What if you went right back to the start and asked yourself – or asked each other – what do I/we really want?

Am I overstating this? Judging by the responses I encounter when someone (or two people in a relationship) realises there is another world of sexual connection out there I am, if anything, understating it.

In a future post I’ll go into more detail about ways to expand your sexual experience.

If you’re concerned about anything I’ve raised in this post and would like to explore this aspect of your life in more detail, you can contact me here.

So you don’t enjoy penis-in-vagina sex? You’re not alone

Shop dummies

Penis-in-vagina (PIV) sex – not everyone loves it

In my personal and professional life I’m hearing an increasing number of people saying that PIV sex is ‘fine but not their main thing’, or that they don’t bother to seek it out, or that they actively dislike it. (This isn’t just about orgasms, but the whole experience of penetration.) For sure, many people absolutely love it – but many, it seems, do not. While you don’t have to be heterosexual to practise it, PIV is a mainstay of heterosexual culture.

In this article I’m exploring the cultural aspects of PIV sex, and offer a number of reasons why some people don’t enjoy it or wish to have it.

A note on terminology

Penis-in-vagina sex is often referred to as ‘penetrative sex’. This is confusing because there are actually a large number of ways one body can penetrate another that do not involve a penis or a vagina. (I will cover these in a future article.) However, where I use the word ‘penetration’ in this post, it refers solely to PIV.

Traditions and beliefs about PIV sex

Here are some ingrained ideas about PIV (and sex in general) that are foisted on us from an early age:

  • It’s ‘the one true way’.
  • PIV is ‘full sex’ – other kinds are merely ‘foreplay’.
  • It’s about being a heterosexual man and woman together.
  • PIV is the only way for two people to be fully intimate and anything else is not sufficient.
  • It’s about couples and being in a couple is something to aspire to.
  • It makes babies so it is special. (To be fair, before science intervened several decades ago, PIV was the primary way to conceive.)
  • ‘Taking’ a woman’s virginity involves putting a penis inside her. No other form of sex counts as loss of virginity. (This is a powerful tradition, as if having a penis inside her creates the woman as an adult, and nothing else can do this.)
  • There must and will be orgasms from penetration alone or something is wrong.
  • Penetration must occur via the genitals or sex didn’t happen.
  • In fact, if there isn’t a penis in the room, it isn’t possible for sex to happen.

Unfortunately, the increased awareness that we are all supposed to have gained via the internet does not seem to have affected the Sex and Relationships Education agenda very much. It still tends to be focused around fear rather than pleasure.

And people often confuse PIV sex not working well with sex as a whole not working well. This causes some people to sideline sex altogether. However, showing people the almost limitless amount of sexual choice available to them beyond PIV can be very challenging. It becomes easier to just hide in the ‘sex isn’t working’ bubble and do nothing about it, rather than really talk about what you want. (See also BISH UK on Why Penis in Vagina Sex can be Meh.)

I have heard BDSM practitioners refer to PIV as ‘just another kink among many’, and this seems far healthier. There can be huge personal cost to going along with what everyone else seems to be doing, in other words trying to be normal. There are as many different body types as there are sexual responses, and that includes inside the body as well as outside. The reality is that some people’s bodies work in some ways and some in others.

There are of course a large number of gendered aspects to this

As I said above, PIV is a cultural mainstay of heterosexual life. There is still pressure on a vagina-owner to ‘submit’ to being penetrated (showing that they like it but not too much and not having opinions about what the sex should be), and that they must be entered only after protracted negotiation (if they give it up too easily they are a slut).  Actually, the majority of people with vaginas don’t orgasm through penetration, but this myth continues to be perpetrated everywhere and it damages everyone, as it encourages false expectations. This creates not only an entitlement culture but a blame culture about who has an orgasm and who doesn’t, and whose fault it was. For more on this, please see my post ‘Some Myths and Half Truths about Orgasm.’ See also this piece on vibrators, which outlines the issues very well.

There is still pressure on someone with a penis to be manly and thrusty and penetrate things because that is what they are obliged to do in order to fulfil some sort of masculinity contract, and this after all is what genitals were designed for. Effectively, penises must chase vaginas for sex, as many as possible, (and possibly impregnate the owner too where possible) and if they don’t, then the very concept of masculinity is in question.

Eight reasons some people don’t like or want penis-in-vagina sex

As you can see, this list ranges from the preferential to the situational to the medical. All have the potential to be pathologised in a culture that values PIV above all else. This list does not pretend to be exhaustive (particularly the health-related content) and I welcome additional suggestions.

(1) You just don’t like it very much.

Or you don’t orgasm from it and prefer sexual activities that are more reliable. Or you prefer other forms of sexual connection anyway.

(2) Sexual orientation

The cultural primacy of PIV sex sidelines and erases non-heterosexual identities. While queer sexuality embraces a multitude of ways of connecting sexually, those who do not do PIV because of their orientation or lifestyle are seen in heterosexual culture as ‘not doing it properly’ and may be quizzed in detail about what it is they actually do.

(3) Varying intimacy tolerance

Intimacy is often stated as something desirable above all else, and if you don’t have ‘enough’ of it, there is something wrong with you. For sure, having your body penetrated by another, (in whatever way), is a very intimate act, both for giver and receiver. But if someone doesn’t want this, it means therefore that they have a problem that needs fixing, medically or therapeutically.

I reject this traditional framing of intimacy because it does not take into account individual experience. For example, one person’s attempt to remove the emotional boundaries between them and another person might be another’s profoundly destabilising intrusion. And in fact many childhood experiences create a bedrock of feeling where physical intimacy is profoundly unsafe, (and this does not need to have come from sexual abuse). People commence their emotional and sexual lives at different levels. It is not an equal playing field. Culturally, individual experience is persistently and ongoingly sacrificed to the benefit of an outdated agenda.

 (4) Performance anxiety

PIV sex demands a certain level of performance from the bodies of both parties. Both sets of genitals have to do certain things to make it happen. Of course there are tools that can help the process – lube, pumps, pills, porn – but there can often be a psychological disconnect between how a person is feeling and what their genitals appear to be experiencing. This is heightened by Sex Olympics Confusion about who has the biggest penis and who is the longest lasting, or who has either the tightest pussy or can take the biggest size, whether of penis or object, or who can ejaculate the most prolifically. Lack of lubrication is also an issue, because everyone’s body and expression of desire is different, and this is not always due to a health/medical issue. ‘Long lasting’ penetrative sex can cause discomfort, but it’s still A Thing that some feel they must aspire to.

In our highly visual culture of competition, it is possible to feel very inadequate. In cases of ‘dysfunction’ (and the whole concept of dysfunction is problematic) the body may be speaking where the mind cannot.

(5) Partner incompatibility 

Genital mismatch, sex drive mismatch, or intimacy tolerance mismatch. Sometimes people put up with these things for years in order to remain in a relationship. Such is the power of couple culture. Some suffer in silence and some end up avoiding sex altogether, simply because it is easier to do this than ask for what you want and negotiate.

(6) Fear/shame

Fear of getting a Sexually Transmitted Infection – HIV, syphilis, chlamydia, herpes, gonorrhoea, etc. Many fear herpes because, while not life threatening and asymptomatic for many, it seems to have more shame attached to it than some other more serious conditions. Also, the shame around having an STI can also make sex a less desirable activity.

Fear of pregnancy or getting someone pregnant. (Also, if you have recently given birth, you may want to be sexual without being penetrated.)

Fear of engulfment inside another person. (Sometimes expressed by the myth of the vagina dentata.)

(7) Pain/discomfort

‘Honeymoon cystitis’ – In the early days of a relationship, PIV sex can put the body into an illness cycle – vigorous penetration can cause cystitis, which is then treated with antibiotics, which then cause thrush, which is treated with messy insertables. This cycle can persist, and needs to be caught and treated to avoid the condition travelling to the kidneys.

Vaginismus – the vaginal muscles clench so that penetration becomes difficult and painful, or impossible. Given the pressures on us all to conform to specific appearances and body types, I am amazed that more people don’t experience this – plus the number of people who have their physical boundaries crossed when they are too young to protest and for whom penetration has deeper and more stressful significance. One of the advised ‘cures’ for vaginismus is dilation with increasingly sized ‘vaginal trainers’, as if the lack of desire for penetration must be fixed at all costs.

Muscle tension – there is often confusion about vaginal musculature. Often there is a rush to do kegels (PC squeezes) because ‘loose’ vaginal muscles are seen as the worst thing in the world. In fact, although the exercises can be helpful, the underlying problem can be excessive muscular contraction rather than ‘looseness’. Biofeedback (which is also used to help urinary incontinence) can help show what is going on in the vagina. Sexological bodywork or intimate massage can help. A person if they are lucky could be sent to a woman’s physio at a hospital. Pelvic tension is an issue for both sexes, but is rarely mentioned by doctors.

Phimosis – the foreskin won’t retract properly and makes sex painful. This is a source of shame and embarrassment and many people even in middle age don’t feel comfortable seeing a doctor about it and continue to put up with painful sex, or none. There is an opposite disorder (paraphimosis) where it becomes stuck in the retracted position.

Pain syndromes such as dyspareunia and vestibulodynia. Also Medically Unexplained Symptoms (MUS) relating to shame.

Internal conditions such as endometriosis, ovarian cysts, Polycystic Ovary Syndrome (PCOS), Pelvic Inflammatory Disease (PID). Tilted or retroverted uterus, which can make deeper penetration painful. Internal scarring/adhesions (either sex). Prostate issues.

External skin conditions which can make genital touch or friction painful – eczema/psoriasis, lichen planus/sclerosus, and thrush (in fact thrush has traditionally been used as a catch-all diagnosis where something else is the problem) – and/or whose appearance may cause the person to feel self conscious.

You might have read the list of health conditions above and thought to yourself, ‘Why not go to the doctor and get it sorted out?’ Unfortunately, many of these conditions are not so easily fixed. Sometimes a person has to learn to live with them and negotiate their sex life around them.

(8) None of the above – you just don’t like it.



Our culture currently privileges one way of being at a cost to the rest. We would save a lot of money public health if we improved sex education around this and people felt able to express their true sexual selves without feeling inadequate.

The more people speak out about this, and promote other ways of being sexual, the happier many people will be.

CBT ‘a scam’, the joy of polyamory, parental estrangement, terrible sex ed…

keyboard close-up‘Are you a pervert?’, invisible disability, trans* history and politics, sex work and the modern slavery bill…

A regular roundup of links to things I’ve found interesting, either because they’re very recent, or because I think they deserve another outing.

Please note: me linking to something doesn’t mean I endorse every word in the the article or anything else carried on that particular website. Some of these articles carry an obvious content warning, and some, depending on their subject matter, may be very slightly unsafe for work.



The Debt – When terrible, abusive parents come crawling back, what do their grown children owe them? (Slate)
Long, excellent article about people debating whether to resume contact with the parents who harmed them.

‘Loved ones and friends—sometimes even therapists—who urge reconnecting with a parent often speak as if forgiveness will be a psychic aloe vera, a balm that will heal the wounds of the past. They warn of the guilt that will dog the victim if the perpetrator dies estranged. What these people fail to take into account is the potential psychological cost of reconnecting, of dredging up painful memories and reviving destructive patterns.’

Lauren Laverne – It’s Time to Make Emotional Abuse a Crime (Guardian)
I think it’s important to keep saying this, whether individuals or charities. But I’m curious about the way language is used when applied to children. Children are ‘bullied’ at school, but this word is often not used when this occurs in families at home. Similarly, the word ‘abuse’ is rarely used in a school context. Sometimes is not quite joining up for me here.

‘What I remember most about emotional abuse is that it’s like being put in a box. […] So you try to make yourself fit. You curl up, become smaller, quieter, remove the excessive, offensive parts of your personality – you begin to notice lots of these. You eliminate people and interests, change your behaviour. But still the box gets smaller. You think it’s your fault. The terrible, unforgivable too-muchness of you is to blame. You don’t realise that the box is shrinking, or who is making it smaller. You don’t yet understand that you will never, ever be tiny enough to fit…’

Am I obligated to disclose my invisible disability? (xojane)
Invisible illness/disability comes up a lot in conversation, particularly around mental health as well as physical.

‘Frequently, when people who know about my accident ask me if it hurts still, I deflect or spew platitudes and just say, “Oh, you know.” I don’t say that physical discomfort has been a near constant companion.’

Oliver James declared Cognitive Behavioural Therapy to be a ‘scam and a waste of money.’ (Daily Mail)
This started a long discussion online, with most having the view that CBT is very useful for specific things, but less effective where there are deeper problems that need longer work and a fuller therapeutic relationship. There’s a general sense of too much money being funnelled for far too long into this very specific way of working. One size doesn’t fit all. I’m curious that this story has not been carried anywhere else. I’ve put it here as a discussion point, and I’m interested as to whether there will be more on this.



The Joy of Polyamory (Archer)
Long and fulsome article by Anne Hunter. One of the big contrasts I notice between monogamy and polyamory is the issue of terminology. It feels to me as if many people in monogamous situations that are not working for them are caught in structures that they would change if only there were a name for what they are looking for.

‘Many of my relationships don’t have a simple label available to them. For example, I have some beloved intimates with whom I will jump into bed, naked, and talk about absolutely anything. The relationship is way past what most people think of as a friend – there’s no sex, so it’s not a lover; we don’t make life decisions together, so it’s not a partner. There is no term that accurately describes our connection.’ 

‘Are you a pervert?’  (Vice)
This is actually a serious and quite important piece by Martin Robbins outlining the double standards around what are still, in some quarters, known as ‘paraphilias.’

‘The thing is, pretty much every type of sexual desire can cause distress or harm to others, regardless of the kinkiness involved. Why fixate on kink? How can you even determine what is normal or paraphilic in the first place? […] Are the people who are trying to express their sexuality really mentally ill, or is the real sickness in the repressed culture that’s so terrified of them?’

The ‘dispute’ between radical feminism and trans people (New Statesman)
Long and important piece by Juliet Jacques in the New Statesman. It’s also an excellent history, both public and personal.

‘In a world where left-wing politics have often derided LGBT identities as ‘bourgeois’ and then accused us of splitting the movement, it infuriates me that I’ve had to take a break from writing a piece on the Tories’ ‘liberation’ of the NHS to write 8,500 words to debunk a sexological concept that was shown to be untenable before the start of the First World War.’

Yesterday (Nov 20) was also International Transgender Day of Remembrance.

Listen to sex workers – we can explain what decriminalisation would mean (Guardian)
After intense campaigning, an amendment to the modern slavery bill was dropped, which would have brought in the Swedish model of criminalising clients.

‘Mactaggart’s justification for attacking “demand” (clients) is that “prostitution is an extreme form of exploitation”. But exploitation is rife in many industries, including the agricultural, domestic and service industries, particularly at a time of increasing poverty, decreasing wages and insecure employment, and no one suggests that domestic work or fruit-picking should be banned.’ 

Sex education in schools: it’s just bananas (Guardian)
Eye popping Guardian piece about the state of Sex Ed in schools. I’m putting this here because this lamentable situation affects us all, whoever we are. The way we are introduced to sex can reverberate throughout our whole lives.