How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!
Dear How to Do It,
I am a trans woman, and while my libido is fairly low, I do masturbate a couple times a month. I recently used a dildo to try and come via prostate stimulation, but when nearing climax, I felt myself start choking. I was alone, so I thought it might have been something to do with how I was positioned, but when I tried from two other positions, the same thing happened. It was a sensation like I was throwing up, and the dildo was forcibly expelled each time. I have never heard of anyone else having this issue. Am I doing something wrong or is this a natural bodily reaction?
—All Choked Up
Dear All Choked Up,
This is a tough one! I hadn’t heard of this condition, nor did I turn it up in a search, which was difficult to perform as it was, as the bulk of material online about choking during orgasm focuses on erotic asphyxiation. There simply isn’t a lot out there on unintentional choking during orgasm—the discourse is flooded with intentional choking during orgasm.
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So, I reached out to Nicole Prause, a neuroscientist and sex researcher who studies orgasms and founded the sexual biotech company Liberos. I thought maybe this idiosyncratic issue of yours might ring a bell.
Well, it didn’t. In an email, Prause hypothesized that it could be a “globus sensation,” which is the feeling of a lump in one’s throat despite the absence of an actual lump. To be clear, this does not mean that the perception is imagined—it can result from physiological occurrences like acid reflux. It can also be a product of anxiety. Again, that doesn’t make it less bothersome. It’s real because you’re feeling it. Here’s Prause’s email:
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I have not heard of this precise constellation of symptoms before, but I suspect it may now reflect a globus sensation common in anxiety. It is difficult to know what the precipitating event was, that is, exactly what occurred the first time this sensation happened. However, the situation sounded highly distressing, as anyone would likely be in that situation. Such an experience could lead to a longer-lasting fear that this may happen again, where the fear itself leads it to reoccur. To be clear, this is not “It’s all in your head.” The throat in globus sensation actually tightens during this anxious period, but I also suspect managing anxiety that it will recur might offer a path to ultimately return to a more pleasurable stimulation.
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Note that this opinion is not a substitute for a diagnosis—it’s just a possibility surmised by someone who has studied a lot about orgasms. UCLA has more on the treatment of globus, which can include low-dose antidepressants and relaxation therapy. I recommend seeing an ENT to make sure there isn’t an actual obstruction, too—said doctor could also help you with a plan for treating globus if that’s indeed what’s going on here.
Anecdotally, some trans-femmes have reported higher gag-reflex sensitivity. Here’s a Reddit thread on the self-reported phenomenon, though no one describes said sensitivity occurring near orgasm. I’m not sure if this is enough to claim that what you’re experiencing is a “natural body reaction,” but it’s possible that you aren’t alone in it.
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Dear How to Do It,
I am a cis female in my 50s who’s been married for four years to a cis man. This is the second marriage for each of us and we have been very happy and supportive of each other. Our sex life has been very fulfilling. We have always worked through any disagreements as a team.
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A few weeks ago, we had our first “real” argument. We were out of town and my soon-to-be college-bound daughter called to ask me a question as we were getting ready to leave to go out. I saw him roll his eyes and sigh and was annoyed as I was speaking with her. He felt she could have handled her question without a call to me and said “she needed to start figuring things out” on her own. This was the third time he had said this in the last few weeks and my reply to him was, “Yes, you have mentioned this several times. I would like for you not to bring it up again.”
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He then doubled down and continued to complain. I asked again for him to stop. He and my daughter have always gotten along well, but apparently, this had been bothering him for a long time and it boiled over. He proceeded to give me the silent treatment the rest of the night. We sat through an entire meal in silence. It was awful and it was a horrible weekend. We have talked about it since that time, and he has apologized and told me he just wants to move past it.
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But … I am having a really hard time moving past it. It has affected my attraction to him. We are still having sex, but I am not enjoying it like I used to. I just don’t feel as close to him as I did, and I haven’t orgasmed since then. When I try to kiss him, I just keep getting flashbacks to that weekend and I get upset all over again. He will be upset if he knows I am still upset. I don’t know how to get that weekend out of my mind.
—Bad Memories
Dear Bad Memories,
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What you describe reads to me like a strong reaction to a mild kerfuffle. That doesn’t mean that you’re wrong to feel the way you do, nor would it matter if it were “wrong,” as you feel like what you feel and that clearly needs to be dealt with and worked through in order for you to achieve emotional homeostasis. But going four years (plus however long you were together prior to marriage) without a “real” argument is extreme in itself (extremely impressive!).
Together with that, your inability to let go of a disagreement that mostly played out in silence and didn’t involve, per your report, shocking revelations or name-calling, makes me wonder if you’re what those in the biz call a “highly sensitive person.” That’s a term coined by psychologist Elaine Aron describing what she estimates is the 15 to 20 percent of the population that experiences sensory-processing sensitivity. That may include being overwhelmed by sensory input like bright lights and/or heightened emotional sensitivity.
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I reached out to Elayne Daniels, a psychologist who works with HSPs, to get her take on my hunch. She wasn’t so sure that you qualify. “I have heard of conflict affecting sexual attraction in both HSPs and non-HSPs,” she wrote to me. She recommended that you and your husband take Aron’s HSP inventory to help determine whether or not you qualify. If you do, you could seek out a therapist who specifically works with HSPs or at least read Aron’s The Highly Sensitive Person for some added insight/tools.
Daniels said that if it turned out you weren’t an HSP and she were your therapist, she’d try the following methods: Roleplay (“Alternative ways each could communicate that would be respectful”), going over the concepts of fair fighting (these aim to streamline and keep clean fraught conversations), and paying special attention to the so-called “Four Horsemen of the Apocalypse” or behaviors in relationships that often lead to failure (criticism, contempt, defensiveness, stonewalling). Note that all of this stuff is long-game material. I don’t know that there’s a wormhole back to where you were–I think your negative feelings still have more cooling to do. Daniels’ tools could help give you some healing perspective and hopefully some strategies to avoid such a disruptive conflict going forward.
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Something Daniels thought it was really important to underline is that your husband’s behavior is not your fault. (For example, he violated Rule No. 6 of that fair fighting list: “No stonewalling.” Stonewalling is also one of the Four Horsemen.) Don’t blame yourself. High sensitivity can make some things harder to get over than they are for others, but it also endows you with unique gifts. When people write in about something they can’t stop thinking about, I tend to recommend meditation practice. Again, it’s not a quick fix, but it can make coping a lot more doable. Give it a try?
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Dear How to Do It,
Your recent letter about adjusting to sex after weight loss inspired me to write in, too—my husband also lost a lot of weight from a health change. Ozempic did what a lifetime of exercise and constant food journaling and diets and obsession couldn’t. His doctor is happy, and he seems more at peace with his body. Lots of our sex life is still amazing, even though it took some adjusting.
One problem: We used to love fisting, and he was always amazing at it—tons of lube, tons of patience, and great technique. He had big, soft hands that cushioned his knuckles. It was my favorite thing to do in bed together. Now, his hands feel sharp and spindly inside me, and I barely even like being fingered because I feel like I’m being poked by his knuckles when he bends his fingers at all—it’s more of a stab than a satisfying stretch. I’ve tried to ask him to change his technique, but I don’t actually know how he could make it better. We’ve tried gentle, slower, but the geometry is the problem. Somehow practice isn’t making perfect with fingering, so I’m scared to even try fisting again. Is there something else I can ask for? I’m trying to be gentle around this because I know the body change is a huge deal for him.
—Practice Isn’t Making Perfect
Dear Practice Isn’t Making Perfect,
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In case you’re not aware, there is a wide range of fisting dildos on the market. Even Amazon has more than you could shake … a fist at, actually.
If you want to keep his hand/s involved, there are also gloves specifically made for fisting that might smooth over the boniness, and also would allow you to experiment with other textures. You could also try having him put his hand inside a stretchy, squishy penis sleeve (which are also called “cock sheaths” and “penis extenders.”) They look like this—as you can see, some are firmer and more phallic, while others are softer, less phallic, stretchier, and more cushion-y. This one might be particularly adapted to your needs.
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I’d play around with that stuff first—see if he’s down and get adventurous. As with any sex toy/implement, you may need to try a few different types before you find something that works for you. You’ve already had the conversation about needing to adapt given his changing body, so frame this as a followup or possible solution. It requires no body commentary at all, and is something that you can both pursue together. Win/win.
—Rich
More Advice From Slate
I’ve been with my boyfriend for 13 years. He’s caring, very thoughtful, and funny, but I have never been physically attracted to him. Over time we both have gained weight and let ourselves go a little, but as we get older, I am getting even less attracted. I want to look at him and have the desire to rip his clothes off, but I look at him and sometimes say to myself, “He’s ugly.” I don’t want to have these thoughts in my head—they’re mean and selfish—and I could never bring myself to tell him to his face. Please help!
I Tried to Use a Dildo. Then I Became a Medical Anomaly.
