Satisfying Your Sexual Curiosity
A Stimulating Conversation With Doctor Amber Hull
Her description of it is spot on:
“Imagine having a conversation with your doctor about sexual health without fear that they would shame you, lecture you, or dismiss your concerns.”
Reading Dr. Amber’s newsletter has enhanced my sex life and I’ll leave it at that for now. Except to acknowledge to my adult children that no child of any age wants to believe that sex is something their parents do.
If you’re interested in the topic of sex, subscribe to
. Many of Dr. Amber’s articles about sex and relationships are available for free; her educational videos are behind a paywall.My conversation with Dr. Amber below hops around from the dreaded “dead bedroom” to kink. From the limits of the sexual power of beauty to the mysterious world of sex parties.
David: Dr. Amber, I put your background and the origins of your newsletter in a note at the end of this post because I want to jump right in to talking about sex.
In your newsletter you approach sexual health topics, both mainstream and what many would think of as kink in such a natural, relaxed, and friendly manner. Can you talk about what’s behind that approach and how you’ve handled being transparent about your own sexuality.
Dr. Amber: In my writing, life, and clinical work, I don’t make assumptions about people’s sexuality. I’ve interacted with folks of many different lifestyles and tend not to assume that anyone is either straight or monogamous unless they tell me so.
It’s been an exercise in courage to write about queerness, non-monogamy and kink but the response from my readers has been overwhelmingly positive. Frankly, I think doctors should receive more education on how to talk to patients about the importance of pleasure. Sexual health has a huge impact on physical health, mental health and relationship satisfaction. My work is an effort to provide education to the public but I love that so many doctors are also paying attention.
David: You emphasize communication as crucial between sexual partners. It took many decades for me to feel less shy in talking about sex with my wife Debbie. I’ve shown her some of the educational videos you put on your website. I don’t think I’d have been comfortable doing that until recently. There can be such a shyness or stigma associated with talking openly about sex even between a couple married for quite some time.
Dr. Amber: Apprehension in discussing sex and fantasy is common. In large part due to socially imposed shame. It’s absurd that our culture has been so completely pornified yet sexual health education, including how to communicate, is still largely inaccessible.
The ability to ask for what one wants really depends on the context of a relationship. When first beginning to date, many people seem to try to fit themselves into the ideal image that they think their potential partner is seeking. This often means hiding certain parts of themselves including sexual preferences. This kind of bait-and-switch strategy does a disservice to both people in the relationship. Why pretend to be vanilla (or straight or monogamous) when you know in your heart that you’re not?
Once a relationship is well established, especially if finances or kids are involved, it gets harder to ask about trying new things. There’s more at stake if a partner rejects the idea of a new sexual fantasy. There are a number of ways to open a conversation around novel experiences. Reading books (or newsletters!) together, listening to provocative podcasts, watching stimulating movies. Using a third, impartial party to broach the subject can be helpful. That doesn’t mean you need to hire a therapist or a sex worker. It can be something as simple as “Hey babe! I was listening to this doctor talk about prostate play and it sounded interesting. What do you think about exploring this together?”
When having these conversations, gentle rejection is important. If you shame, ridicule or become accusatory when your partner suggests trying something new, they probably won’t feel safe approaching you in the future. One can have boundaries without being cruel.
David: One of the things that fascinated me about our conversation was that there’s this whole world of sexually open and adventurous people who get together for what I think of as sex parties. What can you tell us about that world?
Dr. Amber: There are a growing number of play parties and events related to open relationships. Weekend retreats, "Lifestyle" resorts and entire conventions that focus on human sexuality. The quality and safety of these events varies widely so it's important to look into the organizers and rules of any given event. Some are more focused on education and others are more focused on play.
You will probably never know which of your neighbors is into these things because most people prefer to maintain the social perception of monogamy. Some couples like to go out to events and flirt with others because it reignites the spark in their own sexually exclusive relationship. Events focused on education can give couples new tools and techniques to try together at home. As long as no one is being coerced, these playful excursions can be an exciting change of pace in long-term relationships.
From a clinical standpoint, I think it's important that doctors have a "no questions asked" policy when patients request routine STI screening; regardless of their marital status. Needless to say, medical schools and residencies aren't teaching clinicians how to address queer, open and polyamorous relationships.
David: It’s true that when another man flirts with Debbie, part of me is jealous, but part of me enjoys watching the flirtation knowing she’ll go home with me.
Can you address the intersection of physical beauty and sexual opportunity.
Dr. Amber: Excitement tinged with mild jealousy is an incredibly common response to seeing one’s partner though the eyes of a stranger. It’s not a universal response but it’s true across genders and sexualities.
Conventional beauty is a form of currency in many respects. The sexual marketplace is no exception. There’s a multibillion dollar industry around making oneself more attractive because physical appearance makes one more desirable to potential sexual partners. Or, as you mention, current partner(s). If one is able to set aside the learned impulse of jealousy, it can be super-hot to watch or hear about a stranger flirting with one’s partner.
But physical beauty is not a marker of sexual prowess. A male friend of mine once told me about his experience with a woman he described as extremely beautiful. He found her to be a boring lover because she just laid back on the pillows like a princess. As though being pretty meant that she didn’t need to make an effort once the games began. Beauty only goes so far if one is lazy between the sheets.
David: That’s consistent with everything else in life. If sex is handed to you on the proverbial silver platter, you might take it for granted and not put in any effort or intention.
One of the things I’ve thought about my own marriage is that having wealth has helped our relationship in a few ways. One factor is that we’ve had the time and money to spend on maintaining mutual attraction.
For example, I got veneers about fifteen years ago. I used to have yellowish, cragged teeth. Smiling used to actually hurt because my smile muscles were so weak. After I got my veneers, I felt attractive for the first time in my life. Getting them from my excellent and perfectionist Manhattan dentist cost a fortune–– about $70,000 in today’s dollars.
We’ve also had access to help with childcare and housekeeping, which reduces a lot of stress. I know that wealth is no guarantee of a great relationship, sexual or otherwise, but if used wisely, can it reduce the chances of what you’ve called the “Dead Bedroom?”
Dr. Amber: The phenomenon of the “Dead Bedroom” knows no economic boundaries. Lots of couples grow bored with one another in a decades-long, sexually exclusive, monogamous relationship. Emotional disengagement, substance abuse and pouting about sexual inactivity are all huge turn-offs regardless of the gender of the perpetrator. No amount of beauty or money will compensate for being a lousy partner.
Household help can provide the windows for the sexual intimacy you describe, but even with that help the mundane repetition of daily life can absolutely put a damper on the mystery and novelty that makes sex exciting. That’s why getting into a new setting or seeing one’s partner eroticized by someone else can be a game-changer for a sexual relationship that’s become stale.
I want to make a distinction between brief and predictable chapters of sexual disconnection (postpartum, major life stressors, medical crises, etc.) vs complete sexual abandonment. I try to warn people that a dip in postpartum sexual relations can last 2 years or more after the birth of a child. Most couples remain unprepared for that transition.
I know you have three adult children. After they were born, what happened to your sex life?
David: After we had our three children we always made time for each other. Other than the normal and necessary recovery after childbirth, our sex life did not pause. That might not have been possible if we didn’t have the domestic help I mentioned above.
Hotel rooms are a powerful aphrodisiac. We would take trips away from the kids. Sometimes we’d go to a hotel in different neighborhoods in Manhattan for 24 hours. Usually downtown. The Mercer soon after it opened and the Rivington across from Economy Candy, the best candy store in the city.
Dr. Amber: You’ve been very fortunate. That said, being wealthy or well educated does not necessarily imply that one is a great lover. Or even a decent partner. Some people might prefer to date a partner of means but money can't make up for a lack of physical chemistry or emotional reciprocity. It does, as you describe, take certain stressors out of the equation when it comes to having the time and energy to connect
On the topic of libido after birth, see this article and video that discuss that season in the life of a couple. As a pediatrician, I’ve seen countless romantic relationships dissolve within the first 4 years after the birth of a child.
You and your wife are both 62. What do you feel comfortable sharing about sex in your sixties?
David: If our adult children and their friends are still reading this post, the thought that we’re still having sex is likely a traumatic one. When we were their age, we thought “old” people like us would have the decency to leave sex to the young folk.
Now when we hear about people in their late seventies or older having sex, it gives us hope! To be clear, things were different in our twenties than they are in our sixties. To put a positive glow on it, sex for us is now more special.
Dr. Amber : From a medical standpoint, there’s a growing interest among American adults in longevity and integrative medicine. Middle aged folks increasingly recognize the modifiable factors that can reduce signs of aging and risk of chronic disease. A healthy, attractive appearance is often a byproduct of things like alcohol avoidance, regular physical activity, a healthy diet, good hygiene and adequate sleep. The desire for a playful and satisfying sex life doesn’t expire as we age but there are steps that can be taken to prevent “equipment failure”. So to speak.
Hormone therapy, both for men and women, can help to reduce the physical and psychological symptoms of aging. Part of the reason I’m getting a certification in menopause hormone therapy (MHT) is because it’s made a huge difference in my own health and sexual satisfaction.
Unfortunately, our antiquated and for-profit insurance policies don’t cover cutting-edge preventative care; which makes them more accessible to people with means. And the FDA is having a hard time keeping up with the pace of scientific progress. Many practices who provide these services are cash-based but it’s important for the buyer to beware. 1
How have you and your wife approached hormone therapy?
David: My wife and I have a doctor who specializes in hormone therapy with the goal of keeping our energy and libido high. It’s been terrific for us, although we recognize that it’s a luxury unaffordable to many if not most. Our doctor costs $12,000 a year for the two of us and the actual hormones we’re prescribed cost even more although some of that is covered by an expensive health insurance policy (about $3,000 per month).
Question for you: What’s your advice for couples that are facing the sexual dead bedroom?
Dr. Amber: For me, a sexual abandonment (distinct from short seasons of sexual disconnection) would be grounds for renegotiation of the terms of a monogamous relationship. A vow of monogamy is not meant to be a vow of celibacy. If one partner unilaterally decides that the sexual relationship is over, the relationship becomes more of a hostage situation and resentment is bound to grow.
This is where it’s important for adults to:
Take steps to reignite the sexual relationship
Transition to a companionate relationship in which sexual needs are outsourced or
Separate so that each person can live without the emotional heaviness of endless sexual rejection
We do such a bad job with sex education in this country that many couples are afraid to raise the subject or have a meaningful conversation with their partner; the result of that silence is often infidelity. Or divorce. My Substack,
, has lots of articles about sexual health and relationships that are available for free. My medical education videos are behind a paywall but the subscription fee is nominal. Far less than the cost of my medical education or a trip to the doctor's office.David: On a sex-positive note, can you tell us about polyamory and how it differs from Ethical Non-Monogamy. And whether it’s mainly wealthy Blue state liberals who are experimenting with these new sexual structures.
Dr. Amber: Actual monogamy, having only one sexual partner for life, is rare. When we say monogamy, we’re often referring to serial monogamy; having only one sexual partner at a time.
As noted above, Ethical Non-Monogamy (ENM) is an umbrella term used to describe any consensual relationship that is not strictly monogamous. Dan Savage coined the term “monogamish” to describe people who are emotionally monogamous but play well with other people in a sexual context. Swinging involves recreational sex with people outside of the primary couple; often other couples but sometimes with singles. Polyamory or “many loves”, involves emotional as well as sexual relationships with more than one person at a time. Solo-polyamory refers to folks who don’t desire a primary or domestic partner; they’re basically “free agents” in the ENM dating world. This is distinct from people who refer to themselves as “single” because being single implies that they’re looking for a “monogamous” partner.
Some kinky people enjoy playing with or sharing a kink scene with people aside from their primary partner but don’t engage emotionally outside of the kink space. The general ethos of ENM is that the terms of the relationship are up to the people in the relationship. It requires a lot of self-reflection, confidence and honest communication, but this kind of customized relationship design interests many people.
There has been some social critique that polyamory (distinct from swinging) is a privileged status available only to Park Slope elites and bougie West Coast liberals. The reality is that interest in polyamory is much more widespread and growing. According to a 2023 YouGov poll, nearly a third of surveyed Americans were interested in a relationship structure other than complete monogamy. Some jurisdictions are even developing legal frameworks to protect the rights of non-traditional families.
David: You’ve written about kink in a way that seems accessible. Not like a caricature or trope of power dynamics. How would you describe kink to someone unfamiliar with these things?
Amber: Kink is an expression of creativity. I think of it as play; sensual, fun and expressive. A “scene” can be almost like the flow state achieved during deep meditation or yoga. Kink interests people from across socioeconomic strata; both monogamous and non-monogamous. Toys can be pricey but playmates can have a fantastic time with things as ordinary as roses, chopsticks and paraffin wax.
I saw Baby Girl starring Nichole Kidman last week and was impressed with how well the filmmakers captured the vulnerability and connective power of kink. The line that struck me the most in the film was when the male lead looked at the female lead and said “Just be honest.”
Kink is about asking for what you want, exploring boundaries and learning to trust. I thought Baby Girl was a much better portrayal of power play than 50 Shades of Gray. I’m planning to see it again. For research purposes, of course.
David: You had a great post, The Courtesans of Nye County, about legal prostitution in certain rural parts of Nevada. As I understand it, that’s the only place in America where there’s legal prostitution. There seems to be a very large gray zone of what constitutes paying for sex.
Amber: I live in Las Vegas; where every club is a sex club under the thin veneer of propriety. People don’t pay $5000 for a table in the VIP section of a Vegas nightclub because they want to go home alone. Just because sex isn’t allowed on the premises doesn’t mean the intention isn’t there.
Subscribe to
.Question for the comments: Dr. Amber and I (but mainly her!) would love to answer your questions and hear your comments on any of the topics discussed. We’re also planning to record and make available a video, inspired, we hope by your penetrating questions.
Dr. Amber’s background and the origin of her newsletter
As a Board-Certified, Direct Primary Care pediatrician, I get questions all the time about parenting, holistic medicine, navigating the healthcare system and negotiating sensitive conversations about intimate relationships. Although children are the natural result of sex, many couples are unprepared for the impact that childbirth can have on a romantic relationship. Most women aren’t informed of how childbirth can affect their sex lives due to pelvic floor trauma, emotional disruption and the low-estrogen state induced by breastfeeding. In my clinical practice, I saw a huge gap in patient care when it comes to women’s sexual health; particularly around the natural processes of childbirth and aging
I created Under the White Coat Substack to extend my clinical practice into the arena of sexual health and medicine. Readers get a thoughtful, scientifically-sound combination of curated content that stimulates empowered new ways of thinking.
There is a need for more sex-positive and non-judgmental medical education; both for doctors and for the public. But the infrastructure of allopathic medical education is slow to adapt. As a result of working with so many people during the transition to parenthood, I have a passion for women’s sexual health and sexual medicine more broadly. Not many doctors I know possess my particular set of interests and skills.
In fact, US physicians received more sexual health education in the 90’s than they do today. I have an open-minded approach to these topics and recognize their effect on physical and mental health. I write about it because sex is a nearly universal experience that most people, including doctors, are uncomfortable addressing.
There are lots of profiteers out there who are trying to make a quick buck at the expense of patients. For example, testosterone therapy, when dosed appropriately, can improve exercise tolerance, cognitive clarity and libido in peri/menopausal women. But it’s easy to overshoot the mark. Clinics who are charging hundreds of dollars for implantable T pellets for women can stimulate body hair growth, scalp hair loss and significant acne when testosterone levels increase too rapidly. Topical formulations, while not as profitable for the clinician, are easier to titrate and less likely to cause unpleasant side effects in female patients.
I have questions about something we didn't talk about–––pornography.
You mention that our culture has been "pornified" in contrast to an unacceptable low level of sex education. In your view is there healthy porn vs. unhealthy porn? And where can one draw the line between something that's sensual vs. pornographic? The famous line about pornography is "I know it when I see it." Another issue is teen and children being exposed to porn and efforts to restrict it.
Posting on both sites.
Thank you David and Dr. Hull for starting the conversation about sex in such an open and nonjudgmental manner. I understand this first conversation was an introduction to the topic for many people, but if you do a follow up I think there are two really important topics that need covering: female pleasure and consent. The very definition of sex , if you look it up in the dictionary, is male penetration of the female, which results in orgasm for the man, but not so much for the woman. As you so correctly pointed out, Dr. Hull, sex education is basically nonexistent, which leads to dissatisfaction for women at best and sexual violence in the form of coercive or nonconsensual behavior at worst. I think this is a major cause of “dead bedroom” syndrome. There also needs to be a discussion about how women are shamed while men gain social currency for their sexual prowess. The fact that David uses the term prostitution rather than sex work speaks to the implicit bias against women who are performing a service worthy of decriminalization and de-stigmatization in addition to the same rights and protections as anyone in the workplace. Moral agendas have no place in creating laws about sexual practices between consenting adults.