While previous research on sexual behavior and its potential risks has tended to focus on teens and young adults, this study looked at the determinants for number of sexual partners in more than 7,000 men and women age 50 and older.

The researchers found some interesting correlations between the subjects’ sex lives and specific sociodemographic and behavioral factors, which they say could help clinicians identify people at greater risk for sexually transmitted infections (STIs). To get a better grasp of what these findings might mean, I asked some of my colleagues to weigh in on the data.

A ‘male’ issue

Men in this study were more likely to report a higher number of lifetime sex partners than women. Forty percent of men said they had at least five partners, compared with 24% of women. Likewise, being gay was associated with having more sexual partners among men.

That’s not surprising, said sex therapist Dulcinea Pitagora. “Because our culture socializes men — regardless of sexual orientation — to believe that they should be more sexually active than other genders, they may feel they have permission to be more sexually active, or they may feel like they have to present that appearance,” she explained.

In fact, “this is much more of a ‘male’ issue than a ‘gay’ issue,” added sex therapist Kimberly Resnick Anderson. “Men have ten times more testosterone than women (at all stages of life), so gay men share a hormonal push for sexual outlet, whereas heterosexual couples must contend with often discrepant biologic drives.”

For men, and older men in particular, economic status also seemed to increase the overall number of sex partners. That was true for both men in the top 20% of income and those in the lowest 20% . Although that may seem odd, it may actually make some sense. “Wealthier men have less stress about day-to-day necessities. There is more emotional space for pleasure and more time to have it, since they may not be working as much as a person with fewer financial resources,” explained sex therapist Holly Richmond. “On the flip side, for men with less money, having sex with multiple partners may be a distraction from the social burden of having a lower income.”

Better body image, greater opportunity

The researchers identified some intriguing characteristics for women, too. For example, they found that women who were white, bisexual, physically active, or free of chronic illness were more likely to have a higher number of sex partners.

The latter three factors aren’t surprising: Regular exercise likely translates to a better body image — and, in turn, more confidence to pursue sex — while good health makes it easier to engage in sexual activity without discomfort.

“The healthier and more vital one is, the more sex they tend to have” said sex therapist Lawrence Siegel. Bisexuality may also be associated with increased confidence, as well as greater opportunity for sex partners.

But what about race? “In the past few decades, women who identify as white have been receiving messages about how to feel liberated sexually — “Sex and the City” is a great example of such influence,” said psychosexual therapist Sara Nasserzadeh. “But women of other ethnicities — mainly outside of North America and Western Europe — may not feel comfortable expressing desire or experiences with multiple partners.”

Freedom from judgment

Some factors spanned across all genders. For both men and women, being younger, separated or divorced, single or never married was associated with a higher number of sexual partners.

“When we consider factors like being younger —say, 51 rather than 78 — being separated or divorced, single, or never married, this creates space for more ego-driven, self-focused sexual behavior rather than having to worry about a partner’s feelings, children or increased health problems that come from advanced age,” explained Richmond. “These dimensions allow them to be in it for themselves and have less concern about other people’s perceptions of their behaviors.”

What’s more, certain habits could have an effect on one’s number of sex partners. The study found that being a current or former smoker and drinking alcohol regularly or frequently were linked to a higher number of sex partners in both men and women.

“These might be people who tend to be greater risk takers or seek out more stimulation, which could apply to their sexuality as well as use of nicotine or alcohol,” said Pitagora. “Additionally, those who drink alcohol sometimes enjoy being disinhibited as a result, which might flow over into their sexual expression as well.” Regular drinkers may also frequent bars or other public spaces, giving them more opportunities to hook up.

Remember, though, that this study could only show associations between certain factors and sexual activity, not cause and effect. Having such characteristics won’t determine your number of sexual partners — that’s a choice that only you can control.

Ian Kerner is a licensed couples therapist, writer and contributor on the topic of sex for CNN.

By Ian Kerner

Thanks to “Sex and the City,” we’re all familiar with the phrase “he’s just not that into you.” Yet many couples who are no longer all that into each other choose to stay together anyway.

Why do people choose to remain in unhappy relationships? According to a recent pair of studies, the more people believe their partner is dependent on the relationship, the less likely they are to initiate a breakup. In other words, you might be motivated to stay in an unfulfilling relationship for the sake of your partner.
I asked some of my colleagues to share more about why unhappy couples stick together — and how you can end a relationship a little less painfully if you choose to break up.

Staying together can be selfless — or selfish

The recent studies suggest that people stay in unsatisfying relationships because they’re concerned about hurting their partner’s feelings.
“In my experience, there are most often underlying fears and insecurities that prevent people from moving forward into a life that might be less comfortable but ultimately happier and more authentic. These couples tend to settle into a ‘good enough’ relationship,” sex therapist Holly Richmond said. “But there is almost always a point where it’s obvious that not good enough is truly not good enough, and it causes more harm to the unhappy person to stay than it would to their partner if they left.”

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Concerns about children, finances, friends, lifestyle and standing in the community can also influence the decision to stay together. “In my practice, I see clients who stay in relationships because they’re worried they won’t find another partner, while others remain because they don’t want to deprive their children from having the other parent in their day-to-day life,” sex therapist Sari Cooper said.
But staying in an unhappy relationship doesn’t do anyone any favors, sex therapist Kristen Lilla said. “Staying because you don’t want to hurt someone else is selfish because it takes away the other person’s agency to make a decision,” she explained. “You are deciding that your partner will not be OK without you, so you stay with them out of pity.”

Should you stay or should you go?

Clearly, the decision to end a relationship can be a difficult one for many people. It can be helpful to visualize your life after the breakup, Cooper said. “I ask clients to imagine in great detail what their life would be like: Will they able to support themselves financially? Will they feel that they did all they could to improve the relationship? Will they face a loss of a community in addition to the relationship?”

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Sex therapist Kristie Overstreet agreed. “If you’re trying to decide whether to stay in the relationship or leave it, write out the pros and cons of the decision. This forces you to use logic versus emotions and helps you identify things that you wouldn’t have realized before,” she explained. “One of the most important questions you can ask yourself is if you have done everything you could do from your end to make it work. Make sure you have checked off all of the boxes on your list, which will help you come to your decision.”

You might also try picturing your relationship as a box that’s large enough for both of you to move around comfortably within the space, with each of you supporting one another’s growth.

“An unhealthy relationship means that the relationship box you are in is too small for each of you to be independent and separate, and you feel lost and frightened without the other person,” sex therapist Tammy Nelson said. “You may have been taught that this is what true love is — a soul mate that is your other half — but this is really codependency. If you don’t have enough room to grow as a whole person in a relationship, you may not only be holding yourself back but your partner as well.”

Breaking up is hard to do

There’s certainly some truth to this cliché: “There’s no way to break up with someone without the risk of hurting them,” sex therapist Deborah Fox said. That said, Fox stresses it’s important to be honest with your partner about why you want to end the relationship.

“Although it’s not necessary to include every reason, you should end a relationship with integrity, which means with honesty,” she explained. “Little white lies can be justified in a short, barely-off-the-ground relationship but not in one of any length.”

Overstreet agreed. “You can’t prevent your partner from hurting over your decision. However, being truthful and respectful during the process will help lessen hurt,” she said. “The way you handle yourself and your words are the only things you have control over. Remember that you have to do whatever you need to so that you remain healthy — and leaving an unhealthy relationship is one of the steps in that direction.”
The choice to break up is rarely an easy one, but by putting the time and thought into the decision, you can make things a little easier — both for you and for your partner.

By Ian Kerner

It’s called “micro-cheating”: the small, seemingly innocuous acts of flirtation that don’t necessary qualify as cheating but might be considered a little sketchy by your partner.

Many of us have experienced flirtatious relationships with friends and never acted on them sexually. Are these friendships signs of infidelity? Should you be worried if your significant other is attracted to someone else? Or could a little harmless flirtation actually be good for your relationship?

Acknowledge the Benefits

Flirtation is normal, sex therapist Tammy Nelson said. “Why shut down your natural feelings of attraction for someone just because you are in a monogamous relationship with someone else?” she asked. “You might be married, but you’re not dead.”

A flirty friendship could help feed the flames of your relationship, but it depends on the couple. “In some cases, flirting outside the relationship enhances the primary relationship, and in other cases, it siphons energy from the primary relationship,” marriage and family therapist Nicolle Zapien explained. The key is to know your partner and to communicate about the friendship before it becomes a problem in your relationship.

Understand Your Motivations

Sometimes, flirtatious friendships are just fun and entertaining, and each person has a keen awareness that the relationship would never go further, sex therapist Holly Richmond said.

“People like to feel wanted, to feel desired, and having a flirtatious friend can elicit those emotions,” she explained. “I encourage clients to ask themselves, ‘Would I behave this way if my partner were here?’ and ‘How would I feel if I saw my partner behaving like this?’ This takes self-awareness, honesty and empathy for your partner’s position.”

Set Boundries

Having sexual fantasies about someone doesn’t mean you can’t be “just friends,” Nelson said. In fact, most of us have sexual fantasies about people other than our partners. “But some flirting can lead a person on,” she added. “Sending photos, being sexually explicit — these are all things that you wouldn’t want your partner to do, so why are you doing them?”
You can take steps to maintain a flirty friendship without crossing the line. “Keep conversations away from intimate or romantic topics. Don’t comment on appearance or give excessive compliments. And keep an extra step of physical distance in face-to-face conversations,” sex therapist Peter Kanaris advised.

If your partner still feels threatened by your interactions with another person, it’s your job to remove the threat. “You have to ask yourself, ‘What’s more important: the thrill I’m getting from flirting or my core relationship?’ ” sex therapist Deborah Fox said. “If the answer is ‘the thrill,’ then you’re putting your relationship at risk.”

Keep in mind that the Internet is no less a threat to your relationship than in-person flirting. “In some ways, tech is more dangerous,” Zapien said. “People say things that they would never say face to face, and online relationships have the ability to get very close or very sexual very fast without the benefit of facial cues.”

Talk About It

It’s completely fair to ask your partner to limit contact or change the nature of a flirty friendship, but you want to be careful about how you raise the topic. “If you’re uncomfortable with a relationship your partner has with someone else, communicating about it is an important first step,” sex therapist Rachel Needle said. “Spend time on your own trying to understand why you are uncomfortable with the relationship, as well.”

Licensed mental health counselor Kristie Overstreet suggests making sure “that you aren’t being impulsive or irrational in your request. If the relationship bothers you and is affecting your connection with your partner, ask for it to change. If your partner minimizes what you are feeling or requesting, then you need to have a conversation with them about your needs in the relationship.”

One way to spark a discussion is by staying curious rather than accusatory. “You can try a script like, ‘I’m curious about your relationship with your friend ____. It feels flirtatious to me, like you are or want to be more than just friends. Does it feel different than your other friendships to you?’ ” Richmond said. “Hopefully, this will keep your partner out of defensiveness and able to respond in a way that feels respectful and informative.”

What’s worrisome to some couples can seem inconsequential or even fun to others. Only you and your partner can determine — together — what’s acceptable to you in terms of flirting. So keep the lines of communication open.

By Ian Kerner

Americans have a love-hate relationship with Valentine’s Day.

Some of us look forward to February 14 as an opportunity to enjoy our partner’s company (and possibly spice things up in the bedroom). Others dread what they consider a commercialized holiday that can put unrealistic pressure on their relationships.

It’s clear that the bar is high: According to one online survey of more than 2,000 respondents, more than 65% plan to show affection on Valentine’s Day, almost 85% believe that having sex is an important part of the holiday, and more than 60% say they will be disappointed if they don’t have sex that day.

With expectations like these, it’s easy to set ourselves up for disappointment. Fortunately, it’s possible to enjoy the day — and night — without creating hurt feelings or breaking the bank.

“Valentine’s Day can serve as a reminder that it’s so important to stop and appreciate the closest relationships in your life,” couples expert and sex therapist Ashley Grinonneau-Denton said. “To me, the holiday has always been a great reminder of the importance of love, attachment, affection and closeness.
“The caveat is, however, that if this special day stands in isolation, it will quickly become a distant memory and will do very little for a couples’ relationship long-term.”

Here’s how to make the most of February 14, whether you’re coupled or single.

Make a plan

It may not seem so, but having a conversation about Valentine’s Day ahead of time can make the actual day much more romantic.

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“Talk with your partner about what you’d like out of the holiday and whether you feel Valentine’s Day is important to you,” sex therapist Sari Cooper said. “By beginning the conversation a week or so beforehand, you can co-create a celebration (or not) that is a collaborative event, making compromises for both partners’ desires and creating a realistic plan to ensure both of you feel heard emotionally.”

And remember that the element of surprise isn’t the most important part of the day. “Don’t set your partner up to fail, and don’t keep desires and expectations to yourself,” advised Rachel Needle, a psychotherapist and sex therapist. “Telling your partner ‘I would love to go to Pier 115 for dinner,’ for example, or ‘I would love sunflowers’ doesn’t make them bringing you flowers or taking you to the restaurant any less special.”

Pay attention

Surprise can be a good thing. A little insight into your partner can go a long way by showing them you’ve listened to them. “Consider doing something your partner has told you in the past they wanted to do: a picnic, a walk on the beach, a certain new restaurant,” Needle said. “It doesn’t have to cost a lot of money to be special, but rather it needs to be thoughtful.”

Spice things up

According to that online survey, 55% of the participants indicated that they were willing to try something new sexually on Valentine’s Day. Of course, what that means for you and your partner depends on your particular relationship. “One way to increase intimacy on this holiday is to take a different stance on things and make it all about fun,” sex therapist Francie Stone said.

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“You could put together a goodie basket of things like massage oil, a feather, a sexy dice game, a blindfold and more. You can try them all or only the ones you really like, or just use the fun to get started and leave the rest to your individual imaginations.” This helps make the night playful without necessarily the pressure of intercourse.

If you plan on having sex, try doing so before you go out to dinner on Valentine’s Day, sex therapist Tammy Nelson said. “Lots of couples go out to dinner or cook a rich meal at home and drink wine or cocktails to celebrate February 14,” she explained. “After a full meal and drinks, it is less likely that any sex — much less hot sex — will follow.”

Or consider taking sex off the table altogether. “There are so many nerve endings in the lips that are connected to the limbic system and can help create the perfect foreplay for future intimacy encounters,” sexual health counselor Aleece Fosnight said. “A good makeout session that only leads to kissing can leave partners wanting more, creating more intensity for future intimate activities.”

Love yourself

If you’re single, Valentine’s Day can seem like a holiday for everyone else. But you don’t have to feel left out if you’re not in a romantic relationship. Instead, take the opportunity to practice a little self-love.

That could mean indulging in a massage or a new sex toy, dining out with friends or even seeking out companionship. “If you’re single and wouldn’t mind meeting someone but setting up a date on Valentine’s Day feels too staged, Meetup is a fantastic option,” sex therapist Holly Richmond said. “Hundreds of Meetup groups plan special events and activities for Valentine’s Day, but they aren’t necessity geared toward singles coming together to meet other singles.”

Whether you choose to celebrate Valentine’s Day or ignore it, remember that expressing love and affection for your partner shouldn’t be limited to one special day. Take the pressure off the holiday by celebrating your relationship every day.

Today, sex seems more available to us than ever before. With just a swipe on their phones, singles can schedule their next hookup, while committed couples have an apparent “sure thing” every night. This is also known as “the marriage advantage.”

“We don’t know if indeed the ‘marriage advantage’ is now a ‘disadvantage,’ ” said Debby Herbenick, president of the American Association of Sexuality Educators, Counselors and Therapists, “in part because so many other things have changed about sex and health in America in recent decades, including far more Americans taking medications with sexual side effects, far more Americans dealing with chronic health conditions — like diabetes — known to affect sex, and millions more Americans surviving cancer — which is wonderful — but often with sexual side effects from cancer treatments. An important question for future research would be, all else being equal (including health status), how does marital status relate to people’s sex lives?”

By Ian Kerner

About 15% of men and 34% of women say they’re not really interested in sex, according to a new study, statistics that few experts find surprising. In fact, low desire in one partner is probably the top reason couples seek out sex therapy.

(CNN) In HBO’s series “Westworld,” humans pay for sex with robots in an anything-goes Wild West-inspired theme park. In the movie “Her,” a man falls in love with his Siri-like operating system. And in AMC’s show “Humans,” a husband has an affair with his pretty robotic assistant.

As a sex therapist, I’m also intrigued by the ways in which robotics might transform human sexuality. Along with engineering challenges, sex robots raise a number of ethical and philosophical concerns for individuals, couples and therapists. Here are just some of the facets of future sex that my colleagues and I are pondering.

Who might benefit from sex robots?

The hypothetical applications of sex robots and related products, part of a field called technosexuality, seem endless. I could see couples using them to enact fantasies, such as a threesome, that they might not feel comfortable trying with real people.

If one partner has a higher libido, a robot could allow him or her to enjoy a fulfilling sex life without straying. And robots might help couples break out of sex ruts by adding spice to their relationship or maintaining long-distance romances.

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“I think a huge benefit of using technology and design to develop sex devices is that they open up new forms of sexual experience, ways to experience intimacy with others, to feel good in our own skin, to have mind-blowing orgasms, all of it,” said Shaowen Bardzell, associate professor of informatics at Indiana University.

“Robots could also be useful for virgins or for people with social anxiety who wish to gain practice before actually having sex with a partner,” sex therapist Holly Richmond said.

They also show promise for people who have mental or physical disabilities that may impede their ability to find sexual partners, those who live in rural areas or are socially isolated, and anyone who can’t or doesn’t want to connect with others in an intimate way.

“Technosexuality could potentially open up sexual experiences to everyone,” Tuckman said. “Even people who seemingly have limited options.”

How could robots help sex therapists?

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Likewise, robots and related technologies could offer real benefits to those of us working to help people tackle sexual concerns.

“There could certainly be a role for technosexuality as surrogates in treating men with premature ejaculation or erectile disorders, particularly those without human partners,” said sex therapist Ron Feintech.

Ideally, robots would be an extension of therapists used in conjunction with professional guidance rather than in place of it.

Is there a dark side to sex robots?

Making a sex doll

Anyone who’s watched the first 10 minutes of “Westworld” can see the potential downside of sex robots. People might use robots to act out their darker fantasies like rape, pedophilia and violent sex.

But is that necessarily a problem? If we channel our taboo desires through robots, are we feeding the urge or achieving some sort of safer catharsis? Only time will tell.

Does sex with a robot constitute cheating?

Join the conversation

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Though there’s much about technosexuality that’s still unknown, it’s clear that such advances will undoubtedly impact monogamy: Couples will need to reassess how they define infidelity. Some will probably view sex with a robot as a threat to their relationship, while others will see it as a fun addition.

“If you haven’t discussed it with your partner,” sex therapist Heather McPherson said, “it’s cheating.”

One thing is certain: Just as we’ve had to adjust our relationships to address strip clubs, social media and Internet porn, couples will need to have honest conversations about how to navigate this brave new world together.