I’m on a mission to enjoy my sex life to the fullest now that I’m done having kids. Something stands in my way.

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Dear How to Do It, 

I am a 40-year-old woman with three children. I have been with my husband for 12 years. He’s 48. I’m on a hormonal birth control pill, but now that we’re done having children, I’m considering switching to a different birth control option.

I have a pretty high libido typically, and my husband and I have a passionate and kinky sex life, but I have always felt less horny while on the pill. Whenever I’ve been off the pill (when we were trying to get pregnant, when I was pregnant), it felt like my body was finally working with me instead of against me. I would really like to enjoy my sex life to the fullest extent, and to feel as horny as I naturally can, but I’m not sure what birth control would be best for this goal.

My husband loses his erection or takes forever to come with condoms, and he is considering a vasectomy, but I’m worried the knowledge that he’s shooting blanks would impact his erection, too. I’d rather preserve his consistent ability to get it up than involve him in the birth control decision, even if it means I’m slightly less horny than I naturally would be. Is that the wrong call? Do you have opinions on the best birth control option that messes with libido the least?

—Birth Control Questions

Dear Birth Control Questions,

I have so many opinions, and yet, at the end of the day, your best birth control option is going to come down to your specific body and circumstances. While doctors are human and can have biases or gaps in their knowledge (like all of us), you’re going to be best off consulting with a gynecologist who listens to you and your preferences, and is familiar with both the details of your medical history and what options are feasibly available for you.

What you write in your letter, which is noticeably bare of complaints about side effects aside from a decrease in libido, presents a picture of hormonal birth control having worked very well for you. Oral contraceptives genuinely do seem to function as intended for the majority of women who use them, often with few side effects that bother them, much less significantly impact their quality of life. Laudable gynecologist Dr. Jen Gunter, across three books, speaks incredibly highly of the benefits of hormone pills for everything from birth control, through regulation of menstrual cycles and treatment of conditions like polycystic ovarian syndrome, to hormone replacement during and after menopause because her immense clinical experience has demonstrated to her that they work best for most people. There are absolutely exceptions (I’m one of them), but that doesn’t take away from the fact that often the first option to try is what works best for most.

So you have reason to believe a hormonal IUD will behave as doctors expect—meaning, as it does for most people—and that any systemic effects that might affect your libido may be lower because the hormones are localized and delivered directly to the uterus. No one can make any guarantees here, especially not me, but you didn’t say anything that describes an atypical experience with hormones so far, and, usually, women are incredibly happy with their hormonal IUDs once they’re inserted. A survey of women in China using Mirena found that 90 percent of respondents were “rather satisfied” or “satisfied.” A survey of women with IUDs in the U.S. reported that 83 percent of respondents were “happy” or “very happy.” And these figures reflect what I’ve heard directly from women. IUDs are also incredibly easy to change your mind about and have removed. The removal process is extremely quick. Anecdotally (based on my own experience and that of others) it is quite possible for the strings to be felt during penetration, and one letter writer for this column reported small cuts occurring on the tip of her partner’s penis, but if straight dude’s dicks were getting sliced up regularly, I suspect there would be widespread discussion, research, and changes to the device pretty quickly.

You do have a range of other options, including copper IUDs and sterilization. But I’d start the conversation with your doctor, anticipating that they’ll recommend a hormonal IUD. If that’s the case, try the thing that works best for most people and is easily reversed first.

Dear How to Do It, 

I’ve been married to my husband, “Sal,” for just under 10 years, and we dated for four years before that. As we reluctantly go into middle age, both of our sex drives have declined, but mine a lot more than his. I do still very much love him, but I just don’t have the fire I did back when I was younger. He’s slowed down, but for him, that means going from “wants to have sex multiple times a day” to “wants to have sex every day.”

He’s always been respectful and wouldn’t push when I didn’t want to keep to that kind of pace. But I do feel bad and know he gets frustrated. So, with his birthday coming up, I commissioned a RealDoll made to resemble me. I thought he’d like it. He did not.

While calling it “flipping out” would probably be overmuch, he’s been seriously offended and hasn’t touched me since. He keeps saying he needs to “think things over” and “wants his space.” I’m not sure why this upset him so badly, or how to make amends. How do I fix things? I still don’t get why it was such a big deal.

—Stepped In It

Dear Stepped in It,

Oh gosh. Two misfires with surprising spouses with sex toys in one week. The standard advice with gifting sex toys has been “only if you know the person very well,” and it feels pretty obvious that this needs an edit. Only give a sex toy to a person if you know their sexual desires, boundaries, and the ways their emotions tie in to sex and masturbation well. Additionally, the larger a gift is, or the more consistently mocked it is in pop culture, the more significant the chances are of the recipient having a negative reaction. In the case of a RealDoll, unless the person in question has expressly stated their desire for one and that their desire includes it having a certain appearance, you’re taking a really big risk.

I’m guessing that the context of your husband wanting sex more often than you do contributed to the situation. He almost certainly feels like he’s being made fun of or denigrated by you in some way. You’re going to need to think through how he accepts apologies best (what mood he needs to be in, what format he’s most easily able to hear) and let him know that you feel awful but aren’t able to understand why your gift hurt him so much. If you’re generally oblivious to the ways your good intentions might land differently, there’s a decent amount of hope that he’ll realize you’ve done it again, and let you in on why he’s so hurt. From there, you can start repairing.

Have Your Own Story to Share With How to Do It?

Readers often have great suggestions for our letter writers, occasionally disagree with a point our How to Do It writers make, or simply want to provide some additional advice. Each month, Jessica and Rich will be replying to some of these comments and suggestions from readers, which will be featured on the site for Slate Plus members. Write to us!

Dear How to Do It, 

My partner (we’re both women) has had a fantasy about being choked by a woman who is fisting her while ordering her to come for more than a year now. She has been trying to persuade me to make it a reality, but in truth, I am really put off by it. To my knowledge, she has never suffered any sort of abuse. Is her fantasy within the bounds of normal?

—Sorry Not Into That

Dear Sorry Not Into That,

Fantasies along the lines of what your partner is describing are more common than you’d think. You still shouldn’t do it. The fact that you’re “really put off” by the idea is enough, whether we’re talking about strangulation during sex, having your nipples licked, or any other practice. The validity of your boundaries is not predicated on how typical a desire or activity is in the general population.

Even though you’re not the one who brought up the idea, I also have to address the fact that there’s no such thing as “safe” choking. It’s simply not a thing. If a person is feeling the effects of choking-like behavior, oxygen flow to their brain is being reduced. To really underline it, reducing oxygen flow to the brain is bad for the brain and the rest of the body. If both parties genuinely want to risk immediately killing the chokee, legal ramifications including jail time for the choker if things go awry in the moment, and long term psychological and physical damage to the chokee that may take so long to become apparent that no connection is drawn to the choking, I have no more power to stop them than anyone has to stop adults from taking immediate and long term risks by drinking alcohol, smoking marijuana or nicotine, or innumerable other activities such as underwater cave exploration.

But real consent requires being informed about the risks, and I so often see people talking about aspects of sex, substances, and sports in terms of “being safe.” Mitigating risks is realistic, aiming for safer is realistic, and staring the potential consequences in the face and deciding to proceed anyway is something I consider a basic human right. “Safe,” though? No. That doesn’t exist, especially not with asphyxiation.

To finish directly answering your question, women who fantasize about experiencing violence during sex are pretty normal, as are people who underestimate or avoid considering the risks of various experiences they want to have. If your partner fails to accept the fact that this is beyond what you’re willing to do, and you want to continue the relationship, I’d go with a combination of asking her why she wants to enact this fantasy and presenting her with the alarming facts.

—Jessica

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