DEAR DR. NERDLOVE: I’m reaching out because I’m feeling incredibly confused and frustrated about my relationship, and I really need your perspective. I’m currently dating this stunningly beautiful girl, and I can’t help but wonder why on earth she’s with someone like me. When I look in the mirror, all I see is someone who isn’t physically attractive. I don’t have a gym body, I don’t have money, and honestly, my face isn’t anything special

I’ve tried using Tinder, which everyone seems to treat as the ultimate solution for finding attractive partners. People rave about how it opens doors to incredible connections and allows you to meet people who genuinely appeal to you. But for me, it’s been a complete disaster. I’ve never had any luck on that platform. Every time I swipe, I’m painfully aware that I’m not the type of person that most girls are looking for.

So here I am, with this girl who could have any guy she wants, and I can’t help but think: what does she see in me? Does she have a vision problem? Is she just looking for a charity case? Or is there something about me that I’m completely missing? I feel like a misfit in a world where physical attractiveness seems to be the only thing that matters, and it’s eating away at my self-esteem.

To be honest, I’ve even started to consider whether I should just end things with her. I mean, she’s so beautiful that I can’t shake the feeling that I’m somehow holding her back from being with someone who truly deserves her. It feels like I’m living in a fairy tale where I don’t belong, and I worry that I’m just a placeholder until she finds someone better. The thought of her being with someone else who matches her beauty and charm only adds to my anxiety.

I’m genuinely wrestling with all of this, and I’d love to hear your thoughts on how attraction works beyond physical appearance. Is there something deeper that I’m missing, or is this just a situation that’s doomed from the start? What really matters in the end when it comes to relationships?

Thanks in advance for your help. I really appreciate it.

Stand In Boyfriend

DEAR STAND IN BOYFRIEND: There’re three separate issues embedded in your letter, SIB, but they’re all twisted and tied around each other like horny snakes, creating a Gordian knot of insecurity. And while it’s probably better to cut the damn thing in half, I wouldn’t be me if I didn’t pick them apart a bit first.

So, let’s start with the face you see in the mirror. There’re a couple of things here. The first is actually fairly simple: you’re basing your judgment on your attractiveness on what other men have told you that women want, not what women necessarily are interested in. The qualities you mention – the gym body and money, in particular, are qualities that men tend to admire in other men. These are symbols of status and power to other men, things that other men want to have or to emulate… but not necessarily what women want.

In fact, if you ask women – and I mean literally ask the women in your life – I think you’d find very quickly that your bank account or take-home pay isn’t even in the top 10 of qualities that they’re looking for. The idea of “a man must have money” is a consideration in as much as that women want someone who isn’t going to be a drag on them than wanting Daddy Morebucks. Yes, there’re women out there who (supposedly) want men to be a walking ATM that spoils them and takes care of everything… but this is far more a product of social media than reality. You’ll see a lot of “want a rich man who’ll take care of me” videos on TikTok or whatnot, but those are selling a fantasy to men, not an actual significant population of the dating public. ��(This, incidentally, includes tradwife types; it’s rather telling that they tend to already come from money and are, in fact, running a business of their own, rather than just keeping house for their husband. It’s a fantasy at best, a con at worst.)

While there are genuine gold-diggers out there, they’re few, far between and very, very obvious about it, and you, specifically, are not likely to encounter them in the first place. There are far more women who really just want someone who is going to pull their weight and not be frivolous with money in ways that will make things harder. This is far less about “I want a partner who’s a provider” and more “I want someone who’s a responsible adult and isn’t going to sacrifice the rent check because he wanted a bigger TV”.

The same goes with “gym bods”. This is another area that’s a trivially simple belief to debunk. It just requires going outside and actually paying attention to the couples you see. Go to the park, the zoo or Costco, Target or WalMart on any given weekend and you will see couples all over the place… and significantly, many if not most of them aren’t going to look like they spend all their time pumping iron. Men are far more into the athlete look and what it says than women are. While yes, women have body types that they love – aesthetically or otherwise – what they’re attracted to can be as wide and varied as it is for men. If you can be attracted to someone who doesn’t look like Sydney Sweeney or an Instagram fitness influencer, it should be obvious that women can be too.

I would also point out that not thinking you’re attractive doesn’t mean that you objectively aren’t. A thing that guys rarely consider is that, quite simply, they’re not their own type. Not having facial features that you think are attractive doesn’t mean that you look like the Toxic Avenger; it just means that those aren’t necessarily features that you would think are hot. That’s very different from being objectively ugly. And as I’ve said over and over again: if I had a nickel for every guy who insists that he fell out of the Ugly Tree and hit every branch on the way down but in reality, mostly needed a better haircut and skin care routine, I’d be swimming through my money bin like Scrooge McDuck.

Seriously, go watch some Queer Eye and notice how a simple haircut and better fitting clothes can be transformative.

The next issue that you bring up is Tinder specifically and dating apps in general. I don’t know who told you that Tinder was this amazing place to make incredible connections, but they either were misled or delusional. Tinder’s never fully gotten away from its hook-up app origins and has always focused on a far shallower, split-second judgment rather than forming real connections. It’s always been a place where your ability to look good in photos (which is not the same thing as being physically attractive) is the primary concern. But it – and most dating apps in general – are designed to be frustrating. They are set up to encourage mindless and continual swiping, and your choices (and the choices of others) are constrained both by an algorithm and a user experience that’s intended to annoy you until you’re ready to pay money to be less annoyed. Think of dating apps as being akin to Candy Crush; you can play for free, but they’ve designed it in such a way that you are pushed to convert and buy their boosts to alleviate the frustration.

It’s also important to note that not only are there massive gender imbalances in the user base (approximately a 70/30 male/female split, depending on your source), but it also takes a VERY large number of swipes on average per match and a number of matches to get a date. So, part of the frustration is that there is a limited pool of potential partners overall and the expectation that it will be a quick turnaround from “sign up” to “get date” has always been more marketing hype than reality.  

This is part of why I’ve been telling people to deprioritize the apps and focus on meeting people in person. If you’re going to use the apps, you want to do so deliberately, mindfully and with serious restrictions on how you use them.

Now all of this is to lay the groundwork about your real issue – the mistaken impressions and outright deceptions that are part of the insecurity you’re feeling. You’re experiencing these things, not because they’re objectively true, but because of things that play to your anxieties, deliberately and otherwise.

Now, let’s talk about your girlfriend. And rather than focus on the concerns that your insecurity is throwing your way, let’s focus on things that are concrete. Instead of absurd “what if’s” that only make sense if you are begging the question, let’s pay attention to what is most likely, most reasonable and actually comports with the real world.

Let’s start with an obvious one: yes, sometimes people will date someone they’re not attracted to simply because they are trying to have A Relationship. But this tends to be more male behavior rather than female behavior; guys who are picking someone because they are looking for the chance to have sex. Women who behave like this tend not to seek out placeholder relationships; they are more likely to stay in relationships that no longer work rather than to seek out someone they’re not into. Even the whole “cuffing season” schtick (which, quite frankly, I think is more media hype and memes than reality) is more about “find someone who’s good for the short term”, not “I will take what I can get”.  

But then the question would be: why you? Why would someone pick you if you had no desirable qualities, even if you were a short-term partner by design? What, realistically, would be her motivation? And I do mean realistically; the idea that she’s so myopic that you look like an Impressionist painting rather than a person is absurd on its face. So too is the idea that she’s just pranking you or that she’s taken pity on you. I hate to tell you this but people – not women, people – don’t date people out of pity or for charity. If she chose you, she chose you for a reason, so what reason would that be if she didn’t actually like you and want to date you specifically? Again: is there something that a reasonable outside observer would agree is the case? Or is it more reasonable to say that this is your insecurity talking?

Here’s another thing to consider: what, if anything, about your girlfriend’s behavior would lead a reasonable outside observer to think that she doesn’t actually like you or motivate her to lie to you about wanting to date you? Leave aside your feelings about your attractiveness; that’s not evidence, that’s speculation. I am talking about her behavior, her actions, things that she has said and done. What reason would she have to date you besides wanting to date you, specifically?

Has she acted bored or disappointed when she’s been with you? Has she made comments about wanting better or more or things you don’t offer? Has she talked you down, compared you unfavorably to other men or said that she wished you were more like X person or Y person? With everything you know about her, has she ever done or said anything that would lead a reasonable person to think that she’s the sort of person who would engage in that sort of behavior in the first place, never mind with you specifically? ��And here’s the single, most important question: why don’t you trust your girlfriend? Has she said or done anything that a reasonable outside observer would think is deceptive or indicative that she’s using you? Or is this entirely down to your insecurity and your unwillingness to accept that this is exactly as it appears?

Here’s the thing: I think you’re so invested in your belief that you’re unattractive that you’re afraid to be wrong. You want to believe this is a trick because then you aren’t responsible for this relationship; if it ends, it was always going to end, not because you did something to hasten that ending. People are frequently afraid of success, because now they have something that they have to work at and maintain. They’re responsible for the outcome of their own choices and the dildo of consequences rarely arrives pre-lubricated. It’s much easier when failure is assured, especially if you can blame it on The Universe instead of having to acknowledge your own agency. Hope, after all, is a very scary thing when you’re not used to having it.

So at the end of the day, this comes down to whether you actually trust your girlfriend or not and whether you respect both her choices and her agency. The idea that you should break up with her “because you’re holding her back” is actually kind of insulting; it implies that you know better than she does and that her actual desires and choices mean less than what you think she should want. If you don’t trust her, then yes, you should break up with her. Not because she’s lying to you, but because that lack of trust is corrosive, and it’ll destroy the relationship anyway. It’s incredibly harmful when someone you love calls you a liar every time you say that you love them, and in time you quit fighting them over it because the pain just becomes too much.

But if you do that, then you also have to admit that you didn’t break up with her for the greater good, you did it because you couldn’t let yourself trust her or be happy with her. You snatched defeat from the jaws of victory because you wouldn’t accept that maybe this was exactly what it seemed and she actually cared for you because you’re you.

So maybe the relationship you need to focus on more is your relationship with yourself. This letter is precisely the reason why I bring up the Ru Paul quote over and over again: you don’t love yourself, and so you can’t accept that others love you. So perhaps what you need more than anything else is to learn to love yourself, so you can recognize and accept love when it’s freely given and not a trick.

So, were I you? I would stop questioning why your girlfriend is with you and start questioning why you can’t accept it. And that’s the sort of thing that’s best sorted on the therapist’s couch, not by pushing away people whose only crime is liking your company and finding their time with you to be enriching and pleasurable.

You’ve got a good thing here, and one that goes directly against your own bulls--t beliefs. Maybe you should lean into that instead of fighting against it. Sometimes stories really do have a happy ending. So hie thyself to the therapist’s office and do some couple’s counseling with yourself. It’ll make you much, much happier overall.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: I have a few things I want to talk about, and I promise it all ties back to romantic relationships, so bear with me.

To give some context, my life hasn’t been easy. I experienced severe emotional abuse as a child, and that trauma shaped a lot of my relationships moving forward. For most of my life, I’ve found myself either attracting or being drawn to people who weren’t emotionally healthy, often in subtle ways. This pattern led to a lot of one-sided friendships or manipulative short-term relationships.

I’ve done a lot of work over the last few years with the help of a great therapist, and while I know it’s a long and difficult journey, I’m committed to healing. One of the coping mechanisms I developed early on was to cut people out of my life. Sometimes this has been necessary, but I know at other times it’s been an overreaction or even an inappropriate response to situations that didn’t warrant it.

Most recently, I’ve distanced myself from a friendship group that was, honestly, the healthiest I’ve had in a long time. While I wouldn’t say I was able to fully open up to them, they were good, caring people who genuinely made an effort to get to know me and spend time with me. But I’ve often felt overwhelmed by their attention, particularly when they would ask why I wasn’t dating anyone. On top of that, I’ve become very good at masking my emotions, so people often think I’m fine when I’m actually struggling. About a month ago, during a depressive episode, I ended up blocking all of them. They’ve tried reaching out, but I’ve ignored them, and now I find myself isolated.

This leads me to something else I struggle with: deep down, no matter how much I try to convince myself otherwise, I can’t seem to believe that any woman could be interested in me or fall in love with me. I’ve “put myself out there”, and my friendships with women have been good, but aside from very rarely meeting someone that was available, I just don’t understand the dynamics that lead to a romantic connection. If it weren’t for people suggesting otherwise, I’d almost believe that I am just that undesirable of a human.

In many ways, my life is going well. I’m doing well in almost every area, but emotionally, I still feel stuck. I often feel alienated, like I’m emotionally stunted compared to others. I have no real sense of what it feels like to love or be loved. I can’t picture what it would be like to have a close friend, someone I could confide in. I can’t imagine feeling that warmth in my chest when something good happens, or the excitement of taking the first steps in a romantic relationship.

I know I’m not an ugly man, nor am I useless or unkind. I know I’m not a bad person—quite the opposite, really. But when I look at others who seem to have fulfilling, loving relationships and close friendships, it’s hard not to feel like something’s missing in my own life. Therapy has been helpful, but it often feels like we only see the ‘highlight reel’ of progress, while the messy, painful side of healing is hidden behind the scenes. I’ve seen people recover quickly — like someone I once knew who, despite being suicidal, found a partner just a few months into therapy. But right now, I’m stuck in the messy part, unsure of how to move forward, and I’m left wondering if it’s even possible for me.

Ironically, I work with children now, and they seem to see something in me that I can’t see in myself. It’s clear that many of them find me to be the kindest, most understanding adult they know. Some of them have said I’ve been an inspiration to them, that I’ve made them feel safe, and that they’re grateful for everything I’ve done.

But despite the positive impact I’ve had on others, I still struggle to believe I have the capacity to be loved in return.

Emotionally Stunted

DEAR EMOTIONALLY STUNTED: OK I want to preface this by saying that I am not trying to diminish or otherwise minimize the trauma of the abuse you experienced growing up. That’s the sort of thing that leaves long-term, lasting scars, and I’m sorry you went through all of that.

But I would be remiss if I didn’t point out an obvious truth: it’s going to be hard to accept that you’re worthy of love if you don’t actually give people the chance to love you. This is the very definition of a self-reinforcing cycle; you don’t believe that you’re capable of being loved or worthy of being loved and so you shut out the people who are trying to show you that they love you and they care. That increases your loneliness and isolation and that, in turn, reinforces the feeling that you’re unworthy of being loved or so flawed in some way that you push people away.

And as simplistic as it may sound… have you considered not doing that?

Ok yes, that’s easily said and not so easily done. But even allowing for the fact that this is as much a trauma response and your brain trying to protect you from being hurt further, the fact remains that this is a conscious series of steps that you take. At each step of the way, you have had to decide that you were going to distance yourself from them, block them and then ignore them when they reach out to you. That means that there are multiple points in this process where you could have chosen to stop, to make a different choice and not give in to the fear.

I get that this is doesn’t feel like a step-by-step process to you. I get that it’s something that happens in a moment of panic. Some aspect of your connection with people hits the tripwire in your brain, your endocrine system dumps a metric f--kton of adrenaline and you’re in fight-or-flight mode and you slam your fist on the block button. But here’s the thing: while this may have started as a way to protect yourself, this behavior is no longer serving you. It’s evolved past its utility in a way that’s all too common: avoidance has made the feeling worse.

Like a solider who’s still trying to fight a war that’s long over, this self-defense mechanism no longer has an enemy to fight, but it can’t bring itself to accept this. So the mission has changed. Now you’re not protecting yourself from people who have hurt you; you’re trying to protect yourself from the discomfort of that fear. You’ve, quite literally, become afraid of fear itself, the feeling of that discomfort that the fear brings. Icing people out and blocking them isn’t about protecting yourself so much as just trying to make that feeling go away. 

I think, to some degree, you understand this. But I wonder if you’ve ever stopped and tried to break the cycle. Part of why you’re in this circumstance is because this cycle has gone on for so long that it’s basically just serving to perpetuate its own existence. And the only way to break this cycle is, quite honestly, to choose to break it. 

Now I’m not saying that this is as easy as deciding to do something and magically you’ll have the will to do it. You’re dealing with the most primal instinct humans have: self-preservation. Fear is the manifestation of a desire for safety and security; it’s our brain trying to keep us alive, no matter the cost. Happiness isn’t even a secondary consideration; it’s barely a consideration at all. So that drive is very powerful and very compelling in the literal sense.

But the fact that it’s powerful doesn’t mean that it’s unstoppable. It relies on the immediate response to that fear. But that’s the thing: you don’t need to do anything to push through. In fact, the thing you should be doing is… nothing. You don’t react immediately; you, instead, choose to pause. To wait. To grit your teeth and breathe through the fear. As the litany says: fear is the mind-killer, the little death. You want to face your fear and let it through you and past you. When you do, then you often see that the immediacy of the panic subsides and you recognize that you were about to react to a threat that is, quite literally, only in your mind. Taking that moment to just restrain yourself from making an impulsive decision can be all it takes to realize that this isn’t the dire threat you thought it was.

Now some of this is the something you should be working with your therapist on. But one thing that I think you should start doing is getting in the habit of focusing on your breath. When you feel those moments – whether you’re in a depressive mood or simply feeling the panic starting to rise – you want to do what’s called 4-4-4 breathing. You exhale all the air out of your lungs, then breathe in a slow and controlled pace for a count of four seconds. Then you hold your breath in your lungs for four seconds, then breath out to a count of four. Then you repeat the process: four seconds in, four seconds holding your breath and four seconds out again.

This does two things. The first is that it slows your heart rate down; because you aren’t breathing rapidly, you are disrupting the panic cycle and forcing your central nervous system and cardiovascular system to slow their roll. Just as importantly, however, you are taking your mind off the thing that’s causing you to panic and giving it something else to focus on instead. By distracting yourself and turning your thoughts away from what you’re experiencing in that moment, you give everything a chance to calm down and for the moment to pass. When it does, I think you’ll experience a greater feeling of relief than you would expect. Then, as the rest of your systems come down from red alert, you’ll be in a better position to make choices that will actually benefit you instead of lashing out.

The other thing I would point out is that breaking the cycle doesn’t mean just preventing yourself from shutting people out in a panic. The fact that you closed that particular door doesn’t mean that you can’t reopen it again. You actually have an opportunity to do just that, even as you read this. Those friends you cut off have been reaching out to you. You can choose to reach back, to unblock them and to let them back in. You can say “I’m sorry, I let my fear get in the way”. It’s clear that they care for you and that they’re worried. They’re going to understand, especially if they know your history.

I know coming back to them can be scary. Worse, it’s embarrassing, and we do so many stupid things because we don’t like feeling embarrassed. But much like the fear, if you can recognize the embarrassment for what it is – another form of misaligned attempt to protect yourself – you can push through that too. The momentary sting of coming back to your friends and saying “I didn’t mean to push you away” is far less than the relief that comes from ending your self-imposed isolation.

The last thing I would suggest is that you need to work on learning to love and accept yourself. When we quote Ru Paul’s famous saying of “If you don’t love yourself how the hell are you going to love anyone else,” we’re not saying that loving others is contingent on loving yourself first. We’re saying that if you can’t love yourself, you have a much harder time accepting love from others. You may have love to give, but it’s harder to give when you can’t receive.  

The thing is, part of what makes this insidious and hard to shake is that this really is down to these old systems that had a purpose once, but have long outlasted them. These coping mechanisms were predicated on the hurt that others were inflicting on you, and part of why they linger is… well, because of the ways it’s trying to protect you. One of the ways it tries to protect you is by misunderstanding why you need to be protected in the first place. There are few things more painful than being hurt by people who you love or who are supposed to care for you. It feels wrong. It’s much easier to believe that there’s a reason for their abuse, that someone who supposedly loves you wouldn’t hurt you like this unless they had to or unless you deserved it. Rather than accept that the people who abused you were wrong and mistreated you, intentionally or otherwise, it’s easier to assume the fault is in you. You are protecting yourself from one pain – the pain of someone you love treating you in such ugly ways – by taking the blame on yourself. It’s not their fault. People who love you shouldn’t hurt you or treat you like that. So, the fault must clearly be in you instead.

This is part of why you feel less worthy and more broken than others. It’s why you feel like other people – people who seem to “recover” more quickly than you – are succeeding where you’re failing. It’s not just the highlight reel issue, it’s the continuing acceptance of the framing that you brought this on yourself because you’re flawed, damaged or broken. It’s one more thing that you take as proof that the people who treated you badly saw something in you, something that made their mistreatment understandable, even inevitable.   

And that’s bulls--t. 100%, complete, total bulls--t being expelled from choleric bovines. 

It’s logical in its twisted way, but it’s the logic of a scared and hurt child who doesn’t understand what’s going on. But you’re no longer that child. The pain is still there, the scars are still there… but you’re not the child you were. You can understand now what you couldn’t before: that this wasn’t your fault, that you didn’t deserve this and that the people who hurt you are wrong.

Understanding and accepting this on so thoroughly that it becomes part of you, accepting that mistreatment isn’t part of love, is part of how you break those cycles of falling for toxic or one-sided relationships. You stop accepting that behavior as good or necessary, and you stop believing that you deserve that treatment for sins that you have never committed and that were never yours in the first place.

You shouldn’t feel ashamed for this pain, or for how you’ve tried to manage it all this time. I think you would do better to acknowledge that these coping mechanisms have been doing their best to keep you safe, to thank them for what they intended, and to acknowledge that their job is over and has been for quite some time. It’s time to decommission those defenses, lower your shields, and accept that it’s time for a change. There will still be people who you need to guard against, people who you need to cut out of your life. But that’s not the same as letting your fears control you and isolate you.

You have people in your life who are good for you, who express love and affection for you and who – in your own words – are probably the healthiest social connection you’ve had in years. Start there. Welcome them back in. Accept that they love you and that you’re worthy of being loved. Let that acceptance be part of how you find the strength to simply hold still and breathe when you feel that fear, until the fear has passed through you and you turn your inner eye to see that is has gone and only you remain.

It’s a seemingly small thing, but it’s the first step to ending your isolation and learning to allow others to love you the way you wish you were loved.

All will be well.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: I know you’re not a real doctor, but I’m hoping if you can’t answer my question, maybe you can help me figuring out how to get recommendations from someone who can.

It’s this: I have been dealing with (and trying to treat) chronic tachycardia for a bit over a year now. Recently (past six months or so) it seems like orgasm or even nearing orgasm triggers a cardiac event (usually acute rapid heartbeat and I pass out). I’m not sure exactly, because honestly after it happened twice, I just stopped nearing orgasm during sex/masturbation. I tried last night, though, and I triggered the tachycardia. Fortunately, didn’t pass out, but I felt physically awful afterward.

So: is there a way to orgasm slower?

Or, maybe reduce the risk of rapid heartbeat, maybe ramp up more slowly?

Or maybe, I don’t know, is there a mildly calming drug or supplement that can temporarily slow down heartbeat but keep sex drive going?

Yes, I know, I will not take anything without talking to my cardiologist. But I’m looking for any direction or options.

For context, the chronic tachycardia is likely either a complication of a condition I’ve had since birth, or a side effect of the medication I’ve taken for it for decades. In cardio rehab, physical therapist determined a walking speed of 3.0 mph, for 4 minutes, creates a sustained tachycardia that causes me to pass out and my blood O2 to drop. So… that’s annoying. I have to pace myself at, like, 2.5 mph or slower to walk for half an hour.

Also, I am a cisgender woman, married to a very sexy cisgender man, we’re both mid-30s, and our sex life is solid other than this issue. My husband is honestly more cautious and in general is more into sensual-erotic intimacy that doesn’t necessarily lead to orgasm anyway. Which I also enjoy!

But I also enjoy and desire overtly sexual experiences, including orgasm, pretty frequently. I don’t want orgasm to be completely off the table (even when masturbating?) just because my heart gets too into it!

I have not brought this up to my cardiologist or physical therapist, because it’s extremely awkward. What do I even say?

Also, I feel like it sounds whiny or entitled. Like we’re focusing on preventing a heart attack, or keeping my condition stable so I won’t need a transplant in a few years, but I’m upset because I can’t have a specific sexual experience?

Maybe my question should be, “how do I set aside this desire and be happy with what I have?”

I don’t know. Any advice is welcome.

Heart Is Actually Broken

DEAR HEART IS ACTUALLY BROKEN: I know you said this at the start of your letter, HAB, but I want to repeat this for emphasis: Dr. NerdLove is NOT a real doctor and this is very much something that you need to talk to your doctor about. I’ve got friends with similar issues, and they’ve provided some insight into options, but you absolutely need to be talking to your doctor about this.

Here’s the thing: tachycardia is no joke, and it can present serious issues for people’s day to day lives. Managing it and keeping it under control requires a lot of care and attention. But it also means that you have to be willing to speak up when these issues are causing problems in your life. One of the issues a lot of women in particular have when dealing with doctors and people in the medical field is feeling like they can’t speak up and advocate for themselves… and with good reason. A lot of women find it difficult to get medical professionals to take them seriously, especially if they’re addressing concerns they have with a particular treatment or medication and the effects it may be having on their lives. It’s very easy to get discouraged when a person in a position of authority tells you that it’s not a big deal, all in your head, or something that you should be able to just deal with.

The thing is: you’re the expert on you, and you’re the best authority on what you’re experiencing and how it’s affecting you. So, as scary and as hard as it can be, you want to get in the habit of being your own first line of defense and most zealous advocate, especially with things that are affecting your overall quality of life.

And sex, sexual pleasure and intimacy with your partner are all very much a part of your overall quality of life, not things that should be dismissed or hand waved away. So while it can feel awkward to bring this up, it is something you should be willing to advocate for. Now, maybe you would need to bring your husband as both your moral support and advocate, especially if your doctor isn’t willing to listen or take things seriously. It may be, for example, that the doctor would be more willing to listen if your husband repeats what you said. As absurd as it is and as screamingly sexist as it is, “what she said, but with a penis” is often the only way to break through the systematic sexism that infects so much of life. But also having him with you and knowing that he’s going to back and reinforce your play can give you the additional boost to say what you need to say.

I would recommend memorizing the following phrases and using them as needed: “this affects my relationships, my productivity at work and my overall quality of life”, “what would you recommend for a male patient experiencing these symptoms” and “will you please make a note in my records that I requested this, and you refused?” 

I would also suggest that your husband be ready with “don’t ask/tell me, ask/tell her, she’s the patient.”

Now that having been said, there’re a few things that you can try. The first is: hydrate. Seriously. Treat sex like any other form of physical activity and stay hydrated. The next is realize that certain positions may not be good for you. On your back or on your side can work. On top, with the level of effort and motion needed is likely to be how you end up meeting the local first responders while naked – something you probably want to avoid. Rear-entry positions where you’re bent over or on your knees are less likely to be as risky, but still not great.

You mention that your husband is more into sensuality; that’s good, because it’ll be easier to keep things at a more measured pace. Hard and fast is almost certainly going to be off the table, so a long, slow build-up is going to be the way to go.

As cheesy as it may sound, you may actually want to look into some tantric practices. Focusing on sexual activity where breath control and gradual arousal are prioritized can be good for getting you where you want to be without hitting the danger zone for your heart. The same goes with masturbation; a longer, slower and more gradual build up will likely be better for you than going to town with a high-speed, high-intensity vibrator. If you’re someone who needs direct clitoral stimulation, then something that can give a low buzz and let things build without getting your circulatory system worked up may be helpful.

But again: you really need to be in the care of a cardiologist and discussing options with them – including what side effects you’re not willing to tolerate. A lot of heart medications will tank the libido, which may keep your tachycardia under control but works against your goal of a fulfilling sex life with your husband.

It can be hard to speak up about something so personal, I know. But if it’s important to you – and it certainly sounds like it is – then you should make that clear. Even if your voice quavers and your knees shake while you’re doing it. To paraphrase a particular general: be afraid… but do it anyway.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com