Dr. Laura Berman on why people don't talk about sex.

The Oprah Show is family-friendly television, but Oprah says to send your kids to the other room—today's show is for adult eyes only!

Research shows that more than half of men and women are unsatisfied with their sex lives and one in five couples are in sexless marriages. Dr. Laura Berman, a sex therapist and the founder of the Berman Center for Sexual Health, uses talk therapy to help couples build stronger relationships and improve their sex lives.

Dr. Berman says problems in the bedroom usually stem from communication issues. "Nobody knows how to talk about sex," she says. "It's partly lack of information and it's partly lack of comfort. No one's really addressing the issue. They just kind of sweep it under the rug."

One mistake couples make is that they think sex should happen naturally, Dr. Berman says. But that's not always the case. "Especially if you're in a long-term relationship, you're always going through ebbs and flows physically, socially and environmentally," she says. "You can't expect everything to be working perfectly all the time. You've got to fine-tune things along the way."

Dr. Laura Berman and Oprah

An active sex life isn't just good for your relationship, it's also great for your health. Dr. Berman says frequent sexual activity makes you look seven to 12 years younger, improves your immune system by 33 percent and decreases heart disease by 50 percent. It also decreases stress and insomnia and acts as a natural pain reliever, especially for menstrual cramps and headaches.

Dr. Berman says couples need to keep gender differences in mind when striving for a good sex life. Men take an average of five to 10 minutes to reach orgasm, while women need about 15 to 20 minutes. "If men are a microwave oven, women are a slow-burning stove," she says. "It's a big difference."

Tom and Debra are in a sexless marriage.

Tom and Debra are two of the 40 million Americans in sexless marriages. They've been married for 19 years and have two teenage kids, but they say their sex and intimacy has been reduced to nothing. "We kiss, we hug," Tom says. "But as far as just laying in bed and being close to each other and maybe caressing, Debbie is hesitant to do that because I'm very easily aroused and she thinks that will be the green light."

Debra says she didn't even realize that she and Tom haven't had sex for years. Between raising kids and working, she says sex feels like work. "It was just one more thing on my to-do list," she says. Sometimes, she says, she even intentionally falls asleep before Tom gets into bed so that she can avoid having to say no to sex. "I'm kind of at the point where I could live the rest of my life and not have it again."

Debra's hormones have lowered her libido.

During the therapy session, Debra tells Dr. Berman she doesn't feel much sensation in her genitals, but she says that hasn't always been the case. Dr. Berman suspects the problem may be hormonal and sends Debra to get her hormones checked.

At the doctor's office, Debra uses an external vibrator and watches an erotic video, but she still doesn't climax. "I feel completely drained," she says. "I feel like somebody plugged me into something and sucked all my blood out of me."

Debra's test results show that she is perimenopausal. "Usually in your late 30s into your early 40s, there's a drop in estrogen which causes dryness and thinning of the vaginal tissue," Dr. Berman says. "[It also causes] a drop in testosterone, which will affect your libido, your interest in sex and your sexual response."

Dr. Berman says low libido is the most common complaint she sees among women. "A lot of women don't know that stress—chronic stress—will not only make you not want to have sex, but chemically it will negatively affect your testosterone levels," she says. "As will hormonal contraceptives."
Dr. Berman says couples should share sexual fantasies.

One of the best ways to rev up your sex life is to share sexual fantasies, Dr. Berman says. It adds something special to a long-term relationship and, more importantly, increases intimacy. "[Sharing fantasies] really can help to revitalize the sexual connection," Dr. Berman says. "It requires a tremendous amount of trust and safety to bring those things up."

If you're going to reveal your sexual fantasies to your partner, Dr. Berman says you need to follow certain ground rules. First, don't judge each other's fantasies—you can't open up if you don't feel safe. Secondly, know your limitations and feel free to express them. "If you're not into being spanked or there's no way you're having sex in a public place, you need to say that," Dr. Berman says. Finally, if your fantasy involves a friend, neighbor or in-law, Dr. Berman recommends, "keep it to yourself."

Tom and Debra share their fantasies with Dr. Berman during therapy. Tom says he fantasizes about seeing Debra with other men. "I can't have her, so I'd like to see someone else having her," Tom says. "I think she's a beautiful woman, so what could be better than watching a beautiful woman being pleased?" Debra admits her fantasy is to be dominated. Debra says at first she was nervous to talk about her fantasy, but she's glad she did. "It felt freeing," she says. "It felt good to finally let that out."

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Tom and Debra go on a surrender date.

Dr. Berman says that nearly 60 percent of all women share Debra's fantasy of being overpowered. "They like the idea of being so gorgeous and seductive that he just can't stand it," she says. "And they like giving him complete control because they don't have to feel guilty. ... Women are so crazed and busy and stressed, [sex is] one time that they can just totally give up."

Dr. Berman says a woman's need for control can be a factor in a diminishing sex life. "We're ordering him around and telling him what to do and controlling everything in the household, and then we wonder why we're no longer attracted to him," she says. "It's hard to be attracted to a man that you don't see as powerful and competent and equal to you. If you see him like a child, you're not going to be attracted to him."

Sharing sexual fantasies doesn't always include acting them out, but in Tom and Debra's case, Dr. Berman suggests they try experimenting with domination. First, Tom and Debra go to an erotica shop together to buy props. Dr. Berman also suggests that they go on a "surrender date" where Debra will surrender to all of Tom's decisions—what to wear, where to go and what to do.

For their surrender date, Tom chooses Debra's outfit and a restaurant for dinner without consulting Debra, and Debra has a hard time releasing control. "Surrender is not my strong suit," she says. 

Watch a clip of Tom and Debra's surrender date. Watch

At the end of the night, the couple agrees the date is a success! Dr. Berman says surrender dates are a great way to get the sexual attraction back. "Even if it's just for one night or one afternoon, give the guy some control. Let him make some decisions," she says. "When he rises to the occasion, you'll see how it really positively affects your perception of him, not to mention his own relationship satisfaction."

Dr. Berman explains the female orgasm.

When Debra and Tom got home from their surrender date, Debra says she was able to orgasm using a vibrator. "I was kind of surprised that stuff worked down there. I kind of thought it was dead down there," she says. "So I was a little overwhelmed by that. And just that whole sensation—it was just, like, wow."

"Deb's story is so common. Women don't realize they have a clitoris much less that it has more nerves than any other part of your body," Dr. Berman says.

Dr. Berman says there are three different types of female orgasms: clitoral, vaginal and blended. A clitoral orgasm occurs when the clitoris is stimulated. This stimulation causes pleasurable muscle contractions. Clitoral is the most common type of orgasm and the easiest to achieve, but Dr. Berman says it can be difficult to have a clitoral orgasm during intercourse. "It depends on the position," she says.

A vaginal orgasm is usually achieved through stimulation to the G-spot, a small area of tissue inside the vagina. "Women who have both kinds of orgasms will say that vaginal orgasms will feel more intense because you're having uterine and pelvic floor contractions," Dr. Berman says.

A blended orgasm is a combination of clitoral and vaginal orgasm, and Dr. Berman says it is usually the most pleasurable. "Listen, an orgasm is an orgasm is an orgasm," Dr. Berman says. "But blended is a Holy Grail, a nice thing to go for. ... It's more intense."

Dr. Berman and Oprah

How can regular couples improve their own bedroom behavior? Dr. Berman says it starts with a kiss. "Kissing is so important and goes by the wayside so quickly," she says. "Remember in the beginning of a relationship, you can't stop making out with one another? Women, in particular, love that. It's part of their erotic template—what turns them on."

Dr. Berman has a homework assignment to help couples get in the mood. "Start giving your partner a 10-second kiss at least once a day," Dr. Berman says. "You'll be surprised to see what a difference it makes and how long it feels compared to what you normally do."

Dr. Berman says the emphasis should be on kissing for the sake of kissing. "The only time that women get kissed in a long-term relationship is when it's a prelude to sex. So you want to make it not about sex but just about kissing," she says. "When he's not putting the pressure on and he's just about sensuality and loving her and connecting with her and kissing her, then she often will get turned on as a result."

Dr. Berman

If you want your partner to know your body better, Dr. Berman says you have to know how to guide him! The second homework assignment that Dr. Berman suggests is for women only. Take a hand-held mirror and look at all the different parts of your vulva.

"You have to take your pleasure into your own hands. If you want to get pleasure from your sex life, you have to know how your body works," Dr. Berman says. "If you're not comfortable with your vulva, you can't expect him to be."

Get to know your body! Dr. Berman explains the female anatomy.

Dr. Berman's complete guide to spicing up your sex life!