Every time I try to have sex I set off a bizarre chain of events

How to Do It is Slate’s sex advice column. Have a question? Send it to Jessica and Rich here. It’s anonymous!

Dear How to Do It,

I’m (50s M) a photic sneezer. Moving from a darkened room to bright sunlight (or sometimes just turning on an overhead lamp) can sometimes cause me to sneeze. This is a genetic condition: My kids all have it. I can’t really control it. It’s usually pretty easy to deal with.

In my case, though, there’s another trigger: asking for sex. Something about the anxiety of feeling a little vulnerable seems to also set off a sneeze (thankfully usually only once each time!). I’ve had this for as long as I can remember. It doesn’t happen when I’m feeling confident, but asking for something out of the ordinary or sometimes even just trying to initiate can set it off. I can literally cause myself to sneeze just by imagining asking a woman for something inappropriate (the more inappropriate, the quicker and harder the sneeze).

I tried to hide it, but after many years my ex-wife noticed that sometimes I sneezed when I brought up sex, so I told her about it. Every once in a while, she’d taunt me by not responding when I asked to get intimate. If she waited 10 or 15 seconds, I’d almost always sneeze. The anxiety of knowing what she was up to and my not wanting to sneeze made it worse! I’ve done Google searches trying to figure out why this happens, and it’s an actual thing. I’ve been in a new relationship for a year, and this has already happened a few times (I didn’t try to explain it and she just thought it was random sneezes). Should I explain it to my gal? Is this something I could get away from?

—Not the Reaction You’d Expect

Dear Not the Reaction You’d Expect,

Photic sneeze reflex (PSR) is, indeed, a thing, but it’s not well understood because, as neurologist and USCF professor Louis Ptáček recently explained to me over Zoom, “Nobody’s really carefully quantified this phenotype—it’s not a problem for most people.”

Ptáček, who has studied episodic neurologic diseases like epilepsy, migraines, and periodic paralysis, said that try as he might, he found himself unable to get funding for a PSR study because, understandably, “people are much more interested in trying to understand better treatments for cancer than they are figuring out what the basis of PSR is.” He continued: “If your mom has Alzheimer’s, or your dad has multiple sclerosis, we care more about those diseases and helping those patients than we do about understanding PSR, even though PSR is really interesting in its own right.”

Ptáček said that he believes that PSR is a result of hyperexcitability of something in the nerves. What that something is remains unknown. Based on the limited literature and research that Ptáček himself has done, which includes discussions with patients who have contacted him regarding their photic sneezing and a general patient questionnaire that asks about the phenomenon among many others, the doctor estimates that about 10 percent of the population experiences photic sneezing. He has “absolutely” heard of photic sneezers having sneeze triggers besides light, including orgasm and spearmint gum. He’d never heard of a photic sneezer being triggered by asking for sex, but he wasn’t surprised that someone in the world reported such a phenomenon.

In terms of treatment, there isn’t much to speak of. Ptáček said that it wouldn’t surprise him if drugs used for episodic diseases like epilepsy, cardiac arrhythmias, periodic paralysis, and more might prevent sneezing in people with PSR, but that’s really just an educated guess. I found this paper observing effective use of the philtral pressure technique in some photic sneezers, which is basically when you apply pressure with a horizontal finger (see pic here) between the nose and lip. The sample was small (six) and the number of subjects for which this was effective was even smaller (three). Still, may be worth a try.

I think the bigger picture here, though, is that as inconvenient as photic sneezing may be, it’s a minor and brief one. A sneeze lasts, what? A fraction of a second? Your ex used your condition to taunt you, which may have been amusing for her but wasn’t kind. I wouldn’t expect that reaction from a truly considerate partner. Hopefully, your current one is just that. I would let her know what’s up, and use it as a litmus. If she somehow uses it against you, consider it a red flag.

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Dear How to Do It,

My husband (42M) and I (36 F) have been together for 13 years and while my body isn’t like it was when we met thanks to two kids and more stress than one human should handle, I like to think I haven’t changed much in terms of my physical appearance. But his interest in me has gone to a flat zero in the past two years and I’m officially dying. Every time I try to initiate, he says he’s not in the mood, too tired, etc. I know these reasons are valid and I try not to let it bother me but after two straight years of batting .0000, something is clearly up. I’ve asked, both pointedly and in roundabout ways, what the deal is. He just says he’s not in the mood much anymore, just not interested, swears it’s not me, etc. He’s also not interested in couples therapy or seeing a doctor for the issue. I’ve been trying that since the beginning and he’s not game. He says there’s nothing to work out, he’s just not horny anymore.

I, on the other hand, feel like I’m dying a slow, agonizing death. Dramatic, yes, but I’ve always had a higher-than-average sex drive and the lack of chemistry, intimacy, and non-battery-induced orgasms is frankly killing me. Other than the lack of sex, our life together is amazing. But I’m feeling very neglected and unseen. I’ve told him this and he brushes me off, saying that I’m just horny and hormonal. My therapist (who I’m no longer seeing) suggested porn to help ease the cravings. During our last fight about this, I told him I wanted to open our marriage because if he doesn’t want me, I’ll find someone who does. Needless to say, it wasn’t the best thing to say because he threatened divorce. I don’t want that because I truly love him and our life together but what is happening? Why am I the one who has to suffer because he no longer wants to get busy?

—Flying Solo

Dear Flying Solo,

You’re suffering because you want something that he’s not interested in providing. The list of potential reasons why your husband is presently not interested in sex with you is long and vast. It could be hormonal (if his testosterone levels have dropped, and that’s quite possible at his age, this could be contributing). It could be because it’s hard for him, like many people in long-term relationships, to sustain sexual excitement. It could be that he’s no longer attracted to you. Those are all difficult issues, but you can’t even get to a place where you might unpack and eventually solve them because he doesn’t want to participate. He doesn’t want to see a doctor or a therapist, and he seems decidedly against open relationships, though I have to tell you that bringing up this prospect during a fight was the wrong move.

I wonder what would happen if you brought up the idea of openness during a more peaceful time. I don’t have much faith that it would make a difference, but it might. If the answer is still no, you have to weigh what’s more important: staying in a relationship that is mostly good but missing one key component whose absence is “killing” you, or leaving something consistently amazing to be sexually satisfied. Is your husband worth a vow of chastity?

Perhaps if you showed signs that you were serious about leaving, it would prompt some action from him—counseling or the doctor would be great first steps. But then again, maybe it would hurt his pride and he’d sour completely. The supreme truth here is that you can’t make anyone do anything. You sound miserable and I don’t think letting your sexuality die, or at least go unsatisfied indefinitely, is the right answer. But this is your life, and life is full of sacrifices. Only you can say whether staying with your husband is better than having a fulfilling sex life. I would not wait too long to figure this out, as you may kick yourself later for wasting so much time.

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Dear How to Do It,

So I currently have a “thing” with a married man. He has been in my friend group for a few years, and our “thing” has been going on for the last three years. He has been with this other girl the whole time (dating when we first started, and he got married to her since then). We’ve only slept together twice—but there is a LOT of (very hot) texting during this time. I’m fairly overweight but he seems to love it and his compliments often refer to that (which is beyond rare for me—I’ve barely dated my entire adult life due to my own insecurities).

It’s very clear that this is a sex/sext thing only and I am actually completely OK with it. I don’t think I even like him as a person and would never want to date him! So I’m like that one odd girl who has zero interest or desire for him to leave his wife and “choose me.” What we have is all I would want from him (although I’d like to have more sex). If I were to ever have a relationship that fulfilled more needs, I’m sure I wouldn’t settle for this casual and irregular situation. But since that has never happened to me, this seems pretty good for me now.

So the real question is: Why don’t I feel more guilty? Am I just that selfish? I know his wife (although we aren’t friends)—and I don’t like that I’m hurting her. But I haven’t felt this desired my entire life and even though it’s not ideal (for many reasons), I just can’t seem to want to stop. What do I do now?

—Sorry Not Sorry Enough

Dear Sorry Not Sorry Enough,

Yes, you are behaving selfishly. Though the case you make for being in the situation that you’re in gives me hope that perhaps you aren’t evil or even a sociopath, you’re still doing wrong and you know it. I’m reading between the lines here—there is, of course, the chance that he is in an open arrangement but your surprise at your own lack of guilt and supposed dislike for “hurting” his wife whom you know implies the illicitness of this affair. By the way, you aren’t hurting her if she’s still in the dark, though certainly the patterns of behavior in which you’re engaging certainly could. Your sign-off says it as well as anyone could: You’re sorry but not sorry enough. Your sorry is worth virtually nothing if it doesn’t prompt a change in your behavior. It’s about as deeply felt as a “bless you” after a sneeze.

What bums me out about your letter is how little you’re getting in return for potentially messing with someone’s life. You don’t like this guy, you’ve barely had sex with him. By your own estimation, this relationship (which seems like way too big a word for it) isn’t fulfilling your needs. You’re settling for crumbs. This married guy is not the only one in the world who would specifically appreciate you for your body, if that’s what’s turning you on—you might find more in the expansive world of dating apps. I’d normally steer someone away from territory in which they might find themselves fetishized, but you seem into it. This married guy isn’t even special in that sense—he’s just giving you attention. That’s such a low bar. There’s nothing impressive about this situation; it’s just sad. Work on your self-esteem, and find a guy (or three) who can worship you more regularly. Newsflash: If he isn’t attached, he’ll be able to sleep with you more than twice in three years.

—Rich

More Advice From Slate

I am a woman seeing a new man, and we waited a few dates to sleep together, mostly because he didn’t try. I didn’t think much of it, but when we did have sex, he was sheepish to take off his underwear, and yep, it turns out he has a small penis.