Is Sexual Fantasy Healthy? How to Use Fantasies to Boost Desire and Intimacy

As a Chicago sex therapist, one of the most common questions I hear is: “Is it okay to fantasize?” This question often comes with a mix of curiosity, shame, and worry. For some people, fantasies come easily. For others, fantasizing feels foreign, awkward, or even off-limits.

The reality is that sexual fantasy is a completely normal and healthy part of sexuality. Whether you’re single, in a long-term relationship, or exploring intimacy after a change in life stage, fantasy can play an important role in reconnecting with desire and pleasure.

In this article, we’ll explore why sexual fantasies matter, how they can benefit your intimacy, and practical ways to start fantasizing if it doesn’t come naturally to you.

What Is a Sexual Fantasy?

A sexual fantasy is simply a thought, image, or scenario that creates erotic excitement. Fantasies can range from imagining a romantic, sensual moment with a partner to envisioning scenarios that you would never act out in real life.

Importantly, fantasies are not the same as real-life desires. Many people fantasize about situations they would never want to pursue outside of their imagination. This is one reason why fantasies can be so freeing: they’re a mental space to play, without consequences.

Why Do People Fantasize?

Research shows that nearly everyone has sexual fantasies, regardless of gender, age, or relationship status. Fantasies serve many purposes, including:

• Stimulating arousal: Fantasies can help the body respond when desire feels low.

• Reducing anxiety: Focusing on an erotic image or story can quiet distracting thoughts that interfere with sexual pleasure.

• Exploring identity: Fantasies allow people to try on different roles or explore aspects of themselves in a safe way.

• Enhancing partnered intimacy: When shared (with consent and comfort), fantasies can spark new conversations and closeness in relationships.

The Benefits of Fantasy for Your Sexual Health

For many of our clients, fantasy becomes a tool for healing and growth. Here are some of the benefits we often explore in sex therapy:

Reducing Performance Pressure

If you struggle with anxiety during sex, fantasies can help you shift focus away from “Am I doing this right?” toward erotic imagery that feels exciting. This mental shift can make it easier to stay present and experience pleasure.

Boosting Sexual Desire

Fantasies can reignite interest when desire feels flat. They work like a spark for your erotic imagination, offering new ideas and sensations that the body can respond to. This can be especially helpful for couples navigating loss of intimacy or low libido.

Enhancing Partner Connection

While not all fantasies need to be shared, some couples find that talking about them creates intimacy and trust. Even if you never act out the fantasy, sharing it can help you and your partner better understand each other’s inner worlds.

Healing from Shame and Dysfunction

For those dealing with sexual dysfunction, trauma, or shame, fantasy can be a safe entry point into sexual exploration. Imagining a pleasurable scenario provides a sense of control that real-life intimacy sometimes lacks.

How to Start Fantasizing

Not everyone finds fantasizing easy. Some people worry they “don’t have an imagination,” while others feel blocked by shame or religious or cultural beliefs. If that’s you, here are some steps to begin experimenting with fantasy:

1. Start with Memory

Think back to a time when you felt desired, attractive, or deeply connected. Replay that memory in your mind and allow it to expand into a new imagined scenario.

2. Use Your Senses

Fantasies don’t need to be cinematic. Start by imagining touch, sound, or smell that excites you. For example, the warmth of skin, the sound of breath, or the scent of your partner’s cologne.

3. Try Erotic Media

Erotic short stories, romance novels, or audio erotica can help spark ideas when your own imagination feels blank. Reading or listening can lower the pressure of “making up” something yourself.

4. Focus on Themes, Not Scripts

Instead of creating a detailed storyline, think about a theme that excites you, like adventure, seduction, or tenderness. Let the details fill themselves in naturally.

5. Release Judgment

Fantasies often don’t align with real-life desires, values, or behaviors. That doesn’t make them wrong. Your imagination is a safe place to explore, with no rules.

Common Questions About Fantasy

Is it normal to fantasize about things I don’t want in real life?

Yes. Most people fantasize about scenarios they wouldn’t act on. Fantasy is symbolic and exploratory, not a blueprint for your actual choices.

What if I can’t fantasize at all?

This is more common than you think. Sometimes, anxiety, depression, or trauma makes fantasizing difficult. Working with a sex therapist can help you explore these blocks in a supportive way.

Will sharing fantasies with my partner hurt our relationship?

It depends on how you share them. Approach the conversation with curiosity, not pressure. If your partner isn’t interested in hearing or acting on a fantasy, that’s okay. Talking about fantasies is about connection, not performance.

When to Seek Support

If fantasizing brings up guilt, shame, or confusion, or if you find yourself unable to access fantasies at all, therapy may be a helpful step. At Embrace Sexual Wellness, we help individuals and couples explore fantasies, reconnect with intimacy, and work through concerns like low libido, sexual dysfunction, and loss of desire. You can read more about our work with erectile dysfunction and loss of intimacy, both of which can benefit from integrating fantasy as part of treatment.

TLDR

Sexual fantasy is a natural, healthy part of human sexuality. It can reduce anxiety, boost desire, and bring new energy into your intimate life. Whether you’re imagining something tender or something bold, fantasies offer a private, safe space for pleasure and exploration.

If you’re ready to explore your erotic imagination but aren’t sure where to begin, remember: fantasy is a skill you can practice. And if you need support along the way, our team of Chicago sex therapists at Embrace Sexual Wellness is here to help and are licensed to practice in Illinois, Indiana, Kansas, Idaho and Louisiana.

Pelvic Congestion Syndrome: Causes, Symptoms, and Treatments

Chronic pelvic pain is a common occurrence among people assigned female at birth, affecting an estimated 15% of people of childbearing age in the United States. One of the causes of pelvic pain is pelvic congestion syndrome (PCS). PCS occurs when varicose veins develop around the ovaries. Varicose veins are twisted, enlarged veins that most often appear on the legs because standing and walking cause the blood to engorge the leg veins. Most of the time, varicose veins are completely benign and painless but when they appear on the ovaries, they can cause pain and discomfort. The exact cause is still unknown but pregnancy and estrogen can both play key roles in making the veins structurally unsound. Any type of chronic pain can be disruptive to your life so it is important to learn about the cause of your pain and what your treatment options are. This article will cover the symptoms of pelvic congestion syndrome, how it affects one’s sex life, and the treatment options that exist. 

What are the symptoms of pelvic congestion syndrome?

Dull and achy pelvic pain is the primary symptom of PCS, but it can manifest as a sharp pain as well. The pain can be exacerbated after standing or sitting for a long time, before and during menstruation or sexual activity. Additional symptoms include varicose veins in other places like the pelvis, buttocks, and vulva, an irritable bowel, stress incontinence, and pain with urination.   

How does pelvic congestion syndrome affect one’s sex life?

As mentioned above, pelvic congestion syndrome and the associated pain tends to be exacerbated by sexual intercourse. This not only poses physical obstacles to having sex, especially penetrative sex, but chronic pain can also cause a low libido. That does not mean that you can never achieve a fulfilling sex life though. In addition to the PCS treatment options below, there are ways to have great sex without penetration. You can engage in alternative forms of intimacy, like mutual masturbation, give and/or receive a sensual massage, or cuddle skin-to-skin. There are also ways to try to boost your libido, if you so desire. None of these options provide a permanent solution, but there are treatment options that can make it easier to live with PCS. 

   What are the treatment options for pelvic congestion syndrome?

Diagnosing pelvic congestion syndrome is not easy because the symptoms are easily conflated with other conditions and there is no test that will outright prove that PCS is the culprit. For this reason, doctors will typically run tests to rule out similar conditions, as well as use imaging like ultrasounds. Ultrasounds provide a view of the soft tissue; if more detailed imaging is required, a doctor may opt for an MRI or CT scan. The goal of diagnosis and treatment is to reduce or relieve pelvic pain, but there is unfortunately no known cure for PCS. The treatment you and your doctor pursue will depend on factors such as the severity of your symptoms and your medical history.

Treatment options for PCS may include: 

• Gonadotropin hormone drugs. Gonadotropins are hormones that regulate ovarian function; they are essential for growth, development, and reproduction functions. These drugs can block ovarian function and therefore relieve some pain.  

• Progestin hormone drugs. Similarly to gonadotropins, progestin drugs are hormonal drugs that serve to relieve pain by assisting the regulatory function of your reproductive system. 

• Sclerotherapy or embolization. A sclerotherapy is a typical treatment option for any varicose veins, including pelvic veins, such as is the case for PCS. It involves a needle that injects a solution which causes the damaged vein to scar and eventually fade as blood is rerouted to healthier veins. A similar concept but different execution is gonadal vein embolization is a minimally invasive treatment that involves a small incision for a tube that is used to dispatch a sclerosant that blocks the vein, therefore guiding the blood to healthier vessels, similar to how sclerotherapy works. 

• Oophorectomy or Hysterectomy (to remove your uterus and ovaries). An oophorectomy (removal of the ovaries) and hysterectomy (removal of the uterus) are reserved for the most severe cases of PCS after milder treatments have failed. However, these procedures have been shown to be a very effective treatment for PCS pain in treatment-resistant cases.

The Bottom Line

Pelvic congestion syndrome is a taxing condition that has the potential to significantly impact your quality of life, particularly your sex life. However, with a proper diagnosis and treatment plan, you can find relief. If you suspect you have PCS, you should consult with a healthcare professional to explore your options. Additionally, if you need extra support for your mental health and/or your libido and sex life due to the chronic pain, consider reaching out to a therapist.   

7 Contraceptive Options: An Overview

Practicing safer sex is a vital part of reproductive health and some of the best tools to support safer sex are contraceptives. There is a wide variety of types of birth control and different options suit different lifestyles best. For example, for people who want to prevent pregnancy with a low maintenance option, an implant or IUD may be a good option. Embrace Sexual Wellness has compiled an overview of contraceptive options, with information such as efficacy, pros and cons, side effects, and more. We hope this guide will aid you in figuring out which method will work best for you. Keep in mind that condoms and dental dams are the only form of contraceptive that protects against STIs and should be paired with another method to ensure the most effective protection against pregnancy and STIs. We recommend using at least two methods, one of which should protect against STIs, to ensure the maximum amount of protection.     

Note: all efficacy rates refer to perfect usage of the method and with those that require manual maintenance, human error may diminish efficacy rates

Intrauterine Devices (IUDs)

Overview

• Efficacy: 99% effective

• STI Protection: Does not protect against STIs

• How it’s used: inserted by a doctor. No manual maintenance required

• Types

  • Copper (Paragard) 

    • How it works

      • A copper IUD is a plastic body with copper wrapped around it. Copper changes the way sperm cells move so they can’t access the egg. 

    • Benefits

      • High efficacy at preventing pregnancy 

      • Lasts up to 12 years but can be removed at any time by a doctor

      • Can be used as emergency birth control if inserted within 5 days of unprotected sex 

      • Does not need manual maintenance 

    • Drawbacks

      • Insertion can be uncomfortable

      • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

      • Does not provide STI protection

  • Hormonal (Mirena, Kyleena, Liletta, and Skyla)

    • How it works

      • Hormonal IUDs release a small amount of progestin which mimics the hormone progesterone that bodies naturally make. These hormones both make the cervical mucus thicker to block sperm from accessing the egg and the hormones can also stop ovulation, meaning there’s no egg present to be fertilized  

    • Benefits 

      • Long-lasting

        • Mirena: up to 7 years 

        • Kyleena: up to 5 years

        • Liletta: up to 7 years

        • Skyla: up to 3 years

      • For some, lightened periods and cramps

      • Can potentially manage symptoms of endometriosis and polycystic ovarian syndrome (PCOS)

    • Drawbacks

      • Insertion can be uncomfortable

      • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

      • Hormones may worsen or complicate pre-existing mental and reproductive health conditions

      • Does not provide STI protection 

• How to Access It

  • IUDs have to be inserted by a doctor, most commonly an OB/GYN or a clinic like Planned Parenthood. 

• Potential Side Effects 

  • Longer and heavier periods and cramps for the first 6-12 months

  • Irregular periods and spotting between periods 

• Works Best For

  • People who want to “set and forget” their birth control.

  • People who, for whatever reason, can’t or don’t want to use hormonal birth control (copper only) 

  • People who are interested in birth control that has the potential to lighten or get rid of periods (hormonal IUDs only) 

• Contraindications

  • Conditions that cause pain from vaginal penetration such vaginismus

  • Mental illness (not for all; case by case basis) 

  • People who want a regular, natural period

Birth Control Pills

Overview

• Efficacy: 91% effective

• STI Protection: Does not protect against STIs

• How it’s used: Oral ingestion once a day at the same time

• Types

  • Combination (estrogen and progestin)

    • How it works

      • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

      • The last week of the pack is hormone-free to allow a period to happen. For those interested in skipping their periods, consult your healthcare professional about not taking the hormone-free week of pills.

    • Benefits 

      • Less strict time window for taking the pill, though it’s recommended to take it around the same time everyday to help stick to the routine

    • Drawbacks

      • Does not protect against STIs

  • Progestin only

    • How it works

      • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

    • Benefits

      • For those who want to lighten or eliminate their period, hormonal birth control may help 

    • Drawbacks

      • Must be taken in the same 3 hour window every day to be effective

      • Does not protect against STIs

• How to Access It

  • Must be prescribed by a healthcare professional 

• Potential Side Effects 

  • Spotting or bleeding between periods

  • Sore breasts

  • Nausea

  • Headaches

  • Weight gain

• Works Best For

  • People who can remember and stick to a scheduled daily routine

• Contraindications

  • If you’re prone to blood clots and strokes

  • Any condition involving regular vomiting and/or diarrhea, as the pill will not work following these functions

Nexplanon Implant

Source: New implant device provides continuous birth control for up to three years - Sudbury News

Overview

• Efficacy: 99+% effective

• STI Protection: Does not protect against STIs

• How it’s used: implanted in arm by a healthcare professional under local anesthetic. No manual maintenance required 

• Type

  • Nexplanon

    • How it works

      • Releases progesterone to prevent the release of an egg each month and thickens cervical mucus to block sperm cells. 

    • Benefits

      • Long lasting (up to 5 years)

      • Highly effective

    • Drawbacks

      • Does not protect against STIs

      • Requires minor doctor’s office procedure 

• How to Access It

  • Must be inserted into arm by healthcare professional, most commonly an OB/GYN 

• Potential Side Effects 

  • Irregular bleeding especially in the first 6-12 months

  • Headaches

  • Breast pain 

  • Nausea

  • Temporary bruising around insertion area  

• Works Best For

  • People who want low maintenance birth control 

  • People who can’t use estrogen-based contraception

• Contraindications

  • If you’ve had or do have breast cancer

Depo-Provera Injections

Overview

• Efficacy: 94%

• STI Protection: Does not protect against STIs

• How it’s used: Injected in a doctor’s office once every 3 months

• Type

  • Depo-Provera

    • How it works

      • Releases progesterone which prevents ovulation, thickens cervical mucus to block sperm, and thins lining of womb to lessen likelihood of egg implantation.

    • Benefits

      • May reduce heavy, painful periods

      • Less maintenance than the pill 

    • Drawbacks

      • Ability to get pregnant may not return for up to one year after ceasing injections

      • Does not protect against STIs 

      • Medium maintenance - requires doctor’s visit every 3 months

• How to Access It

  • Injections must be performed in a doctor’s office 

• Potential Side Effects 

  • Changes to period

    • Bleeding more than usual

    • Spotting

    • Lack of a period

    • Nausea

    • Weight gain

    • Depression

    • Sore breasts

• Works Best For

  • Those who cannot use estrogen-based birth control

  • Those who need a discreet method of birth control 

• Contraindications

  • If you want to be able to get pregnant soon after ceasing birth control

  • If you struggle with mental illness (case by case basis) 

Condoms

Source: Sexual Well-Being - Center for Health Education & Well-Being (jhu.edu)

Overview

• Efficacy: 85% effective  

• STI Protection: Yes, when used correctly, condoms protect against STIs 

• How it’s used: worn on the penis to prevent sperm from entering the vaginal canal (external condom) or inserted into vaginal canal (internal condom) 

For an extensive overview of types of condoms and tips for usage, read this Embrace Sexual Wellness article

Diaphragm and Spermicide

Source: Spermicides: side-effects, risks and how to use spermicides to prevent pregnancy (netdoctor.co.uk)

Overview

• Efficacy: 88% effective

• STI Protection: No, they do not protect against STIs

• How it’s used: the shallow, bendable cup is inserted into the vaginal canal and covers the cervix to block sperm from entering. Must be used in conjunction with spermicide 

• Parts

  • Diaphragm

    • How it works

      • Creates physical barrier between cervix and sperm

    • Benefits

      • Non-hormonal option

      • Not as intrusive as more long term contraceptives like IUDs

      • Effective immediately after it’s inserted

      • Few side effects

    • Drawbacks

      • Less effective than other options

      • Efficacy may be affected by human error 

      • Must stay inside vaginal canal for 6 hours after sex but not more than 24 hours

      • Learning curve for inserting it 

  • Spermicide

    • How it works

      • Chemicals stop sperm movement, held in place by the diaphragm 

    • Benefits 

      • Increases efficacy of diaphragm

    • Drawbacks

      • May cause irritation and/or UTIs

      • If you have sex again after applying it, you still must apply it again 

• How to Access It

  •  Must be prescribed by your healthcare practitioner

• Potential Side Effects 

  • Frequent UTIs

  • Irritation from spermicide can make vaginal canal more susceptible to STIs 

• Works Best For

  • Those who cannot use hormonal birth control 

  • Those who don’t mind a high maintenance option 

• Contraindications

  • If you can’t commit to consistently using the diaphragm properly

  • If you’re allergic to silicone, latex, or spermicide

  • If you have vaginal abnormalities that disallow a proper fit or placement

Patch

Source: Contraceptive Patch: Quick guideline for use and safety (drseb.com)

Overview

• Efficacy: 99% effective

• STI Protection: Does not provide STI protection

• How it’s used: Must be stuck to either the belly, buttocks, back, or upper outer arm (latter option for Xulane only) and replaced once a week 

• Types

  • Xulane

    • How it works

      • The patch transdermally introduces the hormones estrogen and norelgestromin, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.

    • Benefits

      • Potentially may help acne and make periods lighter

      • High effectiveness

      • Only needs to be replaced once a week 

      • Possible to get pregnant immediately after ceasing use

    • Drawbacks

      • Only works effectively for those with a BMI below 30

      • Patch may be susceptible to falling off

  • Twirla

    • How it works

      • The patch transdermally introduces the hormones estrogen and levonorgestrel, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.  

    • Benefits 

      • Potentially may help acne and make periods lighter 

      • High effectiveness

      • Only needs to be replaced once a week

      • Possible to get pregnant immediately after ceasing use

    • Drawbacks

      • Only works effectively for those with a BMI below 30

      • Patch may be susceptible to falling off 

      • Requires manual maintenance 

• How to Access It

  •  Must be prescribed by a healthcare professional

• Potential Side Effects 

  • Nausea

  • Headache

  • Skin irritation around patch 

• Works Best For

  • Those with a BMI under 30

  • Those who want a less invasive contraceptive that doesn’t require as frequent maintenance as the pill

  • Those who are not regularly submerged in water because it may compromise the adhesion of the patch

• Contraindications

  • People with a BMI over 30

  • Smokers over the age of 35 

Vaginal Ring

Source: Contraceptive Vaginal Ring. Causes, symptoms, treatment Contraceptive Vaginal Ring (dxline.info)

Overview

• Efficacy: 99%

• STI Protection: The ring does not protect against STIs

• How it’s used: The ring needs to be inserted into the vaginal canal. The NuvaRing needs to be replaced every 5 weeks while ANNOVERA lasts a full year.

• Types

  • NuvaRing

    • How it works

      • The NuvaRing releases a continuous low dose of the hormones etonogestrel and ethinyl estradiol to prevent pregnancy 

    • Benefits

      • Has the potential to reduce acne and make periods lighter

      • High effectiveness

      • Option to skip period altogether

    • Drawbacks

      • Requires remembering to replace the ring 

      • Possible for ring to fall out 

      • Cheaper options than ANNOVERA ring

  • ANNOVERA

    • How it works

      • The ANNOVERA releases a continuous low dose of the hormones segesterone acetate and ethinyl estradiol to prevent pregnancy 

    • Benefits

      • Lasts a full year

      • Has the potential to reduce acne and make periods lighter

      • High effectiveness

      • Option to skip period altogether

    • Drawbacks

      • More expensive than NuvaRing because no generic exists currently

      • Cannot be used while breastfeeding

• How to Access It

  •  Must be prescribed by a healthcare professional

• Potential Side Effects 

  • Headaches

  • Nausea 

  • Sore breasts

• Works Best For

  • Those who want total control over their birth control but don’t want the frequency of maintenance of the pill

  • Those who want a less long term hormonal option than the IUD

• Contraindications

  • Smokers over 35

  • Breastfeeding people

It may take a few tries to find the best contraceptive method for your life. If you’re still unsure of where to start, try this Planned Parenthood quiz about what types of birth control might work for you. Make sure to consult your healthcare professional about the pros and cons of different contraceptives within the context of your life. Remember to use at least two contraceptive methods with one that protects against STIs every time you have sex. Sex can never be 100% risk-free but contraceptives greatly increase safety for everyone involved.