Seeking Sex Therapy: A Primer

Considering sex therapy? Here are some important issues to think about.

Posted Sep 03, 2008

It is hard to imagine a more awkward and uncomfortable dilemma for an individual or couple than to seek out a stranger in order to talk about the sexual problems threatening the relationship. There can be strong feelings of shame, embarrassment and humiliation associated. You can feel like an abject failure, not able to succeed at such a basic and seemingly natural human experience as that of sexual intercourse. While seeking a sex therapy consultation might feel like facing lions in the den for some, this paper might give you some idea of what to expect and how to decide if it is the right thing to do for you and your relationship. Hopefully, then, reading this will make things easier.

Given that seeking sex therapy would not be on your top ten lists of fun things to do, not confronting and dealing with your sexual problem can ultimately create more difficulty and suffering in the future. To deny or avoid the problem and pretend it is not important to your well-being and your relationship is in effect a big step away from intimacy. Clearly, avoidance will turn out to be the greater evil. Let's face it, you are likely to have tried everything on your own to fix the problem and things between you and your partner are not getting better. It might be time to summon up your courage and deal with the problem honestly and directly; that is, by seeking out a certified sex therapist. Here's a smattering of recent cases that have recently come through my office door. The problems these individuals are struggling with can be seen as some of the common issues that present for sex therapy consultation and treatment. Can you identify with any of the following people?

A woman in her 20s is living with her boyfriend and hopes to marry. She is unable to experience orgasm during intercourse and worries that something is wrong with her and her relationship. Her boyfriend is disappointed and frustrated with his lack of success.

Engaged to be married in two months and having just lost his job, a 30-year-old man cannot maintain a strong erection during intercourse or masturbation. Under great pressure, he feels frustrated, anxious and inadequate.

A young couple feels that their sexual relationship has degraded over the past three years. She feels rejected and that he has lost interest in her. He denies he is not attracted to her but has difficulty achieving orgasm and feels under pressure to perform. She would like to get pregnant but wants to resolve these issues before planning a family.

A man suffering from early ejaculation senses his wife's anger and is avoiding sexual contact because it evokes feelings of inadequacy.

A couple married for 30 years are sad and worried that their sexual relationship, long a source of pleasure and sustenance, has unsatisfactory and lost. In the past two years, She has rejected his attempts to initiate sex. She complains of low sexual desire and difficulty with lubrication (arousal). He has been feeling disconnected from the relationship and hurt, not knowing how to please her.

While the specifics of the sexual problems in each of these cases are distinct, what these cases share is that the sexual problems all have psychological, relational, and physical dimensions. The problems are also causing considerable distress to both parties in the relationship, increasing conflict between and impacting on the couples' sense of themselves and optimism about their future together. When such an impasse is reached and it generates conflict and suffering and attempts at solution fail, the best strategy is to seek out professional opinion. Help is available.

Important Points to Consider When Struggling with Sexual Problems:

Sexuality and the quality of your sexual relationship is a highly complicated phenomenon that involves many distinct but overlapping factors - and they all influence each other! For instance, in the examples above, we can see that there are physical, psychological, relationship and even cultural factors that can affect sexuality. Physical factors such as hormones, blood flow, anatomical structure, medication, disease will all affect sexual response. Aging and general physical health will affect stamina and sexual response. Psychological factors such as sexual history and sexual attitude, "permission" to enjoy sexual behaviors, and what one learned about its meaning will also impact on the comfort one has in being sexual. Emotions that become associated with sexual acts such as anxiety, depression, fear, worry, guilt, disgust and shame can act to inhibit sexual response and cause constriction in the body's responsiveness and ultimately the pleasure experienced. Everyday stress and daily hassles can make it impossible to relax and be present for the sexual act. Finally, a personal history that involves sexual abuse inevitably impacts on the person's comfort in being sexual. There is much going on here!
A consultation with a sex therapist can help you explore and understand exactly what the problem areas are and what needs to be the focus of treatment. It also makes sense that the evaluation includes a medical/urologic consultation in order to rule out or assess the possible physical contribution to the dysfunction (e.g. Low sexual desire, anorgasmia, erectile dysfunction early ejaculation).

Importance of the Relationship:

A sex therapist is trained to evaluate the relationship dynamics and how they might play out in subtle ways to sabotage pleasurable sex and even medical treatment. For example, as noted in the third case above, the pressure to perform, to produce an outcome or prove adequacy (of self or partner) can negatively affect the capacity to achieve erection and/or orgasm in men. Anxiety about performance and then becoming a "spectator" instead of mindful participant can create a stress reaction instead of the relaxation needed for good sexual response.

The comfort and security in your relationship is fundamental to the quality of pleasure derived in sex. A man with early ejaculation is quite susceptible to his partner's anger at his problem and will avoid sexual opportunities which lead him feeling more inadequate. As in the first case above, a woman with sexual arousal issues will be quite sensitive to a man's frustration at her not responding to his attempts at pleasuring her. A certified sex therapist is trained to evaluate the psychological and relational components of sexual dysfunction.

What to Expect in a Sex Therapy Evaluation:

It is a difficult and anxiety-provoking decision to pursue a consultation with a sex therapist. Your sexual relationship is central to the overall well-being of your connection with your partner and far too important to ignore. A question to consider is if your sexual problem derives from disharmony or conflict in your relationship; say, problems communicating and leading to sexual avoidance. Or, rather, if there is a sexual problem/disorder which then leads to conflict and disconnection. In the former scenario, a qualified couple's therapist might be fine to help. In the latter, you are best to seek a qualified sex therapist.

As a patient, you should always expect a professional approach in a confidential and private setting where you feel comfortable to reveal the intimate and private details of your sexual relationship. You will be asked to provide a history of the problem, a detailed description of any physical issues, your level of distress, conflict and disharmony, and how you are coping with the dysfunction in the relationship. You will also discuss any history of mental illness, psychological difficulties or sexual or physical abuse.

At the conclusion of the consultation the therapist should provide a clear evaluation along with a treatment plan. You should feel that you have been heard and validated and that the findings and treatment plan meet with your approval. You have taken a courageous step forward and should have a good feeling about acting positively in service of yourself, your relationship and your well-being.

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