Six Things That Surprised Me When I Became a Sex Therapist
We carry faulty assumptions about what others are doing between the sheets.
Posted Dec 28, 2019
You don’t have to be a sex therapist to know something about sex. Our personal experiences, combined with the morals and values instilled in us, leave us vulnerable to assumptions about sexuality that feel accurate—though they may be far from true.
Like most therapists, I began my career less knowledgeable about sexuality than I realized. Two decades of working with clients in my private practice have taught me more than books, theories, the media, and even logic ever could. Here are some of the fascinating things I’ve learned about sexuality from the people willing to share their most intimate thoughts and feelings in my therapy room.
1. Sexual concerns and dysfunctions are common.
Research consistently suggests that approximately 40 percent of women report experiencing a sexual concern or dysfunction in the past year, as do 30 percent of men(1). Furthermore, about 20 percent of marriages are considered sexless(2). These numbers have been relatively stable over the last few decades.
My clients are usually shocked by this information. They are used to seeing their friends and family on social media, appearing to enjoy happy, satisfying, intimate lives. However, this is far from reality today. Most people don’t feel comfortable sharing the details of their sex lives with even their closest friends. As a result, everyone assumes that everyone else is having great sex.
2. Most couples embrace the concept of monogamy but find it harder to achieve than they expected.
As a newly minted sex therapist, I assumed that if people loved each other enough, a lifetime of monogamy would be the natural result of this love. I now understand this differently. Monogamy for a lifetime may not be realistic for many people—and that’s not necessarily indicative of pathology, like “intimacy issues,” narcissism, or hypersexuality.
A conservative estimate suggests that 25 percent of people have stepped outside of their marriage at least one time(3). Again, evolutionary theory has helped me understand these struggles. The fact is that human beings are evolved primates, and our primate nature remains a part of who we are as sexual beings.
The vast majority of mammals are not monogamous. Modern lovers must navigate a path that is influenced by both aspects of their sexual selves—their evolved psychology, and their primate biology. For some, this makes monogamy for a lifetime a very challenging endeavor.
3. Folks in consensual non-monogamous relationships are just as healthy and just as satisfied as those in traditional monogamous marriages.
I used to think that the people who embraced alternative marital arrangements had significant psychological struggles. Otherwise, why wouldn’t they opt for monogamy? I also assumed that non-traditional relationships would have much poorer success rates than monogamous ones.
However, research repeatedly demonstrates that these are false stereotypes. The reality is that about 20 percent of adults have experimented with some form of consensual non-monogamy(4), and folks demonstrate similar emotional challenges regardless of the relationship arrangements they prefer(5).
Similarly, monogamous and non-monogamous marital structures have fairly equivalent satisfaction and success rates(6). I tell couples that all relationship structures have risks and benefits. The issue isn’t which one of them is “right,” but rather what is right for you.
4. Just doing good therapy to enhance a couple’s emotional connection doesn’t mean their sexual issues will resolve.
I began as a sex therapist assuming that the majority of sexual challenges were the result of intimacy issues within the couple. It followed, then, that resolving their intimacy concerns would automatically resolve their sexual struggles. Now I understand it’s not so simple.
Regardless of their origin, sexual concerns can develop a life of their own. For example, if his low libido is a side effect of an anti-depressant, she may still take his lack of interest personally, feel rejected, and pull away emotionally. Couples therapy may help their emotional relationship recover, but it won’t automatically resolve their sexual concerns(7).
In spite of feeling closer, his ongoing low libido may result in her eventual loss of interest in sex, and the couple may unwittingly end up in a sexless marriage—in spite of a successful round of couple’s therapy. Sex often needs to be addressed and treated directly.
5. Women can be surprisingly particular about sex.
I was raised to believe there were no significant differences between the genders, and nothing I learned in graduate school suggested otherwise. It was thus a surprise to me when hetero women and men in my therapy room consistently verbalized different sets of sexual concerns. For example, comments I’m more apt to hear from women, and rarely hear from men, include:
- “I can’t have sex when my partner touches me like that.”
- “My partner watches porn every day instead of having sex with me. We’re never intimate anymore.”
- “I don’t care if I ever have sex again.”
In contrast, these are comments I’m more apt to hear from men, and seldom hear from women:
- “If my partner would just relax and let go sexually...”
- “My partner just lies there, lifeless, when we have sex.”
- “I try to be a great partner, but my lover doesn’t even know what feels good.”
These distinctions make sense when I understand them through the lens of evolutionary theory—they represent modern expressions of sexual adaptations developed over hundreds of thousands of years. Neither gender is right or wrong on these issues; they simply represent different manifestations of the characteristics that led to successful procreation over the course of human history. In a nutshell, her choosiness increased the odds of her offspring’s survival, whereas his lack of choosiness facilitated his odds of successful reproduction.
While sex today isn’t about offspring survival, we have inherited those psychological tendencies from our ancestors. Research bears out that women generally have more sexual inhibitions than men, and they find fewer things sexually exciting(8). It’s important to note that these differences are primarily evident in committed couples who have been together for a while. We are evolved apes, and our sexuality remains tied to our primal roots in some significant ways.
6. People’s sexual fantasies are diverse and more commonly involve scenarios that are often considered offensive.
Sexual fantasies depicting paraphilic acts—masochism, exhibitionism, or fetishism—can sound alarming. For example, you may have seen dramatic porn scenarios depicting someone being restrained and seemingly in pain, people wearing unusual or startling costumes, people having sex with partners much younger than themselves, or apparent family members having sex. It has been commonly assumed that these fantasies are deviant, unusual, and only appealing to people with serious mental health issues. However, these stereotypes have been borne out as false repeatedly by research today.
People—particularly men—engage in these types of fantasies more commonly than was previously thought(9). The folks engaging in these fantasies don’t appear to demonstrate more mental health challenges than those in the general population(10). And enjoying these fantasies while masturbating doesn’t indicate that a person would actually enjoy playing out the fantasy in real life(11).
Sexual fantasies are usually not PC. Oftentimes they are simply a manifestation of deep emotional needs that remain unmet in real life—like feeling desired, nurtured, or accepted for aspects of themselves they fear are undesirable.
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1. Laumann, E.O., Paik, A. & Rosen, R.C. (1999). Sexual Dysfunction in the United States: Prevalence and predictors. JAMA, 281(6), 537-544.
3. Atkins, D.C., Baucom, D.H. & Jacobson, N.S. (2110). Understanding Infidelity: correlates in a national random sample. J Fam Psych, 15(4), 735-749.
4. Haupert, M.L., Gesselman, A.N., Moors, A.C., Fisher, H.E. & Garcia, J.R. (2017). Prevalence of Experiences With Consensual Non-monogamous Relationships: Findings from two national samples of single Americans. J of Sex and Mar Ther, 43(5), 424-440.
5. Rubel, A.N. & Bogaert, A.F. (2015). Consensual Nonmonogamy: Psychological well-being and relationship quality correlates. J Sex Rsh, 52(9) 961-982.
7. Hoyer, J., Uhmann, S., Rambow, J. & Jacobi, F. (2009). Reduction of Sexual Dysfunction: by-product of cognitive-behavioral therapy for psychological disorders? Sex and Rel Ther, 24(1), 64-73.
8. Carpenter, D., Janssen, E., Graham, C., Vorst, H. & Wicherts, J. (2008). Women’s Scores on the Sexual Inhibition/Sexual Excitation Scales (SIS/SES): Gender similarities and differences. J Sex Res, 45(1) 36-48.
9. Apostolou, M. & Khalil, M. (2019). Aggressive and Humiliating Sexual Play: Occurrence rates and discordance between the sexes. Arch Sex Beh, 48(7), 21876-2200.
10. Castellini, G., Rellini, A.H., Appignanesi, C., Pinucci, I., Fattorini, M., Grano, E., Fisher, A.D., Cassioli, E., Lelli, L., Maggi, M. & Ricca, V. (2018). Deviance or Normalcy? The relationship among paraphilic thoughts and behaviors, hypersexuality, and psychopathology in a sample of university students. J Sex Med, 15(9), 1322-1335.
11. Martyniuk, U., Okolski, L & Dekker, A. (2019). Pornographic Content and Real-Life Sexual Experiences: Findings from a survey of German university students. J Sex Marital, 45(5) 370-377.