Should We See a Sex Therapist?

Common fears about sex therapy: 1) the sex therapist will suggest a threesome to spice up our sex life, 2) I’ll have to reveal all my past sexual escapades to my spouse, 3) I’ll be shamed for how little I know about sex, 4) the sex therapist will be some New Age-Barbara Streisand-in-the Fockers-flowy-flowery, – a weirdo. (Actually my personal tagline by referring physicians is, “You’ll like her; she’s normal!)

“I can’t believe how long we waited to get help!” is the most frequent comment I hear from sex therapy graduates. Second only to the comments about my consulting room, “oh it looks just like a living room.” Third to the comment, “I didn’t know these feelings were normal.” I think people are afraid that a sex therapy room is a cross between a gynecological exam room and the Red room. Actually, there are no exams, no nudity and certainly no sexual touching. Sex therapy is a branch of traditional psychotherapy and is only “talk therapy”

You’re not alone in having sexual problems. The media paints sex as easy and hot and makes it look like everyone but you is having loads of sex. But everyone has sexual problems – that are often easily fixed! Young newlyweds have sexual adjustment problems. Couples with young children are often exhausted and have trouble keeping the bedroom a priority leading to fights and feelings of doom. Older couples struggle with menopause and ED an unresolved relational resentments that shut down sex.

But what happens in sex therapy and how can simply talking about it help your sex life? How bad should it get before we consult an expert?

1) Sex therapy helps couples talk about sex with each other. A sex therapist feels comfortable talking about sex. While nothing is off-limits and nothing is taboo to talk about, most people have trouble bringing up anything to talk about when it comes to sex. Women don’t talk to their girlfriends about how they renew their sexual desire. Men don’t ask their guy friends how to bring a woman to orgasm. Most doctors don’t have even one day of sex therapy training in medical school, even gynecologists and urologists. They’re good with the body but limited by their own experience when it comes to solving sex problems. Sex therapists are aware of how anxious you might feel talking about this intimate subject with each other and with a near stranger. They will help set you at ease and guide you into talking about sex.

2) Sex therapy gets to the problem. Couples often can’t solve these intimate issues on their own because disappointment, hurt, anger, resentment, accusations, inhibition, and several rounds of fighting might have shut down the very discussion most needed. Most people who have easily solved problems have complicated their problems by waiting until the patterns are entrenched and more difficult. Clients often tell me they have waited a number of years, even after receiving my card from their doctor, to make an appointment. Anxiety is the number one reason people don’t pick up and call for help. Couples are afraid that in sex therapy they will be told they are bad lovers, unattractive to their partner, not big enough in some ways or too big in others when really their partner is often just anxious or unable to freely communicate. Fear of confronting the problem and discovering that they are truly not compatible is so powerful that they delay and delay feeling more hopeless every day.

When a couple comes into my office the first thing I want to know is – what is hurting them. I use the forms (you can see them on under the forms tab) that they fill out to compare with what they’ve told me. Next, we take separate interviews with each partner and coach them individually about how to approach delicate subjects. You’ll be asked about your sexual/relational history sometimes in the private interview as well as questions about your childhood, your parent’s marriage and what they taught you directly and indirectly about sex. I help couples see the road map for how to solve the problems and we set out on the work. The couple must develop an erotic language for clearer communication to work through their difficult impasses. Eventually, after they feel really safe again, they are given direct assignments for things to try, talk about, touch or read about.

3) Sex therapists have hope. I have rarely encountered a problem between two ordinary people that I didn’t feel was somehow workable and resolvable. I’ve been a sex therapist for 18 years and a marital therapist treating sexual problems for 30 years and have treated thousands of couples. Certainly there are sometimes huge differences between partners about what is wanted in their individual sex life. But sex therapy is concerned about neither partner feeling like they have to knuckle under to the demands of the other. Averaging or compromising usually leaves both parties unhappy. If one partner feels starved and the other feels drowned – that is not the final answer. In sex therapy, we find a deeper empathic place between the couple that allows for change to be freely given.

4) What kinds of problems do sex therapists treat? The top two problems in my practice: low sexual desire and frequency disagreements between partners. I’ve written a book called Wanting Sex Again to help with the first one. Women who don’t have orgasms (anorgasmia) and men have premature ejaculation are often the quickest problems to solve – no pun intended. Erectile dysfunction and ejaculating too slowly are other male problems my clinic works with. Breast cancer and prostate cancer survivors should receive mandatory sex therapy as part of their recovery. Technique problems, issues with oral sex, “ick” factor feelings about different sex acts, problems with porn, boring sex lives, can’t get aroused, can’t tell your partner to brush his teeth, inhibitions, suspected sexual addictions or compulsion and fetishes are common reasons to seek a sex therapist.

5) How long does sex therapy take? Three levels of problems take different lengths of treatment.

1. Sexually-oriented problems – For instance, a young woman doesn’t know how to have an orgasm, usually takes 2 sessions or less. Pre-mature ejaculation is easily solved before resentment sets in.. get help fast! A question you can’t ask anyone else. I’ve had single sessions that have relieved people from a lifetime of wondering and worry. Is it normal to think about x? Is it normal that my penis has a curve? , etc.
2. Sexual problems entangled in the relationship – the bulk of the couples I see have sexual problems tied up in the knot of their power struggle with each other. Sex serves as a perfect battleground to work out deeper issues about how close each wants to feel and how much autonomy they want to be granted in the marriage or partnership. This often takes at least 6 months and involves marital therapy as well.
3. Trauma childhood histories of neglect or abuse, difficulties feeling connected to anyone – sexual problems resulting from these issues can take a year or two to resolve. Not every person who was molested needs years of therapy to have a happy sex life but some do, depending on who the abuser was, how long it lasted and if violence was involved. Feelings of deadness sexually are often a defensive pattern from childhood vows to never trust another with one’s primitive needs and often need a longer therapeutic treatment.

6) Is my sex therapist a Christian? Many sex therapists or other psychotherapists do not talk about their personal lives or advertise by way of faith alignment. At Awakenings we understand that sex therapy is moral ground keep in mind sensitivities to moral issues and try to first understand the more deeply held positions that are based on culture or faith. And some of our therapists identify as Christian. Yet there are different ways of viewing things even within similar faith traditions that may or may not be your therapist’s brand. Sometimes sex therapists, might even point out ideas of faith or culture that don’t make sense.

For instance, imagine the young, Christian couple who assumed keeping to their faith tradition of virginity at marriage would guarantee a smooth sexual transition. They feel abandoned by God when things are awkward, painful or flat. Sometimes questioning their assumption strengthens their faith again when I point out the unrealistic expectations that two completely naïve people could have fabulous sex straight from the get-go.

Marital therapists/sex therapists are not going to recommend going outside monogamy. In fact, sex therapists don’t particularly suggest sexy ideas for the couple to try. We believe that eroticism is inside the couple and good sex therapy draws it out into the open as a renewal resource.

However, if your partner is having an affair or wishing for an open marriage, your therapist will also not condemn them as “immoral” but will try to explore the driving forces within their head and within the relationship in order to help the couple heal. Sex therapy is a safe place to deal with wishes, fantasies, and memories. Sex therapists are not judges and the goal of treatment is helping the couples work out seemingly disparate sexual differences in ways that both partners feel keep their integrity of faith, self, and family.

7) What if I get turned on talking about sex with my sex therapist? Most sex therapists keep a balance between warmth and professionalism that makes talking about sex more comfortable than you might have guessed. Sex therapists are aware of how intimate talk engenders sexual feelings in many if not most people. They have often (or should have had) their own therapeutic treatment so that they can more clearly see your issues and separate them from their own personal issues. A client getting turned-on or having sexual fantasy that include the therapist is common and often something that needs to be talked about so that the client can understand deeper things about themselves. It will hardly be the first time the therapist has heard about this situation. Sex therapists have firm ethical boundaries about NOT entering a sexual relationship with any client just so this issue can properly be analyzed instead of acted upon. Again, sex therapy never includes sex with the therapist.