It's quite awkward to have questions about your sex life.
With other topics, it feels quite easy to ask for help. Not sure how to fix the weird sound coming form your washer/dryer? Just google it. Toilet acting strange? Call a plumber. Going on a trip to Portugal and need recommendations? Ask close friends over a catch-up dinner, or any public forum on the internet.
But what happens when you have a question about your sex life? Something that makes you feel anxious for yourself, your spouse, or your relationship? It could be a general health question - like whether something should smell like X, or what it means when your body does Y. Or you could simply be wondering if your emotions or expressions of sexual enjoyment are normal compared to everyone else. We all want to feel a bit more normal; to know that everything is okay. But the fact is, sex is a bit more of a private matter than a plumbing issue or an upcoming vacation. Most people don't want to share their information publicly - and for those that do, it can be hard to tell what is fact or fiction.
Sex therapy is a field that few people have heard of. Well, maybe moreso these days. Rising roles of "sex therapists" in popular TV shows and sitcoms have created their own narrative of what happens in sex therapy - and, in my opinion, most of the depictions are severely misguided.
So I'll give you my impression of what sex therapy is, from the perspective of a sex therapist. The following topics definitely do not encompass all of the specialties that sex therapy can address, but hopefully they can give you a peek behind the curtain.
Talk to a Sex Therapist about Vaginismus
Vaginismus is an umbrella term referring to varying root causes that result in pain in the vagina or vulva. Some women can experience pain from the lightest touch of a Q-tip, while others feel pain related to penetration - whether that be from a penis, the speculum at the gynecologist's office, or even a tampon. Words like "searing," "throbbing," "stabbing," and "a wall," are often heard when ladies start describing what they feel during sex, even if they have never heard the term vaginismus.
Ladies with this condition have often been told to "drink more wine and relax" as a possible solution. I have heard horror stories of women feeling shamed by their doctors for not being able to tolerate the insertion of a speculum. Not all doctors are like this, thank goodness, but it's disappointing to know that it's happening at all. For some women, their partners are very supportive and just want to help - which may also lead to co-occuring sexual dysfunctions for men (such as premature ejaculation), or the desire to avoid sex altogether if it can't be enjoyable. For others, their partners are punitive or slightly immature, leading to feelings of guilt or rejection for not just being able to "get through it." And I'll tell you this: the one thing you never want to do is just push through the pain simply because you feel like it should be easier than it is. This will cause more injury - physically and psychologically.
In the context of sex therapy, we work together to figure out the physical, mental and relational components that may contribute to the pain. There are evidence-based interventions and partnered activities for you to do at home that will translate this new information from head knowledge to an actual experience. It takes time. It really does. But we are doing more than just fixing the pain. We are creating a solid foundation so that your progress is long-lasting and secure. So that your intimacy brings pleasure to you both now and in the future. So yes, sex therapy takes patience - and I have full belief that it is worth it.
That's an exciting part of the process: celebrating the small wins. The desire to initiate sex comes back for the first time in 5 years. Knowing yourself so well that you can identify what you need to shift/change in order to get back in the mood. Knowing what you like - and being able to communicate it out loud without feeling awkward, frustrated, or negative. In sex therapy, we discover your questions, talk about solutions that uniquely suit your situation, and create a result of intimacy that you actually enjoy.
Talk to a Sex Therapist about Low Libido or "Getting In Your Head"
Disclaimer - broad generalizations incoming. I'm just going to describe some themes that tend to show up for men and women when describing their sense of feeling distracted in the bedroom.
For men, it seems that getting "in their head" manifests as doing too much during sex. Meaning, they try so hard to please their partner, make them orgasm, make them feel good...so much so that they become disconnected from the intimacy of the moment itself. Instead of enjoying the love or feeling close, they are reading facial cues, monitoring if their partner is moaning enough, or even turning the inquisitive eye on themselves by criticizing their sexual performance... whew! That is a lot of information to have zooming around in the middle of such a vulnerable moment.
So what happens next? It becomes difficult to get hard or stay hard (we're talking about erections) during sexual intercourse. Or they may overthink to the point of self-sabotage: assuming thoughts that their partner is having rather than opening a direct dialogue.
Women can experience this same phenomenon, of course. But a trend I tend to notice is the "I don't know" wall. By this I mean, being so disconnected from themselves that they truly can't find what they like or desire in the sexual experience. Several ladies will describe loving their partners and finding them deeply attractive, but simply not being able to get into a headspace that would make intercourse sound appealing. Instead, she is thinking about the billions of tasks left undone. She is subconsciously feeling self-conscious about her changing body, or whether her husband is thinking of a porn actor instead of her. She has never truly known how to identify what she likes, so she is having trouble asking to receive pleasure. Instead, it's easier to simply please him and "get it over with." And of course, the most unifying common denominator: she hasn't had any time to herself to refuel her personal cup (by reading, taking a long shower, having an uninterrupted day without tasks), so sexual pleasure is the very last thing on her mind.
Whichever concept you can relate to, you'll find that sex therapy is a helpful place to untangle the compounding factors that are making your brain run into overdrive.
In other words: sex therapy helps you to simplify.
You'll learn how to communicate about the important thoughts, and rewire the harmful patterns that undermine positive sexual intimacy. Often times, couples or individuals come into my office truly frustrated and even hopeless about their situation. But the existence of a knot doesn't mean that you have no options or solutions. It just means you can't see the path forward and need a bit of help untangling first.
Talk to a Sex Therapist about How Your Religious Background Impacts Your Sex Life
This element is a niche area of my specialty that not everyone needs help with - but for those who do, it's a big deal. The millennial clients I work with (born 1981 to 1996) likely grew up in the thick of Purity Culture, when purity rings and crumpled roses were recognizable symbols of the conversation around sexual modesty. For those who don't know, Purity Culture refers to a movement in the 80s and 90s that largely emphasized chastity and women guarding their hearts and bodies in a way that wouldn't cause their male counterparts to "stumble," into sin or lust. I recorded a two-part podcast episode analysis on the heart behind the message, as well as the damage that has been incurred. And in my work, it's mostly the damage side of the equation that needs delicate attention.
The implicit and explicitly-reinforced message was that men are raving sex monsters who have no self-discipline and can't be held fully responsible for their insatiable sexual appetite. Women, on the other hand, were pure creatures who didn't have sexually arousing thoughts or desires - and were to remain untouched until their father handed them over to the next governing male authority in their life, which was to be their husband. This is an over-simplified explanation, but follow me here.
In therapy, couples are trying to detangle these underlying messages in a few ways:
a woman has no idea what turns her on or off, and is trying to meet her husband's sexual desire while not being in touch with her own
a couple is confused by the difference between their passionate "fooling around" during dating when they weren't having intercourse, versus their current lack of sexual ease or initiation in marriage
as a teen, a man's only guidance for managing his sexual flame was "don't have sex until marriage." He is now carrying a decades-long relationship with pornography into marriage and grappling with how this habit of lust-and-release greatly impacts his wife
For some folks, their views around sexuality and religion have changed since being raised in the church. For others, they still hold very dearly to their faith, but would like to detangle some of the negative beliefs they have developed around their sexuality in order to continue together with spirit and intimacy intertwined. Sex therapy can be a very helpful space to navigate this conversation.
I can't speak for how other therapists address these issues, but in my office, we walk through the couple's story and start to identify milestone moments that had impact on them - both during their relationship and even before they met. We highlight any beliefs that may have arisen, subconsciously or consciously. We then step into the present and look at how these beliefs shape their current reality. Do they want to keep some elements? What would they want to change? What would they prefer?
From there, the work begins with honor, tenderness, and curiosity.
Talk to a Sex Therapist about Infidelity or Broken Trust in the Bedroom
Sometimes, couples experience such a profound breach of trust that they can't imagine every opening themselves up to being vulnerable again. Perhaps one person betrayed trust through an emotional or physical affair. Or perhaps there was no affair at all - but an insensitive comment or lack of respect related to sex has created a breach in safety. Instances of marital rape or feelings of objectification are hard to talk about, and can fester underneath the surface like an infected wound.
In instances like these, generic internet advice like "go on more dates" or "try this sexy move" will not work. Deeper work needs to be done, and you need a professional to help you decide how to work towards a physical relationship again - if you so choose. Sex therapists can be a great place to start because even if you aren't ready to engage in sex yet, you'll be able to transition more smoothly into physical topics in the future without having to halt your work entirely in order to switch/find an appropriately-trained therapist.
A Chance to Feel More Comfortable
We want a relationship that is going to stand the test of time, stressors and tragedies. We don't want a complacent or roommate marriage: we want to be loved and look forward to continuing the life journey with our partner. And, I'd think most people would admit that they want to enjoy the benefits of physical affection and romance that come with having a spouse. But when issues arise that threaten our bedroom time, it can be hard to know what to do. Everything simply...stops. We get stuck, and we don't know how to restart.
Talk to a sex therapist so that you can learn how to communicate in a way that gives you a chance at love again. Talk to a sex therapist so that sex doesn't feel uncomfortable and awkward. Talk to a sex therapist to gain a sense of deeper understanding so that you can stop the repeated pattern of issues in the future.
about the author
Sade is a licensed marriage and family therapist in the metro Atlanta area specializing in couples and sex therapy. she also hosts intimacy-focused date nights for couples looking to reignite their spark.
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