Read on to find out what sex therapy entails and where to access it.
Many people find it hard to talk about their sex lives. However, if you were to open up, you’d realise sexual difficulties are very common. In one recent survey conducted by the College of Sexual and Relationship Therapists, 35 per cent of men and 43 per cent of women admitted they were experiencing problems with sex.
If you’re concerned about any aspect of your sex life, there is help available. We spoke with Dr Deborah Lee, sexual and reproductive healthcare specialist at Dr Fox Online Pharmacy, to find out more.
What is sex therapy?
A sex therapist is a health professional – either a trained counsellor, nurse or doctor – who has completed specialist training to help people with sexual problems. They have an in-depth understanding of the interplay between mind and body, along with empathy, sensitivity and excellent communication skills.
Sex therapy is often very successful, with 93 per cent of patients saying it has had a positive effect on their sex life.
Do I need sex therapy?
Human beings have a range of complex physical, psychological, emotional and sexual needs. These are irrevocably intertwined. Our sexual needs are just as important as these other factors. An unhappy sex life can have a range of negative consequences, including anxiety, depression and relationship breakdown.
Why do we have sex?
In one 2007 survey, 1,549 male and female undergraduate students, aged between 17 and 52 years, were asked to list the reasons why they wanted to have sex. They came up with 715 reasons! The authors then categorised these reasons into the following four themes:
- Physical Reasons:to relieve stress, for their own pleasure, to feel desirable, or to seek new experiences.
- Goal Attainment Reasons:to ascertain social status, or sometimes as a form of revenge.
- Emotional Reasons:as part of a loving relationship and to show commitment.
- Insecurity Reasons:to help self-esteem, because of a feeling of duty, to please their mate, or to guard their mate and warn others to keep away.
Compared with men, women more often wanted sex as part of a loving relationship. Men, however, were more likely than women to just want to have sex to feel good.
Many couples have problems with sex at some time or other, but these are usually short-lived and improve by themselves over time. However, if these difficulties become severe, persistent and are causing distress, this is then termed ‘sexual dysfunction’.
Sexual dysfunction causes
There are several different causes of sexual dysfunction:
- Physical causes
Physical illnesses, such as heart disease, diabetes or cancer, can affect your ability to have sex. These can also mean that sex is less satisfying. Other health conditions, such as liver, kidney, or thyroid disease, can affect sex too. Some types of medication, such as antidepressants (SSRIs), are well known to lower libido. Alcohol and substance abuse also reduce sexual desire and alter the normal sexual response.
- Psychological causes
Psychological causes are also very common. Work stress, relationship issues, anxiety and depression can all have a major impact on sexual desire and sexual function. Any history of abuse, including sexual abuse, may also be a factor.
Female sexual dysfunction (FSD)
The four most common causes of FSD are:
- Loss of sexual desire
Tiredness and fatigue, often linked to underlying life stress, are common reasons for women to lose their libido. For many women, it can be the physical demands of juggling home, work and childcare. Additional factors that can reduce libido include the presence of any medical conditions, different types of medication or hormonal changes, for example during pregnancy, after childbirth or menopause. Relationship issues can cause resentment, tension, conflict and hostility, which can all then filter in and affect life in the bedroom.
- Arousal difficulty
Women who fail to become sexually aroused in the usual way, by kissing, touching and genital stimulation, are having arousal difficulty. They may also find they do not get aroused by other sexual stimuli, such as watching erotic movies. This difficulty with arousal may be due to psychological issues, such as low self-esteem, anxiety or depression, or relationship issues. There may sometimes also be a physical cause, such as low levels of oestrogen due to menopause, resulting in vaginal dryness and reduced sensations in the genital area.
- Inability to orgasm
Orgasm is the result of a complex interplay between emotional, physical and psychological stimuli. Anything that disrupts these factors can result in an inability to orgasm. When this happens, there are often multiple contributory factors. Most women need clitoral stimulation to orgasm – far fewer women orgasm from vaginal penetration only. The correct medical term is anorgasmia. If this is causing distress, a sex therapist is recommended.
- Painful sex
The medical term for painful sex is dyspareunia. Superficial dyspareunia is pain that occurs early in a sexual encounter, when the penis is first inserted into the vagina. Deep dyspareunia is pain felt deep inside the pelvis and is associated with the thrusting of sexual intercourse. Both superficial and deep dyspareunia can have physical causes, but they are also affected by emotional and psychological issues. Stress, anxiety and relationship issues can cause muscular tension, such that when you have sex, the pelvis is tense.
Male sexual dysfunction (MSD)
The three most common causes of MSD are:
ED is defined as the inability to obtain and maintain an erection suitable for satisfactory sexual intercourse. It’s very common. One recent UK study reported 50 per cent of men under age 50 suffer from erectile dysfunction. The prevalence of ED also increases with age, affecting 60 per cent at 60 and 70 per cent at 70. ED is common in younger men too. Many are too embarrassed to seek help. Some 10 to 20 per cent of ED have an underlying psychological cause. However, in the remaining 80 per cent, ED is caused by medical conditions that affect the cardiovascular system, such as high blood pressure, diabetes, smoking, raised cholesterol and obesity.
Premature ejaculation is defined as ejaculation that occurs within one minute of vaginal penetration. It’s very common – 39 per cent of men say they have experienced this during their lifetime. There are many possible causes of PE. It may be related to anxiety, for example, anxiety about sexual performance or anxiety about erectile dysfunction. There may be underlying psychological reasons, due to religious or cultural beliefs or upbringing, or it may be due to any previous poor sexual experience, including sexual abuse. PE may be a feature of stress, depression, and/or relationship issues.
Men also experience loss of sexual desire, although it’s less common than it is in women. However, because male sexuality is so closely related to masculinity, when they find they have lost their libido it affects them more severely. Loss of libido in men may be related to ED or PE – if you fear having sex and don’t have sex very often, you may lose interest in it altogether. It can also be related to stress and anxiety. If a man has lowered self-esteem, he may feel worthless and unable to perform. Medical conditions and different types of medication can also be a cause. Often, relationship issues are a factor.
How to access sex therapy
If you’re having problems with sex and this is causing you distress, you are strongly advised to see your GP. Try to overcome any feelings of embarrassment. Your doctor is there to help you. The consultation is confidential and you can request either a male or a female doctor, if this makes you more comfortable. Your doctor will do their best to put you at ease and will take your problem seriously. Your GP can refer you to a sex therapist on the NHS.
You can also be referred to a sex therapist by making an appointment at the Sexual Health Clinic.
If you’d prefer to go privately, you can access a sex therapist yourself by contacting:
Before a sex therapy session
If you are considering seeing a sex therapist, it’s always a good idea to see your GP first. They will ask lots of questions, do any relevant examinations or tests, check your medication and give you treatment advice. This is important – for example, perhaps you need treatment for high blood pressure? Or a change of antidepressant medication? Or a prescription for some vaginal oestrogen cream?
Once these important factors have been dealt with, this may be all that is needed to solve the problem.
What to expect from a sex therapy session
Sex therapists prefer to see couples, but they do also see individuals. The appointments usually last between 30 and 50 minutes, either weekly or fortnightly. The session involves talking and listening. Homework is given between sessions. Sex does not take place at the clinic. Couples are often delighted at how quickly things seem to improve.
What will a sex therapist do?
It’s natural for people who attend sex therapy sessions to feel very awkward and embarrassed, especially at their first few sessions.
Remember that the sex therapist is specially trained to be able to talk openly about sex. They are good listeners – nothing you could say would shock them! They are open-minded, nonjudgemental and not biased in any way towards gender or sexual preferences. Success depends on obtaining a deep understanding of your problem and then taking positive steps to put things right.
Sometimes a sex therapist may ask to see each partner separately and then see you together. Sex therapy sessions may include education about your body and all about the sexual response. The therapist may use role-play to help demonstrate issues – this is a good way to highlight communication difficulties. They may suggest the use of sex toys at home in the bedroom. Gradually, the sex therapist will work with you to reduce anxiety and build your confidence in the bedroom.
How many sessions might you need?
For some people, just one session is all that is needed to get things back on track. For others, several sessions may be required. However, the therapist will give an indication, at your first session, how many sessions they think you might need.