Many Women Don't Tell Their Male Partners When They Have Pain During Intimacy

Painful intercourse is a common problem for many women of all ages. Unfortunately, instead of telling their partner about the pain, more than 50% of women endure the pain without ever mentioning it (see my article: Getting Help in Sex Therapy For Painful Sex).

Why Women Don't Talk About Painful Intercourse

Why Don't Women Tell Their Partners They're Having Pain During Intercourse?

When researchers asked women why they didn't tell their male partners about painful sex, they received the following responses from women:

• They thought pain was "normal" during sex (it's not).

• They felt pain wasn't worth mentioning because the pain wasn't severe.

• They were concerned that if they told their male partner they had pain during intercourse, it would mean they wouldn't have intercourse at all.

Why Women Don't Talk About Painful Intercourse

• They prioritized their male partner's pleasure over their own discomfort--even if it meant they would keep experiencing painful sex every time.

• They felt too embarrassed to talk about painful sex with their partner, so they would rather endure the pain than talk about it.

• They didn't want to make their partner feel uncomfortable.

• They didn't want any awkwardness between them and their partner.

• They thought they just needed to "power through" intercourse--even though it's painful.

• They didn't know they could engage in other sexual activities that could be just as sexually satisfying for them and their partner and that sex involves more than just intercourse.

What Causes Painful Intercourse For Women?

There can be many reasons why a women experience painful interourse.  

To determine the reason for the pain in their particular case, women need to consult with a knowledgeable sexual health professional (not all primary care doctors or even gynecologists are knowledgeable about painful sex).  

Some potential causes for painful sex include:

• Lack of sufficient lubrication during sexual intercourse, which cause irritation and pain

• Insufficient sexual arousal because women and their male partners rush through sex without taking the time to ensure women are sufficiently aroused for sexual intercourse

• Longstanding resentment due to relationship conflict which gets in the way of sexual pleasure and, in turn, can result in painful intercourse

• Undiagnosed vaginismus, resulting in muscle spasms at the entrance of the vagina which either restrict entrance or clamp shut the vagina

• Pain around the vulva, the outer part of women's genitals, which is called vulvodynia which can result in pain, irritation, a burning sensation, soreness or rawness.

• Vaginal infections, including a yeast infection or bacterial infection (vaginosis)

• Vaginal dryness due to menopause

• Vulvar Vestibulitis, an inflammation of the vestibular glands just outside the vagina

• Birth control pills as a cause of sexual pain due to biochemical changes

• Other medical conditions, such as uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome (IBS) and other gynecological problems can lead to painful sex

• Other medical problems 

What Can Women Do to Deal With Painful Intercourse?

• Talk to your partner (see my article: How to Talk to Your Partner About Sex - Part 1 and Part 2

Talk to Your Partner About Painful Intercourse

• Seek help from a knowledgeable gynecologist or a sexual health professional

• Seek help from a pelvic floor specialist

• Seek help from a sex therapist, especially if the problem involves sexual anxiety, unresolved resentment toward a partner or other unresolved emotional issues, including a history of sexual abuse

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy that focuses on sexual issues for individuals and couples (see my article: What is Sex Therapy?)

Seek Help in Sex Therapy

Individual adults and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no sex, nudity or physical exams during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can have a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, trauma therapist (including EMDR, AEDP, Somatic Experiencing), Emotionally Focused Therapy Couples Therapist and Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

To Improve Intimacy in Your Relationship, Get Off the Sexual Staircase

In their book, Desire - An Inclusive Guide to Navigating Libido Differences in Relationships, Lauren Fogel Mersey, PsyD and Jennifer A. Vencill, PhD., discuss the "Sexual Staircase" to describe the kind of routine, goal-oriented sex that people engage in when they're having sex with their partner (see my article: Understanding Your Sex Script).

Improve Intimacy in Your Relationship

What is the Sexual Staircase?

According to Mersey and Vencill, the Sexual Staircase, which is a metaphor, is how most people think sex is "supposed to be."

The Sexual Staircase is a list of hierarchical steps that usually start at the bottom of the staircase with foreplay and ends with sexual intercourse and orgasm.

Depending upon the couple, the sexual acts between foreplay and intercourse can include kissing, caressing, genital touch, oral sex, and so on.

For many people in long term relationships these steps don't deviate. They engage in the same steps in the same way most or all of the time.  

After a while, people in long term relationships often skip some of the steps as they prioritize a goal-oriented approach that always ends with penetrative sex and strives for orgasm.  

Having sex the same way all the time becomes boring after a while (see my article: What is Sexual Boredom in Long Term Relationships?).

What's the Problem With the Sexual Staircase?

If you and your partner enjoy doing the same thing, the same way all of the time and neither of you have a problem with it, then there's nothing wrong with the Sexual Staircase for you.

But many people find this approach to be too routine and unfulfilling.  The problem is that they think this is the way they're supposed to do it, so they just keep doing it the same way.

People who find the Sexual Staircase boring, sexually unfulfilling or not applicable to them often have the following problems with it:

• It's a heteronormative sex script that focuses on cisgender heterosexual men. For heterosexual men, sexual intercourse is one of the most reliable ways to have an orgasm, but this isn't the case for most women (see below).

• It assumes that most people want penis-in-vagina sex even though there are many people who don't want it or it doesn't work for them because of problems with dyspareunia (persistent or recurrent genital pain that occurs during penetrative sex) or erectile unpredictability (a persistent or recurrent problem with getting and maintaining an erect penis) or because they're not heterosexual (see below).

• Sexual intercourse is the least reliable way for most women to have orgasms because they need direct clitoral stimulation, which they often don't get from sexual intercourse or clitoral stimulation is skipped altogether (see my articles: Closing the Orgasm Gap - Part 1 and Part 2).

• The Sexual Staircase emphasizes goal-oriented, performative sex instead of focusing on sexual pleasure (see my article: What is Performative Sex and Why Is It a Problem?).

• In many long term relationships, the Sexual Staircase gets shorter and shorter over time so that there is little or no foreplay, which has a negative impact of women's sexual pleasure. The focus becomes getting sex over and done with it as quickly as possible because it's unsatisfying.

• In addition to problems with painful sex and erectile unpredictability, penetrative sex isn't always possible for a variety of reasons, including childbirth, certain disabilities, age-related physical limitations, surgery or other types of problems.

• When penetrative sex isn't possible (for whatever reason), many couples skip having sex altogether because penetrative sex is the only way they know how to have sex.  Over time, one or both of them become frustrated and dissatisfied.

• The heteronormativity of this model isn't useful for LGBTQ people, as previously mentioned. Many LGBTQ people assume that since they're not having penis-in-vagina sex, they're not having "real sex," which, of course, is false.  This often leads to feelings of shame, guilt and self consciousness about their sexual orientation.

The Wheel Model

The authors of Desire cite the Wheel Model, which was inspired by Robert T. Francoeur in his book, Becoming a Sexual Person (1991).

Picture a wheel that's divided into different sections with sexual activities represented in a non-hierarchical way.  

Rather than the linear, hierarchical model represented in the Sexual Staircase, in the Wheel Model none of the sexual activities has a higher priority over any of the others.  Other than sexual pleasure, there are no goals, which usually means less pressure for both people and more enjoyment.

In addition, with the Wheel Model, people can engage flexibly pick and chooe what they like, in whatever order they like without being constrained to the rigid model of the Sexual Staircase.

The authors provide an example of what sexual activities might be included in the Wheel Model:

• Kissing
• Caressing
• Touching
• Massaging
• Using a sex toy
• Showering together
• Cuddling
• Oral sex
• Orgasm
• Penetrative sex
• Manual stimulation

And more.

The sexual activities included with the Wheel Model are only limited by your imagination.

But this is not to say that you and your partner should engage in the activities they write about or that you should stop having sexual intercourse if it's enjoyable to both of you.  You can do whatever you both enjoy.

The Wheel Model helps to dispel the myth that there's one right way to have sex or that everyone should have the same predetermined sex script.  

Making Changes to Your Sex Script

Once again, I want to reiterate that if you and your partner are happy with your sex script, you can continue using it without a problem.

But if you're stuck in a routine and you're getting tired of doing the same thing over and over again, consider how you can work towards making changes  in your sex script (see my article: Changing Your Sex Script).

As Emily Nagoski, PhD., sex educator and author of the book, Come As You Are, says, "Pleasure is the measure."

This means "good sex" is what's pleasurable for both of you.

Getting Help in Sex Therapy

A skilled sex therapist can help you to overcome sexual problems.

Sex therapy is a form of talk therapy where the focus is on sex and relational problems getting in the way of sexual enjoyment (see my article: What is Sex Therapy?).

Individuals and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no nudity, physical exam or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?)

Rather than struggling on your own, seek help in sex therapy so you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

 

How to Stop People Pleasing So You Can Reduce Your Anxiety and Increase Your Pleasure in the Bedroom

People pleasing, which is also known by the term "fawning," is often a trauma response (see my article: Trauma and the Fawn Response: People Pleasing to Avoid or Diffuse Conflict).

People who focus on pleasing others, to the detriment of their own emotional needs, often don't even realize they're doing it because it's such an ingrained trauma response from early in their life. 

How to Stop People Pleasing to Reduce Your Sexual Anxiety

They learned to focus on other people's needs to ward off conflict in family dynamics and to try to shore up dysfunctional family dynamics (see my article: Adult Children of Dysfunctional Families and People Pleasing).

As children, these people would extend themselves emotionally beyond what they were developmentally capable of doing, but they tried to do it anyway (see my article: Children's Roles in Dysfunctional Families).

A key component of the people pleasing involves feeling unlovable.  

Examples of Children Who Who Were People Pleasers 

The list below includes just a few examples of children who were people pleasers and who over-functioned in their family.

Children who were people pleasers in their family often:

• Became their parents' confidants at a young age (see my article: Role Reversal in Families)

• Believed they had to take on the family problems in order to be liked or loved

• Believed the family wouldn't survive unless they became people pleasers

• Became perfectionists (see my article: Overcoming Perfectionism)

• Were scapegoated in the family, or

• Became overachievers and the family hero in an effort to please depressed, anxious or traumatized parents

• Became pseudo-independent (i.e., they believed, erroneously, that they didn't need help or emotional support because they could take care of themselves--even though they were children

• Sacrificed their own emotional needs for their parents and other family members

• Emotionally numbed themselves to their own needs

• Agreed to do things they didn't want to do and lost touch with what they wanted and needed

• Were physically, emotionally or sexually abused or neglected

• Carried the family burden of shame

And so on.

People Pleasing Children Become People Pleasing Adults

Unfortunately, people pleasing (or fawning) doesn't stop when children become adults, and these behaviors often carry over into sexual activities so that sex becomes solely performative rather than being pleasurable to them.

How to Stop People Pleasing to Reduce Your Sexual Anxiety

Usually people with this problem are so hyper-focused on their partner's pleasure that they don't pay attention to their own sexual pleasure.  

This creates performance anxiety because they're worried about whether they're pleasing their partner.  The result is that they can become cut off from their own emotions and bodily sensations so they don't enjoy sex (see my article: What is Sexual Anxiety?).

Sexual People Pleasing and Performance Anxiety

Sexual people pleasing often occurs when people are willing to do whatever they think their partner might like--even if it's not what they want or it has a detrimental effect for them--so their sexual partner will like or love them.  

This creates performance anxiety for both men and women which can result in:

• Worry or fear before, during or after sex

• Negative thoughts or emotions about sex

• Negative thoughts about their body image

• Spectatoring (self consciously monitoring and critiquing their own behavior in bed)

• Unrealistic expectations related to sex, especially with regard to their own sexual "performance"

• A disconnect between their mind and body (see my article: The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind)

• A lack of sexual pleasure in a relationship or during sexual hookups

• Faking orgasms
  

• Erectile dysfunction

• Anorgasmia (delayed, infrequent, less intense or absence of sexual orgasms)

• Painful sex

How to Overcome People Pleasing in the Bedroom

Depending upon the specific problems involved, overcoming sexual people pleasing often involves different interventions, including medical treatment to deal with possible physical problems or rule out medical issues, trauma therapy and sex therapy.

• Medical Issues: If there is a physical component to the sexual problem, like painful sex or erectile dysfunction, possible medical problems should be ruled out first.  For instance, many women assume that painful sex is solely the result of anxiety.  However, although anxiety might be an important part of the problem, it's also possible that there might be medical issues that contribute to the problem--like pelvic floor problems, which must be diagnosed by a medical doctor and often requires the assistance of a physical therapist who is a pelvic floor specialist.

Seeking Medical Help to Rule Out Physical Problems

• Trauma Therapy: Since people pleasing is often a longstanding problem that originated in childhood, there is often unresolved trauma that needs to be worked through in trauma therapy. A mind-body oriented therapy, like EMDR therapy, Somatic Experiencing , AEDP and Parts Work/Ego States Therapy is often helpful to bring about increased bodily awareness and work through trauma.  See my articles:

• What is Trauma Therapy?

• What is Complex Trauma?

• Sex Therapy: Sex therapy is a form of talk therapy for individual adults and couples with no physical exam, nudity or sex during therapy sessions. Performance anxiety is a common issue that sex therapists help clients to overcome.  See my articles:

• What is Sex Therapy?
  

• What Are Common Issues Discussed in Sex Therapy?

• What Are Common Misconceptions About Sex Therapy?

How to Overcome Your Fear of Getting Help

If you feel fearful and ashamed to get help for trauma-related sexual problems, recognize that you're not alone.  Many people have similar problems.  In fact, these problems are common.

You can start by finding a licensed mental health professional who addresses both trauma and sex therapy.  Therapists who specialize in both areas can be difficult to find, but you can use a therapist directory to locate someone in your area.

Getting Help From a Sex Therapist Who Specializes in Trauma

If you're already in therapy, you can find an adjunct therapist who specializes in trauma and sex therapy to collaborate with your therapist so you get the help you need.

Make sure the therapist is a licensed mental health professional, which is different from a coach or mentor.

Start by asking for a consultation so you can get a sense of whether you feel comfortable with a therapist (see my article: How to Choose a Psychotherapist).

Be aware that it can take time to develop a therapeutic relationship with a therapist, so be patient.

Once you have worked through your trauma-related sexual problems, you can lead a more fulfilling life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples.

As a trauma and sex therapist, I have helped many individuals and couples to overcome trauma-related sexual problems.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

    

Creating the Potential For Sexual Desire Using the Sex Drive Simmer Technique

In the last several articles I've written about sex and sex therapy, I have been focusing on the book, Sex Talks by Sex Therapist Vanessa Marin.

Creating the Potential For Sexual Desire

In her book, she discussed a technique called the Sex Drive Simmer that has the potential to create sexual desire for individuals and couples.

I'll discuss more about the Sex Drive Simmer technique later on in this article.

What is Sexual Energy?

First, I want to focus on defining sexual energy since this is a crucial part of the Sex Drive Simmer technique.

Most people associate sexual energy with the sexual tension between two people. Although this is one definition of sexual energy, it's not the only one and it's not the one I'm referring to in this article.

Your sexual energy is your life force and it contributes to your vitality, creativity and your overall sense of well-being.

Tips on How to Connect With Your Sexual Energy

To connect with your sexual energy you need to become aware of your body and how energy flows in your body.

 

The Body Scan Meditation:

One way to become aware of your body is to do the Body Scan Meditation. Choose a quiet time and place when you won't be interrupted for at least 5-10 minutes.

The Body Scan Meditation

Start by closing your eyes and doing the Square Breathing exercise to calm and ground yourself.  

Then, focus on the crown of your head and slowly bring your awareness to the rest of your body and notice where you're holding onto any tension.

As you're scanning your body, notice what's happening with the energy in your body. This often takes practice, but if you do the body scan once a day for at least a few minutes, you'll start to notice what's happening energetically in your body. 

Eventually, you'll probably notice that energy moves subtly throughout the body and you can track it.  

After a while, if you keep practicing, you'll also notice how your sexual energy ebbs and flows throughout the day.

As an Aside: People who do Kundalini yoga become especially adept at feeling how sexual energy flows throughout their body. I'm just mentioning it here, but it's outside the scope of this article for me to go into this in detail for the purpose of this article.

In general, being able to detect, develop and maintain a degree of sexual energy is predicated on your overall health and how well you take care of yourself with regard to eating nutritious food, getting enough sleep, and exercising at a rate that's healthy and right for you.

What is the Sex Drive Simmer Technique?

As I mentioned earlier, Sex Therapist Vanessa Marin discusses the Sex Drive Simmering technique in her book, Sex Talks.  

She recommends that, instead of trying to get sexually turned on before you have sex with your partner, you use this technique right after you have sex and keep the sexual energy simmering until the next time you have sex.

Creating the Potential For Sexual Desire

As an example, if you and your partner have sex on a Sunday morning, right after you have sex, focus on maintaining a degree of sexual arousal that you can continue to develop and build for the next time you have sex.

This is in contrast to what most people do. Specifically, most people, who are having problems with sex in their relationship, wait until they have sex again to try to develop sexual desire, but this is often a setup for failure when sexual desire is the problem.

To understand why waiting can be a problem, Ms. Marin compares waiting to get turned on to boiling water in a pot. If you start with ice cold water, it's going to take much longer for the water to boil than if you already had the water simmering on the stove.

Similarly, if you can maintain even a low level of sexual desire between one sexual encounter and the next, all other things being equal, you'll be more likely to enjoy sex.

How to Get the Sex Drive Simmer Technique Going

Everyone's degree of sexual desire is going to look different depending upon what gets you sexually turned on and whether you experience responsive desire or spontaneous desire.

There is no right or wrong way to do the Sex Drive Simmer technique. It all depends on what you enjoy sexually.

You can use imagination and experiment to see what works for you.

Creating the Potential For Sexual Desire

The main thing is that you want to increase your sexual awareness in your body and create and build sexual desire.  

Here are things that have worked for sex therapy clients in the past.  

They may or may not work for you depending upon your situation and what you like.

I'm not recommending these things since I don't know you or your partner and what might work best for the two of you.  This is just information about what worked for other clients, which might spark some ideas for you.

    Core Physical Exercises

For some people keeping sexual energy alive involves doing certain core exercises (core exercises include doing planks, crunches, dead bugs, glute bridges and other similar exercises).  

Remember: If you decide to try these exercises, it's very important before beginning any exercise routine, that you check with your doctor first.

Some people say that when they do core exercises, they can feel sexual energy in their genitals. 

These are often people who are sensitive to sexual energy while doing core exercises and some even say they experience orgasms while working on their core. These orgasms have been labeled "Coregasms."  

Although some people say they have this experience, many others say they don't.  So, this isn't something that happens to everyone.

    Psychological Sexual Stimulation

Other people find ways to generate the Sex Drive Simmer through psychological stimulation (also known as psychogenic stimulation).  

This might involve thinking about your favorite sexual fantasies (if you're aware of them) or your peak sexual experiences, watching ethical pornography or whatever you can do to get yourself sexually aroused on a psychological level.

Keeping an Erotic Journal

Many people find it helpful to maintain an erotic journal to write down their peak sexual experiences, sexual fantasies or other important sexual memories.

When you're working with the Sex Drive Simmer technique, you're not necessarily trying to have orgasms. You're mostly trying to maintain some sexual energy bubbling up so that when you and your partner have sex again, you can tap into this energy and you'll already be turned on before you start having sex.

    Generating Sexual Anticipation: Planning a Sex Date With Your Partner

Sexual anticipation falls within the psychological stimulation category.

A lot of people initially dislike hearing their sex therapist ask them to do homework assignments between therapy sessions.  One assignment can be planning a sex date.  

A sex date is a designated time planned in advance when a couple agrees to have sex at home.

Many of these clients who dislike this assignment (at first) mostly dislike it because they're not approaching it with the right attitude and they need to reframe it for themselves.

The reframe is that, instead of dreading the exercise or expecting it to be boring or mechanical, you and your partner learn to look forward to it with sexual longing and anticipation, which is like an aphrodisiac.  

Sexual longing and anticipation assumes that you and your partner can learn to have the kind of sex which each of you can look forward to and enjoy. 

I know that many clients who come to sex therapy don't start out necessarily wanting the sex they've been having or they're having very infrequent sex or any sex at all.

Needless to say, no one wants to have sex they don't enjoy.  So, it's possible that if this is the case for you and your partner, you'll have to work on this aspect of your sex life before you plan a sex date.

In addition, there could be other factors involved, like sexual pain, significant sexual anxiety or other physical or psychological obstacles that need to be addressed first.

However, if there aren't these or other obstacles, many people learn to look forward to planning a sex date in much the same way they did before when they were dating.

Potential Obstacles to Generating Sexual Desire With the Sex Drive Simmer Technique

Aside from the physical or psychological issues mentioned, there can be other obstacles.

A common problem that could get in the way at first is sexual desire discrepancy where one person wants sex more than the other.

There are also many couples where the relationship has deteriorated to such an extent that the couple needs to work on their emotional connection first before they work on their sexual issues.

Other couples have tried unsuccessfully so many times to revive their emotional and sexual connection that they feel hopeless and too afraid to even try again because they don't want to encounter failure.

Unfortunately, many couples wait until it's too late to work on these issues in therapy. So, be aware that the longer you wait, the tougher it will be to resolve them.

Also, many couples go to couples therapists assuming that these therapists are trained in sex therapy, but this is often not the case.  

In fact, as difficult as this might be to believe, most psychotherapists get no training in how to help individuals and couples to overcome sexual problems.  This is also true for many medical doctors.

Getting Help in Sex Therapy

If you have been experiencing sexual problems as an individual or as part of a couple, seek help in sex therapy (see my article: What is Sex Therapy?).

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy. There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are the Common Misconceptions About Sex Therapy?).

Individuals and couples seek help in sex therapy for many different reasons (see my article: What Are the Most Common Issues Discussed in Sex Therapy?).

A skilled sex therapist will do a thorough assessment of your situation and work with you to help you resolve your problems. 

Rather than struggling on your own and possibly allowing your situation to deteriorate further, seek help from a skilled sex therapist so you can have a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

    

Getting Help in Sex Therapy For Painful Sex

Painful sex is a lot more common than most people think: Approximately 1 in 5 women experience pain during sex.  

Even though it's a common problem, many general practitioners and gynecologists fail to ask women about it during regularly exams.  This is especially problematic when women feel too ashamed to mention it during medical exams.

Get Help in Sex Therapy For Painful Sex

Experiencing painful sex can be confusing, emotionally traumatic and create problems in intimate relationships, especially when the cause of the pain isn't understood.

Sex therapy can help (see my article: What is Sex Therapy?).  More about this later.

What Are the Different Types of Sexual Pain Experienced By Women?

Women can experience different types of sexual pain, including but not limited to:

• Anxiety during sex which makes it difficult to relax and causes pelvic muscles to tighten

• Sexual abuse history that interferes with sex (see my article: Overcoming the Trauma of Sexual Abuse)

• Lack of lubrication due to insufficient sexual foreplay

• Lack of estrogen

• Vaginal dryness

• Vaginal atrophy

• Pelvic pain due to weak core muscles

• Vulva pain when the vulva is touched  (the vulva is the outer part of female genitals, including labia majora, labia minora and the clitoris)

• Pain during sexual penetration (penis in vagina or PIV sex)

• Painful orgasms

• Vulvodynia (chronic vulvar pain without an identifiable cause)

• Vaginismus (the involuntary contraction of the pelvic floor muscles in response to vaginal penetration, including inserting a tampon, toy or penis)

• Dyspareunia (pain before, during or after sex)

• Chronic yeast infections

• Postpartum

• Deep vaginal pain around the cervix

• Endometriosis

• Interstitial cystitis (chronic bladder condition with recurring pain in the bladder and pelvic area)

• Lack of sex education

• Other pelvic floor problems

• Other medical and/or psychological issues

Medical Treatment

If you are experiencing painful sex, you shouldn't ignore it.  Over time, it can get worse.

The first place to start is getting medical help.

Seek help from a medical doctor who is knowledgeable about painful sex.  You can see a primary care physician, a gynecologist or a urologist.  Just make sure the doctor you choose deals with women's painful sex.

Pelvic Floor Treatment

Many women who experience painful sex benefit from seeking help from a physical therapist who specializes in pelvic floor issues.  

Since not all physical therapists are trained to deal with pelvic floor problems, it's important that you ask beforehand to make sure you get appropriate help.

How Can Sex Therapy Help?

Women who experience anxiety or other psychological issues before, during or after sex can benefit from working with a sex therapist who can help them to overcome emotions that interfere with sex.

Women in sex therapy can also learn to incorporate the exercises they learned in physical therapy into their routine at home (see my article: What Are the Most Common Misconceptions About Sex Therapy?).

A sex therapist can help clients to have better sex by learning to use mindfulness.

Partners of women who have pain during sex often don't understand the problem. A skilled sex therapist can also work with a woman and her partner so that the partner understands the problems involved with painful sex, how to overcome these problems, and how to improve their sex life overall.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and a Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

What Are the Most Common Misconceptions About Sex Therapy?

This is the first article in a series of articles about sex therapy where I'll begin addressing the most common fears and misconceptions that people have about sex therapy and some of the most common issues addressed by sex therapists (see my article: What is Sex Therapy?)

Sex Therapy For People in Relationships

There are many misconceptions about sex therapy which, as a sex therapist, I would like to address in this article.  These misconceptions and their related fears often keep people from seeking much-needed help in sex therapy.

Common Problems and Misconceptions That Keep People From Seeking Help in Sex Therapy

Some of the most common problems and misconceptions include (but are not limited to):

• Shame: Shame is a big reason why people, who could benefit from sex therapy, don't go.  Many individuals and couples who are having sexual problems don't know that their sexual problems are common, so they feel too ashamed to see a sex therapist. However, whether the problem is lack of sexual experience, low libido, problems with sexual desire discrepancy in a relationship, premature ejaculation, erectile unpredictability, painful intercourse, a desire to explore consensual non-monogamy or BDSM or kink, or a variety of other issues, these issues and other sexually related issues are common in sex therapy.  

Sex Therapy For Individual Adults

• Fear of Being Asked to Do Things They Don't Want to Do: Many people who have misconceptions about sex therapy fear that the sex therapist will ask them to engage in sexual acts they would be uncomfortable doing (group sex, threesomes, and so on).  But sex therapists focus on what the clients want.  They don't have their own agendas.  

• Fear of Being Judged or Criticized: Many people fear the sex therapist will judge them for their problems or their desire to explore certain areas of sexuality, like kink or BDSM (Bondage, Discipline, Dominance, Submission and Sadism and Masochism) as one example.  The reality is that most sex therapists are trained to discuss these issues in a sex positive and nonjudgmental way. 

Sex Therapy For All Genders and Sexual Orientations

• Fear of What Will Happen in the Sex Therapist's Office: There are people who fear they will have to take off their clothes or engage in sex in front of the sex therapist. However, there are no physical exams in sex therapy, no nudity and no touching.  In fact, a sex therapist's office is just like any other therapist's office.  Sex therapy is a form of psychotherapy which is also known as talk therapy.

Sex Therapy Online

• Fear of Sexual Boundary Violations: As mentioned above, there is no nudity or sexual acts in a sex therapist's office.  You and the sex therapist talk about your problems and there might be assignments for you and your partner(s) to try at home and come back to discuss the following week, depending upon the issue and how the sex therapist works.  Sex therapists don't have sex with their clients.  That would be a serious ethical and legal breach.  Also, a sex therapist doesn't talk about her own sexual experiences.  In other words, sex therapists are licensed therapists who must maintain legal and ethical boundaries with their clients.  

What Are Some of the Most Common Issues Addressed in Sex Therapy?

Most sex therapy begins with the clients discussing what they want to work on in sex therapy.  As previously mentioned, these issues include but are not limited to:

• Lack of Sexual Experience (for all genders/sexual orientations)

• Sexual Anxiety

• Sexual Shame

• Lack of Sexual Confidence or Sexual Self Esteem

• Problems Talking About Sex With Partner(s)

• Low Sexual Desire or Problems With Sexual Arousal

• Sexual Desire Discrepancy or Sexual Frequency Disagreements in a Relationship

• Problems With Body Image That Interferes With Sex

• Problems with Having an Orgasm For Both Men and Women

• Painful Sex

• Erectile Dysfunction

• Premature Ejaculation

• Sexual Compulsivity Including Compulsive Use of Pornography

• Sexual Boredom or Lack of Sexual Pleasure

• Understanding the Conscious and Unconscious Meaning of Sexual Fantasies

• Understanding the Difference Between Sexual Fantasies and Sexual Acts

• Understanding Your Erotic Blueprint

• A Desire to Explore Kink, BDSM (Bondage Discipline, Dominance, Submission and Sadism) or Fetishes

• A History of Sexual Abuse That Negatively Impacts Current Sexual Pleasure

• A Wish to Explore Polyamory or Opening Up a Relationship to Include Other Partners (also known as Consensual Non-Monogamy)

• Problems With Sexual Intimacy After an Affair

• Problems With Sexual Intimacy After Having Children

• Problems Understanding Sexual Orientation or Erotic Orientation or Sexual Fluidity

• Other Emotional or Mental Issues Interfering With Sex

What Happens in Sex Therapy?

Now that I've addressed some of the most common fears and misconceptions people have about sex therapy and some of the most common issues addressed, let's begin a discussion about what actually happens in sex therapy.  I'll go into further detail about this in my next article.

What Happens in Sex Therapy?

Both individual adults and people in relationships, including monogamous and non-monogamous relationships, attend sex therapy.  

As previously mentioned, sex therapy is a form of psychotherapy, which is also known as talk therapy.

Sessions can be in person or online.

The initial session is for clients to discuss why they are seeking help in sex therapy.  

For a variety of reasons, many people feel ashamed to talk about sex, so part of the sex therapist's role is to help clients get more comfortable talking about sex without experiencing shame.  

Sex Therapy Online

It's also common for clients to want to get comfortable with a sex therapist before they really open up to talk about their sexual problems in detail, and skilled sex therapists know how to facilitate this.

Other clients might feel more open and comfortable talking about sex right away.  So, the sex therapist can begin getting a sexual history from the client(s).

Getting a comprehensive sexual history taking is an important part of the initial stage of sex therapy.

When Should You See a Sex Therapist?

If you have tried on your own to resolve sexually related problems without success, you're not alone.  

Many people seek help in sex therapy, and you could also benefit from seeing a sex therapist.

A sex therapist can help you with practical steps to resolve the underlying issues related to your sexual problems.

Rather than struggling on your own, if you're having sexual problems, seek help with a licensed psychotherapist who is a sex therapist.

You deserve to have a fulfilling sexual life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Couples and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples.

I provide in-person and online therapy.

To find out more about me, visit my website where I have many articles about sex therapy as well as other topics: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.