How Sex Therapy Can Help With Sexual Anxiety

In Part 1 of this topic, I discussed some of common issues that cause sexual anxiety.  

In this article, I'm focusing on various clinical scenarios and how sex therapy can help (see my articles: What is Sex Therapy? and What Are Common Issues Discussed in Sex Therapy?):

• Body Image issues include women who feel insecure about their body (perceptions about too fat, too thin, too short, too tall and so on) and men who worry about their penis size and other physical issues (see my article: Is a Negative Body Image Ruining Your Sex Life?)

Sexual Anxiety Related to Body Image

• Sexual Dysfunction like erectile dysfunction or unpredictability, problems with having orgasms, low libido or painful sex

• Shame and Guilt about sex that can stem from cultural issues, religion, family history and other factors

• Relationship Problems including conflict, arguments and other relationship stressors

Sexual Anxiety Related to Relationship Problems

• Sexual Trauma including a history of sexual history of sexual abuse that can get triggered during sex

• Infidelity in a relationship which creates anger, resentment, mistrust and sadness

• Sexual Pressure from a partner including having sex or engaging in certain types of unwanted sexual activities to appease a partner (see my articles: Mismatched Sexual Libido in Relationships)

• Stress and Worry from other areas in life that affect sexual libido

• Sexual Inexperience can create anxiety about sexual performance, which often makes people feel self conscious and ashamed during sex

• Other Mental Health Issues including depression and other types of anxiety

Clinical Scenarios

In the current article, the clinical scenarios will provide more details about sexual anxiety and how sex therapy can help (see my article: Common Misconceptions About Sex Therapy).

Many of these scenarios are a combination of problems and, as always, these vignettes are composites of many cases to protect confidentiality:

Clinical Scenario: Body Image, Shame, Guilt and Erectile Dysfunction

John 

John grew up in a conservative religious home where sex was never discussed.  Although his family never talked to him about sex, when he was 12 years old, he discovered his father's mainstream pornography collection, including films with explicit sex scenes. 

Since sex was never discussed in his home and he attended a religious school where there was no formal sex education, these pornographic films were John's only introduction to sex and his only form of so-called "sex education" (in reality, these films, like most mainstream porn, provided a lot of misinformation). 

John saw images of men in these porn films with huge penises. As as a teenager, he already felt inadequate about the size of his penis and these films made it worse.

By the time he had his first sexual experience in college, he felt ashamed of his body, especially the size of his penis.  In addition, the fact that he was having sex outside of marriage, which was taboo in his culture, created problems for him with maintaining an erection.  

Sexual Anxiety Due to Shame, Guilt and Erectile Dysfunction

His sexual anxiety became an ongoing problem: His shame and anxiety about sex and his penis size made it difficult to maintain an erection and his problems maintaining an erection created even more anxiety. He was caught in what he thought would be an endless negative cycle.  

He eventually sought help in sex therapy where he learned that his problem with sexual anxiety was a common one. His sex therapist provided him with resources, including books on sex education, where he learned that the size of his erect penis was average (the average size of an erect penis is about 5.16 inches).

John also learned in sex therapy how to overcome problems with sexual anxiety to stop the negative cycle he was caught in, including mind-body oriented techniques to help him relax and enjoy sex.

Clinical Scenario: Sexual Anxiety Related to Sexual Trauma and Pressure to Have Sex

Ann and Bob

Ann was sexually molested by her maternal uncle, who fondled her breasts, from the time she was 12 until she was 15.  When she was younger, she was too afraid to tell anyone about the sexual molestation.  

Sexual Anxiety Due to Sexual Trauma

But when she was15, she told her mother, who didn't believe Ann.  Ann's mother couldn't believe that her older brother would sexually abuse Ann, and she told Ann to stop trying to get attention by making up these stories. 

Even though he was aware that Ann's mother didn't believe Ann, her uncle became so scared that his secret was out that he stopped touching Ann.  

Logically, Ann knew she had done nothing wrong but, on an emotional level, she felt she must have been partly responsible for her uncle's behavior, especially since the fondling felt pleasurable to her, which made the experience confusing.

By the time she began dating boys at age 16, Ann dreaded the possibility of being kissed or touched by a boy.  

When she got engaged to Bob, she was relieved that he wanted to wait until they got married to have sex.  But on their wedding night, she was highly anxious.  This set up a pattern where Ann tried to avoid having sex whenever possible, but when she felt pressured by Bob, she gave in to him reluctantly.

She never enjoyed sex because of her sexual anxiety. Every time she had sex with Bob, it triggered memories of her uncle touching her inappropriately.  She just thought of sex with Bob as something to get through and she was relieved whenever it was over.

Two years into the marriage, Bob was fed up with Ann's lack of enthusiasm for having sex. After they started sex therapy, Ann reluctantly revealed her history of sexual abuse, which made Bob never knew about.  Knowing about the abuse made him much more compassionate. 

Ann also learned that it was common and normal for young girls who are sexually abused to feel sexual pleasure during the abuse.  She learned that, even though she didn't want her uncle to touch her, her body responded naturally and spontaneously.  

In addition to what she knew logically, she eventually felt on an emotional level that she was in no way responsible for the sexual abuse or the sexual pleasure she experienced during the abuse.  

Their sex therapist recommended that, in addition to the couple's sex therapy session, Ann work on her unresolved sexual trauma in individual trauma therapy.  

Over time, as Ann worked though her trauma and she and Bob worked on their issues as a couple in sex therapy, Ann began to enjoy sex and their sex life together was much more fulfilling.

Clinical Scenario: Sexual Anxiety Due to Relationship Problems and Infidelity

Ted and Bill

Three months after they started dating, Ted and Bill moved in together in Bill's apartment.  

Prior to moving in together, they were in love and they had a fun and exciting sex life together. But after they moved in together, they realized they had different views about monogamy. 

Bill liked to flirt and occasionally have casual sex with other men, but Ted was completely opposed to nonmonogamy.  This caused frequent arguments and put a damper on their sex life together.  

After Ted found out that Bill was having a sexual affair with a man Bill met at a gay bar, Ted felt angry, sad, resentful and mistrustful of Bill.  Bill felt remorse for causing Ted pain so he ended the affair.  But he told Ted he didn't want to stop having sex with men occasionally.  

Sexual Anxiety Due to Relationship Problems and Infidelity

Since they were unable to resolve these issues on their own, they sought help as a couple in sex therapy.  Eventually, Bill admitted that he would like to have occasional flings with other men too, but he was initially too ashamed to admit this even to himself.  

Their sex therapist provided them with psychoeducation about different types of consensual nonmonogamous relationships.  She also helped them to work out an agreement as to what types of nonmonogamous behavior was acceptable to each of them and, eventually, they worked out a mutually agreed upon written agreement.

They agreed to have a consensual nonmonogamous relationship where they were primary partners to each other and all other sexual encounters would be casual.  

They agreed they could have sex with other men occasionally, but they would try to avoid forming emotional attachments with these other men because their relationship was their primary emotional attachment.  This meant that they wouldn't have sex with anyone else more than a few times to avoid becoming emotionally attached to them.

As issues with jealousy came up, they learned in sex therapy that jealousy was common.  They also learned in sex therapy how to deal with jealousy.

Over time, they would revise their consensual nonmonogamous agreement as they encountered new situations they had not thought of before.  

They both agreed that this form of consensual nonmonogamy worked best for each of them as individuals and for their relationship.  As a result, their sex life became passionate again.

Clinical Scenario: Sexual Anxiety Due to Sexual Inexperience, Shame and Guilt

Ari

Ari and his family moved to the United States when he was 16 years old.  They came from a conservative culture in their country of origin where talking about sex before marriage was considered taboo. 

Since Ari's parents had an arranged marriage in their country, they hoped Ari would allow them to arrange a marriage for him.  But he was adamantly opposed to this, and he told them that he wanted to choose his own partner.

Sexual Anxiety Due to Sexual Inexperience

When he entered high school in New York City, to his amazement, Ari discovered that most of his classmates had already begun dating and having sex.  

This created a great deal of anxiety and shame for him because dating and premarital sex was considered taboo in his country.  He feared classmates would discover he had never dated or had sex with a girl and they would ridicule him. So, he tried to avoid the topic whenever it came up.

After a while, Ari resorted to making up stories about sexual exploits to tell the boys in school but, inwardly, he feared he would be discovered.

By the time he went away to college, Ari continued to feel conflicted about dating and sex.  He felt caught between the culture he grew up as a boy in and the American culture he was currently living in.  Part of him wanted to go out with women and have sexual experiences, but another part of him felt ashamed and guilty for wanting these experiences.

His attempts at dating and sex in college caused him shame and anxiety.  He felt awkward asking women out on dates and he fumbled sexually.  

The one and only time he attempted to have sex with a woman ended up being frustrating and embarrassing for him and the woman.  Due to his anxiety, he had premature ejaculation and he ended the sexual encounter abruptly.

By the time he was in his mid-20s, Ari felt increasingly worried about his ability to date and have sex, so he entered into sex therapy.  

He was able to work through his anxiety and conflictual feelings in sex therapy.  He also learned how to remain focused on his and his partner's sexual pleasure rather than worrying about his sexual performance (see my articles: What is Performative Sex? and What is Sexual Self Esteem?).

Clinical Scenario: Sexual Anxiety Due to Stress and Worry

Rita and Jack

Before they had children, Rita and Jack had a sexually fulfilled sex life.  Sex was fun and passionate between them.

But by the time they had two children, stress and worry intruded on their sex life.  They worried about their children's health and whether they were good parents.  They were also often exhausted by the time they put their children to sleep so they were too tired to have sex.

Sexual Anxiety Due to Stress and Worry

Even when they both had enough energy to have sex, Rita was too distracted to enjoy sex because she was worried that one or both children would interrupt them by coming into their bedroom at night because the children couldn't sleep.

Over time, their sex life dwindled to only a few times a year and they were rarely both in the mood at the same time.  Jack was more spontaneous about sex than Rita, who needed more sexual stimulation to get into the mood (see my article: Spontaneous Sexual Arousal and Responsive Sexual Arousal Are Both Normal).

On their fifth wedding anniversary, they left the children with Rita's parents and they went away to have a romantic weekend.  But when they were alone in their hotel room that night, they felt like strangers to each other. They felt too awkward to have sex--even though they were in a romantic environment with no interruptions.

After that weekend, they began seeing a sex therapist who talked to them about their sex script and how they approached sex from the initial encounter until completion (see my article: Understanding Your Sex Script).

During sex therapy, they both learned a lot about each other sexually and what they liked and disliked--each of their turn-ons and turn-offs (see my article: What Are Your Sexual Accelerators and Brakes?).

They also had fun homework assignments to try at home between sex therapy sessions.  Then, they discussed how they experienced these assignments in the next sex therapy session.

After a while, they planned another romantic getaway and they put into practice what they learned in sex therapy.  

When they were at home, they developed a better sleep routine for their children to minimize interruptions.   They also put a lock on their bedroom door so they wouldn't need to worry about the children coming in while they were having sex.

Eventually, their sex life came alive again (see my article: Keeping the Sexual Spark Alive in Your Relationship).

Clinical Scenario: Sexual Anxiety Due to Depression and Other Types of Anxiety

Ida

Throughout her life, Ida had experienced several episodes of depression and generalized anxiety.  

By the time Ida was in her 30s and in a long term relationship with Jane, her depressive and anxiety-related symptoms were getting in the way of her sexual pleasure.  

She experienced some relief from her symptoms after she saw a psychiatrist and he prescribed medication, but she still didn't look forward to either solo sex or partnered sex with Jane.

Sexual Anxiety Due to Depression and Generalized Anxiety

Her individual therapist, who was helping Ida with her depression and anxiety, recommended that Ida seek help in sex therapy to deal with her low libido.  Her therapist explained that, like most psychotherapists, she wasn't trained in sex therapy, which is a specialty, so Ida needed to seek help with a specialist who was trained in sex therapy.

At first, Ida was reluctant to see a sex therapist because she didn't know anything about sex therapy.  But her individual therapist told Ida that there would be no physical exams, no nudity or touching in sex therapy.  She explained to Ida that sex therapy is a form of psychotherapy, also known as talk therapy, and she encouraged Ida to have a sex therapy consultation.

Ida was relieved that her sex therapist was easy to talk to and Ida was able to open up about her lack of pleasure during sex.  As a first step, her sex therapist also encouraged Ida to talk to her psychiatrist and find out if her medication was contributing to her lack of sexual desire.

After her psychiatrist changed her medication that didn't have sexual side effects, Ida felt more open to having sex with Jane, but she still experienced anxiety during sex.  

So her sex therapist helped Ida with mind-body oriented techniques to help her relax more during sex and stay focused on her own and Jane's sexual pleasure.

They also worked together to help Ida discover on her own what was sexually pleasurable to her during solo sex/masturbation because Ida had problems having orgasms (see my article: Women's Sexual Pleasure: Tips on Sexual Self Discovery).

At first, Ida had problems masturbating because she felt awkward and embarrassed about touching herself.  But, at her sex therapist's recommendation, she started slowly by getting in touch first with what felt sensually pleasurable to her using her five senses--sight, sound, touch, smell and tactile pleasure.

Ida discovered she liked taking bubble baths using herbs in the bath that helped her to relax.  She learned to create a sensual experience for herself by having scented candles, listening to relaxing music, and smoothing on body lotion after the bath.  Afterwards, she was relaxed and open to pleasuring herself.  

Not only did these sensual experiences help Ida to relax, they also helped her to discover what she enjoyed sexually.  Then, she was able to talk to Jane about these sexual discoveries (see my article: How to Talk to Your Partner About Sex).

Over time, sex became pleasurable and passionate for Ida and Jane (see my article: Savoring Pleasure).

Conclusion

One article can't encompass all the problems addressed in sex therapy.  This article attempts to cover some of the most common problems discussed in sex therapy.

One of the most common problems, sexual anxiety, is common. But people who experience sexual anxiety aren't aware of how common it is because people rarely talk about it outside of therapy.

You deserve to have a fulfilling sex life, so if you're experiencing sexual anxiety or other sexual problems, seek help in sex therapy.

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. 

I am also a trauma 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 is Sexual Anxiety?

Sexual anxiety is a common problem for both men and women. It can come up while dating, in an established relationship, in casual relationships or in any other situation where people have sex (see my article: What is Sex Therapy? ).

Overcoming Sexual Anxiety

Sexual anxiety can be a problem that comes up occasionally or it can be a chronic issue that gets in the way of sexual pleasure (see my article: Common Misconceptions About Sex Therapy).

In this article, which is Part 1 on the topic of sexual anxiety, I'm identifying some of the most common situations where people experience sexual anxiety (see my article: What Are the Most Common Issues Discussed in Sex Therapy?).

In Part 2, I'll provide clinical vignettes to show specific examples.

What is Sexual Anxiety? 

Sexual anxiety is any anxiety you experience related to sex.  It can lead to avoiding sexual activities, talking about sex or anything related to sex.

Why Do People Experience Sexual Anxiety?

Sexual anxiety can come up for many different reasons, including:

• Body Image Problems: Body image issues are common for both men and women.  Many people, especially people who watch mainstream pornography (as opposed to ethical porn), feel insecure about their body. Many men feel insecure about their penis size because they see images of men with large penises in mainstream porn.  Many women worry about being too fat or they worry about other physical aspects, including the size of their breasts.  If one or both people are feeling insecure or ashamed of their body, they often feel anxious and have problems feeling sexually aroused or remaining sexually engaged.

Sexual Anxiety: Body Image Issues

• Sexual Dysfunction: Body image issues, as well as other types of sexual anxiety, can contribute to erectile dysfunction, problems having an orgasm, low libido, painful sex for women, and other sexual issues.

• Shame and Guilt About Having Sex: Whether the problem is related to cultural, religious, family of origin or other issues, shame and guilt can create sexual anxiety for people before, during and after sex.

• Relationship Problems: When people in a relationship are experiencing conflict, arguments, stress in the relationship and other problems, these problems often lead to anxiety and an inability to experience sexual pleasure.

Sexual Anxiety: Relationship Problems

• Sexual Trauma: A history of sexual abuse can create sexual anxiety if the trauma remains unresolved.  Even when someone is with a partner they love and trust, current sexual activity can trigger emotions from the past.

• Infidelity in the Relationship: When someone discovers that their partner has been cheating, they can feel anxious about sex with their partner.  Sexual anxiety can develop when a partner worries that they can't trust their partner. They might worry about contracting a sexually transmitted infection.  Also, discovering infidelity often brings feelings of resentment, anger, insecurity and sadness as well as anxiety that interfere with sex.

Sexual Anxiety: Infidelity in the Relationship

• Pressure to Have Sex: Sexual pressure, whether it's spoken or unspoken, is the opposite of sexual pleasure.  Sex should always be consensual.  If a person feels pressured to have sex or to engage in sexual activities they don't want to do, they can feel anxious. It they go along with it just to appease a partner, this isn't consensual.  Feeling pressured creates stress and anxiety as well as anger and resentment.

• Lack of Sexual Experience: If one or both partners have little or no sexual experience, they can experience sexual anxiety about how they will "perform." Rather than being focused on their own and their partner's pleasure, they worry about their performance, which takes them outside the experience. This often leads to "spectatoring," which is being self conscious and stuck in their head instead of focusing on their own and their partner's sexual pleasure. Lack of sexual experience might also mean one or both partners isn't sexually informed due to a lack of sexual education.

Sexual Anxiety: Lack of Sexual Experience

• Stress and Worry: A little stress in the form of sexual anticipation can make sex enjoyable, but too much stress can create sexual anxiety, especially when stress takes one or both people outside their sexual experience.  Even if the stress and worry aren't directly related to sex, it can be difficult to relax enough to enjoy sex.

Sexual Anxiety: Worry and Stress

• Other Mental Health Issues: Mental health issues like generalized anxiety, depression and other problems, can create problems during sex, including sexual anxiety.  

Next Article

As I mentioned earlier, I'll give clinical vignettes about some of these issues in my next article: How Sex Therapy Can Help With Sexual Anxiety.

Getting Help in Sex Therapy

If you're experiencing sexual anxiety, you're not alone--sexual anxiety is a common problem.

Without help, sexual anxiety can get worse over time.

You deserve to have a fulfilling sex life, so instead of suffering on your own, seek help to resolved your problem from a licensed psychotherapist who is a sex therapist.  

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.

What Are the Most Common Issues Discussed in Sex Therapy?

Many people who have sexual problems feel too ashamed to get help in sex therapy or they don't know what sex therapy is (see my article: What is Sex Therapy?).

Common Issues in Sex Therapy

To shed light on some of the most common issues clients discuss in sex therapy, I'm writing this article to help reduce the stigma related to sexual problems and encourage people to seek help.

What Are the Most Common Issues Discussed in Sex Therapy?

The following are just some of the most common issues discussed in sex therapy in no particular order:

• Mismatched Libidos/Discrepant Sexual Desire Between Partners: The initial stage of a relationship is the limerence stage when people experience that heady in love feeling and sex tends to be passionate and exciting.  But it's a common occurrence that the limerence stage only lasts for a relatively short time and then the relationship develops into a more mature phase of love, which is often less exciting. This is normal, but many people think there's something wrong with their relationship when the excitement wanes. When this happens and one person desires sex more often than the other, there is a mismatch in sexual desire, which is called discrepant sexual desire. The mismatch can involve any type of difference. This mismatch can involve sexual frequency or the type of sex each person wants to have. Sex therapy can help couples to reignite the spark in their relationship (see my article: Relationships and Mismatched Sex Drives: What is Discrepant Sexual Desire?).

Common Issues in Sex Therapy: Sexual Desire Discrepancy

• Differences in Sexual Responsiveness in a Relationship: Related to discrepant sexual desire is a difference in sexual responsiveness.  This can occur at any stage in a relationship.  This means that each person in the relationship experiences sexual arousal in a different way.  One person experiences spontaneous desire and the other person needs more time to get turned on, which is called responsive desire.  Again, this is common and normal. Neither type of desire--spontaneous nor responsive--is better than the other. They're just different. Sex therapy can help people struggling with this issue, especially if both people are willing to work on getting to know their turn-ons and turn-offs, which are often referred to as sexual accelerators and sexual brakes (see my articles: Spontaneous Sexual Arousal and Responsive Sexual Arousal Are Both Normal and Understanding Your Sexual Accelerators and Brakes).

• Frustration About a Sexless Relationship: There are relationships where neither partner is bothered by the fact that they're not having sex because sex isn't important to them. If both people feel the same way, there's no problem. But in most relationships sex is important and if sexual frequency has dwindled down to several times a year or to nothing, one or both partners are often dissatisfied.  Sex therapy can help people to get to the root of their sexless relationship so they can enjoy sex (see my article: Have You and Your Partner Stopped Having Sex?).
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Common Issues in Sex Therapy: Frustration About a Sexless Relationship

• Loss of Trust and Sexual Desire After Infidelity: After one or both people in a relationship discover infidelity, they often find it difficult to reestablish trust so that they can enjoy emotional and sexual intimacy.  Even if the person who cheated is genuinely remorseful, the person who feels betrayed often associates sex with anger, resentment, sadness, betrayal and suspicion.  This can make having sex challenging. Sex therapy can help these individuals to work on regaining trust and intimacy (see my article: Learning to Trust Again After an Affair).

• Erectile Unpredictability: When medical issues have been ruled out, most cases of erectile unpredictability, including erectile dysfunction, premature ejaculation, delayed ejaculation, an inability to sustain an erection, are psychological in nature.  The man who experiences erectile unpredictability often experiences shame and guilt, and the significant other sometimes blames themselves or believes their partner doesn't find them sexually desirable.  However, sexual desirability usually isn't the problem.  The problem often involves anxiety about maintaining an erection or a self consciousness about sexual performance. Sexual anxiety often leads to spectatoring. Spectatoring, which can happen to a man or a woman, means they get stuck in their head and they lose focus of their own and their partner's sexual pleasure (see my article: Are Negative Thoughts About Yourself During Sex Distracting You?).
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Common Issues in Sex Therapy: Erectile Unpredictability

• Sexual Performance Anxiety: People who are preoccupied with performance anxiety during partnered sex often have problems with sexual self esteem.  Their preoccupation with their performance, body image issues, and other inhibitory factors often bring about the problems they fear in terms of erectile unpredictability (as mentioned above), problems with orgasms (for both men and women), and other sex-related problems. Rather than focusing on pleasure, they're focused on performance. Sex therapy can help these individuals to reorient their focus to sexual pleasure rather than on performing in a certain way (see my article: What is Performative Sex?).

• Unresolved Sexual Abuse That Has a Negative Impact on Solo and Partnered Sex: Unresolved sexual abuse trauma can get triggered during solo or partnered sex. Individuals with a history of sexual abuse, which include women and men, can experience anything from flashbacks to overall feelings of revulsion when they have sex. Some people are aware of their history of sexual abuse. Others might have fleeting memories or fragments of memories.  Others might have no conscious memories of it, but they have a sense of it. These individuals can be helped in sex therapy with a therapist who also specializes in psychological trauma (see my article: Overcoming the Trauma of Sexual Abuse).

Common Issues in Sex Therapy: Sexual Abuse

• Painful Sex For Women: Even though as many as 1 in 5 women suffer with some form of pain during sexual intercourse (penis in vagina sex), many of these women don't know that this is a common problem. They suffer in silence or they avoid sex altogether.  They also don't know that sex therapy can help them (see my article: Getting Help For Painful Sex in Sex Therapy).

• An Orgasm Gap Between Heterosexual Women and Men:  The orgasm gap refers to differences experienced by heterosexual women as compared to heterosexual men in terms of having an orgasm during partnered sex.  Many women are able to have an orgasm during solo sex (masturbation), but they're unable to have an orgasm during partnered sex with men.  This is usually due to the fact that many women don't have an orgasm from sexual intercourse alone.  They need clitoral stimulation, and many men and some women are unaware of this. Unfortunately, there's also still a double standard when it comes to sexual satisfaction: Some men don't value a woman's sexual pleasure as much as much as they value their own. In addition, some women are also focused more on their male partner's sexual satisfaction.  Or, sex is so unsatisfying for some women that they just want to get it over with as quickly as possible. Often poor sexual communication between the man and the woman having sex is an issue.  In addition, poor sex education in the United States is a contributing factor (see my articles: Closing the Orgasm Gap Between Men and Women - Part 1 and Part 2).

• Compulsive and Out of Control Sexual Behavior:  Sexually compulsive behavior includes an excessive preoccupation with sexual thoughts, urges or behavior. These compulsive thoughts, urges or behavior are disruptive. They often have a significant negative impact on a person's health, relationships, work and other important areas of their life. Compulsive or out of control sexual behavior is not the same as feeling ashamed or guilty about sex in general.  Sexually compulsive behavior can be treated in individual sex therapy or in couples sex therapy (see my article: Treating Sexually Compulsive Behavior in Sex Therapy).

• Lack of Sexual Experience: There are men and women who, for a variety of reasons, have either limited sexual experience or no sexual experience as adults. Shame and guilt are often at the root of this problem, including poor body image.  There might also be cultural factors. Sex therapy can help adults overcome shame and guilt so they can have a healthy sex life (see my article: (see my article: Is a Negative Body Image Ruining Your Sex Life?).

Common Issues in Sex Therapy: Lack of Sexual Experience

• Unrealistic Expectations About Partnered Sex: Due to the inadequacy of sex education in the United States, many people, especially those in their 20s and 30s, get their so-called "sex education" from mainstream pornography. Unfortunately, mainstream pornography gives false and misleading information about sex. People, who rely on mainstream pornography to learn about sex, forget they are watching actors in scripts. They forget that these sexual portrays aren't real.  Not only are these portrayals unrealistic, but the scripts are often very misogynistic in terms of how women are portrayed. Sometimes porn uses women as well as children who have been coerced into working on these films due to sex trafficking.  Pornography also has misleading information about what gets a woman turned on.  This is especially unfortunate because there are sources of ethical pornography that don't have these problems.  Sex therapy can help people, who have false and misleading information about sex and unrealistic expectations, to learn how to have healthier solo and partnered sex.

Common Issues in Sex Therapy: Exploring Kink or BDSM 

• Individuals or Couples Who Want to Explore Kink or BDSM: There are individuals and couples who want to explore kink or BDSM (Bondage, Dominance, Sadism, Masochism), but they might not know where to start. Or, one person in a relationship wants to explore kink and the other is hesitant. Sex therapy can help individuals and couples to start with their sexual fantasies as a way to explore their sexual turn-ons. From there, they can decide if they want to act on their fantasies or if the fantasies are enough without engaging in the behavior (see my articles: Destigmatizing Fantasies About BDSM and What is Power Play?)

• Disagreements About Opening Up a Relationship: Many people who are currently in monogamous relationships would like to have an open relationship, but their partner doesn't want it.  Couples who have a conflict around this issue could benefit from sex therapy where this issue can be negotiated. Other couples both want to open up the relationship, but they don't know how. There are many forms of consensual nonmonogamy. A couple can work out an agreement that suits both of them or they can acknowledge they're not compatible and end the relationship amicably. Sex therapy can help with all of these issues (see my article: What is Consensual Nonmonogamy?)

Common Issues in Sex Therapy: Disagreements About Consensual Nonmonogamy

The categories listed above are just some of the most common reasons why people seek help in sex therapy.  There are many other sexual issues that bring individuals and couples to sex therapy.

Why Couples Therapy is Often Not the Right Therapy for Sexual Problems

Many couples therapists aren't trained sex therapists.  

Worse still, many couples therapists, who were trained in more traditional or outdated forms of couples therapy, don't know how to talk about sex with their clients. Many others collude with couples by avoiding the topic of sex altogether. In cases like this, a couple can go through an entire couples therapy with neither the couple nor the therapist bringing up anything about sex.

Couples therapists who weren't trained in sex therapy believe that if they help the couple to fix romantic problems, sex will naturally improve.  And while this might be true for many couples, it's definitely not true for all couples.  

In fact, there are lots of couples, who love each other and get along well, but there are problems in their sex life.  If a couples therapist doesn't know this, the sexual problems either never get addressed or the couples therapist unintentionally gives misleading or false information.  

In short, many couples therapists, who have no additional training in sex therapy, don't know how to help individuals with contemporary sexual issues.  This often leads to more harm than good.

When to Seek Help in Sex Therapy

Sex therapy is a form of psychotherapy, also known as talk therapy. 

There are no physical exams, no touching and no nudity in sex therapy (see my article: Common Misconceptions About Sex Therapy).

If you have attempted to resolve sexual problems on your own without success, you could benefit from working with a sex therapist.

Rather than allowing hurt, shame and resentment to grow, seek help in sex therapy 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 also a trauma therapist who has helped clients to overcome problems related to sexual abuse (see my article: What is a Trauma 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.

What is Sexual Self Esteem?

Most people are familiar with the concept of self esteem, which is how you see yourself in terms of deserving love and being capable of handling life's many challenges.

Sexual Self Esteem

As it turns out, self esteem affects every area of your life:

• How you feel about yourself
• What you feel you deserve
• How lovable/unlovable you feel
• Whether you get into healthy or unhealthy relationships
• What career choices you make
• How you feel about yourself sexually

What is Sexual Self Esteem?

We are all sexual beings.

Sexual Self Esteem

Sexual self esteem includes: 

• How sexually attuned you are to your body

• Whether your relationship to your body is positive, negative or a mix

• Your openness to sexual self discovery

• Whether you see yourself as a sexually appealing individual

• Whether you believe you deserve a satisfying and enjoyable sex life

• Whether you feel sexually confident

• How capable you feel about giving yourself sexual pleasure during solo sex/masturbation

• How much sexual confidence you feel when you're having sex with your sexual partner(s)

• Whether you make healthy sexual choices, which is part of high sexual self esteem, or poor sexual choices, which is part of low sexual self esteem.  

What Factors Affect Your Sexual Self Esteem?

Your sexual self esteem can be affected by:

• What your psychological and emotional history in your family of origin

• Whether you were taught that you are a lovable, capable person who deserves to be happy

• What your sexual developmental history was including, among other things:
• How you learned about sex and what you were taught

• What you were taught about your sexuality and your body

• Whether sexual boundaries in your family and with others were healthy or unhealthy

• Whether you were sexually, physically or emotionally abused

• What you experienced in your prior sexual and romantic relationships

• Whether or not you had positive experiences in your first romantic and sexual relationships 
  
  
• Other related issues

How Does Your Self Esteem Affect Your Sexuality?

• Your Sexual Choices: People with high sexual esteem usually make positive choices, and people with low sexual self esteem often make poor choices. An example of a poor choice might be going along with a sexual partner's wish not to practice safe sex when you really wanted to be safe.

• Self Confidence: You're more likely to have a satisfying sex life when your self confidence is high.  This includes both solo sex and partner sex.

• Body Image: Whereas having high sexual self esteem allows you to generally have a positive regard for your body, having low sexual self esteem can make you feel self conscious about your body image.

Sexual Self Esteem Can Change Over the Course of Your Life

Sexual self esteem can change over time--from negative to positive as well as from positive to negative.

Most of us are bombarded by images and concepts on social media, magazines, television and other outside sources about what is considered beautiful or sexy, which leads to unhealthy comparisons.

Sexual Self Esteem and the Aging Process

The aging process can be a positive or a negative factor in terms of sexual self esteem.  If a person derives their sexual self confidence based on sources outside him or herself, their sexual self confidence can suffer, especially if they allow negative concepts about aging and attractiveness to affect them.

Sexual Self Esteem and the Aging Process

Being able to maintain a positive self regard for your inner qualities as well as cherishing your body and overall sexuality will help you to develop and maintain a high degree of sexual self esteem.

Developing Healthy Sexual Self Esteem

There are steps you can take on your own to bolster your sexual self esteem, including

• Monitoring your internal dialogue about yourself and being aware of negative self talk

• Keeping a journal to express how you feel about yourself sexually

• Being aware of peak erotic experiences that gave you sexual pleasure--whether they were alone or with partners

• Educating yourself about sexuality through books, podcasts or other forms of healthy sex education

• Developing an awareness of your erotic orientation

• Developing an awareness of your erotic blueprint

• Understanding your sexual turn-ons and turn-offs alone and with partners

• Getting to know your emotional aphrodisiacs

• Being aware of what you're willing and unwilling to do sexually and being able to communicate that to sexual partners

• Focusing on sexual pleasure and not sexual performance both in solo sex and in partner sex

When to Seek Help in Sex Therapy

If you have been unable to increase your sexual confidence on your own with self help techniques, you could benefit from help in sex therapy.

Sex therapy is a form of psychotherapy, also known as talk therapy, where the sex therapist focuses on the sexual issues of individuals and people in relationships. 

There is no physical exam, nudity or physical touch involved in sex therapy (see my articles: What is Sex Therapy? and Common Misconceptions About Sex Therapy).

You deserve to have a fulfilling sex life.

You can free yourself of the obstacles that are keeping you from having a fulfilling sex life when you work with a skilled sex therapist.

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.