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 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.

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.

How to Maintain a Happy Relationship

Developing and maintaining a happy relationship is more challenging these days than ever.  Whereas in former times people had the emotional support of an extended family, people in relationships now tend to rely much more on each other, which often places a strain on the relationship (see my articles: Nurturing Your Relationship and Creating a Safe Haven For Each Other.

Developing and Maintaining a Happy Relationship

While no relationship is without occasional problems, more relationships these days are failing because of the greater emotional burden placed on the relationship.  Also, people often enter into a relationship with unrealistic expectations of their partners and unaware of the work it takes to develop and maintain a happy relationship.

How to Develop and Maintain a Happy Relationship

• Make Your Relationship a Priority:  This might sound obvious and yet, without even realizing it, so many people in relationships allow distractions to get in the way of making the relationship a priority (see my articles: Relationships: The Importance of Unplugging From Your Phone and Computer to Spend Quality Time Together.

Developing a Happy Relationship: Spend Quality Time Together Without Distractions

• Be Loving and Kind to Each Other:  Many couples are loving and kind to each other at the beginning of the relationship but, as time goes on, they forget to do the things that endeared them to each other (see my articles:  Practicing Tolerance and Compassion in Your Relationship).

• Talk About What You Need Emotionally From Your Romantic Partner:  Talking about emotional needs is often difficult for people who are afraid to make themselves emotionally vulnerable, especially if one or both partners grew up in a family where people didn't talk about their feelings. Many couples don't know how to communicate their needs and come across as blaming or complaining, which makes the other partner shut down.  Other people seem to feel that their partner "should know" what they want without their communicating their needs (see my article:  Relationships: Are You Too Afraid to Talk to Your Spouse About What's Bothering and Are You Feeling Lonely in Your Relationship?).

• Respect One Another:  Respecting one another is often related to being able to talk about emotional needs.  For example, if, instead of focusing on what she needs emotionally from her husband, a woman blames her husband for not being more attentive, her husband might shut down and not hear her underlying message, which is: "I need you to show that you care about me."  That message gets lost because it's not getting communicated directly.  The husband will feel criticized and might stonewall.  This often leads to the wife becoming more strident, which leads to even further withdrawal by the husband.  Aside from the obvious forms of disrespect, like name calling, other less obvious forms of disrespect, like eye rolling, show contempt for the other partner and often lead to the demise of the relationship (see my articles:  Emotional Intimacy: The One Who Loves You the Most is Often the One Who Hurts You the Most, and Relationships: When Expressing Your Feelings Turns Into Verbal Abuse).

• Develop Realistic Expectations of Your Relationship:  You're partner can't be everything to you.  You need to have friends and other forms of emotional support in order not to put too heavy a burden on the relationship (see my article: Relationships: Your Spouse Can't Meet All Your Expectations).

• Let Go of the Small Stuff:  When you're in a relationship, you need to know what's most important to you.  Do you really want to argue about the socks that never made it from the floor to the hamper?  If you do, you'll be arguing a lot and this can erode a relationship quickly (see my article: Are You Overreacting to Small Disappointments? and Letting Go of Resentment).

• Find Ways to Grow Together:  Finding ways to grow together is important, especially in a long term relationship.  People change over time, and if one person is developing and growing and the other person isn't, the couple could grow apart.  When you share new interests, you're developing as individuals and as a couple (see my articles: Relationships: Are You in a Relationship Rut? and How to Integrate Change Into Your Relationship).

Developing and Maintaining a Happy Relationship:  Be Playful With One Another

• Be Playful With One Another:  Couples, who are playful and fun with each other at the beginning of the relationship, often forget to do the things that brought them together in the first place.  Having a sense of humor and finding other ways to be playful keeps the relationship fresh and alive (see my articles: Do You Remember What It's Like to Have Fun in Your Relationship? Try a Little Playfulness and Improving Sexual Intimacy in a Long Term Relationship).

Getting Help For Your Relationship in Couples Counseling
There are many couples who have lost their way in their relationship and they're unable to find their way back to the loving relationship that they once had.

A skilled psychotherapist, who works with couples, can help a couple to understand what went wrong and provide them with tools to get back on track (see my article: What is Emotionally Focused Couples Therapy?).

If you've tried on your own to work out your relationship, but you keep coming up short, you could benefit from seeing a couples therapist who can help you to have the loving relationship that you once had.

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 individuals 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.