There’s a lot of pressure on all of us to be good in bed. Movies show impeccably made up actors falling into bed gracefully, fitting together perfectly and climaxing simultaneously without so much as smudging their mascara.
Magazines tell us how to wow him in bed, be the best kisser and how to have "mind-blowing" sex on your honeymoon. And then there’s porn—which, for anyone who hasn’t figured out, tends not to provide a realistic blueprint of sexual experiences.
With all of this weighing on us, it can be hard to admit that our own sex lives are less than stellar and in need of some work.
That's where sex therapy may be able to help.
Sex therapy is simply a form of psychotherapy where a trained professional helps you try to understand the issues that are getting in the way of having a fulfilling sex life and gives you strategies to improve sex going forward.
Most often, couples go to sex therapy together to work through a persistent problem—even if the symptom (like premature ejaculation or lack of interest in sex) is primarily happening to just one of the partners.
But individuals can see a sex therapist on their own, especially if they want help with past trauma, performance anxiety or issues around their sexual orientation or gender identity.
Hers also reached out to Heather Simonson, a sex therapist on Long Island in New York. She added in an email that these issues surrounding sexual expectations of performance and sexual confidence are particularly true for women.
“We are in a sexually saturated yet completely repressed society where, for women, sex is often the last priority,” she said in the email. “And yet, when people seek therapy it often begins with blaming the woman.”
Though we usually assume sex therapy is only necessary if there’s a problem, Simonson said it can also be “a positive way to strengthen relationships and overall health.”
Therapists can, for instance, help couples communicate about sex and negotiate what they each want, even if there are no apparent issues in the bedroom.
Performance issues like erectile dysfunction, premature ejaculation or an inability to orgasm often drive couples or individuals to find a sex therapist.
Chicago-based sex educator and therapist Jen Litner told forhers.com in an email that sex therapy is essentially a tool to help people understand—and navigate—the often complicated roadways of our sexuality.
“We live in a culture where we are told to have sexual confidence, yet we are not taught about how to navigate a healthy sexual relationship or how to explore our bodies," she said in the email. "Many people end up experiencing anxiety surrounding sex, but since that is counter-cultural to how they are told to be (confident) they may not feel so comfortable reaching out for support.”
Therapy can also help with issues of desire such as hypoactive sexual desire disorder (low sexual desire) and the tension caused when one partner is far more interested in sex than the other.
In fact, according to Litner, navigating discrepancies in desire is the most common issue she sees among couples in her practice.
“They are either worried that their relationship has lost all desire and they will have to settle for a 'sexless relationship' or they are worried because each person has such different experiences of desire and all conversations about how to navigate these differences leads to conflict,” she said in the email.
Let’s get this out of the way—there is no sex during sex therapy. The therapist does not see you naked or watch you have sex with your partner while taking notes and shouting pointers from the sidelines.
Sex therapy is like any other talk-based psychotherapy. You’ll sit in an office (it’s doubtful that there will be dildos on the wall or a sex swing in the corner) and the therapist will ask you questions.
Don’t be surprised if the questions go beyond your sex life as your therapist will want to get a complete picture of what’s going on with you. They may ask about other aspects of your life right now (stress at work, family issues, friendships), get the history of your current relationship and even probe into your childhood or early relationships.
Litner points out that licensed sex therapists are psychotherapists first, so if other issues come up during your sessions, they can help with those, as well.
Your sex therapist will not do a medical exam (most are social workers or psychologists; not medical doctors), but don’t be surprised if one of the first things she wants to do is send you for a physical or some medical tests.
Some sexual problems have their roots in physical issues, and even those that stem from a more complicated mix of physical, psychological and social issues may have a medical solution.
Simonson said in her email to us that things like side effects of medications, circulatory issues and hormonal imbalances can be the cause of some of the most common concerns her clients have, and that taking a multidisciplinary approach often results in the most successful treatments.
Therapy is not school, but there may very be homework. Don’t be surprised if you leave your fist session with some exercises to do before your next session.
The clinical term for these assignments is inter-session tasks. They may be as simple as scheduling distraction-free time with your partner or taking a few minutes to reflect on how you communicate about sex.
Litner told us she sometimes gives couples mindfulness exercises involving self-touch or partnered touch, or asks them to “practice a cognitive restructuring skill to help them interact with negative thought patterns.”
Some couples complain that the exercises are embarrassing or feel inauthentic, but they’re an important part of the process.
“Therapy is one hour out of 168 hours in a week, and those who have the most success are those who implement the tools and techniques, and spend time and energy integrating what is learned,” she said in the email.
Many women consider sex therapy if they’re dealing with a diminished or nonexistent sex drive. They may have hypoactive sexual desire disorder (HSDD) which is defined as an absence of desire for sex activity that causes personal distress and/or relationship difficulties.
Of course, when you’re feeling an intense lack of interest in sex, it can be especially hard to find the motivation to talk about sex every week, but sex therapy can really help.
“I think people are dramatically misinformed about sexual desire and some of the psycho-educational work and therapeutic techniques introduced in sex therapy can be very empowering for people,” Litner said via email. “In my experience, when clients are engaged in the therapy process and are working with a therapist who is a good fit, sex therapy can be very effective in treating HSDD.”
HSDD has many potential causes, however, and this is one of the issues where it can be most useful to seek the help of both a therapist and a medical doctor.
Sheryl Kingsberg, a psychologist and Chief of the Division of Behavioral Medicine at Cleveland Medical Center’s Department of OB/GYN told forhers.com in an email, “Desire is best understood as being under the influence of biological, psychological and interpersonal factors. Combining medical interventions with sex therapy can be the best way to address any issues.”
Sex therapists are psychotherapists first, which means they usually have a degree in marriage and family therapy, social work, psychology or medicine, and have then gone on to get further education specific to human sexuality and sex counseling.
Finding someone with the right background and education is important. You can find licensed sex therapists in your area by visiting the American Association of Sexuality Educators, Counselors, and Therapists.
Note that there is a difference between sex therapists and sex coaches. Sex coaches combine counseling with education, instructions and life coaching practices. In most places, sex coaches do not have to be licensed. So, while some people who practice coaching have a solid background in sexology, there are others who do not.
In addition to their credentials, you want to make sure that your therapist is someone you feel comfortable confiding in because they can’t help you if you hold back your thoughts and feelings.
Consider reaching out to a few therapists and having a quick phone call or even an introductory session before settling on the one you will use.
Sex should be a source of joy in our lives and relationships but it’s not always as easy as movies and magazines would like us to believe. When sex becomes more stressful than sensual, it might be time to consult a sex therapist.
Want more sex tips from the pros who get it? Check out the hers blog.