Sexuality / Sex Therapy
Sexuality refers to a person’s preferences and habits regarding sexual activity and desire, and there are as many individual expressions of sexuality as there are individual preferences for dress or music. Sex therapy is offered to address questions or concerns surrounding a person’s sexuality, and sex therapists are trained in helping people to restore or enhance their enjoyment of sex.
Sexual problems are not uncommon. Estimates of prevalence for adults in the United States range between 30% and 45%, depending on gender and age. Some of the most common concerns include:
- Anxiety about sex
- Lack of sexual desire
- Anxiety or uncertainty about sexual orientation
- Conflicting sexual desires between partners
- Recovery from sexual abuse or sexual assault
- Body-image issues
- Sexual impulses or compulsions that cause distress
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Sexual problems can also surface as a product of another mental health issue, such as depression or anxiety, or they may be derived from physical conditions, such as bowel or urinary problems, chemical imbalances resulting from certain medications, or, for women, changing hormonal levels resulting from menopause or childbirth.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) lists three diagnosable sexual disorders for females and four for males:
- Female sexual disorders:
- Sexual interest/arousal disorder
- Orgasmic disorder
- Genitopelvic pain/penetration disorder
- Male sexual disorders
- Hypoactive sexual desire disorder
- Delayed ejaculation
- Erectile disorder
- Premature ejaculation
The DSM lists a number of paraphilias—sexual preferences for unusual and sometimes socially unacceptable behaviors, such as voyeurism or pedophilia—as being potentially problematic when specific criteria are met. A paraphilia might qualify as a paraphilic disorder when recurring personal psychological distress is associated with the behavior, or the distress, injury, or death of another non-consenting person or group results from the behavior. Paraphilias that are acted out between consenting adults are not indicative of mental disorders. Paraphilias listed in the DSM-5 include: fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic disorder, exhibitionism, and voyeurism. Fantasies associated with these behaviors are not necessarily cause for concern, unless the person experiencing the fantasy finds them distressing. In fact, most of these behaviors can be explored in a healthy, safe way between willing partners; they are considered problematic only when someone is harmed psychologically or physically by the act.
The 4th edition of the DSM included gender identity disorder in the section on sexual disorders. In the 5th edition, gender identity disorder was revised, listed in its own chapter, and renamed gender dysphoria to address the significant distress or impairment that may result from the conflict between a person’s gender expression and the gender he or she was assigned at birth. The DSM explicitly states that this condition is not indicative of a disorder, but that the condition is often associated with prolonged stress and anxiety. Most transgender Americans who seek sex-reassignment surgery are required by their medical team to enter therapy and gain the therapist’s approval for their surgery.
Sexual energy is powerful and can profoundly affect a person’s mood, thoughts, and general state of being. Discussing one’s sexuality with partners, family, and friends can provoke anxiety, frustration, and even shame when a person believes his or her fantasies and behaviors may be deemed inappropriate by others. Fortunately, finding the right therapist means finding a safe place to talk about any difficulties, fantasies, fears, memories, or desires regarding sexuality.
Sexual intimacy can be one of the most satisfying and fulfilling experiences, but for many people, sexual activity is void of pleasure. Sex therapists are trained to help individuals and couples identify the source of their distress and reduce or remove those emotional barriers in order to enhance sexual experiences. Whether the physical symptom manifests through the inability to achieve orgasm or maintain arousal, or even through painful sex, a sex therapist can help identify the psychological source of the symptom. By treating the whole person, psychologically and physically, a therapist can help a person enhance his or her sexual experiences.
Therapists who practice sex therapy will likely have received specialized training or postgraduate certification, and choosing the right therapist for you will depend on your specific situation and the therapist's area of expertise. Because certification or licensure for sex therapists has yet to be standardized, it's important to query potential therapists regarding their professional training in human sexuality.
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- Sexual anxiety: Donald, 47, is anxious and depressed. He drinks alcohol to soothe himself. He has never had a serious girlfriend though he is intelligent, fine looking, and financially stable. The therapist’s questions about his romantic desires seem to cause Donald some embarrassments, and the therapist gently inquires further. Donald reveals tremendous feelings of shame about sexual feelings, which are traced to a strict religious background and two disturbing childhood experiences in which Donald witnessed another boy being molested by a teacher. Therapy helps Donald overcome his shame and fear and slowly begin to accept sexuality as a normal, healthy part of life. This leads to diminished anxiety and an improved social life.
- Uncovering new sexual attractions: Missy, 34, enters therapy because she is feeling attracted to women. She reports being happily married to a man, and is at various times ashamed, excited, confused, anxious, and overwhelmed by these new attractions. She is not sure whether to tell her husband, act on the impulses secretly, or try to engage her husband in “some kind of arrangement,” which she is “sure” he would like but may not be her “cup of tea.” Therapy helps Missy examine her feelings, the possible choices before her, and the best ways of communicating with her husband, whom she decides to tell. She and her husband talk about her attractions, and he is neither judgmental nor perverse. Missy and her husband come to no conclusion about how best to handle Missy’s attractions, but their relationship feels stronger to both of them for having had the conversation, and they both express confidence that their marriage can sustain any possible future.
- Gender Dysphoria. (2013). American Psychiatric Association. Retrieved from http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf
- Paraphilic Disorders. (2013). American Psychiatric Association. Retrieved from http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf
- Rosen, R.C. (2000, June). Prevalence and Risk Factors of Sexual Dysfunction in Men and Women. Current Psychiatry Reports 2(3). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11122954
Last updated: 07-03-2015