What if you have a sexual issue that’s driving you crazy? Several good studies show that in two-thirds of cases, self-help resources, for example, my recent book, Sizzling Sex for Life, provide real benefits. But what about the one-third of cases self-help can’t fix? In two-thirds of them, sex therapy either cures the problem or significantly improves it.
Sex therapy dates from the 1960s, when pioneering sex researchers William Masters, M.D., and Virginia Johnson showed that a combination of sex education, whole-body massage (“sensate focus”), and specific sexual techniques could resolve many sex problems. Today, sex therapy combines couples counseling with Masters’ and Johnson’s insights and subsequent refinements. Some sex problems are independent of the relationship, but most involve both the relationship and the sex.
What’s the difference between sex therapy and relationship counseling? Couple counseling often deals with communication and control—how the two people make decisions and resolve differences. It may not deal with sex. But when couples consult sex therapists, sexual issues are usually the presenting problem.
Of course, every relationship has erotic issues—disagreements over sexual frequency and repertoire. How do you know if your issue is serious enough to warrant sex therapy? It’s subjective, but if you feel stuck, if the problem has been festering and is driving you bonkers, sex therapy can probably help.
In the early days, sex therapists counseled many women unable to have orgasms and many men who wanted to gain ejaculatory control. Sex therapists still treat these problems, but orgasm difficulties and premature ejaculation can usually be resolved using self-help resources—Becoming Orgasmic by Heimann and LoPicollo, or my book.
Today, the issues that bring couples to sex therapists include:
Desire differences. “You’re insatiable!” “You never want to!” Disagreements about sexual frequency are couples’ #1 sexual complaint.
Erection problems. The drugs get the press, but they work best in combination with sex therapy. Brazilian researchers analyzed 11 studies comparing the benefits of Viagra by itself versus the drug plus sex therapy. In every trial, combination treatment worked better. In one trial in San Jose, California, the researchers gave 53 couples either Viagra or the drug plus eight sessions of sex therapy. Using the drug alone, 38 percent expressed satisfaction. But among those in combination treatment, 66 percent.
Low or diminished libido. The problem may be caused by drugs (often antidepressants) or low blood levels of testosterone—even in women. Relationship problems and other life stresses may also play a role in libido loss.
Sexual aversion or virginity in people over 30. People in these situations either fear sex or feel so socially awkward that friendships never progress to sexual relationships.
Women’s pain on intercourse. It’s much more common than most men believe. Pain may be caused by: endometriosis, reproductive tract infections, anxiety, relationship stress, or a history of sexual trauma.
Studies of sex therapy outcomes show that it usually helps. University of Pennsylvania researchers tracked 365 couples who sought sex therapy for a variety of problems. In two-thirds (65 percent), sex therapy resolved the problem. Treatment outcome was unaffected by the specific problem, the gender of the person with the main complaint, or the partners’ history of sexual trauma. Among couples who did not respond to sex therapy, the reason often involved an illness, often heart disease or diabetes, which can impair sexual functioning. The researchers concluded, “Sex therapy is effective.”
But the outcome studies involved cooperative couples. What if one person refuses to go? Even when one person has the complaint, the couple has the problem, and the solution involves both. Sex therapy is not some awful experience. The spouse who wants it should appeal to the other saying it’s likely to improve their sex life and strengthen their relationship. But if one person flatly refuses, the other can be seen solo. That person can get information, explore feelings, and take home new information that might help, or eventually persuade the other to join the process.
Sex therapy is similar to talk psychotherapy. Clients never have sex with the therapist or in the presence of the therapist.
For most problems, sex therapy takes four to six months of weekly, one-hour sessions, often with “homework,” for example, conversations to gain experience in new communication skills, or sensual assignments to practice massage or lovemaking techniques.
Depending on location, sex therapy costs $100 to $300 an hour. Some health insurers cover it, others don’t or limit the number of covered sessions. Check your policy.
Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavioral Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study,” Journal of Sex and Marital Therapy (2007) 4(4 Pt 2):1117.
McCabe, M.P. “Evaluation of a Cognitive Behavior Therapy Program for People with Sexual Dysfunction,” Journal of Sex and Marital Therapy (2001) 27:259.
Melnik, T. et al. “Psychosocial Interventions for Erectile Dysfunction,” Cochrane Database Systematic Review (2007) CD004825.