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What should you do if you have a chronic sexual issue that's driving you crazy? Several good studies show that in two-thirds of cases, self-help resources provide real benefit. But what about problems self-help can't fix? In two-thirds of cases, sex therapy either cures them or produces significant improvement.
Sex therapy was born in 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 classic couple counseling with Masters' and Johnson's insights and subsequent refinements. Some sex problems are independent of the relationship, for example, premature ejaculation. But most sex problems 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, pace (extended or "quickies"), the mix of whole-body and genital caresses, types of sexual expression (oral sex, swallowing semen, etc.), and other issues (sex toys, X-rated media, anal play, etc.). 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 is festering, chances are that sex therapy can 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 (the book, Becoming Orgasmic by Heimann and LoPicollo, and the article on ejaculatory control on my site).
In addition to the problems that often resolve with self-help, the issues couples often bring to sex therapists include:
Desire differences. "You're insatiable!" "You never want to!" In about two-thirds of cases, the man wants more sex than the woman, but in one-third, it's the other way around.
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 than just the drug. 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, the figure was almost twice that, 66 percent.
Low or diminished libido. SSRI antidepressants may be the problem, or low blood levels of testosterone—even in women. Relationship problems and other life stresses may also play a role in loss of libido.
Sexual aversion or virginity over age 30. People with these conditions either fear sex or feel so socially awkward that friendships never progress to sexual relationships.
Pain on intercourse. Women's pain may be caused by: endometriosis, reproductive tract infections, anxiety, relationship stress, an unusually low pain threshold, and 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, for example, heart disease or diabetes, both of which can impair sexual functioning. The researchers concluded, "Sex therapy is effective in the real world."
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 and strengthen their relationship in and out of bed, which helps them both. But if one person flatly refuses, the one who wants sex therapy 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 new massage or lovemaking techniques.
Depending on location, sex therapy costs $100 to $200 an hour. Some health insurers cover it, others don't, and some that do limit the number of covered sessions, after which you pay out-of-pocket. Check your policy.
Some people wonder if the sex therapist's gender affects the quality of the therapy. People may have personal preferences, which is fine, but the research shows that the therapist's gender doesn't matter. Men and woman respond equally well to male or female therapists. What matters most is the rapport between the clients and therapist, and clients' commitment to the process.
References:
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.
