Considering Sex Therapy? How You See It Makes All the Difference
KEY POINTS
Sexual problems are common and undertreated.
Societal attutudes about sexuality, and how sexual problems are viewed, compound the problem.
Conventional therapy can be helpful, but specialized referral may be important for resolving sexual problems.
Sex therapy is available but surrounded by misperceptions.
Sexuality is a part of everyday life for most people, a source of joy and satisfaction for many. Sexuality, however, remains conflicted. Many people struggle with sexual problems. And while sex therapy is available, many people don't know what it is or how to get it. Adding to the problem is enduring societal attitudes. While estimates and severity vary, sexual dysfunction affects more than 30 percent of men and 40 percent of women, according to the Cleveland Clinic.
Taboo and stigma, shame and related feelings, avoidance, and judgmental attitudes about sexuality do real harm, as societal mores and a variety of prejudices get in the way of inclusivity and activism. For example, young adults who are not prepared for university environments report great difficulty navigating sexual consent, especially when alcohol and other substances are involved; counterproductive attitudes are the rule, rather than the exception. Therapeutic approaches to sexuality and sexual problems are needed on local and systemic levels.
The Taboo of Sexuality
Psychotherapy is famous for shining a spotlight on sexuality, even at the risk of stereotypically making "everything about sex". Freud was innovative and disruptive, in buttoned-up and repressive Victorian times calling attention to ungratified sexual desire as a source of suffering1. Nowadays, therapy variably addresses sexual problems. It's not a major part of standard therapist education. As with other important topics, sexual problems require specialized training when "treatment as usual" isn't working well enough.
Attitudes and Beliefs About Sex Therapy
Sex therapists are trained to work with individuals and couples and can be extremely helpful when therapy-as-usual is not effective at addressing sexual problems. Clinicians may recommend that people consult with a sex therapist, but follow-through is spotty. Why might this be, given the importance and availability of expertise? Are there gaps in understanding or misconceptions getting in the way, in addition to taboo?
Sever and Vowels, in the journal Archives of Sexual Behavior (2023), interviewed 27 people ranging in age from 19 to 53 about how they view sex therapy. The researchers conducted and analyzed semi-structured interviews (“qualitative research”) to identify shared, common factors. Participants included in the study were 1) currently in a romantic relationship and 2) reported having current or prior sexual problems. They were asked a series of questions (see 2 below), with open-ended responses. Five main themes emerged from the narratives.
1. Overall Perceptions of Sex Therapy. People saw sex therapy as a useful service but reported feeling uncomfortable about privacy and anxiety about having open conversations about sex and bringing up past difficulties, especially with a stranger. Participants noted they avoided discussing sex, a taboo topic even in therapy. Participants perceived sex therapy as requiring vulnerability.
2. For When and Whom Is Sex Therapy Appropriate? Participants stated that sex therapy might be helpful when sex is interfering with relationship satisfaction, highlighting the importance of sexuality for many couples for connection and relationship health. The presence of sexual dysfunction for one or both partners was also identified as a good reason to consider sex therapy, as was a history of sexual trauma and a desire of individuals to explore their own sexuality more fully than they currently were. A final reason was as a second line of treatment, if other approaches weren’t fully effective.
3. Expectations of Sex Therapy. Participants had a fair understanding of what sex therapy might be about. They reported expecting to communicate about sex and have an open conversation with their partner about each other's needs, and to speak with an unbiased third party. Participants expected sex therapy to yield rapid results within a short span of time, typically a few sessions.
They hoped sex therapy would normalize sexuality, reducing stigma and facilitating change. Participants expected to learn techniques or exercises, such as Kegel exercises to strengthen pelvic muscles, Tantric yoga practices, the use of sex toys, and partner-appreciation activities. They expected that sex therapy ultimately would improve their sex lives through acquisition of techniques, reduced anxiety, greater respect and communication, and focus on one another’s needs.
4. Beliefs About Sex Therapists. Two main images of sex therapists emerged from the narratives. Participants generally described sex therapists as “holistic women”, similar to a “regular” therapist but less “professional”, due to the perceived raunchy nature of sexuality, less of a “proper doctor”. In contrast, some saw sex therapists as skilled professionals, qualified to be in the field, empathetic, calm and supportive and more conventional.
5. Sources of Beliefs. Participants discussed the origins of their ideas about sex therapy. Many reported getting it from pop culture—movies, podcasts, and books. The media was a second source of information about sex therapy, in contrast to family or society. Finally, participants noted that ideas about traditional therapy may be extended to sex therapy.
Opportunities for Sexual Growth
This research suggests that people have a general idea of what sex therapy is but highlights areas for better education, which would improve access: Views of sex therapists and sex therapy are clunky, often clichéd, and get in the way. Recognizing the array of uncomfortable feelings and uncertainty surrounding sex therapy helps people contemplating treatment to take the first step of seeking referral and initial consultation.
Good quality information about health care is becoming increasingly available. Unfortunately, misinformation is still far easier to get. For instance, a recent study of ADHD on TikTok (Yueng et al., 2022), found that nearly 80 percent of information was inaccurate (52 percent) or anecdotal (27 percent). Only 21 percent of information was credible.
The research reported in the Archives of Sexual Behavior points out areas where well-selected information is useful. First, seek out quality sources if you are seeking treatment. Turn to professional organizations and information sites, and consider using public databases (e.g. Pubmed.gov) if you are interested in reviewing published research.
When asking healthcare professionals for advice, be prepared with a list of questions—the research reported here helps to clarify what to ask. If one is in therapy, it’s important to know whether specific problems are being adequately addressed or need specialized attention. Meeting with a few sex therapists, and getting more information from them about what they do and how it works, helps in decision-making and finding a good therapeutic fit.
References
1. While he brought the conversation out into the open, he also back-tracked around sexual abuse as a cause of psychological problems–while keeping sexual fantasies and drives front-and-center.
2. Interview Questions
What comes up for you when you think of sex therapy?
What do you think sex therapy involves?
What would you like sex therapy to involve?
What do you think would be the most valuable thing that you would like to gain if you went to sex therapy?
If you were told sex therapy includes structured exercises, what do you think those exercises might be like?
How quickly would you expect to see progress?
Have you ever been, or would you ever consider going to sex therapy?
Why do you think someone might need sex therapy?
What do you think about people who go to sex therapy?
What do you think about someone being a sex therapist? What do you imagine?
Have you experienced any of the following: lack of interest in sex, lack of enjoyment in sex, difficulty with erection, difficulty with arousal, difficulty reaching climax, reaching climax more quickly than wanting to, trouble keeping an erection?
If you’ve experienced any of these problems, can you tell us more about it?
If you've experienced any of the problems above, did you seek help or not?
What help did you seek?
If you did not seek help, what stopped you from seeking help?
Sever, Z., Vowels, L.M. Beliefs and Attitudes Held Toward Sex Therapy and Sex Therapists. Arch Sex Behav (2023). https://doi.org/10.1007/s10508-023-02532-7.
Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. The Canadian Journal of Psychiatry. 2022;67(12):899-906. doi:10.1177/07067437221082854
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ABOUT THE AUTHOR
Dr. Brenner is the co-author of three books Irrelationship: How We Use Dysfunctional Relationships to Hide from Intimacy, Relationship Sanity: Creating and Maintaining Healthy Relationships, and the most recent sequel [Feb 2023], Making Your Crazy Work For You: From Trauma and Isolation to Self-Acceptance and Love (Central Recovery Press). In addition, he is the author of the popular Psychology Today blog, ExperiMentations: Reflections on the Human Condition, with nearly 12 million views to date.