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What is Sex Therapy?

Sex therapy is a form of therapy that addresses sexual concerns and problems. Examples of this these might include an inability to have or maintain an erect penis, not knowing how to have an orgasm, or feeling uncomfortable about sex or the way your body looks.


Sex therapy offers treatments to help change and heal these and other conditions when they cause suffering.


Examples of treatment may constitute talking honestly about your feelings with a sex-therapist, trying different approaches to problems, and utilizing exercises, such as exploring Sensate Focus with yourself and/or your partner, or learning the "squeeze technique" (see Sexual Dysfunction) to alleviate premature ejaculation. Some sex-therapists work in clinics with couples and follow a flexible but specific protocol on improving sexual wellness; others work one-on-one with individuals.


Who Are Sex-Therapists?

A qualified sex therapist offers the perspective of an objective, professional third party who is trained in therapeutic techniques to help you overcome sexual problems. Sex therapy is useful when sexual concerns arise that you can’t change by yourself (as is often the case, because it’s hard to perceive or change our own behavior patterns).


Sexologists, sex therapists, sex counselors, sex educators and psychiatrists and social workers who specialize in sexual issues are all people who you can seek advice from.


Certified sex therapists and sexologists are trained in clinical techniques for treating sexual dysfunction.


Choosing a Sex-Therapist

Choose a therapist whose personal values do not interfere with your therapy. For example, if you’re LGBTQQ or I, working with a therapist who believes that your sexual  orientation is morally wrong or psychologically abnormal is counterproductive. Feel free to ask a potential therapist about their beliefs, tenets, and professional qualifications.


Sexual Surrogates

Sexual surrogates are professionals who give experiential care to individuals with sexual issues, usually in collaboration with a course of treatment outlined by a professional sex therapist. They essentially substitute for a cooperative, caring sexual partner. Many of them have training as sexologists. Professional sexual surrogates can only be contacted through a sex therapist or a qualified sexual health professional.


Food for Thought: Ask Yourself

It can be illuminating to give yourself a preliminary 'therapy session' by  pondering key questions on your own. Sometimes you can learn alot if you just listen within without judgment. Here are some fundamental questions to consider:


How did I learn about sex?


Were the messages I received about sex from my environment positive or negative? How?


Am I comfortable with my body?

If not, in what way?


Am I comfortable with sex?

If not, what do I want to change?


How can I change what I'm not happy with?


Three Examples of Issues You Might Work On with a Sex Therapist:

 Vaginismus (from Sexual Dysfunction)

Vaginismus is the involuntary  contracting of the vaginal muscles. The muscles in the lower vaginal canal, the pelvic floor muscles - especially the pubococcygeal muscles, and in some cases the inner thighs, constrict and lock close. Vaginal penetration becomes painful or impossible.  


A number of things can cause Vaginismus: a physical condition that causes pain during vaginal entry, leading you to dread penetration and clench your muscles to prevent it; or psychological factors such as a somatic response to sexual assault or negative messages about sex. 

Treatment and Healing

It’s important to determine any physical cause of vaginismus, such as an STI, vaginal adhesions, uterine cysts, vaginal dryness, scar tissue, endometriosis, etc.

Take careful note of your symptoms: when do they occur; if there is pain, where is it; is there any symptomatic manifestation a like a rash, or a discharge? 

Have a thorough pelvic examination and share your observations with your doctor. 

If there is no evident physical cause, then duress, fear, or some other psychological factor may be involved. If this is the case, nurture yourself with tons of love and patience. If your symptoms persist, consider seeing a supportive, experienced counselor or joining a support group.  

The medical treatment for Vaginismus is gentle, gradual, methodic relaxation of the tense vaginal muscles. This is done by very gradually inserting size-gradated phallic-shaped dilators into the vaginal canal.  

Starting with the smallest dilator, you will ease it slowly into the vagina and allow it to remain until it is comfortable. You will do this for about fifteen minutes three or four times a day, for as long as it takes to relax the vaginal muscles. 

When you can move your pelvis and masturbate, you are ready to insert a slightly larger dilator, and then a slightly bigger one than that, until the vagina is comfortable with a penis-sized dilator.  

This process can take several weeks, and may be accompanied by supportive counseling, depending on your needs. 

Vaginismus Healing Exercise 

Start with a warm, quite, relaxing bath. Do some deep relaxation breathing.  

Make your bedroom or chosen place to focus on this exercise comfortable, safe, and private. Be sure that you won’t be interrupted. 

If you share choice to share your healing process with a partner, choose carefully. Only be with someone you trust to be caring and nurturing, who you can relax with and feel certain that they won’t place any pressure on you to “get better”.  

Try the relaxation exercise breathing into and exhaling through the vaginal canal. Then using your hands or a vibrator, massage your external vaginal muscles gently. Don’t forget your favorite warm lubrication. 

Have a clitoral orgasm; manually, with a vibrator, through oral sex, or however you wish. This will help relax your muscles. 

Gently insert the first, smallest dilator. Do not force. Breathe with it, relax, and go very slowly. Once it is inserted, just allow yourself to become accustomed to its feel. Do this three or four times a day for about fifteen minutes.  

When you’re ready – and it may take several sessions before you are – begin moving your pelvis pleasurably and practice kegel contraction and releases. 

When you feel comfortable with this, masturbate to orgasm. 

When this feels comfortable, you can insert the next size dilator, and go through the same process. 

Eventually, you can work through all the sizes and can try inserting a penis or a partners’ strap-on. Use lots of lubrication, and go very slowly, stopping to relax if your muscles begin to tense. 

Be patient. There is no hurry. 



An informative website


Treating Premature Ejaculation (from Sexual Dysfunction)

1. The first step is to cultivate equanimity and compassion towards yourself. It will take time to change an ingrained behavior pattern, or treat a physical condition. Be patient. 

2. Begin with dry masturbation. That is, masturbation without the use of any lubrication, including saliva.  

3. Study how it feels when you approach your “point of no return” (PONR) when ejaculation becomes involuntary. When you’ve identified this moment, practice stopping your ejaculation 15-20 seconds before it occurs by pressing firmly on the penis shaft right under the penile gland /coronal ridge, with your thumb on the bottom and your opposing fingers pressing on top. Use both hands if you need to. Hold this for thirty seconds or as long as needed to relax the impulse to ejaculate. 

You can also use a firm grip at the base of the penis, and/or contract your pelvis muscles. 

4. Breathe deeply and evenly to slow your respiration and help you relax your sexual excitation level. 

5. Thinking boring or unrelated, decidedly unsexual thoughts may help you as well. Baseball scores. Old dentures sitting in a glass of dirty water. Whatever turns you off. 

6. Do this exercise three times in a row. The fourth time, allow yourself to ejaculate.  

7. Practice this at least once a day until you gain control over the impulse to ejaculate.  

8. When you are comfortably in control masturbating with dry lubrication, add lubrication, and repeat this process until you again feel comfortable with prolonging ejaculation. 

9. Once you’re comfortable with your ejaculatory control during lubricated manual stimulation, you can try penetrating a toy vagina or anus with your penis. Apply the same technique you’ve developed, using your hand or pelvic muscles to stop ejaculation 15-20 seconds before the PONR. 

10. Try shallow penetration, entering only the first third of the vagina or anus. Most of your partners pleasure nerves are in this area, and you may find it easier to control ejaculation and highly pleasurable to concentrate penetration here. 

11. Also experiment with modifying your movement pattern when approaching the PONR. For example, try circular pelvic movements rather than direct thrusts, and changing your rhythm. 

12. When you are comfortable with this on your own, it’s time to include your partner. It’s essential that your partner be patient and informed, with a clear understanding of what their supportive role will be. 

13. Teach your partner how to stimulate your penis. When the PONR is approaching, show them how and where to press to stop ejaculation. Practice until you feel comfortable with this together.  

14. You can also apply this technique with oral stimulation. 

15. When you are comfortable together with your partner’s ability to sense  and stop your PONR, it’s time to learn how to penetrate your partner. Begin by “stuffing” your penis inside your partners vagina or anus before it is fully erect, and just accustom yourself to the feeling of being inside them without ejaculating.


This will be easier if you are in a position where you don’t have to put weight on your arms, such as lying on your back while your partner straddles you, or spooning. 

16. When you are comfortably being still together, experiment with controlled breathing, shallow thrusting and modified movement patterns while applying the technique of stopping ejaculation 15-20 seconds before the PONR. Practice until you feel able to control ejaculation.  

If this exercise doesn’t work for you, don’t worry! Changing our own behavior patterns is very hard for most of us. You may benefit the most from working with a sex therapist on your ED.

PE Medical Treatment

Medical treatment usually involves the use of a class of selective serotonin reuptake inhibitor anti-depressants that prolong ejaculation. These drugs include Prozac, Zoloft, and Paxil, all of which may take up to ten days before becoming effective. 

If they don’t help, your doctor may prescribe the tricyclic anti-depressant Anafranil, which has also demonstrated some ability to alleviate PE.  

Homeopathic supplements have also achieved some success. Topical anesthetic creams may be applied to numb the penis, which can aid the ability to have a prolonged erection without ejaculation. These creams should be rinsed off the penis entirely before making penile contact with a partner. 

The use of condoms can also desensitize the penis and help prolong ejaculation. Condoms containing the numbing agents’ benzocaine or lidocaine intensify their desensitizing effect. 

Premature ejaculation may be a symptom of physical illness. It’s always a good idea to talk to your doctor about persistent PE, for your peace of mind. 





Alleviating Performance Anxiety

Performance anxiety occurs when we can’t relax and enjoy ourselves spontaneously during sex, usually because we’re self-conscious, and/or worried about how our sexual execution “rates”. We have these niggling concerns:  

      Am I pleasing my partner?  

      Am I good enough at sexual technique?

         (Am I doing it right?) 

      Am I maintaining my erection long enough?  

      Am I having an orgasm soon enough?

         (Am I taking too long and making them work too hard?  

          Should I fake it?) 

      Do I compare well to other partners?    

      Does my body look attractive to my partner?  

When we experience performance anxiety, we doubt our desirability just as we are. We worry that we're deficient lovers, and start to watch and judge ourselves in bed. And we project this fear, anticipating the negative judgments of others.  

What we need to realize is that sex is not about performance, it’s about our involvement in   the unfolding process of sharing intimacy. It’s about taking care of yourself and your partner with respect, tenderness, and generosity, and letting go of fear. 

Three Helpful Steps for Letting Go of Performance Anxiety 

The first step in getting clear of performance anxiety is cultivating self-love and acceptance. When you love and accept yourself, you will realize that others love, accept, and want you, too. And if they don't, that's their problem. 

The second is realizing that you cannot and should not be expected to read your partners mind: you are both responsible for communicating your needs. Sex as a partnership skill can only develop when we are open with each other about our needs. A sexual partnership is refined over time through this intimate exchange. 

The third step is letting go of unrealistic expectations like feeling the earth move and fireworks explode during sex. That does not happen to anyone! Instead, tune into what sex is really like, and learn how to enjoy this very human experience. 

That's it. Breathe, take it in, and let it go. 

Want someone to talk to about it? If you need help, ask.

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