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Getting help with sex and relationship problems

Psychotherapy for sexual and relationship issues

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Many people struggle with relationship and sexual problems. Relationships tend to bring up all the personal issues that in normal life we can hide even from ourselves. Relationships only work with a deep attachment between two people. Once an attachment is forming, it will re-stimulate a person's thoughts and feelings about their earlier history and issues with attachments, which can be very difficult. Therefore, relationships are often difficult and need a lot of effort from both you and your partner to work. They are not easy. Struggling with issues in your intimate relationship is normal and maybe even needs to happen for us to grow as people.

Sexual problems are also quite common, despite the fact that people normally don't talk about having them. A recent study of people attending their doctor's surgery in London showed 22% of men and 40% of women have a clearly identifiable sexual problem (Nazareth et al 2003). The most common problems for men were erectile failure (problems with getting an erection) and lack or loss of sexual desire; for women, the most common issues were lack or loss of sexual desire and not reaching orgasm. Sexual problems are common and should not be seen as a personal failure. To read more about sexual problems click here.


Medical check ups

Sexual problems can be caused by many different factors. Some are caused by medical problems, such as high blood pressure or hormonal imbalances. Quite often sexual problems are caused by a mix of medical and psychological factors. For example, a woman may have caught an infection, which results in a painful irritation of her vagina, which is a medical issue. However, even after it is cleared up she might feel worried about sexual intercourse and develop vaginismus, a psychological response, to her fears about pain.


If you do have a sexual problems, please always consult your medical doctor.

It is important that you rule out any medical causes of sexual problems. For example problems with erections can be caused by the onset of diabetes or high cholesterol. The medical factors need to be identified and dealt with before you look for sex therapy. However, not all doctors are very educated about sexual issues. Some general practitioners have not had a lot of training in this area or may not be very interested in sexual problems.


If you are not happy with your doctor's response to your problem, please consult a specialist.

Your issue is important and you need to get it checked properly. If you are not sure your doctor is doing so, please ask for a referral or think about paying for a private consultation.

If you are a man you would need to see a urologist, that is a doctor who specializes in the male sexual and urinary (kidney and bladder) system. You may also see an endocrinologist if you have hormonal problems, or a doctor who describes himself as an "andrologist" - i.e. one who specializes in male sexual issues.

If you are a woman you will need to see a gynecologist, a doctor who specializes in the female genital system, or an endocrinologist for hormonal problems. Very rarely a woman may also need to see a urologist if she has a urinary problem.

In some countries some sexual issues may still be dealt with by a psychiatrist, a medical doctor who specializes in mental health issues. This could be a help if you feel your main issue is, for example, depression, which has caused your sexual problem. Sometimes psychiatrists also still deal with issues around gender dysphoria. (That's when you are distressed about the sex you are and would like to change).


Psychological help


Many psychological factors can contribute to sexual and/or relationship problems. Stress, grief, ongoing arguments with your partner about sex, money or indeed anything, really, will have an impact on your relationship and your sex life. Also, psychological factors from your past can greatly influence your experience of the world today. If you have left-over feelings of insecurity from your childhood, or strong inhibitions about sex, or a tendency to withdraw when under stress, all of these factors will have been learned in childhood and can still influence your life today in a negative way. The good news is that you can tackle all of these issues and that you don't have to do it on your own.


The professionals who deal with psychological issues are called psychotherapists. There are many different types of psychotherapists, such as those who specialize in couples work, and psychoanalysts who often specialize in long-term individual work. The psychotherapists who specialize in sexual issues may call themselves psychosexual psychotherapists or sometimes sex therapists for short. However, other psychotherapists may also work in this area.


The most important aspect about picking a psychotherapist is that you find somebody, who is properly qualified. In some countries such as Britain there is no law regulating the profession of psychotherapy, therefore anybody can call themselves a psychotherapist.

You need to interview the therapist you're thinking of working with very carefully and ask about his or her training background!

Psychotherapists tend to train for at least four years and must attend personal psychotherapy for themselves, again for at least four years. This is essential to have some confidence that the professional will be able to keep his or her personal life separate from the issues you may be dealing with. Also, a psychotherapist should be in ongoing supervision with a more experienced practitioner and work within a clear code of ethics of a reputable organization in his or her field.

It is OK for you as a client to ask about all of these credentials before agreeing to work with somebody. If they object, go somewhere else.


How does sex therapy work?


Firstly, a psychotherapist will never ask you to undress. You talk with the therapist about the issues, but you are not required to do exercises in front of him or her, or have a medical examination in front of them. A very few centers for psychosexual issues  work with surrogates. This would mean that you work with your therapist as usual only talking about issues, but that you have an additional session with a "co-therapist", "assistant" or "surrogate", with whom you can do the practical exercises. This type of work may lead to intercourse with the surrogate. However, very few centers worldwide work in this way and there will be a clear contract with you before embarking on this type of work. You can look up "sexual surrogates" on the internet if you wish to know more.

Generally speaking, psychosexual therapy involves the therapist taking a sexual history and asking you about the problem you have come to get help with. He or she may also want to know about other factors in your life that may contribute to your problem, such as issues in your current or former relationships, medical conditions, how you deal with stress or the existence of childhood trauma.

The psychotherapist will try and identify factors, which you can work on such as anxiety management, old repressive beliefs, unhelpful behavior patterns etc. He or she will probably also give you practical things to do as homework. Two of the classic behavioral techniques used in sex therapy are Sensate Focus to build up confidence with being sexual with your partner and masturbatory exercises to learn about your own sexual response. Again, these are things you would practice at home by yourself or with your partner and then talk about with your therapist later on in your session.


How to find a sex therapist


The internet allows you to look for a suitable professional online fairly easily. The best way would be to look for an established psychotherapy organization in your country and then to find the section of psychotherapists who work with couples and/or psychosexual issues. This way you have a better chance of finding a qualified person quickly. Alternatively, ask your medical doctor for a referral or a recommendation for a psychosexual psychotherapist.


In Britain most psychotherapists are registered with the UK Council for Psychotherapy or UKCP for short. Psychosexual therapists in Britain are members of the British Association for Sexual and Relationship Therapy, or BASRT, which has a register of practitioners on their web site.


In the US, the Kinsey Institute is a leading research centre for sex, gender and reproduction. If you click on "about the institute" you come to the homepage, which gives you the option to go to "Related Resources" in the top right hand section of the page. You can then find sexuality information links in the text. Here you can find contacts for various organizations and links to "Sex Therapy" associations.



Francoeur, R. (1995) The Complete Dictionary of Sexology. New expanded edition, Continuum

Nazareth, I., Boynton, P., King, M. (2003) Problems with sexual function in people attending London general practitioners: cross sectional study. British Medical Journal 327: 423.

Written by Anna 14.03.07


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