At St. Louis Marriage Therapy, LLC, we offer sex therapy for sexual issues that may affect you or your significant other. These issues may include:
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- Desire Discrepancy or Lack of Desire for Sex
- Painful Sex/Penetration Disorder
- Sexless Marriages
- Depression/Anxiety about Sex
- Affairs
- Sexual Abuse and Trauma
- Opening up your relationship-Ethical Non-Monogamy
- Making sex fun again-incorporating kink, novelty, and sexual exploration
- Poor Body Image
- Erectile Dysfunction/Premature Ejaculation
Sex Therapy for Couples or Individuals
For many issues, it is best to engage in sex therapy as a couple. Even if one partner has the primary issue such as erectile dysfunction or pain during sex, there are usually couple dynamics that play a role in addressing the conflict.
During therapy, the therapist will go over specific strategies each partner can take to improve their sex life. These may include homework assignments, strength based exercises, and sexual communication skills.
Some people will choose to do individual therapy to start to address their sexuality concerns. Eventually your therapist will likely suggest your partner join therapy at some point.
Desire Discrepancy
Desire issues are one of the most common complaints for couples. When one partner wants to have sex frequently and the other person rarely or never wants sex, couples really struggle. In sex therapy, your therapist will help you both look at your sexual relationship to understand what is going on with your sex life. Questions you may face include:
Are you having good sex?
Are you putting effort into flirting with each other?
Do you spend quality alone time with one another and go out on dates?
Do you try to romance one another?
Many couples particularly struggle with their sex life after their second child is born. With the extra childcare duties, the stress of work, chores and finances, a lot of couples lose their sexual luster towards one another. One of the reasons this occurs is that couples are not creating a healthy work/life balance. Part of sex therapy will involve looking at the big picture of your day to day lives. Questions you may need to consider will include:
What resources do we have such as babysitters, mutual friends with kids, and family that can watch our kids so we have alone time?
What ways do we need to work better as a partnership team? Is one of us shouldering more of the overall workload?
Desire issues are rarely about sex alone. Usually they are about having the time for desire. Sex occurs when we are relaxed and enjoying each other's company. Part of working on desire will look at ways you may need to create space for connection and slowing down in your lives together as a couple.
In addition, desire can be very closely related to sexual comfort. Many of us have developed sexual shame from the ways we were raised or taught about sex. If you grew up in an environment where you were taught that sex was evil, wrong or bad in some way, you may be carrying some of that shame into your current relationship. In sex therapy, there are plenty of couples who have a great friendship and are very close. They report their partnership is great and they still aren't having a good sex life. This can be due to sexual shame, anxiety and/or trauma.
In sex therapy that addresses desire, you can expect your therapist to delve into a variety of issues as you go through your assessment. This way, you and your therapist can move forward with an effective treatment plan to help you improve your interest and desire in sex.
Painful Sex/Penetration Disorder
1 in 3 women will experience painful sex at some point in her life. Many women have brought up painful sex with their medical care providers only to feel as though they have hit a brick wall for getting help. Typically, women who have painful sex will do best if they are working with both a pelvic floor physical therapist and a sex therapist.
In pelvic floor physical therapy, a woman can get exercises and guidance on how to relax their sexual muscle system so they are able to have penetrative sex with their partner. However, there is more to good sex than penetration.
Sometimes, a couple has been avoiding sex for so long they do not know how to get their sex life started again. It is not a reasonable expectation to go from absolutely no sex to suddenly having a lot of penetration with your partner. There are steps in between.
That's where sex therapy can help. For couples who have gotten lost in the sexual avoidance game, they can learn how to incorporate various sexual types of play to learn how to enjoy a full sex life with one another again.
Also, some couples want to find a way to still be sexual with one another even though penetration may not be an option for awhile. Again, sex therapist is an opportunity to learn how to enjoy sexuality in new, creative ways. Sometimes called outercourse, a couple can learn ways to play with the hands, tongues, legs, backs, mouths, toys, etc. There are a variety of ways to enjoy sexuality that do not need to include penetration. For a woman who is having painful sex, it helps to know there are options for how to be sexual again with her partner.
Another helpful tool in sex therapy is anxiety treatment. Once sex has become painful, the thought of attempting sex again can produce a lot of anxiety for both partners in the relationship. For a male, he may be concerned about hurting his partner and have actually developed some erectile dysfunction as a result. In this case, sex therapy can be a helpful tool to reduce anxiety as a couple begins to enjoy sex again as a team.
Sexless Marriages or Dead Bedrooms
It is hard to admit when you are in a sexless marriage. A Sexless Marriage is when you are having sex 10 times a year or less. 14-15% of married couples are in sexless marriages.
Marriages can become sexless for a variety of reasons. Sometimes couples hit hard times medically. When someone gets cancer, chronic pain, diabetes, and various other medical illnesses, these can contribute to a sexless marriage.
Other things that can contribute to dead bedrooms include poor sexual communication, anxiety, depression, painful sex, erectile dysfunction, aging, poor physical health in general, menopause and a number of issues.
In sex therapy, couples will identify several key areas they believe are contributing to their sexless marriage. Your therapist will create a treatment plan based on your personal goals. Every couple is different. Some simply want to achieve positive sexual experiences once monthly. Other couples want to find ways to work through their health issues while still maintaining an active sex life.
In sex therapy, you will learn various ways to cope with the challenges you are facing as a couple.
Depression and/or Anxiety about Sex
Many people develop stress related to sex. This stress can show up in the form of long term anxiety or depression. When sex is a problem, it has a way of touching every part of your life. It's supposed to be natural...It's supposed to be easy. But, it's not. When sex becomes a relationship challenge, it can lead to anxiety and depression.
The reality is that sex can be complicated at times. Once a couple has experienced multiple difficult sexual experiences, it can become difficult to resolve the sexual problems on your own.
Essentially, some people's bodies are going into the sympathetic nervous system when they even think or talk about sex. That's your fight/flight/freeze/fawn system. Instead of being relaxed and casual about sex, you are on edge and uneasy.
When sex hits your stress button non-stop, sex therapy is a great option to shift the way you think and feel about sex. In therapy, you will learn tools to slow down and calm your nervous system so that you can approach sex more relaxed and calm. That way, sex can become easy again. Please submit a contact form for more information.
Affairs and Infidelity
A very common reason couples come into therapy is due to affairs. You find out your partner is cheating. Most people will say to you that if they ever found out their partner was cheating, they would leave the relationship right away. The reality is that you have built an entire life with your partner. It is not easy to walk away from a shared home, shared kids, shared responsibilities, shared friends and even shared families. You literally have built and entire life together. Leaving is not an easy option.
Most couples will attempt to work on their relationship after affair to see if they can repair the damages done. While it is not easy work, many couples do find a way to improve their relationship and their sex life after an affair.
Infidelity has a way of making couples re-look at every aspect of their relationship. This evaluation is a good thing. You can't move forward in a relationship that is broken. As a couple in therapy, you will start to make changes for the better. You have to become more honest and direct about your needs and wants. If you want the marriage to improve, you have to examine the things in the relationship that may have led to an affair.
This doesn't mean blaming each other for past wrongs. However, it does mean improving conflict styles, improving personal body image issues, learning to try new things together, learning to put your relationship first, and learning to set clear boundaries going forward. Most couples want to find ways to prevent future affairs. Part of therapy will involve looking at vulnerabilities individually and as a couple that may need change to make sure you are never hurt this way again.
Sexual Abuse and Trauma
There's no way of getting around this topic. Many individuals seeking sex or couples therapy have been impacted by trauma and abuse. As a result, there are ways this trauma history will impact your sexual health. Sexual abuse, physical abuse, emotional abuse and neglect all impact your current relationship. One part of sex therapy is learning to heal past traumas and learning more effective coping strategies in the present.
Trauma by itself will not stop someone from becoming sexual. Many people have in fact experienced various forms of trauma throughout their lives. So trauma alone will not stop you from learning to enjoy sex. What will stop you is when your body essentially gets stuck in the stress cycle with no shut down mechanism.
Essentially, when we go through trauma, our body's fight/flight/freeze/fawn mechanism (also known as the sympathetic nervous system) turns on and takes over to protect us. This is a very positive and much needed nervous system. However, trouble ensues when your body stays here for long periods and doesn't know how to shift back to the parasympathetic nervous system or your "pause and plan" mechanism. You can think of this nervous system as relaxed, calm, home, safe and whole.
After a stressful event is over, the body needs to slow down and feel safe again. Essentially you need an environment that promotes safety and you also need skills to prove to your body you are safe again. Some of the work in couples and sex therapy involves examining your current environment and making changes to promote safety. This could include creating respectful conflict, improving your quality of life, and creating more positive interactions with you and your partner.
In other situations, sex therapy needs to help you create safety in your mind and your body. You may actually be living in a very healthy home environment now, but your body and mind still do not feel safe to explore sexuality with yourself or your partner. In these cases, sex therapy focused on managing personal triggers, developing strategies to soothe your nervous system, and improving your capacity to receive sexual pleasure over time.
Ethical Non-Monogamy
Many couples come to sex therapy because one or both partners are considering polyamory, swinging/lifestyle, kink, open relationships, hall passes, or some form of ethical nonmonogamy (ENM).
Perhaps you have read about nonmonogamy in articles or seen shows about this topic. Currently, around 5% of the population is currently living in an ethically nonmonogamous relationship. Also, around 20% of the population has dabbled in some form of nonmonogamy in their lifetime.
What it is not: ENM is NOT starting a relationship without your partner's consent. That is cheating. It is also NOT coming up with a bunch of controlling rules to "allow" your partner to have an open relationship and then getting mad at them when they are not fitting into unreasonable rules. It is also NOT having a private relationship and then telling your partner you want an open relationship to justify your private relationship with another person. That is also cheating.
Ethical non-monogamy involves both partners in a relationship having explicit conversations about their goals, boundaries, and agreements. Couples who are considering this life journey often don't know what to expect in a nonmonogamous relationship and need help from a professional to identify what their boundaries and agreements should look like to protect them as they embark on this new relationship style.
An unexpected part of the non-monogamous journey is that couples need to shine a light on their own relationship short-comings. If you and your partner are not doing well in your current relationship, non-monogamy will amplify your current relationship problems. As a result, opening up your relationship will require you to grow in your communication skills, your bonding skills and your ability to meet your own needs.
If you can approach this relationship style with curiosity and flexibility, then in many ways your relationship will grow stronger and deeper as a result. You will also develop some really cool emotion regulation skills. If you would like help understanding and creating an ethically nonmonogamous relationship, please contact us for help.
Erectile Dysfunction/Premature Ejaculation
Many clients come to therapy because they are individually struggling with either erectile dysfunction or premature ejaculation. You may have been given Viagra or Cialis to work on the problem, it worked for a while, but now you are struggling again.
One reason people struggle with ED or PE is performance anxiety. Instead of being present in their bodies for the positive sensations associated with sex, they are in their heads over thinking and anxious. Some men are downright aggressively mean to their penis (in their heads) for not working the right way or the way it used to work.
The problem is that as men age, they need to learn how to use their entire body as sexual, not solely their penises. It is natural for things to change as you get older. Men need more direct stimulation to experience erections. They need to use their minds and their emotions to feel desire as well. Since many men have trained themselves to be sexual solely through their penises, once their penis ages, they feel betrayed by their body. The reality is that you need to make a new relationship with your body that is more reasonable and works with your changes.
Sex therapy for premature ejaculation and erectile dysfunction focuses on how to rethink sexual desire from a wholistic mind/body perspective. It will change they way you think and act sexually. In the end, it will teach you to be a better lover and a better friend to your partner.