Powers Ferry Psychological Associates Assessment & Psychotherapy

The most common sexual problem that couples come to PFPA for help with is differing interest in sex. It is a very rare couple that has an identical need/desire for sex. In many couples the desire/arousal discrepancy is a cause of significant conflict. Fortunately Couples Therapy can give couples tools to effectively work with their differences and develop a more mutually respectful and satisfactory sexual relationship.

Desire discrepancy is inevitable at some time in all long-term relationships. It is also inevitable that it will cause conflict since typically both partners will experience the others’ reactions as unreasonable. Many couples need help to develop the skills and willingness to work together to achieve sexual compatibility. The resolution of this conflict frequently leads to a greater ability to communicate about needs and desires, a deeper understanding of each other, and greater sense of mutual respect. Seen in this way, the conflict created by desire difference is a challenge, not a catastrophe. It is an opportunity for personal, sexual and relationship growth.

Let’s start with a few general truths about sexual desire issues. Sexual desire is different for different people and there are frequently gender differences regarding sexual desire and arousal potential. To enjoy a healthy sex life you need to build a healthy relationship. To enjoy a fulfilling sex life you have to live a fulfilling life. These are lofty ambitions! Often outside help is required in order to find the path to a fulfilling sex life.

A broad area that you can think about on your own is what stokes your desire and your partner’s desire. Does your relationship include:

• Mutual respect
• Trust
• A strong commitment

On the other hand, many couples are struggling with some of these difficulties:

• Unresolved and frequent conflict
• Lack of mutual respect
• Lack of ability and/or comfort communicating about sexual and emotional needs
• Feeling dominated, controlled or bullied by the other
• A narrow sexual repertoire with rigid rules about initiation and pleasuring
• A tendency to expect the other to provide happiness to the other
• Untreated or unresolved chronic stress, depression and anxiety

The Couples Therapists at PFPA can help you create a relationship with the capacity for compromise, so that your sex life is not only mutually satisfying but truly helps to sustain and deepen your sense of intimacy and fulfillment.

Here are some strategies provided by the Society of Ob/Gyn’s of Canada that can prevent sexual desire discrepancies from harming your relationship:

• Stop blaming each other for your biology. Realize that the partner who wants more sex or less sex is not abnormal or "wrong".
• Invite masturbation into your sex life. Masturbation can serve as a "valve" that equalizes the sexual pressure between partners with different sex drives. The partner with a higher libido can relieve some of his or her sexual needs through masturbation.
• Adjust your level of mental desire. If you have a higher libido than your partner does, cut back on activities such as fantasizing or reading/viewing erotic material that stoke your desire. If you have the lower libido, try fantasizing or touching yourself before getting into bed with your partner.
• Teach your partner how to prepare you for sex. If you're the slow-to-warm-up type, a body massage, foot rub, or a few minutes of no-pressure cuddling may help ease you into a more receptive frame of mind.
• Be willing to start lovemaking from a sexually neutral state. Cultivate a willingness to occasionally say yes to sex for reasons other than a strong physical need. In a healthy relationship, occasionally having sex simply to pleasure a partner can be an act of love.
• Split the difference. In other words, compromise. Alternate between doing what the higher-libido partner wants, doing what the lower-libido partner wants, and doing something in between such as bringing one partner to orgasm without involving the other partner in full-blown sex.

Someone who is “addicted” to pornography or sex has an unusually intense sex drive or an obsession with sex or porn. Sex and the thought of sex tend to dominate their thinking, making it difficult to work or engage in healthy personal relationships. Addicts engage in distorted thinking, often rationalizing and justifying their behavior and blaming others for problems. They generally deny they have a problem and make excuses for their actions. Sexual addiction also is associated with risk-taking. A person with a these addictions engages in various forms of sexual or on-line activity, despite the potential for negative and/or dangerous consequences. In addition to damaging the addict's relationships and interfering with his or her work and social life, a sexual addiction also puts the person at risk for emotional and physical injury. For some people, the sex addiction progresses to involve illegal activities, such as exhibitionism (exposing oneself in public), making obscene phone calls, or molestation. However, it should be noted that sex addicts do not necessarily become sex offenders. Behaviors associated with sexual addiction include:

• Compulsive masturbation (self-stimulation)
• Multiple affairs (extra-marital affairs)
• Multiple or anonymous sexual partners and/or one-night stands
• Consistent use of pornography
• Unsafe sex
• Phone or computer sex (cybersex)
• Prostitution or use of prostitutes
• Exhibitionism
• Obsessive dating through personal ads
• Voyeurism (watching others) and/or stalking
• Sexual harassment
• Molestation/rape

Generally, a person with a sex addiction gains little satisfaction from the sexual activity and forms no emotional bond with his or her sex partners. In addition, the problem of sex addiction often leads to feelings of guilt and shame. A sex addict also feels a lack of control over the behavior, despite negative consequences (financial, health, social, and emotional).

Most sex addicts live in denial of their addiction, and treating an addiction is dependent on the person accepting and admitting that he or she has a problem. In many cases, it takes a significant event -- such as the loss of a job, the break-up of a marriage, an arrest, or health crisis -- to force the addict to admit to his or her problem.

Treatment of sexual addiction focuses on controlling the addictive behavior and helping the person develop a healthy sexuality. Treatment includes education about healthy sexuality, individual counseling, and marital and/or family therapy. Support groups and 12 step recovery programs for people with sexual addictions (like Sex Addicts Anonymous) also are available. In some cases, medications used to treat obsessive-compulsive disorder may be used to curb the compulsive nature of the sex addiction. (from WebMD.com)

Premature ejaculation is the most common male sexual concern. One-third of men feel they have rapid ejaculation. Defining premature ejaculation is difficult since it depends on many factors. Men who often ejaculate unintentionally before, or immediately after the moment of penetration can be said to be experiencing premature ejaculation. This can be very distressing for both the man, who wishes nothing more than to last longer; and his partner, who in their own frustration might blame him for intentionally not attending to her needs.

Treatment for Premature ejaculation is best conducted in Couples Therapy. The couple will learn to understand the physiological basis for premature ejaculation, and that it is not something the man is doing intentionally to frustrate the partner. Additionally, they can be taught graduated sensate focus massage techniques and masturbation exercises that can help them both learn to relax, communicate their needs more clearly, and recognize the stage of “ejaculatory inevitability” so that they can vary the amount of stimulation to remain below this threshold. This can be taught and refined in therapy sessions so that many times in just 5 or 6 sessions couples show a rapid change toward more sexual freedom, comfort, and ejaculatory control. Frequently, these gains allow the couple to begin experiencing satisfying sexual relations which will allow them to get on the road to a more healthy and satisfying evolution of their sex life.

Acknowledging the partner's feelings (of frustration, anger), and dealing with these is a cornerstone of therapy. Expanding the couple's sexual repertoire beyond intercourse to other ways for both to achieve pleasure allows the negative pressures to abate. All of this is pretty interactive and usually requires the clarity and empathy of an experienced clinician.

Erectile Dysfunction

At one time or another, almost every man experiences erectile dysfunction. Defined as an inability to achieve or maintain an erection firm enough to have satisfying intercourse, erectile dysfunction can be one or intermittent nuisance caused by momentary performance anxiety, alcohol or drug intoxication, conscious and unconscious concern about commitment, pregnancy, or a host of other things. Sometimes an over focus on a one-time problem can lead to concern about later performance resulting in a more significant problem with erections. If this is occurring the sooner one gets to therapy to understand and treat the problem the less problematic the behavior can become.

Significant erectile dysfunction can have an impact on more than just a man's self-esteem - it may also wreak havoc on a relationship. Some women buy into the myth that men are highly sexual and ready at any time. They may see their partner's lack of an erection as a sign that he doesn't love or desire her and she may blame herself for her partner's lack of response.

Embarrassment, anxiety and a lack of information about erectile dysfunction can contribute to this sexual problem. Past sexual practices, including masturbation, do not cause erectile dysfunction, and an occasional problem does not mean that you will face serious or chronic difficulty. "Performance anxiety", fatigue or excessive alcohol or drug use can be enough to sabotage an erection in an otherwise healthy man.

Basically, here's how psychological factors affect male sexuality. Anxiety about performance leads to a surge in the stress hormones, adrenalin and norepinephrine, which constrict blood flow to the penis and impair erections.

If you have significant problems with Erectile Dysfunction you need to be evaluated by a well-trained professional. In addition to psychological factors, medical conditions can cause this problem and need to be assessed. Problems such as diabetes, heart conditions and kidney and liver diseases, can contribute to erectile dysfunction. Some surgical procedures have also been associated with impotence, including cancer surgery of the colon, bladder or prostate gland. Certain medications can also affect a man's ability to achieve erection. Drugs used to treat high blood pressure, and those prescribed for depression or insomnia can cause the problem, but this side-effect can often be reversed with a change in medication or an alteration in dosage.

A man's penis doesn't wear out as he grows older - but he may find that it takes longer to reach an erection, and that it is slightly less firm than it was when he was younger. But if you are having increased difficulty achieving and maintaining an erection, it is important to examine other factors that might play a role: extreme fatigue, stress on the job or at home or excessive use of alcohol. Sex Therapy for erectile dysfunction usually includes relaxation techniques, sexual re-education, and resolving blocks to sensual and pleasure-seeking behaviors. PFPA psychologists can also refer you to a Doctor for medications such as Cialis and Viagra that can assist with persistent problems.

A related sexual problem which can sometimes lead to desire discrepancies is Female Orgasmic Difficulty. Most women have the potential to become orgasmic consistently in their sexual relationship yet research indicates that, a.) only about 50% of married women regularly experience orgasm, b.) only 30% of single women are consistently orgasmic with a partner and, c.) approximately l5% of women never or almost never experience orgasm.

Some women who are not orgasmic may enjoy sexual activity even without experiencing orgasm. Many others are distressed, disappointed and frustrated. They view their problems achieving orgasm as a sign of 'failures' and they feel unfulfilled.

Sometimes the cause of orgasmic difficulties is a misunderstanding on the part of one or both partners about how women respond sexually. Women do respond differently from men (surprise surprise!). Many women find their greatest sexual stimulation and orgasmic potential occurs when their clitoris is being directly stimulated either manually or orally. For most women, intercourse does not provide this direct stimulation. Recent research indicates that only 17% of women are likely to have an orgasm during sexual intercourse. This might be confusing to some men (“What about all those women in the past who had orgasms during intercourse?”) A Redbook survey showed that 52% of women admitted that they regularly fake orgasms. Just learning the truth about a woman’s sexual response system can improve a couple’s sexual relationship.

There is a key paradox in sex: the more you want something that should happen naturally, the less you are able to do it! The anxiety caused by “failing” to accomplish your goal actually inhibits the response (ever heard of a self-fulfilling prophesy?) This is called Performance Anxiety. Male impotence is the man’s version of this, while difficulty relaxing and “letting go” to orgasm is the woman’s version. An intense focus on having an orgasm can be self-defeating, because it can create the very anxiety that ultimately interferes with stimulation, arousal, and orgasm.

Some individual factors that contribute to sexual difficulties include:

• Sexual or body shame
• General and specific anxiety problems
• Chronic stress
• And anger, guilt, and depression.

Treatment for orgasmic difficulties is typically conducted with the context of couple’s therapy. Most often couples need to address marital issues that may contribute to the problem or my have arisen because of the problem. Couples need to be able to communicate honestly about their needs and feelings. Each person must take personal responsibility for their own relaxation, comfort, and sexual pleasure. Even if it sounds uncomfortable to discuss this, it is very important to learn what actually leads you to orgasm and be able to communicate that to your partner.

Other aspects of the therapy may include:

• Directed reading about each others sexual response systems
• Specific homework called sensate focus that helps the couple evolve their capacity for sensual touch
• Referral for Individual Therapy when one member of the couple has unresolved psychological issues that block their healthy achievement of their sexual goals
• Referral to a Physician when side-effects of medicines or some other health concern may be thought to be interfering with sexual/emotional life. (For instance, many times women taking Anti- depressants have orgasmic difficulties.)