Sex therapy is for anyone who is having difficulty with a sexual issue. Most often these are problems of either desire or function. Some sex therapists focus predominantly on behavior and function. Others may focus primarily on psychological problems that impede or limit an individual’s sexuality. And, there is a growing group of sex therapists who take a more systemic and integrative approach and pay attention to what is going on in a person’s mind as he or she is having or avoiding sex. They also consult with relevant medical and other health professionals to assure that physical imbalances are considered. Sex therapists can have areas of focus and specialization.
My specialization has to do with the meaning individuals attach to their sexuality specifically in long-term relationships. Sex does not have to die after marriage or after a relationship has endured multiple years. But the individuals in those relationships are going to have to do more to create novelty than folks in shorter term relationships, (or singles involved in serial or multiple relationships). The longer the relationship, the greater the anxiety tolerance required by each partner. Common themes include: “He doesn’t really care about my pleasure, he just wants to get off whether I’m into it or not.” “Do we have to talk about it, can’t we just fuck?” “If I don’t do things just right, she turns off and shuts down.” Boredom and loss of desire are also common issues.
Problems or changes in sexual function also can create tension in long-term relationships: difficulty reaching orgasm in both men and women, rapid or delayed ejaculation, pain with intercourse, and changes in arousal and desire through the life cycle.