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While it is true that some minor sexual problems can be solved by reading a book, most problems require a board certified sex therapist who works with appropriate doctors.

Every sexual problem involves mental issues—changing thoughts to fix them—and many problems also include physical/medical causes. In addition, relationship issues are often critical to address. Every case is a puzzle to solve, with mental, physical, medical and relationship pieces.

When a man has E.D., there are typically both physical/health pieces, and mental pieces in the puzzle. His performance anxiety may be caused in part from poor health habits such as lack of regular exercise, poor diet and limited sleep. He may also be on medications that adversely affect erections. There may be relationship issues such as poor communication, anger, conflict and hurt feelings, to name just few. He may be overly anxious or depressed. Such mood states can affect his libido and his erections. To solve his E.D., all of these issues must be properly addressed by a board certified sex therapist in conjunction with a urologist, G.P. or another doctor with a grasp of sexual medicine.

Similarly, when a woman has low desire, limited arousal or lack of orgasm, she needs a complete treatment plan (which is not merely “how do you feel?!”) developed by a sex therapist and a gynecologist or another doctor. When there is a couple, a sex therapist usually sees both partners separately, and then together. It is common to discover that both partners have sexual problems, even though one problem may have brought them to the sex therapist.

There are sex therapists who contend that all sexual problems are mental and relationship based, but I am not one of them! When there is a physical problem, it affects a person mentally, and the relationship is also affected. Similarly, some M.D.s think that sexual problems are entirely medical, but many are astute enough to realize there are mental and relationship issues too.

When there is a couple, couples therapy with a sex therapist is appropriate. A marriage counselor usually lacks the background to deal well with sexual problems, and no one should need BOTH a marriage counselor and a sex therapist to solve a sexual problem! Most sex therapists do couples therapy. It would be difficult to solve a sexual problem by seeing one person in a relationship. If a person does not have a lover, working with the individual is important to prepare that person for a satisfying sexual relationship.

It is not uncommon for some to conclude that there is one cause—such as a physical problem—for every issue. This is just plain wrong. Sexuality is complicated. This is why the team approach to solving sexual problems is the most effective. It is also too common for some to seek help, and to drop out of therapy when some progress is made, wrongly concluding that they can solve the rest themselves. It is a mistake to try to save money or time at the expense of a full solution to a problem. This is part of valuing a relationship enough to properly solve the problem(s)!