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Sex & Intimacy


What to Do When a Sexual Issue Drives You Crazy

In 2 cases out of 3, sex therapy can help

Unhappy couple in bed facing away, Sex therapy

Troels Graugaard/Getty Images

When is a bedroom standoff profound enough to demand sex therapy?

En español | Has your bedroom become a battlefield? If so, consider seeing a sex therapist to solve the problem: Research shows sex therapy to be effective in two-thirds of cases.

Unfortunately, many couples feel intimidated by the term "sex therapy." Rest assured that it does not mean having sex with, or in front of, a therapist. Instead, sex therapists practice talk psychotherapy. They also have extra training in sexual issues and frequently assign sensual "homework" to client couples. For a realistic look at the process, see the recent Meryl Streep-Tommy Lee Jones movie Hope Springs, available on DVD.

See also: 7 meds that could be wrecking your sex life

Sex therapy was born in the 1960s, when pioneering sex researchers William Masters and Virginia Johnson showed that a combination of sex education, mutual whole-body massage and specific erotic techniques could resolve many sex problems. Some basic sex problems — premature ejaculation, for example — are independent of the relationship. But most sexual conundrums involve both the relationship and the sex.

What's the difference between sex therapy and marriage counseling? The latter often deals with issues of communication and control — how couples make decisions, how they resolve differences. Marriage counseling may not deal with sex. But when a couple consults a sex therapist, a sexual issue is usually the "presenting problem."

No relationship is forever free of sexual discord, of course: Typical disagreements center on frequency and repertoire (oral sex, anal play, sex toys). So how do you know when a bedroom standoff is profound enough to demand sex therapy? It's subjective, but if a persistent problem is driving you nuts, sex therapy can probably help.

Early sex therapists focused on teaching men ejaculatory control and women how to have orgasms. Sex therapists still treat these problems, but more often they're resolved by self-help resources. (Two examples: Becoming Orgasmic by Julia Heiman and Joseph LoPiccolo, and the ejaculatory-control article on my site,

The issues most couples take to a sex therapist nowadays include:

Desire differences. "You're insatiable!" "You never want to!" In about two-thirds of cases, the man wants sex more often than the woman. In the other one-third, of course, it's the other way around.

Erectile issues. Few people know that erectile drugs work best in combination with sex therapy. California researchers gave 53 couples either Viagra alone or the drug plus eight sessions of sex therapy. Using the drug alone, only 38 percent expressed satisfaction; among those using the combination treatment, the figure was 66 percent.

Low libido. Possible causes include medical conditions, drug side effects, low testosterone, relationship problems or other life stresses.

Sexual aversion or virginity after age 30. People with these complaints either fear sex or feel so socially awkward that friendships never evolve into sexual relationships.

Women's pain on intercourse. Possible causes include anxiety, relationship stresses, a history of sexual trauma, or medical conditions such as post-menopausal vaginal dryness or atrophy.

What if one spouse refuses to go? Then the one who wants therapy can see the therapist alone and gather information, explore feelings, and take home new insights that might help the problem. Or he or she can try to persuade the other to join the process.

For most problems, sex therapy takes four to six months of weekly one-hour sessions. Therapist-assigned homework often involves conversations to gain experience in new communication skills, or sensual assignments to practice massage techniques or other lovemaking skills.

Depending on your location, sex therapy costs $100 to $200 an hour. Some health insurers cover it; others don't. Still others limit the number of covered sessions, after which you pay out of pocket. So check your policy.

Does a therapist's gender affect the quality of sex therapy? That's a common query. People may have personal preferences, which is fine, but the research shows that the therapist's gender is irrelevant: Men and women respond equally well to male or female therapists. What matters most is the rapport between clients and therapist, as well as the clients' commitment to the process.

To find a sex therapist in your area, visit the American Association of Sexuality Educators, Counselors and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

Longtime sex counselor and journalist Michael Castleman answers questions at