Author: laura miano

 

Erectile dysfunction involves difficulty getting or maintaining an erection, not being able to get an erection, or experiencing less rigidity than usual. It can make penetrative sex difficult and may also affect self-image and sexual self-esteem.

Symptoms: 

It is common to experience difficulties getting or maintaining an erection from time to time, which is not usually a cause for concern. For clinical diagnosis, these difficulties should occur most or all of the time for at least six months and cause distress. Erectile difficulties may be lifelong or acquired, and may also lead to reduced sexual desire over time.

Difficulty maintaining an erection may occur when changing positions, putting on a condom, when sexual momentum changes, during some sexual activities but not others, with some partners but not others, or during masturbation and/or partnered sex.

Causal factors: 

Stress, shame, sexual insecurities, and anxiety are common contributors to erectile difficulties. These can create mental distractions that make it harder to stay connected to desire and arousal. Other possible factors include relationship concerns, mental health difficulties, and lifestyle factors such as smoking, alcohol use, lack of physical activity, or poor sleep.

As erectile difficulties can also be a sign of underlying health concerns, it is important to rule out possible medical causes with a health practitioner.

How Therapy Helps: 

Sex therapy can help address the thoughts, emotions, and experiences contributing to erectile difficulties. This may involve working through anxiety, insecurity, and overthinking around sex, while developing healthier sexual expectations and narratives.

Normalising and destigmatising sexual function can also help reduce shame and negative self-talk. Sex therapists can provide education to correct misinformation and address relevant gaps in sexual health knowledge, supporting clients to develop the type of sex life they want.

Strategies to build greater bodily awareness can help clients focus on pleasurable sensations rather than self-judgement or goal-oriented sex. Therapy can also broaden the sexual repertoire, reducing pressure around getting or maintaining an erection.

 

 

Education is a major part of sex therapy. Given the stigmatisation of sexuality, sexual health topics are often neglected in our education systems (i.e. schooling and parenting). Hence, our main avenues for sex education are through friends, film, TV and social media, in which misinformation is rife. These misrepresentations frequently lead to internalised shame and feelings of dysfunction, as well as unsafe sex practices. 

Sex education with a therapist may involve learning more about the body and sexual function, normalising sexual experiences, and developing healthier ideas around sex, gender, performance, and relationships. Education is tailored to each client’s needs, based on their concerns and any gaps in their sexual health knowledge.

 

 

Premature ejaculation involves a persistent pattern of ejaculation occurring within around one minute of starting penetrative sex. For it to meet clinical criteria, it must cause significant distress and occur most or all of the time for at least six months.

Symptoms: 

The main symptom is difficulty delaying ejaculation beyond one minute of penetrative sex. Premature ejaculation can also occur during masturbation or with some sexual partners but not others, and may be lifelong or acquired. Shame and distress around premature ejaculation can also lead some people to avoid sex altogether.

Causal factors: 

There are many possible factors underlying premature ejaculation, and these are not always psychological. Common contributors include performance anxiety, negative self-image, low sexual self-esteem, sexual guilt, and relationship difficulties. Physical and biological factors can also play a role.

How Therapy Helps: 

Sex therapy can help address the behavioural and psychological factors contributing to premature ejaculation. The stress and anxiety around ejaculating too quickly can sometimes create a self-perpetuating cycle, which therapy can help break by reducing shame and performance anxiety around sexual function.

Sex therapists can also provide techniques to develop greater bodily awareness and learn to delay ejaculation, such as pelvic floor exercises and edging. Therapy may also support greater erotic and emotional intimacy within a relationship.

 

 

Masturbation challenges can take on many forms, including difficulties with sexual function, guilt or shame, feeling disconnected from the body, or distress around masturbation frequency. 

Shame and guilt around masturbation are common and can be influenced by cultural, religious, or familial messages that frame masturbation as sinful or dirty. Feeling disconnected from the body may also occur when masturbation becomes a routine way of managing boredom or stress rather than focusing on pleasure. 

Masturbation frequency is generally only a concern when it causes distress or interferes with other areas of life, such as relationships or important responsibilities. Very frequent or intense masturbation can also make other forms of sexual touch feel less pleasurable by comparison, while a strong preference for masturbation may sometimes lead to avoiding partner sex. 

How Therapy Helps: 

Sex therapy can help work through negative messages around masturbation that contribute to shame or feelings that something is wrong. Guided masturbation practices can help to identify areas of pleasure, strengthen the mind-body connection, and increase awareness of pleasurable sensations. 

Sex therapists can also help develop a healthier relationship to masturbation, including exploring when and why it takes place, and how it is done. This may involve adjusting masturbation techniques, such as gradually becoming more comfortable with a softer or less vigorous grip or using masturbation tools.

 

 

Dating anxiety involves feelings of fear, worry, or uncertainty around dating and romantic relationships. It can be influenced by insecurities, past negative experiences, fear of rejection, or worries about worth and attractiveness.

Dating anxiety may involve overthinking interactions, worrying about how a romantic interest feels, assuming the worst, or becoming highly self-critical. For some people, anxiety can lead to self-sabotaging behaviours as a relationship becomes more serious, while others may avoid dating altogether or cancel dates at the last minute.

How Therapy Helps: 

Sex therapy can help build confidence in self-worth and attractiveness, creating a stronger sense of security when navigating the uncertainty and vulnerability that can come with dating. Therapy can also help reduce the attention given to negative assumptions and fears by developing skills for staying present and shifting focus away from overthinking. Mindfulness can be a useful tool for this.

Therapy may also involve unpacking past dating experiences and developing a more balanced understanding of what happened, including separating facts from interpretations. It can also help reduce pressure around dating and romantic relationships, clarify dating intentions, and identify and respond to red flags. Rather than focusing on what the other person may be thinking or feeling, the focus can shift towards personal feelings, needs, and whether the connection feels positive and fulfilling. This can help build a greater sense of agency in dating.

Where dating anxiety is connected to sexual performance, a sex therapist can explore underlying fears, negative self-talk, and past experiences, while supporting greater confidence and comfort in developing a fulfilling sex life.

 

 

Lack of pleasure, otherwise referred to as sexual anhedonia,involves experiencing little or no pleasure during sexual stimulation or orgasm. While experiences vary, some people describe feeling physically stimulated without experiencing a corresponding sense of emotions or mental pleasure leaving sex experiences feeling hollow or disconnected.

Symptoms: 

Symptoms can occur during some sexual experiences, at particular points during sex, with certain partners or during masturbation, or across sexual experiences more generally. These may include: 

• Little to no pleasure during sexual arousal, stimulation, or orgasm, which may feel neutral, boring, or uncomfortable.
• Feeling mentally disconnected, numb, or emotionally detached during sex
• Difficulty reaching orgasm
• Difficulty experiencing pleasure or satisfaction from orgasm

Causal factors: 

Sexual anhedonia can have a range of physical, psychological, and situational contributors. Physical factors may include medications such as SSRIs and SNRIs, hormonal changes, substance use, or conditions affecting the nervous system, such as spinal cord injuries.

Psychological and emotional factors may also play a role, including fatigue, anxiety, depression, stress, relationship difficulties, past trauma, or other mental health concerns. These factors can affect the ability to feel present, connected, and able to experience pleasure during sex.

How Therapy Helps: 

Sex therapy focuses on both the sensory and psychological experience of sex, using a combination of body-based and cognitive approaches to support greater connection to pleasure.

Sensate Focus exercises may be used to explore physical sensations without pressure or the expectation of a particular outcome. Clients can develop sensation maps by noticing which areas of the body feel pleasurable, neutral, uncomfortable, or less sensitive. These exercises can also help reduce performance pressure and increase awareness of physical sensations.

Where anxiety, self-consciousness, or “spectatoring” gets in the way of pleasure, mindfulness and body-awareness practices can help clients become more present during sexual experiences. The Dual Control Model of arousal can also help identify what may be putting the “brakes” on pleasure, such as stress or anxiety, and what may support arousal, such as relaxation and connection.

Sex therapy can also explore whether the type of sex being experienced actually aligns with a client’s desires and needs. This may involve developing a broader sexual repertoire, understanding what satisfying sex means to the individual, and building confidence in communicating these needs with sexual partners.

 

 

Low sexual satisfaction is a common concern that leads people to seek sex therapy. It can occur when sex does not feel pleasurable, fulfilling, or connected, or when the type of sex being experienced does not meet a person’s needs or preferences. It may be influenced by factors such as inadequate stimulation, difficulty experiencing pleasure, relationship concerns, or a lack of sexual connection.

How Therapy Helps: 

Sex therapy begins by exploring what may be contributing to low sexual satisfaction. This may include relationship difficulties, anxiety, body image concerns, low sexual self-esteem, or difficulty staying present and connected to pleasure during sex. Physical factors such as hormonal changes or sexual pain can also be explored and, where appropriate, referred to other health professionals,

Where dissatisfaction is related to insufficient stimulation or the type of sex being experienced, sex therapy can help identify what may be missing and explore ways to expand the sexual repertoire. This may involve moving beyond a linear pattern of foreplay, penetration, and orgasm, and exploring different forms of touch, sensation, and stimulation. For people with vulvas, this may include exploring different types of clitoral stimulation or other forms of touch that feel pleasurable.

Therapy can also support a shift from goal-oriented sex towards pleasure-focused sex. Sensate Focus and other sensory exercises may help develop greater awareness of physical sensations and reduce the focus on performance or outcome. Sex therapy can also challenge sexual myths and support more realistic, personalised ideas about what satisfying sex looks and feels like.

 

 

Sexual communication involves being able to share sexual likes, dislikes, desires, needs and boundaries with a sexual partner. Difficulties can arise when there is a breakdown in open, trusting communication, or when there is not enough psychological or physical safety to have these conversations. 

Healthy sexual communication creates space to express what kind of sex is desired and support greater sexual connection and satisfaction. This may include discussing kinks and fantasies, sharing past sexual trauma or negative experiences, and communicating what helps sex feel safe, pleasurable, and less likely to trigger a trauma response. It can also involve conversations about sexual health, including STI and BBV status and sexual testing. 

Communication is not always verbal. It also involves being attuned to a partner’s body language, eye contact, and vocalisations of pleasure or discomfort. Paying attention to these signals is an important part of maintaining pleasure, comfort, and consent.

How Therapy Helps: 

Sex therapy can identify strengths and challenges around sexual communication and provide practical tools for having more open and comfortable conversations about sex. This may include skills for initiating conversations, setting boundaries, checking in with partners, self-advocacy, and active listening.

 

 

Low libido, also known as low sex drive, refers to a reduced interest in or desire for sexual activity. It is a common experience and can be short- or long-term, as sexual desire naturally fluctuates throughout a person’s life.

Symptoms:

Low libido may involve wanting sex less often, not feeling interested in sex at all, or experiencing a decrease in the strength of sexual desire. This can extend to different forms of sexual activity, including masturbation. Many people also notice that they think about sex less often.

For some people, low libido may not feel distressing. For others, it can cause stress or upset, particularly when there is a mismatch in desire within a relationship. More information about mismatched desire can be found here.

It is also important to distinguish low libido from asexuality. Asexuality is a sexual orientation characterised by experiencing little to no sexual attraction to others, and is not considered a sexual dysfunction or something that needs to be changed.

Causal factors:

Low libido can be influenced by many different factors, which may overlap and compound one another. These can include:

• Relationship difficulties
• Stress, pain, or anxiety related to sexual difficulties such as vaginismus, vulvodynia, orgasm difficulties, premature ejaculation or erectile difficulties) 
• Past sexual trauma or negative sexual experiences
• Stress, anxiety or other mental health concerns
• Hormonal changes
• Perimenopause, menopause and pregnancy, including changes in hormones, discomfort, pain or stress 
• Changes in smoking, alcohol, or drug use
• Too little or too much exercise
• Health conditions such as endometriosis, heart disease, cancer, chronic pain, or headaches
• Medications that can affect sexual desire, including some forms of birth control, antidepressants, and blood pressure medications

How Therapy Helps: 

Sex therapy begins by normalising and exploring differences in sexual desire, rather than treating low libido as something that is inherently wrong. Sex therapists explore the client’s relationship with sex, including what may be influencing their desire, what kinds of sex they enjoy, and whether low desire may be connected to a lack of sexual satisfaction, stimulation, or fulfilled desires. For example, desire may be affected when sexual experiences do not align with a person’s sexual values or preferences, such as wanting more oral sex, fingering, hand jobs, or kink.

Education around sexual desire can help create more realistic expectations around sex and reduce feelings of shame or guilt. Therapy may also explore thoughts, feelings, and behaviours around sex, while supporting stress management, communication, expressing sexual needs, and building erotic intimacy. Clients can learn to recognise what gets in the way of desire, as well as what helps it emerge, which may include mindfulness or body-awareness practices.

When there is a mismatch in desire within a relationship, sex therapy can help normalise the difference and reframe it as something that involves both partners, rather than a dysfunction of one person.

 

 

Sexual shame can involve feeling embarrassed, uncomfortable, inadequate, or “not normal” in relation to your sexuality, sexual desires, body, or sexual functioning. Shame may be directed towards particular desires or preferences (e.g. an enjoyment of foot play), aspects of sexual identity, or sexual functioning (e.g difficulty reaching orgasm).

Causal factors: 

Sexual shame can develop through both our thoughts and experiences with others. It is often influenced by the messages we receive about what sex, sexuality, and our bodies are “supposed” to look like, and can be shaped by broader cultural and societal attitudes towards sex. These messages can come from family, religion, education, media, porn, or past relationships and sexual experiences. 

Over time, these ideas can become internalised, leading to self-judgement when experiences do not fit what is considered “normal” or expected. Sexual shame can also be linked to self-criticism or comparison, particularly around body image, sexual desirability, performance, or feeling like we are “good enough” sexually.

How Therapy Helps: 

Sex therapy provides a safe, non-judgemental space to explore and work through feelings of sexual shame. This may involve understanding where shame comes from, how it has been shaped by past experiences and societal messages, and how these beliefs can influence the way someone sees themselves and their sexuality.

Grounding and self-compassion strategies can help manage feelings of shame when they arise. Education around sexual diversity, common sexual experiences, and myths about sex can also challenge the idea that certain desires, bodies, or sexual experiences are wrong or abnormal.

Sex therapy can support clients to challenge unhelpful beliefs, develop a more accepting relationship with their sexuality, and make choices around sex and intimacy that feel more aligned with their values.