Category: Uncategorized

 

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.

 

 

Vaginismus is a condition where the muscles around the vagina tighten involuntarily, which can make penetration or vaginal insertion painful, difficult, or sometimes not possible. These muscle responses are not under conscious control and can occur during sexual activity, tampon or menstrual product insertion, or gynaecological examinations.

Vaginismus can be influenced by a range of physical, emotional, and psychological factors. With appropriate, individualised support, many people can experience significant improvements in comfort, confidence, and sexual wellbeing.

Symptoms:

The main symptom of vaginismus is involuntary tightening of the muscles around the vagina when something is being inserted, which can make penetration painful, difficult, or not possible. This may occur with medical examination equipment, menstrual products, sex toys, fingers, or a penis.

Causal factors:

Vaginismus can be influenced by a range of experiences and circumstances. These may include painful or traumatic sexual experiences, unpleasant medical experiences such as painful examinations or thrush, difficult births, sexual shame, or fear and anxiety around sex and penetration.

The muscle contractions associated with vaginismus are involuntary and not under conscious control. Importantly, vaginismus does not reflect a lack of sexual desire or arousal.

How Therapy Helps:

Sex therapy starts by understanding the pain, including when it occurs, what may be contributing to it, and how the mind and body respond. Therapists can also help reframe stressful thoughts around penetration, such as “it will always hurt” or “my body is broken”.

Education and practical strategies can help clients understand the relationship between pain and anxiety, manage difficult emotions, and reduce self-blame. Clients are also encouraged to pause penetration attempts and explore intimacy without a focus on penetration.

Relaxation techniques, mindfulness, breathwork, and Sensate Focus may be introduced to gradually build comfort with sensual touch. When ready, penetration exercises such as vaginal trainers can be used to gradually increase comfort with vaginal penetration.

Sex therapy can be undertaken individually or with a partner. Couples therapy can help partners better understand vaginismus, reduce pressure around penetration, communicate supportively, and build intimacy outside of penetration.

 

 

Vulvodynia is a condition involving persistent and recurring pain or discomfort in the vulva, the external area surrounding the vaginal opening. It is generally diagnosed when vulval pain has been present for three months or longer without an identifiable cause.

Vulvodynia can affect people in different ways and may have significant impact on sleep, concentration, emotional wellbeing, body image, and sexual relationships. With individualised support, symptoms can often be managed and sexual comfort and confidence can improve. 

Symptoms:

The pain or discomfort associated with vulvodynia can vary from person to person. It may:

– Feel like burning, throbbing, stinging, stabbing, soreness or aching across some or all of the vulva.

– Be constant or intermittent.

– Be triggered by touch, such as during sexual activity, tampon insertion, or wearing tight clothing.

– Be aggravated by pressure, such as sitting for long periods or during exercising.

– Feel worse during or after urination.

Causal factors:

While vulvodynia has no single, clear cause, it is often influenced by a combination of physical and other contributing factors. These may include hormonal changes, such as a drop in oestrogen during menopause, or irritation and increased sensitivity of the nerves in the vulva.

Previous vaginal infections, allergies, or sensitivities to products such as soaps and lubricants may also contribute. Vulvodynia can also be associated with an overactive or tense pelvic floor, where muscles remain contracted or go into spasm, which can make touch and sexual activity uncomfortable.

How Therapy Helps:

Sex therapy begins by understanding how vulvodynia is affecting daily life, relationships, and intimacy. Education can help make sense of the relationship between pain, fear, tension, and anticipation, while providing strategies to manage pain and reduce shame or unhelpful beliefs around the body and sex.

When ready, sex therapy can support the gradual reintroduction of safe, comfortable touch. This may involve exploring which sensations feel pleasurable, neutral, uncomfortable, or painful, as well as becoming more aware of pelvic floor tension. Vulva mapping and relaxation exercises may be used to support this process.

Sensate Focus exercises can also be introduced to gradually build comfort with touch without pressure or a goal of penetration. These exercises encourage curiosity, body awareness, and pleasure, and can begin individually before involving a partner.

Sex therapy may be undertaken individually or with a partner. Couples therapy can also support communication, reduce pressure around sex, and help partners better understand the experience of sexual pain.

 

 

Sexual pain, or dyspareunia, is a common concern characterised by persistent or recurring pain that occurs before, during, or after sexual activity. It can have a range of physical, psychological, or relational contributors, and may have a significant impact on intimacy, sexual confidence, and overall wellbeing. 

Because sexual pain can present in many different ways and have a range of underlying causes, individualised and specialised support can be particularly helpful. MCS provides specialised support for concerns including vulvodynia and vaginismus. 

 

 

Mismatched desire occurs when partners have different levels of interest in sexual intimacy or want sex with different levels of frequency. This is common in relationships and does not necessarily indicate that anything is wrong with either partner. However, differences in desire can sometimes lead to feelings of rejection, inadequacy, shame, frustration, or pressure.

Causal factors:

There may be many factors that can influence sexual desire, and what acts as a “brake” on desire for one person may not affect another. Stress, fatigue, poor self-image, feeling unsupported or misunderstood within the relationship, or feeling overwhelmed by the demands of everyday life can all influence sexual interest.

Feeling pressured by a higher-desire partner can also create a cycle where one partner pursues sexual connection while the other withdraws, which can make the difference in desire feel even greater.

It may also be that one partner experiences responsive rather than spontaneous desire, meaning sexual interest tends to develop once the right conditions are present, such as feeling relaxed, connected, or experiencing pleasurable touch. In these cases, lower desire may not necessarily mean a low sex drive, but may simply reflect that desire needs the right conditions to emerge.

How Therapy Helps:

Sex therapy involves normalising differences in desire and reframing the issue as something that involves both partners, rather than a dysfunction of one person. This can help reduce the shame and rejection that commonly arise around mismatched desire.

Sex therapists explore the experiences and circumstances that influence each partner’s desire, including what helps desire emerge and what may get in the way. They may also explore the types of sex and intimacy each partner enjoys and, where needed, support communication and sexual compatibility. Intimacy exercises may be introduced to help rebuild sexual and emotional connection.