Carol Boulware, MFT, Ph.D.
ABS Board Certified Sex Therapist -- Clinical Fellow, American Academy of Clinical Sexologists
ABS Certified Sex Therapist treats male and female sexual dysfunctions, sexual anxiety, loss of sexual desire, sexual traumas, sexual abuse from childhood. Marriage and relationship counseling. Intimacy and communication skills. Dr. Boulware has over 20 years counseling & psychology experience. Certified EMDR Therapist.
SEX THERAPY: IS IT FOR YOU?
Do you have any of these concerns?
If you can answer "Yes" to any of these issues, you are not alone. Many individuals and couples experience sex-related problems at some point in their lives. Sexual problems are often the result of a troubled relationship, past sexual trauma, low self-esteem, depression, health problems or medications. All of these can negatively affect sexual functioning.
Fortunately, Sex Therapy can help you resolve these issues.
WHY DO PEOPLE SEEK SEX THERAPY?
According to a recent study in the Journal of the American Medical Association, 3 out of 10 men, and 4 out of 10 women, experience sexual problems. The type of problems most commonly reported by men are premature ejaculation, erectile dysfunction and low sexual desire. Women most commonly reported problems with arousal, low sexual desire and pain during intercourse.
In addition to these concerns, people seek sex therapy when they have tried to resolve their problems themselves without success. They may want to improve their communication during sex, or are unable to resolve the differences in their desired frequency of sex. An individual or couple may feel inhibited or fearful about sex or some aspect of sex. Others may have experienced past sexual trauma, such as forced sexual contact or abuse that has troubled them for years, perhaps from childhood.
These sexual issues can have a major impact on one's self-esteem, as well as on one's intimate relationships. That's why it is so important to seek professional diagnosis and treatment at the earliest opportunity. You and your partner deserve to have pleasurable and satisfying sex lives.
WHAT PROBLEMS CAN SEX THERAPY RESOLVE?
Sex Therapy can successfully treat a wide variety of problems that interfere with health, fulfilling sexual activity. Some examples of the sexual difficulties that can be treated effectively with sex therapy are:
In addition, relationship and intimacy problems may affect sexual functioning, can also be successfully treated by a sex therapist.
Following are brief descriptions of some common sexual problems. Dr. Boulware specializes in the treatment of these disorders.
COMMON SEXUAL DYSFUNCTIONS
Lack of Sexual Desire - (Inhibited Sexual Desire, ISD )
Inhibited sexual desire is one of the most common complaints of couples seeking sex therapy. ISD refers to the lack of sexual appetite or response, together with a low rate of sexual activity. They usually do not fantasize about sex or initiate sex.
There are usually underlying psychological issues with ISD, such as avoidance of sexual contact because of fear of rejection, performance anxiety, embarrassment, fear of criticism or body image concerns. A person with ISD often participates in intercourse only as a marital duty. Affection is sometimes withheld, because there is a fear it might lead to the other partner starting sexual activity.
A person finding sex distasteful or repulsive characterizes sexual aversion, the most extreme form of ISD. This person may have been traumatized by past experiences, such as molestation or rape.
ISD occurs in both men and women and can cause emotional distress or serious relationship problems. When one person is less interested in sex that the other, it can be a source of conflict, communication problems and power struggles. Relationship counseling and psychotherapy can help resolve this condition before the relationship becomes further strained.
Problems with Erections (Erectile Dysfunction - ED)
In the US, more than 20 million men have experienced erecticle dysfunction. In most cases, ED can be successfully treated; however, less than 5% of these 20 million men ever seek treatment!
There are two types of erectile dysfunction, Primary and Secondary. Primary Erectile Dysfunction refers to never achieving or sustaining an erection satisfactorily for sexual intercourse. This group comprises less than 10% of the men who experience ED.
Secondary ED refers to previously being able to achieve satisfying sexual intercourse. It is a persistent or recurrent inability to obtain or maintain an erection long enough to complete intercourse the majority of the time. Most men have erectile problems from time to time, but when it happens frequently, treatment should be sought.
ED should always be evaluated by a physician before sex therapy, since there may be an underling medical condition. Some of the physical problems that can increase the risk of ED are diabetes, high blood pressure, heart problems, hormonal imbalance, prostate problems and certain drugs, especially blood pressure medication and anti-psychotic drugs that can cause ED as a side effect.
Some of the psychological issues that can cause ED are: performance anxiety, depression, low self-esteem, traumatic early sexual experiences, a religious belief that sex as a sin, anger towards women and fear of getting a woman pregnant.
ED is not just a man's problem, it is a couple's problem. Both partners can be adversely affected by communication becoming strained or breaking down entirely and distancing the couple emotionally. His partner may think he no longer loves or finds her attractive. However, it is far more likely that the man is overly concerned with pleasing her. Over a period of time this can turn into "performance anxiety" and set up a cycle of anxiety and fear of failure. Sex therapy can help break this cycle for men with or without partners.
About Viagra and Other Herbal Products
Men frequently assume that once they use Viagra, or similar products, and have reliable erections again, that all the difficulties in their relationship will disappear.
Viagra, penile injection therapy or vacuum erection devices can restore physical erections, but, they do not resolve non-sex related problems in the relationship. Once the ability to have erections is restored, other issues still present for the man and/or his partner might need to be addressed. In fact, sometimes, a return to sexual functioning may create new problems, which, can best be resolved with sex therapy while continuing to use a Viagra-type product.
Premature Ejaculation (PE)
Premature Ejaculation is ejaculation that occurs sooner than a man wishes, or too quickly during intercourse to satisfy his partner. Premature ejaculation is considered the most common male sexual complaint. It is estimated that about 1/3 of the males in the United States experience this problem.
Premature Ejaculation is almost always due to the lack of knowledge and awareness of the sensual or sensory mechanisms of the body. These men simply have not learned to focus their attention on the pleasurable sensations that accompany their rising excitement. Most premature ejaculators do not have major psychological problems -- they just have poor control and lack awareness of their sensory cues.
In cases where psychological issues are involved, they may be related to early negative experiences, (such as masturbating quickly to avoid getting caught or discovered, visiting prostitutes, etc.), performance anxiety, guilt or shame (believing that sex is sinful or dirty).
In therapy, special homework assignments are given for learning to focus on the sensations of arousal and tension leading to ejaculation, and for learning new skills and behaviors that will prevent or delay ejaculation.
PE is highly treatable and a trained sex therapist is very successful resolving it. Studies show that 80 to 90 percent of the men who take advantage of sex therapy for PE achieve better control.
Retarded Ejaculation (Male Orgasmic Disorder)
Delayed ejaculation is the inability to ejaculate inside the vagina during intercourse. It is a less common dysfunction, accounting for less than 5% of cases. Men with this condition need extensive stimulation to orgasm, or, in some cases, are unable to reach orgasm. Many men who cannot ejaculate during intercourse may be able to reach orgasm by masturbation, or manual or oral stimulation by their partner.
Common reasons include heavy alcohol or cocaine use, narcotic addiction, and use of psychoactive drugs, including tranquilizers and antidepressants
Psychological issues that can contribute to this condition are fear of being caught having sex, anger toward one's partner, performance anxiety, or fear of impregnating one's partner. Some married men with this disorder can only orgasm with other women.
Treatment for Male Orgasmic Disorder generally involves exploring psychological issues, graduated homework assignments and behavioral techniques that minimize performance pressure and maximize the focus on pleasure to increase response time.
Lack of Orgasm in Women (Female Orgasmic Disorder)
One of the most common complaints by women is the inability to achieve orgasm. About 15 percent of woman do not experience an orgasm under any circumstances with any type of stimulation. About 20% of women never, or rarely, experience orgasm during intercourse, but can achieve orgasm by other means.
Treatment focuses on emotional or situational factors that that may contribute to the problem. The therapist helps the individual explore psychological issues and fears, such as: giving up control, guilt about sex or masturbation, shame of one's body, physical discomfort or pain during intercourse, a history of physical or sexual abuse, relationship problems, lack of appropriate stimulation, concerns about body image and trust issues.
Therapy usually involves giving information and assigning specific techniques to be practiced at home. These steps help reduce anxiety and modify the tendency to be overly focused on preorgasmic sensations. A unique program of therapy is designed for each woman that will help her discover the sensations that will give her enough pleasure for orgasm. These new skills can ultimately be incorporated during interplay with her sexual partner. With this type of therapy program, most women can learn to become orgasmic.
Women can occasionally experience pain during intercourse. But persistent painful intercourse should be brought to the attention of a medical professional. Intercourse pain can be a sign of endometriosis, infection or sexually transmitted disease, vaginal dryness from lack of lubrication, inadequate foreplay, allergic reaction to a douche preparation or spermicide, or thinning of the vaginal wall in postmenopausal women.
Once physical causes of pain are ruled out, psychological factors can be evaluated. If dysparenia has existed for months or years, psychological counseling is suggested to address stress or anxiety about sexual intercourse.
Women frequently have tension, fear or anxiety accompanying intercourse. Some have psychological trauma, often stemming from a history of sexual abuse or trauma. Painful intercourse can disrupt sexual interest and cause relationship or marital problems. Professional help should be sought as early as possible for this condition.
This is a disorder in which the muscles surrounding the outer third of the vagina opening go into involuntary spasms making sexual intercourse difficult or impossible. In addition, women with this condition may have difficulty using tampons and having a gynecological exams. Attempting sexual penetration may lead to pain, humiliation, feeling inadequate or fear of having sex.
Sexual abuse from childhood, rape or a painful first sexual experience is the most common psychological causes of vaginismus (a defense against recalling the painful memories). Other psychological causes are negative messages about sex, or premarital sex from parents or other sources, belief that one's vagina is too small and fear or guilt concerning intercourse or frightening childhood medical procedures. Other factors may be: fear of intimacy, fear of pregnancy and a woman unconsciously expressing anger towards her partner.
Treatment of vaginismus includes educating the couple about this condition, psychotherapy for underlying emotional problems, self-esteem, body image and relationship counseling for the marital stress this problem usually brings. A reconditioning program directed at eliminating the vaginismus reflex using dilators could be very successful in treating this condition.
Some people with sexual problems have experienced sexual trauma like sexual abuse, incest, molestation, rape as a child, or adult. Sexual trauma can cause a wide spectrum of sexual problems, including the inability to reach orgasm, lack of interest in sex, vaginismus, fear of intimacy or touching. Research indicates that about one in three women and one in seven men have been victims of sexual abuse as children.
Sexual abuse lacks the essential conditions for a positive sexual experience -- consent, respect, trust and safety. Children who are sexually abused are robbed of the opportunity to explore their sexuality at their own pace. Sex becomes associated with feelings of lack of control, violation, fear and mistrust. During sexual activity the survivor may have "flashbacks," sudden images of the sounds, sights and feelings that are reminders of the sexual abuse. These reminders can interrupt the positive and pleasurable feelings they are having at the time. Some survivors have no memories of the abuse (as a self-protective defense) but will experience fear or aversion to sexual contact, or strong negative reactions during sex that they cannot explain or understand.
Partners can become confused about the emotional distance of the survivor during sex. Sex can become a burden for the survivor and a source of rejection for the partner. Feeling powerless to help, partners can develop feelings of inadequacy or sexual difficulties themselves. Psychotherapy helps the survivor recover from the effects of abuse by helping them develop trust, express their anger, resolve their feelings towards the offender, overcome their fears. Abuse survivors can learn to feel safe and have healthy, pleasurable sexual experiences.
WHAT HAPPENS IN A SEX THERAPY SESSION?
The first step in sex therapy is evaluating and assessing the presenting problem or problems. A sexual history is taken which asks the patient to describe his/her sexual experiences. If it is a couple, each partner's sexual history is taken.(Any information you give or conversation you have with your sex therapist will remain strictly confidential).
The therapist carefully analyzes the medical and historical data, together with any issues or related circumstances described by the patient, to identify all the strands that weave into the patients current condition. This evaluation results in a diagnosis and detailed treatment plan.
The treatment will vary depending on the diagnosis, but it usually involves special exercises for each individual or couple.
Sex therapy is not "just talking." Each week the therapist will suggest new experiences for the individual or couple to try in the privacy of their home. These at-home "sensate focus exercises" are designed to take the pressure and worry out of sex. In subsequent sessions, the at-home exercises are discussed and any difficulties are explored. The exercises help the individual or couple "re-learn" more satisfying sexual behavior.
The therapist functions as an sex educator, providing accurate information about anatomy, physical response that is specific to the clients sexual concern. The patient may be given books to read or educational videos to watch.
WHEN SHOULD I SEEK HELP FROM A SEX THERAPIST?
If you feel that a sexual difficulty you have experienced for a period of time is not getting any better, you will probably benefit from seeking professional counseling. The earlier you take action, the sooner the problem will be addressed and corrected. It is also, important to consult your doctor for a medical evaluation early on. A sex therapist can work with a physician when medical treatment is indicated.
If a man or woman continually worries about how they will perform prior to the sexual activity, a cycle of anxiety can turn into a condition called "performance anxiety." The longer he/she worries the more established the "performance anxiety" becomes. Sex therapy can help interrupt these cycles and restore sexual functioning to normal.
If the issue is premature ejaculation and a man has tried reading books, the stop-start technique, the squeeze technique, creams, etc. and is still not able to "fix" the problem, it will probably be helpful to contact a sex therapist to explore what other issues may be at play in the condition.
WHAT IS A CERTIFIED SEX THERAPIST?
A Certified Sex Therapist is a licensed professional, specifically trained in the diagnosis and treatment of sexual problems. In addition to their education and background in psychology or medicine, therapists certified by the American Board of Sexology have extensive training and supervision and have passed strict professional requirements to receive their certification.
Use of the terms "sex therapy or "sex therapist" is not clearly defined in most states. There are many self-appointed experts who call themselves sex therapists on the Internet, in magazines or phone books but lack the proper training and qualifications. The only protection for the consumer is the presence of certification.
A Certified Sex Therapist educates and guides patients towards discovery and resolution of their sexual concerns. Sex therapy sessions never involve sexual contact, or any other kind of sexual activity or nudity in front of the therapist. Certified Sex Therapists are expected and bound to conduct themselves in a professional and ethical manner with their clients, at all times.
HOW LONG DOES SEX THERAPY TAKE?
Therapy sessions are usually weekly and lasts anywhere from a few weeks to a few months, depending on the severity of the difficulty. It is perfectly natural to feel embarrassed about a sex-related problem and it often takes courage to seek professional advice.
The Good News
In my 24 years of treating patient with sexual problems, I have helped many people who have experienced a wide spectrum of sexual difficulties. Individuals or couples involved in a sexual crisis should not ignore it in hopes that it will disappear by itself. It rarely, or never does.
Here is the good news -- there is a excellent chance that your symptoms can be reversed through sex therapy, medical treatment, or a combination of the two. Remember, no matter what problem your are experiencing, you are not alone, and there are caring professionals available to you.
HOW DO I MAKE AN APPOINTMENT?
If you live and/or work in the Los Angeles, Santa Monica or Redondo Beach areas, I offer a Free Phone Consultation to answer any questions you may have about the services provided. I would be happy to discuss techniques used and treatment options with you.
For information about making an In-Office Consultation Appointment or
CALL (310) 395-3351
Day & Evening/Weekend Appointments
Copyright ©1998 - 2006 Carol Boulware, Ph.D.
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