The Trouble with Sex

We live in a world that is deeply confused and conflicted about all matters sexual. If we talk about it at all it is often in whispers, “dirty” talk, or from a negative perspective such as sexual abuse, sexual trauma, or negative and incorrect messages we heard during our formative years.

Even therapists are uncomfortable talking with their clients about sexuality. Unfortunately, most therapists are nottrained in working with the amazing range of sexual expression that exists within each person, nor for approaching the subject in a sex-positive way – that is, as healthy sexuality, not pathological behavior.

Fortunately, there are a growing number of therapists delving into this rich and largely taboo subject.

As a trained sex therapist, I give talks to groups of therapists around the country and internationally, and I often ask for a show of hands of those who have had any kind of sex-therapy training, even a one-day workshop. In a roomful of 50 or 60 therapists, I usually get no more than three or four hands. If I give a talk on problematic sexual behaviors, marital therapy, or sexual trauma and abuse, I fill a room. If I offer a talk on helping individuals and couples with sexual pleasure, less than half as many people will show up.

It is troubling that in a profession seeking to help people in their relationships and personal struggles, such a fundamental element as sexual and erotic intimacy is avoided or not deeply studied by therapists. During therapy, when sexual issues arise, most therapists will often fall back on their training about sexual trauma, sexual abuse and problematic sexual behaviors, seeking out these dark pathologies in order to deal with their clients. Sex therapists also rule out pathology around sexual behaviors, but they do so from an informed sexual health and sex-positivity framework. Too often, the untrained therapist makes unsound judgments about what constitutes a healthy sex life – perhaps based on their own sexual history of abuse or trauma or infidelity – and project this onto the clients and then lead the individual or couple, accordingly, often taking sides with the person who feels aggrieved in the relationship.

This is not helpful.

Another problem arises when the term “sex addiction” is used. For years, there has been a conflict between those who ascribe to the notion that people struggling with “out of control” sexual behaviors should be labeled “sex addicts” (and treated under the same protocols as other types of addicts), and those who believe such people must be understood and treated in a more psychotherapeutic way – one that is more sexually informed. Recently the ICD-11 (the International Classification of Disease, used as a coding manual in healthcare for mental health diagnosis), which therapists use for diagnosis and assessment, included a diagnosis called “Compulsive Sexual Behavior Disorder.” This is not “sexual addiction;” it is listed under the grouping of impulse disorders not addictive or substance disorders.

In my view, and from my years of experience as a sex therapist, the label “sex addiction” is outdated. Instead, we should be focusing on sex-positive attitudes and a deeper understanding of what sexual health is.

When we begin to study healthy sex, we suddenly are presented with myriad worlds of sexual desires and practices that are quite normal, even healthy, for a particular client and couple. While before we may have been successful helping someone deal with sexual abuse issues, we have not guided the individual or couple into a conversation about sexual health.

I’d like to share with you a recent experience I had regarding sexual health misunderstandings. When I was moving my office to a new location, I ran into some issues with the tenants of the new building. When listing my practice – The Center for Relationship and Sexual Health – on the building directory – I got a call from the building’s owner.

He reported that the name of my practice was “upsetting to people.” One building tenant – a pediatrician – had filed a complaint, citing that her clients – parents and children – would be worried about what type of clients would come into the building and would take their business elsewhere. The owner asked other tenants what they thought about the term “sexual health” and he reported that most thought it meant sexual offenders would be coming to our office. It never occurred to me that those two words could be so widely misconstrued.

Despite the fact that we are living at a time in which the words “sex” and “sexual” can be found everyday somewhere publicly, the word “sex” still retains a sort of taboo. At times when I have mentioned “sexual health” in conversations, I have been asked, “Are you having sex with your clients?” Or, “Is sex therapy just supporting the idea that ‘anything goes?’”

I want to emphasize that none of this is part of sex therapy or sexual health.

To set the record straight, sexual health therapy is “talk therapy.” It deals with issues such as:

  • helping couples with discrepancies in their erotic desires and fantasies
  • problems related to painful intercourse or erectile disorders
  • sexual difficulties following cancer treatment or childbirth
  • breaking relationship contracts and infidelity
  • problems underlying the cessation of sex in a relationship
  • religion-based shame around sexuality
  • fighting over the use of porn
  • failure to have an orgasm
  • helping parents to have conversations with their children about sex

Through our work at The Center for Relationship and Sexual Health, we hope to banish some of the shame and misconceptions surrounding sexuality, and begin to see a greater understanding of the forces and experiences that lie at the base of our expressions of intimacy.