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Sexual and relationship difficulties are often connected: if you are having sexual difficulties it is also useful to think about your feelings about relationships or how you are communicating if you have a partner. You may find it useful to look at both sections.
Remember that whatever your sexual issue it is good to start by:
- Stopping worrying about being normal
- Challenging the myths of sex
- Vital statistics
- Thinking about what is going on in the rest of your life
- Taking sex off the menu
- Figuring out what you enjoy
- Building up the sexual menu
Difficulties with Desire
Not Feeling Desire
One part of our sex-obsessed culture is the assumption that all adults should feel sexual desire.
Certainly people in relationships are expected to want to have sex with each other frequently and it can be difficult if their levels of desire don’t match up. First of all it is important to remember that sexual feelings ebb and flow over time and it perfectly common to have periods of lower and higher desire.
If you don't feel desire over a long period of time it is worth asking yourself whether this really bothers you. Remember that desire is on a spectrum and some people feel lots whilst some feel very little. There are groups of people who decide, for religious and other reasons, to be celibate and not to have sex, there are also people who consider that they just don't want sex and call themselves 'asexual'. They might only have sex alone, or not have sex at all. Visit www.asexuality.org to find out more.
However, if you are not feeling desire and wish that you did then sex therapy could help you to figure out what is going on and to move forward. It is worth considering whether other things in your life might be behind it. Did anything else change around the time you lost the desire? For example, many women find that desire changes after having a baby or menopause. Sometimes hormonal changes can be addressed with medical treatments whilst therapy can focus on the emotional impact of life changes.
If your desire has generally been quite low and you wish it was not, then it may be that early messages you received about sex have made it difficult for you to feel positive about it. Many people still learn that sex is a dirty or shameful thing. Think about what you learnt from family and friends and the media about sex. Do you agree with all those ideas now? Perhaps your early sexual experiences were negative or even abusive. Therapy can be a good place to bring this out in the open and to begin to learn a new, more empowering and positive, way of seeing sex.
Whatever the reasons for your low desire, if you want to change it, it is useful to figure out what you enjoy to help you to tune in to what you really like and to think about ways of fulfilling those desires.
Feeling Too Much Desire
There are some groups of people who it is assumed will not feel sexual desire. For example, many people assume that young people, older people and people with disabilities or medical problems do not have sexual feelings. In actual fact children can start having sexual feelings and enjoying touching themselves sexually as young as four or five.
Many people over the age of retirement have sexual desires and satisfying sex lives. And there is no reason why having a disability or health problem should prevent you from being sexual. If you want to find out more about this go to www.outsiders.org.uk. If you are concerned that you have 'too much' sexual desire you should start by asking yourself whether this is really the case or because of the narrow-minded views of others.
Some people find their level of desire for sex is so high that it gets in the way of other aspects of their life. Again it is important to ask yourself whether it is really a problem for you, or just for other people. People devote lots of time to all kinds of things including work, socializing, watching TV, computer games and other hobbies. If sex is something you enjoy putting a lot of time and energy into then that is not necessarily a problem, whether that is sex with other people, online sex or sex on your own.
Of course it is a problem if your level of desire makes you feel uncomfortable and unhappy. Perhaps it stops you from getting on with other interests and relationships. Some people find, for example, that they spend a great deal of time looking for pornography online, having cyber-sex, going to sex clubs or sex workers, or having sex with partners, and this means that they don't put so much time into their friendships, their work or hobbies. Sometimes they spend a lot of money on sex and get into debt. Their relationships may suffer or breakdown.
Often when we spend a lot of time doing something that ultimately isn't very good for us or leaves us unfulfilled it is because we are getting something out of it that we aren't getting elsewhere. It can be useful to think about what that might be for you, and to think about other ways you might get that. For example, one person might want more excitement and adventure in their life and go online for sex. They might think about other activities which could give them the same sense of excitement. Another person might hook up for sex because they want to be close to someone. They could think about forming friendships that could give them more intimacy. Sex therapy can be a good place to think about the meanings of sex for you and how you can get your needs met.
Feeling Uncomfortable Desires
Another common problem people have is when they realise that they have desires which make them uncomfortable, perhaps because they are uncommon desires (although you might be surprised by the things that other people fantasise about) or because they seem scary or dangerous in some way.
The first important thing to remember is that fantasy and reality are two very different things. It is okay to think about whatever you like. Imagining eating a big slice of cake is not the same thing as actually doing so. Most people have things that turn them on sexually which they would not want to do in reality: perhaps because they are impractical, or other people wouldn't be interested, because they wouldn't be consensual, or because they just wouldn't be as exciting as they are in their heads.
If you think these desires are something that you would like to act out then a vital question to ask yourself is whether they are uncomfortable because they are generally considered unacceptable or because they involve forcing someone to do something against their will.
Things Considered Unacceptable
If it is just that your desires are generally considered unacceptable it may well be that there are people out there who have the same desires as you who you could talk to about them and maybe even act them out with (if they require someone else). The internet can be a great place for finding people with similar interests. There are communities out there for most sexual interests, identities and activities.
Remember that there have been times in our society when it have been considered unacceptable to have sex other than for reproducing, to have sexual pleasure alone, or to have sex with someone of the same gender: all of which are now acceptable.
One type of desire which is still often seen as unacceptable is the desire for 'kinky' sex. You might be surprised to learn how common such desires and activities are: around two thirds of people have fantasies about being tied up (bondage), and between 10% and 15% of people think of themselves as being into 'SM' or 'sadomasochism', with many more occasionally using spanking or bondage to spice up their sex life. If you want to incorporate role play, different sensations or power play into your sex life there are some good websites which advise you on how to do this in a way that is 'safe, sane and consensual'. Visit www.informedconsent.co.uk to find out more. You can look for a 'kink-aware' therapist if you want to talk about it at www.pinktherapy.com.
Things that Involve Force
If acting out your desires would involve forcing anyone to do anything against their will then its not OK to act them out. Consent is a vital part of sexual activity and everyone involved needs to know what they are doing and say that they want to do it.
Examples of non-consensual activities would include: making someone have sex who doesn't want to, having sex with a child or anyone else who is unable to consent to sex (for example if they are asleep or drunk), watching or touching people who do not know you are doing so, lying to people to get them to have sex with you, or being sexual in front of people who are uncomfortable with it. If you find that you strongly desire to do any of these things there are some charitable organisations who can help advise you, such as www.circles-uk.org.uk and sex therapy may well be helpful.
Difficulties Having Sex
Many people find, at some time, that despite their desire for sex, they are unable to have the kind of sex they want when they actually try to do it.
Examples of this would include men who want to penetrate somebody else but who find they lose their erection (often called 'erectile dysfunction'), women who want to be penetrated but find that it is painful or their vaginal muscles go into spasms (this is often called 'vaginismus'), people who want to be penetrated anally but who find this too painful or tight, and people who want to give oral sex but who find that they choke.
The first thing to ask yourself is whether you really want to do this activity or whether you are doing it because you think it is the normal or right way to have sex. It is perfectly okay to say that vaginal sex, anal sex, oral sex, hand sex or any other activity is not for you (either forever or just for now). Nobody should make you feel like you have to have a kind of sex that doesn't feel right to you.
If you do really want to do the activity then there are suggestions that might help. The sensate focus exercises are good for helping people to relax and gradually build up to types of sex that they feel anxious about. Relaxation and breathing exercises may also be helpful to get your body ready and your mind less anxious.
Also, you may find that certain sexual positions make certain kinds of sex easier. The Sex Book by Suzi Godson includes good pictures of these and tells you what each position works well for. Often lubrication can help sex to happen more easily, an over-the -counter lubricant (or' lube') can be bought from a sex shop or from a pharmacist (usually right near where the condoms are).
Women who find that their vagina is too tight often find it useful to very gradually build up the thickness of what they can insert.
Start by getting very relaxed and just looking at your genitals in a mirror held in front of you, so that you can get used to how they look and respond. When you feel relaxed doing this you can explore the area with lubricated fingers. It is very important not to rush on to the next stage until you feel completely familiar and relaxed with the previous stage. Once you feel fine touching the area, try inserting the tip of your little finger into your vagina. When it has gone as far as it can comfortably, keep it in place, breathe and relax. After this you can work up very gradually to the whole finger, then larger fingers, then two fingers at once. Some women prefer to purchase 'dilators' for this process but it is fine to use your own hands.
There are also physical and medical treatments for men who have difficulties keeping an erection. There are vacuum pump devices which can increase blood flow to the area. There are drugs called PDE 5 inhibitors which keep blood in the penis to keep it erect. You have probably heard of some of these like Viagra, Cialis and Levitra. The important thing to remember about these is that, although you take them before you become excited, you do need to get an erection for them to work (to keep the erection). If you have trouble getting erections at all then they won't help and it is worth checking for medical problems and low desire. You might ask yourself whether you get erections first thing in the morning or during the night. There are also some penile injections that can give you an erection.
The best person to advise you about medical and physical treatments is a doctor or sex therapist. Definitely do not order drugs or equipment online which have not been advised by your health professional. These may be ineffective or dangerous.
Remember that addressing the difficulty with drugs will not fix any underlying problems, for example, if your relationship is going through a rough patch, or you are feeling very anxious about sex, or you are under a lot of stress. Most people don't want to take drugs permanently, so sex therapy can be good alongside the drug treatment to think about why sex has become problematic and what can be done about this.
Difficulties Finding Fulfillment Through Sex
There are two common ways in which some people may find sex to be unfulfilling. Either they orgasm very quickly or they struggle to reach an orgasm at all.
First of all an important question to ask is whether orgasms are all that important. It was one of our myths of sex that successful sex always involves one or all people having an orgasm (or 'cumming'). Actually sex can be very satisfying when only one person has an orgasm, or nobody does, or somebody has several. Sensate focus can be a good way of taking the focus of sex away from the orgasm and exploring all the other things that you might enjoy sexually. It is also useful to ask sexual partners how important orgasms are for them.
Orgasming too soon
Some people find it frustrating that they seem to be so sexually sensitive that they orgasm very quickly, perhaps before sex has even begun. This can feel embarrassing and awkward, perhaps particularly for men where it is physically obvious that they have orgasmed (due to the liquid that is released and common loss of erection afterwards). Perhaps this is why there is a term for this problem in men: 'premature ejaculation'. However, women can struggle with the problem too.
The first thing to remember is that one person's orgasm does not need to mean the end of sex. If you have had an orgasm quickly then you might focus on your partner's pleasure for some time, touching them or giving oral sex for example. Most sexual partners will not complain about becoming the focus of your sexual attention! Also the process may well make you excited again and often a second orgasm takes longer to achieve. Remember also that people take different lengths of time to orgasm, and on different occasions. Anything is okay.
There are some sex therapy tricks to help men who want to take longer before orgasming. These are the 'start/stop' or 'squeeze' techniques. In the 'start/stop' technique, you can stimulate yourself (or get a partner to stimulate you) orally or with a hand until you feel you are close to orgasm. Then stop all stimulation until that pre-ejaculation feelings goes away. Repeat the process several times before allowing orgasm. You could do this once a day for 15-30 minutes. After a while, if you like, you can do the same process while penetrating someone, lying still at first, then slow movements, then faster ones.
The 'squeeze' technique involves you or a partner placing the middle and index fingers in front of the penis, below the head or at the base, and the thumb behind and squeezing for 4 seconds when ejaculation is about to occur. After a few squeezes you should stop feeling the need to orgasm. Again you can start this with oral or manual stimulation and, if you want to, later do it during penetration, preferably with you on your back and your partner dismounting and squeezing when you get close.
Not orgasming at all
Some people find it very difficult to orgasm at all. First of all it is worth asking yourself whether you can orgasm on your own or whether it never happens alone or with a partner.
If it never happens alone or with a partner then it is worth checking your level of desire and excitement and tuning in to what you find exciting. There are also books for people who struggle to orgasm but want to, particularly for women. Unlike most men, many women never touch their genitals when they are small because they don't need to do so in order to go to the toilet. Because of this they often never accidentally discover how pleasurable it can be and might find it is something they want to learn in later life if they want to experience sexual pleasure alone or with a partner.
Quite a number of people can orgasm alone but really struggle when they are with somebody else. That is quite understandable. Orgasming involves letting go of control to some extent of our muscles, our facial expressions, our emotions, and so on. It can feel like quite a vulnerable thing to do in front of somebody else. Also it can be difficult to let somebody else know how we like to be touched in order to have an orgasm.
Finally, many people find that thoughts run through their head about non-sexual things which seem to get in the way of them having an orgasm. Relaxation exercises can help with this as can taking the pressure off having an orgasm by taking orgasms off the menu for a while. Strangely the thing that makes it most difficult to get an orgasm is trying to have an orgasm, just as many people with insomnia find that trying to get to sleep is exactly the thing that stops them from sleeping.
If you can feel comfortable then the best thing is often to teach your partner how you like to be touched, by showing them yourself, by telling them, or by holding their hand or body whilst they touch you. If your aim is to have an orgasm whilst having genital sex with the other person, then you could start by touching yourself to orgasm, then get them to do it, then get close to orgasm by touching and then have penetration, and finally, after trying all of these for a time, you might be able to have an orgasm through genital contact.
Remember that most women need their clitoris stimulated in order to have an orgasm. Also that there are many different sexual positions and activities which can make orgasm more or less easy.
Sexual and Gender Identity
Two further things which people sometimes come into sex therapy about, but which are not exactly about the act of sex, are sexual and gender identity. Our sexual identity is usually based around who we are sexually attracted to (and sometimes the kinds of things we'd like to do with them). Our gender identity is about what we feel our gender is.
Mostly if somebody is heterosexual (only ever attracted to the 'opposite sex') they don't worry much about their sexual identity. Similarly if you have a female-looking body and feel like a woman, or a male-looking body and feel like a man, you might never wonder about your 'gender identity'. However, a lot of us, at some point or another, have sexual feelings about someone of the same sex, or feel that we don't completely match with the ideas society has about what it means to be a woman or a man. If those feelings are difficult at all then it can be useful to talk about them in therapy.
Of course we now live in a time when it is acceptable to be in a same-sex relationship or attracted to someone of the same-sex. And most people have some knowledge that not everyone who is born looking 'male' or 'female' wants to stay that way their whole life. However, there is still a lot of 'homophobia' and 'transphobia' around, which means that people who are attracted to people of the same sex, or who identify as a different gender, may still experience bullying, being excluded from their family or community, being the victim of abuse, and all kinds of other problems which can cause great stress and unhappiness. If you wish to find out more about this, go to Stonewall or Press for change.
If you are thinking about your sexual identity you might want to consider ideas such as whether you want to identify as gay or lesbian, or as bisexual, or perhaps you are happy to see yourself as heterosexual but open to sometimes having same-sex attraction, or perhaps you don't want to label your identity at all. Similarly some people like to step out of being called 'man' or 'woman' (they sometimes use the word 'genderqueer' or 'androgynous'), others might be happy that they are a masculine woman, a tomboy, or a feminine man. Some may want to wear the clothes of the 'other' gender sometimes as a 'transvestite' or in 'drag'. Others may want to change their body to fit the gender they feel comfortable in, and they often use the word 'transsexual'.
In any of these cases you might well want a therapist who has some expertise and experience in these areas. That is something you could ask about when you are finding a therapist or in the assessment. There are also links of LGBT (lesbian, gay, bisexual and transgender)-friendly therapists links.
For all sexual exercises and activities mentioned here it is important that you engage in safer sex practices.
This means being aware of possible Sexual Transmitted Infections (STIs, such as HIV, gonorrhea and chlamydia), knowing the risks of various activities, and, if necessary, using the appropriate form of protection. One million people are infected with STIs around the world every day so you can see why this is so important. A lot of people think that safer sex is not an issue if they only have one sexual partner, but over a half of all people have sex with someone outside their relationship at some point without telling their partner, so there is still a risk.
Detailed information on STIs and safer sex can be found on www.en.wikipedia.org/wiki/Safe_sex and www.nhs.uk/Livewell/sexualhealth/Pages/Sexualhealthhome.aspx.
Basic good advice is to use a condom for vaginal sex before any kind of genital contact (STIs can be passed without penetration or ejaculation). Only use water-based lubricant (no oils or lotions because these can damage condoms). For anal sex use a non-spermicidal condom and plenty of water-based or silicone lubricant. Do not go from anal sex to vaginal sex without changing the condom. If you have any cuts or lesions then it is good to also cover them with plastic plasters or with latex gloves for foreplay or sex using the hands, or a non-spermicidal condom over fingers. You might want to consider dental dams for oral sex also. The same precautions apply to sex toys as to using parts of your own body: always use a condom.
Cultural and Religious Differences
It is important to point out that you may have cultural, religious or personal reasons for not wanting to take part in some of the exercises or activities suggested or mentioned here.
A sensitive sex therapist should be able to help you to think about your beliefs and which exercises and activities will be acceptable within any limitations that are present.