Sex Therapy: Your Questions Answered Part 2

Welcome to Part 2 of our blog series Sex Therapy: Your Questions Answered!

Richard Ashby, a sex therapist at Prairie Wellness Counseling Center, offered some more insights and answers to questions people asked on a Sex Therapy Questionnaire. Maybe some of these questions (and their answers) will resonate with you, too.

How can I be fully present when engaging in sex because my ADHD brain likes to wander off?

This is hitting right on my specialty. Mind wandering during sex does have some interesting correlations in recent studies. Really we’re just starting to get serious about researching how ADHD and sex interplay. That said, something we do know is that practicing mindfulness in other areas can be applied to sex. So when your mind wanders and you notice it, rather than beating yourself up or forcing the thought away, simply return to the present. Also, work with your partner to have healthy communication during sex so you can both work to keep the experience exciting and novel. Even a subtle position change can be enough. 

What if it hurts when I have sex?

Sometimes, it’s as simple as…lube is your friend! However, if lube does not solve the issue of painful intercourse, you should visit your doctor to see if a medical issue such as endometriosis, ovarian cysts, or a hormonal imbalance is causing painful sex. It’s also important to communicate with your partner, and you can try tips like relaxing before sex and not rushing the sexual experience. If painful sex is still an issue, it might be a good idea to talk to a therapist. Sex is complex, and our emotions are just as involved in sex as our bodies. A therapist can help you work through underlying emotions and issues so that sex becomes an enjoyable experience rather than a painful one. 

How can I continue an intimate relationship into my 70s (asking for a friend :) )?

I love this question! The truth is that it depends on the person/couple. As we age our bodies change, and they change differently, so it’s hard to give a cookie-cutter answer here. But this is exactly what I love to help people with in therapy! 

What do we do if we have different sex drives than our partners? 

This comes up a lot. There’s no cookie-cutter answer here aside from the Dual Control Model along with individual differences which may be exacerbated by gender in our society. According to the Dual Control Model, we all have our excitatory potentials and inhibitory potentials. When one spouse feels more inhibition, they will be less likely to feel aroused. So what should you do? Talk about what excites both of you, what makes each of you feel insecure, unsafe, or just plain annoyed. A lot of sex starts long before the bedroom, and as we mature in a relationship, it actually becomes more difficult to let go of annoyances without some communication. That lack of communication then creates a potential for multiple inhibitions for one or more partners. That said, this is not always the case, and sometimes there is a true drive differential, which then requires a different set of options and communications. 

I have had a hysterectomy, and my sex drive has decreased. What can I do about that?

A hysterectomy basically puts a woman in forced menopause. Her hormones change, and because it’s so sudden, typically the woman hasn’t had a chance to adjust. As a sex therapist, I help a woman get comfortable with this change and work with both the emotional and physical challenges and changes that occur during this time. I also provide education. Pop psychology tells us that in menopause a woman’s sex drive drops off the cliff, but this is not necessarily the case at all. In fact, some women report an increased sex drive during menopause. However, if low sex drive remains an issue, it is likely a good idea to talk to your PCP or OB/GYN about getting your hormone levels checked.

What percentage of people do you see who are dealing with issues related to sexual trauma, and how many are interested in exploring new possibilities?

Far more people have sexual traumas than many of us would like to think about. Working in sex therapy I do see a lot of cases, sometimes recent, other times decades after the event. A trauma-informed sex therapist can provide a safe space to help individuals release painful emotions and learn coping skills to help heal from the emotional distress that occurs after having suffered sexual trauma.  

How do sex therapists approach kinks?

So long as everyone consents and the individuals have negotiated limits, a sex therapist’s approach to kinks is: Don’t yuck someone’s yum. 

How can I get help with male anorgasmia?

I have worked on this with a few people now. It can be a quite complex issue and one that has correlations to several mental health impacts for individuals unfamiliar with it.  Anorgasmia can come from a series of inhibitions, sometimes referred to as anxieties, over both performance and performance consequences. Men may also experience an upset in neurotransmitters instrumental in the ejaculatory process. Another possible explanation is not anorgasmia at all but a condition called retrograde emission, where the man does not have visible ejaculate during orgasm. Many men assume incorrectly this means they did not achieve an orgasm. As with many sexual issues, male anorgasmia may be physical, emotional, or a combination of the two, so talking with both a doctor and a therapist is likely the best way to reach out for help.

I am a cancer patient, and I am uncomfortable talking with my doctor about my sexual concerns. Right now, during chemo, I don’t want to have sex, but if my sex drive increases, is it okay to have sex? 

It makes sense that, if you aren’t feeling well while undergoing chemo, you won’t feel like having sex. However, if at some point in going through chemo your sex drive increases, most of the time, the answer to this question is yes! 

Are you interested in learning more about therapy or talking to a sex therapist? If you would like to further explore if sex therapy is right for you, please read our previous blog post on Sex Therapy 101, check out sex therapist Richard Ashby’s bio page, or give us a call at 913.214.1219.

Do you have any questions you would like to ask a sex therapist?  Fill out this anonymous questionnaire so we can add your data to future articles!