You’re not alone. Many of the clients we get here are clients that didn’t feel they could bring up their sexual concerns to their therapist for a few different reasons, or their therapist referred them to us directly because they wanted their clients to get more specialized care.
First of all, to the therapists struggling to talk to their clients about sex: I get it. It’s hard. This point of this article is NOT to shame the therapist who struggles to talk about sex. We are very against shame of any kind as sex therapists. The point is to educate clients WHY their therapist may not be talking to them about sex so that instead of feeling like it’s about them (SHAME) they can see it’s 100 percent not about them.

Because a big part of my job is to train and supervise new therapists, I get to see firsthand how many therapists have not worked out their own stuff related to sex. With out this, it’s very difficult to then be able to help clients work out things related to sex. The first part is key. We can’t help you go places we haven’t been vulnerable with in some way with ourselves. This doesn’t mean we have to have gone through the exact same issue, but it does mean we have to figure out our own pre-conceived notions about sex from our own growing up that may or may not be helpful in the therapy room (ex: sexual shame). I have had to do my own work on this and continue to make it a priority in my life.

Back to the sexual shame thing again- some therapists hesitate to ask the question, “Is there anything about your sex life or sexuality that you want to discuss in therapy?” because they are afraid of what you might think of that question. They worry it’s too intrusive or assuming. They are worried they may offend you with the question.

So let’s say you do say you want to work on your sex life with your partner. They aren’t always sure of the questions to ask to help you figure out exactly what that means or what goals you could have related to that in therapy.

TALK ABOUT IT!
Tell them as straight forwardly as you can that you have some topics related to sex that you want to discuss in therapy. Likely, they will be happy you brought it up and ask you to tell them more. They will likely know their own capabilities and refer you out if they don’t feel they are the best person to help you, but you can also feel free to ask them if this is something they feel they can work with.
Some clients choose to continue to see their “regular” therapist and see us for the sexual related concerns. We are happy to help in whatever way feels best to you!

See the full list here!

If you have a vulva you likely struggle at times to reach orgasm during partnered sex. If you don’t know what your vulva is - it is the external part of the female genitalia and includes (among other things) your clitoris. Likely you just haven’t quite figured out your orgasm formula – the things you need in order to reach orgasm.

Before I go into this, I have to say to women reading this: Your pleasure is important, your orgasm is important. Women are socialized to believe our pleasure is shameful or unimportant. This is simply not true. Due to this we can feel ashamed of taking the time to figure out what we want during masturbation or asking for what we need during sex.

Dr Laurie Mintz conducted a study where she asked women “What is your most reliable route to orgasm with a partner?” Here are the responses:

•    Intercourse alone…4%
•    Direct Clitoral Stimulation…34%
•    Intercourse plus direct clitoral stimulation….43%
•    Rarely if ever orgasm…19%

So the answer is… learn ways to stimulate your clitoris during partnered sex and you will have more consistent orgasms. Now, as promised, I will give you 4 ways to stimulate your clitoris and reach orgasm more consistently.

Women need time to warm up. One way to do this is to not get naked immediately. Have your partner tease you a bit with your clothes still on. This can include breast or genital contact if you like, but I wouldn’t start out with it. Have them touch or kiss your back, arms, legs, neck…you get the idea.
Once you are starting to feel some arousal, consider continuing to keep your underwear on and have your partner touch you over your underwear. This creates a friction that can feel quite nice! After that consider “outcourse”.
Remember when you were young and would grind with your girlfriend or boyfriend so that your genitals were touching but not penetrating? This is called outercourse and I’m here to tell you that even though you “can” have sex, outercourse should not be off your sexual repertoire. You can absolutely have an orgasm this way! Or at the very least get a really good build up before penetrative or other types of sex. Which brings me to my next point…

The WHOLE vulva is a pleasure center, not just your clitoris. Your clitoris actually has internal structures that are behind your vulva, which means the whole thing is up for grabs to help you to your orgasm.
My point? Constant or direct clitoral stimulation can be overwhelming sometimes and you may way to direct your partner to touch your entire vulva. Maybe when you’re first starting to become aroused you like gentle touch or more of a “teasing” type touch, and then once you get going you like more direct pressure. Maybe direct pressure is never your thing. Pay attention to what feels good and communicate it with your partner.

This might be hard to hear, but your partner is not responsible for your orgasm. It is your job to figure out what you like and to communicate it to your partner. Some women have an expectation that their partner is going to read their mind and should just know what to do to give them pleasure. This is not a helpful way of looking at things. Your partner can help create the right context for things to become pleasurable (Safety, love, emotional connection, etc) but if they don’t know what you like, how are they supposed to do it? Tell them, they will thank you.
How do you figure out what you like? Experiment with different things. Experimenting with different types of touch, toys, visual aids, etc. during masturbation is a great low pressure way to figure this out.

Let’s face it- sex toys can be tough to finagle – especially if you haven’t used them before. Sometimes we can get lazy and not want to try something new due to the sometimes unsexy parts of trying to figure out how a new toy can work best for you.
Try the toy first on your own.  This will help you figure out how it’s going to work best for you, and how it might be able to work during partnered sex.

Clitoral Suction Toy: Read more about how to specifically use it on a previous blogpost of mine – including quotes from my friends on their experiences!
This toy goes over your clitoris and gives suction to it that mimics oral sex. This toy would probably work best for you to use on yourself or have your partner use with you without trying to have penetration at the same time - but it isn’t impossible. If you have historically struggled to reach orgasm this is the toy you want.

The “Fin”: A vibrator that you can wear on your finger or put in your hand in some way to stimulate the clitoris/vulva. You can use it in almost any position whether you are having penetration or not. Your partner can also be the one using it.
The “Eva”: This one is a  G A M E   C H A N G E R. This is a hands-free vibrator that has flexible wings that tuck under the labia to stay in place during penetrative or other types of sex. It has 3 settings to work with. You may have to put it back into place a few times, but it mostly stays in place. Try it out on your own first so you know how to place it in a way that feels good for you. This is a very easy and smooth way to use a vibrator during penetrative sex.

Whatever you try on this list remember that your pleasure is important. You don’t have to be embarrassed to tell your partner what you need in order to have optimal pleasure and orgasm.  They will appreciate a woman who knows what she wants and will be happy to not have to read your mind. Once you figure out your orgasm formula you won’t have to work as hard to get there every time, and who doesn’t want some easy orgasms?

If you want some additional support to deal with feelings around this, past trauma or pain, consider talking with a professional. Our sex therapists want to help you address sexual concerns here in Plymouth, or anywhere in the state with online therapy in Minnesota. Get started by following these simple steps:

1. Contact the Sexual Wellness Institute to set up your first appointment.
2. Meet with one of our skilled sex therapists for an intake appointment.
3. Begin building better communication with your partner, overcome sexual concerns and experience new fun and intimacy in your relationship!​

​In addition to sex therapy, our LGBT & polyamory friendly sex therapists provide a wide range of mental health services at our Plymouth, MN counseling office. Other services include couples therapy & marriage counseling, EFT, evidence-based couples therapy, EMDR & sexual trauma therapy, as well as, teen therapy. In order to help serve the mental health needs of all those living in Minnesota, we also offer online counseling & sex therapy. We also provide a variety of helpful tips on our mental health blog. Please feel free to reach out with questions, or if you would like to schedule an appointment to begin working with a skilled sex therapist! Your sex life can be amazing. Sex therapy can be a part of that process for you.

See the full list here!

Difficulty with erection is probably one of the most common concerns I work with as a sex therapist. Erectile challenges affect a majority of men under 40 at some point in their lives and that number only grows after 40. For such a widespread problem, lack of or loss of erection is something we just do not talk about. Today we are going to talk about erections and what happens when a penis won't cooperate. I am writing both for people with penises that are not cooperating, as well as for those of you who might have a partner whose penis is having some difficulty. As a partner your response to lack of erection is hugely important and can do wonders to get things back on track. For either person, we need to begin by understanding why penises sometimes don't work when we want them to, and why we don't talk about it.

Being raised as a man in our culture you learn early on that your penis is a primary factor of your manliness. As you hit puberty you learn that it's size and ability to become erect are also very important to your manliness. We learn that when you're turned on by something your penis will get hard. Many young women get these messages as well. We are then made to sit through a parade of jokes in movies and television where a man not being able to get an erection either means he's lost his manhood, or he's not attracted to the women he's trying to be intimate with. With these kinds of messages it's no wonder men don't want to talk about their difficulties with erection, even though most of them have dealt with the issue at some point. You're either losing your masculinity or risking directly insulting your partner by showing them that you don't find them attractive enough to get an erection. This leads many men to hide their difficulties from their partners and make excuses as to why things aren't working. Many often end up avoiding sex for fear they might have difficulty again. The problem with this is that none of is an accurate depiction of masculinity or how penises work. So starting the process of working through erectile dysfunction by throwing out these concepts is a good way to start. The next step is educating yourself on how this process really works, we'll do that now.

Sexual arousal is a complicated equation. Many times we only look at the outcome of that equation instead of the complete picture. Step one here is to think of the equation as "Turn Ons - Turn Offs = Arousal"
Many people only think about the Turn Ons side of this equation and this can lead to a great deal of hurt. I hear this come up in sessions like this, "If my wife really found me attractive she'd initiate sex with me" or in this case "If my partner really thought I was sexy he would get an erection." In both of these cases we're missing half of the equation.
​If we look back at the last section we can identify a huge Turn Off that many men experience, especially if they've had difficulty with erection before. This turn off sounds like "If I can't get an erection my partner will think I'm not man, or I'm not attracted to her and she'll be very hurt." This is an incredibly powerful thought and a huge Turn Off. Let's take a look at how this thought takes over. This is the story I see with 99% of men who I help with erectile difficulties. The man is tired, drunk, or uncomfortable in some way, these Turn Offs add up to be bigger than his Turn Ons. This means no erection. This typically does not go well. Partners feel hurt or angry, the man feels great shame, and the sexual session ends on a bad note. Because we don't talk about these things the couple avoids the topic and just hopes things work next time. But when next time comes that thought is there waiting for him. "What if it happens again?" And all of the bad things that happened last time come flooding back, creating a massive Turn Off that is very hard to overcome. This fear leads to difficulty with erection happening again, and creating a brutal cycle of fear and failure. Taking the breaks into account lets us have a very different conversation with our partner that sounds something like, "I'm very attracted to you and would love to have sex, but I'm very afraid you'll be hurt or won't like me if this fear takes over." But we'll come back to solutions later. First I want to acknowledge one other piece of this complicated arousal equation.

Non-concordance is a term coined by researcher Dr. Emily Nagoski. She discusses it at length in her book "Come As You Are" which I highly recommend to anyone. Simply put, non-concordance describes the disconnect between what we want, and our bodies response. This happens to both men and women and in both directions of wanting and not wanting. A very simple a common example is the use of lubrication during sex. Sometimes a vagina simply does not have enough lubrication for comfortable penetration, despite what the owner of said vagina wants. Here it would be normal for most couples to use some lube without a second thought. Simple non-concordance. On theme with our post, sometimes a man very much wants to have sex but he body just doesn't respond and he struggles with erection. Now this also works in the opposite direction as I said. Sometimes we don't want to experience physiological arousal and we do. A common joke here is a man getting an erection when he has to stand up for a presentation, even though he's not aroused. A more difficult but power example is to look at people who have experienced sexual assault. Many people who are assaulted experience erection, lubrication, and orgasm. To suggest that they felt these things because they wanted to be assaulted would be horrific. Sometimes our bodies don't do what we want them to, and having acceptance for yourself and your partner on this topic can bring a great deal of trust, comfortability, and closeness to your sex life.

I want to take a moment here to mention that physiological concerns can absolutely impact erection and it is always worth consulting a doctor to be sure you're ok physically. While there are many ways to start using all of this information to improve your challenges with erectile difficulty, I want to talk through the most simple and effective way to make changes. You're going to have to talk about it. Whether you're the one struggling or you're reading this for your partner, the best way to start moving forward is by talking about it. Let's break this conversation down. There are two key things we want to communicate. Why are we struggling with erection? And, what do we do when it happens? 

I consistently find myself asked by clients if their pornography use is a problem. Or, they show up to my office already having decided that it is. The real answer here is it depends, and it's up to you. Now that doesn't sound very helpful, so let's look at a number of ways pornography does cause problems. We'll also look at times when the problem isn't porn, and give you a few tips for other things to work on instead, in addition to, cutting out porn. The bottom line is that if you want to cut out porn use because you don't like it, that's all the reason you need. The other side is, if you want to keep porn in your sex life but are worried it's causing problems, there might be other things to take a look at before cutting it out. Let's take a look at problems first.

There are a couple concerns with pornography that tend to make up most cases. The first is compulsive use. Compulsive sexual behavior is often caused by a need to cover up some current or past hurt. When someone is feeling bad, looking at pornography causes some of our most core body systems to release feel good chemicals in our brain. The problem here is that people often just keep taking another hit of the porn to cover up their pain instead of actually resolving their problems. So the first question in the "is my porn use a problem?" series is, are you using the positive feelings from porn to cover up less than pleasant feelings? 

The next primary issue I see with porn use is when people lose touch with the separation between the fantasy that is pornography, and the reality of sex. This can lead to all sorts of problems, from trying to do sexual acts or positions that are just not comfortable for anyone, to feeling bad about the way you or your partners bodies look. If you're expecting your sex life to look like porn then there might be a problem for you. This problem, however, doesn't mean you need to cut out porn. It means you need to get in touch with what separates porn from real sex. 

The last major issue I get asked about when it comes to pornography is overstimulation. This one is tricky because it's easy for other problems to hide under the guise of excessive porn use. If the other above mentioned issues are the main problem then it makes most sense to focus on those. If you’re only problem is using porn more than you are being intimate with a partner and you think it’s causing desensitization – you could be right. In this case, just take a break from pornography for a bit to see how it goes.

Probably the most common reason people, men in particular, come to me with concerns about their porn use, is because they're afraid it's impacting their ability to perform with their partner. It means they're afraid it's impacting their ability to get an erection without porn. However, the vast majority of the time it's not the porn that's the problem, it's your own head. The inability to get an erection, or the loss of one, can be an absolutely terrifying experience for many men. They worry about impotence, their partner being angry, their partner being hurt, what if it happens again? These thoughts can absolutely overwhelm many men, and it leads them to look for whatever culprit they can find to fix the problem. The blame often lands on porn and they tell themselves, “maybe if I cut out porn I'll be able to become erect for my partner again.” The problem here is that this is focusing on the wrong problem

So, let's wrap this all up. If you don't want to use porn because you think it's wrong, unethical, or anything else, you have every right to cut it out. You don't even need a reason. However, if you enjoy porn but are worried it's causing problems for you, there are a number of things to be aware of. Don't use porn as a coping skill for covering up hurt, don't forget that pornography is a business selling fantasy, don't use porn as a guide for what real sex is like, and don't expect yourself or your partner to look like porn professionals. Most of all, don't let porn cover up bigger underlying issues that won't be resolved just by cutting out porn. Talking to a professional can be a great way to find out more clearly if porn is causing problems for you. We offer free 30 minute consultations if you want to dive further into these concerns than I've discussed in this blog. Take care of yourself and enjoy responsibly.

No matter how this information gets to you, it can be one of the most challenging and overwhelming moments in your life. The statistics can be hard to define because not everyone is going to admit to cheating, but studies show that anywhere from 20% to 40% of marriages experience infidelity. This number goes up a great deal if we include emotional affairs as well. It's important to know that you're not alone in this, because it can be very easy to feel like you've just had everything taken from you. It can also be easy to feel completely lost as to what to do next. Today we'll take a look at some good first steps and things to keep in mind to make sure moving forward can be just a little bit easier.