Common Sexual Difficulties:

Low Desire/Low Libido:
Some people experience very little or no sex drive. Both men and women report this, but it tends to affect more women than men. It can be caused by numerous factors: physiological, behavioral or psychological. Low libido is not always perceived as a problem, and may be quite normal. Alternatively, someone experiencing low libido may wish they had a greater sex drive. It can be also become problematic when one partner in a couple has a greater sex drive and would like sex more frequently. This is called ‘desire discrepancy.’

Treatment for low desire/low libido or desire discrepancy usually includes talk therapy and behavioral assignments. This approach can help alleviate any psychological or behavioral factors. Sometimes reducing shame or increasing communication between partners can result in more satisfying sex, and a consequent increase in sexual desire. Many people find that the more physically active they are, the more they are interested in sex. Having sex regularly has also been known to maintain higher levels of libido. Hence the old adage, “Use it or lose it.”

Medical practitioners use the diagnostic terms HSDD or ‘hypoactive sexual desire disorder and FSAD or ‘female sexual arousal disorder,’ and may prescribe a testosterone patch or cream. If there is any physical pain involved in sex, then eliminating that pain can also result in increased interest in sex. See “Pain with Sex” below.

Difficulty with Orgasm:
Not all people find their path to orgasm easily. As a matter of fact, the majority of women have had difficulty with this at some stage in their lives. Some men, however, also experience difficulty reaching orgasm. The factors influencing this are usually behavioral and psychological, although medical factors (such as health problems or side effects of medication) may also contribute. While you do not have to orgasm in order to enjoy sex, many people feel as though they are missing out on something if they do not orgasm. And enjoying orgasm is likely to increase both sexual interest and frequency of sexual activity.

Treatment for difficulty with orgasm usually involves talk therapy and behavioral assignments. The goal is to increase your understanding of the way your mind and body build and maintain higher states of sexual arousal. The initial phases may focus on establishing the pre-conditions you may have for a successful sexual experience. Then self-stimulation exercises may be useful. Finally, increased communication with sexual partners can help bring the gains you have made into the realm of sex with a partner. Many people successfully overcome their difficulty with orgasm through the support of a good counselor or coach.

Erectile Difficulty:
Men can have difficulty both getting and maintaining an erection. For many men, erections are a symbol of virility. It can therefore be very upsetting to be deprived of that potent feeling. Erectile difficulty can also be difficult for couples who want to have sex that requires an erect penis. Thus men with erectile difficulty often feel inadequate in their ability to satisfy their partners. Anxiety can increase over this issue with each incidence of difficulty. And this increased anxiety can perpetuate the problem.

Sometimes erectile difficulty is a factor of age or medical factors, and can be treated with medication. Often, however, erectile difficulty has emotional or psychological components that need to be addressed with the help of a counselor or sexual enrichment coach. Most men can learn to have more reliable erections by more effectively meeting their needs, both emotional and physical. Improvements come  through expelling the myth that men are supposed to be ready for sex on demand. Instead, men who learn to meet their pre-conditions for sex, go at their own pace, and stay in touch with their own bodies will have fewer problems.

Ejaculatory Control Problems:
Early ejaculation, premature ejaculation, and rapid ejaculation all describe the problem of not having the amount of control you desire over your orgasm. Many men want to be able to delay orgasm so that they can prolong intercourse or other sex play that requires an erection. It can be frustrating not to have control of the timing of your ejaculation. Early ejaculation affects a lot of men at some point or another in their lives. It is very common in young men who are just beginning to explore their sexuality. It can also happen with men of any age, particularly if you have not had much sex recently, if you have performance anxiety, or if you are in some way challenged by your relationship dynamics.

Fortunately, lack of ejaculatory control is rarely the result of a physiological problem. Treatment for early ejaculation includes talk therapy and behavioral assignments. This approach offers effective techniques to self-adjust their level of sexual arousal prior to orgasm. Men also benefit from gaining more acceptance and comfort with sex and with their sexual partner.

Pain with Sex:
Both men and women can suffer from pain with sex, particularly intercourse. Such pain is more common in women. There are many different kinds of pain and many potential causes. Needless to say, pain with sex will inevitably affect the quality of your sexual interactions. It can interfere with arousal and orgasm, and it will likely affect your libido in the long run.

If you or your lover is experiencing pain with sex, it is important to stop any sexual behavior that is causing the pain. Only engage in sexual behaviors that feel good to both of you and seek medical attention to deal with any physical problems. Counseling or coaching can also help you deal with any emotional or stress related sources of pain (such as very tense muscle tissue). Specific treatment will vary depending on the cause or source of pain.

Compulsive or Unwanted Sexual Behavior
Sometimes sexual behavior patterns can be psychologically or physically harmful to yourself or another person. It can be hard to acknowledge that your sexual behavior may be creating psychological or physical pain, damaging your relationships, or undermining your progress in your life goals. But when a sexual behavior is difficult to control, even though it has negative consequences, the problem should be addressed frankly.

It is important to understand the difference between feeling ashamed of a healthy sexual behavior and identifying a behavior that really is creating harm. This can be very confusing and is best navigated with the support of a sex-positive counselor or coach. A skilled practitioner will not judge you for your propensities, but will help you stay consistently conscious of the need to make healthy choices about sex. The goals are to establish your own understanding of appropriate boundaries for your sexual behavior, break habits of transgressing those boundaries, and find your way to more enjoyable, non-destructive sexual behaviors.

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