Sexual Health Conversations Matter
I’m always torn between the speed and brevity that social media can bring in some platforms and the depth by which I see the complex relationship we have with sex. To confuse things even more the complex relationship my profession has with sex.
Let’s get started: Is it “safe” to talk about sexual health in your relationship? If so, are you prepared to start the conversation?
As a Certified Sex Therapist, I work from the sexual health model.
The principles of Sexual Health:
- Protected from HIV, STI’s and unwanted pregnancy
- Shared Values
- Mutually Pleasurable
During the course of therapy, I usually ask clients if they feel they can be totally honest in their relationship. I’m sorry to say most answer, No.
Honesty is in my opinion a core value in any relationship. Yet repeatedly, I see partners dismissing, judging, shaming and ridiculing the other partner for their honesty in relation to their sexual thoughts, urges and behavior. The critical partner is often unaware of what he or she is doing, because they have not examined their own behavior and expectations for their relationship.
Conversely, is it safe for your partner to talk to you about sex? Safe communication is one of the foundational components for a successful relationship. For some individuals the mere thought of talking about sex with someone provokes anxiety — especially among men. We often fall into the trap of believing that once we accept and embrace our sexual orientation we are all equal. Not so much. Each person has a unique and individualized way of interacting with and expressing their sexuality. Creating a safe zone for sexual conversations is about suspending judgement. Sometimes that involves also suspending emotional reactions. There has been an interesting prioritization of emotion in the dialogue of communication but let me just say a negative emotional reaction shouldn’t be the stopping point. It should be a beginning point to look for ways to increase understanding.
Within the paradigm of “sex addiction” there is no safety to disclose and discuss an individuals unique erotic template. Meaning there is no value of diversity only of assimilation.
As individual’s anxiety grows as his or her perceptions of options decrease. What that means is if someone is anxious about talking about sex to their partner their ability to do so will decrease. This creates a unique challenge for a couple or an individual who actually wants to share and be honest in their relationship.
The more upset we become about a problem, the less likely we are to access the parts of our brains that give us the capacity for complex executive functioning. Some would say that for people in a highly anxious state, their old brain functions engage to help protect them. Often described as the fight or flight response. One of the goals of a sexual health conversation is to concentrate on basic active listening. We have to ground ourselves in a place we feel safe, basic communication, in order to step into a difficult conversation that most likely will provoke anxiety. And when sex is the topic, some people cannot stay present in the executive higher functioning part of their brains. Their ability to regulate their emotions are limited, for example discussing something innocuous like cooking or gardening can go on for quite a while. Conversations about sex are usually quick fast and not very detailed or curious in nature. We can get triggered/activated by our attachment styles and/or our personality traits.
As a young therapist, I was trained to only treat conditions that I knew specifically about. It’s unethical for me to treat something I don’t have any specific training in. I experienced how relationships don’t change the minute you walk into the bedroom. If you’re fighting in the living room, the fight extends into the bedroom, and vice versa. If you are having a miscommunication about sex, the lack of understanding can permeate your whole relationship. And the partner who has the least ability to communicate about sexual health will limit the couple (or systems) ability to communicate and resolve a miscommunication. This is why I went back and got sex specific training and chose to personally align myself with the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
That education has allowed me to appropriately and effectively work with clients’ sexual issues. A common starting point with new clients is to ask, What have you tried already to solve your concern? I ask questions to help fill in the blank spaces while getting to know them what they have already tried. When individuals are sexually unsatisfied, frustrated, angry or in general feel out-of-control, what have they tried before asking for help? I think it’s a big deal when someone trusts me enough to ask for help in the area that we all see as most intimate and private. I actually feel honored when a client trusts me to help explore their sexual life.
Based on the way a client frames the problem, people choose one of several ways to seek help. For example if someone views sex as sinful, they might seek clergy for help. If someone thinks his or her problem is medically-based, they seek a doctor. You get my point.
Let me highlight the different ways most of my clients have already tried to solve their problem before they get to my office.
- Religion- asking for advice about sex in a spiritual context.
Our personal faith is but one component of who we are and the way we live our lives. Religious leaders don’t want to talk about sex. They want to talk about your understanding of a behavioral definition of sin. I wonder what religious leaders would do or see in their parishioners if they ask the question like this. What is your relationship to sin?
Morality and human sexuality are often at odds. Take for example — masturbation. Some religions and religious leaders would say all masturbation is wrong. Some disagree and view it as normal behavior. I’ve met some truly enlightened multicultural religious leaders who preach that living a principled life is our ultimate pursuit. Still, we have unanswered questions…. especially around sex.
- Medical- asking for advice about sex in a medical context.
Again it’s a great starting point, but most doctors lack training in human sexuality. They have a biological understanding of the genitalia, but they lack specific knowledge of the brain / body connection. Many of my clients report that when they’ve asked sexual questions, their doctor dismisses them. A patient’s age is also a consideration. A 24-year-old, who has an issue with low desire, may get dismissed with this answer: Wait till you find someone special — or — the problem will solve its self.
- Friends- asking for advice about sex from your peers.
I’d almost compare this to getting sexual education by watching porn. You know you aren’t getting all the facts about sex by watching adult film stars ply their trade to make a living. Bluntly, it might help you figure out what hole you want to use for sex, but not why it is acceptable with one partner but not with another. Do friends ask informed questions and ponder for hours about how to improve not just the frequency with which you have sex but the quality of your relationship in and out of the bedroom? And where do they get their information? How can you know that it isn’t more than their own personal assumptions or even judgments?
- Internet- asking the Internet for help.
Some of the problems with which individuals struggle are complicated by inaccurate information and myths about sex.
Your P. C. or mobile device cannot interact with you to discover your unique sexual health. The phenomenon that frustrates many therapists is that clients are seeking therapy from the Internet. They call this “using Dr. Google”. After recognizing that there is a problem, this is an excellent place to start. But realize, there is a great deal of misinformation about sex and porn on the Internet. Since the Internet is not interactive, you can not ask nuanced, detailed questions.
Without sexually knowledgable human guidance, the Internet cannot help you refine your question, challenge you to rethink your position or reveal your level of knowledge. So yes, by all means search the Internet, but don’t rely on a single blog post to answer your most important questions.
- Sex Addiction Therapists- there are many well intentioned therapists who are trained to help people “recover” from a place of addiction to drugs or alcohol.
The inherent problem with this approach is that it accepts the idea that sex is addictive. It is not. Let me repeat that, Sex is not and can not be addictive. Research does not support the claim that sex and porn are addictive. Sex addiction therapists are skewed and thus limited in their conceptualization of sexual symptomatology.
This would not be my first choice. Our culture has struggled with many issues and has taken a Nancy Reagan approach — “Just Say No”. This position vilifies both sex and porn.
Then, if you can’t “Just Say No”, there is someone wrong with you. This simplistic approach doesn’t allow for variability in individuals. It also in it’s simplistic nature blames, judges and shames the individual for the symptom.
The sex addiction model and theory are not interested in the values clients hold. They have a doctrine which is centered on specific sexual acts , desires, and values being deemed acceptable or not acceptable. Anything that isn’t approved by their model is deemed a sign of the client as an addict- “addicts acts out”. This allows for the therapist to have a very clear idea of what is and is not “right” and “sanctioned”. This is an uninformed sexological approach. Sex and porn may very well be a part (a component) of a bigger problem, but at most they are a symptom of that problem — not the problem itself. Therefore the individual who seeks help with their sexual expression needs help to increase self awareness. They need guidance from a person who is grounded in a positive sexual health model not a morally shame-based one.
It’s my assertion that “sex addiction” is reparative therapy for the masses.
Your friends, doctor, minister and CSAT therapist mostly likely all lack sex specific training. Sex, sexuality, sexual dysfunction and ultimately sexual performance can only be helped from an informed, nonjudgmental, multi-faceted lens. If someone starts with the idea that sex is by it’s nature pathological it’s a much longer harder road to get to an understanding of sexual health.
Now, if you are someone who requires clear, concrete guidelines to help you understand when you are crossing a boundary or breaking an agreement in your relationship, you already show good self awareness. Then, when you identify specific act-centered behavior that you decide is wrong for you, you can choose not to engage in that behavior. Each individual has unique needs in treatment. Once you decide what they are, I support the implementation of measures to help keep your value system in sync with your sex life. To me this is what sexual integrity is and how one strives to be congruent within their value system.
If you are seeking help with a sexual health concern your main job is to not allow the therapist, your partner, your church or your community to impose their value system or judgement upon you. The relationships you have with each of these individuals or entities are important but they aren’t you. Your job will be to raise awareness and understanding about sexual health and your relationship with your sexuality.
What you don’t want and will regret in the long run is conceptualizing your problematic or out of control sexual behavior as an addiction. Ask yourself things like this:
Is my concern about impulse control?
Is my concern about compulsivity?
Is my concern about childhood trauma?
Is my concern about depression?
Is my concern about anxiety?
Is my concern about relationship style and comfort?
Is my concern about my partner?
Is my concern more about other people or society’s says it is?
If you are someone who has any of these things as part of the unique individual you are those things could affect and possibly can have an effect on your sexual expression. Don’t go down the path of judging it, instead, chose a path of empathy and compassion around problem solving and understanding. Don’t let your therapist go down the path of sex or porn addiction either.
There is this unspoken myth that it is a woman’s job to tame her man. To help them lose their propensity toward being bad boys. Men are wild animals who are unable to behave with self-control, until they are tamed. It’s the wife’s duty to tame her husband because he doesn’t have the ability to tame and control himself.
I call this notion — plain, unadulterated bullshit. I know not very clinical but really this isn’t about clinical manifestation of a problem at that point it’s about an unspoken role expectation. It appears to be the basis for the sex addiction philosophy and the co-dependent nature of the couple where she is suppose to keep track of his behavior. The man, the addict, requires others to help him control himself. This conceptualization perpetuates the idea that men can’t really change and that they are doomed unless they are saved. It just isn’t true.
There are many eloquent and knowledgable writers who do a much better job than I do. Here are some things you can read to hopefully learn more about yourself and your sexuality. I often suggest clients read one or two as part of the work we do together to further their understanding of themselves.
If any of them spark an interest you’d like to discuss with a professional feel free to reach out. You can find a trained therapist at AASECT.org.
by David Ley
by David Ley
by Marty Klein
by Michael Aaron
by Chris Donahue
by Emily Nagoski
Here are some website articles that might help you rethink the concern you have in a way that can help you shift your own conceptualization of a specific sexual health concern.
List articles related to but helpful: