Talking About Sex Without The Awkwardness: Understanding Psychosexual Therapy

A brief overview of psychosexual therapy, highlighting how it can improve intimacy, connection and overall emotional wellbeing — even when there’s no obvious “problem”.

When I talk about practising psychosexual therapy I always get a reaction. People are often curious, sometimes a little uncomfortable, and generally unsure what exactly it is that I’m talking about.  This isn’t surprising given that statistics shows less than 25% of people whose health affects their sex life actually seek help.

There is a myth that psychosexual therapy is just for people who are in crisis, or who have very specific sexual functioning problems. And whilst it absolutely is for those people, it is also at it’s core a deeply human form of therapy that prioritises connection and can support with a wide range of different concerns, whether they be emotional, psychological, social or sexual.

Sexuality is a core component of mental wellbeing. It doesn’t exist in isolation and is intricately connected to our sense of self, our body, our past experiences, relationships, stress levels and societal, cultural and religious messaging.  When our lives feel difficult, this can show up in intimacy. Likewise, if intimacy feels challenging, this can impact our self-confidence, our connection with others and overall feeling of wellbeing.

Psychosexual therapy explores these links with curiosity and compassion, leading to increased self-awareness and a better understanding of your own sexual and emotional needs and how to better communicate these.

What does it involve exactly?

Psychosexual therapy is a form of talking therapy which looks at the psychological, emotional, social, relational and biological aspects of sex and intimacy. It is sex positive and focuses on sexual health and wellbeing, pleasure, and connection with yourself, others and the world around you.

There is no requirement to talk about things you don’t feel ready to talk about, and therapy always progresses at the client’s own pace. You don’t need a GP referral, a diagnosis or an obvious ‘problem’ to benefit. For some people, this is about learning how to feel closer to others, more authentic in their encounters and more comfortable with sex in general. Parents in particular might start to notice their own feelings around sex more as their children grow up and start asking questions. They might want to feel confident talking to their children about sex, keen not to pass on any shame or reluctance that they might have felt growing up.

As well as providing a safe, non-judgemental space to talk about and reflect on anything and everything to do with sex and intimacy, psychosexual therapy also has some core, evidence based interventions that have been shown to work extremely successfully. One of these is Sensate Focus, which is a mindfulness based touch programme that the client practices in their own time with themselves and with their partner/s. The aim is for the client to become more familiar with the different sensations in their body  and to raise awareness around how it feels when their body is touched. This isn’t about become aroused or reaching orgasm, so any pressure is removed. A lot of sexual issues are due to an individual ‘being in their own head’, worrying about what a partner thinks, and feeling pressure to ‘perform’, rather than focusing on what feels good.

Why don’t we talk about this more?

Our market place and cultural sphere is saturated with sexual imagery,  yet meaningful, nuanced conversations about sex and sexuality are few and far between.  Growing up was likely devoid of the language to talk about desire, pleasure and boundaries. Sex therefore became about playing by certain rules, meeting expectations and comparison with others.  Let’s face it –  the only thing most adults I speak to remember about sex ed at school  is ‘wear a condom and don’t get pregnant!’

If sexual problems arise, people often feel alone, ashamed, and as though they’ve failed. There’s an assumption that everyone else is having plentiful, spontaneous, easy sex where everyone climaxes at the same time. This is a myth, but it’s reinforced by the way we see sex enacted and talked about in movies and the media. It’s hugely damaging and we know it’s entertainment, yet it still weaves it’s way into what we think of as standard.

It is completely normal for sex to change over time.  As we age our bodies change, we experience changes at work, in our relationships, in our family life. We deal with stress, health issues, sleep deprivation, hormonal shifts and caring responsibilities. These changes influence how we experience intimacy  - how could they not? It doesn’t mean you have failed or something is wrong. It means you are human.

Who can it help more specifically?

Most people can benefit from psychosexual therapy, however, it can specially help with:

·       Low desire or changes in desire

·       Pain during sex (including vaginismus)

·       Erectile difficulties (unreliable erections, premature and delayed ejaculation)

·       Difficulty reaching orgasm

·       Loss or change in intimacy after: child birth, trauma or abuse, perimenopause and menopause, cancer or other health conditions

·       Questions around sexual identity, orientation and expression

·       Anxiety around sex (either before, during or after)

·       Mismatched desire in relationships

·       Compulsive sexual behaviour

·       Understanding kink and fetish

It can also be incredibly valuable for people who aren’t struggling with any of the above but want to:

·       Explore and unpick unhelpful beliefs around sex including associated shame and guilt

·       Communicate better with their partner/s

·       Adjust to changes within their body and increase body confidence

·       Reconnect with and change their relationship with pleasure in all areas of life

Can I choose a psychosexual therapist as a generalist therapist?

Yes! Psychosexual therapists work holistically, recognising that sexuality intersects with emotional regulation, attachment issues, self-worth, and relational difficulties. This makes a psychosexual therapist well placed to work with low mood, anxiety, chronic stress, relationship issues and general life changes. It also means that should you want to explore intimacy or sexuality as therapy progress or things change in your life, you already have a therapist who is confident and knowledgeable in this area. It can feel reassuring to know that intimacy issues, if they arise, can be explored safely and won’t be minimised due to embarrassment.

To conclude:

Sexual health and wellbeing is about so much more than what sort of sex you’re having and how often you’re having it. It’s about feeling comfortable and confident in your own body, freedom of expression and feeling connected – to yourself, to others and to the environment you live in.

Concerns around intimacy are rarely just about sex.

Just like psychosexual therapy isn’t either.

Please reach out at nicola@ourtherapyspace.co.uk if any of the above resonates or you have further questions. I'm passionate about opening up the conversation around sexual wellbeing, and I can help you decide if psychosexual therapy is right for you.