Sex. It’s a complex experience influenced by a myriad of psychological, physical, cultural and social factors – but it is also a source of joy and pleasure. Sex offers us ways to connect with our own bodies and pleasure as well as that of our partner’s, can strengthen and deepen bonds, and helps sustain fulfilling romantic relationships. So why, when it comes to something so important, are we still so reluctant to ask for help when issues arise?
Many individuals and couples experience difficulties in their sexual lives, from feelings of shame or experiences of trauma, to issues such as premature ejaculation and vaginismus, to periods of sexual disconnection with their partners. Unlike general health issues or even mental health difficulties, many people never seek out support, instead suffering in silence. But many people can benefit from specialised therapy to better understand their sexuality. Sex therapists say their field has long been misunderstood – seen as a last resort for people in doomed relationships, or a fringe practice that involves embarrassing hands-on exercises.
Natasha Langan, Teresa Bergin and Aoife Drury are all sex therapists working in Ireland and accredited from the College of Sexual and Relationship Therapists (COSRT), the professional body for sexual and relationship therapists. They explain what to expect from sex therapy, what kinds of issues they commonly see in their practice and why people should not hesitate to seek out support.
What to expect
Let’s get one thing straight: sex therapy does not require you to engage in any sexual activity in front of a therapist. Sex therapists are not coaches, observing the action and shouting instructions and encouragement from the sidelines. Sex therapy is a form of talk therapy with a mental health professional who has completed specific additional training in the area of sexuality. Sex therapists work with people of all genders and sexualities, and can see single people, couples or individuals – though if you come in as an individual who is in a relationship, your therapist will likely ask your partner to join you at some stage. “I always prefer to see a couple together,” says Teresa Bergin, who is based in Dublin. “I take the view that the sexual difficulty belongs to the couple. And I’m not going to sort of pathologise one person or land blame with one person – the problem, whatever happens, has to be worked on within relationships.”
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I outline very clearly at the beginning that this is just us getting to know each other, that they do not have to disclose anything if they do not feel ready to
The first few sessions with a sex therapist will feel like the introductory session with a general mental health professional but with more of a focus on sexual and relationship dynamics. Clients will be asked to share a bit about their personal history, childhood experiences, childhood development, their life and their current concerns – but always at a pace that feels comfortable. Aoife Drury, who does online sessions with clients in Ireland, emphasises the importance of new clients feeling safe and comfortable.
“I outline very clearly at the beginning that this is just us getting to know each other, that they do not have to disclose anything if they do not feel ready to,” says Drury. “Because they’ve just met a stranger and it might be very unnerving and traumatic for them to open up immediately. I always say to them that if they tell me something that I feel that is outside of my expertise, that I will help signpost them to somebody who might be better at supporting them.”
Sex therapy is most effective when clients not only engage with the therapists during session but commit to engaging with exercises at home. Exercises could include listening to podcasts or reading articles and chatting through them with a partner where applicable; trying new communication tools and techniques; or practising mindfulness techniques, which help clients recognise what’s going on in their mind and body generally, as well as during sex. Sex therapists can also recommend sensate focus which is a technique developed by Dr William H Masters and Virginia E Johnson in the 1960s and encourages couples to go through a series of touching exercises. There’s no penetrative sex involved and the movements build slowly. Sensate focus can encourage couples to focus not on expectations of what they “should” do or feel but rather to be mindful of the sensual touching experience, and reconnect with their bodies and sensations in the moment.
“It really is an awareness practice where the couple’s homework is to put aside 20 minutes or half an hour a few times a week, where you take penetrative sex off the agenda completely,” explains Natasha Langan. “One partner is the toucher and one partner is the touchee. And when one partner touches the other, it’s not to initiate sex, it’s simply for using mindfulness to just be present, noticing all of the different sensations that come up. And the person receiving that experience to also notice what’s coming up for them, and then they’ll change roles. Afterwards, and in the sex therapy sessions the following week, we’ll talk about the experience, to help them understand what came up. It’s about being really curious.
“The communication piece is really important, because it’s a good diagnostic as well. Because they might come back saying, ‘So we didn’t do it, it was really busy’, or, ‘We didn’t make the time’, or, ‘I didn’t want to initiate it’. And even that’s important. You get a lot of information from the couple around the language of mindfulness.”
Stress and sex
Sexual drive and desire can be easily affected by stress, trauma and big life events, but many people still don’t acknowledge these impacts, believing sex to be a frivolous concern during times of difficulty. But when sex offers connection, intimacy, pleasure, expression and embodiment, experiencing sexual difficulties or disconnects can exacerbate the distress of individuals and couples.
Drury has seen how financial stress, menopause, cancer and bereavement has affected clients’ relationship with sex, noting that people don’t often realise how difficult emotional experiences affect their sexual wellbeing.
“Loss is a huge one,” she says. “Whether that loss is a grief or bereavement, whether that loss is a job or a home. Any kind of emptiness or something that’s suddenly missing. Then all the other things as well like a mental health diagnosis or struggling with depression and anxiety, particularly depression. The impact of medication as well. Life just impacts our sex lives more than we give it credit for.”
There was no sort of separation and then coming back together, and eroticism doesn’t function that well in that kind of context
Silence around all kinds of sexual and reproductive difficulties can let these impacts grow and fester. Drury has seen many couples who have been overwhelmed and distressed by experiences of infertility and who feel utterly alone in their struggles, despite it being a common issue.
“The impact tends to be stress related,” explains Drury. “The burden of going through fertility treatments and the stress that might be on the couple and how that’s impacted communication and their sex life and how they feel about themselves. There’s often this narrative of feeling like a failure or this feeling of inadequacy, particularly because fertility issues aren’t discussed, despite them being growingly common. One in five couples struggle with fertility issues and yet there’s a huge shame connected to it as it’s not out there and in the discourse as often and as much as it should be.”
The pandemic and porn
Of course, the pandemic has been a communal source of stress, trauma and disconnection, and people are still feeling the ripple effects of lockdown and the collective trauma on their sex lives. Drury, Langan and Bergin all noticed a spike in couples seeking support around their relationships and sexual interactions during Covid.
“Couples found it really challenging to be at home with [the] same person as much all day long working, living, rearing children,” says Bergin. “All of us need that balance between enough connection or enough distance, enough intimacy and enough of our own individual life. And of course, that was just obliterated during Covid. There was no sort of separation and then coming back together, and eroticism doesn’t function that well in that kind of context. It’s too much closeness. And for some couples, there might have been the expectation of ‘Oh, we have all this time we’re home together, so we can have more sex!’ And that’s not necessarily what happened, or what their partner wanted. That was really difficult for an awful lot of couples and had an impact on sexual relationships.”
It wasn’t just partnered sex that was affected by Covid; Bergin says that during the pandemic more people were contacting her expressing discomfort with their pornography consumption, feeling like their habits were becoming disruptive.
“It was a particular challenge for people during Covid,” she says. “People found themselves using more pornography than they were comfortable with as a means of distraction, as a means of self-soothing, but then it started to kind of get in the way of the rest of life and work and so forth. When working with someone around that, it’s trying to understand the part that that plays in their life and maybe what’s going on underneath that. What other stresses are leading to them to kind of self-soothe in that way?”
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Bergin has also noticed the impact of pornography on individuals’ own sense of authenticity, pleasure and self-image during sex.
“I think the impact of pornography is that a lot of people comprise this sort of increasing performative element around sex, with people feeling under pressure to perform – to do lots of things, to have lots of experiences, to act really free when they might not necessarily feel that way,” Bergin says. “Also, people experiencing issues around their own bodies and having a sense of ‘I’m too much of this and too little of that’. That gets really, really difficult for people, really stressful and distressing. If we’re going to compare constantly and then end up feeling uncomfortable about our bodies, there can be a sense of ‘I can only be sexual if I am a particular size and shape and look a particular way’. I’m seeing a lot of that.”
Painful sex
Sometimes sexual issues can be physically painful as well as emotionally difficult. Langan has worked with many women who experience vaginismus, which is an involuntary and often painful tensing or contracting of muscles around the vagina, often experienced at the start of sex, while inserting a tampon or getting a pelvic exam. Langan takes a multifaceted approach to that which includes helping clients understand their body’s mechanisms and responses, and a variety of exercises and regulation tools to help them feel more relaxed and comfortable, physically and emotionally.
Women are seeking appointments earlier, it’s just wonderful. They’re not just suffering in silence on their own
“It’s a lot around helping them understand what’s going on in their body and the pelvic floor and anxiety response. Then you’ve got your psychoeducation about anatomy and the sexual response and the anxiety response in the body, how fight or flight works, all from a compassionate perspective. You might say, ‘You know your body is trying to protect you and is doing the job really well, maybe a little too well!’ But you can do some pelvic floor exercises, and that’s where it’s really good to have a pelvic floor specialist that can really advise, and you can teach them diaphragmatic breathing, and I would do some general anxiety management and emotional regulation skills.”
Vaginal dilators can sometimes be a part of treatment for vaginismus, to help build up comfort with vaginal penetration, but Langan is aware that there may be fear or anxiety around their use so she focuses first on a combination of talk therapy, mindfulness, breathing and exercises long before dilators may become part of a client’s treatment plan.
“You want to do a lot of work around that to prepare them so that they’re ready, because what you don’t want is for them to have an experience of failure, which they might have had before.”
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Women can also experience painful sex for other reasons, including illness or a loss of lubrication during menopause. Bergin encourages women to seek out support if they experience pain during sex and says that increasing awareness and education is already having an impact on the women she sees.
“Women are seeking appointments earlier, it’s just wonderful. They’re not just suffering in silence on their own. It means we can work on that difficulty at a much earlier time, and when it’s solved they can enjoy their bodies and sexual intimacy in the way that they want.”
Education and culture
Sex education, public discourse and even pop culture can open up conversations around sex, pleasure and trauma, and can prompt individuals to think about their own relationship with sex and seek support. Langan says that when the #MeToo movement began and opened up conversations and education around consent, she saw a rise in people seeking support for past experiences.
“I have definitely seen that in the UK when I worked in the university services,” she says. “We had a lot of people going to consent workshops, then coming and saying, ‘I’ve actually had some non-consensual experiences’, then seeking counselling to make sense of those experiences.”
In Ireland, the work often lies in dismantling damaging and shame-fuelled ideas about sex perpetuated by the Catholic Church, and the influence the church had over all of society, including schools and sex education. Having worked in both Ireland and the UK, Drury notes the specifically complex feelings Irish people have towards sex and their sexuality.
“What I hear from Irish people is the guilt and the shame – that I almost see as inescapable from the teachings of the church – have interwoven themselves into school and education and culture and family dynamics,” says Drury. “They are absorbed like osmosis. And I think you don’t even have to be raised a Catholic for that message to have come through. It’s the insidious stuff that is almost in the body of our country, which impacts our sex lives.”
Drury sees this manifesting in specific ways among Irish clients, including shame around sex and masturbation, feelings around traditional gender roles and a sense of trepidation around pleasure generally. “Sex therapy can be a space to work through those feelings and can be really helpful.”
Support is available
Langan does see great progress, particularly in younger generations who have more education and awareness around ideas of consent, bodily autonomy, pleasure, sex positivity and mental health generally.
“There’s more people in their late teens and 20s coming in because there’s more awareness, and they’re really taking their psychosexual health seriously and realising the impact on general mental health. So they’re aware and confident enough to go to a GP, even if it might be anxiety-provoking, and saying ‘I have a problem with this, I’d like some support’.”
The majority of accredited sex therapists in Ireland are straight cis women and this may feel intimidating or uncomfortable for men seeking support or LGBTQ+ people who would prefer someone within the community. “We have a long way to go in this country,” says Drury, noting the lack of Irish accredited sex therapists who are queer, for example. “We don’t have any therapists currently in Ireland who are trans, or at least that I know of, and, unfortunately, that leaves us with gaps in the ability to support everybody, and that’s not good enough. Changes need to be made.”
Seeing a psychosexual therapist doesn’t mean that there’s something desperately wrong with you, it doesn’t mean your relationship isn’t going to last
It’s important to note that the therapists working in Ireland are trained and qualified in working with all genders, but if potential clients are looking for a male or LGBTQ+ therapist, or someone who has a speciality, many accredited therapists in the UK offer online sessions.
Drury also stresses that you don’t need to be in crisis mode to see a sex therapist. Like other forms of mental health support, sex therapy can be used to help you through difficult times, but also to just improve your relationships with sex or give you tools and exercises to help improve your relationship with yourself and your partner.
“Seeing a psychosexual therapist doesn’t mean that there’s something desperately wrong with you, it doesn’t mean your relationship isn’t going to last, and it doesn’t mean that things can’t be worked through. In fact, reaching out when you feel comfortable rather than when things get really bad is a great way of engaging with a therapist.”
For a list of COSRT accredited sex therapists in Ireland, see sextherapy.ie
