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AAMFT Therapy Topic

Sexual Health

How long will my lack of interest in sex last? Is masturbation normal? How can I keep sex interesting? Are there other ways to reach orgasm? How will my sex life change as I grow older? While the stereotype is that most of us learned about “the birds and bees” during an awkward conversation with our parents, the reality is most sexual education comes from a variety of other sources—unspoken messages about sex, formal classrooms, peers, and personal experience. But how much information is accurate? And does anyone really know anything about sexual health?

Being sexually healthy can mean many things. For some, it can mean being free from sexually transmitted diseases. It may include having a positive attitude about sexuality and being able to talk about it with your partner. Still, for others, it means being knowledgeable about factors that contribute to sexual health and working to control those factors in one’s life. In short, being sexually healthy implies a certain level of physical and emotional well-being, including being satisfied in your relationship and having a healthy, safe, and active sex life.

Effect on Couples and Families

Because sexual health encompasses both physical and emotional well-being, problems with sexual health can significantly disrupt normal functioning for an individual, partner, and the family. For example, issues in a relationship such as power imbalances, resentment, and anger can reduce how much desire one has for his or her partner. Communication problems within a relationship and an inability to talk about how to meet sexual needs can also impact a couple’s ability to be sexually healthy. Couples also may fear being close to one another, which will also reduce their desire. Further, relationships that are not sexually healthy may unwittingly communicate a negative message about sex to other members of the family, such as “sex is bad,” or “sex is something that should not be discussed.” Such messages can impair the future generation’s ability to enjoy sexual health without guilt and shame. Further, negative attitudes and models in our culture also influence one’s view of a sexual problem, and these attitudes can unknowingly be communicated to your partner or other family members if sex is not discussed or is viewed as shameful. Negative views create an environment where sexual issues are difficult to discuss with others without shame or embarrassment, and can potentially lead to a feeling of greater isolation by the individual or couple.

In relationships where couples do not openly communicate about sex, the effects can devastate the relationship. Sexual problems cannot be swept under the rug without negative emotional consequences, nor do they just disappear like the common cold. Unfortunately, we know that the vast majority of couples do not seek help. Several reasons people avoid getting help include: hoping the problem will resolve or disappear after time; a sense of stigma or embarrassment that they are the only one’s with the problem; having low sexual expectations; feeling hopeless about the problem and being skeptical that therapy can help; simply being unable to identify a problem as a problem (men with premature ejaculation often think it is normal); and having difficulty finding a marriage and family therapist who is credentialed in sex therapy and is affordable.

Signs of a Sexual Health Problem

The signs of the deterioration of sexual health are often subtle because of the embarrassment one might experience in calling attention to the symptoms. For example, an individual may notice symptoms, such as loss of desire or an inability to achieve orgasm, but these will be personal and not necessarily noticed or shared by one’s partner. Further, the individual experiencing the symptom may try to explain it away, perhaps attributing the cause to acute stress, recent developments within the couple’s relationship, or aging and other biological changes.

Common sexual concerns include:
  1. For men
    • Trouble achieving and maintaining an erection
    • Delayed ejaculation (which can cause relationship disappointment and distress)
  2. For women
    • Trouble reaching orgasm
    • Pain during intercourse
    • Lack of desire

Other signs of deterioration have to do with the couple’s relationship. These signs may include discord around choosing a time to have sex that is convenient for both partners; approaching your partner indirectly or roughly; not communicating adequately or being clear about your request; being sexually inhibited; and too little foreplay and afterplay.

Seeking Help

In identifying when to seek help, one suggestion is to seek help as soon as you notice a concern. Because a sexual relationship is embedded within a couple’s overall relationship, problems with sex can cause and be caused by other relationship problems. Left unattended, a relationship can slowly begin to erode. You can also seek help if any of the following conditions are present:

  • Unhappiness with how often sex occurs
  • Problems achieving or keeping an erection
  • Inability to delay ejaculation until both partners have had their needs met
  • Inability to experience an orgasm (either with your current partner or any partner) or are unhappy with orgasms you have
  • Pain during intercourse
  • Fear of developing an intimate, close relationship with your partner
  • Lack of desire to engage in sexual activity
  • Unexplained change in your sexual needs/behaviors

Creating a positive sexual environment is based on sharing emotions, affection, and being with each other in a way that allows for sexual feeling to emerge. While there are a host of interventions that therapists use to improve a couple’s sexual health, there are several basic ones. The first is education. Comprehensive sex education has been shown to have a number of benefits, such as improved self-image, comfort with sexuality, open communication with parents and others, and avoidance of risky sexual behaviors that can lead to pregnancy and sexually transmitted infections (STIs). Effective human sexuality education has many purposes. Good education about sexual health includes: scientific information, fostering positive attitudes, values, and insights, teaching relationship and interpersonal skills, and how to assume sexual responsibility. A positive sexual attitude would help one develop positive feelings about body parts, experiments with appropriate sexual self exploration, and is free of sexual inhibitions later in life that impede having healthy sex.

Achieving healthy sexuality in the couple relationship could refer to each partner assuming mutual responsibility for his or her sexuality, being well-informed and educating oneself through a variety of books, classes, and Web sites, being able to communicate openly and spontaneously, being open to sexual pleasure and exploration, and having a sense of passion and sexual desire. Of course, these elements are based on the fact that the couple has a relatively healthy relationship in general and is in fairly good health. When relationship discord does exist, it is important that the couple attend to these issues in order to address the impact on specific sexual areas of their life.

Couples wanting to have a healthy sexual relationship must work to maintain it. The good news is that marriage and family therapists who are credentialed in sex therapy are familiar with a wide variety of sexual problems and can effectively help the couple resolve the problem in a relatively short period of time (with the exception of desire problems, which can take longer). A good therapist will conduct a thorough assessment and work to identify all the factors contributing to a couple’s sexual problem without placing blame, engaging both partners in treatment, and engendering hope. In addition, because sexual problems rarely occur in isolation from other relationship issues, the marriage and family therapist can assist the couple with the general issues first before moving on to the specific sexual issues.

This text was written by Katherine M. Hertlein, PhD and Gerald R. Weeks, PhD.

Locate a Therapist in your area.
Use the AAMFT Consumer Update "Sexual Health" pamphlets to market your practice.



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Online Resources

  • Loving You: A user-friendly Web site that offers resources, date night ideas, discussion boards, and other ways to enrich relationships and enhance sexual communication.
  • "Better Sex" Videos by the Sinclair Intimacy Institute: Serves to increase sexual knowledge while heightening pleasure and intimacy, featuring real couples and leading sex experts.

This fall AAMFT members will be sharing their unique perspectives, knowledge, and research findings in a crowdsourced effort to update our Therapy Topics. Check out the September 8 eNews for more information on how you can be involved!

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