Ann Arbor therapist offers counseling, helping clients achieve satisfying life.

Counseling for Individuals and Couples

Category: sexual health /sex therapy

Vaginismus – the unspoken sexual dysfunction.

Vaginnisums is the term used for a condition that affects a woman’s ability to engaged in any form of vaginal penetration. This includes not only intercourse, but also use of tampons, or getting routine gynecological examination. The vaginal muscle becomes spastic in an involuntary way, which makes any penetration either very painful or impossible. (From Wikipedia).
People tend to believe that with the sexual revolution, and the widely available knowledge about sexuality, this kind of dysfunction no longer exists.  This is not the case; I have come across the condition several times in my practice just in the last year.

We do not hear about the condition, possibly because  of shame or maybe because there is no pharmacological  solution available, so there are no ads  from the  pharmaceutical companies.
However, the good news is that it is quite easily treatable. All the women that I have seen with this condition, and that have persisted with treatment, succeeded in overcoming their issue and were able to have an enjoyable sex life.
The treatment consists in learning to relax the pelvic floor and vaginal muscles, and using dilators in increasing size to learn how to get used to penetration.
You can buy the dilators with instructions on the internet. It is highly advisable to see physical therapists that specialize in pelvic floor.  In my vicinity, you can find qualified physical therapists at the University of Michigan health center. . If the issue has already created stress in the relationship and secondary emotional issues, it is important to consult a qualified sex therapist.

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Premature Ejaculation – Sex Therapy

First it may be useful to define what premature ejaculation is. Although it may seem self explanatory, one problem may be that you or your partner’s expectation of sexual stamina, often nurtured by popular culture, are unrealistic.

Usually, premature ejaculation is diagnosed when a man frequently  ejaculates sooner during intercourse than he or his partner wishes, either  before penetration or shortly after.

If you do suffer from premature ejaculation there are behavioral approaches to the problem and medication. While medication, such as SSRI, may help – they  are effective only while being taken. Once you stop taking the medication the effect also passes. The other downside of taking these medications is that you will need to cope with their side effects. This is why it is better to start with the behavioral methods rather than start with medication. Those can be added later if needed.

Contrary to common beliefs the behavioral approach does not involve either mental numbing, such as distracting yourself from the sensations, or physical numbing with some form of  numbing cream. Somewhat surprisingly, the most successful approaches involve heightening your awareness to your physical sensations, while maintaining physical relaxation. Only by increased awareness and mindfulness, you can learn to regulate better your arousal level, and hence your ejaculation.

These two  self help books teach the basic sex therapy techniques for dealing with this problem.
How to Overcome Premature Ejaculation by Helen Kaplan

Coping With Premature Ejaculation: How to Overcome PE, Please Your Partner & Have Great Sex by Dr. McCarthy and Michael Metz.

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Low Sexual Desire – Women

One of the most common reason that women and couples seek sexual counseling is the women’s low sexual desire.

Surprisingly enough, many times the cause is the birth control pill. If you are on the pill, and you suffer  from low sexual desire, try to switch to a different birth control method, that does not involve hormones. You may want to consult your OB/GYN practitioner, or go to Planned Parenthood. Often the counselor at Planned Parenthood will dedicate more time to hear your concerns, and may suggest a wider selection of options to choose from. Be aware that it may take several months for your body to recover.

There are many other causes for  low sexual desire. But this one is relatively easy to eliminate.

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2 books on sexuality, recommended for women

If you have any concerns regarding your sexual health, or you want to learn more about your body and sexuality, start  from this book:
Sex Matters for Women: A Complete Guide to Taking Care of Your Sexual Self by Sallie Foley and Sally Kope.

Another option is the old and reliable book written by a group of women:
Our Bodies, Ourselves.

This book grew larger and heavier with each new edition. Now it is a website:

Our Bodies ourselves today.

 

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Body Image

Recommended book:
The Body Image Workbook: An Eight-Step Program for Learning to Like Your Looks by Thomas Cash
body image is a major concern and source of depression for women, and sometimes men. Women always seem to think that their body is not “right”. It is either too fat, too thin, not fit enough, or not according to Barby’s model. Many women do not let themselves live until they get to their “ideal” weight, which means they let their life pass by.  This dissatisfaction with their body is a major cause for low sexual desire for women.

This workbook is designed to help people accept and love their own body, just as it is now.

Strangely enough, once people accept their own body, they tend to lose weight more easily often reaching their  optimal weight, according to their body type, which may be far from their original idealized image.Facebookmail