In that day’s sex therapy session, the topic was body hair. But the process was about something else entirely. As we like to say in therapy, it is and isn’t about the content—and with this couple, the content was the heated topic of body hair.
Let me first explain some things. Therapy is about both content and process. Content is the what you talk about while process is how you talk about it. Any good therapist understands that powerful and effective therapy involves toggling between content and process, but ultimately, healing occurs on the process level.

In a recent sex therapy session, the client, a heterosexual couple, asked for some help. They had not had sex in a period of time that felt long for them, and so, while both partners were interested in getting back up on that horse, they both expressed some worries. Worries like: what if it feels awkward (it will and that’s OK and most likely will be short-lived); what if he orgasms sooner than he would like (it’s possible and also OK, so how about prioritizing pleasure over performance); and so many other expectations and hopes and fears.

They also asked for specific guidance on how to give feedback, both positive and negative, to each other. This is not the first time I have been asked this by a client. I file this under “sexual relationship skills” which are necessary for any sexually active adult to know.

There is a curious cultural debate happening now. Let me summarize it like this: when it comes to interpersonal interactions, impact trumps intention. Meaning that, regardless of what Person A’s intention was behind what they said or did, the only thing that matters is how their actions impacted Person B. The reasoning for this, as proponents say, is to prioritize the harmed party's pain and the damage caused. This assumes there is a Victim and a Perpetrator, whereby the Perpetrator is harming the Victim. Advocates say only when you prioritize the painful impact can repair happen.

Myself and most of the couples therapists I know disagree with this. Strongly.​

Sex has been a taboo subject for so long that only in the last few decades has there been an ability to research different aspects of it. Comments abound, such as, “Why would you want to research that?” or on finding grants and funding, “Who is going to fund that?” and even personal attacks on the researcher, “Why would you want to study that?” have been barriers. Thankfully, all this is changing. But sex research can create clinical complications for us sex therapists.

I was asked recently, “How long does it take a woman to orgasm?” And I sighed. Because, while this may appear to be a straightforward question to answer from a sex research perspective, it is not a simple or straightforward question to answer from a sex therapy perspective.

I was reminded of this piece of data recently: that self-identified heterosexual women watch and enjoy lesbian porn yet they do not seem to identify as lesbian, bisexual, or even bi-curious. That watching lesbian porn is not incorporated into the women’s sexual identity and they maintain their (presumed) heterosexuality. And the people around them allow them to watch lesbian porn without challenging their sexual identity or orientation. There have been many articles written about why this may be: that mainstream porn provides for the male gaze and that women are allowed more sexual fluidity are the commonly cited reasons. But I believe this is really just an example of an often-overlooked part of a person’s sexuality: one’s erotic interests.

Dear Wife,
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You discovered your husband’s porn stash, looked at the history on his internet browser, looked at his phone, or otherwise discovered that he is watching porn. And it is porn that you dislike, maybe because you find it off-putting, believe it is demeaning to or exploitative of women, or just plain disgusting. Maybe it depicts sexual activities the two of you have never done or you will not do. So the two of you fought about it. Maybe you called him a sex or porn addict. The whole thing got scary and upsetting. And maybe he has already promised not to watch porn again but you found out he watched porn again. Maybe this is now the fourth or fifth time he has made and broken that promise. Cue more fighting and your demand that he go to therapy.

I do not like the old adage, “Happy wife, happy life." And I know many other couples therapists who feel the same way.
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I realize there is some research from 2014 that supports this idea. Hmph.

What I find troublesome is that we are not looking at why this research supports this adage. What are the couple dynamics at play? How did it come to be that the wife’s emotional state is considered more important than the husband’s? What are the beliefs and values that support this behavior? Where did those beliefs and values come from? How is this working out for both? A deeper dive is necessary. Or, what if the wife has clinical depression? What if the wife is a perfectionist? What if the wife has chronic anxiety? Because in these scenarios, no amount of the husband’s attempts to please her will decrease the effects of those conditions and "make" her happy.

Let me tell you about a very common sexual dynamic I often encounter in my sex therapy practice.
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Many couples have what is known as a desire discrepancy, where one partner has a “higher” desire for sex and the other partner has a “lower” desire for sex. After a certain point, this is the norm and not the exception in most long-term relationships despite whatever happened early on in their relationship.

In graduate school, while studying to become a therapist, I learned that couples fight about predictable issues on which the partners' views differ: parenting, finances, sex, household chores, extended family (like in-laws), and a few scattered other things. I was also taught that while the couple may tell you their fight is about the kids or money or even sex, it’s really about a bigger issue or dynamic, one that’s more subtle and difficult for most couples to identify. Bigger issues can include themes of power and control, autonomy, closeness vs. distance, and boundaries, for example.

It’s only been two weeks since the mass shootings in Atlanta. Let me repeat that: It’s only been two weeks since the mass shootings in Atlanta.
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With the speed of the news cycle being what it is and how news stories seem to quickly come and go, I don’t know about you, but to me, it feels like it was longer than that. But to the family members of the victims, it probably feels like it simultaneously just happened and that it happened a lifetime ago.

Many, many thanks to the readers of the North Bay Bohemian for voting me 2021's Best Sex Therapist in Sonoma County -- for a fourth time.  What a pleasure it is to learn about this during these difficult times.  I hope to continue to support the sex lives of Sonoma County (and beyond -- teletherapy has created a new world for us all) for many years!

​https://bohemian.com/best-of-the-north-bay-2021-romance/

Often when a penis-having person experiences a sexual dysfunction like the inability to get an erection, the inability to maintain an erection, or problems with orgasm, one euphemism we as a society use to sidestep discussing the embarrassing specifics is to say “he/I/they have performance issues" or "performance anxiety.”
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Now, if this person is in a sex therapist’s office (or on a Zoom call with a sex therapist during a global pandemic), that is the cue for the sex therapist to conduct a thorough assessment. Questions like “What do you mean by that?” “Do you have problems with getting an erection? Keeping an erection? Both?” “Do you come when you want to?” “Have you always had this problem during your whole sexual life or is this a recent development?” “Do you have this problem with every partner?” “What have you tried to treat this?” are some of the questions the client should be ready to be asked and answer.

I was reminded recently about a major belief many people have about sex—which is that sex happens spontaneously. “I don't know, it just happens." Shrug.
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When a sex therapy client of mine reveals they have this belief, I generally like to poke around and ask more questions to get a better understanding of this. Common ideas I hear from my clients include thinking the initiation of sex is effortless; that no communication is required—“we both just know we’re ready”—and that it is basically magic when it happens.

I want to discuss an example that is admittedly stereotypically gendered. Bear with me. People of any gender may identify with this.
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For decades, when a couples therapist was working with a heterosexual couple and the issue was sexual in nature where the woman did not want to have sex when the man did, the couples therapist was trained to tell the woman “Don’t have sex when you don’t want to.” So the woman didn’t. She had permission to say no with the support and validation of the couples therapist, the "expert," and without guilt. And what this did was it led to couples becoming engaged in power struggles over sex—whereby the woman was the sexual gatekeeper and controlled when they had sex. The man often felt powerless and then maybe resentful, angry, or emasculated. Sounds just like our patriarchal culture at large, doesn't it?