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?

​Well well well. 2020 just keeps throwing us all curveballs, doesn’t it? Last week, Pope Francis said the following about sex and sexual pleasure:

“Pleasure arrives directly from God. It is neither Catholic nor Christian nor anything else; it is simply    divine,” Francis reportedly explained. “The pleasure of eating and sexual pleasure come from God.”

Now I know that the Catholic church is not without criticism when it comes to their harmful doctrines about human sexuality. And I also know that the pope’s comment may not be relevant to many of you. But I want to give it a little air, so bear with me.

Every week it seems I encounter some harmful message from the culture at large about sex that my clients have internalized. It is these harmful messages that contribute to their sexual dysfunction or their troubled sexual relationships or their outright sexual avoidance. Lately, I have been focusing on the one about who is responsible for what in a sexual encounter and the gendered politics involved in it. Let’s dive in.
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Based on what this client was processing, I recently told a male client in his individual therapy session: “Your erection is not your girlfriend’s responsibility.” He then took a deep breath, paused, and bravely admitted that was painful to hear. (Hooray for honesty!)

Like actor Leslie Jordan often says on his Instagram Live videos, “How y’all doin’, my fellow hunker downers?” Seems like a good time to check in with my readers.
I am four months into doing video sessions, aka telehealth, with my clients. I quickly (and painfully) converted my sex therapy practice back in mid-March when the first cases of COVID-19 were medically confirmed in my community and we knew so little about this virus. I now continue doing teletherapy because we know more about the virus and it appears in-person psychotherapy, and all that it entails, is a higher-risk activity.

We are finding ourselves in a horrible combination: fears about an unseeable contagion plus the need to socially and physically isolate from others.  This is a brutal mixture for many because we often turn to other people to help lessen our anxiety: socializing with friends, going church or temple, time out in the world at restaurants, bar, clubs, shopping, and of course partnered sex.  Most of those options are, for now, not possible, with the exception of sex (as long as you live with your sexual partner[s]).  So where does that leave you and your libido?


Everyone is having different experiences when it comes to the impact of this moment in time on their libidos.  Some, in the face of all this, are reporting that their libidos are increasing while others are reporting a decline or as someone described it to me “it's like it’s dropped off a cliff”.
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You hear the phrase, “sex is natural," and variations of it quite a lot. This is a claim many people and institutions make. This argument is often used to justify certain sexual behavior—and its inverse, that a particular sexual behavior is "not natural,” is often used to condemn other sexual behavior. This is a confusing concept, clearly open to all sorts of interpretations, if my Google search results are any measure of the English-speaking human psyche.
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When people say sex is natural or that certain types of sex are natural, I honestly do not understand what they are trying to communicate. What do they mean by “sex”? What do they mean by “natural”? Do they mean it is involuntary, like breathing? That we just inherently know about the birds and the bees? That we know how to have good sex and healthy sexual relationships? All this, you and I know, is not true.

Whenever something changes in my clients’ sex lives that they do not want, do not like, or are not asking for, I often hear a statement like, “I didn’t sign up for this.”

It is fascinating to me when clients express the expectation that the aspect of their sex life that is changing would stay the same forever. There is this romantic idea of “growing old together” that many couples say they want and look forward to. I have heard something about “rocking chairs on the porch.” Sounds sweet. But nowhere in that idealistic notion are the realities of life. Things change in life and sometimes not for the better. Your health changes. Your body changes. Your stressors change. Relationships change us. Having kids changes us. Aging changes us. Loss changes us.
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Like fish swimming in water, we are swimming in sexual shame to the point where most of the time we are utterly oblivious to it.  No one is immune from sexual shame, not even medical and mental health professionals, and it can even happen within or by institutions.  Sometimes a person’s sexual shame is so ingrained and feels so much a part of their deepest self that they simply cannot imagine themselves without their shame.  Sexual shame is so ubiquitous that when someone or something does not evoke sexual shame and is actually “sex positive”, it can be a shock to the system and cause reactivity like discomfort, anxiety or fear, judgment, anger, threats, and sometimes even violence.  All of us have seen this before.  It's a difficult topic for many.  So let’s pause, take a breath, and look at shame more closely.
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