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Sex therapy is a practical step towards treating and resolving sexual and relationship difficulties

Sex therapy could be just what your libido needs

Sex therapy is a practical step towards treating and resolving sexual and relationship difficulties

Close your eyes for a moment and picture what it would be like to walk into a sex therapist's office. What do you think that appointment is going to look like? It turns out that most people have a lot of different ideas about this, and some of them are completely wrong. For instance, they might think that the therapist is going to have sex with them or that the therapist is going to watch them have sex and take notes on it. This is far from the truth.

Let's talk about sex

While it is notable that discussions about sex are gradually finding their way into dinner table conversations in urban households, these conversations may not always delve into the intricacies of sex and sexuality. But, there is a growing underlying interest in the topic and its significance in maintaining a healthy relationship. This evolving openness to addressing the subject reflects a broader recognition of the importance of healthy and informed discussions about sex in relationships and personal well-being.

Whom do they turn to?

A recent survey on the perceptions and challenges surrounding conversations about sex among Gen Z and millennials reveals some interesting findings. The survey, conducted by the dating platform TrulyMadly, focused on young adults aged 18 to 35 years across both metropolitan and non-metropolitan areas in India.

The survey does stress the fact that both Gen Z and millennials understand the importance of "consent" as a fundamental requirement for engaging in sexual activity. But despite their progressive attitudes, a significant portion of this demographic expresses hesitation when it comes to discussing sex in the context of a serious relationship. Specifically, 59 per cent of Gen Z and 53 per cent of millennials admitted to feeling shy or awkward initiating such conversations.

The taboo surrounding discussions about sex appears to affect women more, with 63 per cent of them indicating that they feel shy or uncomfortable. Nevertheless, 76 per cent of women expressed confidence in purchasing condoms for their partners, suggesting a willingness to take responsibility for sexual health.

Among respondents from non-metro cities, including Bhopal, Indore, Jaipur, and Lucknow, nearly 50 per cent admitted to not fully understanding the implications of Sexually Transmitted Infections (STIs), Sexually Transmitted Diseases (STDs), and Reproductive Tract Infections (RTIs). And around 55 per cent stated that they would rely on friends or the Internet, or resort to self-diagnosis when it comes to addressing sexual or reproductive health concerns.

In the hot seat

Sexuality coach and founder of Get Intimacy, Pallavi Barnwal, believes getting individuals to open up about their sex and sexuality-related issues is the first step in sex therapy. "It can be intimidating and so it's important to assure them that there are safe spaces that support open conversations about sex," she says. 

As a practising sex coach, Barnwal frequently encounters individuals who tend to perceive sex as a purely physical act, devoid of any significant emotional or psychological dimensions. However, they often find themselves perplexed when faced with difficulties in engaging in or abstaining from sex. Responses such as "sex is not a big deal," "you shouldn't discuss these matters with outsiders," or "I've tried, but my partner isn't open to seeking help for sexual issues" are common among her followers who grapple with sexual concerns. "This reluctance to seek assistance stems from a lack of awareness regarding the possibility and necessity of addressing sexual matters. Additionally, those who do opt for help often resort to medical solutions and tests," she says. 

Most individuals  perceive sex as a purely physical act, devoid of any significant emotional  dimensions. Image: Unsplash

Most individuals perceive sex as a purely physical act, devoid of any significant emotional dimensions. Image: Unsplash

Digging deep

In the past two days, Barnwal has had two consecutive clients who exemplify the challenges people face in intimate relationships. One client, a woman, she tells The Established, has been struggling with low libido despite having a loving marriage. Raised in a conservative environment, she was ill-prepared for sexual intimacy, which was exacerbated by misleading advice she received. Her husband's ill-informed remarks regarding the physical aspects of first-time intercourse further added to her distress, causing her to withdraw emotionally. It's worth noting that this client hails from an educated, upper-middle-class background in Hyderabad, with both her parents being doctors, highlighting that sexual inhibitions and societal taboos surrounding sex are not limited to small towns alone. 

"This woman underwent various medical tests, all of which yielded normal results. The crux of her issue lies in the emotional aspect of her relationship, where a lack of emotional intimacy with her partner has contributed to her diminished interest in sex," she says. Another client Barnwal recently worked with faced a similar predicament—a tumultuous, high-conflict marriage led to his inability to achieve an erection with his wife, although he had no such problem when masturbating. His wife suggested taking medication for erectile dysfunction as a quick fix, but he recognised that their constant conflicts was the root cause of his diminished attraction towards her.

There is a growing underlying interest in sex and sexuality  in maintaining a healthy relationship. Image: Pexels

There is a growing underlying interest in sex and sexuality in maintaining a healthy relationship. Image: Pexels

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"Sex is not a big deal," "you shouldn't discuss these matters with outsiders," or "I've tried are popular disses. Image: Pexels

Social conditioning

Human sexuality is an intricately woven tapestry influenced by a myriad of factors—social, psychological, biological, physical, relational, emotional, and even spiritual. This multifaceted nature often goes unnoticed in our society. "Our puritanical values make it challenging for many to accept pleasure as a legitimate human need. While we discuss sexual problems in today's sex education systems, the celebration of the positive aspects of sex remains largely neglected. It's rare to see celebrities, medical professionals, or public figures openly sharing insights into their own sexual lives. Yet, our society harbors a genuine desire for a fulfilling sexual experience," says Barnwal.

Opening up

Growing up in Jaipur, Alisha (who requested to be quoted by her first name only) was encouraged by her mother, who is a practising psychologist, to engage in open and constructive conversations about sex. At times odd but always enlightening, Alisha says her mother would map out strategies with her to enhance desire and arousal within intimate relationships. "My first conversation with her [about sex] was when I turned 18. She knew I would be exploring sex with men and wanted to ensure I had the necessary tools to deal with it," she says.

However, Alisha found it hard to get through to the men she started having sex with. "All they wanted to do was penetrate and release with little to no regard for my pleasure. In my first relationship at 24, I asked the guy if he would consider introducing variations into our sexual routine for mutual pleasure. But, it was always about him. I never orgasmed," she says.

Now, Alisha makes it a point to make her expectations clear when she hooks up with men. "Most of them think I'm being a pain in the butt but I go in knowing what I want. If I don't orgasm, I don't meet the guy again," she says. 

Sexuality encompasses far more than just physical acts. It encompasses one's sexual identity, pleasure, consent, desire, and justice. Image: Unsplash

Sexuality encompasses far more than just physical acts. It encompasses one's sexual identity, pleasure, consent, desire, and justice. Image: Unsplash

In non-metro cities, in India, nearly 50 per cent admitted to not fully understanding the implications of STIs, STDs, and RTIs. Image: Unsplash

In non-metro cities, in India, nearly 50 per cent admitted to not fully understanding the implications of STIs, STDs, and RTIs. Image: Unsplash

We're slowly getting there

Mumbai-born and US-based sexuality educator Kaamna Bhojwani believes, in India, the barriers are multifaceted in accessing sex therapy. "People often struggle to identify where to find qualified sex therapists. The quest to Google ‘sex therapists in my area’ may yield limited results, and individuals may find it challenging to locate trusted and reputable professionals due to the pervasive cultural taboos surrounding sexuality. Discussing the need for a sex therapist with friends is still an emerging practice, unlike seeking recommendations for traditional therapy," she says. 

This separation between sex therapy and general talk therapy or psychotherapy exacerbates the issue. It reinforces the perception that sexual concerns are distinct from broader mental and emotional well-being, further contributing to the stigmatisation of seeking help for such matters, says Bhojwani. 

The right fit

It is also imperative for individuals seeking guidance from psychologists, psychiatrists, therapists, or counselors to ensure that their chosen professionals align with their sexual values. "Suppose a person wants to explore a polyamorous relationship. In that case, it's essential to work with a therapist who respects and understands non-monogamous dynamics, as a mismatch in values can hinder progress," says the content creator. 

Bhojwani has observed a rise in the number of individuals discussing their sexuality within the context of their therapy, counselling, or coaching sessions. This shift, she believes, is a positive development, as it underscores the recognition that sexuality is an integral aspect of our identities. It significantly influences our work, relationships, and overall well-being.

There's been a rise in the number of individuals discussing their sexuality within the context of their therapy, counselling, or coaching sessions

There's been a rise in the number of individuals discussing their sexuality within the context of their therapy, counselling, or coaching sessions

"Sexuality encompasses far more than just physical acts. It encompasses one's sexual identity, expression, sexual orientation, pleasure, consent, desire, safety, and justice. Recognising this broader perspective on sexuality allows for more comprehensive and holistic discussions and support within therapeutic settings," she adds.

Women bear the brunt

According to a study published in the Indian Journal of Community Medicine in 2020, 82 per cent of women who were surveyed had some sort of sexual problems. Also, 64 per cent of women were not comfortable talking about their sexual dysfunction with their partners. And 18 per cent of patients said that they have no sexual problems and were satisfied with their sexual life. However, none of them consulted or took any form of assistance from any medical personnel.

The study also found that 63 per cent women reported desire dysfunction, 77 per cent complained of arousal disorder, 51 per cent had lubrication disorder, 56 per cent had dyspareunia, and 74 per cent had sex-related anxiety. When asked about the sexual frequency, only 4 per cent of women had sex more than ten times in the past month.

The approach

Given the burden women have had to bear in achieving sexual gratification, sex therapy then becomes a conduit for self-healing for them, and a lesson in being more giving for the men involved. 

In her approach to working with clients, Khushi Parikh, who holds a Master's degree in clinical psychology and is an aspiring sex therapist, begins her sessionsby conducting a thorough exploration of the clients’ sexual history. This process involves gathering as much information as possible about subjects' unique sexuality within the context of their lives, including their challenges and aspirations. "I seek to understand their mental and physical health. When assigning homework tasks, I tailor them to the individual's personality and specific needs. During our sessions, we engage in conversations about their desires and struggles within their sex life, aiming to pinpoint their goals and areas of difficulty," she says.

In her role as a coach and counsellor, Parikh says she sets about creating a safe and non-judgmental space for clients to express themselves freely. "Many of them carry years of guilt and shame surrounding their sexual challenges, fearing judgment from others. I facilitate an environment where even the most sensitive and embarrassing concerns can be openly discussed and explored. Sex coaching and therapy often require delving into inner work and uncovering deep-seated vulnerabilities, all within a supportive context," she says.

Parikh employs a three-tiered triangular approach to treatment. The first tier involves permitting clients to be themselves, to engage in masturbation, to explore submissive roles in their relationships, or to navigate challenges like extramarital affairs. "It's remarkable how often individuals resolve their sexual issues simply by receiving this permission, especially when it comes from an expert in the field," she adds.

The second tier focuses on providing information and techniques. "I offer specific guidance, recommend relevant literature, and suggest tailored strategies," she says. The third and final tier involves intensive counseling, particularly when clients are contending with trauma, severe depression, or other mental health issues. In such cases, Parikh makes referrals to mental health professionals.

Parikh likens the field of sexology to fitness, envisioning a scenario in which individuals regularly engage with a sexologist for a "checkup," much like they would visit a gym, yoga studio, or sports centre under expert guidance. Ideally, everyone would have access to a sex coach or therapist with whom they can discuss sexual issues openly. "Recognising that changes in sexual behaviour can serve as coping mechanisms, similar to self-injury or bingeing, it's crucial to reach out to a professional when these behaviours begin to shift, whether it's avoiding or excessively seeking out sexual experiences, as these may be indicative of underlying issues that need to be addressed," she says. 

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