On the sacred Greek island of Delos, birthplace of the twin queer gods Artemis and Apollo
Photo: Otis Charles, 2006
SEX THERAPY
Sex therapy is caring for the sexual health and erotic well being of another by a qualified provider,
through the use of talk and communication. Sex therapy often includes sexual homework assign-
ments for the client to do later in the privacy of their own home.
I am certified by AASECT (American Association of Sex Educators, Counselors & Therapists)
as a Sex Therapist, a Sex Educator and as a Supervisor for sex therapy interns. There is no state
licensing in California of sex therapists. Anyone can claim that they are a sex therapist, but only
AASECT certifies appropriate candidates who have undertaken proper training. Consumer beware.
There are well-meaning therapists who just don't know jack. If they can't tell you what the PLISSIT
model is, a SAR, or sensate focus, then I would recommend moving on. There are some licensed
psychotherapists who are not AASECT certified, but still do a first rate job of sex therapy, such as
Jack Morin in San Francisco.
Sexology, like sexuality, is complex and multidimensional. Sexological research indicates that there
are many differing ways in which Americans approach sex, talk about sex, behave sexually, and
conceive of sexuality. African Americans often reach menarche (first menstruation) and experience
coital debut (first partnered sex) at earlier ages than Asian Americans. Most wives think looking at
porn is cheating,and most husbands don't think it's cheating. The citizens of Utah consume more
porn per capita than any other state. The work of sex therapy is complex, and must be inclusive in
its awareness of the interplay between medicine, biology and physiology, psychology, culture,
environment, and individual interpersonal relationship dynamics.
Sex therapy is sometimes performed as an adjunct to psychotherapy. In these cases, it will be to your advantage for me to consult with your primary psychotherapist.
It might be therapeutically advantageous for you to bring into session a significant sex partner to be a part of the treatment. Depending on your situation, I may suggest that you be treated by (and/or I consult with your existing) psychiatrist, physician, urologist, gynecologist, surrogate partner or sacred intimate, or persons of faith.
There is no guarantee that sex therapy will solve your problems. Sometimes fantasies are better left fantasies, and sometimes sex problems are better left unresolved. Or maybe thought of in a more positive frame. Sometimes there simply is no cure, no treatment known that works. I will let you know all that I know.
Clients:
In sex therapy I've worked with clients of every gender, religion and ethnicity mentioned in the Psychotherapy section. Some sex therapy patients are in relationships, some single. I've worked with all ages from kids to geriatrics. My very very first patient as an intern was a seven year old boy, and within a few minutes he said to me, "Dr. Wilde, I have sex problems." And he certainly did. I've worked with blind people and persons with cerebral palsy, hearing impairments, and Tourette's.
Some of my practice consists of caring for persons with specific sexuality issues. These could be:
body function problems
behavioral struggles
relational concerns
desire issues
Presenting Concerns:
Some clients have genital pain during sexual activity, some have a loss of sex drive or sexual desire. Others may have trouble with erections or lubrication, ability to orgasm when wanted, or may be hooked on one particular thing in order to reach orgasm. Maybe you've never had an orgasm. Some folks worry they're a sex addict. Or a love addict. Sometimes people see me because their spouse says, There's something wrong with you. Others may worry that they're not normal: in their fantasies, behaviors, or genitalia. Clients may have a special concern---a secret for years---which they feel compelled to finally address.
I welcome all inquiries: nothing is too out-there for me. I'm the out-there guy.
Body function problems:
rapid ejaculation
delayed orgasm
genital pain (dyspareunia)
genital spasm (vaginismus)
incontinence
Behavioral struggles
impulse control
masturbation habits
performance anxiety
attraction to danger
unwanted attraction(s)
fear of incompetence
distraction during sex
Relational concerns
negotiating non-monogamy
managing jealousy
love/lust split
troublesome turn-on's
attachment style conflicts
protocol concerns
Desire issues
loss of desire
unwanted desires
too much desire
Style:
The first session is usually a consultation that is one hour and twenty minutes at a fee of $250. I'm perfectly okay with you coming in to see me for only this one consultation visit. We discuss the client's presenting problem, and co-factors that may be playing a role in the sexuality concern. In the style of Masters and Johnson, I may take a brief sex history of the client. I give an assessment of the situation, possibly a diagnosis, and a preliminary treatment plan suggestion.
Sometimes one session is enough. A couple came to me upset that sex had been wonderful and fulfilling until about half a year earlier when the wife seemed to have lost interest in sex completely. Turns out she was also put on an SSRI (anti-depressant) six months earlier. I recommended that she ask her prescribing doctor to switch her to Wellbutrin, a non-SSRI anti-depressant with little-to-no sexual side effects. Most prescribing physicians do not discuss sexual side effects with their patients, especially female patients. In this case, one session of consultation was enough.
Cognitive Behavioral methods of psychotherapy sometimes work for some sexuality issues, such as rapid ejaculation and vaginismus. These body function concerns usually take only a few months of treatment, and have a high success rate.
Some behavioral struggles are:
masturbatory conditioning
compulsive sexual behavior
illegal attractions
dangerous attractions
These behavioral struggles may require more in depth work, and vary in length of treatment depending on the particular struggle being addressed, the client's motivation and diligence, DNA, evolution and luck.
Fair warning: I read the research from a half dozen leading peer-reviewed sexology journals, and I tell you the facts as they are scientifically known to date. This may not be what you want to hear. For example, if you have been married for 50 years and haven't had sex for the last 30 years, then you and your spouse will probably never have epic sex experiences again. And not because you can't do it at 70, but due to historical relational factors. Most clients appreciate the honesty. I feel it's ethically imperative to share the scientific information at my disposal, even if it means there's not much hope for a specific outcome the client may desire.
Sometimes I will assess that what is presented as a sex therapy issue is really a relational issue, or a personality challenge, and will then recommend psychotherapy.