How Sex Therapy Can Help Common Sexual Disorders

By: Theresa Callard-Moore, Ph.D. • Posted on February 22, 2024

What is sex therapy?

Sex therapy is a type of brief intensive talk therapy with an individual or couple that can address medical, psychological, personal or interpersonal issues effecting sexual health and satisfaction. Sex therapy is provided by a licensed clinical social worker, psychiatrist, marriage and family therapist, or psychologist who has been trained and certified to provide sexual health counseling services as well as other mental health services. Sex therapy is a mental health service and never includes direct touching or sexual activity.

What can sex therapy do for me?

Here are some examples of when to see a sex therapist.

When you have any concerns that your thoughts, your body, or your sexual behaviors are not “normal,” and it interferes with your self-esteem or relationships. (You are normal, and we want you to feel confident and comfortable with yourself!)
If you are feeling overwhelmed by the medical issues you are having and need support in integrating your doctor’s recommendations into your daily living and sexual relationships.
Are you having difficulty finding pleasure or becoming orgasmic? Do you have painful intercourse? Are your medications causing sexual side effects? We may be able to help you.
Have you had a life transition such as giving birth or starting menopause that is causing changes in your sexual desires and responses?
If you have a desire discrepancy with your partner and want to work on your connection.
If your partner has any sexual health issues such as low desire, erectile dysfunction (ED), or premature ejaculation along with your medical concerns, it can feel overwhelming to overcome that and stay connected.
If you are a survivor of sexual abuse and/or sexual assault and it is affecting your ability to connect and feel safe. This can affect your ability to relax and experience pleasure with yourself or your partner.
Sexual issues often co-occur with mental health issues such as anxiety, depression, PTSD, etc. Sex therapists can address those issues while addressing your sexual health concerns.

Common sexual disorders

Female orgasmic disorder
Female sexual interest/arousal disorder
Genito-pelvic pain/penetration disorder
Delayed ejaculation
Erectile disorder
Male hypoactive sexual desire disorder
Substance/medication induced sexual dysfunction
Out of control sexual behaviors (frequently called sex addiction)

My role as a sex therapist is like a bridge-builder. I take you from where you are and build a bridge to your goals. We work creatively together to achieve your sexual health goals. Those goals might be to find a balance with sexual activity with your partner or to overcome a medical condition and still have pleasure.

The following are common questions and concerns that I hear from my patients who have limitations on their ability to be sexual.

I don’t have enough blood flow to the clitoris.

There are suction devices for clitoris - they are not vibrators, but may help bring blood to the area. This may help the tissues in those who have had radiation therapy. The Eros device is FDA approved.

I have physical limitations to holding a sex toy.

Eva may be hands free. It sits around the clitoris, and your labia may be able to keep it in the right spot for it to stay in place during intercourse. But every vulva is different, so it may not stay in place depending on the person.

A great resource is Ergoerotics for things like a hand harness glove that can hold your sexual device if you are unable to grip it. They also have a thigh harness to hold your toys on your leg for your partner's enjoyment.

You may also want to check out the Vibrating Finger Glove, Flexa Pleasure, Mini Discrete Butterfly on Amazon.

I have pain with deep penetration.

You may want to try an OhNut ring, it is placed on the penis or toy to prevent it from going too deep.

I can’t find a comfortable position.

The Network of Care website is a good resource older adults or people with disabilities. They offer Love Bumpers and other types of pillows for support.

Can a sex toy help with my pelvic pain?

Mysteryvibe are flexible products that can penetrate you in different ways. You may want to consider Crescendo 2 for pelvic pain. They also have male products to help with erectile dysfunction.

It hurts to have intercourse, or it feels like my vagina is not stretching.

Your doctor, sex therapist, or pelvic floor physical therapist may have suggested that you use dilators. Dilators are plastic or silicone cylinders that are rounded on one end and come in several sizes. The smallest size is about the same size as a tampon or large finger. They are used to stretch the vaginal or anal tissue slowly and gently. When using dilators, you will always have to use lubricants.

Overview on how to use dilators from the Cleveland Clinic:

Start with Your mindset: Think about your goals and how using a dilator will help yourself feel better, just like exercising. This is not a pleasurable activity (until we can get pleasure back into this process). This is homework for your body, no different then if you hurt your hand and had to squeeze a stress ball 20 times a day.
Find a Safe Place: Carve out time for yourself and a private space to do dilator therapy. The bedroom is the most common space. You may want to lock the door, so you are not interrupted. This way you can use the dilator while lying down. Plan for 10-15 minutes a day, four to five times a week. Start with what you feel comfortable with. This may be a long-term exercise for your vulva/anus. Building it into a routine will help you in the long run.
You will need a mirror: We recommend using a mirror to look at the vulva and the vaginal opening. This is good to do for everyone, so that you can be familiar with your body and notice any changes that you would like to talk to your doctor about. Locate the labia or lips, the clitoris, the opening to the urethra, and the openings of the vagina and rectum.
Beginning with Dilators: Use a small amount of lubrication on the dilator. Tense and relax the pelvic floor muscles a few times. When you are in the “relax” phase of the exercise, insert the smallest dilator that you have purchased. Try to lean it in different directions, up, down, side to side as you slowly enter 1-2 inches. The important part of this is that you are in control of how fast you move or if you move at all.
Notice how you are feeling: Do you feel pressure, stretching, ache, or it seems okay? Notice your breathing. If you are tense and breathing is shallow, stop and try to relax while leaving the dilator in place. That may be all you do that day for 10 minutes or you could push in further and see how that feels.
If you have sharp pain - STOP! Dilator therapy won’t be effective if you are in pain. Check with your healthcare provider who is supervising your dilator therapy. You may benefit from further physical therapy techniques or possibly a numbing cream.
Give yourself some time: Leave the dilator in for 10 to 20 minutes. Remember, this is not combined with sexual pleasure yet, so you can read or watch tv. On the same note, we recommend you stay in touch with what you are feeling so that you can monitor when it is time to use a larger dilator.
Change dilator size: When you can effortlessly insert the dilator, it may be time to choose a larger size. When you think you are ready, use the size that you know is comfortable for a few minutes, then use lubrication on the larger one and start with only entering in 1-2 inches, moving up, down, side to side. Remember to breath and relax.
Cleaning your dilator: Dilators can be cleaned with soap and water, make sure they are rinsed thoroughly.

How do you buy a set of dilators?

Amazon
Soul Source
Intimate Rose
Milli expanding dilator is a size adjustable dilator which also vibrates, it expands 1mm at a time for women to have a narrow vagina.

If you have any questions, please ask your doctor or sex therapist for more information. This column is intended to help you be an informed consumer, it is not meant to recommend or endorse any specific product. I want you to be informed about your sexual health choices so that you can have a positive sexual experience. Stay tuned for more of my sex therapy guest columns.

Be Strong! Be Healthy! Be in Charge!
By: Theresa Callard-Moore, Ph.D., Sexual Health Specialist, Cleveland Clinic
Certified Sex Therapist and Certified Sex Addiction Therapist
Appointments: 216-444-6601

Theresa Callard-Moore, Ph.D. is a Sexual Health Specialist in the Obstetrics and Gynecology Department at Cleveland Clinic. Dr. Callard-Moore received her undergraduate degree in Social Work from Barry University in Miami Shores, Florida and her Masters and Ph.D. in Sexology from Modern Sex Therapy Institutes in Florida. To make an appointment with Dr. Callard-Moore, please call 216-444-6601.

women's health, sexual health, sex therapy, menopause, birth, anxiety, depression, sexual disorder

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