Being nearly 10 years in practice, over the last decade, I have been able to identify some common barriers to good sex within relationships. Here is a brief blog on some common barriers I have found. If you have some of these barriers, it’s important to do the work to remove them or help limit the effects that these barriers have on your sex life.
Trauma
Unresolved and/or complex trauma is a huge barrier to good sex. It’s also a barrier to general happiness and satisfaction in life and can be one of the main sources of anxiety, depression, and other mental health concerns. And any type of trauma (even if it is not sexual) can impact your sex life.
Grief and Loss
I see grief and loss as one of the main causes of sexual functioning concerns and sexual disatisfaction in a persons life. Whether active or unresolved, grief and loss appears to directly affect the sexual functioning system and it would be worth the time to resolve and do work around this.
Fear
Fear of anything, nothing, and/or everything can create a barriers to good sex. We live in a fear based society and fear is instilled inside of us from a very early age. Fear greatly affects our ability to feel safe with ourselves and partners and in the world and can be huge barriers to good sex.
Lack of Knowledge
Most people don’t feel super knowledgeable about sex and a lack of knowledge about sex can be a barrier of good sex. I encourage my clients to be “students of sex”, lifelong learners, recognizing that there is no ceiling on how much one can learn about sex. I will never stop learning about sex, and I sometimes feel like there is so much to learn about sex I will never learn it all, and this is MY profession! Sex is an never-ending journey- an EXCITING never-ending journey. Buckle up and enjoy the ride!
Lack of Experience
Experience doesn’t mean competence, but our culture often values more experience as being more competent. Lack of experience can often create a barrier to good sex, but it doesn’t have to. As mentioned above, we are lifelong students of sex. Since we have our whole lives to learn about sex, experience is all relative and quantity is not more important than quality.
Low Sexual Self Confidence
Self-esteem and self-confidence is a huge contributor to whether sex is good or not, and if you have low sexual self confidence and low sexual self-esteem, it can be a great barrier to good sex.
Body Image Issues
I generally believe that you have to feel pretty good about your body in order to want to share it with someone else. If someone doesn’t feel good about their body, they often don’t feel like sharing it with others. Body image issues can be huge barriers to good sex.
Closed Mindedness
The most common way I see closed mindness coming up is when people think that they know what sex is supposed to be like, or what their partner is supposed to be like or like. It’s this closed mindedness to the individuality and nuances of sexuality that prevents good sex from happening.
Perfectionism
Human beings and SEX is imperfect. Having a perfectionistic attitude toward life and sex is a HUGE barrier to good sex.
Marijuana and Sex: My General Thoughts on Therapeutic Cannabis for Sexual Functioning
This November, Maine and Massachusetts, two of the states that I provide online sex therapy to their residents, pass laws legalizing recreational marijuana for consumers over the age of 21 (making the laws similar to alcohol consumption).
I have long had many thoughts about the therapeutic use of marijuana/cannabis/THC for certain sexual functions in certain people but haven’t really had the science or empirical proof to back up anecdotal reports. But as we start to move into a new era around the use of marijuana, I just want to make a general statement that marijuana is worth researching on its negative and POSITIVE effects for some sexual functioning concerns. That’s right, positive.
That isn’t a general statement that I want everyone to think to just use marijuana for sex. That isn’t what I am saying at all, because some usage can actually harm sexual functioning. But for certain sexual functions, it has been reported that therapeutic cannabis actually do a lot of good. But there are a lot of factors, like type of marijuana, dosage, routes of transmission, etc. and sometimes the costs are not worth the benefits.
I particularly like some of the sex specific products that are being developed, such as lube with THC infused in it, so the route of transmission is vaginally or anally. And for certain issues (like desire, performance anxiety, and pre-orgasmia in women) it has been reported that marijuana has really helped in improving the negative symptoms of these issues.
But like with anything that could be harmful or helpful, or a little bit of both, I like to talk to my clients about staying within the boundaries and balance of what is legal, moral, and ethical and when the benefits outweigh the risks. We discuss manageable use, just as we would discuss if we were to use any substance for sexual functioning.
Want to talk about this more? Email me at the contact information below and we can set up an appointment.
“FOOD IS MEDICINE” says Dr. Michael Lara, a physician in private practice from San Francisco in his seminar on “The Pharmacy in Your Kitchen: An Overview of Medical and Medicinal Food”.
“Let food by thy medicine and medicine be thy food” – Hippocrates
The content in this blog is based on information gathered from the above titled seminar that took place on Thursday February 18, 2016. Most of the information presented in this blog was acquired from the presentation and accompanying materials. If you have any questions about what is written here, please feel free to contact me directly or connect with Dr.Michael Lara through Facebook: www.Facebook.com/BrainMD and his website: www.drmikelara.com.
Please be sure to check with a qualified health professional before implementing any medical or medicinal food protocol. Food is medicine and also has a potential to harm. It’s important to include your health care provider(s) in the conversation to keep you safe and maximize benefit.
87% of Americans believe that certain foods have health benefits that go beyond basic nutrition. But most doctors and physicians don’t think of medical foods when discussing health concerns and treatment options with their patients. I signed up for the seminar to see what the options are out there for my clients when dealing with sexual concerns as well as other health conditions, like depression, insomnia, and chronic pain.
What is a medical food? The FDA defines Medical Food as “A food which is formulated to be consumed or administered enterally through the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”
Medical foods aren’t regular foods, but rather the dietary products formulated for the management of diseases for which specific nutritional requirements have been established. They aren’t drugs or dietary supplements and are monitored separately by the FDA. All efficacy claims for medical foods must be based on recognized scientific principles and clinical data and medical foods may be used only under medical supervision (but may or may not require a prescription).
Medical foods are different than supplements and drugs, and are regulated by the FDA.
The purpose of this blog is to discuss the use of medical and medicinal foods in relation to sexual functioning as well as other conditions that my clients present with.
Medical Foods and Mechanisms of Actions
Medical foods affect three mechanism of actions: neurotransmitters, inflammation, and nutrient metabolism. While much of the research presented deal with conditions related to diseases such as Alzheimers, osteoarthritis, and insulin resistance, medical foods also address sleep issues, depression, pain, inflammation, chronic pain, neuropathy, and metabolic issues.
The mechanism of action that I found very interesting and relevant was medical foods that alter neurotransmitter levels. One of the biggest challenges I have as a sex therapist is working with clients who have various mental health concerns such as anxiety and depression who take psychopharmaceuticals to address the anxiety and depression. They often present with sexual issues related to the anxiety and depression AND/OR the side effects related to taking psychopharmaceuticals to treat the anxiety of depression. We sometimes feel very stuck when trying to address the sexual issues while at the same time effectively managing the anxiety, depression, or other health concern.
Medical Foods and Depression
Medical foods that affect neurotransmitters can offer options to address depression without the side effects to sexual functioning.
Deplin (L-Methylfolate) is a medical food for patients with treatment-resistant depression. While Deplin may require a prescription, L-Methylfolate can be purchased over the counter. L-Methylfolate improves depression and reduces markers of inflammation. And even more interesting is that there are tests that can be done (and more and more mainstream doctors are having patients have these tests) that can tell you whether you are deficient in some of these areas. Dr. Lara recommends the company 23 and Me for genetic testing to see if you have deficiencies in areas that could benefit from targeted treatment based on the results. .
Dr. Lara presented extensively on curcumin (found in spice tumeric and mustard) which can have anti-depressant effects via MAO Inhibition as well as other positive benefits.
Medical Foods and Sleep Issues
MANY of my clients struggle with sleep issues, and medical foods might provide an alternative to sleep medications that might have unpleasant side effects, be highly addictive, quickly increase tolerance, and diminish the quality of your general sleep. A medical food that may work on sleep issues through acting on neurotransmitters is Gabadone.
Medical Foods and Sexual Functioning
While I wish Dr. Lara spent more time discussing the benefits of medical foods for sexual functioning (even if just periphery, like, how a medical food can reduce inflammation, possibly inflammation in the genital region due to issues that cause sexual pain, or how medical foods can affect the neuropathy of sexual organs), he did spend some time talking about the benefits of Cocoa and Maca.
Cocoa is derived from the trees and considered the”drink of the gods” and is rich in anti-oxidants. Dr. Lara made it clear that he wasn’t talking about Milk Chocolate (and a groan ensued from the crowd) but dark, unsweetened 70%+ cacao. Optimal dose is 10 grams a day.
Maca is a plant that grows in central Peru in the high plateaus of the Andes mountains. It has been harvested as a vegetable crop in Peru for at least 3000 years. Maca is a close relative of the radish. Maca has been linked to helping with low desire, sexual dysfunction, erectile dysfunction, hormonal issues, symptoms of menopause, and menstrual problems. To be clear, Maca is not a medicinal food, but when combined with cocoa, it can have medicinal affects. Maca Cocoa a libido-enhancing antioxidant drink. It also can reduce the effects of menopause without affecting the hormones and has been reported to increase the subjective feelings of well-being.
Natural Food Sources
While there are several products that can provide some of the medicinal foods to you, it has been stated that the best way to get some of these medicinal foods is through actual FOODS! A great resource to see how much a food has of what you are looking for is the USDA National Nutrient Database for Standard Reference (http://ndb.nal.usda.gov/), The website is a great way to find natural sources of nutrients mentioned above in your food.
Working With Practitioners That Can Help You
Dr. Lara stated that most doctors don’t prescribe or recommend medical food because they don’t know about them. If you are interested in learning more about medical food, especially medical food for sexual functioning, you will want to seek out one of the following providers who are trained and educated on using medical foods for sexual functioning (or just general use): Naturopaths, Osteopaths, and Functional Medicine Doctors are all trained and educated in working with supplements and medical foods. You can find information on these practitioners at the following websites:
Overall, the presentation was well-done and informative, although there wasn’t a whole lot of information presented about sexual functioning. But very valuable information that is relevant to my work is how there are a multitude of options around medical food and insomnia and depression, which are often confounding conditions that affect my clients. Medical foods may offer options to many clients with a variety of medical issues that could be effective in treating their condition while reducing or eliminating the sexual side effects of the issues themselves (one of the hallmark symptoms of depression is low sexual desire) and psychopharmaceuticals and other drugs. While there really isn’t a lot of data on the efficacy of medical food for sexual functioning, its a growing area that has a lot of fascinating implications. Definitely worth asking your healthcare provider about.
There are so many words that people type into search engines when they are looking for some extra help in their sex lives (sex coaching, sex counseling, sex therapy), and sometimes when I am looking through my website data, I am surprised at what people search for, and how many different spellings of sex therapy people can create (sex therpy, sex thrapy, sexthreapy, sex theropy, sex terapy, sex thearapy, sex thearpy, sex therepy, and on and on). People search for services like sex counseling, sex coaching, sex therapy, sex advice, and sex education and search for a professional like a sex counselor, sex therapist, sex educator, and sex coach.
I also get a lot of questions what the difference is between a sexual therapist, a sexual counselor, and a sexual coach. Then some of the questions go even further on if I am a surrogate partner therapist or provide any hands-on instruction/sex services. To be clear, I am not a surrogate partner or a sex worker. Most people realize they have made the wrong call pretty quick but if they stay on the line long enough, they usually realize that they could use my services!
As a Licensed Marriage and Family Therapist and Certified Sex Therapist, I often get asked if I do sex coaching and what the difference between sex coaching, sex counseling and sex therapy are. These are important questions because it will matter how you proceed in seeking out the services you are looking for and what professionals you work with. I will start by addressing what I do.
I am a Licensed Marriage and Family Therapist in the states of Maine, Massachusetts, New York, New Hampshire, and Texas, and an American Association for Sexuality Educators, Counselors, and Therapists (AASECT) Certified Sex Therapist, I provide sex counseling and sex therapy to individuals and relationships.
Sex Counseling vs. Sex Therapy
While counseling and therapy are used interchangeably in the mental health world, in the sexual health world, the certifying body for sexual therapy, sexual counseling, and sexual education, the American Association for Sexuality Educators, Counselors, and Therapists (AASECT) delineates a sex therapist from a sex counselor.
“AASECT Certified Sex Therapists are licensed mental health professionals, trained to provide in-depth psychotherapy, who have specialized in treating clients with sexual issues and concerns. In the absence of available licensure, they are certified, registered, or clinical members of a national psychotherapy organization. Sex therapists work with simple sexual concerns also, but in addition, where appropriate, are prepared to provide comprehensive and intensive psychotherapy over an extended period of time in more complex cases.
AASECT Certified Sexuality Counselors represent a variety of professions, ranging from medicine to the clergy. Examples of sexuality counselors are Planned Parenthood counselors, nurses and other health professionals, school counselors, and clinical pastoral care and counseling providers. Counselors assist the client to realistically resolve concerns through the introduction of problem solving techniques of communication as well as providing accurate information and relevant suggestions of specific exercises and techniques in sexual expression. Sexuality counseling is generally short term and client centered, focusing on the immediate concern or problem.” www.AASECT.org
A sex therapist does sex counseling and sex therapy. A sex counselor is more limited in their scope. For more information on the scope of an AASECT Certified Sexuality Counselor and Therapist, click here.
So when you are searching for general counseling or general therapy, you would essential be searching for the same thing, but when it is sex specific, you may be looking at something different. An interesting point, however, is that the word counseling is often more searched on the internet than therapy, which can also provide some insight that more people refer to”counseling” than “therapy” (and might make the language even a little bit more confusing around what direction to take), but as an AASECT Certified Sex Therapist, I provide sex counseling AND sex therapy.
It can be a little confusing when discussing the different professions practicing sex therapy. There are social workers, mental health counselors, pastoral counselors, art therapists, psychologists, etc. Psychology Today, a great online directory for mental health therapists, has a wonderful link to the differences between the professions here.
It is important that anyone seeking out sexual therapy or sexual counseling is an educated consumer and knows the credentials of their therapist or counselor. Don’t be afraid to ask your counselor for their credentials, what fields they specialize in, and their training and expertise. You wouldn’t go to a orthopedic surgeon for a skin rash, so don’t go to a sex therapist that isn’t trained in your presenting problem (but keep in mind, what you define your presenting problem may not actually be the problem at all).
And there is something to be said about this fact: that there are some excellent sex therapists and sex counselors out there that are not “certified”. However, there are way MORE therapists out there that say they “do” sex therapy or sex counseling, but don’t have the adequate training, knowledge, and experience to work with your sexual issues. As mentioned above, be an educated consumer and do your homework about the qualifications, experience, knowledge, and training of your sex therapist or sex counselor.
What is sex coaching? Sex coaching gets a little more complicated as there isn’t a lot of regulation around what the term “sex coach” is. A dear colleague of mine feels very passionate about sex coaching and her, along with her competent team of experts, have created a training program for Sex Coaches. Since there isn’t a lot of regulation around sex coaches, although last time that I checked with her, she was trying to get AASECT to recognize coaches as a certification level, it may be hard to determine who is actually a qualified sex coach and who isn’t.
I am a sex therapist but do sex coaching. Sex coaching is about providing educational and instructional methods for sex and intimacy. However, since I am also a sex therapist and counselor, I will always operate with that ethical code in mind regardless of the service I offer. That means that where some sex coaches who aren’t regulated by a licensing or certification board may engage in some interventions or recommendations, I would not if it violates my code of ethics or my professional boundaries. Coaching often aims to stay in the here and now and the future, and doesn’t specifically focus on any past or current traumas or intensive work. In general, I find that most people benefit at first from counseling and therapy and once issues that are contributing to/creating the sexual issues are addressed, if their sexual issue remains, then a coaching approach may be the next step. That transition can be easily made with my clients and it isn’t necessary to delineate the approach within the work since even if we are working with coaching techniques, my professional identity and integrity is always as a sex therapist.
I believe the word “coaching” attracts people because it implies that they will just be told what needs to be done and as long as they follow it their lives will be better. Sexual therapy or sexual counseling seems like hard work or very “deep” so people are attracted to coaching because it is more about behavioral change. As a therapist and counselor, I caution those that look to sex coaching and not to sex therapy or sex counseling. A good sex therapist will help construct new solutions with their clients, not direct or provide advice based on their own experiences to a client. A good sex therapist will leave their own experiences at the door (unless therapeutically relevant) and understand that their clients experiences are independent of their own. Also, sometimes a course of sex therapy or sex counseling can greatly improve the situation or completely resolve the situation, whereas coaching may not have because it did not attend to the causal/maintenance factors that required therapy.
While I am not trying to fault coaching, after all, help comes in many different forms and if it works for you, then keep doing it. I am just trying to caution those clients who seek out sex coaching when they really need sex counseling or sex therapy.
If you feel like you are unsure of which route to take, contact me at the information below to talk more to a sex therapist about your goals and which route would be best for you.
A lot of press has been given to the FDA Approval of flibanserin or Addyi, marketed as the “Female Viagara” by the media in the last few months and I wanted to briefly weigh in on my thoughts about this pharmaceutical.
First, flibanserin really isn’t the “female viagara” as Viagara for men works with the arousal system of a male (helping a client to keep and maintain an erection). Flibanserin actually has been promoted to address female sexual desire, not arousal, so the nickname isn’t really suited. Although I wouldn’t recommend promoting this, if we wanted to come up with a more accurate nickname for flibanserin, “pharmaceutical foreplay” might be more appropriate… (please don’t publish that or quote me on that!)
Second, there has been a lot of concern about the negative side effects and possible harmful side effects of this medication. I’m not going to really take a stance on that because every medication ever invented has negative side effects and when a physician makes the decision to prescribe a medication to their patient, they do so hopefully knowing and hopefully being fully aware of the side effects and have made the decision to prescribe this drug, because they believe that the BENEFIT outweighs the RISK to the patient. All drugs have side effects, some positive, but many negative or harmful. What I will say, is that doctors are NOTORIOUS for not going over the side effects of medications (or not being aware of the side effects) so this is something I am going to be firm on. Don’t rely on your doctors to go over this with you- be your own advocate and research the side effects and know what you are taking. Track those side effects over a period of time and be aware of what you can and can not tolerate. Track the positive benefits as well- you don’t want to be taking a drug that doesn’t work or does more harm than good. And clinicians, take the time to go over the side effects with your clients as well. It might save everyone a lot of time and effort around treatment if everyone is informed.
Third, my main issue with flibanserin is the same issue I have for all pharmaceuticals prescribed that aim to address a sexual issue: if the mechanism of change is not targeted at the reason for the problem, the drug will likely not be effective. Taking a pill, that is supposed to fix your issue, and then when it doesn’t, can just REINFORCE the problem. A failed attempt at solution can often just be more fuel to the fire of the problem.
I’ll demonstrate:
I guest lectured at St. Edwards University in Austin, TX in a graduate-level counseling and marriage and family therapy course and we were discussing the diagnosis, assessment, and treatment planning for sexual dysfunctions. I asked the class to pick a sexual issue that a client might present with for therapy. The class chose one of the most common sexual dysfunctions: low sexual desire in females. The next activity I had them do is to come up with all the reasons why a woman might have low sexual desire or low libido. Here is the list they came up with (in no particular order):
Depression
Anxiety
Low Sexual Self Confidence
Religious Concerns
Cultural Concerns
Medication Side Effects
Communication Issues in the Relationship
Communication Issues about Sex
Sexual Orientation Issues
Gender Identity Issues
Body Image Issues
Stress
Not Enough Time
The Sex Isn’t Good
Lack of Creativity or Novelty in Sex
Pain or Discomfort
Illness
Post-Traumatic Stress Disorder
Lack of Pleasure In Sex (no orgasm)
Dysfunctional Meaning of Sex
Fertility/Hormone Issues
Feeling Pressured to Have Sex
Lack of Foreplay
These are all causes of low libido or low sexual desire or female hypoactive sexual desire disorder (as according to the DSM-V). Flibanserin doesn’t say that they treat ANY OF THE ABOVE ISSUES, so then, readers, can you see how this drug might not be that effective if it DOESN’T TREAT THE ROOT CAUSE OR CAUSES OF THE ACTUAL LOW DESIRE! So, I am sure you can understand that if depression is one of the main contributing factors to low desire, and a woman takes flibanserin to increase desire, it might not work. And if it doesn’t work, how do you think that “failure” of that specific intervention might contribute the main contributing factor of depression. It would likely increase it!
Fourth, and final, thing I would like to say about this drug. I am a firm believer of having a lot of different tools in your toolbox for your issues. And I am also a believer that you can never have enough tools- in life and in your “real” toolbox! So I support flibanserin as a tool in our toolboxes to treat low desire. However, just as you wouldn’t use a screwdriver to hammer in a nail, you wouldn’t use flibanserin to resolve low desire if that isn’t the tool you need. How do you decide which tool you need? That is a great question to answer in collaboration with a qualified and certified sex therapist.
I am choosing intentionally not to mention anything about the “equality” of having a drug for women that addresses sexual functioning. The makers of flibanserin started a “Even the Score” Campaign in efforts to rally support around the FDA-approval and subsequent manufacturing and sale of the drug. The idea was that it is only “fair” and “equal” if women have a drug to address sexual functioning just like the men (amongst other ideas). The only thing I will say about that is that as soon as you start keeping score with something, everyone has already lost. There are no winners.
If you are struggling with low desire, low libido, hypoactive sexual desire disorder, whether male or female, I can help.
All clients that come through my practice first start with a comprehensive sexual assessment. Within that sexual assessment, I analyze all your current medications, as many of them unknowingly have negative sexual side effects. Even if it doesn’t say so on the literature, many medications can have a negative affect on your sexual functioning.
It is important that if you are experiencing some sexual issues, that you take a look at the medication that you are taking to see if there are sexual side effects. Often, clients will come to their first session with a list of medications, many or all of which have some reported sexual side effect, and have no idea that they are currently taking things that can inhibit their sexual functioning.
I call it “swimming upstream” (no sexual pun intended!) when you try to resolve a sexual issue when you don’t realistically look at the health and medical issues a client might have, and this includes medication. For some one with erectile issues or early ejaculation who is on medication that has erectile issues as a side effect, all the sex therapy in the world isn’t going to be able to overcome that medicine-induced side effect.
Common culprits are blood pressure medications and almost all of the psychopharmaceuticals that treat anxiety and depression (which is interesting because many folks have no idea that their anti-depressant could be the main reason behind their ability not to have an orgasm, get an erection, etc.).
What can you do? Read the information provided with your prescription and do a little web searching to see what others have to say about it. If you find that your medication has a sexual side effect, make an appointment with your doctor and see if there are alternatives to the medication with lesser or no sexual side effects. You may have other options with other medication or other treatment options that don’t have any negative affect on your sexual functioning.
harvested as a vegetable crop in Peru for at least 3000 years. Maca is a close relative of the radish. Maca has been linked to helping with low desire, sexual dysfunction, erectile dysfunction, hormonal issues, symptoms of menopause, and menstrual problems. To be clear, Maca is not a medicinal food, but when combined with cocoa, it can have medicinal affects. 