What Happens In Therapy?

First of all, you (both) describe the problem as you see it. Usually people think this will be very difficult, but therapists normally find that most people, once they arrive, are articulate and keen to explain their difficulties.

You then usually take it in turns to describe your upbringing and early childhood sexual experiences, give a brief summary of your sex lives, and what your worries have been.

The therapist may redefine what he/she hears and attempts to dispel any myths you might have about sex. Often people are under misconceptions like it's essential for both partners to reach orgasm at the same time. In fact, it's not essential to reach orgasm; it's not essential to do anything, just important to you to fulfil your dreams.

The therapist may encourage a couple to stop having intercourse, to take the pressure off to "perform" and start to re-learn romance, non-sexual affection, real sexual communication and erotic exploration.

Recent rows may be discussed to help you improve your verbal interaction. Many partners "blame" each other instead of stating their feelings. Usually, once you feel safe to express yourselves, your sex life begins to improve.

Here is how each kind of problem might be tackled:

Lack of Desire

Couples can be in love but find a loss of interest in having sex. You realise you are missing a lot of fun in life and seek help.

The therapist will ask whether the lack of desire began at the same time as some other incident in their life, to see if it has a specific cause.

You may be told not to have intercourse for several weeks but to start doing a guided touching exercise which helps people discover (or rediscover) their erotic zones.

Doing these exercises often throws up problems between you that you may not have realised, and these are hopefully solved in the sex therapy.

Often people have misconceptions about sex, areas of guilt, or deep-seated anxieties which get uncovered and dealt with during therapy.

Once the desire returns, you'll become extremely happy and wave good-bye to the therapist.

Problems getting an erection

Not being able to get stiff, or losing your erection during sex, is very distressing, yet easily treated in sex therapy.

First of all, the therapist asks whether the man still gets nocturnal erections and/or gets stiff when he masturbates. If he does not, the problem might be physical and he is advised to go for medical tests.

If the problem isn't physical, the problem must have been caused by something in your mind, probably to do with your relationship with your partner, or anxiety about performance.

You may be told not to have intercourse for several weeks and begin the touching exercises.

Many men suffer from performance anxiety and feel as if they are watching themselves try to make love. This could be the reason why you fail to get hard. The therapist helps you to get more in touch with your feelings. This may seem threatening but, once you get there, is very pleasurable.

Once a man feels under no pressure to perform, it's surprising how the penis springs up!

Inability to reach orgasm

This is usually a female problem, but some men suffer too, with what is called "retarded ejaculation".

Orgasm occurs when a person has enough stimulation (mental or physical) and not too much inhibition. The therapist helps the couple become less inhibited, through masturbation, and encourages you to discover what turns you on most.

Many women find it difficult to reach orgasm during intercourse, and need oral or manual stimulation, or a vibrator. This is discussed during therapy.

It's important to take responsibility for your own orgasms. Another person does not "give you an orgasm" it is your own to experience.

Premature ejaculation

Premature ejaculation is when the man ejaculates before he would like to. There are two kinds:

Primary PE is when the man has never learnt to control his ejaculation, or may have learnt to come quickly by having quick sneaky wanks or "quickies" with partners. Delay can easily be taught by explaining how to masturbate slowly.

Secondary PE occurs only with a partner. Men who suffer from this usually adore their partners, putting them on pedestals, and lose control when the sex begins.

As well as learning control, the couple need to examine the dynamics of your relationship so that you begin to relate as equal human beings.

NB Delay sprays do not work. In fact, they make the problem even worse!

The woman can't bear to be penetrated

This is called vaginismus and is quite common. The woman's vagina clams up when approached by an object, and is an involuntary reaction.

The therapist shows you how to introduce a tiny "trainer" inside, by helping you relax and keep calm. Gradually larger "trainers" are introduced until you can take a penis-sized one.

You'll go home and continue to practice with the "trainers" with your partner, who will gently introduce his erection and slide it inside.

Permission to Part

Sometimes couples come to therapy believing that they want their relationship to improve because they are afraid of parting. The sex therapist can help you explore all potentials, and help you see that parting doesn't necessarily represent failure, but could lead to a better life for both.

The Use of Sexual Surrogates

Some therapists use sexual surrogates to help those who have no partner or whose partner will not co-operate in the process of the therapy.

Surrogates can help to educate people and teach you how to explore, with confidence. Otherwise, their contribution to sex therapy is limited. This is because most problems stem from relationship difficulties, rather than lack of sexual expertise, etc.

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Health Listings

• The Medical Express Clinic offers a walk-in medical testing service, and can deal with any worries you may have concerning STDs or Hepatitis B. They're at 117a Harley Street, London W1N 1DH. Tel. 020 7499 1991>
• National AIDS Helpline 24-hour free helpline 0800 567 123
• Norm UK is an organisation for circumcised men who want to restore their foreskins. Contact PO Box 71, Stone, Staffs ST15 OSF
• Positively Women Run by and for HIV+ women 020 7490 5501
• Rape Crisis Centre (