Sex addict.  Those two words conjure up an image of a wild-eyed man hell-bent on getting his sexual needs met, cheating on his wife, and exploiting other women.  Nothing can stop him in his search for the ultimate sex high.  Like an alcoholic on a bender, the sex addict has no control over himself or his urges.  His need for sex grows without limit.  He can never be sated.  He must have sex or his body will cry out with need.

Really?  That’s not what I see.  When a so-called sex addict comes into my practice, I usually have before me a man who:

• Was exposed to pornography at a young age

• Learned to cope with many adolescent challenges by looking at porn
• Used porn to “self-medicate” stress, anxiety, and depression
• Has difficulty sustaining an intimate connection with his partner
• Doesn’t readily share what will turn him on
• If not yet partnered, may have social anxiety or feel unlovable
• Has a partner that doesn’t understand his sexual needs
• May have been sexually abused and is now trying to figure out how sex is supposed to work
• Is confused by his own secretive nature about sex
• May use porn to satisfy a need for sexual arousal that his partner doesn’t understand

My preferred label, if one must used, is “problematic sexual behavior.”  Usually, what makes the sexual behavior a problem is that it interferes with a person’s relationships or ability to function in other ways.

A man that pays a prostitute instead of (more…)

The University of Warwick and the University of Manchester just sent out a press release about a study that shows that psychotherapy will make you happier than having more money.  They compared the effect of several sessions of therapy vs. a sudden windfall of 25K pounds in cash and found that therapy by far had the larger effect on a person’s sense of well-being.

How can that be?  Because no one can really put a price on mental health.  You know how people say that if you don’t have health, you don’t have anything?  Well, that includes mental health, too.  Yet mental health is the unarguably the most neglected aspect of overall wellness.  And sexual health is a tiny but even more neglected part of mental well-being.  Sexual health is considered an extra, a frill.

Don’t let money stop you from pursuing better mental health.  As I’ve written recently, there is always some way to get help.  Every licensed psychotherapist does a few thousand hours of work in agencies across the country where low- or no cost mental health services are offered.  Therapists also usually will see a client or two for low fee; some therapists, like myself, have an intern that can accommodate a few clients as well.

So if you are miserable and dreaming about winning the lottery as an answer to happiness, dream on.  It’s good mental health that will bring you more contentment.

I am in the midst of researching and drafting a book manuscript on sexuality and mental illness and coming to the increasing realization that because the field of psychology hasn’t embraced sexual dysfunction, things have gotten way off track.

Here’s what I mean:  In my studies as a psychologist, sexuality was kept out of most coursework.  Even in courses about child development, there was little that was specific to sexual development outside the usual Freudian psychosexual framework (oral, anal, phallic, latency, genital stages).  So if I was learning about generalized anxiety, hypochondriasis, or eating disorders, I was learning about every aspect except sexuality.

This splitting off of sexual dysfunction from other types of disorders means a couple of things.  One is that psychologists, marriage and family therapists, and social workers don’t ask about sexual problems when someone comes into their office complaining of, say, panic attacks.  A second is that when people have a sexual concern, they see it as being distinct from other aspects of their psyche.  And a third is that it allows pharmaceutical companies to develop symptom-targeted medications that don’t address the root cause of many sexual problems.

If you are experiencing a sexual concern, try not to see it in a vacuum.  Have you always had anxiety?  Depression?  Is there a history of trauma in your background?  Does your partner complain that you are “obsessive”?  Do you have issues with becoming truly intimate with another human being?  What else is going on with you that you haven’t wanted to address and that is now coming out as a sexual symptom?

Sexual symptoms send people to a sex therapist because, in general, people like sex and want to be physically and emotionally close to a partner.  But sexual symptoms like erectile dysfunction, vaginismus, and lack of sexual arousal can be more difficult to keep hidden than other types of psychological problems.  After all, if you have a fear of spiders, you can just avoid walking in the woods.  But if you have an intimate relationship, it becomes rather obvious that something is wrong.

In my ideal world, all therapists would be knowledgeable about sexual dysfunction, and all clients would accept the connection between other psychological problems and sexual symptoms.

But I think we have a long, long way to go.

Just a few days ago I posted about persistent genital arousal disorder (PGAD) aka restless genital syndrome. Then SNL did a tasteless skit about it.  What if this was a character portraying someone with Tourette’s disorder?  Would that be funny?  I don’t think so.

If you watch the skit you’ll see that the actress says that pretty much anything can cause PGAD.  Not so.  It seems to have to do with damage to the pudendal nerve.  Although it can have a psychological component, there is also a biological basis for its manifestation.  And even if it was purely psychological, why should PGAD or any other psychological disorder be a target for stigmatization?

Anyway, I left a comment.  Maybe you will, too.

If you’ve been reading my blog for any amount of time, you know that I noodle around on the Internet looking for story inspirations.  Today I have a link to one psychologist’s story about Sex and ADD and thought I’d post about it, especially since I have since quite a number of people with AD/HD and sexual issues over the past several months.  (AD/HD is Attention Deficit Disorder, which can be with or without Hyperactivity and can be diagnosed in adults.)

Dr. Lawlis, who works on the Dr. Phil Show, states in his blog entry on Psychology Today that the key to keeping people with ADD or ADHD content in the bedroom is with novelty, and plenty of it.  The problem is, that describes about 99% of all human beings.  I’m being facetious here, but you get the idea.

Since I work with couples, my clinical findings are much different than those of Dr. Lawlis. The most common complaint of men and women with ADD/ADHD is being unable to have an orgasm–and it isn’t because of lack of novelty.  It’s because the mind is either working overtime, so the person is distracted, or because the mind is unfocused and the person loses concentration during intercourse.

The other thing that I have observed is that men with ADD/ADHD look for novelty through pornography rather than getting their needs met with a partner.  It doesn’t seem to be a matter of personality or character; it’s just that pornography works very well for this purpose.  One of the side effects of looking at a lot of pornography is delayed ejaculation when with a partner.  What happens, it seems, is that the person using pornography gets desensitized to plain ol’ vanilla sex with their partner.  This exacerbates the need for novelty, and sometimes it’s a bigger need than a partner can realistically fulfill.

Women who have difficulty with orgasm seem to differ from men in that they are simply distracted by being with a partner.  They may be able to have orgasm on their own, but when having partnered sex they can’t conjure up the state of light concentration that is needed to climax.

What to do? Medication can help, as can refraining from self-pleasuring while trying to learn how to get one’s needs met with partnered sex.  Good communication, as always, is key, in that partners with AD/HD need to be able to talk about what turns them on.  A permissive attitude toward erotic exploration can help both partners experience better sex.

Outside the bedroom, things often need to change, too.  Both partners need to thoroughly understand AD/HD.  There are multitudes of books and websites on the topic, just do a search.  The thing is that the person with AD/HD needs to take responsibility for his or her problem and learn how to work around it or cope with it.  He or she needs to communicate why doing something may be difficult and what kind of support they need, e.g., if remembering to make appointments is hard, then either the person with AD/HD can take on a different task in exchange for help, or they can come up with a system that works.  AD/HD can be frustrating for both partners, but less so if they work together in partnership than as adversaries.

The problems of AD/HD are real.  AD/HD may be overdiagnosed (though there are some people who think it is actually underdiagnosed) but that doesn’t mean that it doesn’t exist.  Also, just because you can’t see a problem like AD/HD proves nothing. Sometimes a partner will think a diagnosis of AD/HD is just an excuse.  It shouldn’t be.  A diagnosis should point to ways to making things better.

If you have a sexual problem, it is entirely possible that you have an attentional problem, too.  Not sure?  A sex therapist is a trained psychotherapist and should be able to help you figure things out.

Kind regards,

Dr. Stephanie Buehler

The answer, which may surprise you, is no.  In this NY Times article by Sally Satel, you can learn about a British reality TV program designed to educate the public about the treatment of mental illness.  Apparently, the judges–a psychiatrist, a psychologist, and a psychiatric nurse–were unable to tell the mentally ill contestants apart from the mentally well, because those who were mentally ill had been properly treated.

By showing the public that mental illness can be treated and that there really should be no stigma to asking for help, the cause of eliminating or controlling psychiatric illnesses has been forwarded, if only to a small degree.

Multiple times, people come to the Institute not know that they have depression, anxiety, obsessive compulsive disorder, or another form of psychiatric illness that is impeding their ability to function as well as they might.  It is only because something is happening that is annoying or distressing to their partner–they can’t function sexually–that they are pressed to come in for treatment.

It some cases, it is quite possible that if the original problem had been treated, they might not develop a sexual concern.  In others, it is not so clear.  But whatever the case, one of the things that we do as therapists is to rule out other psychiatric problems, and talk about treatment.

Does that worry or scare you?  It shouldn’t.  (more…)

The Boston Globe delivers an article today on a problem that many people don’t realize: antidepressants can decrease or eliminate sexual desire and interfere with a person’s ability to have orgasm.

It’s a problem that’s more common than originally believed. Pharmaceutical companies testing their drugs before release have stated only about 3-5% of people in their trials had sexual side effects. But now that the drugs are in widespread use, it turns out the problem is also widespread: about 10 times that number actually have experienced sexual side effects.

What to do? Knowing this, one of the first things I do with clients who come in with mood disorders or anxiety and who have not yet been diagnosed is to educate them about the pros and cons of taking antidepressants. I also give them a reasonable option: Try eliminating symptoms of depression and anxiety without medication. For mild to moderate cases, psychotherapy alone has been shown to be effective. I let the client know that we can revisit the issue of medication if there doesn’t seem to be any improvement after 6 to 8 sessions of psychotherapy.

Second, for those patients with moderate depression, I counsel them about taking the smallest but most effective dose. I also tell them that if they notice a change in their sexual interest for the worse, or have delayed or no orgasm, then they need to speak to the prescriber and make a switch quickly. That’s because the side effects can become permanent. Although the number is very small, I have definitely had people in my office who went off medication, only to find orgasm still difficult to attain, even months and months later.

In a sex therapy practice, it is somewhat rare to have a client come to us with severe mood or anxiety problems that have not been previously diagnosed. Mostly, we see them when they are already on medication. Sometimes they come in with complaints that are related to their medication. Once they realize that is the case, some clients chose to try switching. Others, having tried multiple medications already to find one that works, decide that they will live with low desire or delayed orgasm rather than risking a mood disorder that interferes with their ability to function.

One thing is certain: Physicians needs to take more care about prescribing antidepressants to counsel their patients about possible sexual side effects, and to carefully consider referring people for psychotherapy for mild to moderate problems, rather than immediately reaching for the prescription pad.