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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Psychotherapy

If the problem is one of lack of knowledge, your health care professional or a sex therapist can teach you (and your partner) about the sexual response cycle and the elements of sexual stimulation. Armed with this new knowledge, many couples can go forward on their own.

Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems.

• For some women these problems are fairly clear, including past sexual or other abuse, rape, or traumatic sexual encounters.
• For others, the problems may be less clear-cut, involving unresolved emotional issues or dissatisfaction with other areas of life.
• In either case, the therapist usually focuses on resetting the woman's attitudes toward sex.
• The goal is to get rid of old attitudes that got in the way of enjoyable sex, establishing new attitudes that increase sexual responsiveness.

If the problem relates to your relationship, couples counseling is recommended.

The couples therapist is trained and experienced at helping couples recognize, understand, and solve their problems.

• First, the counselor explores the relationship to find the trouble spots.
• The counselor will recommend exercises and activities that will improve the couple's communication and trust.
• If that can be accomplished, often the sexual problem can be solved more easily.

Sex therapy

A sex therapist may take couples therapy one step further by focusing on the couple's physical relationship. After identifying the couple's attitudes about sex and the sexual problem, the sex therapist recommends specific exercises to refocus the couple's attention and expectations. Specific objectives may include any of the following:

• Learning to relax and eliminate distractions
• Learning to communicate in a positive way what you would like
• Learning nonsexual touching techniques
• Increasing or enhancing sexual stimulation
• Minimizing pain during intercourse

Sex therapists often use what are called "sensate focus" exercises to treat sexual problems. The exercises start with nonsexual touching and encourage both partners to express how they like to be touched. The goal is to help both partners understand how to recognize and communicate their preferences.

Sex therapists can recommend exercises to help with vaginismus.

• One successful technique is the use of Kegel exercises. Many women are familiar with these from their childbirth education classes. Kegel exercises involve voluntary contraction and relaxation of the muscles around the opening of the vagina.
• Some women have been helped by using dilators to relax the vaginal spasms. A small dilator is placed in the vagina for 10 minutes, then removed. Larger dilators are used over time to train the vaginal muscles. Kegel exercises may improve the chance of success with this technique.

Group therapy or a support group may be very helpful for a woman. There she can discuss her problems with others who share them. Women often gain insight and practical solutions from these groups, as well as a greater confidence from knowing she is not alone. Couples groups also can be very helpful if both partners are willing. A sex therapist usually recommends such a group if he or she thinks it would be helpful.

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