Sex Therapy

Sex and Relationship Therapy

INDIVIDUAL THERAPY

RELATIONSHIP/COUPLE THERAPY

The most common male sexual problems are:

Unreliable erections (also called erectile dysfunction): when it is difficult to develop or maintain an erection during sexual activity.
Rapid ejaculation: when unwanted ejaculation occurs before penetration or soon after penetration.
Delayed ejaculation: when ejaculation is wanted but does not occur after a prolonged time of sexual activity.
Male anorgasmia: when wanted orgasm does not occur. This may be linked to delayed ejaculation.
Loss of sexual desire: when there is no desire to be sexual with a partner or self.

The most common female sexual problems are:

Vaginismus: when penetration is not possible.
Dyspareunia: when penetration is painful.
Female anorgasmia: when orgasms do not occur.
Loss of sexual desire: when there is no desire to be sexual with a partner or with self.

"Courage is simply the willingness to be afraid and act anyway"

-Dr Robert Anthony

Body Image

In our modern age of selfies, Instagram and dating apps, many men and women struggle with their body image. People might become highly preoccupied with going to the gym excessively or starting extreme diets.

Feeling bad about your body contribute to sexual problems.

You may have a problem with your body image if:

Frequent preoccupation with body image and body shape to the extent of controlling your life.
Feeling distressed, unhappy or depressed when you look at your body.
Excessive exercise.
Always on a diet, juicing, detoxing, etc.
Problems with relationships: avoiding social occasions because you think you look bad.

You may have body image distress if you feel bad about your appearance:

At social gathering where you know a few people
When you look at yourself in the mirror
When you are with attractive people
When someone looks at parts of your appearance that you dislike
When you try on new clothes
When you exercise
After you have eaten a full meal
When you wear revealing clothes
When you get on the scale to weigh
When you think someone has rejected you
When in a sexual situation
When you are in a bad mood
When you think of how you looked when you were younger
When you see yourself in a photo or on video
When you think you have gained weight
When you think about what you wished you looked like
When you recall hurtful things people have said about your appearance
When you are with people who talk about weight or dieting

Problem with your body image can cause serious difficulties with starting, maintaining or managing a romantic and sexual relationship. It may also be difficult to maintain good friendships. If you feel preoccupied often by the way you look, do not hesitate to make an appointment to discuss it.

Intimate Relationships / Couple Therapy

It is common for people in intimate relationships to become unhappy in their relationship(s) or marriage. Often people in intimate relationships stop communicating with each other. It is common for each individual in the couple/ relationships to feel isolated, angry, resentful or just bored and unhappy.

Sometimes, sexual problems cause the relationship to become unhapppy. And sometimes unhappy relationships can create sexual problems.

Sometimes, living busy lives, managing careers, having children, not finding time for each other can be a cause for people to slowly drift apart. Some people can't remember what was once so attractive about their partner.

Being in an unhappy relationship can be very difficult because it can make life miserable.

The most common problems for people in intimate relationships are:

Communication problems in a relationship, including frequent arguments, rows, blaming. A relationship with frequent arguments, rows and blaming can feel like a toxic space. There is so much anger and resentment that it can bring up intense unpleasant feelings and emotions as well as unrecognisable behaviours. Over time, it is exhausting to be in such a relationship. Many people in this situation feel stuck and unable to move on.

Differences in sexual desire within the relationship. It is perhaps one of the most common sexual problems with people in intimate relationships. Many people feel stuck, unsatisfied and find it difficult to address this problem.

Sexless relationship. Many people in intimate relationships lose the desire to be sexual with each other. It can be caused by various factors including living busy lives, having children, getting older, feeling bored in the relationship or holding some resentment.

Healing after the disclosure of infidelity. Infidelity has a tremendous negative impact on relationships, marriage and sexual lives. It is very challenging for people to heal from it individually and as a couple/ people in relationships. The healing process and the re-building of trust and compassion can be long and challenging, but it is possible.

Lack of intimacy. Some people lack, or have lost, intimacy with each other. They may be in a good companionship or even friendship but there is little sense of intimate feelings. Some people start to feel like they are living with a stranger or a house mate. It can bring a sense of loss and sadness in which people feel stuck.

Ending a relationship. Relationship Therapy is also useful to help with ending a relationship. Often people struggle to make sense of an ending, and it can leave both partners wounded for a long time. Ending a relationship in a constructive and therapeutic way, with understanding and empathy, is important and a great gift of love to yourself.

"The divorce rate has been 50% for the past 60 years, because people think conflict means you're with the wrong person"

-Dr Harville Hendrix

The discovery or disclosure of an infidelity is heart-breaking and can be traumatic for the person who is betrayed. The person with the affair faces a tremendous amount of guilt and shame for causing so much pain to their partner.

An affair shakes a relationship at its core, causing a lot of damage. For some people, the affair marks the end of the relationship. For others, it can be an opportunity to heal, re-assess the relationship, find the areas in the relationship that needs growth and start to rebuild a new relationship.

At the point of disclosure or discovery of an affair, the current relationship is finished, but a new one can emerge from the ruins.

If you decide that you want to end the relationship, a short course of relationship counselling can be helpful to separate in a therapeutic way which can be helpful for both partners. Individual therapy may be recommended so that the two of you have your own space to process your intense emotions and thought patterns to help you come to informed choices on how you want the next step in your life to be.

If you decide that you want to repair the relationship, a journey of healing and growth is possible. There are three stages to repairing a relationship after an affair:

1- Be together with the damage. The first step to healing is for the two of you to be with the damage. It is a very painful place to be but it is an essential step. At this initial stage of recovery, I will guide the betrayer to take full responsibility for the hurt and damage so that there is space for the betrayed to heal the wounds. Essentially, it is almost like putting the scaffolding onto a building that needs much repair. This first stage can last many months. Healing a broken heart takes time and cannot be rushed.

2- Understanding. The Second stage is understanding: putting together the pieces of the whole history of the relationship and identify what did happen in the past that set up the stage for an affair to happen: sometimes, there are previously unidentified deficits in the relationship, sometimes it is that the relationship didn’t grow as the partners aged and became an ‘outdated’ relationship. Sometimes it can be a slow relationship burn-out for specific or non-specific reasons. Understanding the narrative of the relationship isn’t a way to excuse the damaging and dishonest behaviours of the betrayer, it is a stage that encourages reflection and collaboration, instead.

3- Re-building. The last stage is the rebuilding stage. The relationship is over at the point of the discover or disclosure. So, after healing the broken heart and understanding the narrative, you can be ready for rebuilding the relationship. It is also a stage that can take many months: it takes time to consciously look at every pieces of the relationship and deciding which ones you are going to use to rebuild and which are no longer suitable and needs to be discarded.

Trust is one of the essential element of a relationship that gets destroyed at the moment of disclosure or discovery of an affair. Trust will take a long time to heal and may not be re-established until the very end of therapy.

The three stages guideline means that there is a particular process of post-affair recovery, however, every relationship has its own unique process within the recovery process, and the stages can be overlapping. Other therapeutic interventions may be needed to add to the process.

Healing and rebuilding a relationship after an affair is a deep, painful and courageous process. It is also the ultimate testimony of people’s commitment for growth and love.

My practice of Relationship Therapy for healing after an affair is non-judgemental, non-shaming and open-minded. I am fully trained with extensive experience to help you both in your post-affair recovery.

Differences in Sexual Desires

Struggling with your partner having a different sex drive is one of the top reasons people in intimate relationships come to see me. People often feel angry, resentful, sad or hurt because of unsatisfying frequency or quality in their sex life.

First, I say to people in relationships that it is usual. I also acknowledge the pain that it causes. The person wanting more sex often feels rejected, unloved or undesired. The person wanting less sex often feels irritated by the sexual demands of their partner, they can feel that their partner is pestering them, they often become avoidant of any touch or kind words for fear that their partner will take the wrong hint that would lead to an expectation of sex.

The result is a relationship that feels distant, cold and, as time passes, more and more hopeless.

There are many things you can do to resolve the situation:

Medical/ hormonal investigation. Low sexual desire can be caused by low testosterone. A high sexual desire can be the result of high testosterone. Checking your levels can be a good idea to identify if your problem can be resolved medically.
Communication factor. Develop a sexual language in your day to day life to maintain a sense of the erotic. For example swap: ‘You look good in those jeans’ with ‘you look sexy in those jeans’. An important rule to follow is: no expectation of sex. It means that both partner can be free to play with a sexual language without the anxiety of having sex.
The importance of touch. Following the same rule of no sex expectation: you can be free to learn to touch each other’s body and re-discover it without the anxiety to have sex. Be curious about the areas of your body and your partner’s body that are sensitive and bring pleasure. Even if you get aroused, you can stay with the sensual play without having sex. Take some time to stay sensual, and build up an anticipation for sex. You can also use sex toys to enhance the experience of touch.
Sharing sexual fantasies. This can be harder than you may think. Many people struggle to do so. We usually keep our fantasies in our private world. You may have sexual fantasies that you are curious to try out in reality, and you may have other sexual fantasies that you do not wish to try. Both are ok. Getting to know each other’s erotic world can be a fun and exciting adventure.
Honest conversation about what you like and don’t like in sex. So often, people have sex without talking honestly about it. It can lead to some awkwardness and even make people avoid sex. They might be parts of your body that you don’t like to be touched. Or there may be a specific sexual activity that is a no-go for you.
The meaning of sex. It has a massive influence on our sexual desire and how we have sex. For some, sex means entertainment: it doesn’t matter if it is sex with a loved one or a stranger, it is a pleasurable experience. For some other people, sex is a pathway to deep connection, an expression of love. Some people have negative meanings of sex: they think that sex is dirty, or it is somewhat wrong. Or there can be a lot of shame in someone’s erotic world. Having an exploration and knowing what meaning you put on sex will help you understand your sexual desire and navigate your sex life.
Setting realistic expectation. This is another honest conversation to have. Your partner will probably not want sex exactly when you want it. If you want sex five times a day but your partner is satisfied with sex twice a month, you can discuss how to meet half-way. Also, good sex is not only a matter of frequency: quality is also important to consider. Is making reasonable compromise on your sex life worth it to keep the relationship with your loved one?
Getting yourself in the mood. Often people mistakenly think that they have to be ‘in the mood’ for sex. For some people, waiting to be in the mood could mean waiting forever. We don’t need to wait for sexual desire, as long as we can feel sexual arousal. If you’re not in the mood, you can touch your genitals until you become sexual aroused, and by then, you may be more in the mood for sex. Make sure that you only do so when you fully consent to sexual activities. Getting yourself in the mood doesn’t mean that you have to force yourself to have sex when you really don’t want to.

Navigating your sex life with the different libido to your partner is a usual struggle many people face. It is not the sign of a relationship going wrong. And it can be resolved with many different steps. Take your time, approach the issue with empathy for yourself and your partner. And be courageous to step into an erotic exploration together.

If you want some help with this difficult problem, do not hesitate to contact me. I can help with every step of the way.

Silva Neves

Online Specialist Psychotherapy for Central London, Mayfair W1

Sex and Relationship Therapy

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