5 Things You Learn About Sex As A Sex Therapist

5 Sexual Dysfunction Is Rarely Physical

If your basement bar closes down early, you might think something physical is going on. It's probably not. As Amber put it, "A lot of people, they'll often go to a doctor first for a sexual problem, and they'll get referred to me. can have a whole range of causes, but it's usually some kind of psychological issue. A big misconception is that people will think there's something wrong with their body, but that's rarely the case."

We've previously discussed -- in what some might call excessive detail -- a condition called vaginismus, in which your lube tube holds its breath and refuses to let go. Well, nervous pants parts aren't just for the ladies. Concerning erectile dysfunction, for example, Amber explains: "It can be that they're stressed from work, or they're having an affair, so they feel guilty and have trouble performing."

She remembers one particular client who was confused about why all the men with whom she was cheating on her husband seemed to be having difficulty rising to the challenge: "She'd say, 'I'm starting to get very self-conscious, because these men I bring home, sometimes they have a hard time getting erections, and I don't know if I'm unattractive or what.' We figured out that the root of the problem was that she was bringing them into her husband's house ... It's very difficult to perform under those conditions."

In other words, you may not need to get a prescription, so much as you need to stop doing literally everything else that you are doing. Good lord, lady.

On the other end of the spectrum, Amber says, "such a high percentage of the time with premature ejaculation, it's a psychological thing, usually an anxiety thing -- men being really worried about their own performance and getting caught up in their own heads."

If you're a generally healthy person, but your peep is on the fritz anyway, you're probably looking at some time on the couch. Treatment for psychologically-driven sexual dysfunction involves "work out the root cause of where this anxiety might be coming from and separating that event from future events."

Ah, see, we knew it had something to with the future! And our prom date said that "time travelers stole my mojo" was the dumbest excuse they ever heard ...

4 Sometimes, The Solutions Will Be Physical

Having sex is like riding a bicycle: You can prepare as much as you want, but the only way to learn is to get out there and do it and fail miserably for a while until you get it right. That's why treatment for sexual dysfunction will often include a combination of regular counseling sessions as well as practical exercises, some of which sound like medieval torture.

For premature ejaculation specifically, "there's the squeeze technique, where they get close to ejaculating and then squeeze the head of the penis really hard. It sounds unpleasant, but it reconditions the body to respond a different way."

The squeeze technique is pretty effective, as our absolutely real Canadian friend assures us. But a lot of men are averse to crushing the little soldier's helmet. For the squeamish, there's also the "stop-start technique," which is a hands-free upgrade that involves taking strategically timed breaks from the action. For women with vaginismus, there's dilation therapy, which involves inserting progressively larger dilators (basically, tiny dildos). You can do breathing exercises until you pass out, but in order to know if they work, you're gonna have to shove something up there, and you probably don't want it attached to a person who is definitely judging you. That's why ...

3 A Therapist Can Bring Someone In to Have Sex With You

They're called surrogate partners.

"They're normally used if somebody is having problems working up to touching another person or having trouble with angles or penetration," Amber says. "They work out positional stuff, how to penetrate someone and where to touch, and they're helpful for getting immediate feedback as well ... Sometimes they're former sex workers. Not always, but sometimes."

Amber hasn't had the pleasure of working with surrogate partners herself. "It's actually, from what I have seen, more common in the States than Australia," she says. But do we look like people who don't know how to track down some professional sex-havers?! You bet your ass we did it.

According to Larry, a surrogate partner who worked primarily with "abuse survivors, grieving people, people who never had an orgasm," therapeutic sex is a whole lot different from a routine booty call. He's had extensive training, because when it comes to these vulnerable populations, fucking someone wrong can fuck them up. In fact, it may be weeks before you even get naked.

"The first appointment, I'll take a sexual history, and then we start with a hand caress. Then she'll go to her therapist and process that. The next session is what we call face caress, which is when we lean back against each other's chest, maybe with a pillow in between ... and we'll take turns caressing each other's faces and talk about what was pleasurable, what was anxiety-inducing. The exercises get more and more intimate ... It can last anywhere from eight weeks to sometimes two years."

Taking these microscopic baby steps is necessary for gaining trust and establishing intimacy, something those of us who go around mashing genitals without any supervision are bad at. "In real life," Larry says, "we move too fast. We have dinner or something and then we want sex."

As a result of all this long-term care, a lot of clients become very attached to their surrogates, which is wholeheartedly encouraged. Larry says "it's normal -- there's love, there's physical intimacy, I may be their first partner." He's maintained relationships with a lot of former clients -- but like everything else involved in sex therapy, only within strict parameters. Exchanging Christmas Cards is fine; exchanging bodily fluids is less so. So normal holiday mailing list rules, then.

2 Communication Is The Biggest Problem

Sometimes, the problem doesn't stem from any one person so much as a relationship itself. "There's a lot of crossover with relationship therapy," Amber says. "Sometimes, one will refer to the other. They don't know how to talk to each other, and they suffer as a result. A lot of people are really afraid to ask for what they want, so they end up being really dissatisfied during sex."

It might seem simple enough in the heat of the moment to shout out "Fondle my kneecap, Mr. Belvedere!" And good for you if it does, but some people have problems with their "sexual scripts." We all share a cultural script that we learn through talking to other people, and from Hollywood and porn. But then we develop another script through our own experiences, and those tend to be quite different.

It's easy to start thinking that your script is the script, tricking you into thinking you know what you're doing. And why not? Sex should be easy, right? It's a natural bodily function. Do you need someone to explain to you how to eat and poop every time you do it? Of course not, you're a very experienced eater and pooper, thank you. But then we get our brains all wrapped up in that function, and it's a whole different story. Sometimes, you need to wipe the slate entirely clean.

"A lot of the time, it can be very 'going back to the drawing board' and rediscovering your partner sexually," Amber says. "I'll give them exercises like 'Lay with your partner and touch their skin for half an hour.'"

Uh, do try to find somebody you already love and trust for that one, though. "Can I touch your skin for half an hour?" is possibly the worst pickup line we can imagine.

1 People Don't Know A Lot About Sex

According to Amber: "Some people orgasm just from having their skin stroked. There's I think 12-14 different ways a women can orgasm." Which is about 12-14 more ways than we knew about.

" only seven ways for men," Amber says. "There's penetration, oral, anal, nipple stimulation ... Women will often ignore nipples on a man -- like 'Ah, they're only decorative.' And some of them don't like it, some are too sensitive, but lots of men like it, and I find a lot of women really neglect that. It seems to be associated only with women."

For women: "There's the clitoris, vaginal opening, penetration ... nipples, anal, mouth -- there are some people who orgasm from either kissing, or if they're performing oral sex and get really into it, they can orgasm that way as well. It's amazing how many different ways there are."

Ever wandered into the shampoo aisle of a grocery store and become frozen for choice? You just want something to clean your hair, and suddenly you're presented with 1756 bizarre concoctions vying for your attention? Well, sex is a bit like that. Adding to the confusion: If we don't have problems, we'll still make some up.

Amber explains: "People come in and say they have premature ejaculation problems, and I'll ask them how long they last, and they say 'Only 10 minutes.' Well, the average is seven minutes. Premature ejaculation is usually anywhere from 30 seconds to a few minutes."

Explaining how we all got into this sticky mess, Amber points to a culture that discourages sexual exploration. Like any good therapist, she specifically blames your mother. "Parents will do things like see their child masturbating and say 'That's dirty, stop doing that.' A lot of men will have trouble orgasming while they're masturbating because they feel guilty about it for that reason. A lot of women are shamed for masturbating, so they don't know what they like sexually. They'll say 'Oh, I just do whatever my partner does.' That can even manifest in things like inability to orgasm altogether." The crux of her job, she says, is "teaching people to be positive about their sexuality."

So that's the key to a healthy sex life, everyone: Stop feeling bad about that weird, weird shit you like. Even if it's super weird. Like that one thing you're into. You know the thing.

Manna sublimates her anxieties all over Twitter. Just, all over it.

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