When treating erectile dysfunction the first course of action is a physical rule-out. It is important to meet with a doctor to determine that the erectile dysfunction is not flagging a physical or hormonal imbalance. Usually, patients have checked this box before they call a therapist. It is difficult to see a therapist when everything in life works but your sex life.

We, both patient and therapist, must be careful listeners to the voice of the erectile dysfunction. Not all erectile dysfunction is created equal and therefore there is not a one-size-fits-all treatment model. Sometimes erectile dysfunction is a more generalized anxiety response. Erectile dysfunction can also be an expression of unrealistic sexual expectations: all men are ready to go sexually at any time with anyone. Erectile dysfunction may have to do with the aging process. Sometimes what gets labeled erectile dysfunction is a reflection of not being in the mood and erectile dysfunction is a misnomer. Perhaps you just had a big meal, are tired after work, or just don’t feel it.

Successful treatment of erectile dysfunction involves anxiety reduction, a lessening or cessation of viewing porn, and a close look at sexual details. I offer my clients techniques to stay body focused so they do not shift to disassociation, people pleasing, and negative thought. Ask any of our ancestors as far back as the caveman, worry, sexual anxiety, and pressure our unique bi-products of our age.  The penis knows how to have sex. It really is that simple once the psychological blocks give way.

 Sex addiction can be confusing. On one hand sex is fun, feels good, and is a natural part of being human and on the other hand when sexual behavior turns addictive, the fun stops cold and gels quickly to shame and pain. Even more confusing and contradictory, sex addiction is not ultimately about sex. Sexual acting out is almost always about self-regulation, attachment trauma, chasing a high, wanting validation, and relief from internal or external pain. When a client or couple comes to my office post-discovery I often hear the addict say, “I just have a high sex drive.” Usually, a partner, spouse, or girlfriend has done some snooping on a cell phone, an email account, and/or bank statements and found evidence of sexual betrayal; compounded research has perhaps led the couple to suspect sex addiction. For the addict, admitting to sex addiction is a step towards authenticity and recovery. For the betrayed partner naming the infidelity as sex addiction provides a container to help hold the pain and trauma that has just side swiped the coupleship. Here are some signs of active sex addiction:

-Escalation in unwanted sexual behaviors

-Secret keeping

-Lying to self and others — rationalizations

-A desire to stop or cut down on sexual acting out and an inability to do so

-Transactional sex

-Loss of money on webcams, sites, etc.

-Health and safety risks

-Increasing fears about getting caught

-Shame.

Whether it is sexual addiction, sexual compulsion, or sexual acting out the treatment model is the same.  Boundaries must be placed around destructive behaviors and trust restored with self and others. Sex addiction is an intimacy disorder involving a divided well-defended self. Process addiction like sex and food are usually older developmentally than substance addictions and therefore more pernicious. Abstinence does not work; the goal is healthy sex not stopping all together. Sex addiction tends to germinate long before we are sexually active and grows like a vine around a tree as the structure of self forms.

Healing begins with accountability and asking for help. The wounding is relational and therefore the healing must be relational as well. My office is a shame free zone which allows us to explore the painful experiences of the past that have become sexualized.  Sex addiction is not just about the lust hit, it also involves the dopamine reward system of the brain which means we have to look at the complete picture of self. My approach is confidential, discrete, and compassionate. There is a way out. Life can be sweet when you don’t have to manage secrets and cover your tracks.