Although sexual health should be a priority for everyone every day, September 4 is dedicated to promoting the importance in educating people around the world about sexual health and its effects on our emotional, mental, physical, and social well-being. So we thought it was only fitting to speak with our very own Dr. Laurie Betito from our Sexual Wellness Center site.
As a psychotherapist and clinical psychologist with a specialty in sex therapy, Dr. Laurie has dedicated her career to helping and educating people on sexual health issues through her TEDx Talks, books, and broadcast programs. And let’s not forget Pornhub’s Sexual Wellness Center where Dr. Laurie and her expert contributors publish weekly articles on sexuality, love, and health.
So for World Sexual Health Day, we decided to chat with Dr. Laurie about what sex therapy is all about and the importance of sexual health.
What is the biggest misconception people about have about the practice of sex therapy?
I don’t think people quite know what it is. Maybe they think I’ll teach them how to have sex. When people tell me they want sex therapy, I often ask them what they think it is so they don’t expect me to physically examine them when they come in.
Sex therapy is a form of talk therapy that involves many different aspects of sexuality. So when I see a problem, I always try to find the root cause because, in my opinion, any sexual problem is usually a symptom of something else. So a thorough evaluation is the first step in sex therapy. We need to first figure out whether it’s the mind or if it’s a physical condition, that way, I can refer them to the appropriate person.
For example, if someone can’t get an erection with their partner, the first question that needs to be asked is, “Can you get an erection with masturbation?” If the answer is yes, then it’s not a mechanical issue. That’s a straightforward situation, however, if someone says they have a desire for their mistress but not their partner, then it’s a little more complicated.
You’re looking at the evolution of a problem, like how it’s changed over time. You’re looking at age-related factors, potential side effects from medications, stress issues, anxiety disorders, and so on. There are many things we need to take into consideration, which is why we look at the person in the context of their whole life.
What would you say are the most common reasons for men and women to seek a sex therapist?
I see a lot of couples, so I would say the number one reason is desire discrepancy, which is where we have one person who doesn’t want as much sex as their partner or who doesn’t want sex at all. I also see many men with performance anxiety and some premature ejaculation. And as for women, it’s often about desire, but sometimes it’s about the ability to orgasm.
In recent years, people have become more open about mental health issues, but sexual health still seems a little taboo. Why do you think that is and how should we open up that conversation more and stress its importance?
Sexual health is big part of mental health, too. People who have a lot of sexual difficulties could also develop mental health issues. For example, I’ve met men who suffer from premature ejaculation who are suicidal, where their sexual problems either stop them from engaging in relationships or believe that they can’t get into a relationship because of their sexual issues. Their anxiety is so high and it causes mental health issues. The two are very much linked together.
I get a lot of emails and questions from all over the world where sexual health is not discussed, and they’re seeking answers on whether or not they have a problem and if so, what it is and how to fix it. So I do think worldwide, it’s a problem. We do have the WAS which is a great organization where they promote our human right to be sexual and equal. They do quite a bit of work in holding conferences where they talk about the education and clinical component. It has to start with education, it has to start with having more of an openness to discussing sexuality from a young age, starting with families. We have ways to go before it becomes less taboo and it’s still one of those things parents have a hard time discussing. It’s one of those subjects that in many parts of the world, it’s not talked about in school, or if it is, it’s about the mechanics of it, about pregnancy and disease and not about pleasure. Things like the evolution of sexuality in a relationship or sexuality in people who have disabilities aren’t talked about, and we need to open up that conversation far more.
So I’m doing my little part as much as I can by talking every night to an audience and it’s one of the reasons why I joined Pornhub. I was looking to disseminate more information to a wider audience. It’s important for me to be able to provide the other side of sexuality. Many people go to porn sites for entertainment and self-pleasure, but they also turn to porn for education, so I wanted to shed light on the real deal when it comes to sexuality and not just the fantasy part. On Sexual Wellness Center, we deal with just about every possible issue when it comes to sexuality.
If someone who is looking to seek sexual health guidance or has concerns about sexual wellness, but they're too embarrassed to reach out, how can they overcome that reluctance to finally take that step to seek a sex therapist?
You’ve got to just dive in. I think a lot of people suffer a very long time before they have the courage to call somebody and talk about it. I want people to know that, as a sex therapist and someone in the field, there’s nothing I haven’t heard in 30 years; I’ve heard it all. You could tell me anything and I’m not going to shout it from the rooftops; it’s confidential. I think it’s difficult for many people to even say what the issue is out loud because if you do, then it's like it becomes real. Sometimes, it takes people a very long time to get help and that’s very unfortunate because they suffer needlessly, especially when they find out what they thought was a problem wasn’t actually a problem at all, and it’s part of the norm. I tell people, “Bite the bullet and make the call; it’s just a phone call. Get your questions answered. It’s worth it rather than spending years suffering over questions like, 'What’s wrong with me?'" And many times, these sexual problems are also breaking up relationships because people aren’t dealing with them. However, things are changing, and people are reaching out.
Is there advice that you can offer to someone who’s in a relationship where they feel like their partner should seek a sex therapist?
Oftentimes, people say, “You go get help and get fixed. You’re the problem.” That’s the wrong way to go about it because any problem that affects one partner affects both. For example, men will send their female partner to a sex therapist thinking there must something wrong with her because she can’t orgasm during intercourse. Well, most women don’t orgasm through intercourse, so why are you pathologizing and making her feel like there’s something wrong with her. Or sometimes, a man will think there’s something wrong with their female partner because she doesn't want to have sex every day or she's not initiating it. Again, this is normal female sexuality, but over time, after being told this so often, there will be something wrong because she’s going to grow to resent him for making her feel inadequate. So that’s where you start to see it breaking down the relationship.
I’ve seen couples fall apart and disconnect because one is trying to get to the issue but they’re doing it in a way that is judgmental and not compassionate, ultimately pushing their partner away. Their partner will get defensive and avoid sexuality because they’re going to get criticized either way. They’re going to become resentful and if that lasts a long time, it grows into contempt, and contempt is close to hatred.
Can you offer some advice to couples who are thinking of joining the industry together? Maybe some questions they should ask each other first or conversations they should have before joining?
Couples who want to do this have to have really good communication. You have to able to talk about your feelings when they come up. You have to be able to set boundaries with each other and be able to say, “I’m comfortable with you doing X, but not Y,” or, “This is reserved for us at home, so don’t do this outside of the home.” There’s no size fits all, but every couple has to figure out their comfort level and decide where their limits are and debrief on a regular basis. Every so often, ask each other, “How are you feeling? Are you still with this? Is this bringing up any feelings of jealousy or mistrust?” Keeping communication open is vital.
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