It’s your penis – your problem – you go get fixed!

Many a client comes in alone and states, “My wife (husband, partner) told me this is my problem and I have to come and get fixed.” I always sigh (on the inside), knowing that every sexual concern is couched in the context of the relationship and at some point, both partners must work together to get information, repair damage caused by experiencing unexpected issues, and learn to create or re-create a positive, fun, connected sex life.

I also guess that the person now sitting in my office has suffered any combination of hurt, embarassment, guilt, shame, low self esteem, as well as anger and resentment towards their partner whether or not they can admit to that. Lets focus this discussion on erectile dysfunction – although many sexual problems experienced by both women and men can cause serious relationship upset, thanks to advertisements for vasodilators, erectile dysfunction is now a household term.

If the problem is erectile dysfunction (or rapid ejaculation, or less heard of delayed ejaculation), for a man to be told “go get fixed” then you can approach me for sex! causes additional emotional and physical impairment. In our culture (and some others) men are measured by their sexual prowess and performance. We are unfortunately mis-informed that all men think about sex every five minutes, and get a hard-on at the very sight of any woman, at any time, under any circumstances. As a culture, we define having sex as having intercourse, which is of course not possible if the man involved does not have a lasting erection. What pressure!!!!

The woman who tells her man to “go get fixed” is suffering herself – from a belief in these myths about men and sex perpetuated in our society. How unfortunate that we allow girls to believe that a man’s hard on is a direct reflection of his love for her, and that if he does not have an instant, lasting erection every single time she or they think one should appear – several painful and confusing thoughts and feelings result. I’ve heard it all: “He doesn’t love me; he loves someone else; he’s actually gay; he’s not attracted to me; he’s having an affair; it must be a medical problem because its certainly not about ME!…” and more.

Please rest assured people! Contrary to popular belief, the man’s penis IS connected to his brain and his emotions! Men do need to feel connected and safe in order to be sexually responsive and ready. For some men at certain ages, that happens more automatically than for other men, young or old. Variation in the number, quality, and duration of erections IS NORMAL. Period.

If you’re a women who has only experienced guys that get big hard ons every time they see you or have a sexual thought in their head – you are lucky, if that’s what you want! But you do not represent the entire population.

If your partner does not experience consistent or persistent physical arousal, it is not just their problem. Guess what? That’s your penis now too! and you have an effect on how your partner feels, and responds physically. This does NOT mean that your fears are true, that you are no longer attractive! It means you are involved with a great guy! Who is sensitive enough to care about how things feel and how connected the two of you are, before he can get that erection sometimes! Thats a good thing!

Many men who are sensitive to the connectedness factor respond with loss of erection more easily when they feel anxiety, and they may not be clear that it’s anxiety they are experiencing. They may have a history of being shy, and/or a low level of sexual experience in their lifetime. This is not their fault! It’s also partly why you love them! Because these men also tend to be compassionate and less egotistical. This is an opportunity for you, as the woman, to develop those same qualities yourself – toward your partner!

When the erection doesn’t appear on your cue, or it comes and goes during sex, DONT PANIC! BE KIND!!! The worst thing you can do is blame him, insult him, make him feel bad about it, or to feel bad about it yourself. Whether or not you like it – it’s normal.

The best thing you can do is be understanding, and don’t quit the session – change focus and activities. Go back to other sexual activities, or resume sensual, relaxing touching and kissing. Give it a break, and a minute; reconnect and restimulate! The penis does not have to be the main focus in sex, and intercourse is not the entire definition! If it is for you, you are really missing out, and I recommend reading, experimenting – expand your ideas, feelings, thoughts, and activities with regard to sex.

It’s always important to rule out medical issues, yes there are some that can hamper erectile function. So the first stop may be with a physician. There are, however, relatively few possible medical causes for ED (overweight is one of them, sorry!).

Many things can interfere with spontaneous sexual desire, response, and enjoyment including individual personal problems and unresolved relationship issues. It’s reasonable to try and solve problems together, on your own, but don’t go on and on without help if the problems do not get resolved, and stay resolved. Most people need help at some point and those who go get it are far more likely to have lasting, happy relationships. Unaddressed sexual problems are one of the top reasons for divorce.

If or when you feel there’s a need for professional help with erectile issues, support your partner – support your local penis!!! Go with him to the sex therapist and/or physician. This issue is no one’s fault. Not his, not hers. He may have certain work to do, but your report as his partner about problems is important to the physician and therapist – the woman’s point of view ( so to speak, regardless of gender). You need help as a couple: get information, support each other, and learn together how to have a more expanded and relaxed approach to sex.

Remember that any issue either partner experiences with sexuality effects both partners and the couple as a whole. Be supportive, seek information, and work together. That in itself will help your relationship and your sex life!

You won’t be the only ones who need help being more relaxed and connected. Most Americans do!

…so come along and join in the fantastic voyage…”


Physicians and Clinicians Guide: Sex Therapy

Informal paper: Information for Physicians and Clinicians: qualifications to provide Sex Therapy

            To heal and do no harm to patients who present with the prevalent sexual and relationship problems of the 21st century, comprehensive and specialized education and training are needed. Just as general and family physicians diagnose and treat an array of common physical ailments, general and family therapists diagnose and treat an array of common mental health and family problems. A good general physician refers patients appropriately to specialists; patients know that specialists have the training and experience to deal with specific problems. What is not well known is that sexual problems and treatments are currently a specialty. Research of the past two decades has brought knowledge of sexuality, the brain, and relationships, and, therefore, of treatment of sexual problems well beyond general medical and therapeutic training.

Because of patients’ needs, some physicians and therapists – ethically motivated and confident that their approaches are sound – do undertake treating sexual complaints. Unfortunately treatment approaches commonly being used are at best not fully effective and at worst, actually compound sexual, personal, and relationship problems. This is a case of well meaning and otherwise qualified professionals not realizing how much they don’t know. Concomitantly with brain science, the field of sex and relationship therapy has grown, especially in the recent decade, but education about the field has not.


Qualifying as a sex therapist

A certified sex therapist is a specialist. Few ways of becoming qualified exist; only a few colleges offer any focus on sex therapy. Perhaps the best-known organization to provide certification is AASECT (American Association of Sex Educators, Counselors, and Therapists). A sex therapist certified by AASECT must first be a licensed, master’s level psychotherapeutic clinician. Then coursework and hundreds of supervised hours working specifically with relationship and sexual issues must be completed. A practitioner without AASECT certification, or one of the few recognized degrees in clinical sexology, is not qualified to accurately and comprehensively deal with sexual issues.

Certified sex and relationship therapists are also required to complete yearly continuing education programs. The field of sex therapy has much scientific, specialized, and continuously expanding information and treatment tools, which are rarely followed by physicians, psychologists, or other psychotherapists – all of whom have their own requirements to keep up with!

As information concerning sexuality and treatment becomes more widespread, focused training opportunities grow. For example, sexual abuse is a focus for which a range of specific certificates and treatment approaches are available. It is important to note, however, that such targeted training opportunities may fall short of providing tools to help patients develop intimacy and a positive, functional sex life after dealing with a specific problem.


Aren’t marriage and family therapists trained to treat sexual issues?

It’s a reasonable expectation that practitioners with a license to treat marital problems can effectively address sexual issues, at least with couples! It’s surprising that requirements for licensure as an MFT (marriage and family therapist) do not include any sex therapy courses, nor are any offered in most programs that provide MFT clinical training. In a survey of practitioners by The American Psychological Association, most respondents stated that they did not feel qualified to handle sexual issues, and that sexual issues come up in approximately 70% of cases.

How can physicians and psychotherapists approach sexual problems?           

Several sexual complaints have a medical component, which may be helpful or imperative to address prior to or during clinical work, but it is important to be clear that few academic and training requirements for physicians, psychotherapists, or clinicians include any sex therapy. Asher’s 2010 meta-analysis of requirements for medical, doctoral, and clinical master’s degrees revealed that only 2% even address human sexuality – far from synonymous with sex therapy, for which no requirements exist. Unfortunately, physicians and general clinical practitioners do not have the training to effectively discuss sex and assess sexual situations, nor the tools to provide full treatment.

The best approach is one of collaboration between practitioners. As one example, women complaining of low sexual interest who consulted with both a gynecologist and a sex therapist reported a 25% improvement from medical help (treatments for hormonal balance, lubricants, and “designer” enhancement creams), and 75% of the reported overall improvement in their sex lives from utilizing tools, information, and support from sex and relationship therapy. Women rated intimacy and quality of sexual experiences at a median of 2 when they began treatment; the same women and their partners rated their sex life a median of 8 after utilizing both medical and sex therapy interventions, including at 6 month and 1 year follow-up.

The medical components of treatment were described as helping with physical comfort and function – certainly imperative in supporting clinical therapeutic work of developing a healthy, satisfying sex life. Similar types of cases involving erectile dysfunction, sexual pain, and other male and female health issues confirm the necessity for both medical and qualified sex therapy treatment.

In some cases, sexual issues may improve for an individual or couple with general psychotherapy. Trauma, mental health, communication, anger, and other problems can severely impact intimacy and sexuality. When such issues are dealt with, sometimes sexuality improves as well. More commonly, however, intimacy and sex have “taken a hit” amidst the other problems and remain completely ignored or inadequately addressed even when other problems have been resolved. Yet another scenario is that sexual problems that don’t get discussed were the cause of other presenting issues.

Sex therapists often hear such statements as, “We went to a marriage therapist but the sexual issues – we didn’t feel we could even bring that up.” Or “We went to therapy before; we’re doing better but the sex part is still a real problem.”  Non-certified clinicians do not know how much they don’t know; nor does the patient seeking treatment. The differences between general, marriage, and sex therapists are not well known, and no separate category for certified sex therapy exists in marketing venues. A qualified sex therapist can be hard to find.

Do sex therapists treat other issues?

By definition, sex therapists must be able to treat issues in addition to those presenting as sexual. Because sexuality is integrated with many body mind functions, AASECT certification requires that the specialist be a licensed psychotherapeutic clinician. Sex therapy incorporates general psychotherapy because sex is not a disconnected, isolated issue existing in a box. Sexual difficulties may also be symptoms of other even more fundamental emotional, spiritual, physical, or mental problems.

Well-delivered sex therapy is holistic, comprehensive personal and relationship therapy, which includes directly addressing sexuality and intimacy in the context of overall treatment. Many therapists who specialize in sex therapy focus their outreach and practice on individuals and partners whose presenting issues include sexuality as one primary complaint.


The sex therapist’s toolbox

Sex therapy is a wide field rich in information and approaches designed to integrate treatment of sexual symptoms with overall personal and relationship therapy. This usually means talking in detailed depth about sexual experiences, problems, history, and symptoms, then offering research-supported intimacy/sex education and activities (“homework”) appropriate to each issue and patient.

Some tools of sex therapists may be similar to those tried and true techniques used in general treatment, but modified or expanded to include direct attention to sexuality. These include providing scientific, social, and cultural information; CBT (cognitive behavioral therapy); teaching mindfulness practices; supporting and integrating spirituality; psychodynamic approaches; psychosexual education; applied brain science; working with physicians and complementary/alternative health practitioners; applied family and consumer sciences and more. In sexological circles, sex therapy itself is viewed as an approach.

One technique called sensate focus, originally developed by Masters and Johnson and widely used in sex therapy, has been updated and adapted over the decades. Sensate focus can be part of effective treatment for a variety of prevalent intimacy and sexual problems, including those involving low desire, erectile dysfunction, sexual pain, past abuse, mental health issues, physical disability, chronic illness, age related problems, and others. Because it’s part of historic overviews, many practitioners may have heard of sensate focus, but clinicians without specific sexological training in applying the technique should not use it.


Working together to treat the whole patient

Clearly both medical and clinical sexological treatment are necessary for sexually oriented problems. While sexual symptoms highlight need for clinical attention, some sexual problems may involve a primary medical diagnosis such as those related to illness or disability, sexual pain, erectile dysfunction, and others. These conditions remain catalysts for relationship and family issues, however, so medical treatment is but one fundamental component of comprehensive help. Among the following top ten influences for development of sexual problems are items that may involve medical care, but assessment and treatment of how these manifest in patients’ relationships and sex lives is plainly outside the scope of medical practice:

*Personal and family background

*Cultural influences and misinformation

*Attention problems

*Stress and overwhelm

*Health issues

*Lack of positive information and experience


* Trauma and PTSD


*Obsessive and compulsive behaviors

Since few patients know where to seek help for sexual distress, physicians may be the first receivers of such complaints. Fortunately medical treatment is available for several sexual problems, but specialized help with issues that developed prior to or during medical treatment may frequently be needed. In other words, even when sexual issues and problems have a treatable medical cause or component, patients suffer consequences in their personal and relational lives that are beyond the scope of medical treatment or general psychotherapy. Clinical sexologists have empirically supported information and tools to directly address intimacy, relationship health, and sexual activity (following physician’s guidelines for the patient) prior to, during, and after medical and psychiatric treatments and procedures.

Treatment compliance and efficacy

It’s well known that regular visits to physicians and counselors promote self-care, treatment compliance and efficacy. Patients referred to therapists by physicians report a high rate of satisfaction with that physician, and with having concomitant clinical support. Research in several fields shows that empathy, expanded care, and comprehensive follow-up provided by therapy result in earlier complete recovery, improved immune function, and lower rates of relapse. Patients appreciate collaboration between practitioners; collaboration supports consistency, follow-through, and complete utilization of both medical and clinical resources by patients.

Studies show that most couples have not even discussed their sexual issues with each other, let alone a physician or counselor. Men are 60% less likely than are women to talk to a physician about health problems, especially those involving sexuality, until the symptoms become severe. When patients finally ask for help, if medical care includes the physician’s referral to a clinical sexologist, patients may feel justified hope that the issue is not only a medical one with limited treatment options: there are additional types of trustworthy help; they are not alone with their struggles when they leave the physician’s office; patients are relieved to learn that it’s OK to talk about sexual problems.

Conversely, if medical help with sexual problems doesn’t work or isn’t enough, and no referral to a sex therapist is provided, several unfortunate results may occur. Patients may lose faith in medical help; lose hope for getting better at all; conclude that they are even worse (“wow, even Viagra didn’t help me I must be really bad…my marriage is over…”). Some patients unsuccessfully and even dangerously try to solve the problems on their own; others may stop seeking help anywhere – which is a shame, and can lead to possible serious risks to well being.

Some sexual symptoms indicate unaddressed abuse, trauma, or other health issues that are not easily diagnosed by a physician without additional input from a therapist. Untreated sexual and relationship problems frequently lead to damaging personal, marital, and family problems, and impact community health.

Physicians have limited time; health care provides limited coverage

In the current economic climate and world of managed health care, treatment provided by physicians is regulated as to diagnosis and time. Even if physicians were provided with the necessary training, time is not allowed to counsel adequately for sexual and concomitant relationship problems, nor is payment approved.

Although several diagnostic codes exist for sexual complaints, these codes (whether or not empirically sound) are recognized but not covered by most insurance plans. Reimbursement to patients for therapy with a clinical sexologist is sometimes possible when other covered diagnoses are involved in the sexual and relationship problems. Time, tools, and training that physicians and general psychotherapists do not have are required to assess if and how approved diagnoses impact the sexual complaints of the patient.

Common problems addressed by sex therapists

As many physicians also experience, possibly the most common complaint received by sex therapists is low desire and low-sex marriage. “Low desire” and resulting low and no-sex marriages often end in breakups that in turn impact children and families. Low desire and low-sex marriage have many causes and many complications. These complaints need to be addressed by a qualified sex and relationship therapist.

Prevalence of low and no-sex marriages attributed to low desire bears brief discussion here since low desire is often treated as a medical and/or psychiatric problem. There are medically treatable components of low sexual interest; however, lack of sexual desire and activity are symptomsnot a diagnosis. The “official” diagnosis of Hypoactive Sexual Desire Disorder (DSMIV, 302.71) is unsound. There is no empirically determined “amount” of sex to want or have. There is no high, no low – because there is no norm – a fact stated in the DSMIV itself (p. 539). Sexological research has clarified over one dozen causes for so-called low and high desire in both women and men, only a few of which are biologically related or treatable in part with medications: a fact which supports the necessity for assessment by a qualified sex therapist in every case of low or high desire.

            This guide is written in the spirit of collaboration between practitioners for the purpose of ethically and effectively serving patients in our communities. Deliberate intention and action is needed to overcome the separateness of professional domain and practice unintentionally created by the vastness and complexity of our health care system. When medical treatment is provided to patients with the following complaints, consider as you would with many other health issues a referral to the appropriate specialist, in this case a qualified sex therapist, for further assessment.

Scope of practice – issues in clinical sexology

* low and high desire

*low or no-sex marriages

*desire discrepancy in relationships

*erectile dysfunction/rapid ejaculation

*inhibited orgasm/anorgasmia

*sexual pain/vaginismus

*compulsive sexual behaviors including “sex addiction”

*extra-marital affairs

*pre-marital counseling


*relationship conflict

*past or present abuse

*childhood or adult trauma and abuse

*sexual orientation issues

*alternative sexual interests

*persons with disability and chronic illness

*alternative and open relationships

*any physical, mental health, or relationship problem impacting sexuality

*family members and family issues involving sexuality: marital happiness, sex education and health, family life management, family planning

updated explanation: How I work ~ what is multi-modal, holistic, cognitive behavioral therapy?

Cognitive-Behavior Psychotherapy (CBT, also known as CBE – cognitive, behavioral, emotional) focuses on the thoughts, feelings, physical symptoms & behaviors that comprise an area of emotional, relational, and life difficulty. Controlled clinical trials of treatment for Anxiety & Mood disorders demonstrate that CBT decreases symptoms in 60-80% of sufferers. Research comparing CBT to psychotropic drugs for anxiety and mood problems repeatedly show that therapy is equally effective but more comprehensive and long term: Drugs change your brain chemistry, with some unwanted side effects, but do not change your circumstances nor the origin of anxiety, mood, or relationship problems. New behaviors as developed through CBT also change brain chemistry and therapy helps you address the cause(s), not just the symptoms. In acute situations, research shows that combining drugs with therapy is the most effective treatment.

The goals of CBT are to:

• recognize maladaptive patterns of thinking/acting

• decrease the intensity & frequency of problematic symptoms

• increase coping skills, change feelings and behaviors

• prevent relapse

What is multi-modal, holistic therapy?

 Multimodal therapy allows individualization of approach and techniques defined by what each client needs. Dr. Orion’s application can incorporate brief therapy approaches, individual or couples work, CBT, mindfulness and relaxation, traditional talk/insight therapy (psychodynamic), solution focused techniques, family systems theory, sex therapy, and clinical humanistic psychology. Holistic means we address the whole of your life – physical, mental, emotional, spiritual, cultural – as needed, in relation to the problems and issues you present, rather than just focusing only on specific symptoms with a single approach. It’s body, mind, & spirit; it’s bio-psycho-social.

 A whole person is more than behaviors and thoughts, but maladaptive thoughts, feelings, and behaviors can impair lives and relationships. People suffering from such impairments also need to clarify, heal, express, tolerate, and share emotions. Emotional closeness is the essence of intimacy and a vital part of any significant relationship whether between parent and child, family members, friends, or adult partners. Using CBT to address behavior and thinking patterns is often a necessary component in further developing emotional and relationship health. Sexual health is more than the absence of disease; relationship health is more than the absence of conflict.

Psycho-education is yet another important component of most clients’ therapeutic experience. Everyone in this complex society and stressful demanding world needs information on a variety of topics including the process of change, relationships, brain function, physiology, nature and instinct, and how culture has and does impact our selves, families, and relationships. Many people also, or instead, need other kinds of help, including understanding and differentiating from family of origin influences and experiences, and with problems that may NOT require a comprehensive CBT program. Multi-modal, holistic approaches allow for such individualized, yet expert, treatment.

The importance of clinical counseling in holistic vaginismus treatment

Women with vaginismus not only suffer pain but experience many side effects. Few vaginismus patients have been diagnosed correctly, if at all, from the start of their seeking help. Many tell of a long journey involving several kinds of physicians, alternative practitioners, and therapists, most of whom have misdiagnosed the problem often telling the woman in effect that it’s all in her head. Stories told by patients include feeling “not being a whole woman” and therefore unable to be a “real wife”. Others tell of dating men who abuse them because they don’t deserve better: “No good guy would want someone who can’t have real sex.”

Because understanding of vaginismus is recent, clinicians and physicians often lack training in the diagnostic criteria. They “see” nothing wrong and conclude that the pain stems from psychological issues of the individual or her relationship. Other types of practitioners focus treatment on emotional and physiological awareness and pain control, or on manual relaxation of the pelvic region.

Vaginismis myths


Several myths exist regarding the causes of vaginismus. One of the most prominent is that sufferers were raped or sexually abused and, in response, developed resistance and pain. Another is that negative background, including attitudes of shame or fear of sex, caused the problem. These sound like reasonable causations based on symptoms, but recent research suggests no more prevalence in backgrounds of abuse or negativity than in women with no vaginismus. Nor does sexual pain appear to be a consistent response in women who do have abusive or negative backgrounds. Many vaginismus sufferers report no exceptionally negative backgrounds with regard to sexuality; their female siblings, raised in the same family, do not have vaginismus. The condition of vaginismus has also been confirmed cross-culturally, suggesting that background is not a causative factor.

Vaginismus realities


The most telling support for the diagnosis that vaginismus is NOT “all in your head” is the experience of women who receive appropriate medical treatment. During treatment, under anesthesia, spasms still occur when muscles are touched. Since the woman’s “head” is not involved at the time, one conclusion is that spasms are local and physical as well as involuntary. When such spasms occur in another part of the body, such as facial tics, [botox] is effective in eliminating the spasms. The same treatment works on vaginal muscles. Even after the patient wakes up and her thinking head is again involved in her physiological functioning, the spasms and pain are gone.

Elements of treatment


As in many medical treatments, ending the physical cause is not the total healing process. As we know from other types of bodily injury and rehabilitation, the body may have to learn new muscular responses to the brain’s new signals. Women with vaginismus have tight, short muscles that need stretching over time. Since painful spasms have now been stopped, other forms of therapy can begin. Successful vaginismus patients have daily contact with the physician or nurse for many days or weeks during the dilation therapy that follows Botox treatment. If this supportive, coaching style follow-up is not provided by the physician or her/his well-trained staff, a sex therapist trained in vaginismus treatment and follow-up is necessary.

This process has been reported as 95% successful, success being defined as ability to have painless intercourse within weeks or months of treatment. This success, however, also involves clinical counseling. Although the cause of vaginismus is not in the head, many side effects of suffering from the condition become lodged in the mind and manifest in the woman’s relationships.

Sexuality is central to one’s personal identity; pain of any kind experienced during sexuality affects self-identity. After physical pain has stopped and normal physiological function can begin, lack of positive sexual experience, self -esteem issues, and awkward or scary feelings inhibiting sexuality do not necessarily disappear along with the pain.

What is called “low desire” refers in part to experiencing less automatic desire for sexual relations than one wants to have. Not only the woman, but also her male partner, may have low desire for sex even when her pain is stopped and her muscles have stretched. In her, a lack of sexual desire may result from years of associating pain with sex. Her relationships have also been negatively affected: Women with vaginismus and their partners often experience anxiety, depression, deep feelings of rejection, doubt in themselves and in the relationship, guilt, and lack of trust.

A man in relationship with a woman who has vaginismus may have low desire stemming not only from lack of positive experience, but from feeling he’s caused pain for his partner. This results in no confidence and poor sexual functioning. Not wanting to hurt their partner may lead to erectile or orgasm problems. Both partners are afraid of pain and emotional disappointment, and sexual encounters have often been fraught with apologies and attempts to convince each other that failure of “normal” sex is not due to a lack of loving one another.

Who could have an automatic desire for sex after all that?

Instead, what is now automatic for many couples are negative and anxious emotions and thoughts, recovering from which is not an instant or given result of the medical treatment that stops her spasms. Such issues and experiences are also not exclusive to vaginismus sufferers, fortunately, because this means that qualified sex therapists can help with these non-medical aspects of healing.

Misdirected therapies


Many women and couples who, prior to medical treatment, undertook counseling that did not help are leery of seeing another therapist during or after treatment. Many a woman has been told that she may have repressed memories of abuse, or that some other deep-seated psychological problem is causing vaginal spasms, or that her vagina is closing up because somewhere in her psyche she wants to “keep out” the man’s penis or “avoid emotional as well as physical penetration” (quotes from therapists on e-list discussion).

Objections have been raised by some therapists about the use of botox and dilators to correct vaginismus, claiming that inserting the dilators while the patient is under anesthesia is a violation of the woman, even though she stated wanting (and consented in writing) to the treatment. This is a specious argument unless one assumes that women with vaginismus, despite what they say, don’t really know what they want, whereas the therapist does: that the therapist knows more about the woman than she does about herself – the therapist cannot trust what the patient says and has the right to override what the patient says.

Such assumptions presume that vaginismus IS a psychological problem based on “not wanting to be penetrated.” Such a perspective may be seated in political views. If those views are meant to support women, then it is imperative to understand that women with vaginismus are not psychotic; they have a physical, medically treatable condition.

All women so far treated (Pacik, 2011, 2015) report resulting positive experience, including being happily surprised, even healed from their disbelief, when they wake up with a dilator inserted without pain. Healing does not result from violation. If we adopt the “violated” view, we must also conclude that every woman is lying post-treatment.

Design of successful, non-physiological treatment


A comprehensive and holistic treatment plan for vaginismus includes counseling with a relationship and sex therapist as part of pre-medical treatment preparation. The woman and couple will almost certainly need post-medical relationship and sex counseling. Having a rapport with such a therapist already in place is arguably imperative so that the couple is comfortable with the counselor when pain has stopped, rehabilitation is happening, and intercourse becomes possible. Connection with an appropriately trained counselor prior to treatment combats mistrust caused by any experiences with therapists who may have compounded personal and relationship problems with incorrect diagnosis and treatment.

If the physician is providing much of the vaginal rehabilitation follow-up counseling, part of post-treatment counseling need is being met, but issues beyond the scope of any physician ought to be assessed and addressed by a qualified clinician. Often physicians understandably don’t know what questions to ask, nor how to address the answers; women and their partners themselves often have not sorted out the details and depths of the negative side-effects caused by struggling with vaginismus for months or years. A qualified sexuality counselor with additional current information on vaginismus treatment is integral to helping the woman, her partner, and their relationship heal from the effects of this painful and damaging condition.

Rhea Orion, PhD, CST

Dixon and 

Napa, CA


Practice random kindness…

A client told me a story today that made me think of the saying practice random acts of kindness. You just never know what people may have been going through in life, or this day, so its best to practice kindness as often as possible.

How crazy would this be: the receptionist who answers the phone at a hearing aid facility talks too fast and doesn’t listen to the caller even when the caller states that they are hard of hearing?

Crazy is too often true but this story is even worse – the receptionist hung up not once, not twice, but three times on my client, a disabled man who wears two hearing aids!

This client, we’ll call him Joe (not his name), had lost one of his custom made, expensive hearing aids which is why he was calling. He was quite worried and obviously having even more trouble hearing without one of his aids. When the woman answered the phone, she spoke rapidly and Joe asked first if he had reached “the hearing aid place”. Instead of answering yes or no, and surmising that the caller has at the least, a hearing problem, the receptionist rattled off several sentences that Joe could not understand. He then asked her to please speak more slowly – and can she just say yes or no if he has reached the right place? Again, she rattled off several sentences that he did not understand. When he tried to explain that he has a phone for the hearing impaired and if she speaks more slowly he can adjust the receiver – she continued to talk over him without listening.

Keep in mind – she’s answering the phone at a place that makes hearing aids….

As the woman continued to talk over Joe, he raised his voice and said – hold on, hold on, please hold on…and she hung up on him! This was very upsetting to him, but he dialed the place again. When she answered he said – if this is the hearing aid place, i think im the person you just hung up on…and she hung up on him again without a word!

Fifteen years ago this man was a working truck driver, transporting goods that you and I count on, when in winter he had a terribly serious accident. He has since had some memory, comprehension, and hearing problems. It also took him a couple of years to regain the ability to walk or have feeling in several areas of his body. He has never been able to work or live a full life since.

People who experience such traumas have long lasting affects to their emotions as well – easily set off panic, anxiety, fear, and memories of their trauma; your basic post traumatic stress disorder. Something as “simple” as being rudely dismissed and hung up on when trying to call for help – sets off anxiety and even memories of his life threatening accident.

My client’s wife, also an older woman with some disabilities of her own, called the hearing aid place a third time and was able to speak to the physician who makes the hearing aids. When she explained what had happened, the physician said – “The receptionist told me that Joe was rude to her. I know he has hearing problems but she’s new – there’s two sides to everything.”This cavalier attitude made Joe feel betrayed by a practitioner who had worked with him for a long time and usually understands.

It also suggests that he will not do much to retrain this new receptionist – who needs to perhaps realize that people calling a hearing aid place, may be hard of hearing.

The practitioner obviously did nothing about it that day. Joe called the next day to inform the physician that the hearing aid had been found and to ask if it should be brought in for adjustment so Joe wouldn’t lose it again. The receptionist hung up on him the minute she heard Joe’s voice!

What happened to common courtesy? Any patience or compassion? Is “the customer is always right” completely outdated?

Joe told me he thought about his phone call “for several days” trying to learn how he had acted so badly as to “deserve” such treatment. His wife confirmed for him that he had likely done nothing at all wrong. I agree and I’ve worked with Joe for nearly a year.

I hope we’ve all had the experience of our day improving because someone smiled at us or had a kind word to say. I know I have. Unfortunately the opposite is also true.

Fortunately, Joe has gained some wisdom and strength during his years of recovery and rebuilding life. Despite his ruminations, and the usual feelings he has of being isolated, left out, misunderstood, and a bother because he always has to ask people to slow down when speaking, he was able to go on with relative stability and whatever joy he is able to experience.

No thanks to a young receptionist who needs to learn manners at least – and to practice kindness more than randomly, at best.

Americans’ Main Regrets Are Lack Of Romantic Relationships, Higher Education

09 Jun 2011 Regrets – we’ve all had a few. Although too many regrets can interfere with life and mental health, a healthy amount of regret can motivate us to improve our lives, say researchers Mike Morrison of the University of Illinois and Neal Roese of Northwestern University in the current issue of Social Psychological and Personality Science (published by SAGE).

The researchers telephoned a representative sample of nearly 400 Americans to ask them about what they regret. The most frequent regrets of Americans are about love, education, and work. Romantic regrets – America’s most common – focused on lost chances for potential romances, and relationships that did not live up to their potential.

The other common regrets for Americans involved family, education, career, finances, and parenting. Women were more likely to have regrets about relationships (romance, family), and men were more likely to have regrets about work (career and education). It was the lack of romantic relationships and the lack of higher education that were regretted most.

At first, people tend to regret the things they’ve done more than the opportunities they didn’t take. But with time, people come to regret more keenly the chances they let go past. Over their lives, Americans had more regret about the times they’ve lacked opportunities than about the choices they’ve made.

“We tend to regret matters that are most important to us,” said Morrison, “people crave strong, stable social relationships and are unhappy when they lack them.” Regret can be painful, but it can also be useful. “Some people say they try to live life without regret and, I think that’s being unfair to the human condition,” said Roese, “if we try to squeeze regrets away, we’re sacrificing a bit of our humanity.”

The article:
“Regrets of the Typical American: Findings From a Nationally Representative Sample” in Social Psychological and Personality Science.

Resolve to be mindful – its easy, and gets the house clean!

We made it through another holiday season, I hope it was joyous and wonderful for all! In between carrying out your new years resolutions and getting back to a more routine life, which can actually seem restful after a few months of holiday exceptions and mayhem, we may notice that the house needs some attention. If you are among those who entertained or decorated, chances are you’ve put away the tree ornaments, but the house is in need of a good post holiday clean.

Maybe you didn’t change your home much for the holidays and kept up with your usual housecleaning – or your usual not housecleaning. In either case, the following way to approach cleaning as a mindfulness activity will accomplish at least two things: your house will look and feel better, and so will you!

Read, lather, rinse – and repeat often! Happy new year!

Mindfulness Exercise #4: Cleaning House
The term “cleaning house” has a literal meaning (cleaning up your actual house) as well as a figurative one (getting rid of “emotional baggage,” letting go of things that no longer serve you), and both can be great stress relievers! Because clutter has several hidden costs and can be a subtle but significant stressor, cleaning house and de-cluttering as a mindfulness exercise can bring lasting benefits. To bring mindfulness to cleaning, you first need to view it as a positive event, an exercise in self-understanding and stress relief, rather than simply as a chore. Then, as you clean, focus on what you are doing as you are doing it — and nothing else. Feel the warm, soapy water on your hands as you wash dishes; experience the vibrations of the vacuum cleaner as you cover the area of the floor; enjoy the warmth of the laundry as you fold it; feel the freedom of letting go of unneeded objects as you put them in the donations bag. It may sound a little silly as you read it here, but if you approach cleaning as an exercise in mindfulness, it can become one. (I also recommend adding music to the equation.)

“Eat Food. Not too Much. Mostly Plants.” Michael Pollan, in Defense of Food, The Omnivores Dilemma