When sex hurts….

When sex hurts….

There are various medical terms to describe different types of female genital pain – dyspareunia, vaginismus, vulvodynia, vestibulitis, pelvic pain… As a specialist Clinical Psychologist and qualified psycho-sexologist, sometimes the women I work with have one of these diagnoses, and sometimes no diagnosis at all. Often women have had multiple diagnostic labels, which can be even more confusing.

If you are experiencing pain during sex, it is important to first investigate any medical factors that might be causing or contributing to your sexual pain problem.

‘This is not all in my head!’

Some women are disappointed that medical examinations and tests do not show up any physical explanation for their problem. Other times, the biological factors (such as a skin problem, for example) contributing to the pain has been treated but still the problem persists.

One of the questions people often ask me is “Do you think it is all in my mind?”, as if somehow they are imagining their problem or causing it themselves, or that their problem is not ‘real’.  It is important to remember that the body and mind are connected in complex ways, so dividing problems into body versus mind is not a helpful or representative way of looking at problems.  When we look at women’s sexual response cycle as well as the psychology of the pain system, it is clear that sexual pain problems are complex, involving physiological and psychological systems which are inter-related, and feed information back to each other. A specialist psycho-sexology approach, in addition to recommended medical treatment where advised, has been shown to be effective for female sexual pain problems.

Just as specialist Clinical Psychologists play a key role in treating chronic pain problems, clinical psychologists also play a key role in treating sexual pain problems. Everyone’s problem is different and therefore treatment and therapy is tailored to the individual.

I have worked with many clients who thought that they would never have pain-free or even enjoyable sex again, and came along to psychology reluctantly, as a ‘last ditch effort’, only to surprise themselves by how much progress they made in a relatively short space of time, and have been able to reclaim their bodies and resume a pleasurable sex life.


Mindsurgery London provides individual sessions, face-to-face and over Skype, for a range of psychosexual issues. See www.mindsurgerylondon.co.uk for more details.



The Desire Myth: The things you never knew about sexual desire

The Desire Myth: The things you never knew about sexual desire

What if we were missing some vital information on desire and how it works in our bodies? What if this information could help us view our bodies and our sex lives differently?

In my clinical practice as a Psycho-Sexologist and Clinical Psychologist, I see many women who feel that something is very wrong with them if they don’t experience sexual desire in the way that they expect.  They complain of low libido, low sex drive, no interest in sex….

Behind these complaints is often the idea is that desire is something innate, something that we feel or that we don’t, something that is spontaneous and cannot be forced.  But where do these ideas come from? Popular culture, magazines, films, all portray desire as something we can think of as spontaneous desire.  Spontaneous desire is high adrenaline, it’s exciting, it’s ripping each others clothes off.. it’s Hollywood, it’s porn, it’s advertising, it’s pop songs.

But, is there more to desire than this? Our understandings of sex and desire have been changing slowly over the past 50 years, since Master’s and Johnson’s pioneering sex research.  More recent theory and research led by Rosemary Basson, Clinical Professor at University of British Columbia, and her colleagues, introduced the concept of responsive sexual desire.

Responsive desire is when the motivation to have sex begins AFTER something sexy has started happening. For example, you are sitting on the couch watching TV, not thinking about sex at all, not feeling remotely horny, and your partner leans over and starts kissing your shoulder, your neck, and you think, ‘Mm thats nice’, and things continue and after a while you feel desire, ‘in the mood’. That’s responsive desire. You are responding to the context and situation. Desire has come out of an openness to go with what feels good.

Desire can be spontaneous or responsive. Desire is not a pre-requisite for sex, it can follow with an openness to see what feels good. Of course there are reasons that some men and women don’t experience either spontaneous or responsive desire, and that can be very difficult, but more about that in another post..

Spontaneous desire is more common a style in men, and responsive desire more common in women, but both men and women can experience both at different times.  Women’s desire tends to be more varied and more sensitive to context. Relationship dynamics, mood, intimacy, and how we feel about our bodies, all play an important role in women’s sexual response.

Research on style of responsive versus spontaneous desire in men and women and found that about 30% of women and 5% of men experience their sexual desire as more or less exclusively responsive, while about 15% of women and 75% of men experience their desire as more or less exclusively spontaneous. About half of women experience some combination of both spontaneous and responsive desire, depending on the context.

Why do we need to know this?

Media and popular culture and even out-dated academic research may have us believe that if, as women, we don’t feel desire in the way that it is most commonly culturally portrayed then SOMETHING IS WRONG WITH US… Responsive desire doesn’t translate so well onto the screen or into cultural media. It’s a slower burn. But it is absolutely just as normal as spontaneous desire.

Understanding responsive and spontaneous sexual desire can change how, as women, we view ourselves and our sex lives. It saddens me when I see women who are so quick to label themselves and their bodies as faulty in some way, when it is perfectly normal to not feel spontaneous desire much or any of the time. And of course, this can lead to a vicious circle where some women feel that they are not meeting some imagined sexual standard in terms of desire and sex drive, so then feel less sexy, and are less likely to experience desire.  If they believe that spontaneous desire is the one true desire, then they can often abort any sexual activity without going with the flow to see if desire follows….

Men, what does this mean for you?

Often the male partners I see feel that their partner’s lack of spontaneous desire means that she has gone off them, or are no longer attracted to them.  At the beginning of a relationship, sex is commonly more frequent, and spontaneous desire is more common in both men and women. With time, as the relationship progresses, frequency of sexual activity reduces, and also the responsive style of desire can become more dominant for some women. Men, be reassured that simply because she does not experience desire in the same pattern as you, this does not (necessarily!) mean she is not attracted to you or that she has low libido.

Take charge of your sex life!

There is nothing more guaranteed to kill any kind of desire than the belief that you are somehow broken or faulty.  Language matters. The more you and your partner label you as being somehow ‘deficient’ in desire, the less opportunities you have to escape this label. So, embrace your desire style, whatever it is. If responsive desire is more common for you, think with your partner about how you can create situations so that you are open to responsive desire.

Let’s start breaking down the dominance of spontaneous desire. Let’s stop buying into the idea that desire is one dimensional.

So perhaps the question to ask your partner is not ‘are you in the mood tonight darling?’ But rather, are you up for seeing if you get into the mood…

Mindsurgery London provides individual sessions, face-to-face and over Skype, for a range of psychosexual issues. See http://www.mindsurgerylondon.co.uk for more details.