Behind the doors of a sex therapist, clients seek understanding, acceptance, and answers. But how can mental health professionals help their clients achieve these goals? Dr. Stephanie Buehler, a licensed psychologist, sex therapist and a recognized author, invites you to “Step Into My Office” with monthly sidebars taken from her own experience.
A woman (or man) is said to have a sexual aversion when she finds all or some aspects of sexual activity repulsive. Sexual aversion is associated with feelings of disgust, humiliation, shame, and low self-esteem (DSM IV-TR, 2000). The aversion can be to an act, such as oral sex or being penetrated; an odor, such as semen; a sensation, such as saliva during kissing or sweat; a body part, such as the woman’s or partner’s genitals; or even a sound, such as a partner’s moan during orgasm. It can also be a thought or fantasy associated with sex. The aversion can be situational or generalized. A woman may, for example, enjoy all aspects of sex except kissing, or she may avoid all sexual stimuli. The symptoms of sexual aversion include avoidance of sexual stimuli; physical symptoms typically associated with panic attacks; and nausea and vomiting. There is generally a disturbance in the woman’s relationships, or she may never have been in a romantic or sexual relationship because of the aversion. Sometimes alcohol and drug use cover up a sexual aversion, as they allow a woman to numb herself for participation in sex even when the activity is unwanted.
STEP INTO MY OFFICE...
Jo Ann developed a sexual aversion because her husband had pressured her since before marriage to have sex, coercing her by making her feel ashamed for having had sex a few times with other partners but not with him. Over time, giving in to her husband lead Jo Ann to feel repulsed when he touched her genitals or breasts. Thus, she avoided sex and they were active only once or twice a month, which led to escalating passive aggressive behavior by the husband, such as complaining and wheedling Jo Ann for sex, which was a further turn-off.
The prognosis for sexual aversion is generally guarded or poor, in part because treatment is long-term and intensive. The treatment plan consists of couples therapy if the woman is in a relationship; education; cognitive behavioral therapy; relaxation; and customized activities that are designed to help desensitize the woman to the unwanted sexual stimuli. It is highly individualized because of the variety of stimuli to which a woman can develop an aversion.
Cognitive work addresses maladaptive beliefs about sex, such as worry about getting pregnant by kissing, losing control during orgasm, or sex “always being for the man’s benefit.” Some exploration regarding where the myth originated can be helpful as the client may realize that what she heard as a child or teen doesn’t fit the adult self’s schema of sexuality.
To treat with systematic desensitization, employ the client’s help in creating a hierarchy of activity from least to most noxious. In the case example above, the woman didn’t mind if her husband stroked the tops of her thighs, but would start to feel nervous if he approached the inner thigh, so we identified a starting point for sensate-focus type activity. Choosing to do the touching activity with clothing on or off creates another step in the hierarchy, as from being touched on the inner thigh she thought she could manage being touched at the groin with clothing on as a next step. From there, she progressed to being touched on the mons with clothing on. She then repeated the sequence with clothing off and the couple next worked their way to the husband being able to touch her on her labia. The most important aspects are relaxation and building trust.
In couples therapy, the focus is often on issues of control. An aversion is a defense mechanism that controls either some aspect or nearly all of a person’s sex life, including how emotionally close they can become to a partner. Creating an atmosphere of understanding and compassion between the couple helps them see that they are both part of the solution. As they work on the assignments together, they are strengthening their emotional bond as well as learning the elements of good sex: patience, knowledge, time, exploration, relaxation, arousal, and last but not least, love.
For a full list of activities to help overcome a situation like this, check out Stephanie Buehler’s book What Every Mental Health Professional Needs to Know About Sex.