What Do Sex Therapists Do? (Hint: It's Not What You Think)

When it comes to sexual health, if you don't ask, patients won't tell. Plus: how to find a sex therapist.
www.medscape.com/viewarticle/...
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Rachel S. Rubin, MD: I'm Dr Rachel Rubin, a urologist and sexual medicine specialist in the Washington, DC area. We are here at the Harvard Continuing Medical Education Course in Orlando, Florida. It's all about testosterone therapy and sexual medicine. I have with me today the wonderful Dr Marianne Brandon, who is an amazing sex therapist. Could you introduce yourself?
Marianne Brandon, PhD: I am a clinical psychologist and sex therapist. I've been in practice for more than 25 years. I'm currently located in Sarasota. I have a Psychology Today blog called The Future of Intimacy, which I have a lot of fun with.
Rubin: It's very important, when taking care of patients, that we work in a biopsychosocial model. Yes, we can fix erectile dysfunction. We can help with menopause symptoms and that helps sexual function. But what I find makes my patients able to live their best lives is when they have a team, including a mental health professional - often a sex therapist or a couples' therapist - where they can learn communication skills. Why is it important for primary care doctors to talk to their patients about sex? My primary care doctor has never asked me about sex.
Brandon: For most people, sexual intimacy is critical for their experience of life. It correlates with their relationship satisfaction and life satisfaction. It's much bigger than what's happening in the bedroom. People have more struggles than you realize. Sexual dysfunction correlates with emotional issues such as depression and anxiety, with medical problems, and with medication use. Chances are that your patients have some kind of sexual concern, even if that's not to the degree that it would be classified as a sexual dysfunction.
But sexual concerns wreak havoc. Believing they have a sexual problem, they stop touching, they stop relating to their partner. It becomes a really big deal in their lives. If you can open the door for a conversation about sex with your patients, it could do them a great deal of good. It's also good for the practitioner, because if your patients think they can talk with you about anything, that's going to establish your relationship with them. Practitioners avoid these conversations because they don't have the time or the training to offer help.
Rubin: You don't have to know all the answers. You just have to show empathy and compassion and say, "I hear you." That's the magic in the doctor-patient relationship. We refer patients to specialists when we don't know what to do. What happens when I send a patient to a sex therapist? Do they watch them have sex? Of course not, but everyone thinks that is what sex therapists do.
Brandon: Sex therapy is just like any other type of therapy, but we discuss sexual issues. And because just about anything that's happening in your patient's life can trickle down into the bedroom, we end up talking about a lot of stuff that's not directly related to sex but ultimately impacts the patient's sex life.
Rubin: It's true. Most medical conditions that we treat - from diabetes, hypertension, high cholesterol, and obesity to depression and anxiety - are strongly correlated with sexual health. We treat the underlying condition, but our patients don't care about their A1c levels. They care about the fact that they cannot get aroused; their genitals don't feel the same way they used to.
Brandon: I love that point because people make meaning out of their sexual concerns and dysfunction. Suddenly their body isn't responding the way it used to. They think something's wrong with them, or maybe they are with the wrong partner. This meaning becomes very powerful in their mind and perpetuates the sexual problem.
Rubin: First and foremost, we are educators. We can say, "You have pretty out-of-control diabetes," or, "You're a smoker, which can affect the health of your genitals. Have you noticed any issues going on there?" If you don't ask, patients will not bring up their concerns with their doctors.
So how do people find a sex therapist?
Brandon: There are a few fabulous organizations that provide on their website ways to find a therapist: the American Association of Sex Educators, Counselors and Therapists (AASECT) and Sex Therapy and Research (STAR). Giving patients this information is a huge intervention.
Other places to find a therapist include the International Society for Sexual Medicine, and the International Society for the Study of Women's Sexual Health.
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