Working With Sexual Aversion

I’m continuing my series responding to the answers my readers sent me in response to the question, “What is your biggest challenge working with sex issues in therapy?” This week, I’m discussing a really challenging one: sexual aversion.

Understanding a little about the Dual Control Model of sexual arousal will help you begin to approach sexual aversion with more confidence. The Dual Control Model was developed by Jansson and Bancroft from the Kinsey Institute. Emily Nagoski’s excellent book Come as You Are presents the model accessibly and in depth, if you want more information. 

The Dual Control is useful in understanding lots of sexual dynamics. The idea of the Dual Control Model is that sexual arousal isn’t an on-off switch. It has two components–excitation and inhibition, which Nagoski frames as being like an accelerator and a brake. That is to say, things that turn you on hit the accelerator, and things that turn you off hit the brake. The point is, you can stomp on the accelerator all you want, but if something’s holding down the brake, you’re not going to get anywhere.

With sexual aversion cases, generally what’s going on is that something is holding down the brake, hard. No matter what your client or their partner might do to increase stimulation (or hit the accelerator), nothing is going to improve in any substantial way unless they figure out how to let up the brake. Your job as a therapist is to help them identify what’s hitting the brake, and how to let it up.

Anxiety is the biggest brake ever. Sexual aversion is a form of anxiety, or even panic. Aversion sometimes results from a history of trauma, or from untreated sex pain, or a subtle (or overt) feeling of coercion or pressure around sex, but there isn’t always an obvious cause. If you think of it as anxiety, you’re more likely to get to the bottom of it. There might be subtle but pervasive shame about sex, for instance, or body image issues. Start with the Will Lily brief assessment to make sure you are targeting your questions and not missing anything crucial. (Spoiler alert: don’t forget to ask if any kind of sexual contact is uncomfortable or painful!)

Regardless of cause, there are some skills that usually require strengthening in order to resolve an aversion. These include: 

  1. Help them get control over the situation. Your client must feel in control, at all times, when in sexual contexts. It is extremely helpful if their partner is on board with taking a supportive role until the aversion resolves. The role of the partner is so important to this treatment plan, because aversion is an entirely systemic phenomenon. Any little hint of external or internal psychic pressure about sex will have to be addressed. If this is an individual client, see if you can have the partner come in every now and then so you can see the dynamics between them, and strengthen the collaboration and teamwork. It is also very helpful to have both partners in the room for complicated psychoeducation that requires a perspective shift, as is often true when discussing sex pain, psychic pressure about sex, sexual pleasure (which can really increase desire!), and sexual differentiation of self. The partner of someone with a sexual aversion probably also could really benefit from some support; it is an extremely difficult situation to be in! It would be fabulous if you could support them both as they learn to work together and heal this dynamic around sex. They have a lot to gain.
  2. Build their ability to identify desires, set boundaries, and hold those boundaries. Without the ability to identify desires, preferences, and boundaries, communicate them, and back them up with action, it will not be possible for the client to really feel in control.
  3. Diagnose physical problems. Painful sex will make aversion worse, guaranteed. Absolutely get any sex pain diagnosed and treated. While that is under way, the client will need to completely abstain from any painful type of contact.
  4. Practice relaxation or mindfulness. Once safety and control are in place, the linchpin of your treatment plan will be teaching the client, and their partner, how to relax in sexual situations and enjoy sex for the purpose of pleasure, rather than performance. This is a lot easier to do in a relational therapy where you have both partners in the room. Consider bringing in the partner for a few sessions if this is an individual client.
  5. Explore intrapsychic blocks. Ambivalence about sex is worth a deep dive. Look for signs of past or current trauma, including psychically “benign” sex pain, but don’t forget to look for subtle shameful messages about sex, which are extremely pervasive. What were they taught about sex? About themselves sexually? About people who enjoy sex? Are they able to enjoy pleasure in any aspect of their life? How about sexual pleasure? You can identify blocks by having a client talk you through a sexual interaction, step by step. Ask what occurred, but also what they were feeling, and what they were thinking. At the first little sign of anxiety, which might be merely a body sensation, delve into the multiple messages they are telling themselves in that moment. “What are you telling yourself to make yourself feel anxious?” “What are you telling yourself to make yourself feel scared?” Chair work can be very helpful in both uncovering and treating blocks of all types.
  6. Keep your client’s goals front and center. Don’t forget: Having sex is not a requirement of life. It is possible your client is asexual, or just not very interested in sex. Before you really dig into treating an aversion, ask where your client would like to get. There is no point in working toward a goal that your client isn’t interested in meeting. That said, if they have the type of aversion that comes with a big “ick” reaction or panicky feelings, they might want to resolve the negative feelings. But having anxiety-free sex is not the only possible positive outcome. Being in control of what they choose to do, even if that means being able to feel good about themselves while saying “no” to sex forevermore, would also be a great outcome.
  7. Refer or consult if necessary. If you don’t find your treatment plan progressing, a sex therapist can probably help. You might choose to refer the client, for a time, or permanently. You could also consult with a specialist every now and then as the treatment evolves, while continuing to do the therapy yourself.

Rediscovering Sex in a Mixed-Desire Partnership

In last week’s post, I wrote about the common advice that partners experiencing a desire discrepancy “just do it,” and the way that can backfire. I argued that willingness (not desire) is the key ingredient for partners seeking to rediscover their sexual connection.

However, I also acknowledged that many couples feeling awkward and uncertain when they try to return to a sexual dynamic that has fallen out of practice. This week, I’m going to share a few strategies that couples can use to reduce their anxiety or generate sexual energy when “breaking the ice” around sex.

  • Explore other kinds of shared pleasurable touch. When partners don’t have sex for a long period of time, it’s common for other kinds of intimate, connecting touch to fall by the wayside–perhaps because one partner is anxious about touch “leading to” sex, or the other is anxious about pressuring their partner unintentionally. But engaging in pleasant, connecting touch can go a long way to reducing awkwardness and bringing you closer together. Try cuddling, kissing, lying close together, and holding hands, without making the endgame sex or orgasm. Instead, focus simply on enjoying each other’s closeness and presence.
  • Eliminate performative goals. Reducing anxiety about sex can be challenging, but one good strategy is for everyone to take responsibility for their own experience of pleasure. No intimate interaction should feel like a test for you, or your partner, and than can be a pitfall when sexual connection already feels vulnerable because its been awhile. Instead, think of it as an experiment you run together, with the goal of exploring multiple ways to add intimate physical touch back into your repertoire of ways of being together. Rather than focusing on giving  each other orgasms, achieving penetration, or any other end goal, why not agree to have fun with it? Laugh together, play a little, keep it light-hearted and low-stakes.
  • Don’t rush it. If you’re breaking the ice after a long time, it’s completely understandable to feel like everything has to go perfectly in order for the experience to be a success. But remember: success is just having a connecting, pleasurable experience with your partner. If either of you starts to feel scared or overwhelmed, slow down and be in the moment together. Loving, intimate touch (sex!) often includes holding one another, soothing uncomfortable emotions, kissing tears away, cozy foot rubs to start or finish, reassuring one another than all is well, and creating a safe space for both of you to be exactly where you are in the moment. After all, we’re discussing real life here, not Disney.
  • Reconnect with your body. Are you living in your head most of the time? Going through the motions of your life, rushing around, holding a big to-do list in your mind? Busy lives make it very easy to lose touch with the physical self. A good first step is to reconnect with everyday bodily sensations of pleasure. Notice how great your next shower feels. Shampoo your hair with attention to sensation. Rub lotion into your feet, hands, face, and body, and most importantly, open yourself up to the pleasure of the experience. Then, see if you can let your mind and body drift into a more sexual realm. What you can find within yourself, you can share with your partner.
  • Work with your own eroticism. If you have lost touch with your sexual desire, but you want to ignite that part of yourself and your relationship again, spend some time and energy attending to your own erotic self. Rather than waiting for your partner to turn you on, ask yourself “What do I do that turns me on?” Can you turn yourself on by noticing how sexy your partner looks in bare feet and jeans at the kitchen sink? Thinking about sex mid-day and texting your partner about it? Wearing or shopping for sexy underwear? Give this some thought. You may have many ways of turning yourself on, or you may not have thought much about it before. If that’s the case, you can have a lot of fun learning what is sexy to you. You might even decide to share your turned-on self or your newfound sexy vibe with your partner.

Should You “Just Do It” To Fix A Desire Discrepancy?

The conventional wisdom about desire discrepancy in a relationship is “just do it.” I’ve had many clients whose previous therapists have recommended some version of this approach, ranging from “ice-breaker sex” to “it’s like doing the laundry; sometimes you just have to get it done”.

I get that when a couple hasn’t had sex in a long time, it can become difficult to find a way to connect, get started, get vulnerable, or initiate intimacy. People frequently ask me “Where do we start? We’ve forgotten how to find one another”.

The problem is that desire can be a fragile thing, in need of a gentle touch. When desire is fragile, tentative, small, or hesitant, it can very easily tilt over into aversion if emotional pressure is applied, or even perceived.

So, what’s the difference between a tentative sexual encounter that results in a stronger connection, and one that has the unintended consequence of creating an aversion, or increasing anxiety?

Willingness.

Willingness is the crucial ingredient that is required for a sexual interaction to be a positive experience. Notice that I didn’t say “desire.”  In fact, desire is optional. Willingness is NOT optional. In order to run the experiment of trying to connect sexually after a dry spell, both partners need to feel willing. They might also feel worried, anxious, concerned, shy, tentative, vulnerable, embarrassed, or anything else. But as long as they are able to identify willingness, there is a good chance the interaction will be successful.

Here are some questions you might ask yourself to help yourself get in touch with willingness:

  • When sex goes well, how do I feel about myself?
  • When sex goes well, how do I feel about my partner?
  • What do I want to express to my partner sexually?
  • What makes a positive sexual interaction for me? How do I help create that?
  • What types of intimacy sound fun to me right now?
  • What types of intimacy would I prefer to postpone for another day?

Remember, you don’t have to do everything all at once. Consider inviting your partner to do something that sounds fun to you. Let them know, for now, your experiment is to keep it simple and stick with what you’re most comfortable with.

If you would like to have a conversation with your partner about having sex, try taking turns with these conversation prompts:

  • A part of me wants to have sex because….
  • A part of me is not so sure about having sex, because…

Make sure both of you respond to both prompts, so you don’t reinforce a polarized dynamic. Then see if you can work together to come up with a strategy to help you both get something you want from the interaction, while helping one another feel as little anxiety as possible.