What Do You Need To Know About Asexuality?

I believe that every therapist, and certainly all sex therapists, should be prepared to work with asexual, or “ace” people. Some might assume that sex therapists don’t have anything to offer asexual clients. I can understand the misconception: what could a therapist who specializes in sex issues have to offer someone who has little or no interest in sex? However, NOT wanting sex is just as valid as WANTING sex, and both can create relational stress in certain circumstances—which you might be called upon to work with in therapy. 

Asexuality is one of the topics therapists ask me about frequently, so I’m going to provide a very brief primer on asexuality here, focusing specifically on challenges therapists have asked me about. There is much more to know; check out these online resources about asexuality:

The Asexuality Visibility and Education Network

Trevor Support Center: Asexual

50 Shades of Attraction: Understanding the Asexual Spectrum

If you’re going to work with asexual clients, there are a few basic things you must know. Asexual people and everyone in that ballpark (ace, demi-sexual, aromantic, grey-a, etc.) are marginalized populations. That means they get discriminated against as a result of people either having misconceptions and misinformation about them, no information about them, or believing they are in some way inherently bad, wrong, or broken. When you work with marginalized populations in therapy, it is extra important that you know enough about their identity (in this case, asexuality) to avoid causing harm. 

Happily, my blog post, a little online browse, and an open mind should be sufficient to get started. There is one important caveat: if you do a little reading, and find that you still believe asexual people are in some way flawed, you are not yet qualified to be their therapist. In that case, if you are still interested in working with the ace population, you will need extra training, consultation with an expert, and/or to refer those clients to someone who knows more about asexuality. 

Here are some basics:

  • An asexual person doesn’t need to have sex in order to be healthy and happy. 
  • It is possible to have a wonderful relationship without having sex. 
  • Asexuality isn’t a problem; it’s a perfectly normal way of being. 
  • Asexuality is an identity, meaning it is part of the way some people are, or how they see themselves. 
  • Asexuality is not the same as sexual aversion, or low desire, and is not a sexual dysfunction.
  • Asexuality is not caused by fear of intimacy, or attachment wounds. It is not connected to any psychopathology, any more than any other sexual orientation or identity is. That said, of course some people in any group may have attachment wounds or psychopathology. It is the lack of causation that is the important part. 
  • Asexuality is not the same as abstinence; some aces are abstinent, and some are not. Some experience self-pleasure, arousal, orgasm, and/or partner sex, and others do not.
  • Some aces enjoy romantic connections, some do not.
  • There is a huge range of self-expression in this, as in any other population. If you can imagine it, it exists.

You can put your asexual client at ease by making it clear that you understand and respect their identity, and that you’re not going to try to “fix” their asexuality. It’s ok to tell them you don’t have much experience in this area. For most people, the most important part is that your mind is open, your heart’s in the right place, and you’re willing to learn (and not just from your client). But if you happen to have a client who really wants a therapist with a lot of experience with asexuality, it would be doing them a disservice, and would also be unethical, to misrepresent yourself in this matter.

There are a number of sex- and relationship-specific challenges that might bring an asexual person to therapy, in addition to the vast array of challenges people experience that are not related to sex, sexuality, or asexuality.

For one thing, it can be very challenging as an asexual person to find an intimate partnership where they can be themselves comfortably, not feel pressured for sex, and experience intimacy in ways that they enjoy. As a therapist, your role might be to help your client navigate that challenge. You could support them through the emotional pitfalls of seeking and nurturing a relationship, and help them hold steady and speak their truth to potential partners. As always, you can do a great deal of good simply by normalizing asexuality and affirming your client’s identity. Sometimes there is also an opportunity to provide support, information, and resources to partners.

You might also see a client who needs help navigating an already existing relationship. Sometimes asexuality has always been part of the picture, and other times it emerges somewhere down the line. It is also not uncommon for a couple to come to therapy for a desire discrepancy, and in the course of therapy it begins to become clear that one partner is actually asexual. This may have always been the case for them, and they may or may not have been aware of it. Or their asexuality may have emerged more recently. Sometimes the client, and/or their partner, knows what asexuality is, and other times they are learning about asexuality from me in therapy. 

Here are some concepts that may help you as you begin to work with asexual clients:

  • Some asexual people experience willingness to have sex, even though they don’t experience desire. Being willing is sufficient for having a consensual and positive sexual experience. Identifying and accessing willingness to have sex, in the absence of sexual desire, can be a very successful solution for some couples. Of course you must ensure that the asexual partner’s choice to have sex is freely chosen and authentic, without any external or internal coercion or pressure. Otherwise, it doesn’t really check the box for “willingness”.
  • Sometimes consensual non-monogamy is a workable solution, because it makes it possible for the couple to preserve their relationship while also allowing the non-asexual partner to express and explore their sexuality. 
  • Lots of asexual people experience romantic love, so this can offer a point of intimate connection that works for all involved.
  • More people are somewhat ambivalent about sex than you might think, without being asexual. It is certainly possible for a sexual person to be in a relationship with an asexual person, and to make the decision that sex isn’t as important to them as other ways of connecting, experiencing intimacy, and being close. 
  • All relational therapy is about strengthening connection, so place your focus there. Some people connect through sex, some through outdoor activities, some by raising children together, some by playing video games, some by cooking together; the sky is the limit. Sex is far from the only way to experience closeness, intimacy, and vulnerability. 

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.