Sex Therapist’s Couch

No Orgasm? Lots of Good Reasons

Just about every week I see a new patient who complains that he has trouble having orgasms.

Of course, I ask lots of questions. Does this happen only with a partner, or with masturbation too? What medication is he taking? How much alcohol is generally involved before and during sex? How does his partner usually respond? How does he usually respond?

And if he’s been bothered about this for a while, why is he coming in now?

I want to eliminate medical issues first, so I always ask if he’s seen a physician. Since many of these guys are referred to me by a doc, let’s skip over the possible health issues (such as diabetes, auto-immune diseases, and possession by the devil) and…

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How Much Sex Do People Need?

Old therapy joke:
Q: What’s the difference between defense mechanisms and sex? A: You can go a whole day without sex.

Actually, we can go without sex for a lot longer than that. But you wouldn’t know it from listening to some of my patients. Or their partners.

It generally sounds like this: “So I just need a lot of sex. I can’t help it, that’s just how I am—I need a lot of sex, preferably every day.”

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“Is that infidelity?” Why that’s the wrong question

As a therapist, I deal with couples in conflict every week. Frequently, two partners want different things: another child versus a vasectomy; saving versus spending; how much sex to have.

Of course, there’s no “right” answer to questions like these—just two people with different values that may or may not be reconcilable. But couples also ask me to arbitrate questions that…

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