The term ‘dysfunction’ can promote feelings of anxiety, shame, feeling ‘broken’ or ‘wrong’ and maybe even the idea that it needs to be ‘fixed’. I prefer to stay away from this word and use different words to help reframe what is happening for this person with the ‘dysfunction’.


You have probably heard the term erectile dysfunction, which I tend to call an unreliable erection. This could also describe premature or delayed ejaculation. Another way to describe premature ejaculation is ‘early’ ejaculation, just like delayed ejaculation could be reworded as ‘late’ ejaculation or ejaculation challenges. If you have experienced any of these, how do these reframes feel to you? 


 If you were to look at the DSM 5 (Diagnostic Statistical Manual of Mental Disorders), you would see the word ‘disorder’ rather than dysfunction attached to  vaginal/vulval issues, such as Sexual Interest/Arousal Disorder or Orgasm Disorders (although both of these issues are about more than the vagina/vulva) and Genito Pelvic Pain/Penetration Disorder. 
What if I was to describe an orgasm disorder as ‘being preorgasmic’? What if sexual interest/arousal disorder was just called desire issues or mismatched desire with one’s partner? Then what about just pain during sex or vaginal pain?

This is just a small handful of examples to show you about my approach to supporting people with genital challenges. One of the most interesting aspects of being a sex therapist, for me is the idea of clients feeling like they need to be ‘fixed’ but me knowing very well that people can have a rewarding and happy sex life without needing to have ‘penis in vagina’ sex. 

My approach

The approach I therefore take with you is to help you look at your genital challenges in a biopsychosocial way – addressing your relationship to your genitals and sexuality, acknowledging the messages you receive from your culture about sex, reframing ideas about sex and pleasure and also giving you an opportunity to do practical exercises inbetween sessions in order to see if you can move towards what you would like to gain from sex therapy. I also make room for some ‘back to basics’ sex education that you may not have ever received before to help you understand how genitals function.

Challenges/Discrepancies in Desire

Low desire is often (although not always) highlighted when you are in a relationship or having sex with somebody. It’s almost impossible to have the exact same amount of desire as your partner throughout a long term relationship, but it can get to a point where the discrepancy in your desire becomes an issue with you or your partner/s. 

Although I treat every client differently, depending on who they are and what they want, what I have found is that looking at messages we receive from films, porn and books as well as the culture we grow up in, it can help take some of the anxiety away from it, and just like I have written above, a change in viewpoint/approach or a slight shift in the way you are sexual with your partner/s can make all of the difference. Just having the space to talk about it with somebody like me can also have a positive impact on a person’s experience of desire.