1. Old people having sex, it’s that boombox I’m telling you

I interned at a sex therapy clinic, and here are just a few of the examples I can think of…

1. Elderly couples. Bringing the spark back into their sex life, what to do when certain abilities start to go, etc. The most common advice I saw given was to stop scheduling sex and initiate whenever passion struck. If there was a physical barrier, such as a lack of lubrication on the lady’s end, or ED, using alternate methods of intimacy was advised. You wouldn’t believe some of the kinks some of the older folks devised!
2. Religious. A lot of people came in with intimacy issues because they had grown up learning great shame when it came to sex. A few women hated themselves after their first sexual experience because they learned their body was this great temple and after they had sex, it was ruined. These were pretty difficult, and one of the therapists I worked with said to one couple, “You believe God meant for you two to find each other, right?” “Yes.” “And you feel your relationship is divinely guided?” “Yes.” “You are here today because God led two people together. It was love that brought you into this world and love that keeps you together. Intimacy is a display of this love, and you aren’t ruined. Just as God shares his temple with those he loves, so can you share yourself with your partner.”
3. Abuse. This is easily the most common issue I observed. Both men and women come in with their partners having endured some sort of sexual abuse in the past that their current sex life triggers. A combination of standard therapy and relationship compromise usually helps this. (Eg. A woman is triggered by giving blowjobs, her husband is upset by this. Helping her overcome her past as well as finding other forms of intimacy that are not triggering are primary goals).

2. Don’t feel intimidated in bed

I’m a sexual health counselor.

1. Never stick anything in the butt you can’t pull out easily. If something ends up stuck in the butt, don’t try to get it out – you’ll only push it in deeper. Prepare for a really weird poop.
2. Not saying yes means no. Make sure you have consent. No maybe.
3. Wash your goddamned sex toys. And consider using condoms on them. They’ll last longer, and be more hygienic. But wash your goddamned sex toys.
4. If you think you need to use lube, use lube. Try to use a water-based lube. Never use an oil based lube. Never use a silicone lube on a sex toy.
5. If they say you don’t need a condom for any reason, then you need a condom.
6. Learn how to use sex toys. Trust me.
7. There is no shortcut to finding your perfect sexual partner. You need to experiment to find out.
8. Don’t try to inflate her vagina like a balloon by blowing into it.
9. Don’t smack the balls unless you have consent.
10. A vibrator isn’t a dick replacement. Don’t be intimidated if her dildo is larger than you.
11. Each person has a different thing that turns them on. Never assume your current partner will be turned on by what worked on the last person.
12. Get tested. If you haven’t been tested before, do it right now. Then get a subsequent test every six months – and don’t assume you don’t need protection just because both your and your partner’s tests come up clean. Some STIs take a long time after transmission to register in tests.
13. The G Spot is real.
14. The best sex toys are either high-grade silicone, glass, or surgical steel. The latter two are also great for temperature play. Any of these three can be washed in the dishwasher.
15. NEVER FUCKING DOUBLE WRAP. You might as well not use a rubber – the friction will cause holes in both.
16. If you’re girthy, don’t just shove it in. For the love of fucking god, don’t just shove it in.
17. If you haven’t fucked before, your dick is probably going to be limp as a noodle due to stress. Shit happens. Get on your knees, and express yourself with oral. It’ll win you big points, and probably a second chance.
18. Don’t shit yourself. Unless that’s what your partner is into.
19. Don’t assume your partner is going to have the same kinks five years from now. People’s tastes change.
20. If you’re a sexy vanilla, don’t be ashamed of it. Most people are, and you’re potentially comparable with the majority of the people on this planet.
21. Men – there is an orgasm button in your butt which will give you an orgasm like you have never ever experienced in your life. You can hit it yourself, but it’s easier with a partner. Good luck.
22. The nipple is amazing – but there’s a whole tit you’re not paying attention to.
23. If the sex act has a weird name, ask what’s involved before you give consent.
24. Female condoms (receptive partner condoms) have improved significantly over the years. They’re a lot more comfortable, they cost less, and they give you a lot of control.
25. As romantic as it sounds, never sleep inside you partner/have your partner sleep inside you, if you’re using a condom. Between shifting and shrinking, all that semen will have a nice easy opportunity to work it’s way up the sides of the rubber.
26. If you are sharing cocks or toys with someone, use condoms, and change them every time they’re used on a new hole (anyone’s hole).
27. Don’t use flavoured condoms for penetrative sex. They’re better than nothing in a pinch, but you’re pretty much asking for a yeast infection.
28. Lastly – don’t give a fuck what anyone says. If it’s consensual, safe, and private, then the whole world can fuck off, except for the two of you. Do whatever feels good.

3. We’re all insecure

Not a sex therapist, but specialised in sexual health as an agony aunt for about a decade.

All humans are equally insecure about their genitals; what they look like, what they do, how they smell, everything. A good third of the stuff I did was essentially reassuring people that they weren’t abnormal/someone was going to laugh at them when they got naked.

Another biggie? The confessions you get of wrongdoing and sheer stupidity when someone is afraid of being pregnant or having an STI is staggering. They’re all people who have an awareness of things like contraception, but either don’t know all the facts or just plain ignore them. Most of these involve me trying to diplomatically suggest that they use the scare to actually use condoms consistently, and maybe get tested if it sounds like they have due cause.

The most common thing though was pretty cliché and so is the response, I’m afraid. “My SO wants to do this, but I’m not sure/uncomfortable…” “I hate it when my SO does this, how can I…” “My SO won’t do this, how do I…” Yaddah yaddah, you get the point.

The solution? TALK. My mind boggles how people are more comfortable at someone manhandling their genitals, regardless of their enjoyment/sense of safety, over talking about them. If you can’t talk about what you’re doing with a partner honestly without fear of mockery/causing offense, you shouldn’t be doing anything with them, if you should be with them at all.

4. Oh, this is a good one

I worked only with teens, but the problem I inferred from the way they spoke about sex was that they didn’t feel confident standing up for what they wanted or needed from sex. If the guy didn’t want to use condoms, they didn’t. If the guy wasn’t interested in her orgasm, she didn’t have one. The girls wanted to have boyfriends and it seemed like they thought that meant having to have sex on the guy’s terms, whatever they were. I encouraged them to demand respect and to ask their partner for what they wanted.

5. Some mutual touching

A lot of problems couples have in bed result from unrealistic ideas about how “good sex” should be. For example, there was this one guy who told me he suffered from premature ejaculation. He was afraid that his girlfriend who he was dating for about 2 months would leave him because of it. He was pretty reluctant about details, so I started questioning him about previous relationships. I was pretty surprised that he never considered his stamina a problem before, so I talked to his girlfriend. As I asked her about how long her boyfriend would last, she told me in an embarrassed and desperate manner: “You know, he always finishes after only 25 minutes or so.”

So in that case a little sex ed did the trick.

Sexual dysfunctions (like premature ejaculation, erectile dysfunction, sexual pain etc.) are the most common problems though. The standard treatment for these (if the cause of the problem is not biological) is sort of a “reprogramming” of the couple’s sexuality. It’s called Sensate focusing by Masters & Johnson. The convenient thing about this method is, that you can adjust it to almost any sexual dysfunction and every couple’s needs. Depending on the dysfunction, specific exercises can be added, for example the start-and-stop technique for premature ejaculation, dilators for vaginismus or masturbation training for anorgasmia. One reason why sensate focusing works really well is that in comparison to other psychological treatments it’s actually pretty fun.

There is a pretty good description of sensate focusing on HowStuffWorks.

Not every couple has to go through every step. If the dysfunction occurs in a later stage of the sexual response cycle, a few steps can be skipped. The couple can move on to the next step when both partners can enjoy and are relaxed during the current step. Besides, for the whole treatment (except the last few steps) full intercourse is forbidden. In a lot of cases in which the couple has regular sex before the treatment is over, their problems will come back again. Also, the sex interdiction usually takes a lot of pressure off the partner with the dysfunction and builds up a lot of excitement for the couple.

6. Not that simple, but okay

The most common theme I see in practice is people not communicating openly and honestly. The fix is simple– talk to each other.

7. Erectile dysfunction

I worked in a Sexual Health Clinic as a para-professional on the way to my M.S.W. degree. From my experience in being part of team meetings, performing intake client assessments, and learning of outcomes from senior therapists, I can say that erectile dysfunction was the easier of the diagnoses to resolve. Here’s why: E.D. is an anxiety based disorder.

Once it medical issues are ruled out, the therapist begins with addressing the basics. E.D. clients are certainly capable of a fulfilling sex life however tended to “over think” and therefore rush the outcome. They are planners and since sex starts in the brain, they often reported ways in which they planned to sustain their erection hours before the event.

The solution to this is to work backwards to address that this is not about self-esteem and more about overcoming logistics. In order to distract the brain and to induce longevity, a steady commitment to pelvic floor exercises (2-3 minutes per day) seemed to help our clients immensely.

8. Desire

ED in men. Low or no desire in women.

For ED you need to rule out physical causes (or address them), then move on to working with anxiety around performance. It’s totally a cycle. There are easy fixes to everything if you just do the homework!

For women, they need to have a sexual relationship alone, that’s satisfying, before trying to coordinate one with a partner.

9. Shaming sex to becoming nymphos

My professor is a sex therapist and he said his most common problem is women who were raised super religious. They’re taught all their lives that sex is evil and dirty so they repress their sexuality. But then they get married and are expected to suddenly become nymphos overnight for their husbands and it just doesn’t work like that.