Many of my patients with sexual concerns come from a patriarchal and conforming social background, such as religious communities.  Devout communities, for example, pushes against play and sexual pleasure.  Women are not supposed to strive for sexual pleasure, and sexual touch outside of marriage is not allowed.  This repressive and male dominant culture creates fear and shame that may continue even when the sexual act is “legal” (marriage). The resulting sexual dysfunctions may include pain with vaginal penetration, anorgasmia, lack of sexual desire and more.

When approaching a patient or a couple who seeks help with sexual concerns, there must be intermediate steps before attempting to discuss or practice sexual touch, and sexual pleasure.  The goals are centered on being open and free, and it is encouraged by permission to “play”.

You may start with intimacy exercises that do not include touch.  For example:  The couple are instructed to each make a list of at least 10 sensual items that bring them joy.  This could be certain smell, sights, hot bath.  The list should not include sexual items.  For the next session, the couple will decide on one item that they both enjoy and are instructed to experience that together.  This exercise allows the shift to joy/pleasure, and sensuality.

Another exercise would be asking the patient what pleasure they might deny themselves (during lent, for example), and what excuses do they use to deny that pleasure.  For example: the patient might say:” I like freshly baked bread, but I do not eat it because it has too many calories and carbs”.  The exercise could be sitting at a bakery, and enjoying the smell of freshly baked bread, then even enjoy eating a slice.

By experiencing joy, sensual pleasure, and receiving permission to do so by their therapist, the couple may then move on to learning to experience touch freely and without fear, shame, or guilt; first sensually then sexually.

BY: AYA CARDELLINI, PT MS, ASSECT, CSC