Talking about specific problems

“I can talk about anything except my double incontinence with regards to sex, 
but I do need to learn how to cope, and put my life on track” 
Anon

A client’s specific sexual problems might include:

• For her: pain during intercourse; vaginismus; anorgasmia

• For him: erectile dysfunction; problems controlling ejaculation; anorgasmia

• For both: loss of desire; sexual identity issues; inhibition; communication; boredom; fear; sexual difficulties caused by ill health, medication, mental or physical impairment

The section Sexual Problems on this site may help you feel you have the knowledge to cope with this.

Here are some useful guidelines for conversations about these more specific topics:

Choose vocabulary carefully. Begin by using words you consider to be acceptable – perhaps clinical terms for body parts and sexual activities. If a client gets confused or uncomfortable when they hear these terms, ask what words they themselves would use and if you can, use those.

Ask about changes. Use phrases such as “Have you noticed any difference lately in… the amount you have sex… your ability to have sex… your mobility during sex… your comfort in having sex?”

Ask about distress. Use phrases such as “Are you happy about how much sex you’re having… the quality of sex you’re having?… Are any difficulties affecting your relationship?”

Ask about specifics. Use phrases such as “Are you able to… feel desirable… feel aroused… have an erection… get lubricated… enjoy masturbation… enjoy oral sex… enjoy intercourse… enjoy anal sex… have an orgasm?”

Ask about action already taken. Use phrases such as “How have you tried to overcome these difficulties?… What helps you… What doesn’t help you?”

Refer on.  Use phrases such as “I have a hand-out with resources and practitioners that you might find helpful… There’s a member of my team who specialises in… There’s a local counsellor you could see. ”

Offer practical suggestions. It will always help to find ways around practical concerns such as lack of sensation, restricted movement or discomfort. These ways could include guidance on easing pain or guidance on what level of sexual activity is safe after events such as a heart attack or during pregnancy. Doctors may consider altering medication if this is contributing to the problem.

For comprehensive resources to support your work, click here