Questions for a sex therapist

When the topic for this issue was announced, I knew just who to call about all things sex: my friend and colleague, Dr. Kate Morrissey Stahl — a sex therapist. We met as we started a doctoral program together, and four(ish) years later, we both had earned our Ph.D.s. During the same time we also developed our own humans (Kate has two beautiful children, and I have one). 

We continue to collaborate as we both focus on aging issues related to individuals and families. Kate is an assistant clinical professor of social work at the University of Georgia and licensed clinical social worker. More importantly, she’s a genuine person and I’m delighted to share her expertise and thoughtfulness with our readers.

We had lots of questions, and Kate had great answers. 

Describe what a sex therapist does?

So, I meet with individuals and couples and talk about sex and gender issues. And certification by the American Association of Sexuality Educators, Therapists, and Counselors (AASECT) means that I’ve worked on issues of sex in abuse and trauma, alternative sexuality like BDSM, gender care, sexual dysfunction and pleasure enhancement, couple issues, medical effects on sexuality, and out of control sexual behavior, and have been supervised in those areas. 

What is the craziest assumption about your job that you’ve encountered?

The assumption that people sometimes have is that I have sex with clients, which is not true and is in fact prohibited by both my licensing and certifying bodies.

What are people's biggest issues when it comes to sexual health? 

It seems like the most common issues are couple issues like difference in desire and then issues of pleasure and dysfunction. I also work a lot on gender identity questions with people. My practice also includes a lot of folks who are finding pleasure in ways that are outside of the mainstream because my training has made me quite open to the large array of workable ways people sort out their sexual lives. 

Do these issues change according to gender, sexual orientation, or age? 

They do to some degree. People with vulvas are more likely to want to explore how to orgasm, for example, although some people with penises also are exploring that issue. People who are not heterosexual often have a leg up (so to speak) when understanding a flexible approach to sexual expression, thinking beyond penetrative intercourse, which is important as well to people as they age. Age also seems to change the function of sex and creates opportunities to re-think what’s appropriate and not in a sex life.

There are so many terms for sex these days. Are there any misconceptions or inaccuracies that you feel are important to iron out?

 Among sexual and gender minority (SGM) individuals?

I find this group to often be the most educated about sexual expression.

Among younger or older adults?

I think younger adults often assume older adults are more conservative sexually than they are.

Among women?

Heterosexual women sometimes still have the sense that penetrative intercourse should be a good way to orgasm, even though it often isn’t for them. 

Masturbation is so lovely for women, and yet is under-emphasized as though it’s the threat to partnered (heterosexual) sex. People with vulvas usually do not have a refractory period (a period of time after stimulation in which nerves are unresponsive), so we can really enjoy masturbating and still have other partnered sexual experiences. I also think we’ve been trained to think of masturbation as more “second rate” than it is.

Among men?

I hope men aren’t getting their sex education from porn. But some are, and that’s not optimal —  especially for teaching consent and safer sex — but also really for teaching anything. Porn is for fun, not for education.

What is your viewpoint on virginity?

I grew up with the “magical penis that taketh away virginity” story, and I think it’s pretty unhelpful. I would love for people to think about their virginity in terms of orgasming with someone they love, or orgasming the first time whether it’s alone or with a partner. Or we could dispense with the idea altogether except in thinking critically about the idea that some sex “counts” and some sex “doesn’t count” in some mysterious societal way.

How do mental and physical health impact sexual health (or vice versa)?

A lot, really. Depression and anxiety are hard on sexual expression, often, as are the medications used to treat them. Physical health can require some real creativity in terms of what is pleasurable given physical limitations and if it can be okay to engage with that rather than a cultural norm of what is supposed to be pleasurable.

Questions from readers: 

What should you do when you and your spouse are two very different ages. One of you is horny AF all the time, and the other is maybe half that excited...

That kind of sounds fun. Can the less excited one watch the “horny AF one” masturbate and see if that is a turn-on? Would the less excited one be willing to contribute by some creative hand-work somewhere that feels good to the “horny AF one” while the masturbation is underway? Sexual desire differences are so common, and the most difficult part is often how we interpret the differences, rather than the differences themselves. The differences themselves call for some creativity about the wide array of sexual activities available.

How can I frame turning down sex so that my partner doesn’t feel like I’m rejecting them?

I love the Gottman idea of using a scaling system, like “I’m a 4” (not super into it, but you could convince me), or “a 2” (give it up. It’s not happening), to find out if there’s space for sexual compromise. We also have to look to questions of gender that okay a sort of badgering-type requesting by people with penises — which is almost never sexy — and a resentful giving in by people with vulvas — which also does not end well. Overall, thinking about sharing the risk of asking for sexual activity often is helpful, because it can be relatively difficult to keep asking if feeling one is being continuously rejected.

I don’t orgasm as often as I used to during sex. AM I LOSING MY ORGASM?!

Probably not, but pelvic floor strength and other nervous system and endocrine system changes can impact both the frequency and the intensity of orgasm. Medications can do the same thing. If you are a person with a vulva, using a vibrator internally and orgasming can help to keep the vaginal tissues healthy over time. You also could talk to your GYN about local estrogen if issues of dryness or thinning vaginal walls is creating discomfort. Good lube is helpful at any age. 

For people in general, the nervous system is less sensitive with age. So, often people need multiple forms of stimulation, rather than just “I’m turned on, and my erectile tissues respond.” This sometimes means adding prostate stimulation for people with penises, or adding fantasy material along with physical pleasuring, or enjoying the longer build-up to orgasm.

Overall, the same rule mentioned before applies: if sex is being defined as intercourse, it’s probably not the best way to orgasm, and finding what is best for you and then being patient as you move towards orgasm is helpful, as is giving yourself permission to not orgasm on occasion and to enjoy other dimensions of sexual pleasure.

If I have to google what it is, should I be doing it?

Yes — especially if you have to Google it.