Sexual Function & Performance
Evidence-informed sex therapy for erection, ejaculation, orgasm, pelvic pain, penetration, and menopause-related changes
Sexual function can change at any stage of life
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A single difficult experience can create worry about the next encounter, and that worry can gradually develop into monitoring, pressure, avoidance, or a loss of confidence.
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Physical health, medication, hormones, stress, relationship dynamics, sexual learning, body image, attention, and emotional safety all influence sexual response. Effective treatment considers the entire system surrounding the concern.
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I provide sex therapy for individuals and couples experiencing difficulties with erections, ejaculation, orgasm, penetration, sexual pain, and changes associated with menopause.
Sexual Concerns I Work With
Erectile Difficulties
Erectile difficulties may involve trouble developing an erection, maintaining an erection, or feeling confident that an erection will remain present during sexual activity.
Once worry enters the experience, attention often shifts toward monitoring the erection. Each physical change may begin to feel significant. Sexual encounters can become organized around whether the body will respond, creating a cycle of anxiety, vigilance, and pressure.
Therapy may address performance anxiety, sexual confidence, attention, communication, partner responses, erotic context, and the meanings attached to erections. Medical evaluation can identify relevant health, hormonal, neurological, vascular, or medication-related factors.
People may begin attempting to control every sensation, mentally disconnecting from pleasure, or approaching sex with a strong sense of urgency. Partners may also develop frustration, hesitation, or uncertainty about how to respond.
Treatment can help you recognize changes in arousal, develop greater awareness and regulation, reduce anticipatory anxiety, communicate more openly, and expand the sexual experience beyond a single endpoint. Medical consultation may also contribute to a comprehensive treatment plan.
Difficulty Reaching Orgasm
Orgasmic difficulties may include delayed orgasm, infrequent orgasm, absent orgasm, or orgasms that feel less pleasurable or satisfying. The clinical term anorgasmia describes persistent difficulty reaching orgasm.
Orgasm is influenced by stimulation, attention, arousal, context, medication, health, sexual knowledge, comfort, trust, and the ability to remain engaged with pleasure. Some people have never learned what type of stimulation works for their body. Others experience orgasm easily alone and encounter difficulty with a partner.
Therapy may include sexual education, exploration of learned beliefs, communication about preferences, attention to effective stimulation, reduction of pressure, mindfulness, and exercises that support greater familiarity with your body and pleasure.
Vaginismus and Penetration Difficulties
Vaginismus is commonly associated with involuntary pelvic-floor tightening, pain, fear, or difficulty with vaginal penetration. Contemporary clinical language may place these experiences within genito-pelvic pain/penetration disorder.
These concerns can affect intercourse, medical examinations, tampon use, and other forms of penetration. Repeated painful or unsuccessful experiences may create understandable anticipation and protective tension.
Treatment often involves collaboration among sex therapy, gynecological care, and pelvic-floor physical therapy. Sex therapy can address anxiety, bodily safety, communication, consent, gradual exposure, partner involvement, and the emotional meaning of penetration.
Vulvodynia
Vulvodynia involves persistent vulvar pain that may be experienced as burning, stinging, irritation, rawness, or tenderness. Pain may occur with touch, pressure, sexual activity, clothing, sitting, or daily movement.
Chronic pain can influence desire, arousal, confidence, body image, and relationships. Anticipating pain may also lead to muscular tension, avoidance, grief, or difficulty remaining present during intimate experiences.
Sex therapy can support communication, pain-related coping, sexual flexibility, partner understanding, pleasure mapping, and the gradual restoration of erotic agency. Medical and pelvic-floor care address the underlying physical factors.
Genitourinary Syndrome of Menopause (GSM)
Genitourinary syndrome of menopause encompasses the vulvar, vaginal, sexual, and urinary changes associated with declining estrogen and androgen levels during perimenopause and menopause.
Symptoms may include dryness, burning, irritation, tissue sensitivity, reduced lubrication, urinary discomfort, and pain during sexual activity. These changes can affect desire, confidence, pleasure, and a person's relationship with their body.
Medical care can address the physical symptoms of GSM. Sex therapy supports adaptation, communication, expanded approaches to pleasure, erotic self-understanding, and the development of a satisfying sexual life within a changing body.
The Sexual Response System
Sexual response emerges from an interaction among the body, mind, relationship, and environment.
Several factors may influence functioning:
Physical health and hormonal changes
Prescription medications and substance use
Pain, illness, surgery, injury, or disability
Stress, fatigue, anxiety, and depression
Sexual shame or restrictive messages
Body image and self-consciousness
Relationship tension or fear of disappointing a partner
Limited knowledge about arousal and effective stimulation
Performance monitoring and distraction
Previous painful, pressured, or frightening experiences
The setting, pace, and emotional context of sexual activity
Assessment helps us understand how these factors interact in your particular experience.
How I Work
Treatment begins with a comprehensive sexual-health assessment. We will discuss the history of the concern, when it occurs, how it affects you, and the changes you hope to experience.
We may explore:
Your medical, medication, and sexual history
The onset and pattern of the difficulty
Situations in which functioning feels easier or more difficult
Your relationship with your body and sexual self
Thoughts and emotions that arise during sexual activity
Your understanding of arousal, stimulation, and pleasure
Communication with current or previous partners
Cultural, familial, or religious messages about sexuality
The effect of the concern on intimacy and self-confidence
Existing medical care and opportunities for coordinated treatment
From there, we create a focused treatment plan that reflects your goals and the factors maintaining the difficulty.
What Treatment May Include Your treatment plan may incorporate:
Clear sexual-health education
Strategies for reducing performance anxiety
Mindfulness and present-moment attention
Greater awareness of arousal and bodily sensation
Non-demand touch and sensate-focus exercises
Communication about pleasure, pacing, and preferences
Identification of contexts that support sexual responsiveness
Exercises specific to erection, ejaculation, orgasm, or penetration concerns
Gradual rebuilding of safety and confidence
Expansion of sensual and erotic experiences
Partner involvement and collaborative sexual problem-solving
Coordination with physicians, pelvic-floor physical therapists, or other healthcare professionals
Exercises are discussed in advance and completed privately between sessions. Sessions consist entirely of conversation.
Expanding Sexual Possibility
Sexual satisfaction includes pleasure, curiosity, agency, affection, sensation, play, communication, and connection. These elements provide multiple pathways into a meaningful sexual experience.
Treatment helps reduce pressure, build confidence, and create a broader repertoire of satisfying experiences. The work supports a sexual life that can evolve alongside changes in your body, health, relationships, and stage of life
In-person sex therapy in Boulder, Colorado, and telehealth throughout Colorado and New York.