A Guide to Sexual Concerns and Pleasure

Sexual concerns are more common than you may think. Here is a brief overview:

• Lack of interest in sex or low sexual desire. This means you are not interested in sex or have a low desire for sex, and this bothers you. (Note: this is not to be confused with being asexual, which is when someone experiences little or no sexual attraction to others. For more information, visit “Resources to Learn More” in this guide, and the section: “Resources for Transgender, Genderqueer, Agender, Nonbinary & Asexual Commuities.")
• Lack of sexual arousal. This means that you’re in the mood for sex, but your body isn’t. In many cases, this happens when you don’t respond to sexual stimulation – either emotional, physical, or a combination of both. 
• Pain during penetration or during intercourse. This can happen during any type of sex such as oral, finger, vaginal, and/or anal penetration.
• Delayed or inhibited ejaculation. This occurs when you can’t completely finish ejaculating (coming), or when you can’t come at all.
• Difficulties reaching or having an orgasm. This can mean either you don’t have an orgasm or there’s a delay in having an orgasm.
• Erectile dysfunction. This occurs when you can't get or keep an erection firm enough (to stay hard) for sex.
• Premature ejaculation. This can happen when you finish (or come) before you or your partner(s) wants to.
• Vaginal dryness or atrophy. When a person’s vagina isn’t wet enough to comfortably have vaginal intercourse, which could be due to vaginal dryness or atrophy. 

Note: this resource aims to provide comprehensive information for all individuals; however, transgender people may have specific concerns and questions, especially if you’ve had gender-affirming surgery. For more information, visit “Resources to Learn More” and the section: "Resources for Transgender, Genderqueer, Agender, Nonbinary & Asexual Communities."

• Alcoholism or Drug Abuse
• Diabetes
• Cancer and cancer treatments
• Chronic Diseases
• Gynecological Conditions 
• Heart and Vascular Diseases
• High blood pressure
• Hormonal Imbalances
• Menopause
• Neurological Diseases
• Obesity
• Physical, Intellectual, and Developmental Disabilities
• Surgery

A health care provider can help diagnose and treat sexual difficulties related to these conditions. If something doesn’t feel right to you, seeking help from a provider can help you address undiagnosed conditions you may have, along with any related sexual concerns.

Side effects from medications used to treat chronic conditions, such as high blood pressure, or mental health conditions, such as depression, can sometimes affect your sexual functioning. While sexual concerns can be a frustrating side effect of your health condition and/or medication(s), your health care provider should be able to help you manage them.  

Lifestyle factors, such as stress, using alcohol or drugs, and lack of exercise, might also cause sexual difficulties. While moderate alcohol use might increase sexual desires and confidence, excessive use could put a damper on your sex life. In fact, it could reduce sexual desire and affect the ability to have or keep an erection, or to reach orgasm. So, moderation is key to a good sex life. 

Natural Aging Process. Aging can bring physical changes in people of all genders, which can sometimes affect sexual function. For people with a vagina, menopause can affect sexual desire, increase vaginal dryness, and change the shape of the vagina; these factors could make sex uncomfortable or painful. For people with a penis, erectile dysfunction (ED) – when you can’t have or keep an erection – becomes more common. But ED isn’t just linked to age; in fact, it often results from a chronic medical problem. 

Also, as people grow older, they are more likely to have illnesses, disabilities, or surgeries, or to take medicines that affect their ability to have and enjoy sex. However, there are strategies and treatments available to help overcome the difficulties caused by these conditions and by the natural aging process. For more information, visit “Resources to Learn More,” and the section “Resources for Aging and Sexuality.”

Past and/or Present Experiences of Sexual Violence, Abuse, or Trauma. Experiencing any type of sexual trauma or abuse – in the past or present – can have a big impact on your emotional and physical health, along with your sex life. It can cause depression, anxiety, anger, and chronic physical pain. Trauma can also affect sexual desire, arousal and the ability to orgasm. What is sexual abuse? It’s when you are pressured or forced into having any type of unwanted sexual contact. This could include kissing, touching, any kind of sexual intercourse, and even digital abuse like forced sexting. 

Sexual abuse violates your trust and feelings of safety, and it’s a crime. Partner abuse comes in many other forms, too – it can be emotional, verbal, physical, digital, or even financial. Any type of trauma can be hard to discuss, but speaking with a mental health professional – who is trained in addressing trauma – can help you address these issues. Many survivors can still enjoy pleasurable sex lives, especially if they get counseling. For more information, visit “Resources to Learn More, “ and the section “Resources for Survivors of Trauma and Abuse.”

If you have experienced past or present trauma and/or are currently experiencing abuse, there are resources available for you. The Rape Abuse and Incest National Network (RAIIN) or the National Coalition Against Domestic Violence (NCADV) can connect you with free local resources. If you are in immediate danger, please call 9-1-1.

Religious, Social, or Cultural Causes. If you are surrounded by negative messages about sex, it can be hard to have a healthy sex life. Guilt or embarrassment, religious upbringing, and social norms regarding sex can shape your sexual experiences. However, remember that your sex life is yours, and you should be able to make decisions about your personal sex life and what appeals to you. Also, counseling might help you tackle some of the barriers that stand in your way.

To improve your sex life, you might be able to take steps on your own and/or with your partner(s). But, in other cases, you might want to seek help from a mental health or health care provider. These professionals can help you assess your concerns and identify solutions. But it’s up to you to decide where you’d like to start. 

Provided below is an overview of solutions. Based on your concerns and/or diagnosis, one or more of these solutions might be right for you. For many people, a combined approach may be the best answer.

Self-Help Strategies and Education

Sometimes, you can figure out sexual concerns and increase pleasure on your own. Getting to know your body can help you discover what types of sex you enjoy, what arouses you, and what is most pleasurable. And since this is rarely part of standard sex-ed, we usually need to do some education and exploration ourselves.

When it comes to sex, there’s a big menu out there. You can learn more about the many options for sexual expression and activities – either on your own or with a partner – through books, websites, and ethical porn. 

You could make sex toys, lubrication, and/or other devices part of your sexual routine. Masturbation is also a good way to explore your body, and what feels good to you. Also, there are many exercises and self-stimulation techniques you can use to increase pleasure. For more information, check out "Resources to Learn More" in this Guide and the "Resources for Self-Education" section. 

Improved Partner Communication

Talking openly with your partner(s) about what you like and don’t like when it comes to sex – and what you want to try together – can help address sexual concerns. But easier said than done, right? Talking openly does get easier with practice, and it’s worth the effort. You can have better sex, feel safer, and be closer with your partner.

How we express intimacy, and our sexual feelings can change, especially if we’ve been together for a long time, or as we get older. Beyond sexual intercourse, there are many ways to be close with your partner(s). Other forms of physical touch – such as cuddling or massage – might be become even more appealing. When it comes to sexual expression and pleasure, there’s a big menu of options to explore.

Also, your interest in sex may increase or decrease at certain points in your life. If your sex drives are mismatched – when one of you wants sex more often than the other one does – it's key to talk openly and find solutions that make both of you feel good. There are many free resources at "Resources to Learn More" in this Guide, and the section "Resources for Partner Communication" on how to improve communication with your partner. 

Here are some tips on how to discuss a variety of topics with your partner(s):

Parenting. When raising children, it can be tough to find quality alone time with your partner(s). But to stay strong, relationships definitely need time and attention. So, even you’ve been together for a while and life gets busy, it’s important to make time for each other.

• For example, each week you could set aside some “date” time, even if it’s just for a few hours, or a night out. Note: this could also include scheduling time for intimacy and sex. 
• Get creative and plan fun, different dates. There are many things you can do together, such as taking a walk or hike, going to a park, seeing a movie or concert, going for a bike ride, or cooking together.
• Working with a general therapist, couples therapist, or a sex therapist can also help improve your communication skills with partner(s).

Check out "Resources to Learn More" in this Guide, and the section "Resources for Parenting and Sex" for resources on keeping up a good sex life while being a parent.

Therapy 

If your sexual concern is rooted in emotional, relationship or mental health issues, sex therapy or other types of therapy by a licensed mental health professional can be very helpful. Therapists can also address concerns that may stem from your religious, social, or cultural experiences.

Sex therapy is talk therapy which helps you identify and resolve sexual concerns through a practical plan. This could include partner communication strategies, exercises, or exploring new options and techniques for sexual expression.

Other licensed mental health therapists, who may not have sexuality training, can help you address mental health conditions that could affect your sex life, such as anxiety, depression, low self-esteem, lack of confidence, and stress. A therapist can also help you cope with past trauma. If you are having marital or relationship problems, a trained marriage and family therapist or relationship therapist can help you overcome these difficulties.

Lifestyle Changes 

Use of alcohol and drugs, lack of exercise, and stress can negatively affect your sex life. Decreasing your alcohol and drug intake might help resolve sexual concerns and improve your overall health. To do so, you could seek advice from a professional with expertise in substance abuse. Other lifestyle changes, like exercising regularly, can boost self-confidence and overall well-being, which can also help improve your sex life.

Medications

A health care provider can help you determine if a medication that treats specific sexual concerns may be right for you. There are approved medications available that may help treat low desire, erectile dysfunction, and vaginal dryness. Below you will find their common brand names.

• Erectile Dysfunction: (Pill Form) Adcrica, Cialis , Levitra, Staxyn, Stendra, or Viagra; (Injection) Caverject, Edex, or Prostin VR
• Low Desire: Addyi or Vyleesi
• Vaginal Dryness: Vaginal estrogen, prasterone, or ospemifene

Mechanical Aids and Other Devices  

Mechanical aids and other devices can also help you overcome sexual concerns. Some could be prescribed by a health care provider, like vacuum devices or penile implants. Or, for those with a vulva/vagina, a dilator might be prescribed.

If you are looking for devices to enhance self-exploration, you could purchase some products on your own, such as sex toys and lubricants. To learn more about the different types of sex toys and how to care for them, check out Planned Parenthood’s resource here.

The table below describes common sexual concerns that you may experience, along with possible causes, solutions, and the types of providers who can help.

We have laid out these concerns based on whether you have a vagina/vulva or penis. We do this because the treatments, resources, and the types of providers who respond to these concerns are typically recommended based on gender and/or anatomy. You can visit the "Resources to Learn More" and "Glossary of Terms" sections under the "To Learn More" tab to get more detailed resources or learn more about terms you may be unfamiliar with.

The table below describes common sexual concerns that you may experience, along with possible causes, solutions, and the types of providers who can help.

We have laid out these concerns based on whether you have a vagina/vulva or penis. We do this because the treatments, resources, and the types of providers who respond to these concerns are typically recommended based on gender and/or anatomy. For each concern, you can click on the hyperlink which will direct you to more detailed information and resources. You can visit the "Resources to Learn More" and "Glossary of Terms" sections under the "To Learn More" tab to get more detailed resources or learn more about terms you may be unfamiliar with.

Health care providers and/or licensed mental health therapists can often help people address their sexual concerns, which can lead to a better sex life. Here are some guidelines to help you decide where to start: 

• If you think your concern is rooted in physical causes, it might be best to start with a health care provider.
• If you think your concerns are rooted in emotional, mental health, faith-based or relationship issues, you might want to start with a therapist.
• For some people, working with both a health care provider and a therapist is the best option.

Health Care Providers. If you think your sexual concerns are caused by physical factors, which could include illnesses, chronic conditions, or medications, you might start by seeing a health care provider (HCP).

• Your first stop could be a primary care provider, such as a family doctor, internist, nurse practitioner, nurse-midwife, or physician assistant. These providers are trained in general medicine, and to care for the whole body.
• You could also start with a specialist who focuses on reproductive health, such as an obstetrician/gynecologist or a women’s health practitioner for people with a vulva/vagina or a urologist for people with a penis. 
• Health care providers can help diagnose sexual concerns and recommend treatment options that might include medications, exercises, devices, surgery, and/or referral to a sex therapist. 

Sex Therapists can help you work through a variety of sexual concerns that might be standing in the way of a pleasurable sex life. They can address issues relating to sexual function, sexual feelings, relationships, partner communication, and sexual trauma.

Sex therapists are licensed mental health professionals – such as marriage and family therapists, psychologists, counselors, social workers, and psychiatrists -- who have specialized training in treating clients with sexual issues and concerns. 

• When looking for a therapist, you should ask about their education, license, and any specialized training or education they received related to sexuality/sex therapy.
• Therapists should have a graduate degree in mental health, such as psychology, counseling, or social work.
• They should have a license to practice mental health, and
• They should have additional training in sexuality. This training may be accompanied by a certificate in sex therapy from a national professional organization, such as AASECT (American Association of Sexuality Educators, Counselors, and Therapists). You can find AASECT certified therapists in their online directory.

Sex therapy is TALK therapy, and there is NO physical contact with clients in the office or elsewhere. In other words, everyone will keep their clothes on.  

• Typically, a sex therapist will listen to your concerns, ask about your sexual history and experiences, help you figure out if the problems are psychological, physical or both, and create a plan to improve sexual functioning.
• They will recommend practical, problem-solving techniques and various resources.  If they think your problem might be caused by physical factors, they will also refer you to a health care provider.  And, they can coordinate care with your medical provider.
• Usually, sex therapy is short in duration, and involves a limited number of sessions. But, therapy could be provided for a longer period of time, based on the client’s needs. 

General, Family, and Marital Therapists. While they may not be trained in sex therapy, these therapists can help you address relationship issues such as communication, intimacy, and trust. Also, they can help you manage mental health conditions, such as anxiety or depression, that could interfere with your sex life and relationships. In addition, they can provide counseling to people who have experienced sexual violence, and other types of abuse and/or trauma.

How should I prepare for a visit?

Before you have your first visit, it is helpful to gather information and/or think about the following:

• What type of sexual concerns are you having? This could include when and how often you’re having these concerns. Try to be as specific as possible when talking with your provider.
• What is your sexual and relationship history? Your provider will probably ask about your sexual history and relationships. This could also include questions about sexual abuse or trauma. If you feel comfortable, sharing this information may be helpful in diagnosing your concerns.
• What is your medical history? Do you have any physical and/or mental health conditions? Are you taking any medications? Have you had any recent surgeries? Knowing this will be helpful to your provider. Feel free to bring any medical documents that you think will be useful.
• What questions do you have for your health care provider or sex therapist? It’s always helpful to pull together a list of questions before your appointment. That way, you won’t forget anything, and can focus your visit on your concerns. You can look at "Tips and Scripts for Talking with a Health Care Provider or Therapist", and the section "What Type of Questions Can I Ask?" for some sample questions that you may want to ask. 

What should I expect during my visit with a provider or therapist? 

During your visit with a provider or therapist, you can expect:

•  to share a complete medical history, including your symptoms;
•  to discuss your sexual history and other factors that could be influencing your sex life; and
•  to receive a diagnosis and treatment recommendations, if possible. 

If they are not able to help you, they might refer you to another type of health care provider or therapist. Or, you can ask for a referral.

Note: A sex therapist will not conduct a physical exam or order diagnostic tests, but they will ask you about your medical history and any physical concerns you are experiencing.

• If you have a primary care provider (PCP) or a reproductive health specialist, you could start by making an appointment with either one of them.
• If you don’t have a PCP, you could ask your insurance company or reach out to your local health department for a list of PCPs in your area. Online search engines (ZocDoc, etc.) can also connect you with a provider. If you don’t have insurance, you can search for a free health clinic or community health center in your state.
• To schedule an appointment with a therapist, you may need a referral from your primary care provider first, depending on your insurance. If you are unsure, you can check your benefits online or talk to an insurance representative. Be sure to ask what types of therapies are covered. If you don’t have private insurance, or are on Medicaid or Medicare, ask your provider if you need a referral.
• Finding a general therapist: In many cases, you can search “therapists near me.” However, there are many resources available to help with the search as well. Psychology Today has a “find a therapist” function that allows you to look by zip code. You can also filter the results based on your insurance type, gender of the provider, type of therapy, age, price, and issues the therapists has expertise in. 
• Finding a sex therapist: You can go to AASECT’s online directory to find sex therapists near you. Your insurance provider may also have a list of covered therapists in your area.

The cost of services will vary based on the type of provider, where you live, and the recommended treatment and/or therapy. Rates could also vary if you are receiving services in person or virtually.

If you have insurance, ask the provider if they accept your insurance. Be prepared to discuss the type of insurance you have.  If you’re seeking therapy, it is also a good idea to contact your insurance company and ask if they cover mental health sessions.  Also, ask about your co-pay and deductible, and find out if the provider who you would like to see is covered by your plan.

If you don’t have insurance, ask about whether the HCP or therapist offers a sliding fee scale, based on your ability to pay. Also, some providers may even have payment plans, which will help you spread out the cost of care over a longer period of time. Getting this information will help you prepare for any costs before your first visit.

It might feel awkward or embarrassing to bring up your sexual concerns with your health care provider, or with a therapist. But, good sexual health is key to your overall health and well-being. So, this topic – like so many others – should be a routine part of your conversations with health care providers and/or therapists. You can be as brief or detailed as you’d like to be – do whatever is comfortable for you!

If you talk openly and honestly about your body and concerns, they can give you better care and guidance. And, you can be on your way to a better sex life. Sometimes, just saying the words “I’m having trouble with sex” is the hardest part.

Here are some conversation starters you can use in your visit:

• “I’m having trouble with my sex life…”
• “I’m struggling/having issues in the sex department…”
• “I wanted to talk with you about my sex life today...” 

If you prefer, to help break the ice, you could write down your concerns on a notecard, and give it to your nurse or doctor at the start of the visit. Also, there may be space on an intake form to write down your concerns as well. With this information, your provider would hopefully start the conversation. If not, you can do so and refer to the written tool(s) you’ve completed.

Once you bring it up, your provider will probably want to know a little more about what’s going on. You can follow up by saying something like:

• “It’s not what I want it to be, and I’m having concerns with _______(e.g., low sexual desire, lack of sexual arousal, pain during sex, lack of orgasm or orgasm difficulties, not being able to get hard before sex, not staying hard during sex, or having a dry vagina). Can you help?”

Your provider should then ask follow-up questions to get more information. You can also read more about how a good provider should address these concerns under the section "What If I Don't Feel Comfortable with My Provider or Therapist?"

Great job – you took the first step in getting help by starting the conversation!  Next, it’s always helpful to come prepared with questions that you want answered. Here are some questions that you can have handy for your visit:  

• Can you help me address my sexual concerns? If not, can you refer me to a provider who can?
• What might be causing my sexual concerns?
• Do I need medical tests?
• What is your diagnosis? (e.g., caused by physical factors, psychological factors, relationship problems, or a combination?)
• What solution(s) do you recommend?
  • Self-education strategies
  • Improved partner communication
  • Therapy (sex therapy or other types)
  • Devices
  • Lifestyle changes
  • Medication
  • Other?
• Should my partner(s) be involved in treatment and/or therapy?
• Do you have other information or resources you can share with me?

Health care providers and therapists should routinely ask all of their teen and adult patients about their sexual health and sex lives. It may feel like they are being nosey, but they are just trying to help you take care of your whole body and overall health.

While it might seem a bit awkward to talk with your provider or therapist, sex is natural part of life that should be positive and pleasurable. However, difficulties and concerns sometimes get in the way. If so, many providers can help you find solutions.

If you bring up the topic, your provider should also have some questions for you. Your answers will help your provider better understand your concern(s) and recommend the best solutions.

Your provider could ask questions such as:

Overall health and sex life:

• How is your overall health? Do you have any specific health concerns?
• How is your sex life going? What concerns do you have? 
• Are you currently involved in any sexual relationships? How are they going?
• Is the sex you’re having pleasurable for you?  If not, why do you think this is the case? 
• Do you desire sex? If you have a partner, do your sex drives match up?

Sexual concerns:

• Are you having any difficulties when you have sex (e.g., low desire, lack of arousal, lack of orgasm, pain during sex, vaginal dryness, premature ejaculation, erectile dysfunction)?
• How much do these concerns bother you?
• Do you become aroused during sexual interactions with partners?
• Do you have orgasms? (Have you had them in the past, but not now?)
• Do you have pain with intercourse or penetration? This can be anal, digital (finger) or vaginal penetration.

Other factors:

• Do you use any types of birth control or contraception? 
• Do you take any medications that are not listed in your records? Make sure to tell them about prescription and over-the-counter drugs you are taking.
• Do you use alcohol or recreational drugs? How often?
• Have you ever had surgery? Specifically, have you had surgery focusing on your reproductive system? Examples include a hysterectomy, ovarian cyst removal, and gender affirming surgery.
• Have you been diagnosed with other medical conditions and/or mental health conditions?
• Have you ever had an unwanted sexual experience?  Been sexually assaulted?  Experienced any form of intimate partner violence or abuse?

If you are not comfortable with your health care provider or therapist for any reason, listen to your feelings, and consider finding a new one. You are entitled to non-judgmental, comprehensive care to  address your sexual concerns. A good provider will: 

• Be comfortable discussing your sexual history and concerns
• Respect your gender identity, sexual orientation, and sexual activities
• Answer your questions in a respectful and honest way, explain what they are doing and why, ask what you are comfortable with
• Speak clearly and make sure you understand, and
• Keep your visit confidential.

Health care providers and therapists are people, too. Some providers are not comfortable having open conversations about sexual health or addressing sexual function. If that’s the case, ask your friends or family to recommend someone you can trust, research providers through an online rating site, or ask your health plan for a list of top-rated providers in your area.

Resources for Transgender, Genderqueer, Agender, Nonbinary & Asexual Communities

Transgender people may face unique challenges in their sex lives. If you’ve had gender-affirming surgery, you might be interested in how to have pleasurable sex with your body changes. Organizations including the Human Rights Campaign, Fenway Health, Kimberly Keiser and Associates and the American College of Obstetricians and Gynecologists have information that may be helpful.

Many times, asexuality (sometimes abbreviated as the word Ace) can be confused with lack of desire for sex. The Asexuality Visibility and Education Network provides online forums and educational resources for the asexual community. PFLAG and the Human Rights Campaign provide definitions as well.

Resources for Aging and Sexuality

• Mayo Clinic: Sexual Health And Aging: Keep The Passion Alive
• Mayo Clinic: Sex Tips for Older Men
• National Institute on Aging: Sexuality in Later Life
• EverlyWell: Sexuality and Aging: Your Guide to Maintaining Sexual Health
• The North American Menopause Society: Frequently Asked Questions
• Joan Price: Books on Aging, Sex, and Sexuality

Resources for Survivors of Trauma and Abuse

• Self: What It's Like to Reclaim Your Sex Life After Sexual Assault
• InStyle: How to Reconnect With Your Body After Sexual Assault
• Modern Intimacy: Developing Hot + Healthy Intimacy After Sexual Trauma
• Chicago Alliance Against Sexual Exploitation: Reclaiming Sex and Romance After Assault

Resources for Self-Education

• American Sexual Health Association: ASHA provides a variety of content on understanding your body, sexual pleasure, sex as we grow older, and how to find the right provider.
• Bedsider: Bedsider provides information on birth control methods, helps users find clinics, and also includes articles on sexual pleasure.
• COSMO: 19 Ways to Make Sex Last Longer
• Men’s Health Magazine: The 25 Best Men’s Health Sex Tips Ever
• Planned Parenthood: Sex, Pleasure and Sexual Dysfunction
• PsychCentral: How to Leave Shame out of Your Sex life
• Scarleteen: Sex Ed for the Real World: Scarleteen provides resources for teens and emerging adults around relationship issues, sexual orientation, abuse, sexual health and much more. Check out their sexual inventory stock list to learn how to communicate your sexual desires with a partner.
• Sex Positive: How to Masturbate With A Vagina, Step-by-Step
• Teen Vogue: How to Masturbate: There’s No “Right” Way

Resources for Partner Communication

• Atlanta Innovative: Communicating About Sex: How Sex Therapy Can Help You
• Five Action Steps for Good Sexual Health: Steps 3 & 4
• Bustle: Let’s Talk About Sex – And The Best Way To Do That
• Refinery29: 30 Sex “Rules” For People in Long Term Relationships
• Well + Good: I Have a Higher Libido Than My Partner—How Can I Be Both Supportive and Satisfied?

Resources for Parenting and Sex

• Medium: How To Have A Sex Life When You Have Kids
• Scary Mommy: How To Still Have Sex Once You Are A Parent
• Parents: 3 Ways to Have Hotter Sex As a Parent

Books:

This collection of resources provides general and additional information on sex, sexual health, and sexuality.

• Our Bodies, Ourselves – Boston Women’s Health Book Collective
• S.E.X.: the all-you-need-to-know sexuality guide to get you through your teens and twenties – Heather Corrina
• Pleasure Activism – Adrienne Maree Brown
• Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life – Justin Lehmiller
• The Game of Desire – Shan Boodram
• Not Always in the Mood – Sarah Hunter Murray
• Better Sex Through Mindfulness – Lori Brotto
• Come As You Are – Emily Nagoski
• Becoming Cliterate – Laurie Mintz

Resources to Help Understand Your Concerns

This section provides more detailed information on specific concerns you may have, along with links to helpful resources. We have laid out these concerns based on whether you have a vagina/vulva or penis. We do this because the treatments, resources, and the types of providers who respond to these concerns are typically recommended based on gender and/or body parts. 

Sexual Concerns for People with Vagina/Vulva

• Decreased desire and sex drive is common among people of all ages and genders. It can be caused by a variety of physical and mental health conditions. For more information, here are a few resources:
  • Low Sex Drive in Women – Mayo Clinic
  • Decreased Desire – North American Menopause Society
  • Why do Women Lose Interest in Sex? – WebMD
  • Low Sex Drive for Females: Symptoms, Diagnosis, and Treatment – Healthline

• The inability to become aroused occurs when your body does not respond to physical or non-physical sexual stimulation. This can happen at any age, but is most common for older women who have experienced menopause. The following resources provide more details:
  • Understanding Female Sexual Arousal Disorder – Healthline
  • What is Female Sexual Interest/Arousal Disorder? – Medical News Today
  • Female Sexual Interest/Arousal Disorder – University of Texas

• Lack of orgasm/orgasm difficulties. Orgasms vary in intensity and frequency for people who experience them. But, the inability to orgasm can cause distress and may interfere with a relationship. There are many resources that can help you understand this concern, and reach an orgasm by yourself or with a partner(s): 
  • Anorgasmia in women – Mayo Clinic
  • Orgasmic Dysfunction in Women – Medline Plus
  • Orgasmic Dysfunction – Healthline
  • Orgasmic Disorder – Merck Manual

• Unwanted pain during penetration and pain during intercourse should not be part of sex. Pain can be experienced during initial penetration or can occur throughout vaginal, digital or anal sex. To address the issue, you could try using a water-based lubricant. If this doesn’t relieve the pain, seek out professional advice. To learn more about pain during sex, you can explore:
  • What Women Need to Know About Pain During Sex – Cedars Sinai
  • Painful Intercourse (Dyspareunia) – Mayo Clinic
  • Painful Sex in Women – WebMD
  • When Sex is Painful – ACOG
  • Painful Sex After Menopause: Causes and Treatments – Healthline

• Vaginal dryness can be frustrating, but it’s something you can manage. While people can experience this concern at any age, it’s most common in those who have gone through menopause. Using a water-based lubricant can help address vaginal dryness; however, if the concern persists it could mean you are experiencing vaginal atrophy. You can seek help from a medical professional, who can prescribe other treatments. To learn more about vaginal dryness, you can check out these resources:
  • Vaginal Dryness – Mayo Clinic
  • Vaginal Dryness: Causes and Moisturizing Treatments – WebMD
  • Vaginal Dryness – North American Menopause Society

Sexual Concerns for People with a Penis

• Decreased desire and sex drive is common among people of all ages and genders. It can be caused by a variety physical and mental health conditions. For more information, here are a few resources:
  • Decreased Libido in Men – Merck Manual
  • Low Sex Drive: Common Causes and Treatment – Healthline
  • Let’s Talk About Low Libido – Mayo Clinic

• Erectile Dysfunction (ED) is one of the most talked about types of sexual dysfunction for people with a penis. It means you can’t get or keep an erection firm enough to have sexual intercourse. Having trouble with an erection from time to time isn’t necessarily a cause for concern. But, if this is an ongoing issue, it’s a good idea to speak with a medical professional. The following resources provide more information on ED:
  • Erectile Dysfunction – Mayo Clinic
  • Everything You Need to Know About Erectile Dysfunction (ED) – Healthline
  • Erectile Dysfunction (ED) – Urology Care Foundation
  • Erectile Dysfunction – MedlinePlus

• Premature ejaculation occurs when you ejaculate (come) sooner during sex than you or your partner(s) would like. Like ED, premature ejaculation can happen from time to time, and is only a cause for concern if it happens often or is having a negative effect on your sex life. The following resources explain what premature ejaculation is:
  • Premature Ejaculation – Mayo Clinic
  • What is Premature Ejaculation? – Urology Care Foundation
  • Premature Ejaculation – WebMD
  • Premature Ejaculation, What Is It? – Harvard Health Publishing

• Delayed or inhibited ejaculation is when a person takes an extended period of time to ejaculate (come) or does not ejaculate after sexual pleasure at all. Causes include lack of interest in sex, performance anxiety, or certain medications. However, this can also happen when under the influence of drugs or alcohol. A medical professional can help address the concern if it is inhibiting your sex life. You can learn more here: 
  • Delayed Ejaculation – Mayo Clinic
  • What is Delayed Ejaculation (DE)? – Healthline
  • Delayed Ejaculation – UCLA Health

• Edging: Edging (also called surfing, peaking, teasing, and more) is the practice of stopping yourself from reaching orgasm right when you’re on the cusp of having one.
• Hormone Therapy: The use of products to increase the levels of hormones throughout the body. This can be helpful for vaginal atrophy and related pain during vaginal sex (systemic estrogen products). Other types of hormone therapy can be used to address concerns like erectile dysfunction by increasing the testosterone in your body (Stendra, Viagra, Cialis). 
• Kegel Exercises: Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum. You can do Kegel exercises, also known as pelvic floor muscle training, just about any time.
• Masturbation: Masturbation is the self-stimulation of the genitals to achieve sexual arousal and pleasure, usually to the point of orgasm. It is commonly done by touching, stroking, or massaging the penis or clitoris until an orgasm is achieved. Some women also use stimulation of the vagina to masturbate or use "sex toys," such as a vibrator.
• Pelvic Floor Physical Therapy: Pelvic floor physical therapy involves the pelvic floor muscle group, which is responsible for a variety of functions. These muscles support the pelvic organs, assist in bowel and bladder control, and contribute to sexual arousal and orgasm.
• Penile Implants: Penile implants are devices placed inside the penis to allow men with erectile dysfunction (ED) to get an erection. Penile implants are typically recommended after other treatments for ED fail. There are two main types of penile implants: semirigid and inflatable.
• Penile Injections: Penile Injections are injected along the lateral side of the penis and help increase blood flow to the penis. The three main types of medications used in penile injection therapy include: papaverine, phentolamine, and prostaglandin E1 (PGE1)/alprostadil (Caverject, Edex, MUSE)
• Squeeze Technique: Also sometimes known as the pause-squeeze technique, or the stop and squeeze technique, is where you squeeze the end of your penis, at the point where the head (glans) joins the shaft and maintain the squeeze for several seconds until the urge to ejaculate passes.
• Vacuum Device: A vacuum device is a tube made of plastic that fits around the penis. You coat the base of the penis with lubricant and insert the penis into the tube. Air is pumped out of the tube, which creates a vacuum. The vacuum helps blood flow into the penis, producing an erection-like state in about 5 minutes.
• Vaginal Dilator: A vaginal dilator is a tube-shaped device that’s used to stretch your vagina. Vaginal dilators come in kits with different size dilators ranging from small (about the size of a finger) to large.
• Water-based Vaginal Lubricant: A water-based lubricant is a product designed to reduce friction during foreplay, intercourse, and masturbation. Some brand names include: Almost Naked, Coconu, Babelube, KY, and Hydra Glide.