Would you benefit from seeing a psychosexual therapist?

By Violeta Jawdokimova, Psychosexual Therapist


When discussing fertility, one topic that is very rarely mentioned, yet it seems intrinsically connected to fertility, is sexual dysfunction.

The possible reasons why this is a rarely discussed subject, is that very often helping professionals assume that people do have sex because they want to have babies. The other reason is that people are embarrassed to talk about sex. It is easier to talk about blood results and various medical treatment in regards to fertility then talking about sex, yet sexual functioning or not functioning is one of the key factors for successful outcome. We also need to mention that sometimes health professionals also feel embarrassed or not qualified to ask or talk about sex, so the issue gets side-lined. Additional reason is that people think that sex is a natural skill and we should all be able to do it without any problem. Let’s have look at how sexual problems can affect fertility treatment and what we can do to amend them.

Some of the most common sexual issues in regards to the fertility treatment are:

  • Premature ejaculation

  • Delayed or absent ejaculation

  • Problem with erection

  • Painful sex

  • Low interest in Sex

Premature ejaculation is the term that describes diffculty for a man to regulate/control ejaculation, so instead of ejaculation in the vagina, he ejaculates ether as soon as he is touched or before entering the vagina. In some cases he might even ejaculate in his underwear. It is almost always psychologically based. This is very frustrating and disheartening for the couple, who are already anxious about their fertility issues. In fact sometimes fertility treatment initiates premature ejaculation. The couple may be subjected to numerous expectations from families, wider society etc. and the last thing they want is to experience a psychosexual problem. However, a fertility practitioner can very sensitively address this and make an appropriate referral.

Delayed or absent ejaculation. When a man finds it very difficult to ejaculate or is unable to do so, we call this delayed or absent ejaculation. The causes can be numerous and again can be physiological or psychological.

Problems with erection can be caused by either physiological or psychological factors. Sometimes they are a combination of both. Difficulty for a man to have a sufficient enough erection for penetrative sex or to masturbate is considered to be ‘Erectile Difficulty’.

Painful sex is the cause of many unhappy instances of sexual activity. Usually women suffer from this, but we cannot exclude men. When a woman cannot have penetrative sex or cannot have penetration without pain she is diagnosed with ‘Vaginismus’. The causes can be physical, psychological or both. The effect on fertility is obvious as it prevents the couple from having regular sexual intercourse, as well as any enjoyment. Pain is not something that anyone should experience through sex. There is sometimes a misconception, especially among young woman and men that the “first few times are painful”. Sex should never be painful and the earlier this can be addressed the better. It is often discovered much earlier than the first penetrative sex, generally with a use of tampons or during genital self-exploration.

Low interest in Sex. Regimented routine that is sometimes an integral part of a fertility treatment may not be the best aphrodisiac for sex and although sex does not always have to be super exciting, I think that intimacy that is produced through sex increases a couple’s bond and positive feelings in general.

Is high interest in sex necessary for fertility? Absolutely not, but it is definitely desirable and the baby making time can be remembered with fondness and good feelings.


Sexual problems cause a lot of painful emotions. For men, it is usually embarrassment, shame, anger, fear and frustration and sometimes sadness. For women, it is feeling of inadequacy, insecurity, worry, anger, frustration and sadness. Women are more likely to seek help, whilst men find it easier to talk about the problem in a professional setting. For a couple the key thing is to stay calm and not to put too much emphasis on the problem, at least not if the problem happened only a few times. Every man experiences erectile problems at some stage of their life. There is a myth that men want sex all the time and that they are always ready. So, for a couple this is an important thing to remember and not to panic. Both partners can try to be relaxed and enjoy sex how they used to do it before they started trying to conceive. Open discussion is also good, as long as it is facilitated with love, compassion and understanding.

Sexual organs do not operate on their own. Our emotions, moods, state of mind, physical wellness and social conditions dictate how we operate sexually, so before you start blaming one another, try to understand that the other person is a human being with their emotions, insecurities and doubts and try to give each other love and understanding. Instead of moving away angrily after an “unsuccessful” attempt, come back to each other, hold each other tight and enjoy each others bodies. You will be surprised how quickly your body can react positively to positive emotions and sensations.



During an initial consultation with your fertility specialist, hopefully you will be asked about your health in general, but also about your sex life. Although the questions about sex can be initially difficult, it can also feel like a relief because for some couples this might be the first time they seriously talk about the subject.

The clinician should approach the subject with sensitivity and good knowledge about sexual problems as well as confidence to do so. Depending on that talk, they might decide to make a further referral.

As I mentioned earlier, every sexual problem has its origin either in psychological or physiological area. Depending on the couple’s answers, the clinician will decide in collaboration with the couple what would be the best plan of action. Sometimes attending psychosexual therapy would be the first step into a successful outcome.

Psychosexual Treatment

Psychosexual Treatment is a type of counselling/psychotherapy which belongs to a talking therapy. This means that you are not going to be physically examined, but rather to talk
about your body, thoughts and feelings, your relationship and development, including sexual development. The focus will then be on a particular sexual problem and you might be given a “homework”, as psychosexual treatment involves practical “exercises”.

This talking therapy is where the couple will have a chance to explore not just the sexual problem, but wider elements involved in their life like their lifestyle, beliefs and developmental stages of their life (childhood, schooling, teenage years, early youth).

Sexuality is a complex system in which so many things need to be explored. Sometimes a therapist might focus on the couple’s dynamics and how they relate to each other, sometimes more individual work needs to be completed.

The sessions are usually 50 minutes long, which provides a couple with space to express themselves fully. Generally inadequate communication, anxiety and lack of good sexual education are the major culprits in regards to the sexual problems, but we can also meet with some early trauma or other emotional problems.

The work can be short term (up to a six sessions), medium term (up to a year) or long term, with an open end. Psychosexual therapy is one of the most successful therapies and the results are really good. Once the couple is committed to the therapy, results are very certain in regards to the sexual problems.


Violeta Jawdokimova, MA, PG Dip. Psychosexual Therapist, COSRT accredited, UKCP registered, BACP accredited www.talkinghelps.co.uk

Juliana Kassianos