David Avruch, LCSW-C

Psychotherapy & Social Work

Ethical and effective psychotherapy and social work services in Baltimore, Maryland.

A Feminist Approach to Sex Therapy

Feminism means different things to different people. I call myself a feminist psychotherapist because certain key tenets of feminist theory - in particular, examining the the distribution of power in society and in relationships - can be powerful tools in my work with clients. This is true when it comes to treating sexual problems as experienced by an individual or couple.

How does it work? First, we look at the status quo and ask what’s missing. Contemporary discussions of sexual problems privilege a biomedical perspective. For example, two of the most common reasons people seek sex therapy - erectile dysfunction and lack of sexual desire - are often viewed as exclusively medical problems, with expensive pharmacotherapies being prescribed for both conditions. While for some clients medication brings relief, the biomedical approach alone ignores other potential causes and solutions.

Traditional sex therapy examines a sexual problem from three different angles: biomedical, psychological, and relational. Often, more than one angle is in play. For example, a biomedical reason for erectile dysfunction could be hypertension, a psychological factor could be depression, and a relational factor could be a feeling of emotional distance from one’s partner. By jumping straight to medication, we ignore important - and treatable - problems underlying the sexual complaint. One possible consequence of ignoring other causes: if a client manages his ED by taking a prescription medication without treating an underlying depression, he may lack the motivation to remain adherent to the medicine. Research on the drug Viagra, for example, has documented that up to 50% of patients who are prescribed the drug will quit taking it within a few years; a significant minority never fill the prescription to begin with.

Feminist sex therapy introduces a fourth angle for examining a sexual problem: the political. It seeks to understand sexual functioning in the context of society’s expectations of women and men, as well as how we are taught to think about our bodies and sex. For example, female hypoactive sexual desire disorder (HSDD; “hypoactive” means underactive) is thought to occur in up to one third of all women in the United States. A feminist analysis would ask: is this the product of social conditions? For example, research has documented that in heterosexual relationships in which both partners work full time outside the home, a disproportionate share of housework and childcare continues to fall on women. This can create resentment and discord within a relationship. Conversely, other data has shown a positive correlation between marital satisfaction and sexual desire. A feminist psychotherapist would be curious whether the division of labor in the home is related to the female partner’s experience of sexual desire.

Sexuality is inherently complex. In my experience as a therapist, examining a problem from multiple angles and gathering as much data as possible, rather than being limited to a single model, can lead to new opportunities for improved functioning both for the individual and the couple.
 

Sources:

  • Female hypoactive sexual desire disorder: epidemiology, diagnosis and treatment. Warnock JJ. CNS Drugs. 2002;16(11):745-53.
  • Women in the Workplace Survey 2015, LeanIn.org & McKinsey
  • How long do patients with erectile dysfunction continue to use sildenafil citrate? Dropout rate from treatment course as outcome in real life. Sato et. al. Int’l Journal of Urology, April 2007
  • The F.A.S.T. Model. Teresa L. Young. Journal of Feminist Family Therapy, 2007; 19:2
  • Sexual desire and relationship functioning: the effects of marital satisfaction and power. Brezsnyak M & Whisman MA. Journal of Sex and Marital Therapy. 2004 May-Jun; 30(3):199-217.