By Sunita Menon, Psychotherapist – Specialised in CBT & Sex Therapy

First it was physical health, encompassing fitness and diet. Then we moved to mental health, both preventive and curative. And now, it’s the dawning of the next era, that of sexual health.

So what is sexual health all about? It includes sexual orientation (heterosexual, bisexual, gay and lesbian, asexual), gender identity (also gender at birth and gender expression) and nature of romantic/ sexual relationships (monogamy, non-monogamy, polyamory).  Add to this, sexual hygiene (intimate hygiene behaviours engaged in before, during and after sex), sexual dysfunctions and other behaviours (that gratify our sexual needs).

With sexual health, the ‘don’t ask – don’t tell’ game is played out between therapists and clients. It’s the huge elephant in the therapy room that clients don’t want to acknowledge. So I figured out, best to address it in the very first session itself by including in the first-intake-form questions regarding gender and sexuality. Much required pieces of information to fix our client’s context and help with case conceptualisation. We follow the PLISSIT model (an acronym for Permission, Limited Information, Specific Suggestion and Intensive Therapy) when it comes to talking sex in therapy. So questions asked in the form are with regard to sexual orientation, gender identity, frequency of sex and sexual dysfunctions if any (and diagnosis/ medication details as the case may be).

To date I haven’t had a client who has refused to answer the questions pertaining to their gender and sexuality in the form. In fact it comes as a relief to many when an early check-in about the same is done for it makes so much easier to speak more about the same in the session itself or thereafter.

Strange, how conditioned we are, to not talk about money and sex in spite of both playing a significant role in our overall wellness. Money and mental health let’s keep for another day and focus on just sex today.

Clients also come in specifically to address sexual health issues — couples (same sex or opposite sex), individuals and even families. Families when it involves children or even a parent coming out about their sexual orientation or gender identity and when parents want professional input on how to deal with their children and their masturbation habits and pornography addiction, for instance.

As for male sexual dysfunctions, when urologists are of the medical opinion that it has nothing to do with between their thighs, then they recommend therapy to deal with that which is between their ears. Ranging from masturbation and pornography addictions to ED and ejaculatory issues (early or delayed). Moreso when it has begun to impact their relationships and mental state of being.

And as for women, sex therapy is offered to not only cope with fertility treatments, inability to have orgasms and a general lack of interest in sex (perimenopausal, menopausal women for example) among many such issues.

What we need to bear in mind is how entwined sexual health is with emotional well- being and its ability to impact every day functioning, affect levels of self-confidence and even lead to mood disorders. Not to forget sexual health issues that stem from diseases, illnesses (of body and mind) and side-effects of medication (like that for hypertension and diabetes) — all of which can give rise to anger, shame, guilt (STIs and STDs), sadness and even fear.

Sex is not for reproduction alone. It plays a significant role in bringing fun, spontaneity and the child in us. Don’t forget we can also get our free daily dose of endorphins, dopamine and oxytocin by indulging in an activity of sexual pleasure. Why then struggle in silence (because we are embarrassed to speak about it) when we can get professional help to redress the situation?