Most of sex therapy is not about sex; it is largely about working with grief and loss. This statement hit me hard when I first heard it in graduate school.  I decided on the spot to become a sex therapist.

Sex therapy helps deal with the losses that come with illness and disability.

Loss becomes a stark reality with the diagnosis and experience of a chronic illness or disability. If you are struggling with heart disease, cancer, diabetes, HIV/Aids, mental illness or physical impairment, you face a variety of losses, and many of them relate to the expression of your sexuality. The way you thought about your body and yourself as a sexual person can change when you become sick or disabled, and this affects your identity, creating a subtle but impactful loss. If you are unable to have sex the way you used to, you have lost your familiar sexual interactions and the sensations that you were used to. If you have lost body parts or the use of any of them, your body may no longer feel comfortable or familiar, and some sexual behaviors may now be out of reach. These are all losses that must be accepted and grieved before you can move on to create a new chapter in your sexual life.

You might need to grieve or process past sexual or traumatic experiences.

If you have been sexually molested, abused or assaulted, you have also suffered loss. Not only do you deal with the emotional and physical trauma of your experience, but you may feel robbed of your innocence, your ability to trust in people, your opportunity to relax and enjoy sex, and your willingness and eagerness to express yourself sexually. Sex can become a very loaded topic – tolerated and avoided, or indulged in risky and excessive ways. Again, grieving the losses becomes part of the path to reclaiming a healthy sexuality for yourself.

Even the passing of time creates losses.

You also deal with significant loss if your body stops responding sexually the way you want it to. Whether due to aging, relationship issues or psychological reasons, you may find that your body is difficult to arouse, slow (or too quick) to orgasm or easily distracted. These physical changes in functioning can also result in changes in your confidence, body image, and sexual self-image. All of these changes can result in feelings of loss.

People can become lonely in their relationships.

You may feel a profound sense of loss if you are sexually distant from your partner. What promised to be a rich celebration of love and intimacy can dry up, leaving a hole in its place. Relationships that started with a robust sex life often creep slowly into the sexual desert, in which sex is rare, routine, disconnected or nonexistent. You may experience this as a significant loss, although the sadness and loneliness can be hidden behind resentment and anger.

Sex therapy can help deal with grief and loss and work toward your best possible sex life.

Working with loss is a process that involves accepting the loss, experiencing the emotions associated with it, adapting to the reality of the situation and creating the next chapter of your sexual life, and finding a way to honor what used to be while moving forward with what is. Sex therapy can help with your emotional process of working with loss and address your options for sexual functioning.

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