Sex Therapy for Gay Men and Couples

AASECT Certified Sex Therapy for Gay Men and Gay Male Couples

Many gay men, both individuals and couples, face challenges in their sexual functioning and in their sexual relationships, but the number of sex therapists who are trained and available is few, and the number of gay men’s specialist sex therapists even fewer. I am proud to provide these much-needed services, as over 70 percent of even licensed psychotherapists receive no training in sexology.

I am a Certified Sex Therapist with AASECT (American Association of Sex Educators, Counselors, and Therapists), as well as being a member of The Secular Therapy Project and Kink-Aware Professionals, with expertise both in helping people with sexual dysfunctions and extensive experience in Consensual Non-Monogamy and polyamorous relationships, as well as people trying to reconcile cultural issues with their spirituality and sexuality. Over the course of my long career as a therapist and coach working almost exclusively with gay men and gay male couples (28 years), I’ve helped many individuals and couples solve a variety of problems and challenges with effective gay sex therapy.

About Me

Do you have concerns about:

Difficulty getting or maintaining erections?
Concerns about sexual behaviors that feel compulsive or out of control (or what is often erroneously referred to as “sex addiction”)?
Concerns about the use of porn?
Reconciling your sexual interests or behaviors with your spirituality?
Discomfort with bottoming?
Frustration with premature ejaculation?
Problems with delayed ejaculation?
Concerns about penis size, load size, or body image?
Topping as well as you’d like to please yourself and your partners?
Painful erections?
Questions about kink or BDSM scene play?

Concerns about your sexual fantasies or sexual thoughts?
Anxiety about maintaining your sexual health?
Questions about identifying STD symptoms, exposure risk, or treatment options?
Curiosity about PrEP?
Problems with libido or desire?
Mismatched desire in your relationship?
Being conflicted about monogamous versus open relationships?
Communication challenges in asking and getting what you want in sex?
Making a connection between your sexual fantasies and what you act on?
Other questions/concerns about sex, but feel like you don’t know how to get help?

When gay men usually think of sex therapy, or therapy for sexual issues, their first thought is probably that that’s something to work on in couple’s therapy with a partner or spouse. For the most part, they would be right; when I work with gay couples, assessing the current status of their sex life is part of the work, and then discussing strategies and ways to improve it if either partner, or both, has complaints about their sex life.

What you might be overlooking is the role, value, and purpose of therapy for sexual issues, topics, and challenges that affect you that might be a part of individual therapy. In my practice, I focus on gay-affirmative therapy; that’s my specialty area of expertise that sets me apart from most licensed psychotherapists in my local community (West Hollywood, Los Angeles, Beverly Hills). You might not be aware of some of the sexual topics that might apply to you, that I help a lot of individuals with.

Below are some of the areas about sex and sexuality that can be part of the work in therapy with gay individuals or couples. Think about which of these might apply to you, and consider if it might be time for you to talk to someone about these or similar issues:

Validation for a Gay Male Identity

My clients often tell me they enjoy working with a gay male therapist because they feel especially comfortable talking to therapist who “gets it” on gay sexual content, as opposed to the awkwardness that might come from trying to talk about sexual issues to even the most well-meaning female therapist, straight male therapist, or even to another gay male therapist who either isn’t experienced or who doesn’t specialize in working with gay men. My clients describe how they have less fear of judgment, but also that they appreciate working a gay male therapist who not only specializes in gay men, but also with a wealth of experience. There are almost no sexual issues that a client can report to me that I haven’t heard before and helped the client with his situation. I draw not only from my work as a therapist (and professor of psychotherapy practice), but also from my identity as your gay male peer in the community, and from my experience working with other clients, as well as my own gay male friend network. This validation can help enhance your gay male identity and help you to feel comfortable speaking frankly about sensitive sexual issues.

Dating and Sexual Choices

What “feels right” for one client about how to approach dating and/or sex might not work for another client. Some clients only want to have sex under certain circumstances (like active dating), while some “hook up” through fuck buddies, escorts, bars, clubs, websites, apps, sex clubs, or bathhouses. Sometimes clients need support to talk freely about what works for them, and what doesn’t. Sometimes it’s about having less or different sex, and sometimes it’s about finding ways to have more sex, but with the guys and circumstances they want. Therapy about sex is what I call “Sexual Self-Empowerment”, which is having absolute control over what happens to your own body: saying “yes” when you want to say “yes”, and saying “no” when you want to say “no”, without guilt, embarrassment, or explanation. This is about the choices you make as an adult, consenting man. For clients who are survivors of sexual abuse, incest, or sexual assault, much of their therapy can be about a healthy “reclaiming” of the integrity and control of their own bodies after experiencing a trauma. For others, it can be about honoring what your particular body (and mind) long for, discussing ways that you can get fantasies and desires fulfilled in ways that are both safe and satisfying, or even thrilling; a robust sex life can contribute to your overall quality of life.

Sexual Performance and Other Anxiety

Some guys have quite a bit of anxiety around sex, and therapy can help overcome this. “Performance anxiety” about being able to penetrate as a top, or to be a “good” bottom, or the ability to reach climax can all be areas of concern. Sometimes, a discussion of alcohol and drug issues is part of this, because some guys can over-rely on alcohol (or even drugs like crystal meth, marijuana, ecstasy/molly, cocaine, GHB, etc.) to get to the point where they can “relax enough” to have the sex they want, or even sex at all. Developing the ability, over time in treatment, to have the sex you want without having to rely on substances is common goal in sex therapy.

PrEP, Condoms, and HIV Prevention

As a therapist who has been open about being HIV-positive since 1990, I know a lot about HIV, its transmission, and how to live with it successfully (I was the Chair of the LA County HIV Mental Health Task Force for 9 years, and co-coordinated its annual mental health conference in LA, “Coping with Hope”). I also know a lot about risk management and HIV prevention. This information changes frequently; just last year, we had more highly-compelling research come out about the effectiveness of Truvada, an HIV treatment medication, being taken by HIV-negative guys (and women) as an HIV prevention medication, called “Pre-Exposure Prophylaxis” (PrEP). While some guys use this in addition to condoms, some guys use it in place of, and have stayed reliably HIV-negative. Many guys use PrEP as an alternative to condoms and enjoy enhanced pleasure from it. But it’s important to learn about the educational resources about PrEP, and where to go to get solid information, as well as being referred to an HIV-savvy physician who can enroll someone in PrEP care, which is more than just taking a pill every day; it’s also about regular HIV testing and other STD screening for comprehensive sexual health. Often my HIV-negative clients have anxiety about HIV transmission risk and prevention, and my clients who are newly-diagnosed with HIV (although there aren’t many anymore, thanks to PrEP), want emotional and practical support for living with HIV for the long term, including around disclosure, dating, and getting good medical care.

STD Prevention and Management

If you’re on PrEP, that effectively takes care of HIV transmission risk (with good adherence), but other sexually-transmitted infections exist and they need their own kind of attention. These aren’t usually life-threatening, but can be annoying. Mostly this is a medical issue, but my clients in therapy might discuss their feelings about if they contract a non-HIV STD, or need support for how to disclose to recent partners, and also about reducing risk. The fact is, if you’re a sexually active adult, you might have to get treatment for an STD once in a while, and there is no shame in this. Sometimes discussing anxieties in a way that separates the HIV issue from the issue of other STD’s is a topic in sex therapy.

Coping with Erectile Dysfunction

It’s hard (ahem, no pun intended) to talk about erectile dysfunction except with another guy. ED can have both psychological and/or physical origins, and coping with ED is a frequent topic in sex therapy. Issues like poor self-care (diet, exercise, sleep, stress management) can contribute to ED, and so can unconscious conflict with a primary partner – conflict you weren’t even aware you had. Or, issues like low Testosterone can contribute to ED, easily, even if guys who aren’t “all that old” yet. Often, I refer guys to information that educates men on hormone issues, especially in the context of midlife and aging. I also disclose my own experience having treatment for hormonal issues, and make referrals when necessary for these kinds of resources. Low Testosterone has implications for ED, but also for mood, stamina, fatigue, identity, and overall outlook. This is where both the medical and the psychological often overlap, and as a gay sex therapist, I often collaborate with MDs (urologists, internists) to consult on the same patient.

“Sex Addiction” Theory and “Compulsive” Sex Theory, and Their Alternatives

I’m not a fan of the current “sex addiction” fad among certain therapists, particularly in Los Angeles (heavily influenced by the sensationalized and dumbed-down media), or in places like Salt Lake City, where the conservative sexual views of the Mormon Church find their way into therapy discussions. While extremely lucrative for therapists, “sex addiction” treatment is not an “evidence-based” treatment vetted by formal academic research on its outcomes. “Sex Addiction” (or its other name, “Hypsersexuality Disorder”) was specifically rejected by the American Psychiatric Association as a clinical diagnosis, because it doesn’t have a consistent clinical definition, and also because it is heavily influenced by varying cultural norms and religious moralism (a good article challenging this concept, by Marty Klein, Ph.D, is here, and a great book by David Ley, Ph.D., is here). Similarly, the American Psychiatric Association removed “homosexuality” from its list of diagnoses (called the Diagnostic and Statistical Manual of Mental Disorders) in 1973, because being gay is not a pathology nor a disease. “Sex Addiction” was coined by Patrick Carnes, an aggressively self-promoting addictionologist who capitalized on AIDS fear and hysteria in 1983, when, as Bette Midler once joked on a comedy album, “You gotta be careful these days. You fuck the wrong person and your arm falls off” (“Bette Midler: Mud Will Be Flung Tonight”).

“Sex Addiction” expanded on Alcoholics Anonymous (AA) and added behavior issues to chemical addiction. As an alternative, I look at this a different way: In sex therapy, I explore what my client is doing sexually as a matter of course, and how he feels about that. If the client feels he is having “too much” (or, “too little”) sex, according to him (not me!), we discuss strategies for coping with that. Often, stressors like responding to social anti-gay rhetoric, over-work, not taking care of yourself, or not coping with previous traumatic experiences (such as abuse, grief, loss, bullying, etc.) can drive “compulsive” sexual behavior. Despite its popularity (and extremely aggressive marketing; there are five full-time “sex addiction” clinics in Los Angeles alone), insurance does not reimburse for this therapy. Instead, I work with the client on their depression, anxiety, trauma, impulse control, obsessive-compulsive disorder, attention deficit disorder, or others as the underlying diagnosis, and address sexual issues and behaviors as a symptom of those things. What some therapists label “sex addiction” behaviors now would have been considered normal sexual expression for the liberated gay male of the 1970’s after the Stonewall revolution, so we have to discuss and examine sexual issues not only for the individual, but also in a historical, cultural, social, and even political context.

Working to Get Sexual Needs Met from a Primary Partner

Research shows that gay male couples tend to have less sex the longer they are together. This is a common pattern. I often work with gay male couples on discussing their options, such as having “three-ways” or opening their relationship, and how that would impact their relationship. Research also shows that relationships get much better just for having a frank discussion of the issues. Sometimes, a guy can work on getting his sexual needs and desires met from a primary partner, and sometimes other options, such as the opportunity for sex with others, can be discussed in a calm, sensitive, rational way that preserves the emotional safety of each partner. Sometimes, clients in individual therapy need a place to discuss their sex life with their partner when their partner is not present, and the therapist is an objective listener that can help the client identify, implement, and evaluate their options. Other times, clients in gay sex therapy discuss the dilemma of how to get their sexual needs met if they are not partnered, and how “single sex” can be consistently sexually satisfying, while emotional needs might be met by close friends and other “Family of Choice” people.

Quality of Sex: Lovemaking versus Sportfucking

Clients will sometimes discuss a need to differentiate between the kind of sex that involves a deep emotional bonding, versus the kind of sex that represents mostly physical gratification. These sometimes overlap, but not always. Clients in gay sex therapy might need a place to discuss “taboo” things like fetishes, kink interest, BDSM play, or even just their trepidation about trying new things, even when they want to. All of this assumes, of course, that it is sex with another consenting adult. When there are issues that involve a discussion of feelings, impulses and behaviors that are not involving consenting adults, that becomes a different kind of therapy topic. I am able to work with some “sex offenders”, but I focus my practice on gay men who are sexually active with other gay men. While sometimes this can include gay male consenting adolescents and their adolescent gay male consenting partners, this is rare.

Couples and Sex

While couples therapy is often very effective, focusing to improve concepts like Commitment, Communication, and Compromise, there are times in individual therapy when a client needs the opportunity to discuss his relationship with a third party clinician in privacy. Research has shown that gay male couples go through quite predictable stages of development over time, and each stage requires its own approach and response. Having the opportunity to have “relationship therapy with only one of the partners present” can be very beneficial for some clients.

Gay sex therapy has many advantages, but perhaps the most basic one is that it is a validating experience. Any topic is “fair game” for discussion, without moralism, judgment, stigma, or shaming. When we feel good about ourselves sexually, it has implications for other aspects of our physical health and self-care, but also for our mental health: feeling confident, satisfied, and enjoying one of the most primal pleasures that humans can experience.

With so much denigration of gay men by conservative political candidates, anti-gay religious figures, a lack of full legal civil rights in the United States and certainly abroad, and with the hard-fought battles for equality, recognition, and dignity that gay men have had to fight historically, it’s nice to know that our sexual needs and desires have validity. When we feel good about our sexual selves, we feel good about our lives. Sex therapy for gay male individuals is a part of this, and I’m proud to offer this as a specialized professional service for those in need.

I am a proud member of AASECT (American Association of Sexuality Educators, Counselors, and Therapists) and regularly attend professional continuing education with the Sexual Health Alliance, in association with noted sex therapy figures such as David Ley, Ph.D. (author of the book, The Myth of Sex Addiction), Chris Donaghue, PhD, LCSW (author of Sex Outside the Lines), and Justin Lehmiller, PhD. (author of Tell Me What You Want).

Get the help you need and deserve.

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