ptimal sexual health is more than mere physiological functioning. It includes a positive view of one's sexual history, one's desires and behaviour as well as confidence in one's ability to derive adequate and appropriate pleasure from sex. Although sexuality is basic to every human being, not everyone experiences maximum sexual well-being.
The therapeutic goals of people working on sexual issues vary widely. Some may wish to come to terms with their sexual past, resolving the trauma of childhood abuse or forced sex as an adult. Others may be burdened by guilt over having committed sexual acts which had negative consequences for themselves or others. For some people, the thought of engaging in sex brings up feelings of anxiety which make it difficult to enjoy themselves and be intimate with partners.
Others may be uncertain of their sexual orientation or experiencing conflict about what they know are their true desires. ‘Coming-out' issues may lead people to question long-held assumptions about themselves and how they live.
As our society becomes more and more sexualised, sex is continuously available in one form or another. This creates difficulties for an increasing number of people who find themselves engaging in sex compulsively, either with paid companions, strangers, themselves or via on-line pornography and webcams. The term ‘sexual compulsivity' is applied when one is sexual more often than one would like to be, or engages in kinds of sexual behaviour one would rather not, or whenever there is lack of congruence between one's sexual life and one's self-image or principles.
It can be confusing to choose amongst all the options available for contemporary sexual self-expression. Is one drawn to bondage and discipline, to sado-masochistic activity, to polyamory, to swinging, to fetishes of various kinds? How does one make decisions balancing sexual freedom with self-care in non-traditional behaviours?
Since 1985, I have met with individuals working on some aspect of their sexuality with the result of increased comfort and a greater sense of self-mastery and satisfaction in their sexual lives.