Couples or individuals come into sex therapy for a diverse array of sexual complaints, says Dr., including erection problems (probably the most common problem), lack of orgasm, lack of desire, premature ejaculation, perfor¬mance anxiety and marital conflict. But generally, she says, all sexual dysfunctions are thought to be caused by two general sorts of trouble: either immediate, short-term problems or more deep-seated, more intractable psychological difficulties. It's the shallower, more immediate problems that sex therapy is especially good at treating.

"In these cases, the therapist's job is to remove the inhibitions that are close to the surface and in the way, so the person's underlying sexual functioning can come through," says Dr. For instance, it's not uncommon to uncover a good deal of repressed rage in couples who are having trouble sexually. "When it's the man who's angry, his penis becomes an instrument of rage toward his partner, although he may be quite unaware of this," Dr. explains. In order for him to begin functioning sexually, the anger needs to be acknowledged and dealt with - and that's the role of sex therapy.

Sometimes, though, the trouble turns out to have a more deeply buried soure, and these problems are more difficult to treat. The therapist may uncover a great fear of intimacy, for instance, or terrible guilt about sex, a strong inhibition against any kind of pleasure at all or a fear of abandonment. In some cases like this, she says, patients will be referred to another therapist for longer-term psychoanalysis. A man may have little interest in sex because he's deeply depressed, for instance, so he'll be treated for the underlying depressionjirst, then come back for sex therapy focused on his erection problems.