Tag Archive for: sexual health

sex therapy

10 Things You Should Know About Sex Therapy

People in any form of relationship structure; whether it be monogamous couples, conscious/ethical non-monogamous or any form of polyamorous relationships seek relationship therapy for whole number of reasons, and sexual issues can be one of them.

Psychosexual therapy or as it’s commonly known, ‘sex therapy’ is recommended when people are experiencing sexual difficulties that are causing distress in their relationship/s.

Some common issues that may warrant sex therapy include varying sexual desire, sexual pain, difficulties with arousal, and any relationship problems related to sex. Sex therapy can also be helpful for those who want to improve their sexual satisfaction, sexual pleasure and overall relationship and is important to seek as soon as possible, as sexual difficulties can lead to feelings of frustration, anger, and disconnection if left unresolved.

A trained sex therapist can help identify and address the underlying issues contributing to their sexual difficulties, and work with them to develop a plan for improvement.

10 things you should know about sex therapy:

  1. Sex therapy is a type of therapy that addresses sexual issues and concerns, including those in relationships.
  2. It is a collaborative process between the therapist and the client/s.
  3. Sex therapy may involve individual and/or joint sessions, as well as homework assignments.
  4. Sex therapy is based on open communication and respect for both partners.
  5. Sex therapy can help couples improve their sexual satisfaction and overall relationship.
  6. Sex therapy is not just about fixing sexual problems, but also about improving intimacy and connection.
  7. Sex therapy is confidential and private.
  8. A qualified therapist who specializes in sex therapy should be licensed and formally trained in human sexuality.
  9. Couples should feel comfortable discussing intimate topics and should be willing to actively participate in therapy.
  10. Sex therapy for couples is not a quick fix or a magic solution to all relationship issues.

In addition, it is not about placing blame or finding faults in either partner, but rather a collaborative and non-judgmental process. It is not solely focused on physical intimacy, but also addresses emotional, psychological, and relational aspects of a couple’s sexual well-being.

A word of caution:

When seeking any form of sex therapy or couples/relationship therapy, it is important to consider your personal safety. By doing your homework on your therapist and making sure they are registered with a legislative body such as the Health Professions Council of South Africa (HPCSA), SA Council for Social Service Professions (SACSSP) or any other local or international ethical and legal body, as these organisations have ethical and legal rules which therapists must abide by.

Sadly, like any profession there are people who claim to be relationship or sex therapists who are not trained or registered with a governing body causing harm to people. Because of this it is important to check that they have qualifications of a therapist and are experienced in working with relationship and sexual issues.

As sex therapy involves discussing sensitive and intimate topics consent and respect for everyone’s comfort level are essential. Please bear in mind that this form of therapy does NOT involve intimate touch, performing sexual acts in the therapist’s room or with the therapist. Sex therapy is a ‘talk-therapy’, however you may be given homework to do on your own or with your partner/s.


Stephan Laverack

Counselling Psychologist

Qualifications: BA(Hons) Psychosocial (UEL, UK), MA Couns. Psych. (Wits)

Email: stephenlavpsych@gmail.com

Website: https://www.stephenlaverack.co.za/

Kegels aren't always a good idea

Kegels: Friend Or Foe?

Kegels in layman’s language refers to the process of activating the Kegel muscles (pelvic floor muscles) to generate tension and increase strength.

What are Kegel/pelvic floor muscles?

Pelvic floor muscles are muscles that are located at the floor of the pelvis. You can think of your pelvis as a bowl and the pelvic floor muscles as a hammock from the pubic bone in the front to the tailbone at the back.

In an individual with a vagina, three holes pierce through these muscles namely, the urethra from bladder, the vagina and the anus. In an individual with a penis two holes pierce through namely, the urethra through the penis and the anus. There can also be variation in anatomy when there has been reconstructive surgery in this area.

What is the function of the pelvic floor muscles?

Control of the sphincters around the urethra and anal openings to prevent leakage of urine and bowel, as well as controlling the process of urination and passage of stool.

They have a sexual function, helping you to achieve and maintain erections and play a role in orgasm.

Support of the pelvic organs namely bladder, uterus and rectum during activities of daily living.

Provide stability to the pelvis and lower back as they are part of the ‘core’ support in this area

When are the Kegel/pelvic floor muscles your friend?

i.e. When should you consider doing Kegel exercises:

Post prostatectomy: During the procedure of removing the prostate gland, the muscles that are just below the bladder but above the prostate are removed as part of the procedure. These muscles, when intact, work automatically to maintain urinary continence. After the procedure, to maintain urinary continence, the pelvic floor muscles immediately below where the prostate gland used to be can be trained by voluntary control to generate tension in them to maintain or improve urinary continence.

During orgasm: During orgasm the pelvic floor muscles can go into explosive pleasurable contractions. When these muscles are weak the intensity of the orgasm will be reduced. Strengthening the pelvic floor muscles helps to achieve stronger orgasms.

Post partum: The pelvic floor muscles can be weakened by pregnancy itself and/or the mode of delivery (particularly vaginal delivery). Individuals can complain of struggling with bladder control, struggling to hold in gas voluntarily, feeling that the ability to ‘grip’ a penetrative object in the vagina is decreased, or a feeling that the pelvic organs are ‘sagging through the vagina’ (pelvic organ prolapse). When the pelvic floor muscles are underactive they need to be activated by generating more tension to provide better support.

When are Kegel/pelvic floor muscles your foe?

i.e. When should you consider avoiding Kegel exercises:

During sexual intimacy: one might have difficulty progressing in the sexual response cycle, for example, difficulty in getting aroused. Your pelvic floor muscles could be having excessive tension and not allow for the relaxation that encourages blood engorgement in the clitoris or penis. Here activating the Kegel muscles would lead to further frustration.

Vaginismus is a medical condition where an individual with a vagina struggles with any kind of penetration, and at worst cannot achieve penetration through at all. This can be penetration with a penis, a sex toy, a tampon, or a medical device e.g. a speculum or vaginal examination. Doing Kegels here would definitely be your foe and make things worse.

Dyspareunia refers to painful sex. Here penetration is achieved but it is painful. Your pelvic floor muscles are likely to be tight with increased tension so they need to be relaxed. Doing Kegels would only make things worse.

Tight (overactive) pelvic floor muscles during orgasm: in individuals with penises, during orgasm as the pelvic floor muscles explosively contract, it can cause an ascension of one of the testes into the pubic area resulting in excruciating pain. Kegels in this instance are not advisable.

Your pelvic floor is part of an integrated system

It should be noted that the pelvic floor is part of an integrated system. This means that dysfunction in another area of the system could be driving the perceived tightness or weakness of the pelvic floor. Working on the affected tissues in another area can have a positive resultant effect on the client’s primary complaint, for example, dyspareunia (painful sex).

It is therefore advisable to seek help from a physiotherapist who works in pelvic floor rehabilitation who will be able to do a comprehensive assessment. A pelvic floor physiotherapist will be able to teach you how to assist your pelvic floor muscles to respond appropriately by increasing or decreasing tension in addition to using other techniques.

It’s also important to note that treatment is usually multidisciplinary, involving pelvic floor physiotherapists, medical doctors, clinical psychologists, sexologists, or sex therapists depending on the individual’s condition.

In summary

It’s important to remember that doing Kegel exercises isn’t always a good idea, depending on what the problem is. If you, or someone you know, has any concerns about your pelvic floor, such incontinence or pain during sex, it’s best to first see a pelvic floor physiotherapist for a proper assessment.


Lorato T. Mosetlhi-Molelowatladi

Pelvic Floor Physiotherapist

SASHA Executive Committee & Membership Committee

Email: physiotherapytouch@gmail.com

Queering Sexual Health

Initially, when I was asked to write something about queer sexual health, I assumed it would be fairly simple. I identify as queer, I’ve used queer theory in my research, I work with sexual health, and I boldly tell people that I am especially interested in queer sexual health. Yet, weeks after the request I found myself at my desk staring at an empty word document, trying to wrestle a pen away from one of my cats. I felt at that point, despite the lack of opposable thumbs, they would be better placed to write this than me.

The main reason for this drawn-out process actually has something to do with one of things I love most about queerness – its resistance to definition. The word ‘queer’ is often used in numerous ways, with the meaning changing from context to context. Something that is both rich with possibility and potential but can also feel somewhat out of reach.

Consequently, in the spirit of queerness itself, I propose instead to engage in a reflective imagining about what queering sexual health does. As Julie Tilsen (2021, p.6) notes, using ‘queer’ as a verb is its “queerest elaboration”, and, let’s be honest, we all know that queers love to queer things. I would not be remotely surprised if we started seeing research queering toilet paper, isolation, and lockdown. That is, if they don’t already exist.

Exploring what work the word ‘queer’ is doing in sexual health

My central imagining is about exploring what the work the word ‘queer’ is doing in queer sexual health. What does queer mean is this context? And most importantly, what does it do? A simplistic way of understanding the role of the word queer could be to say that queer sexual health is about sexual health for queer people. And while that is certainly an admirable and useful goal, my feeling is that queer sexual health is less about sexual health for particular kinds of people, and more about a queer approach to sexual health.

In this sense, queering sexual health is more about what possibilities become available to you as a healthcare professional when you start to queer your understanding and practice of sexual health. As Tilsen (2021, p.6) argues, “when we queer something, we question and disrupt taken-for-granted practices and we can imagine new possibilities”.

In a sexual health context, this could mean many things, and the remainder of this post will be about articulating some of these possibilities. For instance, this could mean an insistence on the importance of pleasure. Making our work about facilitating pleasure and wellbeing. This is as opposed to a focus on dysfunction, damage or disease. In centering pleasure and wellbeing, we can begin to see sexual health framed as erotic possibility, cultivating shared kindness, openness and curiosity in ourselves and our clients.

Challenging preconceived rules and ideas

A queering is almost always about challenging preconceived rules and ideas. In sexual health, this may mean challenging our own and our clients’ assumptions about gender, sexuality, anatomy, identity, relationships, and the relationships between these. This means tossing out the rulebook that suggests particular kinds of sexual play have anything significant to say about your identities. Or that particular body parts mean anything about your gender identity.

Queering sexual health is a rejection of binaries. It’s about a resistance to simplified labels, and instead embracing the beautiful messy complex reality of people’s experiences. What is allowed to emerge in sexual health practice when we take seriously that experiences cannot be reduced to boxes? And when we give our clients permission to exist and explore outside of them?

This therefore means embracing uncertainty and exploration. It’s a rejection of the idea that the simplest answer is often the right one, or the idea that there is a right answer in the first place. In much the same way as pleasurable sex embraces the journey and the process rather than a particular outcome; queer sexual health is about fluidity and a commitment to remaining open to new possibilities and realities.

As Tilsen (2021, p.6) argues “Queering is an ever-emergent process of becoming, one that is flexible and fluid in response to context, and in resistance to norms.” What happens when we center becoming instead of being, what do we remain open to and curious about in our own and clients’ lives?

Prioritising the client’s knowledge and experiences

Queering sexual health is also about starting from where your client is at and prioritising their knowledge and experiences. From this viewpoint, consultations can be viewed as the meeting of two (or more) minds. Each mind with their own perspectives and expertise.

Consequently, we can resist conventional notions of medicalised professionalism by being able to identify and disrupt the power dynamics which are so present in healthcare settings today. This is about rethinking informed consent as an ongoing process, always giving your clients all the of the options available and letting them make the decisions that are best for them, perhaps guided by, but not determined by our own ideas and beliefs.

In order to facilitate this kind of reflective process, healthcare workers need to be mindful of our own beliefs, values and assumptions, and the ways in which these may create blind spots and/or undermine our clients’ agency. Being aware of the complexity of our clients’ identities and experiences is also about a commitment to intersectional practice.

Intersectionality and diversity

Intersectionality has recently become something of a buzzword which treats inclusivity and diversity as little more than a box-ticking exercise. Queering sexual health is about remaining aware of all our own intersecting identities, experiences and social realities, and the recognition that each client comes with their own. Some of these identities and experiences are less visible than others. We need to ensure we are able to listen out for these as and when they are articulated (or not), and the ways in which they may enter the consultation room and our lives. This requires an ongoing commitment to authenticity which can hopefully facilitate the same for our clients.

Tilsen (2021, p.6) says that a queering is about breaking rules “in order to liberate people who have been held hostage by what the rules require or prevent”. Sexual health tends to operate from the viewpoint of cisgender, heterosexual, vanilla, monogamous, able-bodied white humans, and their relationships. Rules about what kinds of sex and relationships are legitimate and normative are widespread, whether they are explicitly stated or not. As a result, breaking the rules is about identifying and labelling the discrimination and marginalisation experienced by those outside of Rubin’s (2011) Charmed Circle, and instead turning the circle inside out.

In healthcare settings like South Africa where white, middle class, able-bodied, cisgender men continue to be a large focus of research and intervention, we can queer our sexual health practice by centering the experiences of those who are currently on the margins.

What does sexual health look like when we start with the experiences of sex workers? Ace, intersex, trans and gender fluid humans? Non-monogamies and kinksters? What erotic possibilities are opened up by moving away from heteronormativity and monogamism?

Expanding our toolbox

Queering sexual health is about recognising that the toolbox we’ve been given is limited, comes with sets of rules and expectations and frames client experiences in ways that can have negative consequences for their emotional and sexual wellbeing. For instance, defining sex as a penetrative act that involves only a penis and a vagina has consequences for the ways in which we are able to engage with clients around their sexuality. It creates a hierarchy around what kinds of sexual practices are considered legitimate and normalised, makes assumptions about body parts and pleasure, and limits the ways in which we can talk about consent, play and safety.

A queering of sexual health is about offering new and alternative frameworks that challenge essentialism, reject binaries and facilitate fluidity. Let’s begin from the perspective of those on the margins, make a commitment to inclusivity and authenticity and dismantle power dynamics. Let’s center pleasure and wellbeing and suspend our assumptions and judgements long enough to work collaboratively towards facilitating sexual health, whatever that looks like from person to person.

In line with my feeling about the importance of locating yourself socially and being authentic, it would be remiss of me not to own that this is a vision of what queering sexual health could/does look like from my perspective: a queer, white, middle class, mental health professional in South Africa. I can also acknowledge from personal experience that it may feel anxiety-provoking and difficult to toss the rulebook out the window (although not your ethics please). It can leave you feeling stuck or wondering “Well, where do we go from here?” While that uncertainty isn’t always easy, it is also rife with potential.

Where do we go from here? Where can we go now that we could not previously? I invite you to dive headfirst into this beautiful complexity with your clients – who knows where the adventure will take you.


  • Rubin, G. S. (2011). Deviations: A Gayle Rubin Reader. Duke University Press: Durham & London.
  • Tilsen, J. (2021). Queering Your Therapy Practice: Queer Theory, Narrative Therapy, and Imagining New Identities. Routledge: London & New York.


Chant Malan
Counselling Psychologist
SASHA Executive Committee & Media Committee
Email: malan.chantelle@gmail.com

Tag Archive for: sexual health

Sexual Health in the Public System

Sexual Health in the Public System: Navigating Help and Hindrance

About The Event

Considering that most patients access sexual health services through the public health sector, it is vitally important to explore how the clinical diagnosis and treatment of sexual health problems are impacted by the setting in which the clinical services are provided.

This event looks at the ways in which sexual health services are enabled or disabled by issues of access and affordability