Many people find sex tricky to talk about, which can mean feeling alone when there are problems.
But peek behind the curtain of sex therapy and you may realise your concerns are not unique.
"The number of Australians who will struggle with sexual problems at some point in their lives is really high," says Isiah McKimmie, a couples therapist and sexologist based in Brisbane/Meanjin.
For example, almost half of men will experience erectile dysfunction, and half of women will experience sexual issues related to arousal, desire or orgasm.
We spoke to Ms McKimmie and Tanya Koens, a sexologist and relationship counsellor based in the NSW Northern Rivers/Bundjalung Nation, about the most common struggles they see in sex therapy.
What is sex therapy exactly?
If you've never been to sex therapy, you might be curious about what goes on.
Ms McKimmie says sex therapy helps people have more satisfying intimacy and pleasure during sex and has "really high success rates".
"We don't watch patients having sex," she says, referring to some of the misconceptions people hold.
"It's a really professional relationship."
Clients may want help with relationship issues or sexual dysfunction, explains Ms Koens, or to learn about themselves regarding gender, sexual orientation, or specific sexual practices.
"We're only as good as the sex education we've had," she says.
"We need to learn how to communicate well and learn how our bodies work to understand how to get pleasure."
Because sex therapy is a self-regulated industry (meaning untrained and inexperienced people can call themselves sex therapists), be selective about who you engage.
"Look at a practitioner's qualifications," says Ms Koens. "Look at the length and duration of the courses [they have done] … and look at if they're a member of any industry bodies, like the Society of Australian Sexologists."
Common issues raised in sex therapy
Mismatched desire is the most frequent issue our sex therapists see when working with couples.
"There is generally one person wanting more sex or different sex than the other person," Ms Koens says.
And it's "very rarely" about that person's individual sex drive, she says.
"More often it comes down to difficulties in communication, difficulties in understanding what the other person likes.
"It can include cultural shame and anatomical ignorance — all of which are prevalent."
Ms McKimmie says at the beginning of a relationship, many couples want the same amount of sex, but over time it changes for one person.
"Sometimes they were never fully matched, and the frustration and hurt around it has built up over time."
There are many reasons someone may have reduced interest in sex, she says, including life transitions such as job stress and having children, and hormonal changes such as menopause.
Tension in the relationship, an unequal mental load, and not enjoying the sex on offer are also common.
Our sex therapists frequently see women experiencing sexual pain.
"Sometimes it's people who've never actually been able to have sex because they have a lot of anxiety around sex or negative sexual beliefs, and a really tight pelvic floor," Ms McKimmie says.
"We might also see changes later in life, such as hormonal changes in post-partum, or due to illness … that can lead to increasing pain and discomfort."
Ms Koens says it can often take someone a long time to get support for sexual pain.
"Some sexual pain issues are really common and can be addressed — like vaginismus and things like stinging pain from not having enough arousal and attempting penetration too soon."
While seeing a team of health professionals including a pelvic floor physio can help with treating pain during sex, Ms Koens says a good sex therapist will support people to navigate it with their sexual partner/s and work on intimacy and connection while "working on a very stressful other thing".
Ms McKimmie says she is seeing an increase in both men and women having difficulty in reaching orgasm, known as anorgasmia.
"For a lot of women this is like — very often they don't know what they like, don't know how to ask for it, and don't necessarily have realistic expectations of how their body should reach orgasm."
She says men experiencing delayed ejaculation or losing an erection will often assume they have erectile dysfunction, but it's not always the case.
"Because of the unrealistic expectations of porn, they are expecting to hold an erection for up to an hour, but it would be normal to lose erection if you are spending that long having sex."
Ms Koens also says anorgasmia is regularly raised in her practice.
"A lot of it is education about the body, how things work, and teaching people how to relax and seek pleasure, rather than technique."
Ms Koens says it's common for men to experience erectile dysfunction at some point, and it can lead to performance anxiety.
"There are really simple ways people can deal with the anxiety around sexual functioning, and men are often grateful when they seek help."
Matt Tilley, a clinical psychologist and lecturer in sexology at Curtin University, has previously told the ABC sometimes the person can become fixated on the loss of erection further preventing them regaining their erection.
"They can still experience high levels of stimulation and pleasure without an erection."
A safe space
Sex therapists create a safe space for people to talk about their sexual desires and fears, and "get to the bottom" of whatever the concern is, says Ms Koens.
"Our job is to be very curious, not to tell people what to do.
"It quite often comes down to a lack of sex education and understanding … religious values, problems in the relationship, communication and sexual dysfunction."
Ms McKimmie says for many people, seeing a qualified therapist can make an "enormous difference".
"A lot of people think that sex is natural, and we should just be able to do it.
"But it's a skill we need to learn."
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