Sex therapist Julia O’Loughlin discusses reasons, demand, and clinical approaches for sex therapy
Photo via uvic.ca.
Julia O’Loughlin is a sex therapist and UVic undergraduate alumni who started teaching in UVic’s counselling psychology unit in 2024. She completed a PhD in counseling psychology at UBC, and maintains a part-time private practice with the West Coast Centre for Sex Therapy in Vancouver. The Martlet connected with Julia over the phone to learn more about sex therapy.
This interview has been edited for clarity and concision.
Why do people come to sex therapy?
“It’s a really long list. Generally, desire-based concerns are really common, and the most common thing that brings people in is low sexual desire, or what they’re conceptualizing as low. And then there is the functional aspect [of why people come to sex therapy], such as difficulty getting an erection or struggling with ejaculatory control. Penile pain or vulvar pain is another reason — things that are making it so that sex is not enjoyable, or sex is painful.
Some clinicians also specialize in what’s called ‘out-of-control sexual behaviors.’ There’s really no science that reflects that there’s sex addiction or pornography addiction. It’s complicated though, because it’s not to say that these behaviors can’t negatively impact someone’s life — and they might look similar on the outside to an addiction, but it doesn’t map onto our scientific models of addiction. So, there is a body of work and clinical practice that addresses the types of behaviors that people feel they’re not in control of.
Non-monogamy and navigating non-monogamy is another area we’re seeing a lot more interest in. Another common issue is people who grew up in religions that had very conservative beliefs, and they’re struggling with sexual shame. We also work with people who have sexualized trauma in their history, and are struggling with their relationship with sex and want to reestablish a positive relationship with sex. But those are just a few.”
What is a ‘biopsychosocial’ approach to sex therapy?
“What it means to me is that sex is super complex. People often distill it down to hormones. And hormones do play a role, don’t get me wrong, but it’s just one role, and it’s mediated and moderated by the psychological components and social components. What we see more is this interaction with psychological variables. Common ones that might disrupt sexual functioning are things like really high stress levels, as well as depression and anxiety.
Then there’s the social piece around relationship functioning. If someone has normal levels of hormones, and is not depressed or anxious and [are] generally psychologically healthy — but they have low relationship satisfaction — that could be enough to reduce someone’s level of sexual function and sexual health. Again, it’s not one or the other; it’s this unique combination of how those three things interact together.”
Is there a significant demand for sex therapy?
“Clinicians at the team I work with are all on months-long waitlists because there’s so much demand for this service, which tells us that a lot of people struggle with their sexual health but don’t really have a place to talk about it, or to get treatment to better understand it. It’s still very much a point of shame, and something that is silenced.”
So, stigma still exists around talking about sex?
“People talk about sex when things are going well — when it’s a point of pride. But for a lot of people, it’s not. As a clinician, I say this to my clients a lot: sex is everywhere and nowhere at the same time. We’re inundated with messages about sexuality, and often, women’s sexuality is this almost paradoxical presentation that you can really never get it right. There’s a lot of confusing messages that lead people to feel that they’re not getting it right, or that everyone else has figured it out and they haven’t. It leads people to feel extremely isolated in their experience of any kind of sexual health concern, and that’s often true for any gender.”
How is Cognitive Behavioral Therapy (CBT) used in sex therapy?
“One of the ways that CBT might be applied is to understand people’s sexual beliefs. Generally, if people have really rigid beliefs around sex, that’s probably not going to lend well to their sexual health. For example, someone might believe that penis in vagina sex is the only sex that is real. Then if there’s an erectile difficulty, or vulva pain gets in the way of having pleasurable intercourse, they’re ‘doing it wrong’; they’re ‘broken.’ Or someone who believes that all sex should end in an orgasm, and if it doesn’t, it’s ‘bad sex.’ Then, they end up having this adverse, anxious anticipation of sex: that it is not going to go well, that their partner is going to be disappointed in them, or that they’re going to be disappointed. Again, that’s just one application of CBT, but it’s about getting a better understanding of how someone is thinking about themselves in relation to sex and or sex in general.”
I’ve read that mindfulness-based approaches in sex therapy are becoming more common, is that true?
“Some people would consider mindfulness research to be the most meaningful research that’s been done in the world of sexual health, as far as the psychology piece. What it points to is that we really need to be in our bodies to experience pleasure. Some people are so in their heads about their anxiety: ‘Am I doing the right thing? What does my face look like? What’s my partner looking at, are they enjoying themselves? Is this going to hurt? Am I going to maintain my erection?’
Or maybe it’s someone who’s multitasking all day long, and they start thinking, ‘I have to do the laundry, I haven’t made the kid’s lunches, I have an assignment due,’ and all of a sudden, their brain is hooked into something else — they’re out of their body. Mindfulness is really about learning to be more in your body and in that present moment of awareness, so that the sensory input can happen and elicit pleasure and arousal.
Research around mindfulness-based approaches for sex therapy is still coming out. For the most part, the research has been with female or female-identified populations, and there have been really positive findings across a large range of sexual health concerns.
But the newer area of the research is the application to sexual health issues among penis owners — taking what we found in sexual health concerns with vulva owners, and then seeing if those mindfulness-based approaches are efficacious with penis owners.”
