Differences in sexual desire

Quite often, there is a difference in how often each of you feels the desire to have sex. Sometimes, this difference can grow over the years, and there can be barriers for one of you to be able to enjoy sex. This can be very difficult for both of you, for the one who feels less desire and for the other one to cope with this
Then typically, the couple slips into a very negative interaction pattern with one pressurising and the other one avoiding, usually ending up in both avoiding the issue altogether, and both being unhappy.

As a sexuologist, I can help in changing this interaction pattern, in finding out what barriers may play a role in decreasing your sexual desire. Maybe there are thoughts crossing your mind that are not helpful at all. I can help you revealing what it is that is bothering you, or help you finding what aids in arousing you sexually. It is important to consider the fact that, although in the beginning when you were in love with each other there was often sexual arousal, this changes over time. That is normal. Also, sexual arousal is not something that comes instantly and automatically, usually you have to do something to make it happen. On the other hand, I can help the other partner dealing with a difference in desire, or helping eachother in finding the right way to stimulate sexual arousal. Maybe you will see that there are other things you can do or think that will help you both.

Sex addiction

Some people find themselves in the situation in which the need for sex, the desire to visit prostitutes, the need for watching porn or cybersex is an important part of their everyday life. Obviously, most marriages won't be able to deal with promiscuity of most of these types. Furthermore, sometimes also working life can suffer, you may experience that the need for sex is increasing and increasing over the years and not really satisfying.
Then there might be that you are suffering from a sex addiction, and that we need to deal with that. I treat sex addiction according to the method of van Zessen (LINK) added with either cognitive behavioral therapy or EMDR.

Pain during coitus or other sexual activities

Usually pain is a problem that mostly women encounter, but also men can have pain problems (e.g. during or after ejaculation). For women, quite often, pain (dyspareunia) is in the long run or the short run a result of coitus without enough sexual arousal. If that is the case, the focus of the treatment is on causes that prevent sexual arousal, causes of still having sexual intercourse with a partner whilst being in pain, relation therapy, exercises, cognitive therapy, often also EMDR. Dependent on the type of pain there may be co-treatment with physician-sexuologist.

Some women suffer from vaginismus. In that case, there is an anticipation of pain or disgust with coitus which automatically triggers spasm in the muscles in the pelvis. These women are not able to control this and cannot relax those muscles when they want to. Treatment involves treating the anxiety or the disgust, usually by behavior therapy and co-treatment with a physiotherapist and EMDR.

Erectile disfunction

A common problem that men may experience is that sometimes the erection disappears or is not showing at all in sexual contexts. Sometimes there may be a physical problem, or it may be a side effect of drug taking, but if there are regularly morning erections than usually the problem is merely psychological. This can be treated by finding out why the focus is fading or distracted, what the thoughts may be that causes this to happen. Cognitive therapy, sometimes EMDR, and exercises to be done at home, is the most frequently used treatment method. Communication between the partners is also an import point of discussion, to see what needs to be improved.

Premature ejaculation

Most men ejaculate between 3 – 10 minutes after penetration. However, also many men ejaculate sometimes between 1 and 3 minutes and both partners can be completely happy with that. I would hesitate by stating how long the latency time should need to be, since it is mostly a matter of what both partners like and what fits in their pattern of love making. Men can have the experience that they experience no control regarding their ejaculation. Sometimes men experience a lot of tension which disables them to focus on what they feel and then the ejaculation can be sudden and quick. Drug taking can be a cause, or other physical causes. Treatment is usually by exercises at home and finding out what factors play a role in building up the tension levels.

Orgasm problems with women

Women sometimes report that they find it difficult to reach an orgasm, either with their partner or also when that have solo-sex. First it is important to check possible physical causes, in particular drugs. Then, the cause may be that there are barriers that disable focusing and enjoying sexual intercourse. That may be all; kinds of thoughts, memories. Then, there is the matter of technique and communication. Obviously, men and women are different in their anatomy, therefore it cannot be expected that every man knows exactly which part of the female body is sensitive at which point in time and how this may change. Sometimes the partners need to learn how they can communicate in a gentle and clear way regarding likes and dislikes.

EMDR Therapy

I have copied the following text describing EMDR therapy from http://www.emdr.com/general-information/what-is-emdr.html 
I think it is described beautifully on this site. Please refer to this site for additional information.

What is EMDR?
EMDR therapy is recognized as an effective form of trauma treatment in numerous practice guidelines worldwide. In the US, this includes organizations such as the American Psychiatric Association and Department of Defense. More than twenty randomized studies support the effectiveness of the therapy in the treatment of PTSD. Further, more than twenty randomized studies have demonstrated positive effects of the eye movements.

Eye Movement Desensitization and Reprocessing (EMDR)¹ is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies².

EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.
During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.

Eight Phases of Treatment
The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures.

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1Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.
2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.