Ask Dr. Ruth: When Should I See a Sex Therapist?

After 30 years of working as a sex therapist, the legendary Dr. Ruth isn’t done sharing her wisdom. Here, she answers your most pressing questions on sex, relationships and life. Email your own queries to drruth@time.com, or catch up on previous installments of the Ask Dr. Ruth series.

Q: Why should I take sex advice from someone in her 80s?

A: If you asked me to give you advice on computers, perhaps my age would be an issue, but for the most part sex hasn’t changed much since the days when men and women lived in caves. What has changed a great deal is our knowledge of sexual functioning, and in that realm I’ve always made sure to keep up.

For starters, I’m a well-trained sex therapist. I studied at Cornell under the renowned Dr. Helen Singer Kaplan. But more important than my training is the experience I’ve accumulated over the years. No, I’m not talking about my personal experience with sex, but rather what I learned in my 30-plus years of practice as a therapist.

When I gave advice to my clients, I got something back that was invaluable — feedback. This allowed me to discover in subsequent sessions with these patients what advice worked and what advice didn’t work.

It’s that knowledge that gives me the confidence to still give advice today. I’m not shooting from the hip, but offering up techniques that I’ve honed with many, many individuals and couples. Now I can’t exactly do therapy in this format. There has to be a give and take in real therapy, and here I’m only getting a brief question to base my response on. But to the extent that I can offer advice that I believe will be helpful, that’s what I’ll do.

If I feel as if nothing I’ll say will be helpful or that the situation is too complicated for me to even attempt to guess what is really going on, then the advice I’ll give to that person is to go see a therapist — sorry, I’m no longer taking new patients!

Q: When should I seek help from a sex therapist?

A: When you recognize a problem in your sex life that you can’t alleviate on your own, you should seek help from a professional sex therapist. Basically, if your problem is not caused by medical reasons, then a sex therapist is your best bet to fix your sexual dysfunction.

Relationship issues are the most common type of of hurdle that impacts a person’s sex life. If two people aren’t getting along, then there’s a good chance that they aren’t going to be engaging in sex, at least not as often or joyously as they once did. So a drastic drop in the frequency of sex that a couple has may appear to be purely related to their sex life, but the actual culprit is an underlying relationship issue. Many sex therapists also counsel couples with marital problems. If a sex therapist thought the problem was beyond his or her abilities to handle, then you’d be recommended to see another type of therapist — or perhaps a divorce attorney.

There are also many medical issues that inhibit sexual functioning. When a client came to me with a problem that I knew might have a medical cause, the first thing I would do is to send him or her for a check-up. For example, impotence could be a psychological issue, and therefore treatable by a sex therapist, or it could be caused by a disease like diabetes, which is beyond the scope of a sex therapist.

Many of the problems stemming from psychological issues can be repaired without the services of a sex therapist. For example, premature ejaculation is rarely a physical condition, but rather a psychological one. A man, especially one with a cooperative partner, can learn how to gain the control he desires. But often men who try, even those who read all about it and follow the proper procedures to the letter, end up failing. What they need is some coaching, someone like me to report back to and give them the confidence that they’re on the right track.

And then many women don’t know that a key to reaching sexual satisfaction is to continue stimulation even through a lull in the action, so to speak. A sex therapist can help convince a woman not to give up.

So if anyone has a problem with their sex life, there’s no harm in trying to find the solution on their own if success can be achieved in a relatively short period of time. But if frustration starts to become part of the problem, then I’d recommend that a consultation with a sex therapist be scheduled as soon as possible.

Email questions to drruth@time.com.