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A recent article in The New York Times by Alix Strauss titled “Setting Couples on the Path to a Richer Sex Life” in which she interviewed Cyndi Darnell, a Manhattan clinical sexologist, sex therapist and relationship coach, piqued my interest.

Ms. Darnell states that “when it comes to sex, everyone seems to struggle. I teach people how their bodies work from a pleasure perspective and how to identify what makes sex meaningful for them and give them the skills they need to navigate the difficulties they face while creating a richer sex life.”

On the surface, Darnell’s therapeutic goal for dealing with sexual issues is laudable. However, in my experience in treating thousands of men and women for over 35 years, I have found that not everyone struggles. More importantly, Darnell fails to include many other crucial factors that need to be acknowledged, addressed and resolved before people will be able to have satisfying sex lives. Among them are an understanding that:

1. Each person needs to be in a reasonably healthy emotional, psychological and psychiatric state. Issues including clinical depression, anxiety and other psychiatric problems, low self-esteem, eating disorders, body dysmorphic disorder, early child sexual abuse, sexual assault, post traumatic stress disorder, domestic violence, divorce, the discovery that one’s spouse is having an extramarital affair, sudden layoffs and unemployment all affect our sexual desire in one way or another. All of these issues need to be dealt with, since they will invariably interfere with our being able to live our life to the fullest both in and out of the bedroom.

2. Our relationships need to be healthy and satisfying if we are to enjoy a satisfying sexual relationship. This is particularly true for the majority of women.

3. Sexual side effects from a multitude of prescription and over the counter medications, including SSRIs, high blood pressure medication, alcohol and pot can and do interfere with people’s sex lives. This is precisely why doctors and patients need to talk about sex and the medications that can have an adverse effect on sexual desire, arousal and orgasm.

4. Issues including pain with intercourse and other physical problems affect sexual desire. These problems, worries and concerns need to be discussed with your doctor. And if your doctor does not bring up the subject of sex, patients need to be proactive and be willing to take the initiative and ask the tough and perhaps embarrassing questions. We do not need to navigate this frightening and confusing journey on our own. Remember that even though you may have zero desire for sex, non-sexual touch can feel wonderful and can also help couples feel connected.

5. Our hormone levels including testosterone for men and estrogen for women also affect our sex drive. It’s yet another issue that needs a doctor/patient discussion(s). Erectile dysfunction and premature ejaculation are common problems with a variety of evidence based treatment options.

Communication and sensate focus exercises are very helpful for all couples, whether they are experiencing sexual difficulties or not. However, ignoring the other factors that I’ve described gives an incomplete picture of the complexity of human sexual functioning.

Case Study:  Beatty Cohan

Last summer I awoke one morning and immediately felt the twinges, discomfort and pain associated with a Urinary Tract Infection (UTI). I tried the usual remedies of cranberry extract, D-mannose, AZO, an over the counter remedy and drank, which seemed to me to be gallons of water. Nothing was working. It was time to go to an Urgent Care Center, since my gynecologist, Dr. Judith Schwartz was out of town.

Big mistake! I was examined by two different male doctors at two different Urgent Care Centers on the Upper West Side. Both prescribed antibiotics.  Unfortunately, my symptoms persisted. When I returned to my original Urgent Care physician he recommended a variety of tests including an ultrasound and an x-ray. Neither test explained my symptoms. We then discussed the possibility of exploratory surgery. I began to panic. Was there something really wrong with me?

By this time, Dr. Schwartz had returned to New York. I made an appointment to see her, describing the various tests and remedies that I had tried. She looked at me and smiled. Beatty, she said, your estrogen levels are low. She prescribed estrogen pellets, which I insert twice a week. Within a few days I was symptom free. Had I not been fortunate to see Dr. Schwartz and receive an accurate diagnosis and treatment, it’s hard to know what crazy and medically harmful journey I might have found myself on.

I am not diagnosing, prescribing or recommending any treatment for UTIs.  Nor am I suggesting that all male doctors would have missed, which turned out to be a fairly obvious problem. But how careful we all must be who we let into our lives both personally and professionally.

Beatty Cohan, MSW, LCSW, AASECT is a nationally recognized psychotherapist, sex therapist, author for Better for Worse Forever: Discover the Path to Lasting Love, columnist, national speaker, national radio and television expert guest, consultant to Organa, an Israeli Sexual Wellness company and host of the weekly ASK BEATTY SHOW on the Progressive Radio Network. She has a private practice in New York City and East Hampton.

Beatty would love to hear from you. You can send her your questions and comments to BeattyCohan.msw@gmail.com. For more information go to BeattyCohan.com