Speaking of Sex

Let’s focus on what we can do during a period of sheltering in place. Here, a certified sex therapist talks about how she helps people improve their intimate relations.

Megan Negendank grew up in love with love, frequently taking personality quizzes about her future perfect partner and analyzing her friends’ relationships. She also found herself drawn to psychology because anxiety and depression run in her family, and the two interests married in college during a class on intimate relationships, which helped her unlock her own romantic woes. As she learned more, went to therapy herself, and finally built a healthy relationship for the first time, she felt called to help others find joy and authenticity in their relationships—and in their bedrooms. Now she’s Megan Negendank, LMFT, certified sex therapist, and founder and executive director of Love Heal Grow Counseling.

Why is this work important to you?
Sex is special and essential for couples, but it can be so sensitive and taboo and awkward for partners to discuss it with each other. I saw a lot of couples getting really stuck. I don’t know if there is anything as professionally fulfilling as sitting next to someone who is opening up about something they are embarrassed about and being able to support them to where they don’t feel ashamed anymore.

What exactly do you do for people?
If you’re familiar with therapy for anxiety, it’s just like that, except we’re talking about sex instead. At first, I spend time getting to know what the person is going through. I learn about what they’re going through sexually and what seems to be getting in the way. I get a picture of past experiences that could be impacting how they’re performing sexually or feeling sexually, and where they learned about sex. I get an idea of the problems they’re experiencing and if these problems are more physical/medical or emotional/psychological. A lot of times, it’s little pieces in all of the categories. Once I have that, I create a plan to support them, and it varies—maybe they need help communicating better with sexual partners, or getting clear on their turn-ons or turn-offs, or they need to explore themselves sexually. I provide sex education if necessary—better sex ed than we got growing up—and give them research-based exercises or activities to do at home. This should go without saying, but they never do anything sexual in the office with me.  

Through this work, what has been the biggest thing that you’ve learned?
How sensitive men are within their relationships, even if they don’t express it directly. Working with couples, I have seen really traditionally masculine men get very vulnerable with their partners about their loneliness, longing to be understood, desire for connection, and closeness from the partners they love. Men are often socialized to “suck it up” and that showing sadness or vulnerability is a weakness. Not all men are stuck in this trap, but seeing some clients break out of these gender roles has reinforced my belief that we all long for closeness, connection and empathy.

Let’s get controversial. What’s a stance you hold that not everyone agrees with?
I don’t use the terms “sex addiction” or “sex addict” in my work. We see a lot of people who think that they or their partner might have a sex addiction. There isn’t a diagnosis for sex addiction, and when we typically think of an addiction, it’s for alcohol or drugs—substances that we can, with help, ultimately stop using. Sexuality and sexual health is a huge part of the human experience: We aren’t going to be able to just stop being a sexual being. Sex therapy can help people get more in touch with what is driving their choices, explore their sexual needs, and ultimately decide if there are things they need to do differently. I frame it more as “out of control sexual behavior” instead of an addiction.  

How often are most couples having sex, and how often should they be?
There is no “should,” “shouldn’t,” “healthy,” or “unhealthy.” It’s important for me to voice that because when we have those expectations, it can really reinforce shame, embarrassment and frustration. I do want to validate that it’s normal to want to have something to compare your experience to—it’s normal to want to know what’s “normal,” but there isn’t an answer. I can say that research shows that couples who have the most relationship satisfaction average having sex one to two times per month. Research shows that relationship happiness doesn’t seem to increase if couples have more sex than that. 

What are the most common sex concerns people have?
When couples come in, it’s because sex drives don’t match. By the time they’re coming in, there’s a pretty big gap, and it’s painful for them. There are a lot of different causes of this—a common one is when a woman is postpartum, she can have a hormonal shift and issues surrounding her body image, but her partner—male or female—didn’t have the same body shift and they are looking for reassurance that they still matter in the relationship. It could also be a reflection of relationship problems, so maybe one person is carrying a lot of hurt and resentment and avoiding sex because they’re still upset about something in the past. There’s also the fact that some people are more spontaneously aroused and don’t need a lot of warmup before they’re ready to have sex, where their partners might have a different style.

When individuals come in, it’s usually related to anxiety around their performance with sex. Anxiety in life is very normal—it would be abnormal if anyone didn’t experience anxiety—and it shows up differently for all of us. When it comes to sex, it can look like erectile dysfunction, avoiding sex, having low sex drive, or pain during intercourse.  

What demographic do you see the most of in sex therapy?
There’s a really wide range. We only work with adults, but the range is from people in their 20s all the way to their 80s coming in to work on sex and intimacy. What’s really cool about being in Sacramento is how diverse it is, so we see all cultures and races, and all sexual and gender identities.

What is the most important issue or topic under the sex umbrella that isn’t getting enough attention today?
Stress, and how busy we feel like we need to be. It’s hugely negatively impacting our sex lives and sexual satisfaction.

What’s your take on porn?
I’m not anti-porn, but it does absolutely impact our expectations around sex. I’ll compare it to how romantic comedies or Disney cartoons can impact our expectations around romance. They all have in common an element of fantasy, and fantasy is a wonderful gift of being human, but we need to find pleasure and joy in real sex and real partners with real bodies. When we hold in our minds that sex is going to look like this, or that our partners should look like that or do that, we are going to be really disappointed. Real people aren’t scripted or airbrushed or planning on how to stretch their bodies in a certain way that looks good on screen. I’m sex positive, so I’m not here to tell anyone what their sex life needs to look like. What I do want people to feel like is that their sex life is balanced and fulfilling, whatever that means for them. If they use and enjoy porn, that’s fine, but is it interfering with life? Is it causing fights with their partner, are they using porn to avoid connection, or are they spending too much time or money on it?  

How common is infidelity, and can/should it be worked through?
We don’t really know how common it is. The statistic is that 20 to 30% of adults are unfaithful at some point in their lifetimes, but that’s based on self-reporting. I’m an eternal optimist with my couples, and I don’t think infidelity is a death sentence. I do think it can be worked through, and I do think that it’s hard to work through. I am also of the belief that the relationship, up to the point of the betrayal being confronted, does end. It has to be a new relationship that they are building together.  

Do you coach aging adults in new ways of being intimate as their bodies change?
The Boomer generation is in this space right now and figuring this out. A lot of Boomers have felt a lot of success in their lives—they’ve had a successful career, a comfortable home, been with partners for decades, and raised kids—so they feel empowered in a lot of areas. To have to face aging and not have control of their bodies in different ways—ED in men or vaginal dryness in women, hormone changes—there is a whole reckoning that we go through as our bodies change and as we age. One thing that comes up for older folks is helping them have a realistic expectation for their bodies. By the time people come to me, they have usually tried Viagra, but they don’t want to rely on it or it hasn’t been successful. For example, if they’ve had penis-in-vagina sex for most of their lives and they have to face that maybe sex isn’t going to look like that for them anymore, that can be a grieving process—a big loss. Part of therapy is helping people enjoy, do, and discover exploring differently and being able to enjoy being with their partners without penetration.  

What issues surrounding sex or intimacy are more prevalent in our city/region than in other areas of the state or country?
Because we are such a diverse city, we have a lot of mixed relationships, whether that’s racially or culturally or religiously mixed. In that, there are a lot of differences that couples can experience. There can also be expectations or beliefs surrounding sex that differ.  

Other than communicating more, what can someone or a couple do today to start improving their sex life?
Prioritize it. We have busy lives. Early on in relationships, it can feel that sex is spontaneous or happens more easily, and over time, it can feel that it is being forgotten or being put to the bottom of the to-do list. So make it a priority to connect and talk, or cuddle and mess around after coffee in bed. You have to protect that time. If you don’t, it’s just not going to happen.