At first glance, this distinction seems negligible. What difference does it make if you’re treating the sexual dysfunction or trying to promote sexual wellness? I just want to get help for the problem!
If a patient is experiencing a sexual difficulty, let’s say erectile dysfunction or vaginismus, what he or she may be focused on is how to get rid of the difficulty. Perhaps they want to know what medication to take, what behavioral strategy to use, or how to reduce stress. The general mindset is often, “If I could just get rid of my erectile dysfunction”, or, “If only intercourse wasn’t painful”, then I’d have the sex life I want. But what many find is that resolving a sexual difficulty does not translate to the fulfilling or rewarding sex life they really desire.
This relates to a common challenge many people have with their experiences of distress. In the effort to navigate the presence of this distress, it often comes down to the question, “Am I trying to move away from what is unpleasant or uncomfortable, or am I trying to move towards what is meaningful and rewarding?” This is a common phenomenon I see on a regular basis, and not just related to sex. Someone who is depressed may identify their goal for therapy as “to not feel depressed”. Someone who is experiencing conflict in their relationship may identify their goal to be a “reduction in conflict”. But these goals, as you may notice, do not speak to the vision the person has for where they’d like to see themselves, just where they don’t want to see themselves. Treating sexual dysfunction is really about moving away from a difficulty that causes distress. Promoting sexual wellness is about moving towards the sex life that is desired.
For example, successfully treating erectile dysfunction does not make sex playful, engaging, interactive, exploratory, etc. Successfully treating vaginismus does not make sex vulnerable, exciting, passionate, pleasurable, etc. What does make sex those things? Exploring how we think and communicate about sex, how we engage our values about sex, how we open ourselves up to the deeply human parts of our sexual selves, how we connect, in a mindful way, to the experiences of our bodies. You’ll notice, none of these elements here are inherently linked to a sexual function. Individuals and couples who have no specific sexual difficulty can still create more reward in their sexual experiences by engaging in this exploratory process. This is the act of moving towards the sex life you do want, not just trying to move away from the sex life you don’t want.
Many difficulties that people may experience with their sexual function cannot be fully avoided. Changes to physiology or hormonal function over the lifespan are a normal part of the developmental process. The presence of family, emotional, medical, or psychosocial stressors are an expected part of life, as undesirable as they may be. If our sole focus is the eradication or prevention of dysfunction, we may miss out on meaningful and rewarding sex when some of these normal and expected events do occur. But, if our focus is on sexual wellness, great and fulfilling sex can be a part of your experience, even when difficult of painful experiences arise, through the continued movement towards the things that are most important to you. But, this promotion of our sexual wellness is not a passive process. It is an active process of self-exploration, communication, curiosity, and connection to the journey of our sexual selves--not just the destination.
In short, we don’t just focus on treating sexual dysfunction. We focus on promoting sexual wellness.