The psychobiology of sexual behavior is an analysis of how mind and body shape your sex life. In brief, how you feel (psychology) impacts your body, and how your body works (biology) impacts your psychology. (You’ll find an in-depth discussion of this branch of science from the British Psychology Society in Psychobiology: Where Mind Meets Matter).
I consider both biology and psychology in treating my clients for many different types of sex problems. Some examples would be
— a person with a sexual dysfunction that stems from a mind/body disconnect
— a trauma victim whose brain may flash back to memories that hurt their libido.
— a fetishist or kinky person who may be genetically different from others and suffers in mind or body from shame
These and other problems typically appear in my practice. They are complex mysteries. I love untangling them.
The Mind-Body Connection
Some of us believe our ability to enjoy life is all a product of the mind. Others believe that health status is key to a happy life. Evidence shows you cannot separate them: both aspects of our existence cooperate subconsciously to make us who we are. If you’ve ever noticed that you’re in a lousy mood when you don’t feel well, that’s a simple example of the hard-wired mind-body connection. Your brain and whatever ails you are having a silent conversation that alters your mood. Similarly, when you get deeply sad about something, you are likely to feel it on a physical level, with gut problems, headaches, fatigue, and changes in blood pressure.
Sex problems are often a mirror of that invisible interplay between our bodies and our minds. To heal someone, I need to understand who the person is on the deepest possible level. Knowing your life experiences, your personal history, and the forces that shaped your psychology isn’t enough. I also want to know about any physical challenges you have faced, what kinds of medications you may be taking, and any significant changes in health status that may have impacted your sexual performance.
Working out the puzzle
Piecing together the puzzle of who you are and the truths you have lived helps me to tailor treatment to the individuals I work with. Examining your feelings and reactions to life experiences lets me know how you think and feel about yourself as a sexual being. For example, if you had a trauma in childhood, you may still be carrying the stress. If you were raised in an anti-sex environment, those early attitudes may have altered your natural state of well-being and given you fears, shame, or phobias.
By exploring your biology — what medications you take, and your health history — we can uncover productive paths to healing. Is your body giving your brain signals that disrupt your ability to be intimate? Or is it your mind that is harming your sexual health?
By looking at both mind and body, I get a better picture of how you process sexual acts. That allows me to gain insight into who you are and how to treat you as a unique individual.
How Psychology Can Impact Your Sex Life
Your inner thoughts account for about 50% or more of your sexual attitudes and performance.
How you receive and express emotions, what factors influence your self-esteem, and how you process feelings are intrinsic to your sexual health.
Case Study
“Tyler” was a very fit, athletic, and optimistic-minded man in his 40s. For years he struggled with his inability to make good choices about partners. He was constantly working on his physique. Daily visits to a local gym had helped him recreate his body. He was lean, muscled, able to run for miles. He worked so hard on his body because, unlike his mind, it felt to him like it was much easier to control work-out habits than romantic choices.
He didn’t understand how someone as health-conscious as he was would fall into crippling depression. Or why, even though he now had the body he always dreamed of having, he still ended up in abusive relationships. He had never felt stronger and more attractive on the outside.
In his mind, he still felt like a loser, an incompetent, and an idiot. He couldn’t take compliments very well but saw insults as just desserts. When people praised him, it made him happy at first. But an hour later, he felt bleak again and brushed the compliment aside as coming from someone who couldn’t see past the strong man he presented to the outside world. “If they only knew what I was really like,” he said.
When he developed Erectile Dysfunction, he was at a complete loss. He could make his muscles powerful but not his sex organs when he wanted intimacy. I asked Tyler if he could get a solid erection when he touched himself. He said yes. This told me it was a psychological problem. His ED only happened when he had a partner.
The psychology part of the psychobiology of sexual behavior
The treatment plan for him meant asking a myriad of questions about his background, his childhood, and his teen years. As he told me his story, he diminished its impact: his mother always made him feel like a loser but, he asserted that she was still a great mom to him. She did everything a mother should do — dressed him nicely, kept him well-groomed, cooked good meals. He couldn’t have asked for more, he told me.
As he spoke, it became clear to me that there were big components of mothering that he had never factored in. He couldn’t recall getting hugs as a child. Nothing he did ever seemed good enough to her. Her sharp words always made him feel like he was lesser than others, especially his older brother, who she favored. “Why can’t you be like your brother,” she’d say. “He never complains.”
Tyler forced himself to stop complaining. He became stronger by keeping his thoughts to himself. He made sure never to let down the wall of stoicism he built around his inner personality. He wanted to be, he told me, an “alpha male” who never showed weakness.
By the time he was in his 20s, he was already emotionally stressed, but he squelched his fears. He turned his life around by engaging in physical exercise. It improved his ability to cope with his demons, and he continued to suppress his true feelings. At the same time, he was beginning to feel the weight of that suppression. His blood pressure was high. He had some stress-related disorders. He developed a twitch that his doctor couldn’t resolve.
The heart of the problem
We finally got to the heart of his problem. His outer strength was a facade. Under the surface, he still felt inferior to other men, even though he could outlift many of them. He studied martial arts, so he could defend himself ably should someone try to assault him. But those inner emotions he’d been repressing poured out in therapy. He never allowed himself to be emotional with others so it caught him by surprise when he began sobbing. All his insecurities poured out. It was a breakthrough experience for him to realize the emotional weight he’d been carrying inside.
Getting him to a better place required comforting his wounded inner child. It made him accept that while his mom was dutiful, she didn’t reassure him, much less boost his self-image. His poor choices in women were not the result of him making conscious mistakes. They were the product of low self-esteem. Women whose behavior resembled his mother’s resonated with him deeply. He was drawn to them like the proverbial moth to a flame.
Overcoming the emotional obstacles that blocked him from building a realistic portrait of himself, and going after the loyal, caring partners he truly craved, was a long but ultimately successful process. He may have had a great body but defeating the psychological forces that had disabled him from performing in bed was the only path to restoring his function. He learned that it is never enough to “look good.” You have to feel good in your brain to be able to enjoy the pleasures of sex.
Despite some residual ED, when he finally met a woman who loved him as much as he loved her, the problem vanished. It was all about learning to trust and allowing himself to be vulnerable with her. The twitch vanished!
How Biology Can Impact Your Sex Life
Even when your natural biology is great, time and events take their toll on everyone. For most of us, by the time we’re in our 50s, we may be taking medications that may alter our sexual behaviors (that includes blood pressure meds, anti-depressants, blood thinners, drugs for diabetes, and an array of other medications). Or we develop other health-related issues
This is, in part, because of the gut-brain axis. Your “gut feelings” mirror your physical reaction to events. Your brain takes that information and factors it into your feelings — about yourself and your life.
Case Study
“George” was an easy-going, friendly person. He had a great relationship with his wife of 20 years, children he adored, and a solid family life. Like Tyler, though, he was struggling with ED. It struck him out of the blue. At first, he figured he needed to cut back on his alcohol intake and it would all be fine. But cutting down the alcohol didn’t change anything. He still found his wife sexy, but he felt that he could no longer please her, and worried that ED would be his life.
Delving into his youth and raising, there were no big red flags. Sure, there had been occasional disagreements with his parents, and his dad was hard to get along with. Still, he had solid nurturing from his mother and didn’t remember a time in his life when he didn’t have a lot of friends. Socially, he was successful in most situations. His personality endeared him to most people he met. So what was the problem?
The biology part of the psychobiology of sexual behavior
He came to me because he was deeply stressed over his inability to perform. He was scared and ashamed. I tried my rule of thumb for diagnosing the source of the ED. Was he able to achieve a solid erection when he touched himself? His answer was no. He inflated to more of a rubbery state and then it went away when he attempted to bring himself to orgasm.
I suggested that before we talked again, I’d like him to see a physician to check his heart and overall reproductive health. When he came back, he reported that his heart was good and his testosterone levels and prostate health were normal for his age.
Prescription medications can cause problems
Now I took a careful inventory of the medications he was taking. And there it was, bright as day! He was taking diuretics and beta-blockers for blood pressure. He was on Metformin for Type 2 Diabetes. His grief about ED led his doctor to prescribe an SSRI (anti-depressant) to level out his moods.
Any one of those and other prescriptions can cause ED, as can recreational drugs. Doctors had fixed George’s health problems but, along the way, created a sexual one.
So we had to work around the drugs that were keeping him healthy. He also had to consider that staying alive was more important than sexual function. I hate to admit it as a sex therapist, but it’s a fact I cannot deny. Life itself matters more than sexual function.
The work-around
The best treatment for him was to focus on improving his physical health while rebuilding his self-image as a manly man, even with an uncooperative penis. We spent a lot of time discussing other ways of having intimacy that did not depend on penetration. He slowly began to open the door to sexual creativity with his wife — and she was happy to take the journey with him. They shyly began to add sex toys and games to their intimacy. He read a couple of books on oral sex and followed my advice on experimenting with new ways to make her climax. Their intimacy took a new wing. I also insisted that he embark on healthier ways to live, something his wife had been begging him to do for years. He stopped bitching about eating salads and joined her on brisk morning walks.
There were no miraculous transformations. He had to work hard mentally to get on a new physical plan. The great news is that he was eventually able to quit the anti-depressants, while weight loss along with a far healthier diet, turned his diabetes around. His doctors cut back his drugs. I also suggested a few small “tricks of the sex therapy trade,” like wearing a silicone ring at the base of his penis to help trap blood in his penis and give him firmer erections.
George’s breakthrough
Two years from the day he first came to me, he called to report that he was able to make love to his wife “the normal way” (as he put it). It wasn’t a complete success but it gave him huge hope that, one day, he might get full function back. Maybe not as vibrantly as when he was in his 20s, but now that he had discovered so many different ways to please his wife in bed, he felt a hundred times better about himself.
Sexual Health is the Sum Total of Your Psychobiology
I picked two clients with the same problem to illustrate how psychobiology works. Even when you have the same problem as others on the surface, the underlying causes can radically differ. For Tyler, it was his emotionally traumatic childhood that led him to believe he would never be good enough, which made him anxious in bed. For George, it was underlying health issues that drove his dysfunction.
The double-whammy of mind/body issues that impact your sex life can ruin a sex life. Or you can repair your mind/body connection, take kinder, more affirmative care of yourself, and start leading a better life.
If you are ready to take that journey, I have two spots open right now in my practice. Get in touch and let me help you reap the rewards of an individualized treatment plan.
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