Welcome to Consult Judy

The go-to place for clinicians with questions about sexual issues.

Whether you’re new in clinical practice or a seasoned vet, sexual issues can seem mystifying and uncomfortable.  Through this consultation service, I aim to provide a helpful resource for practitioners to call upon when sexual issues arise that you’re unsure how to address.

My philosophy is that sexuality is an important part of an individual’s sense of self and well-being.  Sexual problems can diminish that sense of self, thereby decreasing satisfaction in a relationship and life, overall.  My orientation is not to focus on pathology per se but rather on the development of optimum health for the individual or couple. I look for solutions to people’s problems that will be practical and likely to be successful in their particular life situation.

As a sex therapist, I have worked with clients with all types of sexual problems including male and female dysfunction and dissatisfaction, sexual pain and trauma, lack of desire and desire discrepancy, gender identity/transgender issues, intimacy concerns for cancer survivors, and healthy aging.

Through faculty appointments at Dartmouth Medical School, Antioch University of New England, and University of New Hampshire, I have taught courses in sex therapy for psychiatry residents and psychology interns, master’s and doctoral clinical psychology students, and master’s students in marriage and family therapy.  I also present workshops to professional groups and do public speaking on sexuality topics including intimacy issues for cancer survivors.

I invite you to explore my website, sign up for a consultation or speaking engagement, or read my latest blogs.

You and your clients are not alone. Let me know how I can help.

When Your Body Is No Longer A Safe Place

Many people when diagnosed with cancer have the feeling that they are no longer safe in their bodies, that their bodies are threatening their very lives.  Where can you go when you are no longer safe in your physical home where you’ve lived all your life?  For most of us, our bodies are our sanctuaries, our safe places to which we retreat when the world outside gets too much for us.  Or sometimes it may be where we go to be calm, relaxed, or perhaps to experience private pleasure.

For young people, newly diagnosed, this feeling of threat can be especially strong.  Their expectation is that they will have years of use to come before they have to begin worrying about how their bodies are doing.  No “organ recital” for them when they great others, telling them about how various body parts are doing.  “That’s for old people,” they think, ”not me.”

Older people may also feel a new sense of threat.  They may feel their own mortality, that they are one step closer to death.

These are not comfortable feelings, and they generate many different responses.  Some people go into denial about what’s happening, some get very involved in actively seeking out the best treatment and doing all they can to help it be effective, some need to talk about what’s going on with everyone who will listen, others need to think about what this means in their lives, and some just go numb.

fh_102010_002Whatever a person’s response, I encourage everyone to ask for the help they need, to seek out what level of information they can handle, develop a plan to deal with the situation that they can manage for now, and get reassurance from others for the anxiety that the situation holds for them. Although it may sound counterintuitive, they also need to use the body perhaps in new ways to restore calm and provide a new sense of safety.  It’s like when I moved to New Zealand for a few years.  I was in earthquake country and I needed to learn a whole new understanding of “normal” when the earth could move in violent and threatening ways without any notice.  So it is with cancer and our bodies.

When anxiety and fears come up, it helps to practice breathing in deeply and slowly to calm things down again.  Meditation, mindfulness training, and prayer can all help.  Calming, restorative exercise also maintains one’s energy level and helps with sleep so that  people can cope better with their situation.  Reducing other stressors, simplifying life where they can, and focusing on the positive or “silver linings” are all ways that people get through these terrifying times.  Most of all people need to reach out and not try to go through such an experience alone.  It’s too overwhelming for most of us and it’s important to know that we’re not alone.

But I’m Not That Old!

One of the difficulties I’ve seen in cancer survivors is the developmental time warp they feel they are in once they begin to face the impact of cancer on their lives.  Oftentimes people feel as though they’ve been jumped into a different and much older developmental stage.  They may be 35 or 55 but now they’re having to deal with life and death issues they hadn’t anticipated confronting for many decades into the future.  They may also be faced with premature menopause, incontinence or erectile problems  that they think only much older people have, not people their own age.

Frequently a major challenge is having to develop a new way of being intimate with their partner.  Difficult conversations need to occur about what each person wants, what’s possible and how to get there.  How to accomplish this challenging task is some of what I talk about with cancer support groups.  These wonderful groups provide an invaluable service in a setting where newly diagnosed patients to long-term survivors can discuss their many questions and concerns and get much-needed information and support.

Orgasm is a Developmental Task

For many women having an orgasm just never happens.  One of the frames I like to use in approaching the problem of lack of orgasm is that of the developmental task.  Figuring out how their bodies work, what they need to focus on in their mind as well as their body, what is arousing, and what their best conditions for being sexual are all things that women need to learn about in order to have orgasms.

Related to this focus is a larger one of being a sexual person with her own sexual identity.  This is a bit of a challenge for many women.  Often they have little information or encouragement about becoming a sexual person.  They may have received definite negative messages about not becoming sexual.  Many begin sexual activity in response to someone else’s desire, not their own.  They become focused on pleasing others so that they will be loved, accepted, fit in.  Alcohol and drugs may also be part of the picture.  This is not a lasting foundation for an adult person in an on-going relationship that is going to include sex.

Women need their own sexual identities in order to function in these longer-term relationships and as part of their birthright as women.  They need to develop the sexual part of themselves, learn to take it seriously, and figure out their own unique way of being sexual.

What Women Should Know About Men and Sex

In my clinical work one of the “secrets” I share with women is the undisclosed meaning of sex for men.  The way many men talk about sex is a real turn-off for women.  It seems very impersonal, not specific to them, when their partners talk about the lack of sex or whether they’re going to “get any.”  This language sounds very immature, objectifying, and entitled.  Of course women are going to be turned off by this kind of talk.

This way of speaking is a manifestation of the hurt and confusion that many men feel.  They really don’t understand why someone they love and who says she loves them often doesn’t want to have sex with them.

The secret I am happy to share with many women is that sex for men is very emotional.  During lovemaking is when many men say they feel most loved, accepted, whole, vulnerable and open.  They have this idea that if a woman is having sex with them that it’s clear evidence that she likes them.  It’s tangible, real, can be felt, experienced at a physical level of knowing.