Lyndsey Fraser is a certified sex therapist and licensed marriage and family therapist with a private practice in south Minneapolis. We sat down with her to learn more about the most common issues she sees in her sex therapy practice, generational shifts in attitudes on sexuality, and how we can inject more fun, connection, and playfulness into our sex lives.
What are some of the most common issues you see in your practice?
The No. 1 thing I see is desire discrepancy, where one person has a higher desire for sex than the other, or one person’s more affected by context, so it’s harder for them to move into desire.
One of the things I often say is sex is not about sex. All these other factors come into play: How emotionally connected am I to my partner? How much stress do I have in my day-to-day life? How do I feel about my body? How do I feel about the sex that we’re having?
Some people need emotional connection before they want to have physical connection. And for another person, it might be through physical connection that they get emotional connection. So you end up with a stalemate. That’s probably the most common issue that comes into my office.
I also see a lot of women with sexual pain. In that scenario, I always make sure they’re seeing a medical professional to rule out any physical issues. But often, even if there is a physical underlying cause, it will be accompanied by psychological issues or concerns. It could also be anxiety-related, resulting from tensing up the pelvic floor. And of course there’s sexual trauma, which can get wrapped up in pain. It’s one of the harder issues that I work with.
I also see sexual compulsivity (which can encompass compulsive sexual behaviors and porn addiction), but I can only work with about one or two people at a time with that issue because it’s so complicated and emotionally draining to address. I always think of sexuality as a big onion and I have to peel back a ton of layers to actually get to the heart of what’s happening. It’s a really hard behavior to stop once you’ve activated the dopamine and oxytocin cycles around sexual activity, just like any other drug. With drugs and alcohol, people can reach a point of no use. We can’t really do that with sex, so it’s harder to extinguish the behavior.
I see a lot of people just wanting to explore their sexuality in general—wanting to understand their likes, desires, and wants so they can advocate for themselves in relationships around what they want or what they don’t want sexually. I work with clients on how to be upfront with partners about what you can give or not give.
My stance is that vanilla sex is good sex, and kinky sex is good sex. I see people on both ends have shame. Some who like vanilla sex think, “I’m boring, I’m not interesting.” And then people who are really kinky are like, “What’s wrong with me? I shouldn’t be this kinky.” I always say all sex is good sex, as long as it’s pleasurable and enjoyable for you.
What are some ways we can all add more fun, freedom, honesty, and authenticity to our sex lives?
One of the things that can happen, especially in longer term relationships, is we get stuck in routines of doing the same thing every day. So try mixing things up. One of the things that we know that works well for sexual desire is novelty, but we also know that in longer term relationships we want security and safety and comfort. These things can kind of work against each other. So go take a ballroom dancing class, go somewhere you’ve never gone before, or do an activity together that you’ve never done before.
There’s a book I frequently recommend called “A Little Bit Kinky.” It’s like a vanilla kink book. It’s got some little ideas in there. You can just pick one out and try it.
Another thing that can be really helpful is planned spontaneity—putting aside a full morning or maybe even a full day with the intention of creating romantic, connected, sensual time with your partner with the opportunity for sex to happen. Sex isn’t the goal, but the idea is we’re creating the environment that will be more conducive to sexuality without creating a lot of pressure. I call it planned spontaneity because everything else in life will take up the space and time if you let it—your children, your career, your parents, your house, your friends.
And for women who still get a period, knowing your menstrual cycle can be helpful. The follicular and ovulation phases are going to be the most conducive to your hormones pushing you to want to engage in more sexual activity. There’s a period-tracking app called Stardust that you can invite other people to. It’s not just about having babies. It can let your partner know, “OK, she’s ovulating, this is probably a better time to initiate than right before she’s supposed to get her period.”
Have you seen an increase in people coming to you for help exploring polyamory, open relationships, gender identity, or other issues that maybe weren’t so prevalent a decade ago?
I’ve worked with polyamory and open relationship dynamics since I started practicing. I have a subset of clients who come to me—they tend to be previously monogamous couples—who want to explore open relationship dynamics and polyamory. I have clients who have always been in that world as well. It can be hard for people here in Minneapolis because everybody knows everybody in the polyamory world, which can bring its own issues.
The majority of my clients right now are in their early 30s to mid-40s or 50s. But I also have clients in their 70s and people in college as well. So I see the full spectrum. There is more acceptance around open relationships, polyamory, and gender fluidity in the younger population. They have better language around who they are as far as their gender and who they want to be in relationships with. Sometimes I find, too, with younger people, they wonder if it’s still OK to want a monogamous relationship.
There are people in their 50s and 60s who want to navigate open relationships but have a tough time because it’s not as accepted in their social sphere. So they end up being more closeted around it. They’re not sharing with their family and friends, whereas people in their 20s tend to be really open about—“This is who I am.” With people in their mid-30s and older, there’s more fear about, “What will happen if I share this aspect of myself with others? Will I lose friends or community?” And they do sometimes lose their community and their friends, and they do get more judgment. People in their 20s often don’t get that judgment in the same way.
How does one decide to become a sex therapist?
When you go to graduate school to become a marriage and family therapist, you get one course on sexuality. I ended up in a practicum site at the Neighborhood Involvement Program in Minneapolis, where I was one of two marriage and family therapists. Anytime couples or families would come in, they would come to me, and of course sex comes up. And I wasn’t sure I knew exactly how to handle it, because I’d only had this one course.
I wanted to get more education and understanding around sexual issues so I could be more helpful to couples. And I started noticing that most therapists are really uncomfortable discussing sex. To me, it’s such an essential part of who we are as human beings. Whether we’re seeing individuals or couples, we should be asking clients about their sexuality and their sex lives, because clients won’t tell you unless you ask.
I decided to pursue the sex therapy certification through the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). It was another two-year process of coursework covering different aspects of sexuality, working with a mentor, and accumulating practice hours. After that I felt much more confident and comfortable in how to address sexuality issues and concerns in my practice. I’ve had my sex therapy certification for 10 years now.
What are some signs that it might be worth seeing a professional?
When you’ve gotten in a cycle where one person feels significant pressure and the other person feels significant rejection. When one person is afraid to approach their partner or initiate any type of sexual activity because they’re afraid they’ll get rejected, and the other has a physical aversion even to being touched because they receive it as pressure to have sex.
One of the things I tell people is I never want anyone having sex when they’re not into it. If your body and your mind are telling you no, then it’s a no. If you’re neutral or you’re into it, go for it. But when people have sex out of obligation, it can create a pattern of resentment and frustration and anger, and your body can sometimes physically start to respond in ways that you don’t want it to. When you start to get into that cycle, it’s important to come in to a sex therapist.
I highly recommend seeing a sex therapist who’s certified through the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Search for one in your area on their website at aasect.org/referral-directory.
This story appears in our Jan/Feb issue as part of a longer feature on sex. Find it on newsstands now.