I'm the only clinical sexologist in the state of Montana, and if you look at other places, the numbers aren't much higher. So knowing that many of you have sexual challenges and limited resources, I'm going to give you a helpful tool to problem-solve your sexual issues: the Three-Dimensional Model.

The three dimensions are Duration, Context, and Frequency. Let's take the example of low or no sexual desire, which is one of the most common issues my clients bring to the table. Not asexuality - that's an orientation, not a problem. I'm talking about people who are frustrated by and negatively affected by the lack of sexual drive and desire.

So under Duration, you'll want to determine if it's a) primary or b) secondary. Primary means that it's always been a part of your sexual experiences. In the case of low sex drive, as far back as you can remember, you've had a lower sex drive than your peers. Secondary duration means the problem is around now but hasn't been present at some point in the past. Maybe you've had a low sex drive for the past year, but before that it was much higher. That's Duration.

The next dimension is Context. Is the problem global, occurring in all settings (with a partner, with another partner, alone masturbating, watching porn, etc.), or is it situational, meaning that it only occurs under some circumstances and not others. Like your sex drive being low in committed relationships, but not in casual ones, or low with men, not with women, low without protection, but not when there are boxes of condoms, gloves, and dams to use.

I bet you can already tell how valuable understanding the context and duration of a problem can be.

Now let's break down the third dimension: Frequency. Frequency also has two categories: total (every time in a given setting), like, let's say, every time you're trying to be intimate with a partner, which is in comparison to partial frequency, where the problem shows up sporadically, not every time you go to get it on, but enough that you're annoyed by it.

If you've done the math, you know there are all these ways to classify a sexual problem with this method. Where you put the checkmarks determines how to solve the problem. 

If it's something that's been around as long as you can remember, happens in all situations and every single time, then the cause is probably biological and you want to seek the care of a medical provider.

Whereas if your responses were opposite (secondary, situational, partial), like let's say you were horny until you moved to college, or you're far less turned on when drunk people are hitting on you, and it's intermittent, this would fall under psychological, relational, or cultural causes. 

Psychological causes are things like the stress that someone will walk in, the fear of getting an STI, and even concerns that aren't directly sexual like self-esteem and body image. Somatization is actually a term for how the mind copes by altering the physical body. A classic version of this is when a person has stage fright, a psychological anxiety about being in front of an audience, and they feel physically nauseous. When this happens sexually, like the vagina clamping closed or the penis losing an erection, you might hear another term: body armoring, or in this case, genital armoring. Of course this is psychological, but when it relates to partnerships, poor communication, loss of trust and love, the causes are relational, the most common.

We're talking about loss of sexual desire because you don't find your partner attractive anymore or you feel pressured, unloved, or unloving, that there are unresolved conflicts or unmet expectations, grudges, scorekeeping, abuse. So often the people I work with think that they can separate relationship "ick" from sex and they wonder why they don't want intimacy anymore or why it feels like a chore. Sure, you may be able to have sex without emotional stability, but your mind and your groin may also shut that down.

The fourth source of sexual problems is cultural. You and your culture at odds, or your culture and your sexual partners (buzzer sound). Family values, social attitudes, political beliefs, religious upbringing, traditions, customs, laws... can you imagine someone from Mangaia, the most sexual culture in the world trying to have awesome sex with someone from Inish Beg, the least sexual? There are going to be problems.

Let's go back to the Three-Dimensional Model with the example of low sex drive. Culture could be primary or secondary, depending on when you received the messages about sex. Was it after you'd been masturbating that someone shamed the sex drive right out of you, or were you scolded from birth for anything remotely pleasurable? 

Context: culture has subsets. Family, school, work, YouTube. Maybe school has instilled a sex-negative culture like "You're a cake, no one wants a cake that someone has taken a bite of!", but elsewhere, like Sexplanations, you're supported sexually. If the sex problem is cultural, situations that remind you of the school mindset can inhibit your sex drive, whereas situations like marathoning our videos can get you excited to be sexual.

Frequency: if there's a mixed bag of messages, then it would make sense that the problem would be infrequent. Depends on what's on your mind in the moment. Unfortunately, if the "sex is bad" cultural ideas are really embedded, then the problem is likely to be a total frequency experience.

Evaluate the duration, context, and frequency, sort through the source or sources (biological, psychological, relational or cultural), and stay curious! 

I've put some example sex problems in the comments for you to test your understanding of the Three-Dimensional Model. Feel free to also share your own challenges and we'll group think some solutions for you. Once you know more about your own circumstances, use this playlist of my favorite resources and sexology services to get you the help you deserve.

(Blooper Reel)

What!?

Be-boo-boo-boo.

Yes, yes, yes.

Bluh-luh-luh-luh-luh-luh-luh.

(Fart noise)

(Laughs)