Just to be clear: No sex occurs in a sex-therapy session. “I had one guy who asked, ‘So what do you do, exactly? Do you stand there with a clipboard and a stopwatch and watch us have sex?’ No! I do not want to watch you have sex!” Buehler says with a laugh. “That is definitely not part of my job. There’s absolutely no touching or disrobing in my office.”
While actual sex isn’t part of her job description, Buehler’s extensive knowledge on the subject has manifested in a successful career.
In her 20th year of practice as a psychologist and certified sex therapist at the Hoag Pelvic Health Program, Buehler regularly sees clients, speaks at national and international conferences, has written four books, and operates The Buehler Institute—a continuing education program on sex therapy. We talked with Buehler about her experience as a professional “sexpert.”
You previously worked as an elementary school teacher in downtown L.A. before becoming a psychologist. That’s quite a career change! What made you pursue sex therapy?
I decided I wanted to be a psychologist, and when I was earning my doctorate, I started to work with an endocrinologist. And the endocrinologist said, “You know, people come in all the time to get their hormones tested to try and figure out why they don’t have any sexual desire. And if you learn sex therapy, I can send them to you, because most don’t have any problems with their hormones.” I thought, “Well, that sounds interesting.” I’ve been doing (sex therapy) ever since.
What is the path to becoming a sex therapist?
There’s no degree yet for sex therapy, and no license for it. You have to have at least a master’s degree or doctorate and be licensed as a psychotherapist, and then you get additional training on your own. I’m certified with the American Association of Sexuality Educators, Counselors, and Therapists. It requires 150 hours of education, 50 hours of supervision, 300 clinical hours, and a few other requirements to get that certification.
What does occur in a typical sex therapy session?
Most people don’t know how to have a sit-down at the kitchen table, using adult language, about what they need sexually. I create a space that’s safe, where people don’t feel judged, and where they can open up and learn how to have productive conversations about sex.
You treat a wide range of sexual problems. Is there an issue you see often?
I would say the most common issue is mismatched sexual desire. And that happens a lot: One person has higher desire than the other, and people sometimes treat it as a disaster. But it isn’t. It’s a very common issue.
How much can an unhappy sex life affect a person?
It’s huge! This quote sums it up well: When a couple’s sex life works, it accounts for 15 percent to 20 percent of their relationship satisfaction, but when it doesn’t work, it accounts for 50 percent to 70 percent of their dissatisfaction (from “Rekindling Desire” by Barry and Emily McCarthy). Sexual dissatisfaction is cited as one of the top reasons couples divorce.
Other than unsatisfying sex lives, what sexual problems in our society concern you most today?
More recently, the orgasm gap between men and women. About 75 percent of women do not have an orgasm with intercourse, and yet we act as if it’s the norm to have (one). We have all of these role models—whether it’s in film or “Game of Thrones” or something—where with traditional intercourse, the woman is having an orgasm, and that’s just not true. I think a lot of couples and women are puzzled by this and sometimes feel inadequate. It’s OK for women to figure out how they can have pleasure. There’s not just one way, and there’s nothing wrong with that.
What situations have most surprised you in your 20 years of practice?
I think what surprises me is how many people today are wanting to explore open relationships and open marriages. There have been various social experiments in the U.S. with open marriage, and if it works, that’s great. But the thing that saddens and surprises me is how many people think that’s going to be a solution to an already rickety relationship.
What does your husband think about your work?
He thinks it’s great! He gets bragging rights with his friends—“I’m married to a sex therapist.” He’s a very humorous person, so I can’t even imagine the kinds of jokes that he thinks up when I’m not around. I probably don’t want to know!
What do you think is Orange County’s biggest problem with sex?
I would say it’s chasing after the Orange County dream and having a hard time balancing that with having a healthy sex life. So many couples come in and say, “We don’t have time for sex.” If you’re working 50 or 60 hours per week and are a helicopter parent on top of that, you’re not going to have any time left for sex. Sometimes, it really is getting people to look at their lives and reset their priorities.
Can you give advice to readers about when to consider seeing a sex therapist?
I think the big one is if a couple is fighting about their sex life and they seem to fight about it a lot; stop fighting and call somebody and get some help, because it’s here and it’s available. Another would be if one of you is dissatisfied with your sex life. That’s serious! Sex is not a trivial thing, and it shouldn’t be marginalized. Don’t be embarrassed if it’s something you want to address in your life. It’s an important part of your life. If you had migraine headaches, you would not hesitate to find a doctor and get treatment. But for some reason, if you have issues with mental health or your sex life, there’s sometimes a stigma or not wanting to spend the money on therapy.