I’m sure you have been waiting

Make Love: Are there things which still shock or surprise you?

Tanya: Honestly, no. Probably the most shocking thing I have heard a man say during a session was: ‘I paid $11,000 for these breasts and I demand to see what goes on them’ He demanded to choose what his partner was wearing and was very aggressive and demanding. These relationship dynamics shock me more than any sexual practice that people are into.

Make Love: Are there cases where you say you can’t treat or help clients and then refer on to other doctors?

Tanya: Yes, there are some cases where you have to refer patients to colleagues. An example of this is where some women have involuntary contractions of the vaginal muscles during sex which makes it quite painful or you can’t get anything in there at all. I then work with a really good physiotherapist to try and help relax those muscle groups. I do the work on the mind and the anxiety and she does the work on the muscles and pelvis.

Then there are, of course, men with erectile dysfunction and that can be for psychological reasons as well as physical ones. If I suspect that there might be something medically wrong then I will refer the patient to a doctor colleague. It is really important to get this checked out. Studies have shown that regular erectile dysfunction in older men can be about a 3 year predictor for a heart attack which is, as ironic as it sounds, extremely useful to know. The smallest arteries are in the groin so if there is something wrong there it is good to get it checked in order to avoid the problem getting worse.

Then there are some men who have a lifelong struggle with premature ejaculation. If this is really bothering them and causing stress in their relationship then the only way you can treat it is by a type of antidepressant and then I would refer to a doctor as well.

Make Love: Is it hard not to be personally affected by what people say in the sessions or at least not to show it?

Tanya: Of course I am personally affected. It makes me happy to see people getting better and having healthier sex lives. But it also makes me very sad if relationships break and can’t be fixed. Also, if someone in the relationship is clearly overstepping the line and behaving aggressively I see no value in not mentioning this to the patient. I am usually very frank and tell them that it is not acceptable behaviour. Some of them are shocked to hear that, some of them are thankful. There are many men who get angry when they feel they don’t have enough sex. I then ask them ‘Has being angry at her or whining or crying ever got you sex? It might sound simple but many of them say ‘No’ and are surprised at that. And they need to come to realise that an angry person is not sexy. Somebody shouting at you is not sexy.

You have to bring yourself into the situation; you can’t be so remote that you’re not present. But as for the sex itself: I have no judgement, I really don’t get affected. I think you get to meet so many more interesting people if you suspend judgement and it makes you enjoy life more. There is so much shame involved in the way people think about sex which makes it really hard to enjoy it. In my view ‘any sexual act between consenting adults’ is normal. And that says it all, it’s beautiful.

Make Love: How long do you see your clients for?

Tanya: *smiles* I knew you were going to ask that! It really depends on how willing to do the work the people involved are. Sometimes people are very open and ‘ready to go’ whilst others might take a long while to drop their defence. The first thing both partners must achieve is to become what I call ‘undefended’. It is listening to the other one without immediately leaping into a defensive argument or feeling personally attacked. It is accepting the other person for who they are. Sometimes it takes one session, sometimes it takes weeks or months. And when I see couples have become undefended I am very happy and excited for them.

An interesting observation is that I have found that same sex couples work harder and get there faster, first the girls, then the guys and the slowest are the heterosexual couples, I don’t know why. I guess becoming undefended depends on how much self insight people already have, how open they are to making themselves vulnerable.

Make Love: Maybe a reason could be that homosexual couples, are part of a social minority and had to go through a process of first realising their own sexuality and then ‘coming out’ and placing themselves into society. Maybe that naturally results in more self-reflection and a commitment to fight harder for their relationships?

Tanya: Yeah, absolutely. Even though in Sydney we have a higher gay population than San Francisco, there still comes a stigmatisation with being gay . I have a lot of gay friends and clients and they all, without exception, had a journey to get to where they are now. And this journey, be it mental or physical or both, is something that straight people don’t have to embark on. They just are what they are. Does anybody ever come up to you and say ‘Are you straight?’ Enough said …

Make Love: I am interested in medication and other substances and how they have an influence on sexuality and sexual performance.

Tanya: Yes, you might have already guessed this but medication does definitely have an impact. For example 71% of women who are taking SSRI antidepressants have a reduced libido or sexual sensation which can lead to problems reaching orgasm.

Part of taking a good sexual history is asking questions about medication they are taking. The same goes for ‘street drugs’ so whether you drink a lot, smoke, cocaine etc. All these things impact sexual functioning. I often say to the guys you can’t go out and have a snout full of coke and 17 beers and then expect to satisfy your girlfriend at the end of the night, sorry but it’s just not going to happen. Even smoking, long term smoking; it will have an impact on your erectile function, so it’s a good message to give people.

Make Love: How strongly connected do you believe love and sex are?

Tanya: Very connected. Love may not always be important to have good sex. But I definitely think that the other way round is true: Sex is important for relationships. It fosters intimacy. The better your physical connection is the more elasticity you have in your emotional relationship. This connection shows in daily life. If you compare a couple who had sex the night before and one that hasn’t had sex for a couple of months. If one of them drops two litres of milk on the kitchen floor the first might say ‘Ah darling, that was a bit silly, wasn’t it?’ and the other one ‘God you idiot, why did you do that?. This may be a bit simplistic and not to be broad brushed but I do definitely observe this in my every day work. People need touch, even if it’s not always sex. And it doesn’t always have to be full on sex. A grope in the shower, a 5 minute hand job or just lying on top of each other whilst watching telly.. it all helps keep that connection.

Relationship sex is sex that weaves its way around what is happening in the relationship. Sometimes coupls can decided that one or none of them will have an orgasm, or they will just lie and stroke each other or that one will stroke the other while they masturbate. It may be confronting at first, but it is an extremely intimate thing to do without one of them having to ‘give in’.

Make Love: What role do you think sex toys can play?

Tanya: They can be great for women who have problems achieving orgasms and they can be used with a partner to discover how they like to be touched. But I try not to get them dependent on it because they need to learn how to enjoy the touch of skin, hands, fingers etc. Also, often some men feel threatened when sex toys are introduced into the bedroom in a ‘what’s wrong with my penis’ sort of way. So I try to make them appreciate those things as an add- on, not a replacement. They can definitely spice up a sexual relationship and add another dimension. Toys are also often great for women who take antidepressants or other medication that lowers their sensitivity or who have illnesses that have that effect. I had a patient who had MS which resulted in low sensitivity in her fingertips and genitals and a strong vibration was something she could enjoy. Her husband didn’t take well to that at all in the beginning but he came around to the idea after a couple of sessions and she made him understand that she really wanted to be with him and they managed to share the experience more by him driving the toy during their sex.

Make Love: And how do men take to toys for themselves?

Tanya: It depends: Some men are really very much into anal stimulation and enjoy incorporating that whereas others jump just at the thought of it and go ‘stay right away, I’m not going anywhere near that’. I think in general there is still a lot of thinking that toys are for girls and not for boys. But there are also some really nice toys for men that are not for anal stimulation such as vibrating rings. I especially like the Lelo products from Sweden; they are so beautiful, like a work of art.

Make Love: Tanya, I am aware that our time is sadly already running out but please can I ask one last thing: What would be your one and only sex tip you would give to everyone?

Tanya: Be present. Don’t think things like ‘What if this is a mess?’, ‘What are we having for dinner tonight? Keep yourself in this moment only and think thoughts like ‘It feels really good when he touches me there’ or ‘She looks really hot from that angle’. Being present is the best ingredient for good sex, concentrate on the sensations in your body, not the thoughts in your head.