Sexual difficulties are common and rarely talked about. Many have a physical cause. Many others are driven, or made worse, by anxiety: worry about performance, fear of pain, or tension that the body cannot override by willpower.
That second group is where hypnosis has been tested, in a small number of trials.
See a doctor first
Sexual problems can be the first sign of something physical.
- Erectile problems can signal heart disease, diabetes, hormone problems or medication side effects. They deserve a medical check, particularly in men over 40.
- Pain during sex can be caused by infection, skin conditions, endometriosis, menopause-related changes and more.
- Loss of desire can follow from depression, hormones, medication or relationship difficulties.
Hypnosis is only appropriate once physical causes have been looked for.
Why anxiety matters so much
Sexual response depends on the relaxed, “rest and digest” side of the nervous system. Anxiety activates the opposite side. The result is a loop:
- Something goes wrong once.
- Next time, you watch yourself anxiously.
- Anxiety interferes with arousal.
- It goes wrong again, confirming the fear.
This is sometimes called spectatoring: observing yourself instead of being in the experience. Trying harder makes it worse, which is the pattern Émile Coué called reversed effort.
Erectile difficulties without a physical cause
A Turkish research group ran two trials in the 1990s on men whose erectile problems had no detectable organic cause.
First trial. Seventy-nine men received testosterone, the drug trazodone, hypnosis, or a placebo. Improvement was reported by 39 per cent on placebo, 60 per cent on testosterone, 67 per cent on trazodone and 80 per cent with hypnosis. The authors concluded that the only treatment superior to placebo appeared to be hypnosis.
Second trial. Comparing hypnotic suggestion and acupuncture with placebo, about 75 per cent improved with hypnosis against 43 to 47 per cent on placebo.
These are old, small studies from before modern erectile medication, and the high placebo response shows how strongly expectation affects this problem. They suggest that when anxiety is the cause, a psychological approach can work well.
Vaginismus
Vaginismus is an involuntary tightening of the muscles around the vagina that makes penetration painful or impossible. It is not under conscious control, and it is strongly linked to fear of pain.
In a trial comparing hypnotherapy with behaviour therapy, both worked: successful intercourse was achieved by 95 per cent of the hypnotherapy group and 93 per cent of the comparison group. The hypnotherapy group needed fewer sessions on average. In another comparison, hypnotherapy did better at reducing the woman’s sex-related anxiety.
The standard treatments remain education, pelvic floor physiotherapy, gradual desensitisation with vaginal trainers, and psychosexual therapy. Hypnosis appears to be a useful way of delivering the relaxation and desensitisation those rely on.
How hypnosis is used
- Relaxation of body and of the pelvic floor in particular
- Reducing anticipatory anxiety
- Shifting attention from self-monitoring to sensation
- Graded imagined exposure: rehearsing each step while relaxed
- Imagery of the body responding naturally
- Changing the meaning of a setback
- Confidence building
Sessions are talk and imagination only. Nothing physical is involved, and a practitioner should never suggest otherwise.
What else works
- Medical treatment of any underlying cause
- Medication for erectile problems, which is effective for most men
- Psychosexual therapy, often with a partner
- Sensate focus, a programme of non-demand touching that removes performance pressure
- Pelvic floor physiotherapy
- Treating depression, anxiety or relationship problems
Choosing a practitioner
This is a sensitive area and standards matter.
- Look for a registered psychosexual therapist or a doctor or psychologist with relevant training, who may also use hypnosis.
- A general hypnotherapy diploma is not enough for complex sexual problems or a history of abuse.
- Expect clear boundaries and no physical contact.
- Avoid anyone who suggests your problem must come from a forgotten trauma, or offers to search for one.
- You can bring your partner if you both want.
In the UK, your GP or a sexual health clinic can refer you for psychosexual therapy.
A relaxation exercise
Away from any sexual situation:
- Lie comfortably and breathe slowly.
- Relax your body from head to toe, including the jaw, belly and pelvic floor.
- Imagine warmth and ease spreading through your body.
- Tell yourself: “My body knows how to respond. There is nothing to prove.”
- Practise daily.
The aim is to teach the body what relaxed feels like, so it is easier to find later.
The bottom line
Where anxiety drives a sexual difficulty, hypnosis can help the body relax and take the pressure off, and small trials support it. Have physical causes checked first, and see a properly qualified therapist.
Next in the series: Hypnosis for Procrastination: Getting Yourself to Start
This article is for general information and is not medical advice.