April 10, 2000 (Reno, Nev.) -- Shari Dawson (not her real name) was having difficulty with physical intimacy and pain during sex, but was too embarrassed to bring it up with her doctor.
Instead, Dawson found a free Internet site where the doctor posted her question and, in his answer, suggested she get in-person therapy. "The Internet got me on the right path," she says. "I wasn't scared to talk about it anymore. I went to my doctor and found out I had a bladder infection. She also put me on a long-term therapy program with my partner to become more comfortable with physical intimacy."
While the cast of television's "Sex and the City" discuss a myriad of sexual quandaries with ease, in real life, most people -- like Dawson -- will stammer through questions about such topics as pain during sex or masturbation. In fact, embarrassment can be the biggest obstacle between a sexual problem and help. That's where online sex experts can help, says Deborah Fox, MSW, a Washington, D.C., sex therapist with her own web site. "The Internet is useful for addressing sexual problems because people are able to ask questions that [otherwise] make them feel uncomfortable."
Online Roles and Limitations
Fox and other sex therapists offer their expertise online, providing educated responses to a variety of questions. They're quick to point out that this does not, however, qualify as therapy. At "Ask the Sex Doc," for example, William Fitzgerald, PhD, a sex therapist in Santa Clara, Calif., posts his answers to hundreds of questions, choosing the ones he feels are most universal.
Common questions easily answered online, according to Fitzgerald, include the effect of masturbation on sexual performance, the regaining of sex drive after the death of a spouse, and the way to approach a spouse about acting out a sexual fantasy. Some sites answer questions free of charge and post the answers for other users to see, while they may require a fee for answering questions privately.
Sandor Gardos, PhD, an online sex expert, also responds to questions on many sexual topics. But when a question is beyond the scope of what can be or should be answered online, Gardos is quick to suggest face-to-face professional help. He and other online sex therapists often recommend traditional therapy for issues that involve more complex problems, such as childhood sexual abuse. Fox adds that current technology simply doesn't allow for the equivalent of ongoing, in-person meetings necessary to resolve many sexual issues.
The Marriage of Therapy and Technology
Online sex therapy falls under the umbrella of "telemedicine," which also includes videoconferencing and telephone therapy. Because telemedicine is in its infancy, the American Psychiatric Association and the American Psychological Association are still grappling with guidelines. Even so, both organizations emphasize that therapists who are online must adhere to ethics standards already in place.
William Stone, MD, who is on the American Psychiatric Association's Committee on Telemedicine, says the new technology is a mixed blessing. Although it is starting to bring therapy to people in remote locations, it also has limitations and potential dangers. For instance, doctors can usually prescribe drugs only in states where they are licensed to practice medicine, making it difficult to treat patients signing on from other states. And the images transmitted during videoconferences don't always allow detection of subtle changes in body language or expression that are often helpful in making a diagnosis during face-to-face meetings.
How to Judge the Sites
A reputable sex therapy site should have a disclaimer saying that the content and interactions do not constitute therapy or medical treatment, says Mitch Tepper, PhD, MPH, who has been researching online sex therapy sites for more than five years and launched his own in 1996.
Tepper also suggests checking sites to see if the therapists are certified by the American Association of Sex Educators, Counselors, and Therapists (AASECT) or belong to other organizations such as the American Psychological Association or the American Psychiatric Association. Ask therapists where they were trained and how many years they have been in practice (or look on the site for background information on them), as well as how long they have been online.
By doing a bit of research on the therapist and the site, you will be more likely to find someone who is credible and competent.
Elaine Marshall is a freelance writer living in Reno, Nev. She also reports for Time magazine and teaches at the Reynolds School of Journalism at the University of Nevada, Reno.