-DR. HEATHER S. HOWARD, Sexologist  Mind-Body Health Facilitator


The following questions are asked most frequently by prospective clients and referring practitioners:

Sex is painful for me and I’m afraid of sexual activity or sexual touch because it might lead to pain.  Can you help me? 

Many people who have experienced pain or discomfort during sex become afraid of attempting sexual activity again—or any touch that could potentially lead to sexual activity—even after the pain is gone.  It is a normal and healthy human response to avoid repeating a negative experience.  But sexual touch does not have to be painful or uncomfortable.

If you want to experience sexual pleasure again, I (Dr. Heather Howard) can help.  I have developed a treatment program to reduce sexual pain, reduce fear of pain, identify safe, comfortable and satisfying sexual activities, and improve sexual communication and intimacy with your partner(s).
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I have chronic pelvic pain and sex hurts.  Will all sex make my condition worse?
Your sex life does not have to fall victim to your pain condition.  Certain activities may cause a flare in your condition, but all sexual activity does not have to be painful or trigger a flare.  In fact, when sexual options are discovered that are tolerable and pleasurable, they might actually relieve your pain.  By taking charge of your sexuality, you could help to reduce your own pelvic pain.

I conducted the first study designed to integrate sexuality into the treatment plan for pelvic pain.  In just four weeks, the women in the couples who participated in the study experienced pain relief (reduced pain levels), improved pelvic floor muscle function (reduced levels of pelvic tension), increased sexual confidence, and reduced fear of pain.  All participants experienced improved sexual experience, communication and confidence.  This approach has been successful for couples in my clinical practice.
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I’m the one with the problem. Should my partner come with me?
I work with individuals and couples.  If you are in a relationship and have a medical condition or other issue that affects your sexuality, the sexual implications are a relationship issue and are best addressed with you and your partner as a team.  If your partner does not feel comfortable attending sessions or if you would prefer to do address your concerns on your own, that is also fine; the changes you experience will benefit your relationship.
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Why are sexual problems a relationship issue?
A sexual relationship is a dance, and each partnership dances together uniquely and responds to changes and challenges differently.  If you have danced with more than one person, you will probably have experienced each partnership differently—you don’t dance the same way with every person, and every person doesn’t dance the same way with you.  When two people are involved, each partner learns to meld with the other and create a new style together as a team.  Each dance with the same partner can also feel different—we evolve as individuals and as a couple, and our dance evolves with us.

When one partner is having an issue that affects or involves sexuality, the partnership will adjust to the change. Some partnerships adjust in ways that feel good for both partners and the issue becomes absorbed or goes relatively unnoticed in the sexual partnership; others adjust in ways that feel bad or punishing for both partners, and the couple finds itself unable to move past bad feelings and a sense of isolation and blame. The initial issue or change is not the cause of the partnership problem; the way partners work together to resolve issues and address changes determines whether or not there will be a problem in the sexual partnership.

Even the closest and healthiest partnerships can experience sexual difficulties. Some life changes can be very difficult to confront for either or both partners, and a sense of frustration or hopelessness can prevent the couple from getting back on track. A trained practitioner who is not too close to the problem can offer a new perspective and practical skills and tools to allow the couple to move forward again.
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How does sex counseling work?
Individual or couples sex counseling helps you to identify your sexual goals and offers education, resources, tools and techniques to help you meet those goals and ultimately manage your own sexual growth. The process entails the following steps:

  1. Helping you to identify where you are when you arrive for your first session and where you ultimately want to be.
  2. Helping you to Idetify the factors that allow you to feel safe and those that prevent you from meeting your sexual goals.
  3. Designing and suggesting exercises to help you progressively expand your sexual comfort zone until you reach your goals

This is considered “brief therapy,” which is rapid and goal-oriented. If sexual difficulties appear to be rooted in deeper issues that require intensive therapy, your practitioner will refer you to a therapist. If you require medical attention before or during your work with a sexologist, your practioner will do his or her best to provide a referral. 

Please see the Private Consultation page for more information.
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How does the couple's sexual rehabilitation program work?   What happens during a session?
This program is designed for couples who have experienced sexual challenges related to health conditions such as pelvic or sexual pain, chronic pain, or limited mobility. I will work collaboratively with you and your partner to help each of you as individuals and as a team to better understand your bodies, your partnership, and your sexual needs and desires.  Through education and assignments geared towards meeting your sexual goals, your sexual confidence and competence will increase and you will be empowered with information and tools necessary to manage your own care and improvement.  You will also better understand your partner and have tools for communicating your needs on an ongoing basis.

The way this works is we figure out what feels safe, comfortable and pleasurable now.  Then we expand your zone of safety, comfort and pleasure.

The following are the steps we will take:

  1. Identify the goals of each individual and the couple as a team
  2. Discuss each partner’s sex and health history and identify any changes that have taken place due to health or other challenges
  3. Map your pleasure and pain patterns
  4. Learn about your past and current sexual patterns as a couple
  5. Identify long-term sexual options and short-term steps to get there

Short-term steps can be implemented through home-play assignments and follow-up phone sessions.
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Will you touch me?  Will I be asked to undress during a session?
No and no.  All of the work in private sessions is done through verbal communcation. I do not practice modalities that include touch, and you will remain clothed in all of your private sessions.  There may be exercises in which you will practice non-sexual touch with your partner during a session, if it is appropriate.  All sexual touch between you and your partner will take place during home-play assignments and we will review your assignments in the following clinical sessions.

If you ever require a hands-on approach, I will provide you with a referral to a qualified practitioner.
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What other tools do you use?
It is common for people who live with pain to have a sense of separation between their minds and bodies, a negative body image, and shame around their sexuality and sexual organs.  Re-integration of their minds and bodies can be a critical process for self-acceptance, sexual satisfaction and pain recovery.   

Experiential modalities can be effective tools for addressing issues such as body image, mind-body integration and sexual shame.  These can include guided meditation, voice dialogue and body dialogue, which are all talk-based techniques aimed at developing consciousness and self-acceptance.
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How long will it take?
The focus in the work is to help you identify and meet your own goals.  You will be given information and tools to do so.  This approach is brief and goal-oriented, meaning that you should experience rapid improvement and meet your goals in a short period of time (typically within 1 to 8 weeks).
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How much will it cost?
The introductory evaluation costs $295 and lasts between 90-120 minutes.
Additional sessions are offered at the rate of $265 for 60-90 minutes and $105 for 30-minute videochat check-ins.
More information is available on the Payment Information page.
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Do you accept insurance?
I am not on an insurance plan and I do not bill insurance companies on behalf of clients.  I will be happy to provide you with a bill to submit to your insurance company for potential reimbursement.
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When do you see clients?
I am in the clinic Tuesdays, Wednesdays and Thursdays from 2:00-10:00PM.
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I don't live in San Francisco.  Can you still help me?
Yes. I work with clients all over the world via video consultation. We would meet just like all other clients, but you would come into my office through the computer instead of through my door. I was concerned it would be difficult to build a clinical relationship and trust that way, but my clients and I have found our video-based relationships to be natural and effective, just like in-person sessions. Many of my local clients also find it convenient to meet over video conference on a regular basis.
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What is your background?  What do you offer that is unique?
I am a clinical sexologist who has a lived most of my life with a chronic pelvic pain condition.  As I was recovering, I encountered few resources for dealing with the sexual challenges I faced.  Once I began to feel better, I turned my focus to the improvement of care for all people with pelvic pain conditions and have worked to educate and provide tools for healthcare practitioners in supporting the sexual challenges their clients face. 

Through my own process of recovery and growth, I learned methods for recovering from and managing chronic pain and also developed a technique for integrating sexuality into my own treatment for pain.  This technique has worked for other clients and allowed them to take charge of their sexuality, reduce sexual pain, and find pleasure even in the presence of pain. 

Because of my understanding of how pelvic pain conditions work and my ability to take relevant sex and pain histories, I can design a specific and finite treatment plan for each couple that will help them find sexual satisfaction.  In four weeks, couples will feel sexually knowledgeable, confident and connected and have the tools to develop an evolving and satisfying sex life. 

If one or both partners have a pain condition, you need to have been evaluated by a medical practitioner for your underlying pain condition before working with me.  If you do not know who to see, I will do my best to help you find a practitioner in your area.
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What is a sexologist?
A sexologist is interested in the scientific study of sex.  Specifically, a sexologist is concerned with what people do sexually and how they feel about what they do.
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What is a clinical sexologist?
A clinical sexologist offers sex counseling to help people understand and accept themselves as sexual beings and meet their sexual goals.  Sexologists are aware of the broad spectrum of human sexual behavior and maintain a broad perspective in working with clients, meaning they take biological, psychological, sociological, anthropological, and historical factors into account when helping clients.  This perspective helps sexologists maintain a nonjudgmental approach to helping people, which means that sexologists do not have any preconceptions about what a client’s sexuality “should” look like. 

As a clinical sexologist, I facilitate my clients’ growth processes by offering education, resources, tools and techniques for understanding and ultimately managing their own sexual growth.  This is considered “brief therapy,” which is rapid and goal-oriented.  If issues appear to be rooted in deeper issues that require intensive therapy, I will refer clients to a therapist.
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Can’t my therapist help me with my sexual concerns?
Your therapist is trained to work with psychological issues and may or may not have been trained in the area of human sexuality—the required training for therapists and sex therapists in the area of human sexuality is minimal.  Your therapist may be highly skilled at helping his or her clients work with sexual issues, but being a therapist does not imply an understanding of human sexuality.

Your psychologist will most likely look at sexuality from a psychological and relationship perspective, and your doctor will look at it from a biological perspective, but you are one integrated person whose sexuality has been influenced by all of these factors and more.  A sexologist is a specialist who understands and views sexuality from a broad perspective, including but not limited to the biological, psychological, sociological, anthropological and historical, and will look at all relevant factors in helping you to address your sexual concerns.  It is often useful to work with a specialist on a specialized issue.
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I’m already working with an expert.  How can you help?
People who have pain conditions are often in simultaneous treatment with many other practitioners, and a multidisciplinary, multi-modal approach has been found to be most effective in treating chronic pain.  Your personalized program will be designed to integrate with all of your other treatments.  I routinely coordinate treatment with pelvic floor physical therapists, psychotherapists, medical doctors, alternative practitioners and other sexologists, and would be pleased to coordinate treatment with your providers with your written permission.

If you have a pain condition and have not already been evaluated by a medical doctor, I will provide you with a referral to a qualified practitioner.  If I determine in your evaluation that I am unable to help you meet your goals or I think there is someone better qualified to help you, I will let you know and provide you with a referral when possible.
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