Between the Pages: 'So Tell Me About the Last Time You Had Sex'

When a couple first visits sex therapist Ian Kerner, Ph.D., he asks them about the last time they had sex. Many couples are in pain and distress by the time they see Kerner for intimacy therapy. Kerner, author of the 2004 bestseller "She Comes First: The Thinking Man's Guide to Pleasuring a Woman," said their description of the most recent sexual episode can reveal a lot about the true nature of their problems.

In his most recent book, "So Tell Me About the Last Time You Had Sex: Laying Bare and Learning to Repair Our Love Lives," Kerner shares the methodology he uses to help couples climb out of sexual ruts. Drawing on research and decades of clinical experience, Kerner provides tools to assess and repair our "sex scripts," and discusses common issues that can hinder a fulfilling sex life.

In this exclusive interview with Giddy, Kerner discussed what can be learned from sex scripts, the causes of low desire, how couples may benefit from porn and more.

Editor's note: This interview has been edited for length and clarity.

Why did you decide to write this book?

Kerner: I see individuals and couples with all sorts of issues: arousal, orgasm, sexual anxiety and sexual function issues. I found that sex is often pretty low on the list of priorities that need to be addressed by therapy. By the time someone gets to my office, they're really looking for a solution, and the situation has somewhat escalated. I developed a methodology that allows me to work with individuals and couples on sexual problems rather quickly.

I really like to look at sex in action. That's why I say, "So tell me about the last time you had sex," because I want to hear about a sexual event in great detail from beginning to end; how it was initiated, how arousal was cultivated, who had orgasms and who didn't. By looking at a sexual event in great detail—which I call the "sex script"—usually a sexual problem is expressed. If we change the sex script, we can usually solve the problem.

That's why the book is called "So Tell Me About the Last Time You Had Sex." It's really to help couples or individuals look at their own sex scripts and understand what's working, what's not and what might need to be addressed in order to create experiences that are really absorbing, connecting and pleasurable.

When you ask a new patient to tell you about the last time they had sex, what are you learning?

I'm basically looking for where a problem occurs in a sex script. Is there a desire issue? If so, there's probably a discrepancy in a couple's desire framework—how they each get to desire. Is there an issue with arousal? Why is there an issue with arousal? Is it performance anxiety? Is it due to rushing to intercourse as opposed to percolating and generating arousal? Is there a difference in sexual personalities in terms of the behaviors that one partner wants on the table and maybe another partner wants off the table?

The sex script really reveals a lot of information and always helps me create the first homework assignment an individual or couple takes home; it really launches the process. We're continuing to come back to the sex script and work our way through obstacles and really help people get to a place where they just feel comfortable where pleasure and connection flow freely.

A lot of people struggle with low sexual desire. In general, what is your process when counseling patients for this symptom?

Desire is a function of many factors: biological, psychological and relational. People experience desire differently. Desire ebbs and flows. It's usually very easy for couples to get into a rut. There can be a dynamic where one partner might be labeled the "high desire partner" and the other partner the "low desire partner." Those labels are incredibly damaging.

For the person labeled low desire partner, why did they never initiate sex? Are they sexual anymore? Are they attracted or interested? For the one with high desire, they might be experienced as someone who just focuses on sex. That's all they can think about and they don't pay attention to contextual factors. I try and get beyond labels and the beliefs that underlie those labels and really look at the sexual environment in each partner's desire framework.

For example, one partner, very often if we're talking about heterosexual couples, is usually in a spontaneous desire framework, meaning they can metabolize a sexual cue very quickly and feel it in their bodies. They want to have sex. They see something sexy. They think about something sexy. And it really provides all the energy and motivation to get going. That's a person who's sexually activated very easily. That person may be partnered with someone who's more of what we call a responsive desire framework, in which desire isn't the first thing that occurs. It's more like the second, third or fourth thing that occurs. There has to be much more of a simmering and percolation of arousal. There has to be much more attention paid to context.

One of the main things I hear from women that I don't really hear from men when it comes to sexual desire is how all of the outside stressors of the world can really cut off desire. I always hear from my female partners, "If the environment isn't right or if I have chores to do or work to do, I can't just get into desire." That's really what a spontaneous desire person can do. They can very quickly get into desire. Just explaining the difference in desire frameworks can be helpful to create mutual understanding. From there, we can work to create the right sexual environment that would be conducive to generating desire.

You write about injecting life into our sex scripts and that some couples may benefit from erotica and porn. Talk about why you think that could help.

When I'm looking at couples' sex scripts, the major complaints are, "I don't enjoy sex," "I'm not getting aroused," "I'm not having orgasms," "It isn't fun" and "It's boring." If you look at people's sex scripts, usually what you find is a short sequence of behaviors that move quickly and culminate in intercourse. Sex has basically been reduced to just a series of physical behaviors.

It's different at the beginning of a relationship when there's so much newness and excitement and stuff to discover. All of that is wrapped around those sexual behaviors. As couples go through life and things become more typical and predictable, our sex scripts get drained, they get dehydrated from erotic life. I'm a big advocate of psychological arousal, bringing our imaginations and creativity, and stimulating our sense of fantasy. There are studies that show women can fantasize their way to orgasms without even touching themselves. Men can certainly think about something sexy, start watching something sexy and begin to get erections, and sometimes very powerful erections.

The power of psychological arousal is very strong, and we usually employ it when we're masturbating, but we rarely bring it into our partnered sex script. My focus is on bringing that psychological arousal into the sex scripts. There are a couple of different ways of doing it. Many of the couples I work with don't really have much experience with sexual play, fantasy and sharing, and it often leads to a lot of embarrassment and shame.

Rather than give couples face-to-face assignments that generate psychological arousal, I often begin by focusing on side by side. Lie next to each other and read something sexy. You can listen to an erotica podcast. You can watch something sexy. We're really living through a boom of ethical porn, porn created for all sorts of tastes and porn directed at women and couples. I'm a big fan of that side-by-side taking in of psychological arousal. It really helps.