Let's Talk About Sex

A local sex therapist discusses her practice and Spokane's dysfunctions.

Dr. Stephanie Kuffel - LORETTA SURMA
Loretta Surma
Dr. Stephanie Kuffel

You can tell this woman anything. And it’s not just because she’s charming and easy to talk to. It’s because she’s a licensed clinical psychologist who happens to be a sex therapist. We sat down with Dr. Stephanie Kuffel to ask all kinds of questions about the kinds of sex people are having in Spokane. And she told The Inlander that Spokane’s sexual behavior is pretty ... normal.

How did you get into sex therapy?

It was actually unintended. But I really love it. Treating sexual dysfunction is so complex. There are so many different pieces to the puzzle, like medical factors, mental health factors like depression or anxiety and relationship issues, religious issues, family history, age and cultural issues. And it’s fascinating to see how they all fit together.

What does a sex therapist do?

First and foremost I’m a clinical psychologist. I work with people who have some sort of sexual dysfunction that’s negatively impacting their lives. And sex is so important. It affects our relationships and how we view ourselves, yet people don’t talk about it.

Why are we afraid to talk about sex?

I have no idea. You can say the Puritan values on which our country was based, but for whatever reasons, we carry a lot of shame. And sex is very personal, and we feel like something is wrong with us if something is not going right, which in turn makes us feel vulnerable. So we don’t talk about it.

What do you mean when you say you treat sexual dysfunctions?

It can mean a lot of different things, but I mostly work with people who have no desire or interest in sex. That can include having problems with arousal, problems with erections, problems with lubrication, problems reaching orgasm, or experiencing discomfort and pain.

Do you see one specific age, gender or type of patient more than others?

No, my clientele is really mixed. The only patterns I tend to see are age/dysfunction related. For example, if a woman is dealing with genital pain during sex she is usually in her mid-20s. Or, it probably comes as no surprise, men facing issues with erectile dysfunction are typically older men.

What does a healthy sexual appetite look like? We all want to know if we’re having more or less sex than our neighbors.

I mean that’s a big question: Am I normal? And I would say first, are you happy and satisfied? Is your partner? If yes, then the question isn’t relevant.

Are people educated about their bodies, or are we bumping around in the dark?

There are some that are educated and some that aren’t. I think in particular, there are a lot of women that just don’t want to look down there, which means they don’t know what’s going on.

Do homosexual and heterosexual patients and couples experience similar sexual dysfunctions?

Yes, but I don’t have as many same-sex couples in my practice as heterosexual couples. But in my experience they face the same arousal issues and relationship dynamics.

Is homosexuality a choice?

To be honest, that question makes me feel uncomfortable. But my gut sense is that it’s not a choice. It’s not a choice for any of us who we’re attracted to, whether it’s heterosexual, homosexual or bisexual. And I don’t think it’s so clear-cut as to whether you’re in one box or the other. There’s just a wide range of variability in what people are attracted to and what they act out on.

Have sexual medications like Viagra changed our sexual lifestyles?

For some people those medications are very helpful in providing fulfilling sexual interactions, and it gets people talking to their doctors about sex, which is great. But like I’ve heard before, Viagra is one of the prescriptions that doesn’t get refilled because it doesn’t always work. It’s not just about the erection. It’s about the interaction between people and anxiety issues and pleasure issues, and the medication doesn’t do anything for that.

What about sex toys? Do you recommend them to your patients?

If the couple or individual seems open to the idea, yes. If one or both partners are having trouble feeling sexually satisfied, sex toys can provide a really pleasurable experience. Even the act of going to the store and purchasing the toy is an intimacy-building experience. They can feel like teenagers again.

How’s your sex life?

[Laughs.] I don’t think I’ll get into that.

How do you feel about pornography?

I don't even know my opinions just yet. On one hand it can be very liberating. It can provide a source of excitement, and it can even educate people about what sex looks like. And on the other hand, it can be problematic and get in the way of people really developing an intimate sexual connection with partners.

Do you anticipate this becoming a larger part of your practice?

Yes. I think what’s problematic is that, not only is this material two seconds away, but if that's not doing it for you, you can click to the next thing to find something else that's perfectly arousing. And when that wears off, you'll need something else, which means you might build up a tolerance and become desensitized. I think that's going to become the issue.

Why do we like to watch other people have sex?

I don't know the answer to that. It might just be how we're wired. I know there have been a lot of studies, and even when we report that we're not aroused [by] erotic images, our bodies are still responding. Something I think that’s particularly interesting is that men are more aroused by specific images. For example, a homosexual man is aroused by male images but for women it doesn't matter, they get aroused by pretty much anything. There have even been studies of women getting aroused by watching monkeys. And I don't know why that is or what that's all about, but it's interesting.

What about masturbation?

If people are open to the idea, that can be something I assign as homework for someone having problems with premature ejaculation or delayed ejaculation or women having difficulty reaching orgasm. And just to be clear, those are things that happen on their own, outside of the office.