Your Whole Life Well
Sex Therapy Ponte Vedra Psychologists
Embrace more passion, connect more deeply, and live more fully.
What to Expect: A Safe Space for Exploration and Connection
At Ponte Vedra Psychologists, we recognize that sexual health is a core component of overall physical and emotional well-being. Sex therapy assists individuals and couples in addressing medical, psychological, personal, and interpersonal factors that influence sexual satisfaction and overall sexual health.
Our mission is to deliver compassionate, scientifically grounded care that helps people lead more satisfying and meaningful lives, including their most meaningful and fulfilling sexual lives.
Sex therapy is a type of talk therapy where individuals and their therapists discuss experiences, worries, thoughts, feelings, hopes, and dreams related to sexuality.
Our approach is collaborative, practical, and strengths-based, creating a safe and accepting environment where you can explore your sexuality, increase overall fulfillment and pleasure, and address any concerns without judgment.
We draw upon well-established methods such as cognitive-behavioral therapy (CBT) and solution-focused therapy, tailoring our approach to your specific needs and goals.
We aim to help you heal from past trauma, cultivate sex-positive relationships, release shame, and deepen intimacy and connection.
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Who We Serve
The client base for sex therapy is notably diverse in age (with millennials and Gen X forming the majority), gender (with cis women outnumbering men, who often seek help for performance concerns), and sexual orientation (including LGBTQ+ individuals, those exploring kink, and non-monogamous individuals).
We understand that cultural and religious backgrounds can profoundly influence perceptions of sexuality, often instilling elements of shame and fear. We are committed to providing inclusive, sex-positive, and culturally competent care, ensuring that people of all ages, cultures, and demographics feel welcome and understood.
Our compassionate approach ensures that wherever you are on your personal journey, you will find a supportive and non-judgmental space.
Male Sexual Dysfunctions
Sexual dysfunction in men can take many forms, but all share one thing in common: they interfere with a man’s ability to enjoy a healthy and satisfying sex life fully. These difficulties often create emotional distress, reduce self-esteem, and strain relationships. At Ponte Vedra Psychologists, we understand the sensitive nature of these problems and offer supportive, evidence-based treatment tailored to your individual needs.
Male sexual dysfunction includes various problems related to desire, arousal, and orgasm. These issues can arise at any age and may be either situational or persistent in nature. Understanding the nature of the problem is the first step toward discovering effective solutions.
Female Sexual Dysfunctions
Sexual health is an essential part of overall well-being, yet many women experience sexual difficulties at some point in their lives. These challenges can interfere with physical intimacy, cause emotional distress, and affect relationships. At Ponte Vedra Psychologists, we provide compassionate, evidence-based care to help women address these concerns and restore confidence and connection.
Female sexual dysfunction encompasses a range of problems related to desire, arousal, orgasm, or pain during sexual activity. These issues can occur at any age and may be situational or persistent in nature. Understanding the nature of the problem is the first step toward finding practical solutions.
Your Path Forward: Benefits of Sex Therapy
- Exploring Desire: Understand and enhance libido, interest, and personal sexuality, shifting focus from dysfunction toward a more fulfilling experience.
- Enhancing Connection: Deepen both physical and emotional intimacy with yourself and your partner(s), fostering stronger bonds.
- Addressing Dysfunctions: Work through concerns related to desire, arousal, pain, or other sexual functioning issues, identifying root causes and developing strategies to overcome them.
- Healing from Trauma and Shame: Find a safe space to process past trauma and release sexual shame, building a sex-positive relationship with yourself and embracing self-acceptance.
- Living Fully: Lead a meaningful, fulfilling, and authentic sexual life, free from unhelpful patterns and societal pressures.
Why Choose Ponte Vedra Psychologists for Sex Therapy?
Founded in 1991, Ponte Vedra Psychologists is a well-established private practice in Ponte Vedra Beach, Florida, serving children, adolescents, adults, and seniors. We are proud to serve a broad geographic area, including Ponte Vedra Beach, Jacksonville Beach, Neptune Beach, Atlantic Beach, Nocatee, Palm Valley, St. Augustine, and the greater Jacksonville area.
Dr. Gregory L. Garamoni, the founder and director, is a licensed clinical psychologist with a doctoral degree (Ph.D.) from the University of Pittsburgh, consistently ranked among the "World’s Best" in psychology and psychiatry. With over 30 years of clinical experience, 20 peer-reviewed publications, and extensive corporate and cross-cultural experience, Dr. Garamoni's diverse background uniquely shapes the comprehensive and empathetic care provided.
Dr. Garamoni also received advanced clinical training in the practice of sex therapy at Robert Wood Johnson Medical School’s Sex Therapy Clinic, under the direction of internationally recognized leaders in the field of sex therapy, psychologists Ray Rosen, Ph.D., and Sandra Leiblum, Ph.D.
Ready to explore your desire, enhance your connection, and live fully?
Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.]]
Sex TherapyErectile Disorder
Overview
“The most powerful sexual organ is the brain.”— Dr. Esther Perel
What It’s Like to Struggle With Erectile Disorder
Imagine stepping into the most intimate of moments and suddenly feeling betrayed by your own body. The anticipation is there, the desire may even be present, but your physiology refuses to cooperate.
For many men, erectile disorder isn't just about the mechanics of arousal—it strikes at the heart of identity, masculinity, and relational confidence. It can feel like a silent, invisible wall between you and your partner.
At Ponte Vedra Psychologists, we understand that this experience is more than a symptom—it’s a story, often wrapped in layers of stress, fear, disappointment, and unspoken worry. Our work begins not with judgment or performance metrics, but with compassion and clarity.
Erectile disorder (ED), sometimes referred to as erectile dysfunction, is characterized by persistent difficulty achieving or maintaining an erection sufficient for satisfactory sexual performance. While occasional difficulties are normal, ED is diagnosed when the issue recurs frequently and causes distress or interpersonal problems. It can occur at any age but is more common as men grow older—though not inevitable with aging.
Sex TherapyErectile Disorder
Symptoms
Men struggling with erectile disorder typically report:
- Trouble getting or keeping an erection during sexual activity
- Erections that are less firm or less consistent than they used to be
- Anxiety or dread before intimacy because of fear of “not working”
- Avoidance of sexual situations altogether—sometimes without explaining why
- A drop in sexual confidence, accompanied by frustration or shame
Some men feel like they’ve “lost their edge.” Others describe feeling like a spectator in their own body, watching themselves try and fail. These patterns often emerge gradually but can accelerate when left unaddressed.
Sex TherapyErectile Disorder
Impairment
Erectile disorder can have a profound impact on self-esteem, romantic relationships, and overall quality of life.
Men often report feelings of shame, inadequacy, or loss of masculinity.
Partners may feel confused, rejected, or falsely believe they are to blame.
Over time, this dynamic can lead to avoidance of intimacy, tension in communication, and a loss of emotional closeness.
At Ponte Vedra Psychologists, we approach these challenges with sensitivity, professionalism, and a commitment to restoring both function and confidence.
Sex TherapyErectile Disorder
Diagnosis
From a clinical standpoint, erectile disorder is diagnosed when at least one of three specific difficulties occurs during most or all sexual activity (75–100%) over a period of at least six months, and causes clinically significant distress. These diagnostic criteria are:
- Difficulty obtaining an erection
- Difficulty maintaining an erection
- A noticeable reduction in rigidity that interferes with satisfaction or penetration
A medical condition, substance use, psychiatric disorder, or relationship conflict must not better explain the issue.
Epidemiology
- ED affects approximately 13–21% of men aged 40–80 years, with increasing prevalence in older age groups
- Among men aged 40, prevalence is around 5%, rising to 15–25% by age 65 and older
- Many cases are underreported due to stigma or reluctance to seek help
Sex TherapyErectile Disorder
Causes
Erectile disorder is best understood through a biopsychosocial lens—a blend of medical, psychological, and interpersonal factors. These may include:
- Medical Conditions: Cardiovascular disease, diabetes, obesity, neurological disorders, low testosterone, or side effects of medications
- Psychological Factors: Anxiety (especially performance anxiety), depression, unresolved trauma, stress
- Interpersonal Dynamics: Communication difficulties, sexual pressure, trust issues, or emotional disconnection
- Lifestyle Influences: Smoking, alcohol use, lack of physical activity, poor sleep
- Cognitive Patterns: Catastrophic thinking (“It’s happening again”), anticipatory fear, or avoidance loops
At Ponte Vedra Psychologists, we take the time to understand your story—not just check a list of causes. We work collaboratively to identify the contributing elements and create an approach tailored to the full picture.
Sex TherapyErectile Disorder
Treatment
Treatment for erectile disorder varies based on the root causes, and we tailor every intervention to the individual and their unique context. Our approach often includes:
- Psychological Interventions: Cognitive-behavioral therapy (CBT), mindfulness-based approaches, and guided exposure to reduce performance anxiety and maladaptive thought patterns
- Couples Therapy: Addressing relational patterns, improving communication, rebuilding intimacy, and resolving mutual expectations
- Behavioral Strategies: Relaxation techniques, sensate focus exercises, and sexual education to reduce pressure and increase comfort
- Medical Collaboration: When appropriate, we coordinate with physicians to ensure that medical issues (e.g., hormone levels, medications, vascular health) are addressed in tandem
We don’t treat “a dysfunction”—we work with you, with care and confidentiality. Our goal is not just restored function, but restored confidence, connection, and freedom.
Moving Forward
If you or your partner are struggling with erectile disorder, you don’t have to face it alone. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyErectile Disorder
Sex TherapyPremature Ejaculation
Overview
“The greatest sexual organ is the brain, and the greatest aphrodisiac is trust.”— Dr. Gina Ogden
What It’s Like to Struggle With Premature Ejaculation
For many men, the moment of climax is supposed to be a crescendo—an expression of connection, pleasure, and release. But when it comes too quickly, it can feel more like a crash.
Premature ejaculation often leaves men feeling embarrassed, frustrated, or inadequate.
Partners may be confused or disappointed, and both people may avoid sex altogether rather than risk awkwardness or hurt feelings.
Clients at Ponte Vedra Psychologists sometimes describe the experience as being "rushed by the body"—like their arousal system has a mind of its own. It’s often accompanied by performance anxiety, self-monitoring, or even dread. Over time, what begins as a physiological reflex evolves into a psychological trap.
Premature ejaculation (PE), sometimes called early ejaculation, is defined by ejaculation that occurs sooner than desired—either shortly after penetration or even before. While occasional episodes are common, PE becomes a clinical issue when it is persistent, causes distress, and limits sexual satisfaction.
Sex TherapyPremature Ejaculation
Symptoms
Men struggling with premature ejaculation often report:
- Ejaculation that occurs within one minute of penetration, or even before
- A sense of being unable to control or delay ejaculation
- Anxiety or tension before or during sexual activity
- Avoidance of intimacy due to fear of embarrassment
- Reduced sexual satisfaction and feelings of failure
Some men have experienced PE since their first sexual encounters; others develop it later in life, often following stress, illness, or relationship changes.
Sex TherapyPremature Ejaculation
Impairment
Premature ejaculation can significantly impact confidence, emotional intimacy, and relationship dynamics.
Many men feel inadequate or ashamed, while partners may feel confused, unfulfilled, or even blamed.
Over time, couples may stop initiating sex or discussing the issue altogether, leading to distance and disconnection.
At Ponte Vedra Psychologists, we don’t view PE as simply a timing problem—it’s a layered experience that deserves compassion, clarity, and practical support.
Sex TherapyPremature Ejaculation
Diagnosis
PE is diagnosed when a man persistently ejaculates within approximately one minute of vaginal penetration (or before), has little or no control over timing, and experiences distress, frustration, or avoidance because of it. These symptoms must persist for at least six months and occur during most or all sexual activity.
A diagnosis may be:
- Lifelong (primary) — present since first sexual experiences
- Acquired (secondary) — develops after a period of normal function
Epidemiology
- Premature ejaculation is estimated to affect 20–30% of men across age groups
- Lifelong PE may be more common in younger men; acquired PE can occur at any age
- Many men do not seek help due to embarrassment, or the belief that “nothing can be done”
We differentiate PE from other conditions, such as erectile disorder or generalized anxiety, ensuring the diagnosis reflects the complete clinical picture.
Sex TherapyPremature Ejaculation
Causes
PE often results from a complex interaction of psychological, neurological, and relational factors, including:
- Neurobiological sensitivity in the ejaculatory reflex arc
- Performance anxiety, especially in early or pressured sexual experiences
- Relationship stress or lack of communication about needs and timing
- Low distress tolerance—difficulty managing high arousal without losing control
- Early conditioning (e.g., learning to climax quickly due to secrecy, shame, or rushed situations)
- Medical contributors such as prostatitis or thyroid imbalance (less common)
At Ponte Vedra Psychologists, we help clients identify which of these may be playing a role—not through blame, but through discovery and insight.
Sex TherapyPremature Ejaculation
Treatment
PE is one of the most treatable sexual concerns. At Ponte Vedra Psychologists, we offer a multi-dimensional approach tailored to your needs and history. Treatment may include:
- Behavioral techniques such as the stop-start method or squeeze technique
- Mindfulness training to increase interoceptive awareness and reduce performance pressure
- Cognitive restructuring to challenge catastrophic or self-defeating thought loops
- Communication skill-building for couples to discuss timing, pressure, and pleasure
- Psychoeducation on sexual response cycles and arousal regulation
- Collaboration with medical providers if pharmacological support is indicated
Treatment focuses not only on slowing things down—but on helping you feel more connected, confident, and in control.
Moving Forward
If you’re struggling with premature ejaculation, real change is possible. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyPremature Ejaculation
Sex TherapyDelayed Ejaculation
Overview
“Sexual connection is not just about climax—it’s about presence, responsiveness, and attunement.”— Unknown
What It’s Like to Struggle With Delayed Ejaculation
You want to feel connected. You may be aroused. You may be doing everything “right.” But no matter how long you try—or how hard you focus—it just doesn’t happen.
For men struggling with delayed ejaculation, orgasm becomes elusive, sometimes impossible, and often anxiety-provoking.
Some describe it as a mental block. Others feel like they’re on the edge of something they can’t quite reach. Partners may interpret the delay as disinterest, or worry that something is wrong in the relationship. Many men continue to try silently, blaming themselves or their bodies, growing increasingly discouraged with each attempt.
At Ponte Vedra Psychologists, we understand how demoralizing and misunderstood this condition can be. Delayed ejaculation is not laziness, disconnection, or lack of desire—it’s a complex sexual concern that deserves skilled and sensitive attention.
Sex TherapyDelayed Ejaculation
Symptoms
Men with delayed ejaculation typically describe:
- Difficulty achieving orgasm despite prolonged sexual stimulation
- A significant delay in climax—sometimes taking 20, 30, or more minutes, or not occurring at all
- Orgasm that may occur during masturbation but not with a partner
- Growing anxiety or mental distraction during intercourse
- Feeling emotionally “blocked” or pressured to finish
This struggle may be present from early sexual experiences (lifelong) or may develop later in life (acquired), often following a medical issue, major stressor, or change in relational dynamics.
Sex TherapyDelayed Ejaculation
Impairment
Delayed ejaculation can strain both emotional and sexual intimacy.
Men may feel embarrassed, ashamed, or abnormal.
Partners may feel confused, rejected, or assume they’re doing something wrong.
Together, couples may begin to avoid sexual situations, stop communicating about needs, or build up quiet resentments.
At Ponte Vedra Psychologists, we help men and couples name the experience, understand the underlying factors, and move toward more fulfilling and relaxed intimacy.
Sex TherapyDelayed Ejaculation
Diagnosis
Delayed ejaculation is diagnosed when a man experiences a significant delay in, or absence of, ejaculation during sexual activity with a partner, despite adequate stimulation, in a way that causes clinically significant distress. The condition must persist for at least six months and occur on most or all occasions of partnered sexual activity.
The condition may be: - Lifelong (primary) or acquired (secondary) - Generalized or situational
Diagnosis involves ruling out physical conditions (e.g., nerve damage, medication side effects) as well as relational, psychological, and contextual variables.
Epidemiology
- Delayed ejaculation affects 1–5% of men, with lower rates in younger populations
- The condition is more likely in men over 50, especially when comorbid with health issues or medications
- It is often underdiagnosed, as men may feel awkward discussing it or assume “taking longer” is desirable
Sex TherapyDelayed Ejaculation
Causes
This condition often arises from a mix of psychological, biological, and relational factors. Common contributors include:
- Psychological: Performance anxiety, guilt, suppressed emotions, trauma, or intrusive thoughts
- Medical/Neurological: Diabetes, MS, prostate surgery, or medication side effects (especially SSRIs)
- Relational: Lack of emotional connection, unresolved conflict, or fear of vulnerability
- Conditioning: Habitual masturbation patterns (e.g., rapid, private, highly specific stimulation) that don’t translate well to partnered sex
- Beliefs & Cognitions: Perfectionism, rigid expectations, or overthinking during intimacy
We work with clients to explore these influences in a non-blaming, emotionally attuned way.
Sex TherapyDelayed Ejaculation
Treatment
Treatment for delayed ejaculation begins by reducing pressure and building understanding. At Ponte Vedra Psychologists, we take a comprehensive and collaborative approach, which may include:
- Insight-oriented therapy to identify emotional or developmental factors contributing to sexual inhibition
- Cognitive-behavioral work to address perfectionism, distraction, or intrusive thoughts
- Mindfulness techniques to help shift from performance to presence
- Couples therapy to rebuild trust, communication, and emotional safety in sexual contexts
- Behavioral strategies to adjust stimulation patterns or gradually recondition arousal
- Coordination with medical providers if physical causes or medication effects are suspected
We don’t push for performance. We support the unfolding of a healthier, more relaxed sexual experience.
Moving Forward
If climax feels out of reach and it's affecting your confidence or connection, help is available. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyDelayed Ejaculation
Sex TherapyMale Hypoactive Sexual Desire Disorder
Overview
“The opposite of love is not hate, it’s indifference.”— Elie Wiesel
What It’s Like to Live With Male Hypoactive Sexual Desire Disorder
It can feel like you're drifting through your relationship with the volume turned down. The closeness is there, the affection may be genuine, but the spark of sexual interest is missing. And that absence often feels more confusing than any clear dysfunction.
“What’s wrong with me?” is a question we hear frequently—especially from men who still love their partners but no longer feel the urge to be sexual with them.
Some men describe feeling broken or ashamed. Others worry that they’re disappointing their partners or being misread as cold, disinterested, or even unfaithful. At Ponte Vedra Psychologists, we understand that low sexual desire is not a moral failing or character flaw. It’s a complex, emotionally charged experience—one we approach with empathy and insight.
A persistent lack of sexual thoughts, fantasies, or desire for sexual activity defines Male Hypoactive Sexual Desire Disorder (MHSDD). This is not just a temporary dip—it’s a chronic condition that causes significant distress and relational strain.
Sex TherapyMale Hypoactive Sexual Desire Disorder
Symptoms
Men experiencing hypoactive sexual desire often describe:
- A noticeable decline in interest in sexual activity
- Rare or absent sexual thoughts, daydreams, or fantasies
- Reduced initiation of sex, even in long-standing relationships
- Feelings of guilt, frustration, or numbness about intimacy
- Pressure to “perform” or fake interest to avoid conflict
These experiences are not the same as temporary disinterest due to stress or life transitions. They persist over time, and they often leave men feeling emotionally disconnected and confused.
Sex TherapyMale Hypoactive Sexual Desire Disorder
Impairment
The impact of MHSDD can extend beyond the bedroom. Partners may feel rejected, undesired, or blamed. Conversations around intimacy can become tense—or disappear entirely. Over time, this can lead to emotional distancing, loss of shared joy, or feelings of isolation within the relationship.
For the man himself, the experience can feel quietly devastating—a gradual erosion of identity, confidence, and connection.
At Ponte Vedra Psychologists, we don’t reduce desire to hormones or habits. We listen carefully and explore the internal, relational, and existential dimensions of low desire in a judgment-free space.
Sex TherapyMale Hypoactive Sexual Desire Disorder
Diagnosis
Male Hypoactive Sexual Desire Disorder is diagnosed when a man experiences persistently or recurrently deficient (or absent) sexual thoughts and desire for sexual activity, combined with significant personal distress, for a minimum of six months.
Diagnosis includes:
- A thorough review of medical history, psychological state, and relational context
- Evaluation of whether the condition is better explained by another mental disorder, a medical issue, substance use, or relationship distress
- A distinction between lifelong versus acquired, and generalized versus situational desire issues
Epidemiology
- MHSDD affects approximately 6% of younger men (under 60) and up to 41% of older men (60+), though rates vary by study and definition
- Prevalence is likely underreported due to cultural stigma around male sexual desire
- Many men normalize low desire or assume it’s just part of aging—even when it causes distress
Sex TherapyMale Hypoactive Sexual Desire Disorder
Causes
Desire is one of the most nuanced aspects of human sexuality. In our clinical experience, the causes of MHSDD often involve a blend of biological, psychological, and interpersonal factors, such as:
- Biological: Low testosterone, chronic illness, medication side effects
- Psychological: Depression, anxiety, unresolved trauma, or body image concerns
- Relational: Conflict, lack of emotional intimacy, unspoken resentments, sexual incompatibility
- Cognitive: Performance anxiety, sexual shame, negative sexual conditioning
- Cultural: Messages about masculinity, aging, or “normal” libido that create internal pressure
Rather than guessing, we collaborate with you to explore these influences thoroughly and compassionately.
Sex TherapyMale Hypoactive Sexual Desire Disorder
Treatment
Treatment begins with a respectful, in-depth exploration of your experience—not a rush to pathologize or prescribe. Depending on your unique presentation, we may recommend:
- Insight-Oriented Psychotherapy to explore internal blocks, early learning, or emotional avoidance
- Cognitive Behavioral Techniques to identify and shift unhelpful thought patterns or avoidant behaviors
- Couples Therapy to address emotional distance, unmet needs, or pressure cycles
- Psychoeducation about sexual response, aging, and the many faces of desire
- Referral for Medical Evaluation if hormonal or physiological contributors are suspected
Our goal is not just to “fix libido,” but to help you reclaim a sense of aliveness—whatever form that takes for you.
Moving Forward
If you’re struggling with low sexual desire, you’re not alone—and there is no shame in seeking help. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyMale Hypoactive Sexual Desire Disorder
Sex TherapySubstances, Medications, and More (Male)
Overview
“When the body speaks through silence, we must learn to listen with compassion and curiosity.”— Ponte Vedra Psychologists
What It’s Like When Sexual Problems Have No Obvious Cause
Sometimes, sexual difficulties begin suddenly after starting a new medication. Other times, a man struggles with arousal, desire, or climax but doesn't quite fit any known diagnosis. These situations can feel frustrating, isolating, and easy to dismiss—by others or even by oneself.
Men in this position often say things like, “I think it’s the meds,” or “I’m not sure what’s wrong—I just know something isn’t right.” At Ponte Vedra Psychologists, we specialize in helping clients make sense of those confusing in-between experiences. Whether the issue is substance-related or simply doesn't fit a textbook category, it’s real—and it’s treatable.
Sex TherapySubstances, Medications, and More (Male)
Symptoms
Clients dealing with substance- or medication-induced dysfunctions—or dysfunctions not captured by standard categories—often report:
- A noticeable decline in desire, arousal, or ability to orgasm after starting a medication
- Difficulty pinpointing the cause of their sexual problem
- Feeling overlooked, especially when medical or psychiatric symptoms improve but sexual side effects remain
- Anxiety, shame, or confusion about what the “real” issue is
- Worry that no one will take their sexual concerns seriously
These symptoms may not match one specific disorder, but still have a significant impact on quality of life and intimacy.
Sex TherapySubstances, Medications, and More (Male)
Impairment
Sexual functioning doesn’t exist in a vacuum—it affects mood, self-image, relationships, and overall well-being.
When the cause of dysfunction is unclear or indirect (such as a medication side effect), men often feel dismissed or left out of the treatment conversation.
We understand how easy it is to internalize the problem or feel lost between specialties. At Ponte Vedra Psychologists, we bring the focus back to you—not just your symptoms, but your whole story.
Sex TherapySubstances, Medications, and More (Male)
Diagnosis
Substance/Medication-Induced Sexual Dysfunction
This diagnosis is made when sexual symptoms (e.g., low desire, erectile difficulties, anorgasmia) occur during or shortly after substance use, intoxication, or withdrawal, or following the initiation of a medication known to affect sexual functioning.
To qualify:
- The substance or medication must be capable of producing the symptom
- The dysfunction must not be better explained by another sexual disorder
- The problem must cause clinically significant distress and last beyond typical acute effects
Other Specified/Unspecified Sexual Dysfunctions
These categories are used when a sexual problem:
- Causes significant distress
- Impairs functioning
- Does not meet the full criteria of a named disorder
- Or when the clinician chooses not to specify the cause (e.g., in an emergency or short-term setting)
Epidemiology
- Medication-induced sexual dysfunction is common, especially with SSRIs, antihypertensives, antipsychotics, opioids, and alcohol
- Many men stop or adjust medications without telling their prescriber due to sexual side effects
- The actual prevalence of "unspecified" dysfunctions is unknown due to lack of clear diagnostic boundaries—but they are clinically significant and often under-treated
Sex TherapySubstances, Medications, and More (Male)
Causes
The causes in these categories are diverse, and often involve:
- Pharmacological effects (e.g., reduced dopamine or testosterone activity)
- CNS suppression or stimulation from substances (e.g., alcohol, stimulants, opioids)
- Drug interactions or cumulative side effects
- Misdiagnosis or underdiagnosis of subthreshold sexual conditions
- Unrecognized relational or emotional blocks that don’t fit cleanly into existing diagnostic frameworks
Rather than forcing a fit, we help clients unpack what’s going on in a way that’s holistic, curious, and validating.
Sex TherapySubstances, Medications, and More (Male)
Treatment
Treatment begins by investigating the timeline and context of the symptoms, collaborating with other providers when appropriate. Our approach includes:
- Comprehensive sexual history-taking, including medications, substance use, and sexual development
- Psychoeducation to clarify what is and isn’t known about medication-related dysfunction
- Communication coaching so clients can advocate for themselves with medical providers
- Cognitive and emotional work to address shame, anxiety, or relational effects
- Referral coordination, when needed, for medication adjustment or evaluation
We help clients move from confusion to clarity—even when the problem doesn't fit a neat category.
Moving Forward
If you’re experiencing sexual difficulties related to medications, substances, or an unclear source, you’re not alone—and you're not without options. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapySubstances, Medications, and More (Male)
Sex TherapyFemale Sexual Interest / Arousal Disorder
Overview
“Desire is not a constant state. It is an evolving dialogue between the self and the relationship.”— Dr. Marta Meana
What It’s Like to Live With Female Sexual Interest / Arousal Disorder
It’s not just that the spark is gone—it’s that it feels like it never even shows up. You may care about your partner, feel affectionate, even enjoy physical closeness, but do you desire sexual activity? Nowhere to be found. Or maybe you go through the motions, trying to “feel something,” but nothing ignites. And worse, you might not even miss it—until you see the effect it’s having on your relationship or your own sense of identity.
At Ponte Vedra Psychologists, we often hear this: “I love him, but I just don’t want him.” This isn’t about failure, coldness, or dysfunction in the moral sense—it’s about a mismatch between inner experience and sexual readiness. And that mismatch is more common and more complex than most people realize.
Female Sexual Interest/Arousal Disorder (FSIAD) is a condition characterized by a persistent lack of sexual interest, fantasies, desire, and physiological arousal. It often impacts emotional intimacy and can feel both confusing and deeply frustrating—not only for the woman experiencing it but also for her partner.
Sex TherapyFemale Sexual Interest / Arousal Disorder
Symptoms
Women with FSIAD typically describe:
- Little or no interest in sexual activity
- Few or absent sexual thoughts, fantasies, or daydreams
- A lack of initiation of sex, or reduced receptivity to a partner’s advances
- Minimal physical or emotional arousal during sexual activity
- A diminished sense of pleasure, even when intimacy occurs
- Anxiety, guilt, or self-doubt about what this means for them or their relationship
These symptoms may be lifelong or acquired and may occur in all situations or only with certain partners or contexts.
Sex TherapyFemale Sexual Interest / Arousal Disorder
Impairment
Low sexual interest doesn’t just affect sex—it touches self-image, confidence, and emotional connection.
Women often report feeling broken, inadequate, or disconnected from their bodies.
Partners may interpret the disinterest as rejection or assume the problem lies with them. This dynamic can lead to tension, avoidance, and quiet emotional distance in what would otherwise be loving relationships.
At Ponte Vedra Psychologists, we don’t pathologize women for not wanting sex. We explore the why with respect, care, and clinical insight—helping women and couples move from confusion to clarity.
Sex TherapyFemale Sexual Interest / Arousal Disorder
Diagnosis
Female Sexual Interest/Arousal Disorder is diagnosed when a woman experiences at least three of the following symptoms on most occasions of sexual activity for six months or longer, and finds the experience distressing:
- Reduced or absent interest in sexual activity
- Fewer sexual thoughts or fantasies
- Decreased initiation of sex and lack of receptivity
- Limited excitement or pleasure during sex
- Reduced physical sensations during sexual activity
- Less interest or response to sexual cues (e.g., erotic media or situations)
Another mental disorder, medical condition, or relational issue must not better explain symptoms.
Epidemiology
- Estimates suggest up to 30–40% of women report low sexual desire, but only about 8–10% meet criteria for FSIAD
- Prevalence increases with age but is not limited to midlife or menopause
- Many women normalize their symptoms or feel too embarrassed to seek help
Sex TherapyFemale Sexual Interest / Arousal Disorder
Causes
Desire and arousal are influenced by biology, psychology, relationships, and context.
Contributing factors to FSIAD may include:
- Hormonal changes: Menopause, birth control, postpartum shifts
- Mental health issues: Depression, anxiety, trauma, or body image concerns
- Relational dynamics: Conflict, lack of emotional intimacy, unresolved resentment
- Cultural and personal beliefs: Messages about female sexuality, gender roles, or shame
- Medical factors: Chronic illness, fatigue, medications (especially SSRIs or hormonal therapies)
We work with women to untangle these threads and restore a sense of ownership over their sexual selves.
Sex TherapyFemale Sexual Interest / Arousal Disorder
Treatment
Treatment begins with validation and a deep understanding of what’s going on—not quick fixes or generic advice. At Ponte Vedra Psychologists, our approach may include:
- Insight-oriented therapy to uncover emotional and relational barriers to desire
- Cognitive-behavioral interventions to challenge avoidance, guilt, or pressure-based thinking
- Mindfulness practices to reconnect with bodily sensations and internal cues
- Couples therapy focused on emotional attunement, communication, and non-demand intimacy
- Collaboration with medical providers when hormonal or physiological contributors are suspected
- Psychoeducation on how female desire differs from spontaneous “male-style” arousal
We tailor treatment to the woman—not to a sexual performance model. Our work is about restoring comfort, curiosity, and confidence.
Moving Forward
If you feel like your sexual desire has faded—or was never fully there to begin with—you’re not alone. And there is help. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyFemale Sexual Interest / Arousal Disorder
Sex TherapyFemale Orgasmic Disorder
Overview
“A woman’s orgasm is not a performance. It’s a deeply personal response to trust, safety, and presence.”— Adapted from Dr. Gina Ogden
Female Orgasmic Disorder is characterized by a delay in, infrequency of, or complete absence of orgasm during sexual activity, despite adequate stimulation and desire. It can be lifelong or acquired, generalized or specific.
What It’s Like to Struggle With Female Orgasmic Disorder
You might feel aroused. You might be enjoying the moment. Everything may seem “right”… until the moment that never comes. For some women, orgasm feels frustratingly elusive—just out of reach. For others, it’s never happened at all, despite years of sexual activity. And for many, there’s shame in even admitting it.
At Ponte Vedra Psychologists, we often hear some version of: “I enjoy sex, but I’ve never actually had an orgasm,” or “I feel broken.” But you’re not broken. Female orgasmic disorder is more common than most people realize—and more treatable than many women are told. It’s not about performing. It’s about connecting—with yourself, with your partner, and with the parts of you that may have gone quiet long ago.
Sex TherapyFemale Orgasmic Disorder
Symptoms
Women struggling with orgasmic difficulty often report:
- Infrequent or absent orgasms, even when aroused and stimulated
- Difficulty “letting go” or staying present during sex
- Fear of disappointing a partner or feeling ashamed of their response
- Anxiety about not reaching orgasm “on time” or “at all”
- Feelings of inadequacy, guilt, or numbness
- Secretly faking orgasm to avoid discomfort or conflict
For many, the problem isn’t sensation—it’s inhibition, distraction, or internal pressure.
Sex TherapyFemale Orgasmic Disorder
Impairment
Orgasmic difficulty can create distance in even the most emotionally connected relationships.
Women may feel self-conscious or avoidant. Partners may feel inadequate or confused. Over time, the tension can lead to avoidance, blame, or mutual disappointment—despite care and love.
At Ponte Vedra Psychologists, we explore these experiences with sensitivity and skill, helping you tune back in to what your body and mind truly need to feel safe and responsive.
Sex TherapyFemale Orgasmic Disorder
Diagnosis
Female Orgasmic Disorder is diagnosed when a woman experiences a marked delay, infrequency, or absence of orgasm, or a reduced intensity of orgasmic sensations, in a way that causes clinically significant distress, and persists for at least six months during most sexual activity.
The condition can be: - Lifelong (primary) or acquired (secondary) - Generalized or situational
Diagnosis involves careful attention to context—cultural expectations, relationship quality, trauma history, and physiological contributors are all considered.
Epidemiology
- Approximately 10–15% of women report never having had an orgasm
- Up to 30–40% experience occasional or consistent difficulty achieving orgasm
- Orgasmic dysfunction is more common in younger women and those without prior sexual education or positive sexual experiences
Sex TherapyFemale Orgasmic Disorder
Causes
There is no single cause of female orgasmic disorder—it’s often the result of intersecting factors, including:
- Psychological: Anxiety, trauma history, body image concerns, or self-monitoring
- Relational: Lack of emotional safety, communication barriers, or pressure to “perform”
- Educational: Lack of knowledge about anatomy, stimulation, or what feels good
- Cultural/Religious: Messages that frame female pleasure as shameful or secondary
- Medical: Hormonal shifts, pelvic floor issues, nerve damage, or medication side effects (especially SSRIs)
- Behavioral: Habituation to masturbation patterns that don’t translate to partnered sex
Our role at Ponte Vedra Psychologists is to help you understand these variables—not to assign blame, but to illuminate a path forward.
Sex TherapyFemale Orgasmic Disorder
Treatment
Treatment focuses on increasing connection, reducing inhibition, and building both physiological and emotional responsiveness. At Ponte Vedra Psychologists, our work may include:
- Psychoeducation on anatomy, orgasmic pathways, and myths about climax
- Cognitive-behavioral therapy to address negative beliefs, pressure, or perfectionism
- Trauma-informed work for clients with a history of sexual, emotional, or religious shame
- Mindfulness practices to build interoceptive awareness and arousal regulation
- Behavioral exercises (e.g., sensate focus, guided self-exploration) tailored to your comfort level
- Couples therapy, when appropriate, to improve communication and intimacy without demand or pressure
We approach this work with warmth, respect, and a fierce commitment to helping women reclaim joy, curiosity, and agency in their sexual lives.
Moving Forward
If orgasm feels out of reach—physically, emotionally, or relationally—you’re not alone, and you’re not without options. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyFemale Orgasmic Disorder
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Overview
“The body remembers what the mind may try to forget.”— Bessel van der Kolk
What It’s Like to Struggle With Genito-Pelvic Pain / Penetration Disorder
You want to connect. You want to enjoy. But your body says no. For some women, the experience of vaginal penetration—during sex, a gynecological exam, or even tampon use—is marked by tension, fear, or pain. Sometimes it's sharp and immediate. Sometimes it's anticipatory and reflexive. Either way, it can feel like betrayal from within.
Women often say things like, “It’s not just physical—it’s emotional,” or “I want to be close, but my body shuts down.” These aren’t exaggerations. Genito-Pelvic Pain/Penetration Disorder (GPPPD) is real, deeply personal, and incredibly common—and it is treatable.
At Ponte Vedra Psychologists, we listen with care and respond with respect. We understand that this is not about being “frigid,” anxious, or uncooperative. It’s about understanding your body’s signals—and helping your mind and body relearn trust.
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Symptoms
Women with GPPPD may experience:
- Pain during vaginal penetration, whether mild or severe
- Fear or anxiety about anticipated pain, often before sexual activity
- Involuntary tightening of the pelvic floor muscles (vaginismus)
- Difficulty with, or avoidance of, intercourse, exams, or tampon use
- Emotional distress, embarrassment, or shame related to sexual activity
- Feeling disconnected from one’s body or “out of control” during attempted intimacy
The pain can feel burning, stinging, tearing, or simply intolerable—and often, no medical cause is found, which increases confusion and frustration.
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Impairment
This disorder impacts more than just physical intimacy.
It can erode confidence, limit romantic connection, and leave women feeling isolated. Many stop seeking intimacy entirely or avoid relationships altogether. Others “push through” pain to preserve the relationship—often making the problem worse over time.
At Ponte Vedra Psychologists, we don’t push. We listen. And we help women reclaim their bodies—not just for sex, but for comfort, confidence, and personal agency.
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Diagnosis
Genito-Pelvic Pain/Penetration Disorder is diagnosed when a woman experiences one or more of the following:
- Difficulty with vaginal penetration during intercourse
- Marked pain during intercourse or penetration attempts
- Fear or anxiety about anticipated pain
- Marked tensing or tightening of pelvic floor muscles during attempts at penetration
These symptoms must persist for at least six months, cause clinically significant distress, and not be better explained by a medical condition.
Epidemiology
- GPPPD affects up to 15% of women at some point in their lives
- It can occur at any age—young adulthood, postpartum, perimenopause
- Prevalence is likely underreported due to stigma, embarrassment, or misdiagnosis
- Many women see multiple doctors before a psychological evaluation is ever considered
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Causes
A single factor rarely causes GPPPD. It's often a mix of:
- Past trauma: Sexual abuse, coercion, medical trauma, or painful early experiences
- Psychological distress: Anxiety, perfectionism, fear of vulnerability, or religious sexual conditioning
- Physical issues: Endometriosis, infections, hormonal changes, or hypersensitivity
- Relational dynamics: Pressure to “perform,” fear of disappointing a partner, or unresolved conflict
- Anticipatory fear: Once pain is expected, the muscles may involuntarily brace against it—creating a self-fulfilling loop
At Ponte Vedra Psychologists, we help you break that loop with skill, science, and unwavering support.
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Treatment
Healing from GPPPD involves addressing both the body and the mind. Our treatment approach may include:
- Psychoeducation about the sexual pain cycle and pelvic floor reflexes
- Trauma-informed therapy to process past events and reclaim body trust
- Cognitive-behavioral therapy to reduce anticipatory fear and catastrophic thinking
- Gradual desensitization through mindfulness, breathwork, and guided body awareness
- Collaboration with pelvic floor physical therapists, OB/GYNs, or other medical specialists when appropriate
- Couples therapy, if desired, to help partners navigate intimacy without fear or pressure
We take our time. We follow your pace. And we help you feel safe again—in your body, in your relationships, and in your life.
Moving Forward
If intimacy feels painful or impossible, you’re not alone—and there is hope. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapyGenito-Pelvic Pain / Penetration Disorder
Sex TherapySubstances, Medications, and More (Female)
Overview
“There is no such thing as ‘just in your head’—what affects your mind, affects your body.”— Ponte Vedra Psychologists
What It’s Like When Sexual Difficulties Have No Clear Name
You may have started a new medication—and suddenly your desire vanished. Or you’re struggling with arousal or orgasm, but no one can tell you why. Maybe everything looks “normal” on paper, but something just isn’t right.
At Ponte Vedra Psychologists, we work with many women who’ve heard versions of:
“It’s probably just stress,” or “Give it time.”
But what you’re experiencing is real. Whether your symptoms are caused by medications, substances, or something that doesn't quite fit into a defined diagnosis, you deserve to be heard—and helped.
This section includes two often-overlooked categories:
- Substance/Medication-Induced Sexual Dysfunction
- Other Specified or Unspecified Sexual Dysfunctions
Each can cause real distress—and both are treatable.
Sex TherapySubstances, Medications, and More (Female)
Symptoms
Women in this category may report:
- A sudden drop in sexual interest after starting or stopping a medication
- Reduced arousal or inability to achieve orgasm, with no known medical explanation
- Numbness, lack of sensation, or feeling “disconnected” from the body
- Emotional distress about sexual changes that don’t make sense
- Frustration with being dismissed, misunderstood, or misdiagnosed
- Difficulty naming the problem—just a sense that something is “off”
These experiences don’t always fall into neat categories, but they are no less valid.
Sex TherapySubstances, Medications, and More (Female)
Impairment
Sexual difficulties without clear causes can erode confidence, intimacy, and well-being.
Many women feel embarrassed, invisible, or even gaslit.
Relationships may suffer—not because of lack of love, but because of unspoken confusion and emotional distance.
At Ponte Vedra Psychologists, we take these “gray-area” experiences seriously. Our focus isn’t on fitting you into a category—it’s on understanding your experience and helping you move forward.
Sex TherapySubstances, Medications, and More (Female)
Diagnosis
Substance/Medication-Induced Sexual Dysfunction
This diagnosis applies when symptoms (e.g., low desire, arousal difficulties, anorgasmia) arise during or shortly after substance use, intoxication, withdrawal, or after starting a medication known to affect sexual functioning.
To qualify:
- The timing of the sexual problem must match the use of the substance or medication
- The symptoms must cause clinically significant distress
- The problem must persist beyond the immediate pharmacological effects
- Another sexual disorder must not better explain it
Other Specified or Unspecified Sexual Dysfunctions
These are used when:
- The symptoms cause distress and impairment
- But don’t fully meet criteria for a specific sexual disorder
- Or when the provider chooses not to specify the exact cause (e.g., in short-term or complex cases)
Epidemiology
- Many antidepressants (especially SSRIs) are associated with reduced desire, arousal, and orgasm
- Hormonal contraceptives, antipsychotics, opioids, and certain cancer treatments can also affect sexual function
- Many cases go unreported due to shame, dismissal, or confusion
- True prevalence is hard to estimate—but these issues are common and often missed
Sex TherapySubstances, Medications, and More (Female)
Causes
The causes are diverse and may include:
- Pharmacological effects on hormones, neurotransmitters, or nervous system function
- Indirect emotional effects of medications (e.g., numbing or flattening mood)
- Withdrawal or adjustment symptoms
- Complicated conditioning from past experiences, beliefs, or trauma
- Subthreshold or subclinical sexual difficulties that don’t meet formal criteria
- Lack of provider awareness or screening during treatment for other conditions
Our job at Ponte Vedra Psychologists is not just to assess—but to connect the dots with you.
Sex TherapySubstances, Medications, and More (Female)
Treatment
Our work begins with curiosity and respect. We help you untangle the roots of your symptoms without rushing to assign blame or push for performance. Treatment may include:
- Collaborative review of medication history, in partnership with prescribing providers
- Education on the sexual side effects of commonly used drugs
- Cognitive work to address self-blame, confusion, or hopelessness
- Emotion-focused and mindfulness techniques to restore body awareness
- Support for communication in relationships affected by these symptoms
- Referral coordination for medical re-evaluation or pelvic-focused physical therapy if needed
You don’t need a perfect label to deserve real support. If it matters to you, it matters to us.
Moving Forward
If your sexual concerns don’t fit into a neat box—or seem tied to medications, substances, or something unclear—we’re here to help. Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Sex TherapySubstances, Medications, and More (Female)
A life lived well is a work of art.
Lives lived well in passionate love? A romantic concerto, a shared crescendo. – Dr. Garamoni
Fast Facts Footnote
WHO we are
At Ponte Vedra Psychologists, we are a compassionate and experienced team led by Dr. Gregory Garamoni, Ph.D., a licensed clinical psychologist with over 30 years of experience. We serve individuals, couples, and families navigating emotional, relational, or psychological challenges—with care that emphasizes clinical excellence, transparency, and personal respect. Based in Ponte Vedra Beach, we also support clients from across Northeast Florida, including Jacksonville Beach, Neptune Beach, Atlantic Beach, Jacksonville, Orange Park, Nocatee, Palm Valley, and St. Augustine.
WHAT we do
We provide therapy for anxiety, depression, relationship difficulties, and other emotional concerns. We also offer life coaching to support personal development, decision-making, and forward momentum, as well as psychological assessments for a wide range of cognitive, emotional, and educational needs—including specialized gifted IQ evaluations. Our approach blends evidence-based methods like cognitive-behavioral therapy with individualized strategies that promote insight, clarity, and lasting change.
WHERE we are
Our office is located in the Sawgrass Village Shopping Center in Ponte Vedra Beach, Florida. We offer a discreet and welcoming environment in the heart of the community, making it easy for clients from throughout the First Coast—including Jacksonville Beach, Neptune Beach, Atlantic Beach, Jacksonville, Orange Park, Nocatee, Palm Valley, and St. Augustine—to access care.
Ponte Vedra Psychologists
2304 Sawgrass Village Drive
Ponte Vedra Beach, FL 32082
(In Sawgrass Village Shopping Center, our office has a private exterior entrance on the 3rd floor of the professional office building, Park Place.)
🧭 Get Directions on Google Maps
WHEN we're open
Appointments are available Monday through Thursday, from 9:00 a.m. to 8:00 p.m. We’re flexible, so you can find a time that works best for your life and schedule—whether you're seeking therapy, life coaching, or psychological evaluation.
WHYchoose us
Choose Ponte Vedra Psychologists for our deep clinical experience, our warm and respectful atmosphere, and our unwavering commitment to your long-term well-being. We value transparency, privacy, and personalized care—offering therapy, life coaching, and expert psychological testing to meet you wherever you are in your journey and help you take confident steps forward.
HOWto connect
We invite you to call us at (904) 285‑4229 to schedule a confidential consultation, or visit our Secure Contact Form page to send a message or request an appointment online.
Our office is located at:
Ponte Vedra Psychologists
2304 Sawgrass Village Drive
Ponte Vedra Beach, FL 32082
(In Sawgrass Village Shopping Center, our office has a private exterior entrance on the 3rd floor of the professional office building, Park Place )
🧭 Get Directions on Google Maps
Availability
We are currently accepting new clients for both in-person and online sessions. Whether you're local to Ponte Vedra Beach or connecting from elsewhere in Florida, we’re here to support you with flexible, confidential care.
Please note that all appointments must be scheduled in advance. We do not accept walk-in visits, as unplanned arrivals may disrupt our scheduled sessions.
Whether you're reaching out for therapy, life coaching, or psychological assessment, we're here to support you with responsive and compassionate guidance every step of the way.
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