I am a 39-year-old female married for seven years. In the past four years, I have avoided sex like the plague. Today my therapist and I began a discussion on the sexual issue, and I realized that I simply can't talk about it. What can I do to overcome my fear of dealing with subjects past and present pertaining to sex? --Sharon

One of the first things I recommend, if you haven't done so already, is to let your therapist know that you are having difficulty talking about the subject. That way, he or she can first help you resolve your trouble talking about sex. Then the two of you can work on the sexual problem itself.

When one of my clients finds it hard to talk about something, I usually suggest that we slow down and first explore why they're having trouble. I let them know that they're in charge of what and when we talk about something. (Some therapists may have a different, more directive approach, but I focus on empowering the client as much as possible. If a client isn't able to talk about something, I think there's a reason for his or her difficulty, and I want to understand and address that reason instead of trying to force the person to talk before he or she is ready.) Sometimes I might suggest a client write a journal about either the issue itself or his or her problem talking about it, with the option of sharing that writing with me at some point if he or she wishes.

We might talk about why he or she can't talk about "it" without even having to say what "it" is. Some people, for instance, may feel something terrible will happen if they talk about "it" (whatever "it" might be). They may fear that I'll be horrified at their disclosure and refuse to work with them anymore, or that I will think less of them in some way. Some people have been taught that it's bad to talk about certain subjects (like sex) with other people, or that it's wrong to air their family's "dirty laundry" outside the home. And some people who have stuffed down or numbed feelings for a long time may fear that once they start talking about a painful subject they'll open up old wounds and be overwhelmed with pain or sadness.

Some child abusers silence their victims by threatening bodily harm to the child, family members or beloved pets if the child ever discloses the abuse to others. Given such threats, of course, a child may understandably be terrified of talking about the abuse. And sometimes the child grows up to be an adult who still has that frightened child's belief that something bad will happen if he or she ever approaches the topic.

I don't know why you're having difficulty talking about sex, of course, or why you've been avoiding sex. (The two problems may be related.) But I do recommend working first with your therapist on being able to talk about sex, period. Let him or her know you're having trouble and may need to go slowly. See if you can first identify and address whatever you fear might happen if you talk about the subject. Good luck.