Couples counselor Sara Nasserzadeh has helped clients who don’t want, or can’t have, a life in the bedroom find happiness elsewhere.

Question: How does sexuality differ across the globe?

Sara Nasserzadeh: When we're talking about global perspectives on sexuality, I have to say, again, based off my experience when I travel around the world, I can give you some really -- they are not strictly caught, you have to understand that, but on the other hand, there are some specific areas that I can generalize.

The first part is in the Middle East. The whole culture is so sexualized; the literature and the whole talking to each other women to women, men to men, they make lots of jokes and all that. But as soon as it comes to problem, problematizing the sexual life, people go silent. This is not something to be discussed. So they go to the doctor probably, at most.

In Asia and countries, South Asian countries, they are more conservative I would say. There is not a chance for you to joke around sex or use the sexual words. They are not as many sexualized words, if you like, in those cultures, even in the terminology that they have. So that is the difference between those two cultures.

But one of the similarities that you can find among Middle Eastern, South Asian, and Asian cultures is that actually sexuality is a part of the person's life; it comes naturally. So nobody tells them to supress them forever. For example, in some of the more religious Christian based countries or cultures. So they come to know their sexuality after marriage, but it is a part of the social life of a human being. So you are expected to be sexual, but it is after marriage.

But then you come to Western European countries and Northern American countries, it's mostly you can joke about sexuality. As far as you medicalize it, you problematize it, you speak about it scientifically, or on the other hand put it on the Hollywood movies, naked pleasureville and sassy, then it should be okay. But in everyday life, really, you don't sit with your girlfriends or boyfriends and joke about sex or talk about sex all the time.

So this is -- and also sex is a separate phenomenom. It could have nothing to do with your social life. You can just have sex, one night stands, and all that. It's your sexual part. And then you can have a total separate social life for yourself as well. So it's not something that is quite supported by your social network.

Question: What were some problems you saw in your London practice?

Sara Nasserzadeh: The good thing about being a clinician or practitioner in big cities like London or New York is that you don't necessarily see people from that specific city but you get to see people from all around the world. To add another plus, London, because it's close to many, many places like other European countries or Middle East or Southern Asia, I used to get some clients flying from Israel or France, different European countries as well as Middle Eastern countries or Israel. Just for short intense therapy, for specific sexual dysfunction. Most of the cases that I saw were related to vaginismus, which is the involuntary contraction of the vaginal entrance so that the penetration actually is not possible, the intercourse. So at the point that I used to see those couples, most of them would come to me based from very, very religious backgrounds and they just came to me to get pregnant.

For some of them, I would just ask them, "Is it important to you to have a sex life or are you just here to have sex to get pregnant?" If it is the second choice that you're making, no sex life but the baby, don't waste your money on me. Go and do it yourself. Like with the turkey baster or something. Or even go to a gynecologist. Just ask them to do the insemination for you. If was very interesting-- I had three couples who chose to do that, rather than going through the whole sex therapy and getting close to each other and all that. And that's perfectly okay because it really depends on the dynamic of the relationship. And when we are getting trained as therapists, the most important thing for us is the goal that the client wants to achieve because I might go there with lots of perceptions and expectations and want to impose it on my clients; that's not how it works. They come to you with specific agenda. You might give them information and based on that they might change their goals in their minds, but it doesn't happen all the time because they have their own dynamic of their relationship and the whole playing thing going on, give and take between the couple and the whole social circle around them: in-laws and the social capital that they have and all that.

Recorded on October 20, 2009