The Ultimate Guide to Understanding Sex Therapy

Sex therapy can help address a variety of issues, including sexual dysfunction, intimacy problems, and relationship difficulties. Learn more about what to expect in this comprehensive guide.

What is Sex Therapy?

Though sex is often seen as a taboo topic, it is an important aspect of many people’s lives. For some, sex is a source of pleasure and intimacy, while for others, it can be a source of anxiety and stress. Therapy is often seen as a tool for helping people deal with their mental health. Sex therapy is a specific type of therapy that focuses on addressing and resolving sexual problems and concerns such as issues with desire, orgasm, pain, and arousal. It can help individuals understand and communicate better about their sexuality and increase overall satisfaction in their relationships. Sex therapists provide a nonjudgmental place to talk about sexual health, sexuality, and problems that affirms your core beliefs and values. Everyone is different and the journey or process is unique for everyone.  

What can I expect to happen in a session?

Sex therapists will need to get to know and understand the problem you are coming with, so they will need to ask questions about your current and past sexual functioning, your current and past relationships, current and past medical history, and understand more about your thoughts, feelings, and fantasies if relevant. They will ask at a pace that is comfortable for you. While they are comfortable with the topic of sex, they understand that it may be hard for others to talk about it. 

Are there different types of Sex Therapy?

Sex therapy can be done with individuals, couples, or groups. There are four main types:

  • Behavioral Therapy
  • Cognitive Behavioral Therapy
  • Sexual Surrogacy
  • Medication

Behavioral therapy involves a technique called Sensate Focus Therapy which is typically done as part of couples’ work but can also be done individually. At Sexual Health and Healing, we refer to it as a part of mindful masturbation. Both are a process where people connect with the sensation of touching either alone or with a partner to connect with nonsexual touch. Without the erotic or sexual component, people can relax more and enjoy pleasure in many different kinds of touch. This is done mindfully. At Sexual Health and Healing, we also monitor thoughts and feelings, because connecting with touch can be a powerful experience and bring up emotions or experiences that may benefit from further discussion with talk therapy. Sensate Focus works well for those with Vaginismus, Erectile Dysfunction, Dyspareunia, and Premature Ejaculation. It also works as a good adjunct to Out of Control Behavior Treatment as a means of reconditioning a healthier replacement for previous behaviors. 

Cognitive Behavioral Therapy (CBT) utilizes thoughts and does not just focus on the behaviors like in behavioral therapy. CBT will target the thoughts that create problems with desire, arousal, pain, and orgasm. People learn how to replace them with more adaptive thoughts to reinforce a more comfortable response, which is often emotionally driven. This approach is helpful for those that have self-deprecating, anxious, or distracting thoughts that inhibit their sexual responsiveness. 

Sexual Surrogacy is a more controversial approach where the therapist works with a person (sexual surrogate) who engages in touch with the client to help safely practice various techniques or behaviors. Sex therapists do not touch their clients and why surrogacy always involves another person. This has been helpful for those with disabilities or very limited sexual experience who are very anxious about what time to do it. The therapist collaborates with the client and surrogate to come up with a comfortable approach that will meet the client’s goals. They provide emotional support, and social skills, and help them learn how to relax (Lehmiller, 2018). There was a movie based on a true story called The Sessions starring Helen Hunt where she was a sexual surrogate to a man with physical disabilities. It shows how sexual surrogacy can be powerful, helpful, and professional.

Medications can be a good adjunct to sex therapy. They are often not the sole answer to challenges. Medications most often used include: 

  • Hormone therapy: testosterone for low desire in women and men and estrogen replacement for women with arousal issues post menopause
  • Viagra: erectile dysfunction
  • SSRIs: premature orgasm
  • Botox: vaginismus and premature orgasm

What are the benefits of Sex Therapy?

Sex therapy can be helpful for individuals of all ages and genders who are experiencing difficulties with sex. Some of the benefits of sex therapy include improved communication, enhanced intimacy, sexual confidence, greater understanding of one’s body, and increased satisfaction in sexual relationships. Our bodies and hormones change throughout our lives. The are many biological, psychological, and social factors that can impact our ability to experience desire, arousal, and orgasm. How we see ourselves as sexual beings can also change throughout our life span. Sex therapy helps you move through emotions, trauma, negative, thoughts, and relationship issues that may be a barrier to your sexual expression. 

How do you know if you need Sex Therapy?

Many people would struggle with the idea of needing a sex therapist. Sex is personal, private, and taboo for some. The idea of talking to a stranger about your genitals, sexual fantasies, or sex life could be scary. That said, for some their sexual issues may cause such distress, that not getting help could be just as difficult. Here are some of the reasons that people may seek out a sex therapist:

  • I don’t think my partner understands my sexual needs or fantasies
  • I am nervous too or never have talked about my sexual needs or thoughts with my partner
  • I am scared to have sex
  • I feel pain when I try to have sex
  • I can’t seem to maintain an erection
  • I used to have more sexual interest, but I don’t anymore
  • I feel shame before, during, and/or after sex or masturbation
  • I think about sex too much and am bothered by it
  • I violated the relationship agreement I have with my partner regarding sex
  • I think I masturbate too much
  • I want to explore polyamory or ethical nonmonogamy
  • I want to create boundaries for one of my kink interests

There are many other potential reasons why someone would seek a sex therapist, but the above list names a few. It is important to remember that as our bodies and lives change, so may our desire, arousal, and orgasm abilities change. As we have new experiences and partners, things may change. Most people experience some kind of sexual challenge at some point in their life. While we can’t prevent these challenges from happening all the time, here are some tips to try to minimize sexual problems:

  1. Communicate verbally and non-verbally with your partner about sex before, during, and after
  2. Don’t pressure yourself or your partner to race to an orgasm finish line. Sex is meant to be relaxing and pleasurable. Expectations create judgment and ultimately make it difficult to relax. 
  3. Sex isn’t something you are obligated to do or fill a quota
  4. Take care of yourself physically and psychologically. Physical health can impact the blood flow that is needed for sexual functioning. Anxiety, shame, and depression are common causes of sexual and relational challenges as well as communication. 

Will Sex Therapy help my marriage?

Sex therapy often includes all partners who are involved in sex. Treatment will focus on communication, boundaries, education, and intimacy (not necessarily sex). The therapist won’t view one person as a problem but rather view the sexual challenge through the lens of the partnership. Communication and complicated emotions often are the root of many (not all) sexual issues. There may be times in treatment where the therapist may meet with each of you individually or it may be suggested that individual treatment become an adjunct to address something specific that requires more attention and loses sight of the partnership. That said, if someone has medical or biological challenges, those will be addressed by a medical doctor and outside of sex therapy, though your therapist and doctor may collaborate. 

How do I find a Sex Therapist?

A sex therapist has specific training above and beyond the education needed to be a therapist. The American Association of Sexuality Educators Counselors and Therapists (AASECT) is the certification and education authority for sex therapists. Those who are certified go through a rigorous series of education and supervision to ensure they develop specialized skills and knowledge to be a sex therapist. It is important to choose a therapist with AASECT certification because many states don’t have a certification or a license for sex therapists. Therefore, therapists can say they are sex therapists but do not have the specialized training, rather a therapist is comfortable talking about sex. At Sexual Health and Healing LLC, we have an AASECT certified psychologist, Dr. Waldron, but to review a state-by-state list of certified providers, AASECT has a directory

Please contact us if you have more questions about sex therapy or are interested in starting your journey. 


American Association of Sexuality Educators Counselors, and Therapists (AASECT)

Lehmiller, J. (2018). The Psychology of Human Sexuality. 2nd Edition

Ladies! There is a great research based resource filled with videos, animations, and articles to help women connect with their pleasure. This info was created from the sexual discoveries of 20,000 women and in collaboration with Yale University, The Kinsey Institute, and Indiana University. There is so much information on the internet that it can be hard to know who to trust. OMG YES is a trusted resource!

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