Sex Therapy How It Works What It Helps and More
Sex and intimacy can be pleasurable and fulfilling, but they can also be fraught with complicated, uncomfortable, or even painful emotions. If you aren’t satisfied with your sex life or are experiencing relationship problems related to sex, a certified sex therapist may be able to help.
What Is Sex Therapy?Sex therapy is a form of psychotherapy in which a licensed healthcare provider uses evidence-based treatments to help people overcome emotional and mental challenges related to sex and intimacy.[1]It can improve individuals’ experiences with pleasure and strengthen couples’ relationships.
Most sexual therapy takes the same fundamental approach as talk therapy.[1] Therapists usually begin by asking questions to understand a patient’s problem and how it affects their life and relationships. They’ll also help patients identify a problem’s root cause, says Wendi Dumbroff, a sex therapist in Madison, New Jersey.“It’s understanding how a person became the sexual being that they are through their sexual and relational history and all the messages we get from culture, religion, and family growing up about what sex is, what it means,” Dumbroff says.
Simply talking to a trusted person in a safe, confidential, and nonjudgmental space can be beneficial, but therapists also give patients tools to cope and make positive changes.[2]“When we don’t have a solution for something, we seek outside help. Just like if you’re sick and your cold is getting worse and it’s now in your chest — you may need an antibiotic, and you go to your doctor,” Dumbroff says. “When something is inhibiting your relationship, your happiness, your personal goals … it’s useful to come to sex therapy.”
Types of Sex TherapyAs noted, almost all sex therapy is psychotherapy (counseling), which encourages patients to talk about their experiences and emotions. Some practitioners also incorporate sensate focus therapy. “There are several approaches to sex therapy, each tailored to different challenges,” says Lisa Lawless, PhD, a sex therapist and the CEO of Holistic Wisdom in Bend, Oregon.
Talk TherapyLawless says the following are some of the most common types of psychosexual therapy techniques.
Cognitive Behavioral Therapy (CBT) A widely used method, CBT helps people recognize and change negative thought patterns or beliefs that are affecting their sexual experiences, Lawless says.[3] CBT can also be used to address unhelpful behaviors. “It’s especially helpful for those struggling with anxiety or other mental blocks that interfere with their ability to enjoy sex,” she says.Psychodynamic Therapy For those who want to explore how their past experiences and unconscious factors affect their present, psychodynamic therapy may be helpful, Lawless says.[4] “This approach delves into how your early relationships or past events may be influencing your current sexual life, uncovering subconscious factors that could be holding you back,” she explains.Emotion-Focused Therapy (EFT) Emotion is fundamental to the human experience and identity, according to the principles of EFT.[5] “This method dives into the emotional issues beneath intimacy struggles, helping couples reconnect and heal deeper emotional wounds that may be getting in the way of physical closeness,” Lawless says.Mindfulness-Based Therapy Lawless says mindfulness encourages people to be present and fully engaged in the moment.[6] “It’s especially useful for managing low desire or anxiety, helping individuals focus on sensation and connection rather than letting their mind race with worries,” she says.Systemic Therapy Lawless says systemic therapy looks at the “bigger picture” of how various relationships, including those with romantic partners, friends, and family, could affect your sexual health.[7] “This type of therapy is often used to help couples navigate relational dynamics like communication or unresolved conflicts that affect their intimacy,” she says.Acceptance and Commitment Therapy (ACT) Lawless says ACT is about learning to accept uncomfortable feelings without letting them take over.[8] “It’s a great option for people who feel stuck in negative thought patterns related to sex or intimacy, helping them refocus on what really matters to them in their relationships,” she says. ACT can also help someone build more adaptive behaviors that are consistent with a person’s values.Sensate Focus TherapySensate focus is a form of behavioral sex therapy that helps couples reconnect physically without pressure to perform sexually, Lawless says.[9] Therapists give patients homework assignments that specifically involve physical touch with increasing levels of intimacy.“It’s incredibly useful for couples facing mismatched desires or performance anxiety,” she says. “By focusing on touch and connection rather than specific sexual outcomes, it helps reduce the stress that often builds around intimacy.”
What Conditions Can Sex Therapy Be Used to Treat?Sex and intimacy involve a complex interplay between the brain and body.[10] By helping people overcome mental and emotional barriers, therapy can improve various facets of people’s sex lives, including sexual function, relationships, and identity.Specifically, sex therapy can help with the following challenges:[1]Low desireProblems with arousalErectile dysfunction (ED)Premature or delayed ejaculationPainful sexTrauma related to sex and intimacyShame, anxiety, or other negative feelings about sexProblems with gender or sexual identityPoor body image as it relates to sexIssues stemming from cultural, religious, or societal messages about sexDiffering desires or levels of desire between partnersRelationship problems related to sexImproving communication in relationshipsDealing with a sexually transmitted infection (STI)Sex or porn addictionSex therapy can be a standalone treatment for many emotional and relationship problems, Lawless says. But if you’re dealing with a physical problem such as an STI, painful sex, or ED, it’s important to get medical treatment for that, too, she says. Sex therapy will work better if you also attend to your physical health, she adds.[1]“Sex therapy is often recommended as part of a larger treatment plan for issues like erectile dysfunction or premature ejaculation. For instance, organizations like the American Urological Association include sex therapy in their guidelines alongside medical treatments,” she says.[11] “In these cases, therapy helps address the psychological or relational aspects of the condition while medical treatments handle the physical side.”What Does Research Say About Sex Therapy?Research suggests sex therapy may be effective in addressing many types of concerns.
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For example, one systematic review and meta-analysis of 18 studies noted that sex therapy was effective in improving sexual function, communication, and satisfaction.[12]Another review and meta-analysis evaluated the effects of internet and mobile-based psychological interventions (IMIs) on sexual function and satisfaction.[13] IMIs, in this case, include online sex therapy tools that incorporate techniques such as CBT and mindfulness. After analyzing 12 clinical studies, researchers concluded that IMIs were “significantly more effective than control conditions” for female and male sexual functioning and female sexual satisfaction.Moreover, a systematic review and analysis of 11 studies and 449 participants found mindfulness in sex therapy was effective in treating female sexual dysfunction.[14] And a randomized controlled trial of 70 women with low sexual desire found mindfulness in sex therapy improved symptoms.[15]Finally, in a small, preliminary study of 28 young men with nonorganic erectile dysfunction (ED), a type of ED linked to psychological factors such as stress, anxiety, or depression, researchers found cognitive behavioral therapy for sex problems had a similar effect to sildenafil (Viagra) in improving people’s symptoms.[16]How to Get Started With Sex TherapyIf issues related to your sex life or sexuality are adversely affecting your mental health or relationships, it may be a good idea to schedule an appointment.[17]What Is a Sex Therapy Session Like?A typical sex therapy session is much like any other talk therapy session but with a specific focus on sexual issues, Lawless says. “When you arrive, the therapist will usually start by asking about your concerns, history, and what you hope to achieve,” she says, noting that sessions typically last 45 minutes to an hour.
Dumbroff stresses that your therapist will not touch you or ask you to touch yourself or your partner. After the session, they may ask you to do certain activities, such as holding hands or role-playing with a partner, but these homework assignments are the only physical component of sex therapy and happen privately in your home.[1]“We may and will talk about intimate things, but it is talk therapy,” she says.
It can be challenging to discuss emotional, intimate topics, Lawless says, but therapists are trained to create safe, nonjudgmental environments where you can open up at your own pace.
“Each session is tailored to your specific needs. Sometimes, the focus is on improving communication between partners, while other sessions may include exercises like mindfulness or relaxation techniques to ease performance anxiety,” she says. “There’s no one-size-fits-all approach; the therapist will work with you to develop a process that supports you as you explore these sensitive areas.”
How to Find a Sex Therapy ProviderOne of the best resources for finding a certified sex therapist is the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), which offers a searchable directory of certified practitioners, Lawless says. The Society for Sex Therapy and Research has a similar directory. Local clinics and organizations like Planned Parenthood can also provide low-cost free referrals and sexual health services, she adds.
Some therapists accept insurance, but Lawless says to check with your provider to ensure your sessions would be covered. “Many therapists also offer sliding scale fees based on income, making therapy more accessible for those without insurance coverage,” Lawless says.
How to Prepare for a Sex Therapy SessionLawless says it can be helpful to prepare a list of concerns you want to discuss, along with your treatment goals. Have some of your health or medication history on hand, because medical issues and medications can sometimes affect sexual health, she adds.
“If you’re attending as a couple, it’s a good idea to discuss your goals beforehand — whether you’re looking to improve communication, rekindle intimacy, or tackle a specific issue,” she says.
Who Shouldn’t Try Sex Therapy?Sex therapy isn’t suitable for everyone, Lawless says. If someone is dealing with severe mental health conditions, such as untreated depression, anxiety, or schizophrenia, she says it’s best to develop an effective treatment plan for those things beforehand.
“Also, for those in abusive relationships, safety needs to come first,” she says. “Addressing the abuse is the priority before focusing on intimacy, as therapy in these cases can sometimes obscure the real issue rather than solve it. A safe, supportive environment is crucial before any intimacy work can begin.”
For people who’ve experienced sexual trauma, Lawless adds, a trauma-informed therapist is essential.
“Addressing trauma can bring up difficult emotions, so having the right support is key to navigating those challenges without making things worse,” she says.
The TakeawaySexual health counseling provides a safe, comfortable space to identify and overcome various psychological issues related to sex and sexuality. Although a certified sex therapist can’t diagnose or treat physical health conditions, research suggests therapy can help alleviate symptoms, especially when used together with other medical treatments. If you’re unhappy with your sex life, experiencing mental or emotional issues related to sex, or want to foster more connection with your partner, consider scheduling an appointment with a licensed provider.