People come to sex therapy for many different reasons. Sometimes, people may feel depressed, experience anxiety, or have trouble with their partner and not realize that the reason is related to a sexual issue.

For example, some couples may come to counseling because they complain of not having any emotional or physical intimacy or they just feel unhappy in their relationship. Upon further investigation, it may be revealed that one person was sexually abused as a child or perhaps an infidelity is taking place in the relationship.

Other reasons people decide to come to sex therapy include the following:

For Women:
•    Painful sex
Low sexual desire
•    Difficulty becoming sexually aroused
Inability to have an orgasm
•    Pelvic pain
•    Reproductive sexual issues
•    Birth trauma
•    Vulvar Vestibulitis

For Men:
    Erectile dysfunction
    Delayed ejaculation
Premature ejaculation
•    Peyronie's disease

For Both Sexes:
•    Sexual addiction or excessive sexual behavior
•    Sexual abuse
•    History of sexual offending
Transgender care
•    Pedophilia
Gay, lesbian or bisexual concerns
•    Alternative sexual lifestyles
•    BDSM & Kink
•    Aging and sexuality
•    Unwanted sexual urges or behavior
•    Fetishes
•    Body image concerns
•    Disabilities and sex
Cancer and sexuality
•    Sex education
•    Sexual skills development

For Couples:
•    Decreased sexual frequency
•    Lack of enjoyment of sex
Lack of desire to have sex
•    Lack of intimacy or emotional closeness
•    One partner wanting sex more than the other
•    Issues with sexual performance in one or both partners
•    Polyamory
Infertility issues
•    Infidelity

What a Sex Therapist Does

A sex therapist can hold an advanced degree in the areas of counseling, psychology, medicine, or social work. In addition to holding a license from their respective licensing body, sex therapists undergo training beyond what is required for gaining credentials in their field.

This training includes education in the areas of human sexuality, sex therapy theories and techniques, supervised clinical experience by a practicing sex therapist, and exploration and understanding of one’s own feelings, attitudes, values, and beliefs regarding human sexuality and sexual behavior. In the United States, the national certifying body for sex therapists is the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). A sex therapist does not have to be certified in order to practice sex therapy, but seeing a certified sex therapist ensures that your therapist has received extended training and has illustrated competency as a sex therapist. 

Your choice to see a sex therapist versus seeing a counselor or psychologist who is not certified as a sex therapist is similar to seeing an oncologist instead of your family practice doctor if you are diagnosed with or are treating some form of cancer. In short, the focus of a sex therapist’s practice is on assessing and treating sexual issues. This results in sex therapists having an in-depth knowledge of human sexuality, sexual anatomy and physiology, and the treatment of sexual dysfunctions. 

How Sex Therapy Works

Sex therapy is conducted in a similar fashion to other forms of psychotherapy or counseling. It consists of meeting with a counselor or psychologist to talk about and explore your concerns. Once you and your therapist have a basic understanding of the problem, your therapist will design a treatment plan for you.

Given the multi-faceted nature of sexual issues, your issue may be linked to other psychological, relational, or physical conditions that you might have. Some types of sexual dysfunctions are related to a biological cause. In this case, your sex therapist may ask you to sign a release of consent so that he or she can collaborate with your physician, psychiatrist or physical therapist to provide the most comprehensive treatment possible.

Other types of sexual issues may be the result of a dynamic between you and your sexual partner. In this case, your therapist may ask that your partner attend sessions with you. In any case, you will be asked to collaborate with your therapist to provide feedback on what works for you in the therapy process. Therapy is a very personal process and should make you feel safe, respected, and encouraged.

How Sexual Issues Are Understood

Sex therapy can focus on many different aspects of sexual health and functioning. In the field of sex therapy, sexual issues are broadly categorized, diagnosed, and researched under three main umbrellas: 

1.  Sexual Dysfunctions – Issues related to psychophysiological changes in the sexual response cycle, including the following diagnoses or related symptoms:

  • Delayed ejaculation (persistent difficulty in ejaculating)

  • Erectile disorder (failure to attain or maintain an erection)

  • Premature ejaculation (climax occurs too quickly)

  • Male hypoactive sexual desire disorder (low desire for sex)

  • Female orgasmic disorder (not being able to achieve orgasm)

  • Female sexual interest/Arousal disorder (not being interested in sex or not becoming sexually aroused)

  • Genito-pelvic pain/Penetration disorder or Vaginismus (having pain before or during vaginal penetration or inability to achieve penetration)

2.  Paraphiliac Disorders – Sexual urges, fantasies, or behaviors including the following diagnoses or related symptoms that cause distress or impairment:

  • Voyeuristic disorder (observing others undressing or having sex with or without their permission)

  • Exhibitionistic disorder (sexual arousal from exposing one’s of genitals to a stranger)

  • Frotteuristic disorder (sexual arousal from touching or rubbing up against a non-consenting person)

  • Sexual masochism or sadism disorder (sexual arousal in response to the pain, suffering, or humiliation of self or others)

  • Pedophilic disorder (sexually arousing fantasies, sexual urges or behaviors involving a prepubescent child or children)

  • Fetishistic disorder (using non-living objects or specific focus on a nonessential body part for sexual pleasure)

  • Transvestic disorder (sexual arousal by the act of cross-dressing as the opposite gender)

3.  Gender Dysphoria – Incongruence between one’s experienced/expressed gender and assigned gender which causes significant distress or impairment 

Keep in mind that these categories are not mutually exclusive. An issue in one area does not preclude an issue occurring in another area as well. Human sexuality is dynamic, and its expression is unique for each person. In addition, these categories do not specify the cause of the issue.

For example, a person may present with complaints of an inability to maintain an erection. It could be that this person is physically unable to maintain an erection due to a physiological problem, or it could be that this person has a history of sexual abuse that is psychologically interfering with his ability to maintain an erection. Diagnosing sexual issues in broad categories such as these aids therapists and clients in understanding the specific issue.