Should We See a Sex Therapist? An Expert Explains.

It might be just what your relationship needs.

By Lauren Zielinski, MSN, CNM
journal and coffee in bed

Our sex lives ya’ll! Let’s dig into this typically taboo topic. There is so little conversation in the media, and even amongst friends about the ups and downs of what real-life sex is actually like. I have found too, that unless we know someone who’s personally struggling, we might not even be aware that sex can be really complicated for many! It’s also sadly common to “just deal” with whatever your issue is alone, thinking that something is really wrong with you, when really it could be very fixable, and you’re very likely not alone in whatever it is you’re dealing with.  It’s also very common to shove sex to the back burner and develop a sense of complacency, telling ourselves “this is just how our sex is now,” or “I’m too busy or scared or unsure of how to even confront the issue.” Hence the game of ignoring the issue and your innate right to have a healthy relationship with sex begins. So, the question can often come up in a relationship: what is sex therapy? And do we need to see a sex therapist? 

Let’s get real—real-life sex is not easy for every one of us to begin to have, love to engage in, engage in often, or even want all the time (or ever). Another reality is that in long-term relationships, or after a triggering life event, sex can very well change, participating in sex with a partner or alone may become different, uncomfortable, less pleasurable, or even dreaded, no matter how much you love and appreciate the person—both can exist simultaneously. On the flip side, however, things can also get so much better. It’s not uncommon to have a sexual awakening later in life (or whenever it happens to you), to rediscover sex, to make positive changes, and do important work that leads to increased satisfaction, closeness, intimacy and gives you newfound pleasure and excitement. 

Like anything in life, with some focused work and commitment, we can make sex work for us.

“Sex working for us” doesn’t necessarily mean we’re having wild and crazy mindblowing sex every night though. Don’t get it twisted—one sex life does not fit all. What works for each person is deeply individual, and we all have different needs and sex drives, different levels of comfort and desire, and that’s totally okay. There is no “normal,” only what is comfortable, right, and true for you in the end. Perhaps just getting that broader idea across to your partner and finding a healthy middle ground is reason enough to attend sex therapy. 

I love to remind everyone too, that we all have 100% full permission for our sexual health needs to change over time, or even from day to day. That’s a sign that you are always staying in tune with your own body and mental health.

How freeing is that thought? Sexual satisfaction—again, whatever that looks like for you—is a staple of embodying your health holistically and is totally worth confronting if you’re having a less than easy time or have questions. So, let’s talk about how using a sex therapist might be the perfect fit for you, or the two of you, to take control and begin to work through whatever it is you’re needing. 

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Sex therapy is not instructive—it works at the root of the issue. 

You’re not alone if you heard the words “sex therapy” and imagined someone teaching a couple how to have sex. Perhaps you even thought sex therapy included having sex in front of someone or involved a tantric sex or kama sutra workshop. So what is sex therapy? Well, first of all, sex therapy is none of these common misconceptions. With such a marked disconnection and lack of confrontation of both mental health and sexual health concerns and how poorly they are addressed and legitimized in our society, it’s no surprise that an amalgamation of the two is broadly misunderstood. 

Sex therapy is a well-regarded and legitimate form of therapy. Sex therapists are most often licensed therapists, social workers, or psychologists, hold a master’s degree, and have completed additional specialized coursework and training in sex therapy. They are experts in their field and have a profound dedication to helping couples or individuals address their relationship and personal sexual concerns at the root cause of intimacy issues. A sex therapist won’t help you have sex in the moment (that would be weird right?!), however, they will help you address what is causing concern around sex to become more comfortable or confront fears with the hope that this aids in a healthier relationship with sex in the future.

Sex therapy is also beautifully proactive work. It allows you or you and your partner to get ahead of issues that may be building in the background of your busy lives.

It could even save a relationship you feel like is on the verge of failing. Of course, that includes time, energy, and hard work from both parties, but with willing participants, sex therapy could be hugely helpful to a troubled relationship or one in which there is a communication breakdown. 

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How did we get here? What can a sex therapist help me with?

As uniquely individual human beings, each relationship is intricately complex, and the reasons you may want some assistance delving into finding a better place in your sex life will be unique to your own body, your history, your mental state, your past, etc. However different we each are though, there are certainly broader commonalities we may share when it comes down to why sex doesn’t always look or feel like it does in the movies, or why perhaps things were one way, and then they changed. I’ve listed some normal, and common concerns or root issues that could lead to difficulty in the bedroom. 

A reminder that however emotionally or physically traumatic or challenging your unique concern may be, whatever is happening to you is likely normal, because it’s normal for things to not be perfect—it doesn’t mean you need to live with it though. 

While this list is not exhaustive, it skims over some of the big hitters that are beyond valid reasons to begin sex therapy:

  • A breach of trust in a relationship—either physical or emotional—leading to distrust and intimacy issues between two partners
  • Feeling like you and your partner are no longer connected intimately
  • Feeling like sex has become “boring” or “routine” in either partner 
  • Misaligned sex drives between partnered people
  • Post-birth changes in hormones, libido, anatomy, or confidence
  • Feelings of guilt around sex, sometimes relative to a religious upbringing or culture that views sex as “wrong” or “dirty” 
  • Individual physical conditions that cause pelvic pain or painful sex such as
  • Complicated / negative / traumatic past experiences with sex or sexual function 
  • LGBTQ+ individuals who may have complicated relationships with sex due to illegitimate shame or alienation that has been inflicted on them in the past for their sexual choices
  • Coping with acquiring a long-term sexually transmitted infection
  • A history of erectile dysfunction or other sexual dysfunction in men or women
  • Confidence issues that hinder you from relaxing and enjoying sex
  • Inability to orgasm 
  • Coping with and accepting feelings of asexuality, wondering if it’s normal if you’re just not a sexual being
  • Anxiety
  • A history of traumatic sex, rape, incest, or sexual abuse 
  • A physical deformity in the genitalia

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Sex therapy can be addressed alongside broader relationship concerns. 

Therapists who work in the realm of sex therapy are most often relationship specialists as well and don’t typically only offer sex therapy—this is a big pro for the patient. A therapist who primarily works and is trained in family, trauma, or relationship counseling will often obtain an additional license in sex therapy to broaden how they might help their clients with complex issues.

A common example here: a woman may have a medical condition that causes painful sex alongside a history of sexual abuse from childhood. Every time she tries to have sex, even when she really wants to, she must stop due to pain and anxiety. The issue in this example (and in many cases) is two parts, the woman probably needs to address her history of sexual dysfunction as well as her history of abuse to get to a place where she might feel comfortable with intimacy in the future. A relationship and family counselor with a specialty in sex therapy is well trained to do all of this work with the client. A relationship and sex therapist could also make the appropriate referrals for pelvic floor physical therapy or gynecology to work on vaginal or pelvic pain conditions concurrently. Make sense? The two complement each other to provide robust mental and sexual healthcare. Sweet!

How private is sex therapy?

Sex therapy is discreet and HIPAA protected. In non-healthcare language that means totally confidential by law, and the discussions you have with a sex therapist will be 100% private and between only you and your provider. If you live in a small town or seeing someone in your own city feels too close to home, or you simply feel better addressing sex-related concerns with someone who lives far, far away, consider remote therapy. Thanks to COVID-19 the telehealth industry is booming and tell visits are widely available. Sites or apps like Better Help or ReGain are a perfect in-between. 

Are we ready for sex therapy? What will it look like?

Confronting issues that come up during sex is more often than not introspective and potentially heavy, deep work depending on what’s going on.

Make sure you and your partner are ready to dig deep and start working on whatever that is. Understand it may feel like a pretty vulnerable place for many people. Additionally, keep in mind that it will take time, effort, and continued visits—this is not a one appointment fix.

Visits typically feel and look similar to a normal therapy experience. Talk therapy is how most sex therapy begins. You will be asked questions about what brought you in, your history, your past, your current relationship, and your provider will help isolate where the root of your concern may be.

Your therapist may also give you homework, including communication exercises, reading assignments, sexual experimentation exercises, or suggestions to incorporate mindfulness into your day-to-day routine. Some therapists may also inquire if you’d like to participate in a treatment option called EMDR to help integrate specific traumatic experiences and move forward from them. You may also receive referrals for specialty physical therapists or doctors who specifically work with certain sexual dysfunction conditions. 

Lastly, you will also obviously need to take regular time out of your schedule to attend therapy sessions. Hopefully, the time and effort required to work on your needs doesn’t put you off from beginning this deeply healing and potentially life and sex morphing work if needed. The possibility for change in the long term is positive—it may be helpful to focus on that goal rather than stress about what happens in between. Take this one step at a time!

How to find the right therapist 

When you begin your search be sure you find someone who is a certified sex therapist, not just a random person who claims to be experienced—Eep! A trustworthy source would be a therapist with a master’s or doctoral degree in a therapy field, which can include licensed therapists, social workers, psych nurse practitioners, or psychologists, as well as is AASECT certified. AASECT is The American Association of Sexuality Educators, Counselors, and Therapists and is responsible for the rigorous certification needed to become a certified sex therapist. Consider inquiring that whomever you would like to see is legitimately certified. Ask them about their experience!

Don’t forget you’re hiring them to guide you on this journey and you want a good fit and someone who is legit. You very well may be able to find someone who takes your insurance as well. You shouldn’t have to pay oodles of money for this kind of work.

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In closing…

If you decide to pursue sex therapy I wish you the best of luck and I hope that after reading a bit more about what is sex therapy you may be inspired to seek out help if you need it—or perhaps you can pass this article along to someone else who may be silently struggling. Don’t forget to soften where you feel resistance, to breathe life into the parts of this work that feel hard, and be open and malleable to shifting your preconceived ideas and patterns around sex and relationships.

The possibility of change and new growth is so abundant with given time, energy, and work. It’s not easy work, in fact, it takes a great deal of bravery and openness to confront sexual frustration, pain, trauma, or dysfunction. But the sooner you start, the sooner you might begin to heal from whatever wound it is that is derailing you from finding more peace, joy, and satisfaction.

Best of luck on your journey friends, and give yourself a big hug and pat on the back for your vulnerability for even considering and broaching the topic, opening your mind is the first step.