What’s a sex therapist

You may have joked to friends that you don’t need therapy—you have them. But sometimes working through the hard stuff requires help from a neutral party who happens to be a licensed professional. If your hard stuff is about sex, a sex therapist may be your best option. Here are eight signs a sex therapist could be a great addition to your life, and after that, advice on actually finding one.

1. You’re experiencing pain or physical difficulty when you try to have sex.

It’s important to see a medical doctor first to rule out any physical conditions behind this, somatic (body-based) psychologist and certified sex therapist Holly Richmond, Ph.D., tells SELF. Unfortunately, a ton of things can cause horribly painful sex, like cervical inflammation from a sexually transmitted infection, endometriosis, and uterine fibroids. In that kind of situation, medical treatment may help ease difficulty having sex.

If you see a medical doctor and there is no physical issue at the core of your trouble with sex, that doesn’t make what you’re dealing with any less significant. Seeing a sex therapist to discuss any psychological components at play can be helpful, Richmond explains.

For instance, vaginismus, which causes painful vaginal muscle spasms during penetration, can stem from anxiety about having sex, according to the Cleveland Clinic. (That could include anxiety about it being painful even if any condition causing the pain has been treated.) It can also happen due to issues such as post-traumatic stress disorder from a sexual assault. Stress is one of many possible psychological causes behind erectile dysfunction, too.

Point is, the mental and physical are often so closely intertwined that painful sex is a very valid reason to see a sex therapist.

2. You’re processing sexual trauma.

It’s a misconception that trauma leaves all survivors incapable of being sexual beings. Enjoying sex after an assault is possible, and a sex therapist might help you get there.

Of course, recovering from a sexual assault is a different process for everyone. But for some people, a sex therapist is a better option than a more generalized mental health professional. “Oftentimes therapists will talk about the trauma, but there’s no resolution on how we move forward as our sexual selves,” says Richmond, who treats many survivors. “ process the trauma and move forward to help you have sex with your partner. We can help you move from survivor to thriver.” That’s not to say a therapist who doesn’t specialize in sex can’t help you heal after an assault. But if you’d like to specifically focus on the sexual aspect, a sex therapist may be ideal.

3. You’re in a partnership with mismatched desires.

This can mean many things, like one person having a higher libido than the other or being interested in exploring a kink such BDSM, sex therapist Liz Powell, Ph.D., who often sees partners with mismatched desires, tells SELF.

While having a kink is generally becoming more accepted, disclosing one can still be scary. This is where a sex therapist can help. For instance, Richmond recalls a couple who came to her because the male partner was struggling with the female partner’s urge to explore her submissive side in a specific way. “She wanted to be called a slut, a whore, and her partner just could not do it. So, we had to figure out other ways for her to work within her fantasy,” Richmond says.

If necessary, a sex therapist can also guide you through the realization that the partnership isn’t working due to incompatible desires. “So many people are just petrified of breakups they choose to stay even when they’re not happy,” Powell says. Seeing a therapist together may help you figure out whether to salvage the relationship or bring it to a respectful end.

4. You want to explore opening up your relationship.

This is another scenario Powell, who specializes in LGBTQ+ communities along with kink and polyamory, sees quite often. A sex therapist can help a couple in this situation craft a relationship format that allows both of them to feel safe and fulfilled. That can mean everything from the freedom to have a one-night stand once a year while in another country to dating multiple partners.

While sex for men often begins in the bedroom, women’s desire for sex typically starts outside the bedroom. When, where, how and what a woman wants in a satisfying sexual relationship typically comes within the context of her relationship not just with her partner but also with herself. Challenges for women might stem from physiological, emotional, relational, cultural, spiritual and/or family concerns. The most common complaints that women present with include disorders of desire, arousal, orgasm and pain and most frequently a low libido or difficulty with orgasm.

Sexual concerns are not uncommon for women, especially as they journey through the life span. Forty-three percent of women report a sexual concern and a peak in middle age with women 45-65 having the most distressing complaints, according to a 2015 survey of over 30 thousand women.

Identifying the root cause is important to treatment. Sexual dysfunction in women can arise from physiological as well as mental concerns. Common co-occurring conditions that were noted in the survey include anxiety, depression, poor health urinary incontinence and thyroid conditions. Often there is assistance from a medical doctor, typically an obstetrician/gynecologist who can help rule out any physical and physiological causes and provide short and long-term options as well.

Dr. Winter has helped many women in sex therapy overcome:

  • Age Related Sexual Difficulties
  • Arousal and Orgasmic Disorders
  • Health Related Sexual Difficulties
  • Infertility Issues
  • Infidelity and Healing After An Affair
  • Low or No Sexual Desire
  • Post-Partum Depression
  • Sexual Avoidance or Anorexia
  • Sexual Pain or Dyspareunia
  • Sexual Trauma Recovery

While reaching for help can be uncomfortable, particularly when sex is at issue, there is hope and assistance. In a safe and confidential space, Dr. Winter offers sexual counseling for individuals and couples; she will help you improve your sexual health.

Dr. Winter brings together both traditional methods of sex and psychotherapy as well as state-of- the-art evidenced based therapies and techniques to help you restore your sexual functioning. With access to extensive and a unique blending of knowledge and experience, she will assess each and every factor to design and implement a treatment plan to help revive your sexual functioning and help you regain a satisfying sexual relationship.

Effective Self-Help for Women With Low or No Sexual Desire

Part of the issue involves women’s socialization. Society accepts men’s lust as “vigorous” and “studly,” but disparages lusty women as “tramps” and “sluts.” In addition, women are raised to focus not on their own desire, but on appearing desirable to men.

Another piece of the issue has to do with gender differences in sex drive. While an estimated one-third of women have more erotic interest than the men they’re involved with, in two-thirds of couples, men’s libidos surpass women’s—and women hounded by horny men for sex have little opportunity to experience their own desire.

Meanwhile, a good deal of research shows that women with desire issues tend to feel exhausted by their daily responsibilities—their marriages, parenting, families, and jobs—and have difficulty creating space in their hectic routines for sexual desire.

In 2008, Basson and colleagues conducted a pilot study with 26 women complaining of low or no desire. They used a group-therapy approach that included education about desire and mindfulness meditative techniques to help women take emotional time-outs from their day-to-day responsibilities to focus on their own desire. The program helped. Pre- and post-tests showed significant increases in participants’ desire and arousal. Mintz’s self-help book uses a similar approach.

Six-Step Program

For the study, the researchers (Mintz among them) worked with 45 women who had sought help for low libido. They completed a survey that assessed their sexual desire, arousal, lubrication, orgasms, sexual pain, and overall erotic satisfaction. Nineteen were instructed to read the book. The others did not. All the women were heterosexual, married (4.5 to 29 years), with household incomes ranging from low to high, and education ranging from high school to graduate degrees.

The book focuses on six subjects:

• Thoughts. Women with low desire often slip into negativity: I feel overwhelmed and that’s not attractive. I don’t feel anything sexual therefore I can’t. The book provides cognitive therapy techniques that promote positive feelings about self and sexuality, and mindfulness meditative techniques to promote deep relaxation.

• Talk. Low desire often provokes relationship conflict. Partners ask, What’s wrong with you?! The book advocates standard psychotherapy suggestions for constructive couple discussion of both day-to-day hassles and the couple’s sex life.

• Time. Women with low desire typically complain of feeling harried. The book presents strategies for improved time management—setting goals, prioritizing them, and making the time to accomplish them.

• Touch. Many men get their sex education from pornography, which focuses almost entirely on genital touch. Of course, sex involves the genitals, but to experience desire and arousal, most women need a good deal of whole-body sensual caressing—30 minutes or so— before men reach for their breasts or between their legs. The book strongly advocates whole-body massage as a fundamental element in lovemaking.

• Spice. When sex becomes routine, desire suffers. The book provides suggestions for adding novelty and variety to erotic play to keep it fresh and exciting.

• Tryst. Many people believe that sex happens—and should happen— spontaneously when lovers are “in the mood.” That may be true initially during the hot-and-heavy stage of relationships, but after a year or so, for couples to remain regularly sexual, sex therapists universally recommend scheduling sex in advance. The book advocates scheduling, which allows women to anticipate sex and look forward to it.

Six weeks after completing the initial survey, all participants were surveyed again.

Those who read the book reported significant increases in desire, arousal, and sexual satisfaction.

Don’t Pin Your Hopes on Drugs or Supplements

For many (most?) women, desire is a mind-body phenomenon. This is especially true for women with low or no libido. Drugs and the sex supplements found in the vitamin aisle don’t address the full spectrum of issues that govern desire, which is why there isn’t—and probably never will be—a magic pill that lights women’s erotic fire. But a more comprehensive approach, a class or self-help book that deals with desire in the context of women’s lives, can put women back in touch with their erotic yearnings.

If you’re a woman with low libido or none at all, check out A Tired Woman’s Guide to Passionate Sex and/or another book that’s similar, Wanting Sex Again by sex therapist Laurie J. Watson (2012).

Brotto, L. et al. “A Mindfulness-Based Group Psychoeducational Intervention Targeting Sexual Arousal Disorder in Women,” Journal of Sexual Medicine (2008) 5:1646.

Laumann, E.O. et al. “Sexual Dysfunction in the United States,” Journal of the American Medical Association (1999) 281:537.

Laumann, E.O. et al. “Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age,” Journal of Sexual Medicine (2008) 5:2300.

Mintz, L.B. “Bibliotherapy for Low Sexual Desire: Evidence for Effectiveness,” Journal of Consulting Psychology (2012) 59:471.

Feminist Sex Therapy: A New View of Women’s Sexuality

Some foundational ideas:
  • There are no magic bullets for the socio-cultural, political, psychological, social or relational bases of women’s sexual problems.
  • There is no one-size-fits-all, normal sexual pattern or response. Problems can arise in many different ways, and can be due, in order of likelihood, to social, relational, psychological and/or physical causes.
  • A fundamental barrier to understanding women’s sexuality is the medical classification scheme in current use in the Diagnostic and Statistical Manual of Disorders (DSM). The DSM divides sexual problems into four categories of sexual “dysfunction”: desire disorders, arousal disorders, orgasmic disorders, and pain disorders.
  • The DSM promotes a false notion of sexual equivalency between men and women. Women and men don’t experience or describe their symptoms in the same way! According to research, for example, women generally do not separate issues of “desire” from those of “arousal.”
  • The emphasis on genital and physiological similarities between men and women in the DSM ignores the implications of gender inequalities related to social class, ethnicity, sexual orientation, etc. Social, political, and economic conditions, including widespread sexual violence, limit women’s access to sexual health, pleasure, and satisfaction in many parts of the world.
  • The DSM approach bypasses the relational aspects of women’s sexuality, which often lie at the root of sexual satisfactions and problems–e.g., desires for intimacy, wishes to please a partner, or, in some cases, wishes to avoid offending, losing, or angering a partner.
  • The DSM takes an exclusively individual approach to sex, and assumes that if the sexual parts work, there is no problem; and if the parts don’t work, there is a problem. The DSM’s reduction of “normal sexual function” to physiology implies, incorrectly, that one can measure and treat genital and physical difficulties without regard to the relationship.
  • ll women are not the same, and their sexual needs, satisfactions, and problems do not fit neatly into categories of desire, arousal, orgasm, or pain. Women differ in their values, approaches to sexuality, social and cultural backgrounds, and current situations, and these differences cannot be smoothed over into an identical notion of “dysfunction”–or an identical, one-size-fits-all treatment.
  • The medical model of sexual dysfunction distorts women’s sexual problems, ignores sexual individuality and cultural variations, minimizes the impact of relationship quality, feelings and learning and is promoted by Big Pharma overtly and covertly.
  • exual dissatisfaction results from anxiety, harassment, abuse in the family, relationship or culture; fatigue, grief or stress because of work, family, money or health problems; worries about pregnancy, pain, stress, STDs, or loss of reputation; and lack of sexual knowledge; relationship insecurities; fantasy expectations and displaced conflicts.
  • Effective clinical work, using an alternative framework, focuses not on symptom removal, but rather adopts the humanistic psychology goals of empowerment, self and cultural understanding, individual goal-setting, and the development of appropriate skills.
  • An alternative clinical approach to the evaluation and treatment of intimacy disorders or desire begins with the classification of a woman’s sexual concerns based on a wide variety of factors, rather than just the physical operation of her reproductive organs.
  • For effective clinical treatment of women’s sexual concerns clinicians must listen to and educate women about their bodies, minds and relationships. It is also imperative that clinicians normalize variations in desire, rather than pathologize them.

Sex therapy is a form of counseling intended to help individuals and couples resolve sexual difficulties, such as performance anxiety or relationship problems.

Clients generally meet in the therapist’s office. Some choose to attend sessions alone; others bring their partner with them. Session frequency and length usually depend on the client and the type of problem being addressed.

It’s normal for clients to feel anxious when seeing a sex therapist, especially for the first time. Many people have trouble talking about sex at all, so discussing it with a stranger may feel awkward. However, most sex therapists recognize this and try to make their clients feel comfortable. Often, they start with questions about the client’s health and sexual background, sex education, beliefs about sex, and the client’s specific sexual concerns.

It’s important to know that sex therapy sessions do not involve any physical contact or sexual activity among clients and therapists. Clients who feel uncomfortable with any aspect of therapy should speak up or stop seeing that particular therapist.

Sex therapists usually assign “homework”—practical activities that clients are expected to complete in the privacy of their own home.

Such homework might include the following:

• Experimentation. Couples who feel they’re in a sexual rut may try different activities, such as role playing or using sex toys, to increase their desire. Other couples may need to adjust their sexual routine or positions, especially if one partner has a health condition that requires such changes.

• Sensate focus. This technique for couples is designed to build trust and intimacy while reducing anxiety. Couples progress through three stages, starting with nonsexual touching, progressing to genital touching, and, usually, ending with penetration.

• Education. Sometimes, clients do not receive adequate sex education while they are growing up. As a result, they may not be aware of anatomy and how the body functions during sexual activity. Therapists might assign books or web content to read or videos to watch. They might also suggest that clients use a mirror to learn more about their body.

• Communication strategies. Clients may practice asking for what they want or need sexually or emotionally in a relationship.

Success with sex therapy often depends on how committed clients are to the process. If clients are willing to put in the effort, either alone or with a partner, they may reach their sexual goals.

Six Things That Surprised Me When I Became a Sex Therapist

You don’t have to be a sex therapist to know something about sex. Our personal experiences, combined with the morals and values instilled in us, leave us vulnerable to assumptions about sexuality that feel accurate—though they may be far from true.

Like most therapists, I began my career less knowledgeable about sexuality than I realized. Two decades of working with clients in my private practice have taught me more than books, theories, the media, and even logic ever could. Here are some of the fascinating things I’ve learned about sexuality from the people willing to share their most intimate thoughts and feelings in my therapy room.

1. Sexual concerns and dysfunctions are common.

Research consistently suggests that approximately 40 percent of women report experiencing a sexual concern or dysfunction in the past year, as do 30 percent of men(1). Furthermore, about 20 percent of marriages are considered sexless(2). These numbers have been relatively stable over the last few decades.

My clients are usually shocked by this information. They are used to seeing their friends and family on social media, appearing to enjoy happy, satisfying, intimate lives. However, this is far from reality today. Most people don’t feel comfortable sharing the details of their sex lives with even their closest friends. As a result, everyone assumes that everyone else is having great sex.

Source: Kiuikson/

2. Most couples embrace the concept of monogamy but find it harder to achieve than they expected.

As a newly minted sex therapist, I assumed that if people loved each other enough, a lifetime of monogamy would be the natural result of this love. I now understand this differently. Monogamy for a lifetime may not be realistic for many people—and that’s not necessarily indicative of pathology, like “intimacy issues,” narcissism, or hypersexuality.

A conservative estimate suggests that 25 percent of people have stepped outside of their marriage at least one time(3). Again, evolutionary theory has helped me understand these struggles. The fact is that human beings are evolved primates, and our primate nature remains a part of who we are as sexual beings.

The vast majority of mammals are not monogamous. Modern lovers must navigate a path that is influenced by both aspects of their sexual selves—their evolved psychology, and their primate biology. For some, this makes monogamy for a lifetime a very challenging endeavor.

3. Folks in consensual non-monogamous relationships are just as healthy and just as satisfied as those in traditional monogamous marriages.

I used to think that the people who embraced alternative marital arrangements had significant psychological struggles. Otherwise, why wouldn’t they opt for monogamy? I also assumed that non-traditional relationships would have much poorer success rates than monogamous ones.

However, research repeatedly demonstrates that these are false stereotypes. The reality is that about 20 percent of adults have experimented with some form of consensual non-monogamy(4), and folks demonstrate similar emotional challenges regardless of the relationship arrangements they prefer(5).

Similarly, monogamous and non-monogamous marital structures have fairly equivalent satisfaction and success rates(6). I tell couples that all relationship structures have risks and benefits. The issue isn’t which one of them is “right,” but rather what is right for you.

4. Just doing good therapy to enhance a couple’s emotional connection doesn’t mean their sexual issues will resolve.

I began as a sex therapist assuming that the majority of sexual challenges were the result of intimacy issues within the couple. It followed, then, that resolving their intimacy concerns would automatically resolve their sexual struggles. Now I understand it’s not so simple.

Regardless of their origin, sexual concerns can develop a life of their own. For example, if his low libido is a side effect of an anti-depressant, she may still take his lack of interest personally, feel rejected, and pull away emotionally. Couples therapy may help their emotional relationship recover, but it won’t automatically resolve their sexual concerns(7).

In spite of feeling closer, his ongoing low libido may result in her eventual loss of interest in sex, and the couple may unwittingly end up in a sexless marriage—in spite of a successful round of couple’s therapy. Sex often needs to be addressed and treated directly.

5. Women can be surprisingly particular about sex.

I was raised to believe there were no significant differences between the genders, and nothing I learned in graduate school suggested otherwise. It was thus a surprise to me when hetero women and men in my therapy room consistently verbalized different sets of sexual concerns. For example, comments I’m more apt to hear from women, and rarely hear from men, include:

  • “I can’t have sex when my partner touches me like that.”
  • “My partner watches porn every day instead of having sex with me. We’re never intimate anymore.”
  • “I don’t care if I ever have sex again.”

In contrast, these are comments I’m more apt to hear from men, and seldom hear from women:

  • “If my partner would just relax and let go sexually…”
  • “My partner just lies there, lifeless, when we have sex.”
  • “I try to be a great partner, but my lover doesn’t even know what feels good.”

These distinctions make sense when I understand them through the lens of evolutionary theory—they represent modern expressions of sexual adaptations developed over hundreds of thousands of years. Neither gender is right or wrong on these issues; they simply represent different manifestations of the characteristics that led to successful procreation over the course of human history. In a nutshell, her choosiness increased the odds of her offspring’s survival, whereas his lack of choosiness facilitated his odds of successful reproduction.

While sex today isn’t about offspring survival, we have inherited those psychological tendencies from our ancestors. Research bears out that women generally have more sexual inhibitions than men, and they find fewer things sexually exciting(8). It’s important to note that these differences are primarily evident in committed couples who have been together for a while. We are evolved apes, and our sexuality remains tied to our primal roots in some significant ways.

6. People’s sexual fantasies are diverse and more commonly involve scenarios that are often considered offensive.

Sexual fantasies depicting paraphilic acts—masochism, exhibitionism, or fetishism—can sound alarming. For example, you may have seen dramatic porn scenarios depicting someone being restrained and seemingly in pain, people wearing unusual or startling costumes, people having sex with partners much younger than themselves, or apparent family members having sex. It has been commonly assumed that these fantasies are deviant, unusual, and only appealing to people with serious mental health issues. However, these stereotypes have been borne out as false repeatedly by research today.

People—particularly men—engage in these types of fantasies more commonly than was previously thought(9). The folks engaging in these fantasies don’t appear to demonstrate more mental health challenges than those in the general population(10). And enjoying these fantasies while masturbating doesn’t indicate that a person would actually enjoy playing out the fantasy in real life(11).

Sexual fantasies are usually not PC. Oftentimes they are simply a manifestation of deep emotional needs that remain unmet in real life—like feeling desired, nurtured, or accepted for aspects of themselves they fear are undesirable.

Facebook image: YAKOBCHUK VIACHESLAV/

Sex Therapy

Sex therapy is a type of psychotherapy that addresses mental health issues and/ or emotional concerns affecting a person’s sexual function, drive, and/or desire for intimacy.

These issues are typically explored with the help of a licensed sex therapist. Some people seek help individually, while others may pursue sex therapy with a romantic partner.

  • Understanding Sex Therapy
  • Selecting a Sex Therapist
  • When Is Sex Therapy Recommended?
  • How Can Sex Therapy Help?
  • Limitations and Concerns of Sex Therapy

Understanding Sex Therapy

This specialized form of therapy developed in order to help people address concerns related to sexual intimacy. According to Derek Polonsky, a psychiatrist associated with Harvard Medical School, between 35 and 50 percent of people will experience a long-term sexual issue at some point. Thus, while it may not always be easy to bring up the topic of sexual concerns, they are certainly not uncommon.

Individuals can pursue this type of therapy on their own, whether they are single or in a relationship, or with a partner. While many individuals may find it difficult to talk about sex—especially with a professional they do not know well, while their partner is present—sex therapy can often help couples or individuals gain more confidence, restore or improve sexual health, communicate more effectively, and work on achieving a more fulfilling sex life.

Find a Therapist

In the early days of sex therapy, it was often considered a tool to help individuals repress various forms of what, at the time, was considered “deviant” sexual behavior. Much has changed in the field since then, and today the approach is often recommended to individuals who have issues with intimacy or couples who are seeking to achieve greater sexual enjoyment. Though the topic of sex may still be considered taboo among many couples or individuals, sex therapy can often help people overcome this aversion and address the topic in productive, helpful ways.

Selecting a Sex Therapist

A sex therapist is a professional psychologist, therapist, social worker, or physician who offers comprehensive counseling services for people dealing with some type of sexual issue.

Certified sex therapists will hold an advanced degree in counseling, therapy, psychology, or related field; achieve a number of hours of sex therapy training and clinical experience; and be credentialed by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). An AASECT certification must be renewed every three years.

Choosing the right therapist will depend on the specific situation of the person/people seeking treatment as well as the therapist’s area of expertise. Because certification or licensure for sex therapists has yet to be standardized, it is generally a good idea to ask potential therapists about their professional training in human sexuality and the specific issues they are able to address.

A person who chooses to enter sex therapy individually may be more comfortable discussing sexual issues with a therapist of the same gender. However, all sex therapists are trained to address the emotional, physical, and biological issues that can influence sexual activity in men and women. Many sex therapists also help non-binary, transgender, and intersex people address sexual concerns, but some individuals may find it more helpful to work with a therapist who has experience working with people who are not cisgender. A sex therapist should never attempt to change or deny a person’s gender, identity, or sexual orientation, and doing so would be considered a sign of unethical treatment. Further, the issues that bring non-binary, trans, or intersex people to sex therapy may not be in any way related to their identity, and an ethical therapist will not assume this to be the case.

In session, a sex therapist will work to help a person or couple seeking help achieve an improved mental and emotional state in order for them to enjoy a more satisfying sexual experience and/or relationships. Sessions are strictly instructive and verbal, and all exercises and that involve physical contact are performed outside of the session. Sex therapy does not involve having sex with the therapist or being forced to have sexual contact with anyone else. Therapists may, as part of the process, encourage those in treatment to consider participating in certain intimate activities or exercises with their partner, but a person is never made to do so as part of therapy. Sex therapy is largely a mental and emotional reflection of one’s own internal conflicts, concerns, and/or questions about sex.

When Is Sex Therapy Recommended?

In many cases, people participate in sex therapy on a short-term basis (though in some cases, an ongoing or longer-term approach to counseling is needed). A specific treatment plan will rely heavily on the individual needs of the person or couple in therapy.

There are several reasons why a person might choose to seek sex counseling, but it is most often recommended for anyone whose quality of life is affected by their sexual function or desire and/or for anyone having problems with intimacy within a relationship, regardless of age, gender, or background. Adolescents who are confused or concerned about sexual matters may also seek the help of a sex therapist, in some instances.

How Can Sex Therapy Help?

Adequate and comprehensive sex counseling can have a positive impact on the psychological and sexual health of a person or couple in therapy, even after only a short period of time. Still, the effectiveness of the therapy ultimately depends on the willingness of the person in therapy to accept the concepts presented to them during a session.

Most experts agree that sex therapy—like other modes of therapy—is most helpful when all parties honestly consider the concerns raised and make a considered, collaborative (when applicable) effort to work through them. Most experts agree that sex therapy—like other modes of therapy—is most helpful when all parties honestly consider the concerns raised and make a considered, collaborative (when applicable) effort to work through them.

Sex therapy can be used to address:

  • A lack of sexual desire
  • Intimacy after infidelity
  • A couple’s disparity in sex drives
  • Intimacy after having children
  • Painful intercourse
  • A paraphilia, or desire that cause a person distress
  • Sex addictions and/or compulsive behavior
  • Difficulties achieving orgasm.

Sex therapy is not limited to these issues, but these are some of the most common reasons a person or couple may choose to seek out a qualified sex therapist.

Limitations and Concerns of Sex Therapy

Because sex can be a controversial subject that may challenge personal values in addition to political and religious views, sex therapy may be difficult for some people. Sex therapists are specially trained to balance their professionalism with these factors in mind, but the effectiveness of sex therapy ultimately depends on the quality of the therapeutic relationship and on the goals and motivation of the person or couple in therapy. One or more of these factors may be compromised by the person in therapy’s belief system, which is why it is important for individuals to carefully select a sex therapist they feel comfortable with.

Sex should be fun, but it can also be complicated. Welcome to Sexual Resolution, a biweekly column by sex therapist Vanessa Marin answering your most confidential questions to help you achieve a healthy, joyful sex life. Here, she answers a question about what to expect from sex therapy.

DEAR VANESSA: My partner suggested that we go to sex therapy together to work on our sex life because we’re not having a lot of sex and we are arguing about it all the time. I know I should be OK with it, but I feel really nervous because I’ve never done it before. What exactly do you do in sex therapy? How does it help? – Do I Have To? 26

DEAR DIHT: I’m so glad to get a chance to answer your question. Sex therapy is becoming more widespread, but it’s still a bit of a mystery to most people. (And no, it doesn’t look like what you see on TV or in the movies.) I love my job so damn much, and I appreciate the opportunity to help educate more people about how what I do can help you create an extraordinary sex life.

Sex Therapy 101

First, let’s talk about what this particular type of therapy is. Put very simply, the goal is to help you have a sex life that feels healthy and happy to you. Sex therapy recognizes that sexuality is an integral part of our lives, and seeks to provide education and resources to support you. It can include things like identifying your beliefs or blockages around sex, helping you gain clarity on your goals for your sex life, providing accurate and shame-free information, teaching new sexual skills, improving your communication, or developing sexual self-confidence.

Even though there still aren’t a ton of sex therapists out there, I think it’s really important to look around before picking who you want to work with. I strongly believe that the fit between the sex therapist and client is important. If you don’t feel connected to and trusting of who you work with, you’re not going to get much benefit out of the experience. Check out the websites of a few therapists in detail before booking an appointment, and don’t be afraid to end your working relationship if your gut’s telling you it doesn’t feel right.

How to Choose a Sex Therapist

I also recommend looking for someone who is upfront about their training and credentials. The sex therapy field isn’t regulated in the same way psychotherapy or medicine, so there isn’t a standardized training. There are a lot of awesome people out there with different backgrounds doing great work, but you want to make sure you’re aware of their training before deciding whether or not to work with them. You want to know that your sex therapist has training in the area that you need support. For your situation, I would recommend finding someone who is also a trained psychotherapist, since this seems like it might be a deeper issue than something like, “We’re looking for new ideas to spice things up in the bedroom.”

What to Expect

Sex therapists work in a lot of different ways, but most of us meet with clients for regular sessions, typically weekly or every other week. I used to work in an office, but now I work over video chat. A lot of my clients enjoy the ability to be in the comfort and privacy of their own home while they’re talking about such sensitive issues. Video chat is also a great option if you’re in an area where there isn’t anyone available for you, or if you’re just not finding someone you like, though you may also find you prefer to work in-person.

Sex Therapy: What Men and Women Should Know

RELATED: 8 Rules for a Healthy Vagina

Expect Some Sex Therapy Homework

While nothing sexual in nature will happen at the office, the therapist may offer some ideas for things you can try at home. “The therapist may suggest you try something called sensate focus exercises, which are designed to help you attune more to your partner,” says Dr. Montague. The exercises are typically done in stages, starting with touching or stroking anywhere on the body, except the breasts and genital areas. The goal is to experience the sensation of touching rather than trying to reach orgasm. Eventually, the exercises can lead to intercourse.

It May Help to Bring Your Partner to Sex Therapy But It’s Not Necessary

“Sex therapists can be very helpful in helping to guide one person to help themselves or their partner to overcome self-defeating behaviors. Or we can work one-on-one and then work with the couple together as a unit as well,” says Dr. Bartlik, coauthor of Integrative Sexual Health.

RELATED: What Do Sex Dream Really Mean?

You Keep Your Clothes On When You Work With a Sex Therapist

One thing is certain: Under no circumstances should you have to take your clothes off in a sex therapist’s office or should the therapist be touching you. “Sex therapists don’t touch their patients unless they are gynecologists or urologists and a physical exam involved,” explains Bartlik.

Be Picky When Shopping for a Sex Therapist

This person will help you with your most intimate secrets so it has to be someone you trust. You will need to feel safe being vulnerable and taking risks. First, start by considering what gender therapist you and your partner feel most comfortable with.

If you are LGBTQ, make sure the therapist is trained and knowledgeable in a way that makes you feel valued. A University of California, Santa Barbara, study published in the journal Psychotherapy Research found that “basic counseling skills and relationships were key determinants of the quality of LGBT clients’ therapy experiences.” Also important were variables such as the therapist’s professional background and attitude toward the client’s sexual orientation or gender identity. Client variables existed as well, such as their stage of identity development, health status, and social support. Environmental issues, such as the confidentiality of the therapy setting, were a factor, too.

“Usually, there will be some indication on the therapists’ website that they have experience in this area. I put on mine that I am inclusive so patients know that I am paying attention and know what to do,” says Bartlik.

Where to Find the Right Sex Therapist for You

Ask to see accreditation. A sex coach is not a sex therapist. Sex coaches may do more physical touching, demonstrating body parts. “They don’t have the same licensure that sex therapists do. Anyone can hang up a sex coach shingle,” says Bartlik. Compared with sex therapy, sex coaching is less stringent and not regulated, according to Bartlik.

Sex therapists often hold degrees in marriage and family therapy, social work, theology, psychology, or medicine. You can find licensed sex therapists in your area from the American Association of Sexuality Educators, Counselors, and Therapists.

Additional reporting by Wyatt Myers

A sex therapist can be a psychiatrist, a marriage and family therapist, a psychologist, or a clinical social worker. We are specially trained in sex therapy methods beyond the minimal amount of training about sexuality that is required for each of those licenses.

There are a few graduate schools in the U.S. that specialize in training for sex therapy. Some people assemble their training by rigorous self-study and by attendance at the major sexological organizations’ annual conferences. We have about a dozen scientific journals dedicated solely to sexual research. There are about six major organizations that hold conferences and trainings.

So seeing a sex therapist is like going to a gynecologist for gynecological problems rather than to a family practice physician. Both have specialized particularly in that area. That isn’t to say that one couldn’t get good help from a non-sex therapist for a sexual issue, it’s just that the likelihood might be a bit less.

Most sex therapists have a particular awareness of sexuality that rises above personal opinion or personal experiences. We usually have several choices of ways to treat a particular issue when someone presents it. We tailor our treatment to the person(s) before us. We are not a “bigger hammer” there to coerce a person who wants less sex into wanting more. There is a sexological method to treating sexual issues. With the exception of when separate sexual surrogate therapists are added (in a very small number of cases), sex therapy is completely talk therapy.

Sex therapy views sexual issues as being resolved by specifically addressing them, rather than by the assumption that when the individuals in a relationship work out the relationship issues, the sex will just fall into place. For years, I have had a practice full of couples for whom that simply was not true.

Sex therapists also tend to have much greater than average knowledge about the physiological processes that are a part of human sexuality. We tend to work collaboratively with physicians to address the entirety of the causes of sexual concerns.

I would venture to say that there is near unanimity in the sex field when it comes to acceptance of sexual orientations and transgender existence. I have never met a sex therapist who tried to cure homosexuality — though there are other mental health practitioners who do attempt to do so.

We hold a positive outlook on the beneficial influence that sexuality can have on people’s lives and in the world in general. And we are not naive about the ill effects that come as a result of sexuality. We simply try to address those issues from a rigorous scientific perspective, rather than from an ideological perspective.

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