Sex therapy is an effective way to achieve satisfaction in your sex life. Seeking consultation with a credentialed and knowledgeable provider can help both couples and individuals address common sexual concerns. Typical rates for a certified sex therapist are on the upper end of private pay therapy rates in your area, and treatment can last anywhere from a few sessions to a few years, depending on the issues being addressed.
What Is Sex Therapy?
Sex therapy affirms the fundamental value of sexuality as an inherent, essential, and beneficial dimension of being human. Sex therapists use a non-pathologizing approach, emphasizing sexual freedom of thoughts, feelings, fantasies and healthy modes of sexual activity. Sex therapy allows clients to consider (often for the first time) what their sexual experience has been like over their lifespan, what their sexual experience is currently like and what priorities they have for sexual expression in the future.
Therapeutic goals are established by the client in areas of their sex life that cause them difficulty or dissatisfaction, whether that be through internal thought patterns or outward expression. These goals are often addressed in tandem with other therapeutic topics typical to counseling, such as a sexless marriage or relationship, conflict in the relationship, stress, sexual trauma, anxiety, or depression.
You Keep Your Clothes On When You Work With a Sex Therapist
Sex therapy will never include sexual contact with your therapist. Sex therapy is NOT sex surrogacy or a euphemism for sex work of any kind.
What Can Sex Therapy Help With?
Sex therapy addresses a wide array of sexual concerns that impact both individuals and relationships. Topics include issues with arousal, frequency, sexual pain, difficulty achieving orgasm, out of control sexual behavior, physiological shifts after childbirth or menopause and changes in the sexual dynamic of a couple over time.
When sexual issues cause distress, a sex therapist can help discern what physiological factors to rule out (or refer to other providers for treatment) and what psychological factors can be examined and addressed. Sex therapists typically work closely with general practitioners, psychiatrists, physical therapists, gynecologists and urologists so that a coordination of care can provide the best treatment.
Stress, Anxiety, & Big Life Changes
Common stressors and phase-of-life shifts tend to precipitate the issues presented in a sex therapist’s office. Knowing what these factors are can be helpful in deciding whether sex therapy is the right choice for you or for your relationship.
Stress-inducing factors to look out for include:
- Anxiety
- Depression
- First sexual experience
- History of sexual trauma or other forms of trauma
- History of sex negativity or shame around sex
- Gender fluidity or transition
- Lack of education/information about healthy sexual practices
- STIs
- Disability/illness/medical issues
- Marriage/cohabitation
- Childbirth/child rearing
- Stressful job requirements
- Divorce
- Change in sexual partner(s)
- Aging/perimenopause/menopause
Sex therapy can help mitigate how much impact these factors have on a satisfying sex life. A sex therapist will help identify what the issue is, what physiological components to address, what structural changes can be made and what psychological processes are contributing to the problem.
Sexual Distress
Topics that clients report experiencing distress about include:
- Not having enough sex, as a couple or individually
- Wanting sex more or less frequently than their partner(s)
- Lack of interest in sex
- Pain or discomfort when having sex
- Inability to get aroused or stay aroused
- Inability to have an orgasm
- Having an orgasm too quickly
- Misalignment between gender identity and biological sex/genitalia
- Having intrusive or disturbing thoughts about sex
- Masturbating or having sex compulsively
- Desire to expand the range of sexual experience, as a couple or individually
- Physical Sexual Problems
In addition to these common problems, clients may have received a medical diagnosis from a doctor or believe a medical diagnosis may be relevant to their situation.
Diagnosable psychological and physiological issues that are relevant to treatment by a sex therapist include:1
- Premature Ejaculation/Early Ejaculation
- Delayed Ejaculation
- Erectile Disorder/Erectile Dysfunction
- Vestibulodynia/Genito-Pelvic Pain Disorder
- Anorgasmia/Female Orgasmic Disorder
- Male Hypoactive Sexual Desire Disorder
- Female Sexual Arousal Disorder
- Gender Dysphoria
- Substance/Medication Induced Sexual Dysfunction
- Unspecified Sexual Dysfunction
Do My Partner and I Need to See a Sex Therapist?
If you’re on the fence about sex therapy, consider how your sex life is now versus how you want it to be. If there are specific issues holding you back, a sex therapist can likely help you address them and make appropriate changes to move forward.
There are a number of issues that a sex therapist can help with, including:
- Dealing with and addressing pain with intercourse, including physical pain vs. psychosomatic pain
- Dealing with trauma from your past including sexual contact or penetration
- Uncovering your true libidos as individuals in a relationship
- Discovering or wanting to explore your gender identity and sexual orientation
- Learning how to navigate open relationships
- Addressing issues of shame related to sex and sexuality
What Does a Sex Therapist Do During Sessions?
Sex therapists come from a wide range of backgrounds and employ techniques unique to their own therapeutic style. However, there are a few standard components to sex therapy that are widely regarded for their efficacy and which you are likely to experience in treatment with most sex therapists.
Mindfulness
A sex therapist may help you utilize mindfulness practices, a category of tools which has been studied and proven to be effective when used to address sexual dysfunction. Mindfulness as applied to sex therapy, in the words of Lori Brotto PhD, is “the practice of noticing what is happening inside us and of being kind to ourselves, even when we struggle to do so.”3 Mindfulness improves nonjudgmental attention, one of the precursors to satisfying sex.
Sensate Focus
One type of mindfulness technique, if you are in sex therapy with a partner or partners, is Sensate Focus. Sensate focus exercises are used to reduce anxiety around sexual interactions by slowing down the process of intimacy.4 Partners are directed to incrementally explore basic touch sensations over a series of weeks, dismantling the habitual ways in which they have engaged in physical touch and sexual interaction in the past. The goal is to cultivate awareness around touch and arousal in order to foster a positive feedback loop that increases desire and connection.
Sex Therapy Exercises & Homework
Homework often starts with communication and being able to be vulnerable with one another. Your sex therapist will work with you and your partner to come up with questions that can open up the lines of communication. The goal of these questions and exercises are to continue to build a foundation of safety and security when it comes to sexuality in the relationship.
Physical Issues Won’t Be Ignored in Sex Therapy
It is important to consider physical and medical issues that may be a barrier to a fulfilling sex life. There are various types of conditions such as endometriosis, fibroids, medications, and sexually transmitted infections (STIs) that can cause pain and difficulty with intercourse. Getting treatment for these or ruling out medical issues is a big step in getting a treatment plan for you and your partner.
Evaluate Intimate Dance
Another approach commonly utilized in partnered sex therapy is assessment of the Intimate Dance that partners engage in around sex. This includes how partners initiate sex, who tends to have a higher desire for sex, and what structural factors in the clients’ lives have contributed to an intimate dance that is no longer satisfying to one or more partners.
Dual Control Model
A sex therapist will often employ the Dual Control Model for sexuality in assessing a relationship’s intimate dance.5 The dual control model posits that the context in which our sexuality exists matters. Not only do we need to take a look at what turns us on and the mechanisms of our sexual excitation system, but also what turns us off, or our sexual inhibition system. Utilizing the lens of the dual control model, a sex therapist will help a couple make crucial changes in their intimate dance in order to reach a connected and contented equilibrium in sexual interactions.
Sex Therapy Examples
There are many reasons why an individual or a couple would seek out sex therapy. This section elaborates on some of the more common examples for why clients come to see a sex therapist and what the trajectory of their therapy might look like.
Infrequent Sex & Trouble Maintaining Erections
Angela and Tony have been married for 36 years. They have a loving partnership, but their sex life has dwindled to an infrequent pattern of sex once every 2 months. Their interactions tend to be brief and awkward. Tony has also begun to have difficulty maintaining an erection. If penetrative sex is unsuccessful, they usually stop their interaction. Both Tony and Angela would like to have more frequent and more satisfying sex.
Their sex therapist refers Tony to a urologist specializing in sexual medicine to assess for any underlying medical issues for his erectile dysfunction. She then assesses the habits the couple has in initiating sex and asks them to dismantle their preconceived notions of what sex should look like. She has them create more space in their lives for sensual touch and quality time. She asks them to follow the Sensate Focus model to build a new kind of intimacy. After 8 months Angela and Tony report a higher frequency of sexual interactions and a higher satisfaction in their sex life. Tony is more able to maintain an erection and the couple also has an expanded sexual repertoire for when his erection dissipates.
Pain During Sex
Paul and Jessica have been in a relationship for 3 years. Their sex is not able to be penetrative or involve direct touch to Jessica’s vulva due to pain she experiences when touched. Jessica has never had a physically pleasurable experience or orgasm involving penetrative sex. Their sex therapist assesses Jessica for a history of sexual trauma. She then refers Jessica to a gynecologist and physical therapist specializing in pelvic pain.
Jessica is diagnosed with vestibulodynia and is given dilators in conjunction with regular physical therapy. Their sex therapist addresses the anxiety cycle in the couple that has evolved as a repercussion of Jessica’s pain symptoms. She assigns mindfulness work for the couple to explore in order to reduce the anxiety and increase pleasure. After 14 months Jessica has made significant progress in being able to receive touch pleasurably from Paul and they are working toward penetrative sex.
Compulsive Masturbation
Sam is 27 years old and has never had a sexual relationship. He watches porn and masturbates 1-3 times a day and sometimes is late to work or misses social activities as a result. The frequency that Sam masturbates has escalated over the last year and he worries that his masturbation behavior has become compulsive and that he doesn’t have control over his life. Sam would like to limit the amount of focus he is giving to masturbation and would also like to explore more meaningful relationships.
His sex therapist works with Sam to understand why his behavior has increased in frequency and feels outside his control. She explores how his childhood and family background may have made it difficult to form satisfying relationships. She helps Sam establish therapeutic goals for modified behavior and cultivate mindfulness practices to achieve those goals. After 11 months Sam has reduced the frequency of his masturbation. He feels less anxious, more confident and more in control of his own life. He is beginning to date someone he has developed feelings for and has experienced partnered sex for the first time.
Cost of Sex Therapy
Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and relationships/couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
Insurance Coverage
You may be wondering if your insurance benefits can cover some or all of the cost of sex therapy. Insurance companies typically only offer mental health benefits when there is a diagnosable issue. Some sex therapy topics do indicate a billable diagnosis that most insurance companies will accept, such as female orgasmic disorder or delayed ejaculation. If that diagnosis is the primary reason for seeking therapy, your insurance company may cover the cost.
When seeking sex therapy as an individual, there may be a concurrent or contributing diagnosis, such as an anxiety disorder, which can be billed to insurance companies. In that instance, even if the sexual issues you are presenting with are not billable, your insurance provider may cover therapy.
One other factor to consider in seeking insurance coverage for sex therapy is whether you are required by your insurance provider to see an in-network practitioner. Many insurance companies do not have a certified sex therapist on their panel of providers. If that is the case for your geographical area, you may have only out-of-network reimbursement options.
Alternatives for payment include utilizing your HSA or FSA accounts through your employee benefits, which typically can be used to see any mental health practitioner, including a certified sex therapist.
Where to Find the Right Sex Therapist for You
When seeking a sex therapist you want to make sure to find an adequately trained and certified provider. “Sex therapy” and “sex therapist” are not protected terms under any current state laws. What that means is that anyone can call themselves a sex therapist without having had the training to do so.
Be Picky When Looking for a Sex Therapist
Fortunately, the American Association of Sex Counselors, Educators and Therapists (AASECT) is a credible body of oversight which has been the gold standard in certification for sex therapy since 1967. With its history of impeccable standards for training, experience and ethical behavior, AASECT is increasingly recognized as the guardian of professional standards in sexual health. Sex therapists may receive their education and supervision at a number of universities and sex therapy training institutions across the globe. If the training they receive meets the rigorous requirements of AASECT, they can become a Certified Sex Therapist (CST) in addition to being a licensed therapist in their respective field.
If you’re searching an online therapist directory, in order to receive the best care, always look for an AASECT Certified Sex Therapist (CST).
How to Prepare for Sex Therapy
Sex therapy can feel foreign for many people, and there are things you’ll want to talk through with your partner and a a therapist before your first session, including:
Compatibility
Like in any kind of relationship, it’s important to consider compatibility. Your therapist should feel like a natural fit with you and your partner so you feel safe discussing delicate topics. If you feel like you are not getting what you need from your sex therapist, continuing your search is recommended.
Couples vs. Individual Sex therapy
Many people think sex therapy is only for couples to discuss sexual issues, however you can attend by yourself. It’s important to consider what your issues are and the benefits of both couples and individual sex therapy. You can always start one way and decide that you want to bring in your partner or attend solo.
Practical Things Like Scheduling
Figuring out where and when you can go to sex therapy is another thing to consider. If you are looking to go weekly, you may need to consider rearranging your schedule to ensure you can attend at a standing time. Some therapists offer virtual therapy which may be an option. Talking with the therapist beforehand is important so you know all your options.
Insurance Coverage
Some insurance plans offer more coverage than others, however it’s important to know what is covered before your first session. Checking with the therapist to see what a copay would be and checking with your insurance to see if you have any deductibles is important.
Treatment Plan & Length
Coming up with a treatment plan will take a few sessions as the therapist gets to know you. At times, some people need a couple months of treatment while others need longer. This all depends on your needs as an individual and/or a couple.
What to Expect at Your First Appointment
Your initial session with a sex therapist will primarily entail information gathering and creating a treatment plan. The therapist will inquire about what brings you to therapy, what changes you would like to make in your life, and what measurable goals you would like to achieve.
Your therapist will also ask for a detailed history of your current and past relationships and sexual practices. Your therapist is also likely to inquire about your mental health history, any medications, your current and past substance use, your childhood and family of origin and any history of trauma.
Therapy is most effective when you are able to be honest and forthcoming about the details of your life and what brought you into the therapist’s office. However, you should never feel pressure to answer a question you are not ready to or are uncomfortable with.
Sex therapy and all forms of talk therapy are most effective if you feel a strong therapeutic alliance, or professional rapport, with your therapist. Your initial session is a time to assess whether this therapist is the right fit for you. Make sure that you utilize this time to ask any necessary questions of your provider in order to make an informed decision about proceeding with treatment.
Is Sex Therapy Effective?
Based on the issues you present with in therapy and how entrenched they have become, therapy can last anywhere from a few sessions to a few years in order to see the results you are hoping for. Much of that success depends on how frequently you attend therapy, how motivated you are for change and how active you are between sessions in implementing the tools assigned by your therapist. Results may also depend on coordination of care with other medical providers such as primary care physicians, gynecologists, urologists, psychiatrists or physical therapists.
Although many presenting issues in sex therapy have a physiological component and can sometimes be treated with medication or other medical intervention, optimal outcomes occur when an appropriately trained therapist addresses psychological issues concurrently with medical professionals. A consensus statement from the 2015 International Consultation on Sexual Medicine recommended that both women and men with sexual dysfunction should be offered psychosocial evaluation (sex therapy) in addition to any medical intervention they receive in order to achieve the most positive outcome for treatment.6
While studies in the field of sex therapy are somewhat limited, the studies that have been conducted have largely shown promising results. In a study conducted in 2017, participants in mindfulness-based sex therapy reported significant improvements in sexual desire, sexual function and sex-related distress.7 A meta-analysis of the study found evidence that mindfulness-based sex therapy was effective for treating female sexual dysfunction and held promise for treating men with situational erectile dysfunction.8
Sex Therapy Infographics
