Many people who come to see me have been in therapy before. Some have spent years working on "communication" with a couple's therapist, only to realize that no one ever asked about sex. Others held back, assuming the topic would make their therapist uncomfortable, or that something must be wrong with them for needing to raise it.
If that sounds familiar, this is for you.
So, What Is Sex Therapy?
Sex therapy is talk therapy that focuses on sexuality and intimacy. There's no touching, no nudity, and no sexual contact. It's a conversation, held in a professional setting, with someone trained to discuss sex openly and without judgment.
What makes it different is that sex gets treated as a normal, important part of life. For many people it's a way of connecting, playing, feeling desired, and feeling at home in their body. When it goes wrong, the effect reaches into self-image, mood, and the relationship as a whole.
Why "Just Communicate Better" Often Isn't Enough
Better communication helps, and I often work on it with couples. But sex is loaded with meaning. A mismatch in desire can feel like rejection, and a body that doesn't respond the way you expect can feel like failure. These feelings are hard to untangle in an ordinary conversation at home.
Sex therapy addresses the topic directly, and it brings in something that surprises people: information. Many of us never learned how arousal, desire, and pleasure actually work. Sometimes one well-timed piece of education loosens a gridlock that years of arguing couldn't touch. The couple wasn't failing at communicating. They were working from a script that was wrong.
The Myths We Absorb
We take in confusing messages about sex all our lives. Everyone is supposed to want it constantly. Orgasm is supposed to be effortless. Good sex is supposed to happen without any discussion. Certain bodies count as sexy and others don't. When real life doesn't match, people assume the fault is personal.
Part of my work is gently taking those messages apart, so you can see which ones you inherited and which actually fit you.
Bodies Change, and So Does Sex
Sexual function depends on many systems working together: hormones, circulation, nerves, mood, stress, medications, and more. These shift across a lifetime, through puberty, pregnancy and postpartum, illness, midlife, and aging. Sexual concerns can therefore come up at almost any age, and they don't mean you've done something wrong.
Some concerns have a medical component. When that seems likely, I'll recommend a medical evaluation alongside therapy, and the two usually work best together.
Sex, Identity, and Belief
Sex is tied up with who we are and what we believe. Someone raised in a strict religious tradition may find that sex doesn't feel the way they were led to expect, and then wonder what that says about them. Someone else may be discovering an orientation that conflicts with their faith or family. These aren't simple problems with simple fixes, and they matter. A good sex therapist makes room for the whole picture.
Sex therapy can also help people who have little interest in sex, including people who identify as asexual. You don't need a partner, or even a desire, for this part of your life to be worth talking about.
Who Comes, and What Happens
Individuals come for low desire, trouble with arousal or orgasm, sexual pain, performance anxiety, compulsive sexual behavior, questions about identity, trauma, or shame. Couples come for mismatched desire, sexless relationships, difficulty talking about sex, recovery from infidelity, or opening a relationship.
The first session is mainly about understanding you. I'll ask what brought you in, what you've tried, and what you hope will change. Some questions will feel personal, and you can always tell me to slow down. My work is experiential, so with couples I'll ask you to talk directly to each other, and with individuals I'll ask what you notice in your body as we talk. I'm direct, and with your permission I'll name what I see getting in the way.
You may also try exercises between sessions, but only ones we've discussed and agreed on together. Timelines vary. A defined issue can shift in a month or two, while rebuilding trust or healing from trauma takes longer. Therapy asks something of you, including reflection and sometimes discomfort, and that's where the change happens.
A Word on Shame
Almost everyone arrives carrying some shame about their desire, their history, their body, or what they want. You don't have to get past it before you start. You only have to be willing to be honest.
Finding a Real Specialist
In most states, "sex therapist" isn't a protected title, and listing it as a specialty on a directory is self-reported. The simplest credential to look for is AASECT certification (the American Association of Sexuality Educators, Counselors and Therapists), the field's gold standard. Certified Sex Therapists (CSTs) hold a graduate degree and a clinical license, complete extensive specialized training and supervised clinical hours, and work under a certified supervisor for at least 18 months. They also go through an experiential Sexuality Attitude Reassessment, which means they've examined their own biases before treating anyone else.
To find one, search the AASECT directory at aasect.org/referral-directory, look for "CST" after the name, and confirm an active state license (LMFT, LCSW, PhD, PsyD, or similar). Online therapy widens your options, since most states allow telehealth statewide.
However, there are other ways to become a sex therapist, such as getting other specific trainings or certifications. I myself trained with Martha Kauppi and completed her ATSIP program, alongside extensive consultation and training with trained and certified sex therapists.
Finally, trust your sense of fit. If you can't be honest with someone after a few sessions, it's okay to keep looking.