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Sex Therapy: A Beginner's Guide

Dr. Justin Lehmiller
Social Psychologist, researcher at The Kinsey Institute

by Dr. Justin Lehmiller 10 min read

Sex is a largely unspoken thread that binds all of humanity together.

Although almost everyone has sex and sex is vital for the survival of our species, it is a subject many people today feel great discomfort talking about.

This is especially true when it comes to any type of sexual dysfunction problems.

Sexual performance difficulties tend to push conversations about sex deeper into the shadows, as shame, embarrassment, and worry come to the forefront.

For example, erectile dysfunction (ED) is one of the more common sexual difficulties.

Despite how common it is, many people who have it feel like their problem is unusual.

However, a landmark study called the Massachusetts Male Ageing Study (MMAS) found that more than half of participants in the 40-70 age group had reported some occurrence of ED, making it a rather normative occurrence.

The practice recognizes that sex itself is an incredibly complex undertaking – physically, mentally, emotionally, and sometimes even spiritually – and, therefore, treatment for sexual difficulties must be equally nuanced and informed.

Sex therapists will use the insights they gain to help you positively evolve your current feelings about sex, ensuring you are better able to connect with your current and future sexual partners.

Anyone who’s quality of life has been negatively affected by sexual dysfunction

Before seeking help from a sex therapist we recommend learning more about popular over the counter medications that treat the most common sexual dysfunctions like Promescent

Increasing ED with age

Admitting to or acknowledging sexual dysfunction problems like ED is a near impossibility for many due to the stigma associated with having a sexual difficulty, and getting help for it is a source of apprehension, even for many open-minded, sex-positive folks.

This is a shame because help is readily available to most who are suffering in silence.

Sex therapy is far more common and accessible than most would-be patients might imagine—and not only can it resolve a lot of sexual dysfunction difficulties, but it can help to improve sexual connections with a partner.


What is Sex Therapy?

Whether a patient has issues with performing the sex act itself, struggles with internal guilt over pleasure, or can’t seem to focus and stay in the moment, sex therapy can help.

The practice recognizes that sex itself is an incredibly complex undertaking – physically, mentally, emotionally, and sometimes even spiritually – and, therefore, treatment for sexual difficulties must be equally nuanced and informed.

Who can benefit from sex therapy

However, sex therapy is widely misunderstood.

One of the most pervasive myths is that it is a hands-on practice, so let’s clear that up from the get-go.

The therapist does not and will not be physically involved or present during sex acts.

Rather, he or she will discuss each partner's feelings and experiences, helping uncover self-realizations and transforming relationship-damaging thoughts and behaviors that are impacting sexual health.

And if sexual difficulties have a biological cause, medications or other treatments might become part of the equation.

Both individuals and couples can benefit from sex therapy—it is not a "couples only" solution.

Many non-partnered patients rely on regular visits to help them build a foundation for healthy future relationships.

What Does a Sex Therapist Do?

Sex therapists are a diverse group of people, but they usually have degrees in psychology, psychiatry, or some type of mental health counseling.

Some have certifications from professional sex therapy organizations, such as AASECT, whereas others do not.

However, to ensure competent care, it’s usually best to find certified sex therapists.

When someone visits a sex therapist, the therapist will begin by getting to know their patient(s) through discussing a brief history and asking a number of questions.

Although the questions may seem quite personal, it's important for your therapist to know about any past trauma or unhealthy relationships you may have had because they may be the root of your sexual problems.

Know that they are not there to judge or shame you (and if they do, it’s time to find a new therapist!), but rather to help spot the underlying causes and develop effective solutions for them.

Your therapist will use the insights they gain to help you positively evolve your current feelings about sex, ensuring you are better able to connect with your current and future sexual partners.

In short, sex therapists listen, examines, explains, and suggests ways for you to improve both your sex life and your relationship with your partner(s), while helping you to overcome past traumas or negative learned behaviors along the way.

How a sex therapist helps

Does Sex Therapy Work?

Sex therapy works, and it has a high success rate overall.

However, the success of any type of therapy relies, in large part, on the patient.

If a patient isn't ready to delve into past issues to talk them through, or is unwilling to compromise or explore solutions with their partner, sex therapy won't have much of a chance to make a difference.

The two most important things a patient can bring to a sex therapy session are an open mind and a willingness to change.

It's important that change is made not only for the benefit of any partner in the picture, but also for the patient himself or herself; otherwise, any improvement is destined to be temporary, rather than meaningful and lasting.

Couple in a sex therapy session


Sex therapy works best for individuals and couples that are truly vested in success - those eager to improve their marriage or partnership and grow closer with the person they love, as opposed to those approaching therapy as a hasty, last-ditch effort to "save" a relationship on the rocks.

While this type of therapy does tend to have a net positive effect on a partnership, the biggest impact is likely to be made before resentment has a chance to set in.

Couples who allow sexual problems to fester too long have a more difficult time opening themselves up to the types of changes needed to effectively solve their sexual problems.

Think of sex therapy as a supportive measure, rather than a last-ditch effort, whenever possible.

Course-correcting a persistent sexual issue early on is much easier than pulling a relationship back from the brink after years of hurt feelings and poor communication.

Sex Therapy for Performance Anxiety

Many sexual difficulties have their roots in physical sexual problems.

For example, many cases of ED stem from cardiovascular issues that affect blood flow to the penis.

However, other sexual dysfunction problems (including some cases of ED) are caused by mental obstacles and fears, such as sexual performance anxiety, or SPA.

SPA affects both men and women, but has a higher prevalence in men: a difference of 9-25% versus 6-16%, respectively.

Sex therapy for SPA addresses these issues at the source: your mind.

Sexual performance anxiety can manifest in several ways; there is no "one way" to diagnose and treat all cases of it.

With any sexual health issues, your therapist will make a judgement call on treatment once they have had a chance to ask questions and explore your issue in-depth with you.

Sexual performance anxiety signs

For example, sexual performance anxiety may appear as a man unable to get or maintain an erection, or a woman unable to relax sufficiently for comfortable penetration.

SPA can also interrupt a sexual act that started with no initial problems, causing one or both sexual participants to "freeze up", making sex uncomfortable, painful, or even impossible.

Men struggling with SPA can also experience premature ejaculation, an event in which climax occurs before it is desired, often before the sex act has a chance to begin in earnest.

Sex therapy for premature ejaculation can involve special exercise techniques, such as self-stimulation to climax before initiating sex with a partner later to ensure better ejaculatory control.

Sex therapy can help diminish or even eliminate SPA through a variety of methods, attuned to a patient's specific needs.

These may include practices like or cognitive behavioral therapy (CBT), meditative techniques, or suggestions for sexual exercises that will lessen the pressure to perform and promote better overall sexual health.

What Type of Exercises are Used in Sex Therapy?

Exercises used in sex therapy


Any physical exercises will be given as "homework" after a session with a certified sex therapist.

During the session itself, he or she may:

  • Explain that certain mental images or thoughts may be harming your ability to enjoy healthy sex and the attention of your partner. Your therapist may suggest ways to clear your mind or different sexual problems to focus on.
  • Walk you through visualizations that you can use to help clarify and actualize your sexual wants and goals.
  • Introduce mindful breathing exercises intended for use before or during sex. These exercises will help keep panic or worry from creeping in and firing up sexual performance anxiety.
  • Use educational models and explanations during your office visit. Some sexual dysfunction stems from inadequate sexual education in youth, which in turn creates problematic behaviors in adulthood. Your therapist may ask you to read a certain sexual education book, or view a sexual health education video in the privacy of your home.
  • Instruct you to have a conversation with your partner. This discussion will focus on a specific topic in order to clarify wants, needs, and boundaries before you become intimate again.
  • Suggest certain adult toys or tools to help you learn and discover your body. These may include items such as Kegel exercisers for women or erection rings for men.

A comprehensive approach to healing sexual issues, both in individuals and couples, often uses more than one of these therapies to increase the chances of success.

Does Sex Therapy Deal with Sexual Trauma?

Sexual abuse is distressingly common: 1 in 9 girls and 1 in 53 boys are sexually abused by the age of 18.

Rates of sexual abuse and assault are even higher among college students.

Experiencing sexual trauma can contribute to a wide range of sexual issues.

For victims, physically recovering from sexual trauma is only one small part on the road to recovery.

The mental and emotional effects can linger for years—sometimes decades—and later impact relationships, marriages, and more, sometimes without the victim even consciously realizing all of the effects.

Sex therapy can help help victims "unpack" the emotions that come along with healing in a safe, supervised way under a certified sex therapist’s guidance.

Certified sex therapists provide a safe space to answer important but painful questions, such as "how did that make me feel?" without the stigma that often comes from acknowledging sexual assault to others.

Unresolved emotional reactions that stem from trauma can interfere with sexual function, make sex painful, or even frightening, even when it's with someone you love.

Sex therapists can potentially help you overcome that unwanted connection by forging a new, positive one.

Exercises for overcoming sexual trauma may include journaling, talk therapy, cognitive behavioral therapy, breathing exercises, and proactive sexual experimentation with a partner to help define and enforce healthy boundaries during sex.

Note: Addressing the sexual dysfunction component of trauma recovery is important to your overall sexual health.

However, it's often helpful to see a sexual therapist in conjunction with your regular therapist for a holistic approach that benefits you both in and out of the bedroom.

What is Sex Therapy for Erectile Dysfunction Like?

In order to treat erectile dysfunction effectively, a sex therapist will discuss your observations and medical timelines in detail to determine whether a pharmaceutical, psychological, or hybrid approach will work best.

He or she will ask specific questions and explore your sexual history with you to figure out when the problem began, if it only happens in certain scenarios (or with certain partners), and also whether it's intermittent or persistent.

Erectile dysfunction and you

Severity matters as well: if meditation techniques, physical exercises, and tools like erection rings fail to offer meaningful help, your sex therapist may instruct you to talk with your general practice physician to obtain a prescription for an ED medication like Viagra or Cialis to help you regain some sexual function.

Generally, a sex therapist will walk you through both mental and physical exercises to perform as homework before resorting to medication routes, but diagnosis will vary from individual to individual.

Existing health conditions, such as high blood pressure, may also impact the safety and efficacy of taking certain ED medications.

How Do I Find a Certified Sex Therapist?

Much like traditional therapy, sex therapy sessions and providers are available online and offline, depending on your comfort level and access to care.

Finding a certified sex therapists near you is as simple as a quick google search in most cases, and you can try narrowing the search, depending on your specific sex therapy needs.

Find solutions with a sex therapist
  • In-person sessions may be offered in a therapy office or professional space in your local area. This is an excellent option for couples interested in attending sex therapy sessions together. This offers the most convenience for group discussions.
  • Online sex therapy sessions typically use a combination of webcam meeting software and chat messaging through your home computer. This option is ideal for individuals for whom absolute discretion is important.

  • Telephone sex therapy sessions are less common, but are still potentially helpful. These offer the ability to talk with a therapist from the comfort of home without the potential anxiety or embarrassment of broaching difficult subjects face-to-face with a stranger.

In some cases, sex therapists that ordinarily only offer in-person sessions may be willing to extend their services to an online or phone session.

Once you find a therapist that works well for your needs, you can ask if this option is available.

When searching for a sex therapist, ideally try to find one who is certified by a reputable organization such as AASECT (American Association for Sexuality Educators, Counselors, and Therapists).

They have a handy therapist locator tool on their website for your convenience.

Can Sex Therapy Help Me?

Getting past the stigma of sex as a shameful or guilt-ridden act may feel like an uphill battle, but the view from the top is well worth it.

You deserve a healthy, happy, and fulfilling sex life, no matter what your previous sexual issues are or what your relationship history looks like.

Your sex therapist is your ally and they can help you address your sexual concerns and unlock more pleasure, passion, and fun with your partner(s), as well as help you feel better about yourself along the way.

If you've been on the fence about working with a sexual therapist, give yourself the gift of an open mind: take a deep breath, commit to your happiness, and make an appointment in person, online, or over the phone.

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Dr. Justin Lehmiller
Dr. Justin Lehmiller

Dr. Justin Lehmiller is a social psychologist and Research Fellow at The Kinsey Institute. He is author of the blog Sex and Psychology and the popular book Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life. He is also a prolific researcher who has published more than 50 academic works, including a textbook titled The Psychology of Human Sexuality that is used in college classrooms around the world. Dr. Lehmiller is one of the media's go-to experts on sex and has been interviewed by The Wall Street Journal, The New York Times, and CNN; he has also appeared on dozens of radio, podcast, and television programs.


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