Does Sex Therapy Work? What to Expect and How to Find Help

There's so much pressure on all of us to be amazing in bed.

Movies show us impeccably made-up actors falling gracefully into bed, fitting together easily and climaxing at the same time, all without smudging their mascara. Magazines tell us over and over how to wow him and have more intense orgasms. And porn, for anyone who hasn't figured it out, doesn't show how real sex usually flows.

We're a sexually saturated culture and a sexually repressed one at the same time. With all that pressure, it can be hard to admit your own sex life needs some help.

That's where sex therapy comes in.

What is sex therapy?

A sex therapist is a licensed mental health professional with extra training in sexuality. They help you understand what's getting in the way of a fulfilling sex life and work out what to do about it.

People often think of sex therapy as something for couples. It is very common, and helpful, for couples to go together, even when the issue mostly shows up for one partner, like finishing too soon or low desire.

It's just as normal to go on your own. Individual sex therapy can help with healing past sexual trauma, performance anxiety, questions about sexual orientation, and general sexual confidence.

What brings people to a sex therapist?

Performance worries are a big one: erection problems, finishing too soon, or difficulty reaching orgasm. Both men and women feel pressure to be "good in bed."

Desire is another. That includes low desire, high desire, and the most common one I hear about: a difference in desire between partners. People worry when desire shifts. Will they have to settle for a sexless relationship? If they want different amounts of sex, is the relationship over? When these conversations go badly, they turn into fights.

People also go for help with body shame, dating, and intimacy struggles. And you don't need a crisis. Some people go simply to feel better about sex.

What happens in a session?

Let's get this out of the way: no one is having sex during sex therapy. The therapist doesn't need to watch you with your partner and shout pointers from the sidelines.

A well-trained sex therapist can spot what's out of sync long before anyone takes their clothes off. Most sessions look like a regular therapy session. You sit and talk, and the therapist asks questions. Don't be surprised if there are no dildos or sex swings on the walls. Sorry to disappoint.

Many questions will reach beyond your sex life. You're a whole person, and a good therapist will want the full picture: work stress, family, friendships, the history of your relationship, and probably your childhood and early relationships, too.

Is there a medical exam?

No. A sex therapist isn't a medical doctor. But don't be surprised if they suggest a physical or refer you to a specialist.

Some sexual problems have medical causes, like medication side effects, circulation issues, or hormonal changes. If you've noticed pain, erection changes, or a sudden shift in desire, see your doctor as well.

Will there be homework?

Probably. Therapy isn't school, but you may leave with exercises to try before the next session.

Many involve mindful touch, on your own or with a partner. Some couples find these embarrassing or forced at first. They're often where the real change happens.

So, does it work?

For many people, yes. But like any growth work, you get out what you put in.

You need to be honest with yourself and with the therapist, and be willing to get uncomfortable. Therapy is usually about an hour a week. That's 1 hour out of 168. The people who get the most out of it use the tools between sessions.

A therapist can only help as much as you're ready to change.

How to find a good sex therapist

Most sex therapists are licensed as psychologists, marriage and family therapists, clinical social workers, or counselors, and then add training in human sexuality. In the US, AASECT certification is one credential to look for.

The right training matters. So does how you feel with them. If you're not comfortable, you'll hold back.

Book short consult calls with two or three therapists before choosing. Here's what to ask:

• "What specific training do you have in sexuality?"
• "Are you licensed in my state?"
• "Have you worked with [your concern] before?"
• "Do you see couples, individuals, or both?"
• "How will we know if it's working?"

Where a coach fits

I'm a sex and relationship coach, not a therapist. I trained in counseling psychology and I've been coaching since 2010, but coaching and therapy are different things.

Therapy is the right place for trauma, depression or anxiety, compulsive sexual behavior, or a relationship in crisis. A therapist can diagnose and treat.

Coaching is practical and forward-looking: understanding your desire, talking about sex without it blowing up, building skills, and practicing between sessions. It doesn't diagnose or treat. Some people need one, some the other, and some do both.

Sex should be a source of joy in our lives. It's not always as easy as the movies make it look. When sex becomes more stressful than fun, it's time to get some help.

If this is weighing on you, you don't have to sort it out alone. A licensed therapist is the right first call for some of this; for the rest, I work one-on-one with individuals and couples.