Working With a Therapist to Address Libido Problems and Other Sexual Health Issues

Whether you work with a psychiatrist, psychologist, or marriage or sex counselor, sex therapy can help with a variety of physical and emotional issues that can interfere with sexual satisfaction, such as erectile dysfunction, low libido, a history of abuse, and others. And it can help you and your partner work through these issues in a supportive and educational environment.

So what does sex therapy really entail? And who qualifies as a sex therapist? Read on to discover the truth about this type of therapy.

What Is Sex Therapy and How Can It Help?

Contrary to what some believe, there’s nothing strange, deviant, or kinky going on behind the door to a sex therapist’s office. Indeed, sex therapy is not very different from other forms of psychological counseling. “Sex therapy is a type of psychotherapy that also takes into account possible physical problems. When a couple comes in with a sexual problem, we try to figure out how each of them could be contributing to the issue. We examine behavior, gradually interpret that for them, and come up with solutions,” says Barbara Bartlik, MD, a psychiatrist and sex therapist at Weill Cornell Medicine in New York City.

What Happens in a Sex Therapy Session?

Your therapist will help you work through emotional issues that may be contributing to sexual issues, such as erectile dysfunction, according to Drogo Montague, MD, a urologist at the Cleveland Clinic in Ohio. If performance anxiety is an issue, sex therapy would typically begin with learning about performance anxiety, then move on to teaching a couple how to establish open lines of communication to discuss sexual wants and needs, Dr. Montague explains. The couple may also explore issues causing relationship stress, he adds.

When May Sex Therapy Be Recommended?

Sex therapy may be recommended in a variety of scenarios, says Michael Krychman, MD, executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach and coauthor of The Sexual Spark. Here are some of the most common scenarios:

Personal Conflict Issues Related to Sexuality This includes, for example, sexual trauma or assault. Dr. Krychman recommends seeking individual therapy first to cope with these issues, then gradually including your partner as needed.

Conflict About the Relationship A common example here would be a partner experiencing sexual boredom. In this case, it’s better to seek therapy alone first so that you can better understand yourself and your own sexual concerns, then incorporate your partner, says Krychman.

Compulsive Sexual Behavior (CSB) Once again, in this scenario it’s better for the person with the compulsive behavior or the partner to see a therapist alone first, then bring in the partner. “Sometimes, personal emotions of betrayal, guilt, or fear may need to be explored before incorporating your partner,” explains Krychman. “The one suffering from CSB may also experience a wide range of emotions, such as fear, shame, and anxiety. Addressing your personal emotional experience is important prior to bringing and dealing with your partner — this may enhance communication.”

Couple, Marital, and Sexual Problems For instance, with the infidelity of one partner, Krychman typically recommends that the couple tackle the concern or problem together from the start and address the roles they may have played with respect to the issue. “No one is blameless in a dysfunctional relationship, and couples can jointly work together to improve the quality of their experience,” he says.

Personal Coping Difficulties Related to Sexuality This area might include if you’ve just been diagnosed with a sexually transmitted infection and want to learn how to disclose your status to your partner or partners.

You’ll Learn to Be Mindful and More Aware

In mindfulness training, you learn to be present and focused on the here and now, rather than letting yourself get distracted by grocery lists and carpool plans. When using this concept in sex therapy, you learn to block out extraneous thoughts as well as negative thoughts you might have about your body or your performance. Instead, you are guided in thinking only about how your body is reacting to sexual stimulation.

Lori A. Brotto, PhD, executive director of the Women's Health Research Institute and Canada research chair in women's sexual health at the University of British Columbia in Canada, has done research on this topic, including a study published in November 2016 in Archives of Sexual Behavior. She has found that there's significant improvement in responsiveness in women suffering from anxiety-related sexual dysfunction. Dr. Brotto, also author of Better Sex Through Mindfulness, says that the hypothesis behind the results is that the mindfulness skills that the women acquired benefited their sexual motivation and response both directly, “by allowing them to nonjudgmentally focus on sexual sensations in their bodies before and during sexual encounters, and indirectly, by improving mood and decreasing stress and anxiety.”

Physical Issues Won’t Be Ignored in Sex Therapy

If there is a physical issue, such as vulvodynia or impotence due to radiation for prostate cancer, the therapist will refer you to a medical specialist who will work in tandem with the sex therapist.

Expect Some Sex Therapy Homework

While nothing sexual in nature will happen at the office, the therapist may offer some ideas to try out 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 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 reach an orgasm. Eventually, the exercises can lead to intercourse.

Sex Therapy as an Individual vs. as a Couple

“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.

Traditionally, it’s better for people who are experiencing individual sexual issues to seek therapy alone, then gradually incorporate their partner (if they have a partner), says Krychman.

“If you are treating individuals, you are only seeing one side of the discussion,” he explains. “Partners who are counseled together will often interact and the counselor or therapist can assess communication styles in real time. If they are screaming at each other or using abusive language, interrupting, or disrespecting each other, the counselor can discern the communication style and what is happening in their intimate life.” In addition, during couples sex therapy, the therapist can assess the body language of the partners as they both disclose and discuss intimate sexual details, Krychman adds. “For example, if a couple seems angry or hostile, there might underlying reasons for this,” he says.

How Can Sex Therapy Help My Relationship?

Sex therapy can improve a couple’s relationship in a number of ways, Krychman says:

Enhancing emotional and sexual communication
Enhancing sensuality and sexuality through sexual exercises that may help eliminate sexual boredom
Enhancing the understanding of each other’s sexual needs, wants, and desires
Enhancing fantasy exploration (a neutral third party could make it easier for an individual to disclose their sexual fantasies)

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

One thing is certain: Under no circumstances should you have to take off your clothes 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 is involved,” explains Bartlik.

Do My Partner and I Need Sex Therapy?

Individuals and couples seek sex therapy for many different reasons. According to Krychman, these are some of the most common reasons:

Mismatched libidos (one partner wants sex all the time; one partner wants it rarely)
Sexual boredom (one or both partners are bored by their sexual relationship)
A desire to change the paradigm (e.g., discussions about polyamory, or opening up the relationship to other partners)
Low libido (one or both partners are uninterested in sexual activity)
Coping with infidelity
The impact of compulsive sexual behaviors on the relationship and resulting in personal distress

“If you are troubled by your sexual relationship, [or] feel that there are barriers that may include physical, sensual, or sexual intimacy connections with your partner, you may need counseling or sex therapy,” he explains.

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 the gender of the 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 therapist’s 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 and 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 and Jennifer D’Angelo Friedman.