What Is Sex Therapy? A Complete Guide to Sexual Health Counseling
Sex therapy is a specialized form of talk therapy where licensed mental health professionals help individuals and couples address sexual concerns, dysfunction, and intimacy issues. Using evidence-based techniques like cognitive behavioral therapy, sex therapists create a safe, confidential environment to explore problems ranging from performance anxiety to sexual identity concerns. Treatment typically involves weekly sessions and focuses on emotional factors affecting sexual wellbeing.
Almost everyone is familiar with Sigmund Freud and his theories on sexuality. Often called the "founder of psychoanalysis," Freud thought that personality derives from an individual's Oedipal complexes and stifled sexual urges, which dominate the id, ego, and superego. While Freud's theories focused heavily on sexuality, modern mental health counseling addresses sexual concerns when they impact overall well-being, though it's not always the primary focus of treatment.
When sexual interest and arousal pose significant problems in relationships or identity, meeting with a sex therapist who has specialized training in this area can prove helpful. A sex therapist can help clients gain insight into their fundamental drives and passions and feel comfortable with their sexual nature. Sex therapy is much like other forms of mental health counseling in that it's a form of talk therapy utilizing many of the same methodologies as cognitive behavioral therapy.
Table of Contents
What Is Sex Therapy?
Sex therapy is a specialized form of psychotherapy designed to help individuals and couples address concerns related to sexual function, desire, and intimacy. Often used in conjunction with traditional mental health counseling, sex therapy is also applied as a follow-up form of therapy when issues with sexual interest, arousal, or performance lead to more serious mental health concerns, such as anxiety or depression.
A mental health counselor may recommend sex therapy during the course of treatment when it becomes apparent that addressing sexual concerns may provide peace of mind and benefit a couple's relationship. Unlike other medical treatments, sex therapy doesn't involve physical examination, medication prescriptions, or intimate contact. It's a talk-based therapeutic approach that addresses the psychological and emotional factors affecting sexual wellbeing.
Using targeted discussion techniques, sex therapy sessions address the underlying emotional issues that may be impacting an individual's approach to and feelings about sex. For effective treatment, honesty and an open relationship between both client and therapist are essential requirements. While sex therapy is sometimes offered as a form of couples counseling, it's typically offered to individuals as a tool to help them overcome inhibitions associated with their sex life.
What Does a Sex Therapist Do?
Sex therapists are licensed mental health professionals who've received specialized training in addressing sexual health concerns. While licensed therapists such as psychologists, marriage and family therapists, licensed mental health counselors, psychiatrists, and clinical social workers are legally permitted to provide sex therapy, ethical and effective practice requires specialized training beyond standard licensure.
These professionals work with their clients to improve sexual wellbeing, addressing a broad spectrum of personal concerns ranging from asexuality to hyperarousal. Certified sex therapists typically hold credentials from professional organizations like the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), which ensures practitioners have the necessary expertise to address sensitive sexual health issues.
Professional Credentials and Training
Sex therapists must first obtain their primary mental health license, such as:
- Licensed Marriage and Family Therapist (LMFT) with a master's degree and 3,000+ supervised clinical hours
- Licensed Professional Counselor (LPC) with a master's in counseling and state-specific requirements
- Licensed Clinical Social Worker (LCSW) with an MSW and specialized clinical training
- Psychologist (PhD or PsyD) with doctoral-level education and extensive practicum experience
After obtaining their base license, therapists pursue additional certification in sex therapy through rigorous requirements. AASECT certification, for example, requires 90 hours of specialized sex therapy education, 50 hours of supervised clinical sex therapy practice, and a minimum of two years of professional experience providing sex therapy services. This comprehensive training ensures certified sex therapists have the knowledge and clinical skills necessary to address complex sexual health concerns effectively.
| Credential Level | Education Required | Typical Timeline | Median Salary |
|---|---|---|---|
| Mental Health Counselor | Master's Degree | 2-3 years | $59,190 |
| Marriage & Family Therapist | Master's Degree + MFT Training | 2-3 years | $63,780 |
| Clinical Psychologist | Doctoral Degree (PhD/PsyD) | 5-7 years | $96,100 |
| Sex Therapy Specialist | Base License + Sex Therapy Certification | Additional 1-2 years | Based on the primary credential |
What to Expect in Sex Therapy
Many people feel apprehensive about their first sex therapy session, but understanding what to expect can help ease concerns. Sex therapy sessions follow a structured, professional format designed to create a comfortable environment for discussing sensitive topics.
First Session Overview
During your initial session, the therapist will conduct a comprehensive assessment of your concerns, medical history, relationship status, and treatment goals. This conversation remains strictly confidential and professional. You'll discuss your sexual history, current concerns, and any medical or psychological factors that might be contributing to the issues you're experiencing.
The therapist won't ask you to demonstrate any physical actions or engage in intimate activities. Sex therapy is entirely talk-based. You'll remain fully clothed, and the setting is identical to any other counseling session, a private office designed for confidential conversation.
Ongoing Sessions and Treatment Duration
Following the initial assessment, you'll typically meet weekly or bi-weekly for 45-60 minute sessions. Treatment duration varies significantly based on individual needs, with some clients experiencing improvement within 8-12 sessions, while others may benefit from longer-term therapy that spans several months.
Between sessions, your therapist may assign "homework" exercises designed to help you practice new skills or explore aspects of your sexuality in a safe, controlled manner. These assignments are always appropriate and designed to build comfort and understanding at your own pace.
Guiding Principles of Sex Therapy
Sex therapy follows the same ethical guidelines and therapeutic principles as any other form of professional counseling. The guiding principle is confidentiality. The goal of the therapy session is to offer an empathetic perspective on the individual's problems, creating a patient-centered environment that emphasizes unconditional positive regard, acceptance, and personal guidance.
During sex therapy sessions, the therapist may use a combination of therapeutic tools to address individual concerns:
- Cognitive behavioral therapy (CBT) is used to identify and change negative thought patterns affecting sexual function
- Empathy and active listening to create a safe space for vulnerable discussions
- Exposure techniques to gradually address fears and anxieties around sexuality
- Role play and communication exercises to improve intimacy skills and partner communication
- Psychoeducation to provide accurate information about sexual anatomy, function, and response
- Mindfulness practices to increase present-moment awareness during intimate experiences
The therapist adjusts the strategies utilized during sex therapy based on the unique needs of the individual. What may prove helpful for one patient may not work for another. The most effective sex therapy methods depend on the needs and preferences of each individual.
Issues Addressed in Sex Therapy
Sex therapy addresses a wide range of personal and relational concerns related to sexuality, sexual function, and intimate relationships. Understanding what sex therapy can help with may help you determine if it's right for your situation.
Individual Concerns
Sex therapists work with individuals experiencing personal challenges with their sexuality, including:
- Sexual identity and orientation questions related to understanding and accepting one's sexual identity
- Sexual dysfunction such as erectile difficulties, premature or delayed ejaculation, and arousal disorders
- Painful intercourse (dyspareunia) occurs when psychological factors contribute to physical discomfort
- Difficulty achieving orgasm (anorgasmia) or concerns about orgasmic function
- Low sexual desire or libido that causes personal distress
- Sexual fears and anxieties, including performance anxiety or fear of intimacy
- Sex addiction or compulsive sexual behavior that interferes with daily functioning
- Paraphilia concerns when sexual interests cause distress or interpersonal problems
- Sexual trauma recovery to address the impact of past sexual abuse or assault
- Body image issues affecting sexual confidence and comfort
Relationship Issues
In addition to individual concerns, sex therapy can address relationship challenges, including:
- Lack of sexual desire by one or both partners creates tension in the relationship
- Intimacy issues following infidelity or trust breaches in the relationship
- Sexual intimacy challenges after having children or major life transitions
- Mismatched sex drives or sexual preferences between partners
- Communication difficulties about sexual needs and desires
- Sexual boredom or dissatisfaction in long-term relationships
| Concern Category | Common Issues | Typical Treatment Approach |
|---|---|---|
| Sexual Function | Performance anxiety, arousal difficulties, orgasm concerns | CBT, sensate focus exercises, anxiety reduction |
| Desire Discrepancy | Mismatched libido, loss of interest | Communication training, exploring underlying causes, sand cheduling intimacy |
| Relationship Intimacy | Connection issues, communication barriers | Couples counseling techniques, intimacy-building exercises |
| Sexual Identity | Questions about orientation, gender, and preferences | Exploration, acceptance work, identity development |
How to Find a Qualified Sex Therapist
Finding the right sex therapist is an essential step in addressing sexual health concerns. Not all therapists have specialized training in sexuality; therefore, it's essential to look for specific credentials and qualifications.
Professional Credentials to Look For
When searching for a sex therapist, look for professionals who hold both a base mental health license and additional certification in sex therapy. The gold standard is AASECT certification, which indicates the therapist has completed rigorous additional training specifically in sexual health counseling.
Qualified sex therapists should hold credentials such as:
- AASECT Certified Sex Therapist designation from the American Association of Sexuality Educators, Counselors, and Therapists
- Licensed Marriage and Family Therapist (LMFT) with sex therapy specialization
- Licensed Professional Counselor (LPC) with sex therapy training
- Licensed Clinical Social Worker (LCSW) specializing in sexual health
- Licensed Psychologist with sexuality expertise
Questions to Ask Potential Therapists
Before beginning therapy, consider asking potential therapists:
- What specific training have you completed in sex therapy?
- Are you certified by AASECT or another professional organization?
- How many years have you worked with sexual health concerns?
- What therapeutic approaches do you use for issues like mine?
- What's your typical treatment timeline for concerns like mine?
- Do you see individuals, couples, or both?
- What are your fees, and do you accept insurance?
Where to Find Sex Therapists
You can locate qualified sex therapists through several resources:
- The AASECT directory at www.aasect.org
- Your health insurance provider's directory of covered therapists
- Referrals from your primary care physician or current therapist
- Professional psychology and counseling associations
- University counseling centers and teaching hospitals
Recommendations and Limitations of Sex Therapy
Sex often is a taboo subject, especially in households that are highly conservative or religious. This can sometimes lead to an unhealthy relationship with sex, creating tension and anxiety in association with the subject of sexuality. This anxiety can inhibit an individual's ability to form a healthy sexual relationship, which may have a lasting impact on quality of life and long-term relationships.
Sex therapy can benefit almost everyone, regardless of background. The ability to form healthy sexual relationships is fundamental to experiencing intimacy, and sex therapy can help clients overcome obstacles that may be preventing them from forming those types of relationships.
Who Can Benefit from Sex Therapy
Sex therapy is recommended for anyone who has experienced reduced quality of life because of problems with sexual desire or function. This form of counseling is ideal for anyone who has encountered difficulty in relationships caused by sex, regardless of age, gender, or personal background.
Sex therapy most frequently takes place on a short-term basis, often in conjunction with or following more general talk therapy. Individuals and couples who benefit most from sex therapy typically experience:
- Distress related to sexual function or satisfaction
- Relationship tension caused by sexual issues
- Anxiety or fear around sexual activity
- Questions about sexual identity or orientation
- Difficulty recovering from sexual trauma
- Concerns about sexual behavior or compulsions
Limitations and Considerations
While sex therapy is a useful tool for addressing issues with sexuality, it has some important limitations to understand. Sex therapy is not intended as a sole form of treatment for other problems that may be impacting personal wellness, such as general stress, anxiety, depression, or other concerns commonly addressed in general therapy.
Sex therapy should not be used as a substitute for necessary medical treatment. If sexual dysfunction stems from physical causes like hormonal imbalances, neurological conditions, or medication side effects, medical evaluation and treatment may be necessary alongside or instead of therapy.
While sex therapy may be recommended for couples attempting to overcome issues with sexual intimacy, it should not be viewed as an alternative to traditional couples counseling. Improving sexual intimacy often proves helpful in creating healthier relationships, but more traditional forms of counseling remain important when working through issues with communication and personal priorities, as well as other personal concerns such as stress, anger, or generalized fears.
The Surrogate Controversy
While some sex therapists encourage the use of surrogates for sexual encounters, surrogate partner therapy is not usually recommended and remains controversial within the field. Many mental health organizations and practitioners raise ethical concerns about surrogate partner therapy, noting it falls outside standard therapeutic practice and creates potential boundary issues. When considering sex therapy, patients should not expect or anticipate surrogate involvement.
Frequently Asked Questions About Sex Therapy
Is sex therapy right for me?
Sex therapy can benefit anyone experiencing concerns about sexual desire, function, intimacy, or sexual identity. It's particularly helpful if sexual issues are causing personal distress, relationship problems, or impacting your quality of life. If you're unsure, consider scheduling an initial consultation to discuss your concerns with a qualified mental health professional.
What happens during a sex therapy session?
Sex therapy sessions are talk-based discussions in a private, confidential office setting. There's no physical contact or examination. Your therapist will ask questions about your concerns, medical history, and relationships to develop a personalized treatment plan tailored to your specific needs. Sessions typically last 45-60 minutes and follow the same professional format as any other type of counseling.
How long does sex therapy typically take?
Treatment length varies by individual need, but many clients see improvement within 8-12 weekly sessions. Some issues may resolve in just a few months, while others benefit from longer-term therapy. Your therapist will work with you to establish goals and regularly assess progress toward those objectives.
Does insurance cover sex therapy?
Many health insurance plans cover sex therapy when provided by a licensed mental health professional. Coverage often depends on your specific plan and whether the therapist is part of the in-network provider network. Sex therapy may be covered under mental health benefits, particularly when addressing concerns that impact overall well-being. Contact your insurance provider to verify coverage before beginning treatment.
Is sex therapy confidential?
Yes, sex therapy follows the same strict confidentiality standards as all mental health counseling. Therapists are legally and ethically bound to protect your privacy. Information from sessions cannot be shared without your written consent, except in rare situations involving imminent danger or legally mandated reporting requirements. Your therapist will explain confidentiality policies during your first session.
Do I need to see a sex therapist with my partner?
Not necessarily. While couples can benefit from attending sessions together, especially when addressing relationship dynamics, individual sex therapy is also highly effective. Many people start with individual sessions and later include their partner if appropriate. Your therapist can help you decide whether individual, couples, or a combination of both formats would work best for your situation.
How do I find a certified sex therapist?
Look for therapists certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT) through their online directory at www.aasect.org. You can also ask your primary care physician or current therapist for referrals, check your insurance provider's directory, or contact professional counseling organizations for recommendations.
What's the difference between sex therapy and couples counseling?
Sex therapy specifically focuses on sexual concerns, dysfunction, and intimacy issues using specialized techniques and training in human sexuality. Couples counseling addresses broader relationship dynamics, including communication, conflict resolution, trust, and life transitions. While there's overlap, sex therapists have additional expertise in addressing sexual health concerns that general couples counselors may not possess.
Key Takeaways
- Sex therapy is a specialized form of talk therapy that addresses sexual concerns through cognitive behavioral techniques and targeted discussions in a safe, confidential environment
- Licensed mental health professionals, including psychologists, LMFTs, LPCs, and clinical social worker,s can provide sex therapy, though specialized training and certification are essential for effective practice
- Common issues addressed include sexual dysfunction, performance anxiety, intimacy problems, desire discrepancies, sexual identity concerns, and relationship sexual challenges
- Sessions are entirely conversation-based with no physical contact or examination, typically lasting 45-60 minutes over 8-12 weeks or longer, depending on individual needs
- AASECT certification requires 90 hours of education, 50 supervised clinical hours, and two years of experience, demonstrating expertise in sexual health counseling
- Treatment is typically short-term and can significantly improve sexual satisfaction, relationship quality, and overall well-being when combined with open communication and commitment to the therapeutic process
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2024 US Bureau of Labor Statistics salary figures and job growth projections for Clinical and Counseling Psychologists, Industrial-Organizational Psychologists, School Psychologists, Psychologists-All Other; Psychiatric Techs; Psychiatrists; Substance Abuse, Behavioral Health and Mental Health Counselors; Marriage & Family Therapists; and Social Workers are based on state and national data, not school-specific information. Conditions in your area may vary. Data accessed October 2025.
