When Should I Seek Sex Therapy?
People often assume that sex therapy is only for relationships in crisis or for sexual difficulties that have become severe. In reality, you do not need to wait until something feels “broken” before seeking support.
Sex therapy can provide a confidential and non-judgemental space to understand your sexuality, explore changes in your sexual experiences and improve communication and intimacy. You can attend individually or with a partner, depending on what feels most appropriate for you.
What is sex therapy?
Sex therapy is a form of talking therapy that focuses on sexuality, intimacy and relationships. Despite what its name might suggest, it does not involve any sexual contact or physical examination.
Sessions may explore the physical, psychological, relational and cultural factors influencing your sexual experiences. This can include how stress, health, medication, past experiences, relationship dynamics, body image, beliefs about sex or differences in desire may be affecting you.
The aim is not to tell you what your sex life should look like. Instead, therapy offers a collaborative space to understand what is happening and identify what you would like to change.
Signs that sex therapy may be helpful
There is no single threshold you need to reach before contacting a sex therapist. It may be worth considering support if something related to sex, sexuality or intimacy is causing distress, affecting your confidence or creating distance within a relationship.
Some common reasons people seek sex therapy include:
Changes or differences in sexual desire
Sexual desire naturally changes throughout life. It can be affected by stress, health, medication, parenthood, ageing, relationship dynamics and many other factors.
Difficulties can arise when one person wants sex more or less frequently than their partner, or when a change in desire becomes confusing or upsetting. Sex therapy can help couples move away from blame and better understand the different factors influencing desire.
Difficulties with arousal or orgasm
You may experience difficulty becoming or remaining aroused, reaching orgasm, or feeling mentally and physically engaged during sexual experiences. These concerns can occur occasionally or become a recurring source of anxiety.
Therapy can help explore possible contributing factors, including performance pressure, distraction, shame, relationship concerns, learned sexual patterns and physical health.
Erectile or ejaculation concerns
Difficulties achieving or maintaining an erection, ejaculating sooner than desired or finding it difficult to ejaculate can affect confidence and lead to anxiety around sexual contact.
Sex therapy can interrupt the cycle in which worry about sexual performance makes the difficulty more likely to happen again. Where appropriate, therapy may take place alongside support from your GP or another medical professional.
Pain or discomfort during sex
Painful sexual experiences should not be something you feel expected to tolerate. Pain may have physical, psychological or combined causes, so an appropriate medical assessment is often an important first step.
Sex therapy can complement medical care by exploring fear, tension, avoidance, communication and the emotional impact of experiencing pain.
Anxiety or pressure around sex
You may find yourself monitoring your body, worrying about your performance or feeling pressure to respond in a particular way. When sex begins to feel like a test, it can become difficult to remain present and experience pleasure.
Therapy can help reduce this pressure and support a shift towards curiosity, communication and connection.
Avoidance of sex or intimacy
Avoiding sexual or affectionate contact does not necessarily mean that attraction or love has disappeared. Avoidance can develop following rejection, conflict, pain, changes in confidence or repeated experiences of pressure.
Over time, couples may become afraid to initiate any affection in case it creates an expectation of sex. Therapy can help make physical and emotional connection feel safer again.
Difficulties communicating about sex
Many people find it hard to talk about what they want, what they do not enjoy or where their boundaries are. You may worry about hurting your partner, appearing inexperienced or being judged.
Sex therapy can help you develop a shared language for discussing sex with greater honesty, sensitivity and respect.
Concerns about pornography or sexual behaviour
Pornography use does not automatically indicate that something is wrong. However, you may want support if your use feels difficult to control, conflicts with your values, affects sexual functioning or is contributing to secrecy or conflict within a relationship.
Therapy can explore the role pornography or sexual behaviour has come to play without relying on shame or automatically labelling the behaviour as an addiction.
The impact of shame, identity or past experiences
Messages from family, religion, culture, previous relationships and wider society can shape how we experience our bodies and sexuality. LGBTQ+ people may also carry the impact of stigma, concealment or earlier experiences of rejection.
Therapy can offer space to examine these messages and develop a more self-directed and affirming relationship with your sexuality.
Changes following illness or significant life events
Sexuality can be affected by illness, surgery, disability, pregnancy, menopause, fertility treatment, bereavement, trauma and changes in medication.
Support may focus on adapting to change, grieving what feels different and discovering new ways of experiencing pleasure, intimacy and connection.
Do I need to attend with my partner?
No. You can attend sex therapy individually, whether you are single or in a relationship.
Individual therapy may be helpful if you want to understand your sexual responses, work through shame or anxiety, explore your identity or consider how you would like to approach a concern within your relationship.
Couples or relationship therapy may be particularly useful when the difficulty is affecting both partners or involves differences in desire, communication, trust or intimacy. Sex therapy can also support people in diverse relationship structures and does not assume that there is one correct way to experience sex or relationships.
What happens during the first session?
The first session is an opportunity to talk about what has brought you to therapy and what you would like support with. You will only be asked to share what feels relevant, and you do not need to provide every detail immediately.
We may explore when the concern began, how it affects you, relevant relationship or health factors and what you hope might be different. Together, we can begin developing a shared understanding of the difficulty and discuss possible next steps.
Any exercises suggested as part of therapy are completed privately between sessions. There is never sexual contact, observation or physical examination during sex therapy.
Should I speak to my GP as well?
Some sexual difficulties may be influenced by physical health, hormonal changes, medication or other medical factors. For this reason, it can be helpful to speak with your GP, particularly when a difficulty is new, persistent, painful or accompanied by other physical symptoms.
Seeking medical advice does not mean that the concern is “all physical,” just as attending therapy does not mean that it is “all psychological.” Sexual experiences are often influenced by an interaction between the body, emotions, relationships and our wider circumstances.
You do not have to wait for a crisis
Sex therapy is not only about solving problems. Some people attend because they want to communicate more openly, reconnect after a period of change, understand themselves more fully or develop a more satisfying relationship with intimacy.
A useful question may not be, “Is my problem serious enough?” Instead, you might ask:
Is this affecting my wellbeing, confidence, relationship or ability to experience intimacy in the way I would like?
If the answer is yes, or even “I’m not sure”, it may be worth having a conversation.
Paul O’Beirne is an integrative psychotherapist, sexologist, and psychosexual and relationship therapist. He provides an inclusive and non-judgemental space for individuals and couples experiencing concerns related to sex, sexuality, intimacy and relationships.
To arrange a confidential consultation or learn more about psychosexual and relationship therapy, get in touch HERE
