Estimated reading time: 9 minutes

By José Ramirez, LMHC, CST

Have you ever wondered what a sex therapist does? No, they don’t have sex with their clients. 

Sex therapy is a type of talk-therapy that is used to treat individuals and couples experiencing a variety of sexual-related issues. Sex therapists are fully licensed mental health professionals who are trained to provide in-depth psychotherapy (aka talk-therapy) to clients experiencing sexual issues and concerns. 

Sex therapists have an in-depth knowledge of human sexuality and use this knowledge, along with their clinical training, to help clients reach their goals. The focus is on sexuality and how it impacts an individual or a couple’s functioning. If you want to read more about whether sex therapy is right for you, check out a blog I wrote on this topic: Is Sex Therapy Right for Me?. 

People often don’t know when they should see a sex therapist vs. a general mental health therapist. My advice is this: if you ever have any sex-related issue or topic that needs to be addressed, a sex therapist can likely help. A general therapist may be able to help as well; however, sex therapists have undergone rigorous specialized training and are very knowledgeable of everything sex related. 

It might help to have some concrete examples so here are…

7 signs it’s time to see a sex therapist: 

1. Desire/arousal problems
   
   A change in libido, or desire, is one of the most common reasons people come to sex therapy. Generally, people worry about a change in their libido and most want to get it back on track. In couple’s sex therapy, this can pose quite the challenge as almost always there is a desire discrepancy in the couple. Unchecked, this difference in desire can wreak havoc on a relationship. 
   
   Arousal problems are also quite commonly seen in sex therapy. Arousal is the ability to get “in the mood.” If you aren’t sexually aroused, having a satisfying sexual experience becomes difficult. Both arousal and desire issues are somewhat related, extremely common, and very workable in sex therapy. 
   
   
2. Sexual confidence issues
   
   A lot of people struggle with sexual confidence. Sex is one of the most vulnerable and intimate acts between two people. Folks of all genders/orientations can have sexual confidence issues and it can really put a damper on the ability to enjoy sex. Sexual confidence issues also make it really difficult to stay present during sex. People get so wrapped up in their anxiety that they aren’t fully present to enjoy the moment, much less their partner. Sexual confidence issues can look like body image issues, worrying about genital size or appearance, worrying about pleasing/disappointing a partner, being unable to ask for what you want, or feeling uncomfortable talking about sex. A sex therapist can help identify the issue and help treat it, as well as help empower their clients to take control of their sexuality. 
   
   
3. Sexual dysfunctions
   
   Sexual dysfunctions are probably the reason most people think of sex therapy. According to Cleveland Clinic, it’s estimated that around 43% of women and 31% of men report some degree of sexual dysfunction. Some of the more well known among the general public include erectile dysfunction, female pain disorders, and premature or delayed orgasm/ejaculation. 
   
   When treating sexual dysfunctions there is a talk therapy component to increase insight and understanding of the problem. Cognitive interventions are used to examine the role of shame, anxiety, relational dynamics, or unhelpful thinking/beliefs which may be exacerbating the issue. 
   
   Usually, there’s also an experiential component (done at home, either solo or with a partner) to work toward improving the issue. This homework can range from mindfulness practices designed to target sexual dysfunction to using sexual aides to improve sexual satisfaction/performance. Medical evaluations are almost always recommended to rule out medical causes of sexual dysfunction. Even if there is a medical cause, sex therapy can be beneficial to learn to cope with something that is more chronic in nature. I wrote a whole blog on this topic, if you want more nitty gritty details check out: Four Types of Sexual Dysfunctions and How to Cope with Them.
   
   
4. Out of control sexual behaviors
   
   This topic is probably one of the most controversial in the sex therapy field. Out of Control Sexual Behavior A.K.A. sex addiction, sexual compulsivity, or hypersexuality is the name given to a group of behaviors that are often considered problematic. The controversy comes from whether this is a true form of addiction. Not everyone agrees that it is. Some experts believe it to be more of a sexual health problem within a larger model of human behavior, not a psychiatric or addictive disorder. Generally, there is some consensus that out of control sexual behaviors are an intense focus on sexual fantasies, urges or behaviors that are extremely difficult to control. These behaviors cause distress and impact overall functioning. 
   
   Sexual behaviors that feel out of control is an especially important issue to see a sex therapist for as they have the training and understanding to treat the issue without further shaming or causing unnecessary harm/distress to the client. Most sex therapists will have been exposed to out of control sexual behaviors in their training or in practice so they know how to skillfully address them.
    
5. Sexual trauma recovery
   
   Most therapists work with psychological trauma on a daily basis and are very effective at doing so. Experienced trauma therapists can help sexual trauma survivors work through a traumatic experience(s). So what makes a sex therapist different? Once again, it comes down to specialized training in human sexuality. A sex therapist is first and foremost a licensed mental health professional, meaning that most of them have experience working with various types of trauma. What sets a sex therapist apart is the knowledge and experience in being able to not only help client’s through the trauma but also how to reclaim their sexuality in a sex-positive manner, afterwards. The ability for a trauma survivor to be able to reclaim their sexuality on their own terms is so powerful and healing. Sex therapists can help empower their clients to do just that. 
    
6. Kinks, BDSM, fetish
   
   When it comes to kinks, BDSM, or fetishes, people come to sex therapy for a variety of reasons. Some clients are just becoming familiar with the community and are looking to explore before jumping in, this may need to be processed. Other clients come to process situations they’ve been involved in that involve kink. Some come in to learn how to come out to their partners as kinky. Others come in to work on shame around a particular kink or fetish. Sex therapy is a great place to learn more about kinks, process experiences, and work through shame or difficulties that arise. Society tends to be sex-negative and puritanical so having kinks or being into BDSM can make people feel weird and ashamed. This can be unpacked in sex therapy. Just be sure to look for a sex therapist who is kink informed. Many sex therapists have received this training, but a kink-informed therapist will be very informed on all things kink so that you aren’t having to explain the terminology. There are therapist directories for this online if you google “kink-informed therapy.” 
   
   
7. Introduction to/Navigating Lifestyle
   
   Consensual non-monogamy, open relationships, polyamory, or lifestyle are all names given to alternative relationship styles. There are nuances between them all, but it basically boils down to having an open relationship to some degree. Couples who live this lifestyle often have agreements set in place regarding what is ok and what is not. Couples of all genders and orientations engage in consensual non-monogamy. In fact, a poll conducted in February 2023 found that 34% of Americans prefer their relationship style to be something other than complete monogamy. 

Sex therapy is a great place for couples or individuals in lifestyle to come and work through any issues that come up. It can be a great place to start the conversation about how to open up the relationship, you can negotiate your agreement with the guidance of a therapist, and you can work through any boundary crossing or betrayals, should they happen.

Most sex therapists receive training around alternative relationships so they’re a good resource. Of course, you don’t have to go to therapy to open up your relationship, you can read my blog post on how to open up your relationship.

However, this can be a sensitive topic for many people and sometimes conflict happens. Insecurities, trust, fear of rejection/abandonment are the usual culprits around the non-monogamy conversation, at least at the beginning. A therapist can help navigate this or any conflict that arises as well as assist in coming up with an agreement that works for everyone. 

Wrapping it all up

Sex therapy may seem mysterious to the average person, but it’s very similar to traditional talk therapy. The difference is that issues related to human sexuality are the focus. Sex therapists are licensed mental health professionals who have undergone specialized and rigorous training to better understand human sexuality and sexual functioning.

They use their mental health training and sex therapy training to help their clients better understand their sexuality, process problems related to sexuality, and resolve the issues.

Couples and individuals receive great benefit from working with a sex therapist. If you have experienced any of the seven categories I discussed above, chances are you’d be a great candidate for sex therapy. 

Florida is the only state in the US that requires a sex therapy certification in order to practice sex therapy. That means that in every other state, any therapist can market themselves as a sex therapist. The only way to be confident that the therapist you are seeing has the adequate education and training is if they are certified by a professional association like AASECT (American Association of Sexuality Educators, Counselors, and Therapists). And by the way, I am a certified sex therapist and would be happy to speak with you about starting therapy with me!

See how to get in touch with me below.

More Interesting Reads on Sex and Intimacy

José Ramirez is a licensed mental health counselor and Certified Sex Therapist. He is an expert in sex therapy, relationships, depression therapy, anxiety therapy, PTSD and trauma-related issues, mood disorders, and LGBTQ+ specific issues. Call 954-488-2933 or email today to discuss how our services can help you.

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