How do you know when you need a sex therapist?

The prospect of signing up for counselling or psychotherapy, which by its nature requires placing trust in another person with our deeply personal feelings and experiences, can be daunting enough – but this trepidation can often be magnified if the issue that we are seeking support for relates to sex. 

Even in this day and age, where the world is increasingly more accepting of sexual problems as a natural part of living, conservative attitudes towards sex mean that people still have to overcome a certain amount of hesitation before they work up the courage to seek help.

It is, unfortunately, still often the case that the issue faced has to become unbearable before we take the last resort of reaching out to another person (regardless of how professionally qualified they are) to discuss the worry that we are carrying. This is not surprising at all, given the amount of secrecy that we usually maintain regarding our sex lives.

When to consider seeing a sex therapist

People who are from a traditional, strict religious upbringing or who have a public profile, visiting a sex therapist itself (at least initially) can be a source of stress due to the perceived personal exposure that is needed. Having financial success or being able to maintain external appearances doesn't exempt one from personal or intimate challenges.

At the same time, the deeply personal disclosure required means that many would much rather visit a consultant for personal financial management or executive coaching to further their career rather than visit a sex therapist.

However, sex therapy isn't just for ‘major problems’ but for anything related to sexual function, desire, intimacy, or satisfaction that causes distress to an individual or intimate partners. This brings us to an important question: "How do you know when you need a sex therapist?"

There are broadly two main factors that can be considered important: distress and persistence. If a sexual concern is causing stress, anxiety, or relationship friction and persists despite some attempt to address these changes on your own, it's time to consider professional help.

Common reasons people seek sex therapy

While the wide range of reasons people can benefit from sex therapy cannot be covered in a single article, let’s look at some of the most common cases here. More observable issues that lead people to seek help include physical issues like erectile dysfunction (ED), early ejaculation, anorgasmia (difficulty achieving orgasm), or painful intercourse, particularly when medical causes have been ruled out.

While these issues are more common than people often realise and not a reflection of how healthy someone is, many may feel anxiety, shame, or guilt that need to be addressed in therapy, or to some extent even before, as the courage to enter therapy is needed.

A lot of people may actively avoid sex or intimacy due to fear of perceived ‘failure’, performance pressure, or anxiety, which then has the knock-on effect towards the general feeling of unhappiness or deep dissatisfaction in other areas of life. In cases of compulsive sexual behaviour, such as the use of pornography, the stress of hiding what is perceived as an ‘unacceptable’ part of their life may in itself cause distress, rather than the behaviour itself.

On the other hand, some clients of sex therapy may have concerns about one's sexual past, fantasies, fetishes, kink, or identity that interferes with sexual enjoyment or relationships. Others may need support for navigating intimacy after sexual trauma, which is best addressed in a safe and supportive therapy space.

Relationship concerns and intimacy issues

Sex-related issues are consistently a contributing factor to arguments in relationships, although these may sometimes not be explicitly stated due to the hesitation in revealing such a deeply personal and touchy subject.

A very common issue that causes conflict, resentment, or avoidance in intimate relationships is the disparity in libidos, or what is called ‘desire discrepancy’. Even when there is sex, one partner might feel that the sex feels routine, mechanical, or like a chore, meaning that there is dissatisfaction regarding the quality of physical connection and intimacy. Major life events might need a rebuilding of trust and intimacy, such as after incidents of non-consensual non-monogamy, childbirth, major illness, or a lifestyle change.

A significant change in sexual interest may cause personal or relational strain. In cases of interpersonal issues between intimate partners, the inability to communicate openly and comfortably about sexual needs, preferences, or boundaries can lead to frustration. When intimate partners are unable to achieve resolution on their own, the safety and confidentiality of a therapy space, and the support of a skilled therapist can be the best recourse.

What to look for in a therapist and what to expect in sex therapy

If the issue faced is directly related to sex and intimacy, clients would be best served by selecting a therapist who is specialised in the area. This would mean that within the UK, the therapist would be at least a registered member of the College of Sexual and Relationship Therapists (COSRT). This gives clients the confidence that their therapist is suitably qualified and abides by the COSRT code of ethics and practice, which is a set of professional standards for members of that covers conduct, skills, safety, and integrity.

As members of COSRT have to have a foundational counselling qualification before they qualify as a specialised sex therapist, it also means that COSRT-registered therapists also have wider talk therapy skills needed, as issues often have links to other areas of life as well. Clients may find that while their most obvious issue is related to sex or intimacy, they have other ‘hidden’ or less observable mindsets or behavioural patterns that may be contributing to this.

A key aspect that needs to be clarified is that sex therapy is strictly talk therapy. There is no sexual contact whatsoever during a session. Although the therapist may show diagrams of anatomy, sex positions (always with explicit consent obtained beforehand), or share information regarding sexual organs or exercises as needed, depending on the issue that a client is seeking therapy for, there is no physical touch between the therapist and client. Any physical contact is inappropriate and is against the COSRT code of ethics and practice.

Seeking help

As is hopefully clear by now, seeking help is not a sign of weakness or failure but a sign of self-awareness and commitment to own health. It means you prioritise your wellbeing, not only in some spheres but across different areas, including sex and intimacy. The moment you feel persistent distress or conflict around sex and intimacy, that's your sign. Timely help can be a necessary and worthwhile investment in personal happiness and the ability to have desired relationships, comparable to any other physical or wellness service. The return on investment is a healthier, more fulfilling life. 

You don't need to wait until the problem becomes a crisis – in fact, the sooner you seek professional help for your issue, the easier it might be to find contentment.