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A couple sits in two blue chairs facing a therapist writing on a clipboard.
A couple sits in two blue chairs facing a therapist writing on a clipboard.

What Is Sex Therapy?

Q&A With a Northwestern Medicine Sex Therapist

Sex can get complicated emotionally and physically. If your sexual interactions leave you feeling uncertain, insecure, dissatisfied, anxious or depressed, there is help.

Here, Jennifer Levy, a licensed clinical professional counselor and sex therapist at Northwestern Medicine Center for Sexual Medicine and Menopause, explains what you need to know about sex therapy and if it might be right for you.

What is sex therapy and how can it help?

Sex therapy is a form of talk therapy, also known as psychotherapy or counseling, with a focus on sexual health. It can help you reconnect with yourself and your partner sexually and strengthen relationships. It can also help you understand how your sexual health impacts your life more broadly.

Is there touching involved?

There is no touching involved during your therapy session, but your therapist may recommend that you work on intimacy in the privacy of your home as part of your treatment.  

What are common reasons to seek sex therapy?

What brings people to sex therapy is typically a change in sexual function or desire. Changes include:

  • Low libido (desire to have sex)
  • Arousal difficulty
  • Orgasm dysfunction
  • Painful intercourse
  • Difficulty being intimate with someone
  • Infidelity

These changes may be related to a life-stage transition; the diagnosis and treatment of an illness like cancer; or part of the natural aging process, such as menopause.

If you have had a past traumatic sexual experience, sex therapy is a great way to process it and work toward healing.

How do I know it is time to make an appointment?

If your sexual health is causing a disruption in your relationship, marriage or day-to-day life, it may be time to get help from a sex therapist to figure out what is going on. It is no different than seeking treatment for a medical ailment. If you have ongoing pain in your ankle that is keeping you from your normal activities, you make an appointment with a physician. If a change in sexual function or desire is affecting your overall well-being, it's time to get professional help. 

What should you look for when seeking a sex therapist? Any specific certifications?

You want to make sure a sex therapist is a licensed mental health professional and certified in sex therapy. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) is one of the largest clinical training and certifying organizations, and the best place to start your search.

Will discussions with a sex therapist stay confidential?

For licensed mental health professionals, including sex therapists, confidentiality is protected by their certifying body's code of ethics, state laws and the Health Insurance Portability and Accountability Act (HIPAA). Therapists who violate patient confidentiality risk losing their ability to practice therapy.

Should you go to therapy solo or with a partner?

You can go to sex therapy individually or with your partner. It really depends on the problem you want to work on. If the core concern is the relationship, going to sex therapy with your partner is often most beneficial. If there are underlying conditions, such as menopause, heart disease or cancer, which are causing a change to the body and sexual health, individual therapy sessions can be helpful to learn how to reconnect with yourself physically and mentally. Your partner can be brought in when it is time to talk about your relationship as a couple.

What can I expect in the first session?

Treat your first session like a consultation to make sure you are comfortable with your sex therapist. It is perfectly OK to say it is not a fit and move on. In my practice, I take a biopsychosocial approach to look at the biological, psychological and social factors in a person's life. In the first session, I ask a lot of questions. I want to know about your sexual function and health, and changes in this area of your life that may be causing you distress. I want to know how your body works, how it stopped working, the quality of your relationship with your partner, if there has been infidelity, your family of origin, if you have children and if you have work-life balance. I always start with the sexual concern, then work to understand where it may be coming from. When I have the full picture, I can put the pieces together and help from all angles.

Any common "aha" moments in sex therapy?

I work with a lot of patients whose sexual health has been impacted by menopause and treatments for cancer. Their bodies might not work the same way anymore. Often, one of the biggest wakeup calls is learning that there are many ways to be sexual and have a satisfying experience that does not always include penetrative intercourse. We call that "outercourse." You can have satisfying, pleasurable experiences that don't involve penetration or don't always end in an orgasm.