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Sexual health is part of our physical and mental wellbeing. When something isn’t quite feeling right, it can be difficult to consider talking to someone about it, even our partners. Emotional and behavioural issues can have an impact on sexual health and satisfaction. This is when sex therapy may help.
Sex therapy is a segment of counselling therapy—psychotherapy or talk therapy—that addresses concerns around intimacy, sexual functioning, confidence-building, desire or lack of desire, 2SLGBTQIA+ and gender-related topics, arousal dysfunctions or unwanted sexual thoughts. Sex therapy can also cover topics like ethical non-monogamy (NM), fetishism, and kink or BDSM behaviours.
Sexual dysfunction is a very common issue affecting millions of Canadians—recent data from the University of Guelph found that it affects approximately 30% of men and 40% of women in middle age in Canada (though sexual health and related challenges affect people of all ages).
While medical practitioners will look for physical health conditions like cardiovascular disease, diabetes or urological issues to explain these sexuality-based concerns, a psychotherapist, social worker or counsellor who focuses on sex and intimacy will look at your cognitive health. This can include your relationship dynamics, ability to communicate with your partner(s), body image issues, trauma, stress, or underlying mental health conditions like anxiety or depression.
A trained sex therapist will draw from biological, social and psychological context to identify what might be contributing to your concerns (such as masturbation patterns), or underlying or unconscious thoughts or narratives (like feelings of shame) that might be impacting your current sexual health.
It’s important to know that sex therapy and medical help will work in conjunction when needed. For example, a sex therapist will often start with an initial assessment to determine if someone might benefit from a referral to a medical practitioner, including physiotherapists, if it appears physical health issues are part of your overall picture of sexual health.
Why see a sex therapist?
Sex therapists will more often have a deeper understanding or interest in the physiology of how sex works (how the body functions) as well as the pscyhology of human sexual behaviour. They will have a sex positive approach and create a non-judgemental environment.
Sex therapy can be for individuals or it can be couples-focused. You might not be in a relationship but want to address issues like body image and bodily esteem, intimacy, or sex-related anxiety on your own. When sex therapy is targeted to couples, you can expect to learn a lot about communication—learning how to articulate your thoughts, feelings and desires to your partner, and to yourself.
Some common concerns that are typically addressed through sex therapy include:
- Mismatched sexual desires, drives or libidoes
- Sexual exploration and intimacy development
- Erectile dysfunction, premature ejaculation and delayed ejaculation
- Inability to achieve orgasm
- Painful intercourse
- BDSM/kink literacy and exploration
- Non-conforming relationships
- Sexual education
- Emotional disconnection
What happens in sex therapy?
Sex therapists can draw from any number of therapy techniques (modalities) to address sexuality-based concerns. These could include Eye Movement Desensitization and Reprocessing (EMDR), Dialectical Behavioural Therapy (DBT), or sensory approaches like Sensate Focus. Senate Focus is grounded in mutual responsibility from each partner, communication, and intimacy and touching exercises—without expectation for sex.
Regardless of the approach, a lot of the work in sex therapy is based on unpacking narratives and belief systems (such as religious-based shame and guilt). You can also expect homework exercises to work toward achieving your specific goals.
It’s likely you’ll take a staged approach to this work. Most sex therapy is based on something called the PLISSIT model. It’s a framework for sex therapy and counselling with four levels. In each session, you move downward through these stages. The stages are led by your therapist, and most people see significant movements within the first three levels.
- Permission (P): your therapist will identify key areas to address and ensure they have permission to have these discussions with you.
- Limited Information (LI): your therapist will provide some details around body or sexual functioning, solutions, methods or exercises to build your knowledge.
- Specific Suggestions (SS): based on the above information, your therapist will provide you with specific solutions or exercises to put into practice.
- Intensive Therapy (IT): this could be a referral to another professional for a more specific or specialized issue, or guidance for couples or individual counselling to work on deeper underlying concerns.
PLISSIT is a type of solutions-focused therapy or Solution-Focused Brief Therapy (SFBT), a brief, goal-oriented type of therapy. You might encounter solutions-focused therapy in other mental health areas as well.
When looking for a sex therapist, you want to make sure this is someone you and your partner(s) trust and have a healthy relationship with. These are intimate conversations, but a sex therapist should never have physical contact with you or your partner(s). Sex therapy is like any other area of counselling—the specialization is in human sexuality, as other counsellors might specialize in anxiety, depression or addiction.
When looking for a sex therapist (or any therapist), you want to assess therapist fit by making sure they are licensed or certified in your area, that you are able to afford the sessions or that you have workplace coverage, and that you can attend your sessions in person or online.
Watch therapist intro videos on First Session to get a better sense of who they are, or try booking a free 15-minute therapy consultation if one is available.
Find therapists that specialize in sex therapy on First Session.
This content has been professionally reviewed by Dr. Teesha Morgan, Psychotherapist, and Dr. Nicholas Balaisis, Registered Psychotherapist (December 2021). Corrections or comments? You can get in touch with us here.