For many people, talking about sex isn’t easy. It can, ironically, be especially hard to get candid with a sexual partner about what you want and don’t want in the bedroom — particularly so if one or both of you are experiencing some kind of sexual dysfunction. These conversations can feel embarrassing, ‘shameful’, or like you’ll face judgement for speaking openly.
And so, for a lot of us, the idea of talking about sex with a professional stranger sounds like the most intimidating thing in the world. But sex is a natural and important part of our everyday lives — and something we should be talking about more, not shying away from — so we should be taking any issues we have with it seriously.
Luckily, as therapy for our mental health becomes more normalised within society, sex therapy is (hopefully!) not far behind. So, for those of you intrigued by how it works — whether you’re considering it or not — I asked sex and relationship therapist Emese Taylor to share her expert insight into exactly what sex therapy is, who it helps, and why it’s about more than just sex.
What is sex therapy?
Sex therapy, in simple terms, is overcoming sexual difficulties or dysfunctions. It is a specialised type of psychotherapy that treats a range of problems, from erectile dysfunction and vaginismus to body image issues and low self-esteem.
Despite the name, it’s not all about sex. If you have been bullied, sexually abused, or emotionally abused and these traumas have left psychological and physical scars, it may be difficult to open yourself up to a healthy sexual relationship. Sex therapy can often help people with past trauma to have better relationships to intimacy.
Taylor adds that it can also help people who have a lack of confidence in the bedroom, which, in turn, is impacting their enjoyment of sex.
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How does sex therapy work?
First, you will have a consultation with a trained sex therapist, who will identify the probable issue(s) and whether it can be treated by them. This is also an opportunity for the potential client to have a feel for the therapist, who is likely to have an academic background in psychology.
Taylor herself is a cognitive psychologist and is currently training to become a more specific clinical sexologist. Different therapists have different styles, but she begins her sessions by asking questions to further understand the client. Once it’s been established that there is some kind of psychological block in relation to sex that’s been built up or caused by something else, then the session moves forward from there.
The sex therapist’s job is to then detangle the problem, go back to its root, and treat the whole issue holistically.
What can you expect from sex therapy?
By the end of the consultation, the therapist and potential client will discuss whether continuing is the next best step. If so, the therapist will outline a treatment plan. Depending on the issue, and if there is no trauma involved, the therapy could take between 8 to 12 weeks.
Normally, says Taylor, these sessions set homework for the client to do. For example, if the client is experiencing vaginismus, which is a spasm of the vagina muscle that makes it difficult to be penetrated, the sex therapist would show them a few vaginal dilators — which are like small, gentle dildos — for the client to use on themselves a few times a week. The therapist may also suggest seeing an intimate physiotherapist, as well as adopting certain exercises to help with anxiety.
If a couple attends sex therapy because they haven’t slept together in, say, five years, Taylor explains that the sex side of things isn’t the only thing that’s treated, but the relationship itself. The couple would likely share more information about their relationship, how they feel about one another, and discuss how they ended up at this point.
For those who have experienced sexual trauma, the process takes time. The sex therapist will want to know what happened, and will then work with the client to digest it and ultimately try to overcome it. It’s all about understanding the client and their story.
Who does sex therapy help?
Sex therapy is for anyone who needs the help. Taylor says she has had a vast range of clients, including 20-year olds and 70-year olds, people struggling with a lack of desire, anyone who has difficulty orgasming, highly religious individuals who struggle with sexual shame, 40-year-old virgins, and people who have sex with inanimate objects. So, depending on what you come to a sex therapist for, the treatment plan and outcome are bound to be very wide-ranging.
Sex therapy is also a great solution for a lot of couples. Taylor tells me about a couple she worked with who were trying to fix their sex life by having threesomes, which just made their relationship much worse. She recalls that they tried everything to spice up their sex life, but instead of seeing an improvement, they almost got divorced. Finally, they realised they needed a professional to help them work through other issues in their relationship, which is, of course, where a qualified and experienced counsellor comes in.
How can you find a sex therapist?
It’s very common for GPs to refer patients to sex therapists, often after excluding all organic/medical issues, so your GP is always the best place to start, especially if you’re worried that your problem could be medical.
Alternatively, you can source a registered therapist on the British Association for Counselling and Psychotherapy. The most important requirement is ensuring you find a therapist who is COSRT-registered or accredited, as COSRT (College of Sexual and Relationship Therapists) is a UK-wide professional organisation with a national register of trained and experienced psychosexual and relationship therapists.
What a sex therapist wants you to know about sex
Dr Karen Gurney, clinical psychologist, psychosexologist, and director at The Havelock Clinic, explains what everyone should know about sex.
1. Sex isn’t all about orgasms, but…
“There’s no reason why women should be orgasming significantly less than men, though many accept this as something that’s part of common sexual experience. In fact, women who sleep with women report orgasming ‘always’ or ‘usually’ 86% of the time. Of those who have sex with men, they orgasmed just 65% of the time.
Reasons for this might include less focus on a ‘set’ sexual menu, more time spent on a variety of sexual acts in no predictable order, and longer sex sessions that don’t necessarily end for either partner after one orgasm.
So what can we learn from all this? Well, that incorporating more of the above into your own sex life can have great results.”
2. Pain is not okay
“Some women believe that pain is an expected part of early sexual experience, or an inevitable part of penetrative sex from time-to-time. The truth is that as long as you are feeling turned on and relaxed, pain should not be making an appearance.
If sex does hurt, it’s important to visit your local sexual health clinic or GP to rule out an infection or another physical cause. Some people experience genital pain in and around the vaginal opening, and this is something that is often not talked about, but is a frequent part of the work of a sex therapist.”
3. There’s no such thing as ‘normal’
“When it comes to frequency of sex, sexual interests, fantasies, or the kinds of things you and your partner like to do, it’s helpful not to get bogged down into the ‘shoulds’ or ‘musts’.
Sexual confidence and enjoyment thrive on variation, exploration, and novelty — so the more you can let go of the shackles of expectation, the better for your enjoyment and your long-term experience of desire.”
4. Communication is the key to good sex
“It doesn’t have to be verbal, but it helps if you can find a way to let your partner know what you want and need. Some couples find communication easier than others, and there’s all sorts of other things that come into this, like having words you feel comfortable with for your genitals, feeling confident to ask for what you want, and even knowing what you want in the first place.
Getting good at communicating about sex can be a really good skill to develop as a couple, as, inevitably in life, there’ll be times that sex will go off track a bit. A good conversation and a bit of troubleshooting can be what you need to get back on course. Make it a routine part of checking in about your relationship; that way you don’t have to talk about it for the first time when something isn’t quite going to plan.”
5. Penetrative sex isn’t the be-all and end-all (pun intended)
“Penis-in-vagina sex is such a small aspect of how male/female or penis-having/vulva-having couples can be sexual with their bodies and each other, but it can be easy to think that it’s the be-all and end-all of sex — especially if you look at how sex is often portrayed or talked about.
Predictability and routine are not always that erotic though, and, interestingly, we now know couples who always have sex this way without much variety have poorer sexual function than those who don’t. It can be a good idea to mix up what you do as much as you can, and have mutually pleasurable sexual encounters without penetrative sex from time-to-time.”
6. There’s no such things as being ‘good in bed’
“It’s impossible to be good at something that happens between two people, as it’s always dependent on factors connected to each of their experience, knowledge, comfort, and confidence.
Real sexual confidence comes from being happy with your body (whatever your size or shape), feeling pride rather than shame about your sexuality and sexual interests, and being able to communicate your wants and needs to someone else.”
7. It’s okay to get distracted sometimes
“Although being completely focused and in-the-moment during sex is the ideal, and usually results in a more enjoyable sexual experience, most people get distracted with thoughts about something else — and that’s totally normal! This can vary from thoughts about the sexual experience, such as how our bodies look, whether the condom is on right, or whether we’ll come. These thoughts can even be completely unrelated, like whether we’ll do the washing up after sex.
For some people, distracting thoughts can interrupt the sexual experience to such an extent that they lead to sexual problems, such as pain or difficulties with erections.
Mindfulness is growing in popularity for all sorts of things, and we now know that it can also be a helpful skill to counteract this and increase our arousal and desire. It’s good to get to grips with mindfulness outside of a sexual experience first, then once you get practised at it, you can use it to help you stay in the moment during sex.”
