Other than eating and breathing, sex is probably the most universal human experience. Yet many of us feel uncomfortable discussing sex and avoid communicating sexual needs with our partner (if we’re even fully aware of those needs in the first place). As a result, disconnection and dissatisfaction fester and, over time, may turn into resentment, which ironically can make intimacy even more challenging.
Enter sex therapy. A distinct specialization within the mental health field, sex therapy provides safe opportunities for both partnered and nonpartnered people to understand their desires and boundaries, improve communication and connection, and, well, enjoy great sex.
To be clear, there is no standard definition of “great sex.” Some couples are content to have intercourse only once in a while, some thrive on frequent sex, and still others feel satisfied with other, purely affectionate forms of intimacy. So long as both parties feel safe communicating their needs and voicing their consent, great sex can mean whatever you want it to.
Why We Need to Talk About Sex
We absorb all kinds of messages about sex. Depending on when and where you were born, how you were raised, and what kinds of religious, family, community, and media influences you were exposed to, you may have learned to see sex as something sacred, dangerous, shameful, not to be discussed in polite conversation, or some combination of the above.
And while gender stereotypes (and the concept of gender itself) have been evolving, pernicious stigmas remain. Women may learn to view their sexual selves as a mysterious collection of parts “down there,” and are taught little of their anatomical atlas (let alone how a partner should navigate it).
Men may learn to view sex as a casual act, or through a quantitative lens — how many inches they boast, how many minutes they can last — which may lead to a goal-oriented, performance-based mindset rife for spurring feelings of inadequacy or, at worst, for harming others.
“People often think they don’t need to discuss sexual compatibility with their partner,” Divine contends. And when the topic does arise, insecurities, fears we might hurt our partner’s feelings, or simply a lack of sexual vocabulary render the conversation inadequate.
Given the fraught relationship so many of us have with our own sexuality, it’s no wonder things get complicated when we enter a relationship. Not only are we merging two (or more) sets of sexual attitudes, histories, and preferences, chances are we aren’t discussing them.
“Sex is a loaded subject in our culture,” says relationship and sex therapist Renée Divine, LMFT, CST, CTMH. She believes that many couples expect sex to simply “fall into place” without talking about it.
“People often think they don’t need to discuss sexual compatibility with their partner,” she contends. And when the topic does arise, Divine explains, insecurities, fears we might hurt our partner’s feelings, or simply a lack of sexual vocabulary render the conversation inadequate.
That’s where therapy comes in.
What Sex Therapy Is — and Isn’t
Like sex itself, a range of stigmas and stereotypes accompany sex therapy.
Let’s start with what it isn’t. Sex therapy is not like physical therapy — there is no physical contact of any kind between client and therapist. Sex therapy is also not a quick-fix tutorial in beneath-the-sheets techniques. It takes time, largely because the causes of sexual dissatisfaction tend to be highly personal and complex.
Which brings us to another thing sex therapy isn’t: couples counseling.
Couples counseling helps partners identify unhealthy patterns, repair rifts, and communicate more effectively. While such work can certainly improve sexual intimacy, couples counselors may not be trained to address sex-specific issues. And this is why sex therapists obtain distinct training and accreditation, and why couples counselors may refer their clients to a trained sex therapist like Divine.
“Couples come to me primarily because they’re experiencing discrepancies in desire and they don’t know how to talk about it,” she says.
Divine helps couples honestly acknowledge those discrepancies, which often means exploring how and why one or both partners are experiencing low sexual desire. Underlying causes may be related to physical issues, such as erectile dysfunction or vulvar pain, or psychological concerns, like performance anxiety or past trauma.
Victims of domestic violence, emotional abuse, and other types of relational trauma can struggle to feel physically and emotionally safe with another person. Past experiences of sexual trauma may be particularly pernicious. (For more on how sex therapists approach sexual trauma, see “Sex After Sexual Trauma” below.)
Unlike couples counselors, sex therapists may work exclusively with individuals rather than with pairs. This is especially common when addressing issues related to physical pain or dysfunction, but it may also be appropriate if an individual wants to change their relationship to sex in a more general sense. This could include individuals with a history of compulsive or out-of-control sexual behavior, or those who find it hard to relax and enjoy sexual experiences no matter their partner.
So How Does Sex Therapy Work Exactly?
Just as they would in traditional psychotherapy, sex therapists start by gathering information about clients’ histories, concerns, and goals. What sorts of personal, social, and environmental experiences have shaped their views toward sex? What does their current sex life entail? What isn’t working? What is? Are they discussing this? If so, how do those discussions play out?
The sex therapist is not only working to understand their clients but to help them better understand each other. “First and foremost, the couple has to listen to and validate each other’s sexual needs,” says Divine.
“First and foremost, the couple has to listen to and validate each other’s sexual needs.”
Validation is not the same as permission, however, and understanding what isn’t on the table is just as important as understanding what is.
Divine often has her clients click through a series of sex-related statements and label each as a want (as in, “I want us to do this”), a will (“I’m open to trying it”), or a won’t (“No, thank you!”). This helps couples identify opportunities to expand their sexual repertoire while still respecting each other’s boundaries.
Crucially, a couple’s sexual repertoire should not be limited to intercourse alone. Physical intimacy exists along a spectrum, and we often need affectionate forms of touch, such as hugging or hand-holding or more playful interactions — think flirting or PDA — as much as or more than intercourse. Helping couples recognize and meet these less obvious needs is a key component of sex therapy.
Because so many individuals struggle to identify and express their sexual needs, sex therapists often assign homework aimed at helping a client tune in to what feels good and letting their partner know it.
Sensate focus therapy is one such approach. Couples engage in a series of progressively sexual touching exercises, focusing entirely on the sensations that accompany their partner’s touch. During the early stages of sensate focus therapy, the couple purposely does not allow touching to lead to sex. This removes performance pressure and enables each partner to focus on the here and now rather than on a preconceived outcome. It’s one tool among many that couples might add to their intimacy toolbox to better help them express their desires.
There are many reasons we feel embarrassed talking about sex, but the truth is, we shouldn’t. With a willingness to listen, communicate, and experiment — and maybe with a little professional guidance — we can all enjoy great sex.
Sex After Sexual Trauma
Rape, assault, and other sexual violations can leave survivors feeling disconnected from their bodies and unable to feel physically or emotionally safe with their partners. Sex may be more closely associated with hurt, degradation, or shame than with pleasure, which means that knowing what feels good — let alone asking for it — can seem entirely foreign.
For individuals who have experienced sexual trauma, treatments such as Eye Movement Desensitization and Reprocessing (EMDR) or somatic experiencing — both of which entail reprocessing past traumatic experiences so that they no longer hijack the brain and body — may need to precede sex therapy. Some therapists have a stable of trauma specialists they refer to when clients need additional healing.
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