Are you currently accepting new clients?

Yes. We are currently welcoming new individual and couples clients across Virginia, Florida, Washington DC, and Maryland — both in person at our Fairfax, VA and Miami, FL offices and via secure telehealth.

What happens during the free consultation?

The free 15-minute consultation is a low-pressure phone call. We'll talk briefly about what brings you in, answer any questions you have about our approach, and help you figure out which therapist might be the best fit. There's no commitment required — it's just a conversation.

How do I schedule a free consultation?

The easiest way is to use our online booking link — you can pick a time that works in about 60 seconds. Click Book a Free Consultation in the navigation bar, or visit our Schedule page. If you'd prefer to reach out first, you can also use our contact page and we'll respond within one business day.

What should I expect in my first paid session?

Your first session is mostly intake — your therapist will ask about your background, what's bringing you in, your goals, and any relevant history. You won't be expected to go deep on your first visit. Think of it as a mutual conversation to understand each other and establish a direction. Sessions are 45–50 minutes depending on your therapist.

What actually happens in a sex therapy session? Will I be asked to do anything sexual?

No — and this is the most common misconception about sex therapy. Sessions are fully clothed, conducted in a standard therapy office or via secure video, and there is no physical contact of any kind. We talk: about your experiences, emotions, relationships, history, and goals. You may be given exercises to practice privately at home between sessions, but nothing happens in the room that wouldn't happen in any other form of therapy.

What is the difference between sex therapy and regular therapy?

Sex therapy is a specialized form of psychotherapy focused on sexual health, functioning, and intimacy. Our therapists hold advanced credentials — including AASECT certification — that go well beyond standard licensure. This training equips them to address concerns like sexual dysfunction, desire discrepancy, sexual trauma, and intimacy in ways that most general therapists are not trained or equipped to do.

Can I come alone if my partner won't join me?

Absolutely. Individual sex therapy is effective and appropriate even when a partner isn't present or isn't ready to participate. Many clients work through deeply personal concerns — sexual trauma, low desire, anxiety, body image, or sexual dysfunction — entirely on their own. If couples work becomes relevant later, that's a conversation we can have when the time is right.

Do I have to talk about things I'm not ready to discuss?

No. You set the pace. Our therapists are trained to follow your lead, and you are never pressured to share more than you're comfortable with. Building a sense of safety in the room is always the first priority — the deeper work follows from there.

How long does therapy typically take?

It depends on your goals. Some clients address a focused concern in 8–12 sessions. Others work with us for a year or more on deeper relational or trauma-related issues. Your therapist will discuss realistic timelines with you early on, and you'll revisit them as the work evolves. Progress is always the measure — not time.

How often will we meet?

Weekly sessions are our standard recommendation. Consistent, regular sessions tend to produce the most meaningful and lasting progress. Bi-weekly scheduling is available in some circumstances. We generally don't recommend monthly sessions — the gap between appointments limits continuity and momentum.

Is everything I share completely confidential?

Yes. Everything discussed in sessions is strictly confidential under HIPAA and professional ethics standards. There are narrow, legally required exceptions — such as if we have reason to believe someone is in immediate danger — and your therapist will explain these clearly in your first session. What you share about your sexuality, relationships, history, or identity will never be disclosed without your explicit written consent.

I'm embarrassed to talk about sex with a stranger. Is that normal?

Completely normal — and expected. Most clients feel some version of this before their first session, and many describe it as the thing they were most worried about. Our therapists have heard it all, and they're specifically trained to make these conversations feel less daunting over time. The free 15-minute consultation is a good first step: a short, low-stakes call that lets you get a sense of us before committing to anything.

Do you work with LGBTQ+ clients and non-traditional relationship structures?

Yes, wholeheartedly. Cushing Counseling is an affirming, judgment-free practice. We welcome clients of all sexual orientations, gender identities, and relationship structures — including non-monogamous, polyamorous, and kink-aware individuals and couples. You do not need to explain or justify who you are here. Our therapists are trained in LGBTQ+ affirming care and approach every client with genuine respect and curiosity.

Do you work with individuals, couples, or both?

Both. We offer individual therapy, couples therapy, and integrated couples and sex therapy. Some clients start individually and bring a partner in later. Others come as a couple from the start. We'll help you figure out the right format during your free consultation.

What does therapy cost?

Session rates vary by therapist: Vanessa Cushing, LPC, CST (AASECT Certified) — $350 / 50 min. Radiance Sanneman, LCPC — $210 / 50 min. Alexandria Da Ponte Cheatham — $175 / 50 min. Noelle Harris, LMSW — $165 / 45 min individual, $220 / couples session. Every new client receives a complimentary 15-minute telephone consultation at no cost.

Do you accept insurance?

We are a private-pay, out-of-network practice and do not bill insurance directly. However, we partner with Thrizer, which allows many clients to use their out-of-network mental health benefits automatically — so you may pay significantly less than the full session rate, depending on your plan.

What is Thrizer and how does it work?

Thrizer is a service that verifies your out-of-network insurance coverage upfront and collects only your estimated share at the time of service. They file the claim automatically after each appointment and your reimbursement comes directly from your insurer. No superbill wrangling, no waiting on reimbursements, no paperwork on your end.

Can I get a superbill to submit to my insurance myself?

Yes. We can provide a superbill at any time — a detailed receipt that includes diagnosis codes, procedure codes, and your therapist's credentials. Just ask your therapist and we'll generate one for any session.

Do you offer sliding scale or reduced rates?

We have a limited number of reduced-fee spots available. If cost is a barrier to starting therapy, please mention it during your free consultation and we'll do our best to find an option that works.

What is your cancellation policy?

We ask for at least 24 hours' notice to cancel or reschedule. Late cancellations and no-shows may be charged the full session fee. We understand that life happens — please just reach out as soon as you know.

What payment methods do you accept?

All fees are collected via credit card on the day of your session, automatically. Your card is kept securely on file — there are no invoices or checks to manage.

Where are your offices located?

We have two physical locations: Fairfax, Virginia — 12875 Yates Ford Rd, Clifton, VA 20124. Miami, Florida — 244 Biscayne Blvd, Miami, FL 33132. We also see clients throughout Virginia, Florida, Washington DC, and Maryland via secure telehealth.

Do you offer online therapy?

Yes. All of our therapists offer HIPAA-compliant telehealth sessions via secure video. Many clients prefer telehealth for the flexibility and privacy it offers. Session quality and fees are the same whether you meet in person or online.

Is telehealth as effective as in-person therapy?

Research consistently shows that telehealth is equally effective as in-person therapy for the concerns we treat — including sexual dysfunction, trauma, desire issues, and relationship challenges. Many clients actually find it easier to open up from the comfort and privacy of their own space.

What states do you serve via telehealth?

We are currently licensed to see telehealth clients in Virginia, Florida, Washington DC, and Maryland. If you are located outside these states, reach out and we can discuss your options or provide a referral.

How do I choose which therapist to work with?

Start with our About Us page to read about each therapist's training, style, and areas of focus. Practical factors like fee and availability matter too. If you're not sure, mention it during your free consultation — we'll help match you with the best fit. It's also completely fine to try a first session and reassess.

What is AASECT certification?

AASECT stands for the American Association of Sexuality Educators, Counselors and Therapists. The AASECT Certified Sex Therapist credential is the gold standard in the field. Earning it requires a master's or doctoral degree in a mental health discipline, hundreds of hours of specialized training in human sexuality, supervised clinical hours with a certified supervisor, and ongoing continuing education. Vanessa Cushing holds this certification, placing her among a small number of AASECT-certified sex therapists in the country.

What specialties does the practice cover?

Cushing Counseling therapists collectively specialize in sex therapy and sexual dysfunction, couples therapy and intimacy, trauma therapy and sexual trauma recovery, LGBTQ+ affirming care, and Internal Family Systems (IFS) therapy.

GLP-1s, “Reta” and Your Sex Drive: What We Know and What We Don’t

Oct 23

Written by Vanessa Cushing

Medication & desire, read by a sex therapist · 8 min read

GLP-1s, “Reta” and Your Sex Drive: What We Know and What We Don’t

Ozempic, Wegovy, Mounjaro, Zepbound — and now black-market retatrutide. People are noticing changes in desire. Here is what the research actually shows, what is still guesswork, and what to do if it’s happening to you.

Written and clinically reviewed by Vanessa Cushing, LPC, NCC, MS — AASECT-Certified Sex Therapist, licensed in Virginia & Florida. The Cushing Counseling team covers Virginia, DC, Maryland & Florida.

Soft folds of warm cream linen in low raking light

The short answer

GLP-1 drugs can change sex drive in either direction. Weight loss often improves sexual function and confidence, but some people report lower desire, harder orgasms or erection problems, and one large records study linked semaglutide to more erectile dysfunction diagnoses in younger men. Retatrutide (“reta”) is not approved, and no trial has measured its effect on libido. If your desire has changed, tell your prescriber and consider a sex therapist.

Book a free 15-minute consultation

If a medication change has shifted your desire, your orgasms or your relationship, that is exactly what sex therapists help with. Consultations are free and 15 minutes.

Why people are asking

Millions of people now take GLP-1 medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). These drugs quiet appetite and what many patients call “food noise.” A growing number of them, and their partners, are noticing that something else feels quieter too.

The newest version of the question is about retatrutide, nicknamed “reta.” It is Eli Lilly’s experimental “triple” drug, acting on GLP-1, GIP and glucagon receptors. In April 2026 the Guardian reported on viral TikTok videos claiming reta was “ruining relationships” and could make people “fall out of love,” with commenters describing lost cravings, lost lust and emotional flatness.

A half-finished breakfast plate with berries, a glass of water and a cup of tea on a sunlit linen table — When appetite quiets down, other appetites can shift too.

First: what retatrutide is, and isn’t

Retatrutide is not approved by the FDA or any other regulator. As of Lilly’s own September 2026 update, it is available only to people in Lilly’s clinical trials, and Lilly says it plans to file for approval in early 2027. Lilly warns that no one should take anything claiming to be retatrutide outside a trial.

That matters, because much of the reta being used today is bought online as a “research peptide.” Lilly says it has found products with too much, too little or the wrong ingredient, plus contaminants. CBS News reported in October 2026 that the FDA had received two reports of deaths in people using bootleg retatrutide (cause unverified), and that poison centres logged 862 retatrutide exposures in the three months to September, up from 249 in the first quarter of the year.

So when someone on TikTok says reta changed their sex drive, we often can’t know what was in the vial, at what dose, or what else was going on.

What the research shows about GLP-1s and sex

Research on sex and these medications is early, and the findings point in different directions. That is not a dodge — it is the honest state of the evidence.

Weight loss itself often helps. A 2025 review in Sexual Medicine Reviews notes that sexual problems are a common, under-recognised part of obesity, and that losing weight is linked to better sexual health.
But one large records study raised a flag for men. Researchers using the TriNetX database compared 3,094 non-diabetic men aged 18–50 with obesity who were prescribed semaglutide against 3,094 similar men who weren’t. New erectile dysfunction diagnoses or ED prescriptions were 1.47% vs 0.32%, and low-testosterone diagnoses 1.53% vs 0.80% (International Journal of Impotence Research, 2024). That is an association, not proof the drug caused it — and the absolute numbers are still small.
Women’s reports are newer. A 2025 case report in Sexual Medicine describes a woman who lost the ability to orgasm after starting a GLP-1 medication, and proposes possible reasons involving blood flow and the brain’s reward chemistry. A single case can’t tell us how common this is.
Bigger studies are underway. Mayo Clinic, for example, is running a study of sexual function in postmenopausal women on GLP-1 therapies.
Retatrutide specifically: no published trial has reported sex drive as a measured outcome. Anything said about reta and libido right now is anecdote or extrapolation from the older drugs.

Why desire might change — the possible reasons

Desire is never just one thing, so a medication rarely affects it in one simple way. The leading ideas researchers and clinicians are exploring include:

The reward system. GLP-1 drugs act on brain areas tied to craving and reward. Some scientists wonder whether, in some people, quieting the pull toward food also quiets other pulls. This is a hypothesis, not a settled finding.
Feeling unwell. Nausea, constipation, fatigue and eating much less are common, especially when doses go up. It is hard to feel sexy when you feel queasy and tired.
Hormones and blood flow. Rapid weight change can shift hormone levels, and some researchers think these drugs may affect blood flow involved in arousal and orgasm.
Body image, in both directions. Many people feel more confident as their body changes. Others feel exposed, unfamiliar in their own skin, or anxious about being desired for a new body.
The relationship. When one partner changes quickly, the couple’s balance can shift: who initiates, how meals and evenings look, how each partner feels seen.

If it’s happening to you

Don’t stop or change a prescribed medication on your own. These drugs are often treating real health conditions, and the trade-offs are a decision for you and your prescriber together.

Tell your prescriber specifically: “My desire / erections / orgasms have changed since I started.” It is a legitimate side effect to report, not a vanity complaint. Dose timing or other options may help.
Notice the pattern. Is it worse in the days after a dose, or during a dose increase? Is it tied to nausea or exhaustion? That detail helps your clinician.
Separate desire from arousal. Many people find that responsive desire — the kind that shows up once touch begins — is still there, even when spontaneous desire is quiet.
Talk to your partner early, before silence becomes a story about rejection. “This is the medication, not you” is a sentence worth saying out loud.
If you’re using research-peptide reta, please tell a doctor. You don’t have to be judged to be safe, and they can’t help with side effects they don’t know about.

Two armchairs facing each other in lamplight, with two cups of tea and an open notebook on a side table — A change in desire is worth one honest conversation, with your partner and with your prescriber.

How sex therapy helps

A sex therapist won’t prescribe or adjust your medication. What we do is help with everything around it: rebuilding desire that runs on connection rather than urgency, working through body-image changes, reducing pressure around erections or orgasm, and helping couples talk about a shift neither of them chose.

We also coordinate with your medical team when it helps, so the physical and emotional sides are looked at together instead of one at a time.

Frequently asked questions

Do GLP-1 drugs like Ozempic lower your sex drive?

Some people report lower desire, but others report improvement as they lose weight and feel better in their bodies. Research is still early and points both ways. If your sex drive changes, tell your prescriber.

Does retatrutide (reta) affect libido?

Nobody knows yet. Retatrutide is unapproved, and no published trial has measured its effect on sex drive. Reports of lower libido on reta come from social media and are often linked to unregulated products of unknown content.

Can semaglutide cause erectile dysfunction?

A 2024 records study found that non-diabetic men aged 18–50 prescribed semaglutide had more new ED diagnoses than similar men who weren’t (1.47% vs 0.32%). It shows an association, not cause. Talk to your prescriber or a urologist if you notice changes.

Can GLP-1 medications affect orgasm in women?

There are early reports, including a 2025 published case of a woman who could no longer orgasm after starting one. Studies in women are now underway. If it happens to you, raise it with your prescriber and consider a sex therapist.

Should I stop my GLP-1 if my sex drive drops?

Not on your own. Talk to the clinician who prescribed it about the change and your options. A sex therapist can help with desire, arousal and relationship strain alongside your medical care.

Is it safe to buy retatrutide online?

Lilly, its maker, says no one should take anything claiming to be retatrutide outside a Lilly clinical trial. Online products have been found with the wrong dose, wrong ingredient or contaminants, and the FDA has received reports of deaths in people using bootleg versions.

Keep reading

Sex Therapy — For desire, arousal and orgasm concerns.
Sex recession data — Why Americans are having less sex.

Also on this site

Clinical resources this page draws on

Next step

Not sure where to start? Take the free 6-question assessment, or book a 15-minute consultation.

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Vanessa Cushing

GLP-1s, “Reta” and Your Sex Drive: What We Know and What We Don’t

GLP-1s, “Reta” and Your Sex Drive: What We Know and What We Don’t

Why people are asking

First: what retatrutide is, and isn’t

What the research shows about GLP-1s and sex

Why desire might change — the possible reasons

If it’s happening to you

How sex therapy helps

Frequently asked questions

Do GLP-1 drugs like Ozempic lower your sex drive?

Does retatrutide (reta) affect libido?

Can semaglutide cause erectile dysfunction?

Can GLP-1 medications affect orgasm in women?

Should I stop my GLP-1 if my sex drive drops?

Is it safe to buy retatrutide online?

Keep reading

Also on this site

Clinical resources this page draws on

Orgasms in Midlife: Why They Change, and What Actually Helps

Can Sex Therapy Help After Sexual Trauma?

Cushing CounselingThe Nation’s Experts in Sex & Couples Therapy

Cushing Counseling
The Nation’s Experts in Sex & Couples Therapy