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.

Sexual pain · 8 min read

Therapy for Painful Sex and Vaginismus

Pain during sex is common, it is treatable, and it is not something you have to push through. Here is what actually causes it and what treatment looks like.

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

Two glazed ceramic vessels standing close together, casting overlapping shadows

The short answer

Painful sex — pain at penetration, burning, or a body that closes involuntarily — usually involves both a physical component and a learned protective response. Effective treatment addresses both: a medical evaluation to rule out treatable physical causes, and sex therapy to unwind the anticipatory tension pain has trained into the body.

What counts as painful sex

Painful sex is an umbrella term, and the specific pattern matters because it points at different treatment. Clinicians generally sort it into a few overlapping presentations:

Vaginismus — the pelvic floor muscles tighten involuntarily at attempted penetration. It is not a decision, and willing yourself to relax does not switch it off.
Dyspareunia — persistent genital pain during or after intercourse, which can be at the entrance or felt deeper.
Vulvodynia — pain, burning or rawness at the vulva that can be present outside of sex entirely.
Pain that arrived after something changed — childbirth, surgery, menopause, a new medication, an infection, or a frightening sexual experience.

Why it usually is not 'just in your head'

The most common thing people are told is that they need to relax, and it is the least useful advice available. Pain teaches the body to brace. Once the body has learned that penetration hurts, it starts guarding before anything happens — muscles tighten, arousal drops, lubrication decreases, and the guarded, dry, tense state makes the next attempt hurt more. That is a loop, and it will keep running on its own long after whatever originally caused the pain has resolved.

This is why a purely medical approach often stalls and why a purely psychological one often stalls too. The infection was treated, the tissue healed, and the pain stayed — because the protective response is still installed.

See a physician first, or alongside

Sex therapy is not a substitute for a medical evaluation. Before or in parallel with therapy, it is worth having a clinician rule out the causes that respond to medical treatment.

We will ask what you have already been evaluated for, and we are glad to work alongside a gynecologist, urologist, or pelvic floor physical therapist. Coordinated care usually moves faster than either piece alone.

Infections and skin conditions affecting the vulva
Endometriosis and other sources of deep pelvic pain
Hormonal changes, including postpartum, breastfeeding, and perimenopause
Scar tissue from birth or surgery
Side effects of medications you are currently taking — ask your prescriber, not us

What treatment actually looks like

Treatment is graded, not heroic. Nothing in it involves getting through a painful attempt to prove you can.

Stage	What happens	What it is for
Assessment	History of the pain, what makes it better or worse, what you have already tried, what you have been told.	Distinguishing the presentations above, and finding what is still medical.
Taking penetration off the table	An agreed pause on attempts that hurt.	Breaking the anticipation loop. The body stops bracing when it stops expecting pain.
Sensate focus	Structured non-demand touch, done at home, in stages.	Rebuilding arousal and safety without the outcome pressure that drives the guarding.
Graded exposure	Slow, self-directed reintroduction — often including dilators when a pelvic floor clinician is involved.	Teaching the pelvic floor that penetration is not a threat, at a pace that never provokes the pain.
Partner work	Sessions with a partner, if you have one.	Pain reshapes a relationship. Partners often carry guilt or rejection they have never said out loud.

If you have a partner

Sexual pain rarely stays contained to the person feeling it. The partner who is not in pain often stops initiating entirely, which the person in pain reads as rejection or relief. Both people end up avoiding a conversation neither knows how to start.

Partner sessions are optional but usually accelerate things. The goal is a couple who can be sexual together in ways that do not hurt, while the pain work continues on its own timeline.

Myth versus reality

What you have been told	What is actually the case
“Just have a glass of wine and relax.”	Involuntary muscle guarding does not respond to intention. Alcohol reduces sensation, not the reflex.
“It will get better once you have done it more.”	Repeating a painful experience reinforces the protective response rather than extinguishing it.
“Use more lube.”	Lubricant helps friction-based pain. It does nothing for muscle guarding, deep pain, or nerve pain.
“Everything looked normal, so there is nothing wrong.”	A normal exam rules out some causes. It does not mean the pain is imaginary.

Where we work

Sessions are available in person in Fairfax, VA, and by secure telehealth throughout Virginia, Washington, D.C., Maryland, and Florida. Therapy is licensed by state, so the state you are physically sitting in during a session is the one that has to be covered.

Frequently asked questions

Is vaginismus curable?

Vaginismus responds well to treatment. Most approaches combine a medical evaluation, pelvic floor work, and sex therapy to address the anticipatory guarding. Timelines vary by person, and we will not promise you one at intake.

Do I need to see a doctor before starting therapy?

It is strongly recommended, because some causes of sexual pain are medical and respond to medical treatment. If you have not been evaluated, we can still begin — we will simply ask you to get evaluated in parallel.

Will you ask me to have sex as homework?

No. Assignments are structured, graded, and explicitly exclude anything that provokes pain. Sensate focus in particular begins with non-demand touch that rules out intercourse entirely.

Can painful sex be treated over telehealth?

Yes. The therapy component — the assessment, the graded plan, the couple work — is conversation and at-home practice. Any hands-on physical treatment comes from a pelvic floor physical therapist we can coordinate with.

My pain started after childbirth. Is that different?

The mechanism is often clearer — scar tissue, hormonal shifts while breastfeeding, or a birth experience the body registered as traumatic — but the treatment structure is the same, and a medical evaluation matters more.