Pillar guide · 14 min read

Sex therapy: what it is, what it treats, and how to start

A complete, clinician-written guide to sex therapy — the conditions it treats, how sessions actually work, what the evidence shows, what it costs, and how to find a properly credentialed therapist in Virginia, DC, Maryland, or Florida.

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

What sex therapy actually is

Sex therapy is a subspecialty of psychotherapy. The clinician holds a standard mental health license — LPC, LCSW, LMFT, or psychologist — and has completed additional supervised training in sexual function, anatomy, desire and arousal systems, sexual pain, identity, and the medical-psychological overlap in conditions like erectile dysfunction and vaginismus. In the United States, the recognized certification body is AASECT, the American Association of Sexuality Educators, Counselors and Therapists.

In practice, sex therapy looks like any other therapy hour. You sit and talk, fully clothed. Your therapist asks clinical questions, maps what is happening in your body and your relationship, and sends you home with a specific exercise to try before the next session. The change happens between sessions; the session is where you plan it, debrief it, and adjust.

Because sexual concerns sit at the intersection of medicine, psychology, and relationship dynamics, good sex therapy is unusually systematic. A therapist who only explores feelings and never asks about your medications, your sleep, your pelvic floor, or the actual sequence of what happens in bed is not doing sex therapy.

What sex therapy treats

The presenting complaints below cover the large majority of sex therapy referrals. Most people arrive with one and discover a second underneath it — low desire that turns out to be unaddressed pain, or erectile difficulty that turns out to be anticipatory anxiety after one bad night.

• Low or absent sexual desire, including hypoactive sexual desire disorder (HSDD) in any gender.
• Desire discrepancy — two partners who want sex at genuinely different frequencies, which is the single most common couples presentation.
• Erectile dysfunction, including situational ED where function is fine alone but not with a partner.
• Premature ejaculation and delayed ejaculation.
• Difficulty reaching orgasm, including anorgasmia and orgasm that changed after starting an SSRI.
• Genito-pelvic pain / penetration disorder — the diagnostic umbrella covering vaginismus, dyspareunia, and vulvodynia.
• Sexual performance anxiety and the spectatoring loop that maintains it.
• Sexual trauma recovery and rebuilding intimacy after assault or coercive experiences.
• Out-of-control sexual behavior, compulsive pornography use, and the shame cycles around them.
• Sexual identity, orientation, and gender-related concerns, including affirming care for trans and non-binary clients.
• Consensual non-monogamy, kink, and negotiating relational structures without pathologizing them.
• Intimacy changes after childbirth, menopause, cancer treatment, chronic illness, or disability.

What happens in sessions

A first session is a 50–60 minute clinical intake: confidentiality, what brought you in, a relational and medical history, and a concrete goal statement. Couples intakes usually run longer because there are two histories to take.

From there, most sex therapy follows a pattern. Weeks two through four are assessment and psychoeducation — mapping the actual sequence of what happens, correcting the surprisingly common factual gaps, and ruling in or out medical contributors that need a physician or pelvic floor physical therapist. Weeks four onward introduce behavioral protocols such as sensate focus, stimulus control, or graded exposure, paired with the relational work that makes those protocols stick.

A focused single-issue concern often resolves in 6 to 12 weekly sessions. Broader work — long-standing low desire, trauma-linked symptoms, entrenched couple dynamics — usually takes 12 to 24. Your therapist should give you an honest estimate at the end of the intake rather than an open-ended commitment.

What the evidence shows

Sex therapy is not folk wisdom. The behavioral core of the field — sensate focus, developed by Masters and Johnson and refined substantially since — has decades of clinical outcome data behind it, and modern protocols for specific conditions are better studied still.

Cognitive-behavioral and mindfulness-based interventions have the strongest evidence base for low desire in women, with mindfulness-based approaches showing durable improvement in desire and sexual distress. Behavioral techniques for premature ejaculation, including the stop-start and squeeze methods, improve intravaginal latency in controlled trials and pair well with pharmacological options. For genito-pelvic pain, combined treatment — sex therapy plus pelvic floor physical therapy — consistently outperforms either alone, which is why a good sex therapist maintains referral relationships with pelvic floor PTs.

For erectile dysfunction, the honest picture is combination care. Medication addresses vascular mechanism; therapy addresses anticipatory anxiety, avoidance, and the relational fallout, which is why men treated with medication alone frequently discontinue it while the underlying pattern persists.

How to choose a sex therapist

Two verification steps take about four minutes and rule out most of the risk.

• Verify the mental health license on the state licensing board site for the state you will physically be in during sessions. Virginia, Maryland, DC, and Florida all publish free public look-ups.
• Verify sexuality certification on the AASECT public referral directory. 'Certified sex therapist' has a specific meaning; 'sexologist' and 'sex coach' do not.
• Ask directly: what is your fee, what CPT codes do you bill, do you provide superbills, and roughly how many sessions does this typically take?
• Ask what they do when a concern turns out to be medical. A therapist without a referral network for urology, gynecology, endocrinology, and pelvic floor PT will miss things.
• Notice how the consultation feels. If you are already editing yourself in the free 15-minute call, that will not improve at session four.

Online vs. in-person

Sex therapy is talk-based, which means video sessions work for the large majority of concerns — low desire, desire discrepancy, performance anxiety, ED, ejaculatory concerns, communication, and most trauma work. The practical constraint is licensure, not clinical fit: your therapist must be licensed in the state you are physically located in during the session, not the state they live in or the state on your driver's license.

Cushing Counseling is licensed in Virginia, the District of Columbia, Maryland, and Florida, and works entirely online across those four jurisdictions.

Frequently asked questions

Keep reading

• What is sex therapy? — The clinical definition, what it treats, and the four things it is not.
• Sexologist vs. sex therapist vs. sex coach — Which titles are licensed, which are unregulated, and how to tell them apart.
• AASECT-certified vs. non-certified — What the credential actually requires, and when it matters clinically.
• Sensate focus, step by step — The core behavioral technique in sex therapy, with the full at-home protocol.
• Individual vs. couples sex therapy — How to choose the format — and why the wrong one stalls progress.
• Does insurance cover sex therapy? — CPT codes, superbills, out-of-network reimbursement, and honest costs.
• Your first sex therapy session, minute by minute
• Free 6-question assessment
• Free therapist-written exercises