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 health · Hub · 7 min read

Women’s Sexual Health Therapy in Virginia, DC & Maryland

One place for low desire, painful sex, arousal concerns, and orgasm difficulties — treated as sexual health, not something you’re just supposed to live with.

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.

A single teal armchair beside a small wooden table in soft daylight

The short answer

Women’s sexual health concerns generally fall into a few overlapping categories: low desire, arousal difficulties, orgasm difficulties, and pain with sex. The International Society for the Study of Women’s Sexual Health (ISSWSH) treats these as distinct but often-overlapping clinical categories, not as one vague catch-all problem — and each has its own path forward. This hub links our dedicated pages for each.

Book a free 15-minute consultation

A free 15-minute consultation is the fastest way to work out which of these fits, and what to do first.

Conditions we address

Low desire and mismatched libido — see our dedicated Low Desire page
Painful sex, including vaginismus — see our dedicated page
Arousal difficulties
Orgasm difficulties
Sexual concerns tied to hormonal or life-stage transitions

Painful sex: vaginismus, dyspareunia & vulvodynia

Pain with sex isn’t one condition — vaginismus (involuntary muscle tightening that makes penetration difficult or painful), dyspareunia (a broader clinical term for painful intercourse), and vulvodynia (chronic vulvar pain without a clear identifiable cause) are related but distinct.

Because these conditions can have both physical and psychological contributors, treatment often works best alongside a medical evaluation — see our Painful Sex & Vaginismus page for more detail.

Desire and arousal aren’t the same thing

It’s common to describe “low libido” as one problem, but ISSWSH distinguishes low desire (not wanting sex) from arousal difficulty (the body not responding even when desire is present) — and the two need different approaches.

Mismatched desire between partners is common and treatable, and doesn’t necessarily mean anything is wrong with either partner individually.

Hormonal and life-stage transitions

Sexual function can shift during perimenopause, menopause, postpartum recovery, and other hormonal transitions.

Therapy can address the emotional and relational side of these changes; for the medical and hormonal side, we typically recommend working alongside your OB-GYN or a menopause-informed medical provider.

Frequently asked questions

Is low desire something I just have to live with?

No. Low desire is one of the most common and most treatable concerns we see, and mismatched desire between partners is common — it’s rarely a sign either partner is “broken.”

Do I need a medical workup before starting therapy?

Not necessarily to start, but for pain-related concerns in particular, we often recommend a medical evaluation alongside therapy since pain with sex can have physical contributors.

Can this help with pain that’s been dismissed by other providers?

Sexual pain is frequently under-investigated in medical settings. Therapy can’t replace a medical workup, but it can help address the psychological and relational impact while you pursue appropriate medical care.

Does this only apply to younger women, or does it cover menopause too?

It covers the full span — this hub includes concerns that show up at any life stage, including perimenopause and menopause.

Keep reading

Low Desire & Mismatched Libido Counseling — Where purity-culture shame and desire discrepancy often surface.
Painful Sex & Vaginismus Therapy — Vaginismus, dyspareunia and vulvodynia, treated as sexual health.
Sexual Trauma Therapy — Our broader approach to sexual trauma treatment.
Couples Therapy — For couples navigating desire, trust or a shared religious background.

Also on this site

About Vanessa Cushing, LPC, NCC, MS — AASECT-Certified Sex Therapist, licensed in Virginia and Florida; the Cushing Counseling team covers Virginia, D.C., Maryland and Florida.
Book a free consultation — A short call to work out whether this approach fits what you're carrying.

Clinical resources this page draws on

International Society for the Study of Women’s Sexual Health (ISSWSH) — The clinical society whose categories this hub follows.
American College of Obstetricians and Gynecologists (ACOG) — For the medical side of sexual pain and hormonal transitions.
National Institutes of Health (NIH) — General research background on sexual health conditions.

Next step

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

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