The 4 Most Common Issues That Come Up During Sex Therapy, According to Sex Therapists Themselves

Photo: Getty Images / katleho Seisa
As mental health stigma eases in American culture, data shows that people have been seeking more counseling. There are many forms of therapy, and sex therapy, in particular, stands to benefit folks who are aiming to work on issues relating to intimacy. From being in a rut in your relationship, to not being as turned on as your partner, to being unsure about how to spice things up—you name it, and a sex therapist has heard of it.

To get clearer about what sex therapy actually entails—and whether it’s right for you—we spoke with two New York City-based sex therapists. Read on to learn about what sex therapy is really like.

What is a sex therapist?

Sex therapy falls under the general umbrella of mental health care. What sets it apart from other forms of therapy is its focus on sex-related issues. If you and your partner are experiencing intimacy issues, talking with someone who specializes in this area can provide clarity on how to address it.

"I normalize clients' sexual challenges because it is so taboo to talk about—but we are all struggling with similar sexual challenges." —Carolanne Marcantonio, LCSW, SIFI, CST

“All sex therapists are first and foremost therapists with additional training that makes them sex therapists,” says sex therapist Carolanne Marcantonio, LCSW, SIFI, CST. “You’re seeing someone who, after getting their master's degree, has spent many more years of their life dedicated to understanding pain disorders—such as vaginismus, dyspareunia, vulvodynia—erectile unpredictability; premature ejaculation; trauma; discrepancy in sexual desires, gender and sexuality.” Some therapists also specialize in working with specific populations, like LGBTQ+ folks or people who are Black, Indigenous, and people of color (BIPOC), and some have experience with specific sexual practices, like polyamory, kink, and more.

One of the biggest aspects of being a sex therapist? Destigmatizing sex and many of the larger issues that are associated with it. “As a sex therapist, there's a lot of psychoeducation and sex education that clients have to learn because of the inadequate information about sex in other spaces. I also normalize clients' sexual challenges because it is so taboo to talk about—but we are all struggling with similar sexual challenges,” says Nikita Fernandes, MHC-LP, a psychotherapist and sex therapist.

Fernandes says another key part of sex therapy for many people is learning to feel comfortable with your own body and who you are. “People can start to build a better relationship with their body so that they can feel more empowered in sexual spaces.”

As is true with any mental health practitioner, sex therapists are often seeing people at their most vulnerable. Being open to the process of therapy, and what you may learn about yourself and your partner, can help make the act of going to sex therapy more meaningful.

The 4 most common issues that come up in sex therapy

Fernandes and Marcantonio say that there are four issues people that come up most often with clients in their practices:

  • Discrepancy in sexual desire (aka one person desires sex a lot more or a lot less than their partner(s))
  • Exploring opening up their relationship
  • Reclaiming sexuality after coming from a conservative religious background
  • Low sexual self-esteem

These challenges can occur in almost any relationship, and if they are impacting your sex life or your relationship, having a professional weigh in can be a great move.

With regard to treating “discrepancy in sexual desire, we talk about how intimacy and sex was in the beginning of the relationship,” says Marcantonio, as an example. “Has it always been like this or did it change? If it changed, what happened before it changed?” Her clients build a timeline and better understanding of the challenge before taking steps to address it. “No one should ever feel pressured to have sex, and no one should have sex because they feel like they should when they don’t want to,” she says.

“When it comes to libido discrepancies, it is important for people to communicate with their sexual partners about how they are feeling,” adds Fernandes.

“For exploring opening up a relationship, we talk about how each person feels about this. Are they on the same page, or is it different?” says Marcantonio. “We want to make sure there’s a good solid foundation in the relationship and continue to build an understanding of each person's wants, needs, and desires around what this would look like if they didn’t open up their relationship.”

Of course, the four above-mentioned concerns are just a few common examples of what brings people to sex therapy. There could be many other reasons why a person would want to work with a sex therapist that are just as valid, like addressing sexual trauma, struggling with gender identity or sexual orientation, or pain during sex.

What to do if you’re interested in trying sex therapy

If you’re curious about trying out sex therapy, both Fernandes and Marcantonio suggest setting up a consultation with a therapist. This is like a get-to-know you visit where you meet the therapist and give them an overview of what you’re hoping to address in therapy—and learn a bit more about their approach, style, and manner. These are generally fairly quick, and typically won't cost you anything right off the bat.

You can also ask a prospective therapist some preliminary questions before deciding to move forward. Important ones, depending on your needs or experiences, might include: “What is your experience working with LGBTQ people?” “How knowledgeable are you about treating the issues I have brought up today?” and “What’s your typical fee per session?”

Once therapy starts, your partitioner might give you some reading to learn more. Some books that Fernandes and Marcantonio suggest include Come as You Are: The Surprising New Science that Will Transform Your Sex Life by Emily Nagoski, PhD; Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love by Amir Levine, MD, and Rachel Heller; and Sex Outside the Lines by Chris Donaghue, PhD.

While some people feel more comfortable than others discussing sex with a therapist, remember that having open and honest conversations as being open to learning about what works for you sexually can go a long way. “Allow curiosity to lead the way before making any decisions that are set in stone,” says Fernandes.

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