Sex can be hard to talk about.
Some people come to sex therapy after years of struggling.
Others come because something changed in their body, desire or relationship.
Some aren’t sure their concern counts, or whether it’s okay to bring it up at all.
Maybe you feel:
- ashamed
- disconnected
- frustrated
- uncertain
When sex has been met with silence or shame from culture, family, religion or past harm, staying quiet can feel safer.
Sex therapy gives you a place to talk openly, without judgment.
What is Sex Therapy?
Sex therapy helps you understand your concerns and build a relationship with sex that feels right.
It starts from the idea that sexual concerns are common, and it’s okay to talk about them.
Nothing you bring is too small, too strange or too long ago to talk about in sex therapy.
It can look at health, hormones or medication.
It can help with desire, arousal, pain, pleasure, orgasm, porn or compulsive sexual behavior.
It can also help with intimacy, infidelity, consent, sexual orientation, identity and sexual trauma.
The work is about making room for your body, your desires, and your questions.
How Sex Therapy Helps
Therapy gives you a place to say what you’ve never said out loud.
It can help with a new or old concern, whether you’re single, partnered or somewhere in between.
In sex therapy you can learn to:
- ask for what you want
- ease pain and anxiety
- explore desire at your own pace
- reconnect with your body
- talk about sex with a partner
Therapy can’t change what you were taught about sex, but it can help you decide what you believe now.
Sexual concerns often shift as shame eases, and it can take time to feel safe in your body.
Sex can become something that feels like yours.
What is a Sex Therapist?
A sex therapist is a registered therapist with advanced training in sexual concerns.
Any therapist can talk about sex, and a therapist with sex therapy training offers specialized care.
Some are certified with the American Association of Sexuality Educators, Counselors and Therapists.
Some work alongside doctors, pelvic floor physiotherapists or gender-affirming care providers.
Some focus on 2SLGBTQ+ people, kink or non-monogamous relationships.
Some specialize in pain or sexual trauma.
What matters most is that the therapist is a good fit for you, whatever approach they use.
Some Approaches for Sex Therapy
Affirming
It is sex-positive and honors your orientation, identity and relationships without judgment.
Emotionally Focused
It helps you understand how emotional safety shapes connection, desire and intimacy.
Feminist
It looks at how gender, power and cultural messages shape what you learned about sex.
Trauma-Sensitive
It puts safety and choice first, especially when sexual concerns are tied to past harm.
What to Expect in Sex Therapy
Sex therapy is talk therapy, and there is never any touch or sexual activity in sessions.
You can share as much or as little as feels comfortable, and you can always say no to a question.
Early sessions often explore what’s happening, how long it’s been going on and what you hope will change.
Your therapist might ask about your concern, your health and the messages you grew up with about sex.
Some therapists suggest experiments at home, on your own or with a partner, at a pace you choose.
If a therapist doesn’t feel safe, it’s okay to end and find another one.
Sex therapy can be short-term for a specific concern, or longer when it’s tied to trauma or long-held shame.
Sex has been shaped by advocacy and shame.
In 1886, psychiatrist Richard von Krafft-Ebing published a book that listed many sexual behaviors and desires as diseases.
Sixty years later, biologist Alfred Kinsey published interviews with thousands of men, and later women, showing many supposedly rare behaviors were common.
In 1966, researchers William Masters and Virginia Johnson published the book Human Sexual Response. They had observed nearly 700 people in their lab. Their work showed sexual response was normal and measurable. A few years later, they published Human Sexual Inadequacy, describing a short-term treatment that launched modern sex therapy. Even the title framed sexual concerns as failure.
In 1967, Canada’s justice minister Pierre Trudeau said there’s no place for the state in the bedrooms of the nation. Two years later, Canada decriminalized sex in private between two consenting adults aged 21 and older, including same-sex partners.
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In 1973, psychiatry’s diagnostic manual removed homosexuality as a mental illness.
In 1974, psychiatrist Helen Singer Kaplan published The New Sex Therapy and brought sex therapy into weekly talk therapy. Five years later, she added desire to her model, so low desire could be treated, not just problems with performance.
That same decade, Masters and Johnson published a book claiming they could change gay people’s sexual orientation. This practice, now known as conversion therapy, tried to make queer people straight or make them deny who they are. Colleagues later questioned whether their results were real.
In the 1990s, psychologist Leonore Tiefer argued that sex therapy measured everyone against a narrow, performance-focused idea of normal. Later, she helped launch a campaign against labeling women’s sexual problems as medical disorders.
In 1998, the drug Viagra was approved to treat erection problems. It had been developed as a heart medication, until men in the trials reported an unexpected side effect. Millions of prescriptions were filled, and sexual concerns were talked about more openly than ever. It drew sex further toward pills and performance.
In 2000, Vancouver physician Rosemary Basson described a new model of desire. She proposed many women feel desire after intimacy begins, not before. Responsive desire is a normal way to feel desire, not a problem to fix.
In 2022, Canada’s ban on conversion therapy came into force. It made it a crime to put anyone through practices that try to change their sexual orientation, gender identity or gender expression. By then, research had linked these practices to depression, shame and suicide.
But sexual concerns are still rarely talked about, even in therapy.
People whose bodies, desires or sexual relationships don’t fit a narrow standard of normal are often treated as broken.
Religious, family and cultural messages leave many people with deep shame and no place to talk safely.
Sexual trauma is common, but many health professionals and therapists don’t ask about it, or don’t know how to help.
And some sex therapy exercises can feel unsafe for survivors without extra care and choice.
Trauma-sensitive sex therapy works inside those gaps. It welcomes every body, desire and relationship. It makes room for shame without adding to it. It asks about past harm and goes at a pace that feels safe. And it puts your consent and choice at the center of every step.
Trauma-sensitive therapy starts by making it safe to talk.
Trauma-Sensitive Sex Therapy
What if your body says no when you want to say yes?
After trauma or sexual harm, your body can shut down, tense up or feel far away during intimacy and sex.
Trauma-sensitive therapists understand that pain and sexual concerns can be your body protecting you.
5 phrases you might hear in Trauma-Sensitive Sex Therapy:
- You can say anything here.
- What does safe feel like for you?
- Of course, your thoughts make sense.
- How does your body say no?
- We can go as slowly as you need.
Trauma-sensitive sex therapy invites you to find what feels good.
Principles of Trauma-Sensitive Sex Therapy
Consent first
You choose what to talk about and what to try. You can change your mind or say no, here and anywhere.
Your time and space
Your body may need extra time and space to feel safe. Change can happen slowly, in small steps you choose.
Non-judgment
Shame often surrounds sex. You can talk openly and explore your feelings without fear of judgment.
Every body welcome
Every orientation, identity and relationship belongs. You don’t have to fit someone else’s normal.
Questions You Can Ask a Sex Therapist
A consultation is a good time to ask questions. Trust how you feel after the conversation as much as the answers themselves.
What training do you have in sex therapy?
Are you comfortable with my identity or relationship?
Do you work with sexual trauma?
Can I come alone, or with a partner?
Do you work with doctors or physiotherapists?
What if I feel embarrassed?
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