Sex Therapy

Sex therapy is a form of talk therapy that is based on sexology, the scientific study of human sexuality. Sexology is multidisciplinary and rooted in a wide range of academic fields from biology to sociology.

Sex therapy is:

• Is a multidisciplinary field of study focused on sexual health and sexual rights

• Is based on diverse therapeutic methods

• Supports people with sexual functioning issues, changes that affect sexuality, identity and preferences, and sexual practices

• Is provided by a therapist who has worked on their own prejudice and can meet you in a non-judgmental way

• Normalizes the diversity of sexuality

• Creates space for talking about stigmatized and taboo topics

• Offers advice and education

Therapists come to the practice from a number of backgrounds. Studying sexology differs from country to country, and so do requirements for previous skills and degrees. Some educational systems categorize sex therapy as a specialization of medicine, while others see it as a separate field of therapy. This means that sex therapy can mean something very different between countries and continents.

Sexology is re-emerging as a field and as it is fairly young, educational standards have not yet been set between countries. There are some alliances between sexological organizations, for example NACS (the Nordic Association for Clinical Sexology) in Nordic countries and Estonia, which upholds a standardized credentialing system.

Towards acceptance

What sex therapy has in common between models is focus on sexual health and rights. In practice this means supporting people with a wide range of issues, from erection difficulties to finding pleasure despite trauma. Some of the most common questions are related to sexual functioning - desire, arousal, and orgasm. Sexual and gender identity, as well as sexual preferences are also often discussed.

Working through a Sexual Attitude Reassessment (SAR) is key to becoming a sex therapist. This means the therapist has worked on their own prejudice and bias towards different sexual identities and practices. They know who they can work with, and refer clients forward if their own attitudes prevent them from creating space for the client to be seen and heard.

PLISSIT: support that meets your needs

Supporting sexuality and sex therapy is often based on the PLISSIT model. The acronym stands for: permission giving, limited information, specific suggestions, and intensive therapy. These are the four different levels of support a sex therapist or other medical or mental health professional can offer.

• Permission giving means creating a non-judgmental and normalizing environment to talk about sexuality openly. It's often a big relief and key to starting to let go of shame related to sexuality.

• Limited information is specific to the client's needs and can be anything from scientific research to contact details for support groups. This part of sex therapy can be sex education, psychoeducation, or researching practical things like events or groups together.

• Specific suggestions are tasks, changes, assignments, or treatment plans that can help fix issues like orgasm difficulties or sexually transmitted infections. Suggestions are only made when needed, and only after hearing the client and offering them information.

• Intensive therapy: If the three first steps are not enough to support with the situation, the sex therapist either starts a deeper therapy process, or refers the client to another medical or mental health professional.

Anyone can benefit from sex therapy. You don't need to have a problem or a big life change to find benefits in focusing on your pleasure. We get so much false information and pressure from media and culture that questioning your beliefs with a sexuality expert can create change you didn't even know you needed. That being said, there are a lot of typical issues people seek help for in sex therapy.

Common topics in sex therapy:

• Sexual functioning: low or high libido, orgasm difficulties, arousal and erection problems

• Performance pressure: difficulty staying with yourself, boundary setting, feeling you're "not normal"

• Relationship issues: changes in desire and frequency, sex outside the relationship

• Identity: changes in or questioning of sexual or gender identity, sexual preferences, kink

• Self-confidence: shame around sexuality, body image, sex skills

• Bodies: surgeries and conditions that affect sexuality, unwanted pain during sex, STIs

• Sexual trauma: first aid, control over your body and pleasure after trauma (only some sex therapists are also trauma therapists, so trauma treatment usually happens elsewhere)

• Harmful sexual behavior: sexual thoughts or behaviors that are harmful to yourself or others

1. Understand your desire, arousal, and deal with performance pressure

Sexual functioning and performance pressure are often linked. You have an image in your head, telling you how your body and sexuality "should" work and what is "normal". This often leads to problems around desire, arousal, and orgasm. On the other hand, these problems can be physical, linked to changing hormone levels, medications, and health issues.

Whether the cause of your struggles is mental or physical, a sex therapist can help you find more sexual pleasure. This process is centered on non-judgement, validation, and acceptance. The aim is to find the best possible outcome for your unique situation. Often this means unlearning outside expectations and relieving performance pressure.

2. Work on sexuality issues in your relationship(s)

Relationships bring with them their own set of challenges to sexuality. Mismatched libido or desires, difficulties connecting, lack of excitement and play, broken trust, and communication problems are common issues in relationships. Sex therapy together with your partner lets you explore the interpersonal dimension of your sexuality.

Every change in our lives from work stress to fighting to illness affect our sexuality. Sexuality often acts as the canary in the coal mine, alerting us to take a look at the big picture. Talking about sex in a partnership can lead you to unexpected revelations. The goal isn't to get you to act like teenagers, but to find greater understanding and acceptance. You speak out the unspoken and find your own way. Sex therapy expands towards couple's therapy to help you find the root of your issues and work on possible solutions.

3. Support your sexual identity, preferences, and confidence

Understanding your gender and sexual identity is not always straight forward. Some people have always known who they are and who they are attracted to, but this is not the reality of a lot of people. You might wonder about your attraction or sexual preferences. Maybe you want to figure out your gender identity or presentation.

Sex therapy can support you with understanding yourself better, in a safe space where you're free to question and be insecure. And after you figure yourself out, a sex therapist can help you explore and get confident with new ways of expressing your sexuality.

4. Deal with bodily changes, injury, and sexual trauma

Sometimes things happen that we have no control over. As much as it sucks, the aftermath is ours to deal with and can't be done by anyone else. Be it chronic illness, the effects of aging, physical injury, or sexual trauma, sex therapy helps you to take control of your sexuality. You work together with your therapist to find the best sexual practices available to you.

If you're dealing with illness, injury, or trauma, sex therapy can help you with:

• self acceptance

• adapting expectations

• reclaiming your power

• finding the right accessibility tools

• building scientific understanding

• fine tuning medical care.

5. When your sexual desires cause harm to yourself or others

You might be seeking sex therapy to deal with sexual behavior that is harmful to you or others. Harmful sexual behavior can range from sexuality related addictions to urges that would be illegal to pursue, or actions that have already caused harm. In more concrete terms this means sex addiction, porn addiction, consent and boundary violations, sexual abuse, coercion, violence, and manipulation. Harm caused to yourself can mean that your behaviors are limiting your ability to work, take care of basic needs, and connect to other people.

There are different sexological models and programs for treating sexual behavior that can cause harm. Support is ideally available as soon as harmful tendencies are noticed in childhood or puberty, and can be individual therapy or group programs. Sex therapy for harmful sexual behavior helps you with understanding thought patterns that can lead to harm, supporting self-regulation, and finding your strengths for living a good life*. LGBTIQ+ people do not fall in this category even if they live in a context where their identity is illegal, and the therapy offered is never conversion therapy.

*Please note that therapists have an obligation to report crimes, illegal activities are not protected by confidentiality.

Sex therapy is shown to help make symptoms less severe, support with sexual satisfaction, and in general create significant improvements with the issue at hand. A sex therapist has training to deal specifically with sexuality related issues, which most other therapists and especially medical professionals do not.

Sexuality is still a taboo topic is most cultures, and just talking about it with a person who doesn't judge you can make a huge difference. You might have internalized negative attitudes and shame that is easily alleviated by being heard, accepted, and validated.

Extensive knowledge on sex and sexuality is part of the skills of a sex therapist. Your therapist can bust myths and share information that helps alleviate whatever you're struggling with. They will also have experience in working through similar issues with other people, and can come up with suggestions you would never have thought of yourself.

A sex therapist has skills in:

• Sexuality, sexual anatomy and physiology

• Diverse sexual identities and preferences

• Unbiased, active listening and validation

• Boundaries and ethics

• Evidence-based interventions and problem solving skills

There's a lot of sex and sexuality related questions sex therapy can help with. That being said, it will not be the answer for every person or every situation. Here are some things a sex therapist can't do for you:

Give you the answers and decide for you

You might have an idea of sex therapist giving you answers like the Q&A article of cosmo. Sex therapy means you working on your issues and finding your own answers. A therapist can give you sex education and offer perspective, but they can not tell you what to do.

Fix your relationship

Sex is often an indicator of struggles in relationships which can't be fixed by improving the sex. If you struggle with managing your conflicts or finding a common understanding of your relationship, you will be more successful if you see a couples therapist.

Change your partner

Sex therapy isn't a tool for you to mold your partner into who you want them to be. Change can only come from the inside.

Solve problems with a medical cause

If antidepressants make you lose sexual interest, you have pain during sex because of vulvodynia, or are struggling with erectile dysfunction, sex therapy can help you find the best possible way to express your sexuality. It can not fix medical problems, and for those you need to see a doctor.

Have sex with you

Sex therapy is a form of talk therapy and does not include touch. If you want to have sex in a safe and pressure free environment, you can try to find a sex worker or sexual surrogate you feel comfortable with.

As with any therapy, a key to success is your relationship with your therapist. How well you can collaborate, form an alliance with, and feel understood by your therapist has a big impact on the outcome. You will want to find a sex therapist who gets you without you having to do education.

If your therapist can adapt their interventions to match your culture and needs, and be flexible in working with you, the results will be better. The exact methodology or direction of sex therapy your therapist follows isn't as important as you resonating with the methods they choose. In fact, there are not huge differences in outcome between different models of therapy.

Check list for finding the right sex therapist:

• Knowledge on the topic(s) I want to discuss, my identities and preferences

• Flexible - interventions and models adapt to my needs

• Helps set realistic expectations for outcomes

• I feel comfortable, understood, and supported

• I feel like a team with the therapist

Ceci Ferox is a Berlin, Germany based sex therapist. They studied sex therapy at Sexpo in Finland under the Nordic Association of Sexology Studies requirements for sexology education. They have also studied Gottman method couples counseling levels 1 and 2.

Ceci has specific knowledge on questions related to:

• LGBTQIA+ identities

• Kink and BDSM

• Non-monogamy

• Neurodivergence

• Body diversity

• Sex work

• Minority stress

• Trauma