If you and your honey are sexually stuck, the research shows that in two-thirds of cases, sex therapy resolves the problem.

Unfortunately, many people feel intimidated by the term “sex therapy.” Rest assured, you don’t have sex with—or in front of—the therapist. Sex therapists practice talk psychotherapy, but have extra training in sexual issues and often assign client couples sensual “homework.” For a realistic look at the process, see the recent Meryl Streep-Tommy Lee Jones movie, Hope Springs.

Sex therapy was born in the 1960s, when pioneering sex researchers William Masters, M.D. (1915-2001) and Virginia Johnson (1925-2013) showed that a combination of sex education, mutual whole-body massage, and specific erotic techniques could resolve many sex problems. Some sexual difficulties are independent of the relationship, for example, many cases of premature ejaculation. But most sexual conundrums involve both the relationship and the sex.

So what’s the difference between sex therapy and relationship counseling? The latter usually deals with communication and control—how couples make decisions and resolve differences. It may not deal with sex. But when couples consult sex therapists, lovemaking issues are usually the presenting problem.

Of course, every relationship has sexual issues—disagreements over frequency (Once a week? Once a month?) and repertoire (Oral? Anal? Sex toys?). How do you know if you need sex therapy? It’s subjective, but if a festering problem is making you nuts, sex therapy usually helps.

Early sex therapists enjoyed great success teaching men ejaculatory control and women how to have orgasms. Sex therapists still treat these problems, but today self-help resources often resolve these two issues—see the book, Becoming Orgasmic by Julia Heiman, Ph.D., and Joseph LoPicollo, Ph.D., and the ejaculatory control article on my site, GreatSexAfter40.com. These days, the issues more likely to bring people to sex therapists include:

Desire differences. “You’re insatiable!” “You never want to!” In about two-thirds of cases, the man wants sex more than the woman, but in one-third, it’s the other way around. Either way, sex therapy can help couples find a mutually acceptable frequency.

Erectile dysfunction. Everyone knows about the drugs, but few people understand that Viagra, Cialis, and Levitra work best in combination with sex therapy. California researchers gave 53 couples either Viagra or the drug plus eight sessions of sex therapy. Using the drug alone, 38 percent expressed satisfaction, but among those in combination treatment, the figure was 66 percent. Brazilian researchers analyzed 11 studies comparing the benefits of Viagra alone versus the drug plus sex therapy. In every trial, combination treatment worked significantly better.

Low or lost libido. Possible causes include personal history, medical conditions, drug side effects, low testosterone, relationship problems, or other life stresses.

Sexual aversion or virginity after age 30. People with these issues either fear sex or feel so socially awkward that friendships never progress to sexual relationships.

Women’s pain on intercourse. Possible causes include: medical conditions, anxiety, relationship stresses, birth control pills, or a history of sexual trauma.

Sex therapy usually works. University of Pennsylvania researchers tracked 365 couples who consulted sex therapists for a variety of problems. Two-thirds reported that the experience resolved their problems. When sex therapy didn’t work, a sex-impairing illness was typically the reason, often diabetes or heart disease. The researchers concluded, “Sex therapy is effective in the real world.”

What if one member of the couple refuses to go? Then the other can consult a therapist solo and obtain information, clarify issues, explore feelings, and take home new insights that might help the problem, or persuade the other to join the process.

For most problems, sex therapy takes four to six months of weekly one-hour sessions. Therapist-assigned homework often involves conversations to exercise new communication skills, or sensual assignments to practice massage techniques or other lovemaking skills.

Depending on location, sex therapy costs $100 to $200 an hour. Some health insurers cover it, others don’t, and some that do limit the number of covered sessions, after which you pay out-of-pocket. Check your policy.

Some people wonder if the therapist’s gender affects the result. People may have personal preferences, which is fine, but the research shows that the therapist’s gender is irrelevant. Men and woman respond equally well to male or female sex therapists. What matters most is the rapport between clients and therapists, and clients’ commitment to the process.

To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.


Melnik, T. et al. “Psychosocial Interventions for Erectile Dysfunction,” Cochrane Database Systematic Review (2007) CD004825.

Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavioral Sex Therapy for Psychogenic Erectile Dysfunction: A Pilot Study,” Journal of Sex and Marital Therapy (2007) 4(4 Pt 2):1117. 

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