When Is It Time to See a Sex Therapist?

In episode three of the first season of Gwyneth Paltrow's "Sex, Love & Goop" on Netflix, lesbian couple Chandra and Camile both experience different problems with intimacy.

Chandra feels pain during penetration and Camille struggles with asking for what she wants. Both are treated with a type of sex therapy called '"sexological bodywork" where the practitioner uses a combination of talk therapy and physical touch to help the couple overcome challenges.

As fascinating as this episode may be to watch, it could create misconceptions about what sex therapy is. FYI, touching clients' genitals is illegal in every state except California.

If you don't have a sexual relationship with yourself and don't know your body, a sex therapist can help guide you through that process.

For most sex therapists, the practice closely resembles psychotherapy, only with an emphasis on sexual issues. They aim to help you understand and overcome the root causes behind sexual challenges.

So what are the reasons you may want to see a sex therapist? We have four of them, as well as advice and tips for finding the right one for you.

1. You and your partner aren't having good sex anymore

Major life changes, such as having children or becoming empty nesters, can cause issues in the bedroom.

Couples often seek sex therapy when either the frequency or quality of sex has changed, according to Heather England, Ph.D., a licensed clinical psychotherapist, certified sex therapist and the owner of Love Filled Life in Charlotte, North Carolina. They miss the connection they used to have with their partner.

"That's a time to get help because it's going to start driving a disconnection in your relationship," she said.

For example, if you're a young couple who's recently had a child, you may feel exhausted.

"Sex becomes another task, and fatigue is a desire killer," England said.

Alternatively, empty nesters might see each other as no more than roommates and have trouble drumming up desire.

"They haven't done things to nurture the relationship throughout all those years," she said. "Not just sex, but even the emotional connection, because good sex is built on a foundation of love, emotional intimacy and connection."

Sex therapy can help you reignite the emotional connection and, in turn, your sex life.

2. You have a clear sexual health problem

People also go to sex therapy when experiencing physical issues such as erectile dysfunction (ED), pain during penetration or not being able to orgasm.

Duewa "Kaya" Spicer, a certified sex therapist and the owner of Infinite Zen Holistic Therapy in Katy, Texas, said she prefers to work with a small network of doctors for these types of problems.

"We take an assessment and look at your medical history, any illnesses and any recent changes," she said. "We're looking for things like fertility issues, sexual trauma or abuse."

Spicer recommends doctors look at the medical side, ensuring there's no neurological damage or hormonal issues.

For example, if a patient is experiencing pain and wants to work on feeling more comfortable and relaxed during sex, she will work with them on their anxiety first. She'll also connect the patient with a pelvic floor therapist, urologist or primary care doctor to work as a team.

"It's very much an interdisciplinary practice," Spicer said.

3. You feel shame in the bedroom

Whether you grew up in a religious family where sex outside of marriage was frowned upon or simply didn't experience a sex-positive environment, you may feel shame around sex. If you grew up hearing that women who had casual sex were "loose" or "easy," you might still harbor those messages subconsciously.

Shame can also come from more nefarious places such as sexual trauma and abuse. For example, England said she had one client who used to be really sexual and loved sex. But when she got married, she suddenly lost her desire.

"We unpacked her childhood and realized she had so much internalized sexual shame over an experience when she didn't have consent," England said. "She also had a lot of negative religious messaging from the church about sex."

The patient's prior experience of having nonconsensual sex devalued her self-image and made her feel not good enough, England explained. Prior to her marriage, becoming more sexual made her feel devalued again. But being in a safe, committed relationship suddenly didn't fit that narrative, which is why her shame resurfaced.

"One of the great questions that I ask clients is, 'Who's at the foot of your bed when you're having sex?' It's metaphorical, but some people will say God," she said. "So they feel like they're being judged."

4. Your confidence has shifted

Another issue is you may feel as if something is holding you back from being confident in the bedroom. Spicer explained this could be from a hormonal shift such as during menopause, in which case you would need a doctor to help you regulate your hormones.

Alternatively, England said this could come from your partner making comments such as "I wish you were better at oral sex" or "I wish you would be more adventurous." This would make anyone feel self-conscious, but there may be a way to compromise with your partner.

If you don't have a sexual relationship with yourself and don't know your body, a sex therapist can help guide you through that process, she explained.

Where do you go from here?

Sex therapy can be a great healing modality for people with a wide range of sexual problems. Since there are therapists who specialize in different areas—LGBTQIA+ issues, ED or pain during intercourse—you may want to find someone who focuses on your particular challenges.

Similarly, you may want to find a cultural fit, such as a therapist who shares your ethnic or racial background.

Most sex therapists will offer a free initial phone consultation, so call around until you click with someone and feel they're a good fit.

While you can always start with your primary care provider for sexual issues, a therapist can help you manage the root emotional components that are causing problems. Once you learn methods to deal with the root cause, you'll experience more freedom and pleasure between the sheets.