What Actually Happens in Sex Therapy (and What Doesn’t)
If the words “sex therapy” make your stomach flip a little, you are in very good company. Most people picture something far more awkward, and far more physical, than the real thing. The reality is quieter, kinder and a good deal more ordinary than the version your imagination has been running.
If nerves are what have kept you from asking for help, this one is for you. Here is what happens in sex therapy, in plain words, and just as importantly, what very much does not.
First, the thing everyone worries about
Psychosexual therapy is a confidential talking therapy. There are no physical examinations, no demonstrations and no touching of any kind. Sessions are conversations, and with us they happen online, from wherever feels private and comfortable to you.
You can go as slowly as you need to. You can say “I am not ready to talk about that yet”, and nobody will push. Nothing is expected of you except to turn up as you are.
Sexual difficulties are far more common than most people dare to believe. They are not a verdict on you, and they are not a sign that a relationship has failed. Many people carry them quietly for years before saying a word, and a good deal of the relief comes simply from saying them out loud to someone kind.
What happens in a session
You begin with a one-hour assessment. It is a relaxed, confidential conversation about what has brought you, what you would like to feel different, and whether you are coming on your own or with a partner. You do not need to arrive with the right words. Your therapist will help you find them.
From there, the work is a gentle mix of understanding and small, practical change. Depending on what you bring, your therapist might help you:
- Make sense of what has shifted, and ease the pressure a little, because anxiety is so often the thing making everything feel worse.
- Find a way to talk about sex with a partner that does not turn into a row by the second sentence.
- Try gentle exercises that you agree on together, between sessions, in private and at your own pace. Never in the room.
- Make room for the feelings sitting underneath a physical difficulty, alongside any medical care you are having.
Your therapist is there to support you, not to assess how you are doing. Our team includes a COSRT-registered sex therapist (COSRT is the College of Sexual and Relationship Therapists), and the people who do this work have usually met what you are carrying before. That tends to make it a little easier to say.
What sex therapy can help with
Most sexual difficulties sit where body, mind and relationship meet, which is exactly where a talking therapy can be of use. Some of the reasons people get in touch with us:
- Desire that has quietly faded, or a gap in desire between you and your partner.
- Performance anxiety, the worry that feeds the very thing you are dreading.
- Arousal and erection difficulties, worked on alongside your GP where a physical cause may be involved.
- Pain, tensing or avoidance, including the emotional side of vaginismus or ongoing discomfort.
- Finding each other again after a big change, such as having a baby, illness, menopause, medication, trauma, or simply many years together.
If there is pain, or something has changed in how your body responds, it is a good idea to see your GP as well, so that any physical cause can be looked at. The NHS has helpful pages on loss of libido and erectile dysfunction. We are happy to work alongside your medical care, and many people find the two together help most.
Can I come on my own?
Of course. Plenty of people come by themselves, whether they are single or their partner would rather sit this one out. Couples are warmly welcome together too, and if it is the relationship as a whole you want to look at, our couples therapy may be the gentler place to start.
We welcome people of every sexual orientation, gender identity and relationship structure. You will never have to explain or defend who you are, or how you love, before the real work can begin.
Some things are easier to say to the right person
Book a one-hour assessment and we will match you with a therapist who has the right training for this work. No GP referral, no waiting list, and no obligation to carry on if it does not feel right.
Questions people often ask us
Is sex therapy physical? Are there any examinations?
No. It is a confidential talking therapy, with no examinations, no demonstrations and no physical contact of any kind. Sessions are conversations, held online from your own private space.
Will I have to describe things in detail?
No. You decide what to share and when. Many people begin with the feelings around the difficulty rather than the details, and that is a perfectly good place to start.
What if I get embarrassed or go quiet?
That is completely normal, and your therapist will expect it. Silences, nervous laughter and “I do not know how to say this” are all part of the work, and none of them is a problem.
Is it confidential?
Yes. What you share stays within our professional and ethical framework. For many people, that privacy is exactly what makes it possible to talk about this at all.
How much does it cost, and do I need a referral?
You do not need a GP referral, there is no waiting list, and most people begin within a week. A one-hour assessment is £50, and session fees depend on the therapist you are matched with. Every fee is set out on our fees page.
If this has stirred up more than you expected, our articles on couples therapy in London and complex trauma may also help.
Psychosexual therapy is a confidential talking therapy for adults (18+). We carry out no physical examinations and do not provide medical treatment. For physical symptoms, please speak to your GP as well. Talking Counselling is not a crisis service. If you need urgent help, call 111 or the Samaritans free on 116 123, and in an emergency call 999.