You may have joked to friends that you don’t need therapy—you have them. But sometimes working through the hard stuff requires help from a neutral party who happens to be a licensed professional. If your hard stuff is about sex, a sex therapist may be your best option. Here are eight signs a sex therapist could be a great addition to your life, and after that, advice on actually finding one.
1. You’re experiencing pain or physical difficulty when you try to have sex.
It’s important to see a medical doctor first to rule out any physical conditions behind this, somatic (body-based) psychologist and certified sex therapist Holly Richmond, Ph.D., tells SELF. Unfortunately, a ton of things can cause horribly painful sex, like cervical inflammation from a sexually transmitted infection, endometriosis, and uterine fibroids. In that kind of situation, medical treatment may help ease difficulty having sex.
If you see a medical doctor and there is no physical issue at the core of your trouble with sex, that doesn’t make what you’re dealing with any less significant. Seeing a sex therapist to discuss any psychological components at play can be helpful, Richmond explains.
For instance, vaginismus, which causes painful vaginal muscle spasms during penetration, can stem from anxiety about having sex, according to the Cleveland Clinic. (That could include anxiety about it being painful even if any condition causing the pain has been treated.) It can also happen due to issues such as post-traumatic stress disorder from a sexual assault. Stress is one of many possible psychological causes behind erectile dysfunction, too.
Point is, the mental and physical are often so closely intertwined that painful sex is a very valid reason to see a sex therapist.
2. You’re processing sexual trauma.
It’s a misconception that trauma leaves all survivors incapable of being sexual beings. Enjoying sex after an assault is possible, and a sex therapist might help you get there.
Of course, recovering from a sexual assault is a different process for everyone. But for some people, a sex therapist is a better option than a more generalized mental health professional. “Oftentimes therapists will talk about the trauma, but there’s no resolution on how we move forward as our sexual selves,” says Richmond, who treats many survivors. “[Sex therapists] process the trauma and move forward to help you have sex with your partner. We can help you move from survivor to thriver.” That’s not to say a therapist who doesn’t specialize in sex can’t help you heal after an assault. But if you’d like to specifically focus on the sexual aspect, a sex therapist may be ideal.
3. You’re in a partnership with mismatched desires.
This can mean many things, like one person having a higher libido than the other or being interested in exploring a kink such BDSM, sex therapist Liz Powell, Ph.D., who often sees partners with mismatched desires, tells SELF.
While having a kink is generally becoming more accepted, disclosing one can still be scary. This is where a sex therapist can help. For instance, Richmond recalls a couple who came to her because the male partner was struggling with the female partner’s urge to explore her submissive side in a specific way. “She wanted to be called a slut, a whore, and her partner just could not do it. So, we had to figure out other ways for her to work within her fantasy,” Richmond says.
If necessary, a sex therapist can also guide you through the realization that the partnership isn’t working due to incompatible desires. “So many people are just petrified of breakups [and] they choose to stay even when they’re not happy,” Powell says. Seeing a therapist together may help you figure out whether to salvage the relationship or bring it to a respectful end.
4. You want to explore opening up your relationship.
This is another scenario Powell, who specializes in LGBTQ+ communities along with kink and polyamory, sees quite often. A sex therapist can help a couple in this situation craft a relationship format that allows both of them to feel safe and fulfilled. That can mean everything from the freedom to have a one-night stand once a year while in another country to dating multiple partners.
Having an impartial, trained person involved can help ensure that no one is simply capitulating to something like an open relationship due to pressure (even the internal kind) and that both partners are respecting each other’s boundaries—even if that means splitting up.
5. You have questions about your gender identity.
But there are setbacks, too, as evidenced by the recent news that the Department of Health and Human Services wants to define gender as a fixed identity determined by a person’s genitals at birth. (It’s not.)
In light of the continued fight to have everyone’s gender identity respected, figuring out the right words or expression for your gender can be a daunting task. A sex therapist, particularly an LGBTQ+ friendly one, may be able to help you alone or with a partner, Powell says.
6. You’re exploring your sexual orientation.
As with gender, a sex therapist can help you navigate questions about your sexual orientation, reassure you that there’s nothing wrong with you, and aid you in your journey of self-discovery. This can be especially helpful if you’re in a monogamous relationship and experiencing sexual curiosity for people of genders other than your partner’s, Powell says.
A sex therapist could also be useful if you’re wondering whether or not you’re asexual or would like to talk about being asexual. “Some people think it’s a sex therapist’s job to make people have more sex and crazier sex, and [it’s] definitely not,” Richmond says. “You don’t have to have any sex. As long as you’re OK with it, I’m OK with it.”
7. You’re a current or former sex worker or dating someone who is.
Richmond says she frequently sees couples in which one person is or used to be a sex worker. A good sex therapist can help people uncover and eradicate any kind of internalized stigma around the profession. “In many people’s minds, because of our cultural lens, that’s something to be ashamed of,” Richmond says. “That’s not my view.”
Another important component may be helping the person not in the adult industry separate their partner from their sex work, Richmond says, explaining that people who are dating sex workers sometimes fetishize their partners accidentally. “Helping separate the person’s identity from [the adult industry] can be tricky because of the shame, but at the end of the day, you’re just dating another person,” she says.
8. You want to overcome sexual shame.
You may have noticed a theme here. From gender identity to surviving an assault to sex work and more, a sex therapist can help you deal with something that brings you shame even if that emotion is totally unwarranted. (As it is with everything on the above list.)
Both Powell and Richmond say that, deep down, most people who see them want to know if they’re “normal.” Shame has a funny way of making you feel like you’re not, and it’s the opposite of conducive to enjoying a healthy sex life. But it can also be almost impossible to escape. “Having grown up in a culture with so much shame, I think most of us could benefit from seeing a sex therapist,” Powell says. If anything is keeping you from having the love or sex life you always wanted, a sex therapist might be able to help you work through it.
Wishing you could teleport to a sex therapist’s office right now? Here’s the next best thing: advice on finding a great sex therapist you can afford.
Finding the right therapist can feel like dating. Despite their qualifications, therapists are humans, too. You might run into a therapist with their own sexual hang-ups or old-fashioned views, or just someone you don’t gel with. But when you find “the one,” there’s no feeling like it. Here are a few steps to try.
1. If you have insurance, call and ask for help finding a local sex therapist. You can also look through their online directory. Since that may not allow you to filter specifically for sex therapists, you might still need to do some digging on the therapists’ backgrounds.
2. Richmond suggests looking into the American Association of Sexuality Educators, Counselors and Therapists (AASECT). They have an online directory of local professionals. Not all of the professionals list their insurance policies, though, so you’ll need to visit their websites or get in touch with their offices to ask about that.
3. Online services such as ZocDoc and Psychology Today have filters that allow you to get more specific about what you want. For instance, on Psychology Today, you can drill the results down to sex therapists who specialize in gender identity, take your insurance, and participate in online therapy. (Even if it seems like you’ve landed upon your dream therapist, it’s always smart to call the office and verify that all the information you’ve found is up to date.)
4. Try asking your potential therapist’s office if they ever accept payment on a sliding scale and, if they do, which income brackets qualify. Unfortunately, not all therapists take insurance. Even if they do, your insurance may not cover your One True Sex Therapist. If your therapist accepts payment on a sliding scale, that can be a great way to lower your financial burden.
5. If price is still an issue, consider seeing a sex educator or a counselor instead of a therapist. Someone with a degree such as an M.S.W. (masters in social work) may have a lower rate than someone with a degree like a Ph.D., but should still be highly skilled.
6. Google “sex-positive therapist in [insert your city here].” You may find a network such as Manhattan Alternative, which lists sex-positive therapists in New York City who specialize in areas such as kink, ethical non-monogamy, and sexual assault survivorship.
7. If you’re looking for help specifically related to an LGBTQ+ issue, check out SELF’s guide on how to find an LGBTQ+ friendly doctor. Much of it extends to finding a sex therapist as well.
8. Ask about virtual sessions. If the best therapist you find isn’t in your city, remember that many are open to coaching you over the phone or virtually with a service like Skype or FaceTime, Richmond says. For all its potential ills, technology can be a beautiful thing.