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What is sex therapy?

Sex therapy is psychotherapy, or talk therapy, focused on helping an individual or a couple address their sexual concerns. There is never any kind of physical contact between the therapist and client. Sex therapy is often most effective when combined with couple therapy, as sexual concerns are often relational in nature. However, individual sex therapy can still be highly effective for many sexual concerns. Sometimes, sexual concerns may be all that you are looking to address during your time in treatment, but oftentimes, it is only one aspect of why you are seeking help. Psychotherapists must first obtain a master's degree where they learn to treat a broad range of general issues, such as depression, anxiety and trauma, before they go on to develop specialized knowledge in treating sexual and relational issues. Becoming a Certified Sex Therapist with the Board of Examiners in Sex Therapy and Counselling in Ontario is a rigorous process involving additional training, supervision and examination. In sex therapy, you may expect to:

 

  • Feel comfortable openly talking about your sexual concerns

  • Feel respected, heard and understood

  • Be free of judgement

  • Collaboratively determine the best course of treatment with your therapist, which may sometimes involve EMDR, CBT, couple therapy, communication training or mindfulness techniques, to name a few.

  • Have your therapist ask direct questions about your sexual thoughts, feelings, behaviours and sexual history for the purpose of helping you to address your concerns

  • Answer as much as you feel comfortable

  • Be assigned behavioural homework, sometimes on your own and sometimes with your partner(s)

  • Have your therapist may recommend couple therapy whenever appropriate

  • Sometimes have your therapist recommend that you speak with a physician to rule out physical causes for the sexual concern(s) in question

  • Some have your therapist recommend pelvic floor physiotherapy as a complement to or alternative for sex therapy.

  • Get accurate information about your body and sexuality that is embedded within a sex-positive framework

  • Feel more comfortable with your sexuality

What concerns can i/we hope to address?

  • Enhancing sexual intimacy

  • Opening up

  • Low sexual desire

  • Desire discrepancies

  • Navigating kinks & fetishes

  • Performance anxiety

  • Erectile dysfunction

  • Premature ejaculation

  • Delayed ejaculation or orgasm

  • Anorgasmia (difficulty with orgasm)

  • Fertility-related concerns

  • Sexual shame/negativity 

  • Sexually-related fears and phobias

  • Sexual assertiveness & communication

  • Self-acceptance

  • Women's sexuality

  • Men's sexuality

  • Lack of sexual knowledge

  • Body image

  • Embracing pleasure

We recommend that you start with weekly or bi-weekly 50-minute sessions (1-4 sessions) to complete the sexual history assessment, assess the nature of the problem and determine whether you may need a physical assessment by a physician or pelvic floor physiotherapist. When you have behavioural homework assigned, we recommend booking an appointment that leaves you with enough time to complete the homework between sessions. If you are experiencing sexual pain, we recommend that you cease the sexual activities associated with the pain, and book an appointment with a physician in conjunction to starting sex therapy. 

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Occupational therapists are health care professionals who help people to resume or maintain participation in a variety of tasks – their jobs, leisure and social activities, getting around, caring for themselves and their home, and much more. Even though occupational therapy covers a wide range of client concerns, an exciting opportunity that has recently come through for our practice is a collaboration with Aleah Johnson, a student of the Master of Science in Occupational Therapy Program at the University of Toronto, who is passionate about using occupational therapy to help clients with their sexual concerns. Occupational therapy for sexual concerns begins with her assessment to understand what aspects of sexual encounters or sexuality create difficulties for clients and creating a collaborative treatment plan to address these concerns. Sessions are offered both online and in-person and will focus on interventions targeting any or a combination of the following:

Sensory Processing: 

An individual may experience hyper-/over-stimulation, hypo-/under-stimulation, or a combination of both in regard to their sensory system. Overall, we have eight different senses which can greatly affect our ability to function in our daily tasks including sexual and intimate activities.

  • Vestibular Sensory System – our sense of balance and body movement 

    • Things that may be affecting sexual interactions – positioning; pace; body movements such as thrusting, swinging, bouncing, etc. 

  • Proprioceptive Sensory System – our sense of body awareness  

    • Things that may be affecting sexual interactions – positioning; location of the sexual encounter; pressure on one’s body or the amount of pressure they are applying to someone else; etc. 

  • Our sense of Smell 

    • Things that may be affecting sexual interactions – smells including but not limited to breath, pheromones, bodily fluids, specific areas of the body more commonly associated with sexual activity, condoms, lube, etc. 

  • Our sense of Taste 

    • Things that may be affecting sexual interactions – tastes including but not limited to breath, pheromones, bodily fluids, specific areas of the body more commonly associated with sexual activity, condoms, lube, etc. 

  • Interoceptive Sensory System – sense of the internal state of our body (conscious and non-conscious) 

    • Things that may be affecting sexual interactions – anxiety and/or fear; sexual desire (high or low); orgasm; premature ejaculation; etc. 

  • Auditory – sense of hearing 

    • Things that may be affecting sexual interactions – sounds of someone’s voice, noises in the environment, sounds related to sexual activity (i.e., kissing, bodies making contact, sex noises made by a partner, bodily fluids, etc.); etc. 

 

Self-Regulation: 

Self-regulation is our ability to recognize what we are feeling in our brain and body and our ability to either remain at or return to an appropriate level of alertness. We may explore your awareness of your bodily signals and if and how you attribute meaning to them. If there is a discrepancy at any point in this process, together we develop strategies to attend to these challenges.  

  • An example of a challenge that may benefit from self-regulation strategies includes premature ejaculation. I.e., are you able to recognize signs that you are coming close to ejaculation? How do you react to this feeling? From here, we develop strategies that help you remain aroused but refrain from becoming over-stimulated or needing to cope in unhelpful ways.

  • Another example of how self-regulation strategies can support sexual functioning is in regard to erectile dysfunction, i.e., when someone is not connected to their arousal in response to physical or mental manifestations of anxiety or a lack of appropriate stimulation.

  • It is also common for individuals to experience difficulties with behavioural rigidity and challenges with transitions, which both can be supported through the use of self-regulation strategies.   

 

Environmental Analysis: 

An environmental analysis consists of the occupational therapist learning more about the environment context in which the sexual activity is occurring (this could be both physical and social environment). Some things we look at include changing the physical environment in order to promote sexual satisfaction, before, during, and after the activity. This process also includes examining the context of the activity, for example the time of day, energy levels, state of the client’s health and wellbeing (using a holistic perspective – mental, physical, social, cultural, etc.), set up of the room, surfaces the activity occurs on, proximity to clean-up areas, etc.  

  • Sexual activities relevant to this – low desire; aversion to clean-up; confidence; positioning; etc. 

 

These are just a few ways that occupational therapists can attend to the sexual needs of clients. While some may experience difficulties with these specific areas, it is common for individuals to experience multiple of these challenges simultaneously.

How often should I/we attend?

Sex Therapy through the lens of (OT) occupational therapy

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