What is Sex Therapy?

This article was updated on September 21, 2026.

Sex therapy is a specialized form of professional psychotherapy—commonly referred to as talk therapy—where a certified clinician focuses explicitly on the sexual health, intimacy, and relationship challenges of individuals and couples.

Modern sex therapy goes beyond addressing dysfunction; it provides a safe space to cultivate joyful communication, deep connection, and emotional intimacy.

Crucially, there is absolutely no physical exam, nudity, or physical touch involved between the sex therapist and the clients during any clinical session (see my article: What Are Common Misconception About Sex Therapy?)

Modern sex therapy involves a compassionate, holistic exploration of the physiological, emotional, relational, and psychological factors that may be preventing an individual or a couple from experiencing a pleasurable, fulfilling sex life (see my articles: What is Your Erotic Blueprint? - Part 1 and Part 2).

Modern Sex Therapy for Contemporary Issues

The field of sex therapy has evolved dramatically over the last few decades. Historically, many practitioners operated under a "neat and clean" model—a term coined by sex therapist and researcher Dr. Jack Morin in his seminal book, The Erotic Mind. This legacy framework assumed that improving a couple's sex life simply required resolving physical dysfunctions, improving basic communication, and boosting romance.

While that classic strategy works for some, contemporary clinical data shows it fails many others. In fact, countless couples experience no structural sexual dysfunction, communicate exceptionally well, and love each other deeply—yet still struggle to cultivate great sex together (see my article: What is Good Sex?).

Pioneering contemporary therapists like Dr. Esther Perel, author of Mating in Captivity: Unlocking Erotic Intelligence, helped revolutionize the field. Today, modern sex therapy proudly addresses pleasure, desire, and sex positivity. 

It provides an inclusive, affirming space for heterosexual, gay, lesbian, bisexual, transgender, queer, polyamorous, and ethical nonmonogamous (CNM) dynamics, as well as other diverse, non-heteronormative sexual expressions. 

What Issues Are Addressed in Sex Therapy?

People seek sex therapy for a wide variety of reasons. Below is a categorized directory of the most common issues addressed in modern clinical practice:

Desire, Arousal & Orgasm Challenges

• Low Libido & Low Desire: Resolving suppressed desire, often rooted in unmet needs during partnered sex or manageable stressors.
• Lack of Initial Interest: Using clinical tools to spark desire 
• Arousal Nuances: Mastering physical arousal patterns (see my articles: Understanding Your Sexual Accelerators and Brakes).
• Arousal Nonconcordance: Navigating the disconnect between physical responses and mental desire (see my article: What is Arousal Nonconcordance?)
• Ejaculatory Variation: Navigating delayed or unpredictable ejaculation during intimacy.

Relational Discrepancies & Communication

• Sexual Desire Discrepancy (SDD): Balancing mismatched sex drives between partners (see my article:  Mismatched Desire in a Relationship is a Relational Problem--Not An Individual Problem).
• Communication Gaps: Learning safe ways to vocalize erotic needs (see my article: How to Talk to Your Partner About Sex).
• Stale Intimacy Routines: Unpacking and modernizing old sexual patterns (see my articles: What is Your Sex Script?).

Confidence, Shame & Psychological Blocks

• Sexual Performance Anxiety: Overcoming mental pressure in bed (see my article: What is Performative Sex?).
• Body Image Concerns: Healing vulnerabilities that block physical connection (see my article: Is a Negative Body Image Ruining Your Sex Life?).
• Deconstructing Sexual Shame: Aligning fantasies with your internal worldview (see my articles: Your Sexual Fantasies Don't Always Match Your Values and Beliefs and That's Normal).
• Pain, Trauma & Relationship Structural Shifts

• Painful Intercourse: Managing somatic issues like vaginismus or dyspareunia (see my article: Getting Help in Sex Therapy For Painful Sex).
• Infidelity & Betrayal: Rebuilding safety and erotic trust after a breach (see my article: Learning to Trust Again After Infidelity).
• Ethical Nonmonogamy (ENM): Safely exploring open structures or polyamory (see my articles: What is Ethical Nonmonogamy?).
• Kink & BDSM Affirmation: Safely integrating power play, fantasies, or role-play (see my articles: What is Kinky Sex?).
• Sexual Trauma Recovery: Processing historical wounding to safely reclaim pleasure (see my article: Overcoming the Trauma of a History of Sexual Abuse).

• Aging & Fluidity: Navigating physical changes over time or shifts in attraction (see my articles: Overcoming Sexual Boredom in Long Term Relationships).

What Happens During a Sex Therapy Session?

Even when individuals or couples willingly seek out a sex therapist, talking openly about sex can initially feel incredibly uncomfortable. This hesitation is completely normal and often shaped by family upbringing, cultural messaging, or religious backgrounds. A skilled sex therapist will explicitly normalize these feelings, co-creating a conversational pace where everyone feels secure.

The initial phase of therapy focuses on gathering a comprehensive sexual history for both the individuals and the relationship. Many modern sex therapists draw from advanced clinical frameworks, such as Dr. Suzanne Iasenza’s book Transforming Sexual Narratives, to explore questions like:

• What is the presenting problem as each person uniquely experiences it?
• When did this challenge first manifest, and what coping efforts have been tried?
• What are your earliest memories or messages regarding sexuality?
• Are there any underlying medical or health concerns intersecting with your sex life?
• How do you uniquely define "sex" versus how your partner defines it?
• What initially attracted you to your partner, and what emotional blocks are currently restricting your pleasure?

Clinical Feedback, Collaborative Goals, and Home Assignments

Expert Feedback & Cycle Tracking

Once the initial assessment is complete, the therapist provides target feedback. For instance, if the clinician is trained in Emotionally Focused Therapy For Couples (EFT), they will help the partners identify the systemic "negative cycle" that keeps them stuck, highlighting relationship strengths while plotting a path out of emotional gridlock.

Setting Cohesive Clinical Goals

Following history taking, the therapist guides clients in mapping out specific, measurable goals. Rather than simply discussing whatever happens to be top-of-mind each week, establishing structured goals gives the therapy clear direction. This allows clients to collaboratively track their progress and dynamically adjust their therapeutic roadmap over time.

Structured Out-of-Office Assignments

Because lasting change requires real-world practice, sex therapists utilize custom take-home assignments between clinical sessions. As highlighted in sex therapist Dr. Ian Kerner’s book, So Tell Me About the Last Time You Had Sex, many of these practices are designed to be playful, communicative, and deeply connecting.

These home practices are entirely voluntary and tailor-made for your specific pacing. If an assignment ever feels emotionally complex, physically uncomfortable, or stalls at home, it simply provides valuable data to explore with your therapist during your next office visit, allowing you to safely unpack the block without judgment.

Get Help from a NYC Certified Sex Therapist

While traditional talk therapy provides vital cognitive insight, it often skims over the complex somatic and relational mechanics of physical intimacy. 

Working with a certified sex therapist offers a holistic, bottom-up path to sexual confidence and relationship vitality.

Rather than struggling through intimacy challenges alone, seek out specialized support to transform your sexual narrative and step into a deeply fulfilling life.

About Josephine Ferraro, LCSW

I am a licensed New York psychotherapist, hypnotherapist, and an advanced practitioner in EMDR, AEDP, EFT For Couples, Parts Work, Somatic Experiencing, and I am a Certified Sex Therapist. 

I am also an experienced Trauma Therapist.

For many years, I have helped individuals and couples dismantle intimacy blocks, heal sexual trauma, and achieve genuine relational freedom.

I offer a complimentary 15 minute phone call before setting up an appointment.

I see clients online throughout New York State and in person at my private office in Greenwich Village, New York, NY 10011.

I offer a free 15-minute phone call before scheduling your initial appointment.

Contact Information

• Website: Visit Josephine Ferraro, LCSW - NYC Psychotherapist to learn more about my practice.

• Email: Reach out confidentially via email at josephineferraro@iCloud.com.

• Phone: Call me directly at (917) 742-2624 during standard business hours.

Relationships: Getting Curious About Your Own and Your Partner's Turn-0ns

As a sex therapist, when I'm working with individual clients or couples who want to work on their sex life, I often hear clients say they're bored or they're not turned on by what their partner wants to do sexually or the idea of doing something new makes them uncomfortable (see my article: What is Sex Therapy?).

Getting Curious About Your Own and Your Partner's Turn-Ons

These are a common problems, which is understandable because no two people are exactly alike and each will have their own preferences when it comes to just about anything--whether it's food, sex, types of entertainment they enjoy and so on.

Aside from the fact that many people don't know how to talk about sex with their partner, talking about sex when two people don't want to engage in the same sexual activity can be especially fraught (see my articles: How to Talk to Your Partner About Sex - Part 1 and Part 2).

The partner who is making him/herself vulnerable by asking for a sexual activity that is outside of their usual sexual repertoire often feels rejected when the other partner doesn't want to even considerate it. 

In most cases, the other partner isn't rejecting their partner--they're rejecting the activity.  But in the moment, it can feel like a personal rejection (see my article: Coping With a Sexual Rejection From Your Partner).

This often shuts down any more talk about sex due to fear of rejection. In many cases, this sets up a dynamic where sex becomes routine and boring over time because there's nothing new and each person is reluctant to talk about it.

Sexual shame and guilt often get in the way of partners being able to talk about sex.  If shame and guilt are worked through in therapy, a reluctant partner can get curious about their partner's and their own sexual interests.

How to Get Curious About Your Own and Your Partner's Turn-Ons

As I've said in prior articles, no one should do anything they don't want to do.  

Consent means more than just going along with your partner's wishes when you don't want to do it.  

But when you're in a relationship with someone you trust, your response doesn't have to be either Yes or No.  Instead, you can get curious about what turns your partner on about the particular sexual activity they're interested in and get curious about your own erotic preferences.

Even if you both decide not to engage in any of these activities, your curiosity and the discussion with your partner can open up other possibilities that you're both interested in.

Are There Sexual Brakes Getting in the Way?

Even more important than understanding your own and your partner's turn-ons is understanding each of your turn-offs.  

According to Sex Educator Emily Nagoski, Ph.D., when a couple is experiencing sexual problems where they're out of synch with regard to sexual desire, it's important to pay attention to whether one or both people are dealing with "sexual brakes."  

The sexual brakes need to be addressed first before looking at the sexual accelerators (turn-ons).  To paraphrase Dr. Nagoski: You have to turn off the offs before you turn on the ons.

This is an issue I discussed in detail in the article listed below, so I won't go into it in more detail here:

Getting to Know Your Own and Your Partner's Sexual Accelerators and Brakes

Clinical Vignette

The following clinical vignette illustrates how to use curiosity and an open discussion to bring a couple closer together emotionally and sexually:

Nina and Tim

Nina and Tim, who were both in their early 40s, were married for several years when Tim told Nina that he felt their sex life had become too routine and he would like to spice it up a little.

Prior to dating Tim, Nina was only in one other long term relationship so she didn't have a lot of prior sexual experience.  

She was also bored with their sexual routine, but she didn't feel sexually confident, so when she heard Tim say he wanted to spice things up, she felt embarrassed and apprehensive.  

Sexual Boredom is a Common Problem in Long Term Relationships

In addition, due to her religious and cultural upbringing, talking about sex brought up guilt and shame for her (see my article: Overcoming Feelings of Sexual Shame and Guilt Due to Cultural Issues).

Even though she felt uncomfortable, she wanted to be a good partner to Tim, so she asked him what he had in mind.  

Tim knew talking about sex made Nina feel uncomfortable, especially talking about trying something new, so he reassured her that he wouldn't try to get her to do anything she didn't want to do.  He only wanted to expand their usual sex script (see my article: Changing Your Sex Script).

Tim told Nina he wanted to try doing role plays (see my article: What Are the Benefits of Sexual Role Play?).

He could tell from the look of her face that she was hesitant about this, which made him feel emotionally vulnerable and embarrassed that he even suggested it, so he told her to forget it.  

When she saw the look of embarrassment on his face, Nina wanted to say something comforting, but she didn't know what to say, so she turned on the TV to cover the awkward silence between them.

After that awkward conversation, they didn't talk about sex again for another year.  They continued their usual sexual routine, even though they were both bored with it.  Over time, they had less and less sex because neither of them looked forward to it.

So, a year after his first attempt, Tim tried talking to her about their sex life again, but he could see how uncomfortable she was, so he suggested they see a sex therapist to work on this, which Nina agreed to do.

Their sex therapist normalized their difficulty with talking about sex.  She also told them that it was common for sex to become routine for couples in long term relationships and they were no different from many other couples (see my article: What is Sexual Boredom in Long Term Relationships?).

Gradually, Nina and Tim began a dialog about their sex life in their sessions.  They also worked on their emotional connection, which they both wanted to strengthen.

Strengthening their emotional connection helped Nina to feel more comfortable talking the possibility of trying new sexual activities, including role playing.  She was also able to listen to Tim tell her what turned him on about role playing.

Nina also worked on the shame and guilt related to her religious and cultural background, so she was able to open up to her own sexual curiosity. 

In addition, Nina explored her own core erotic themes to understand herself as an erotic being. This enabled Nina to get curious about her erotic needs as well as Tim's (see my article: Sexual Self Discovery with Pleasure Mapping).

Getting Curious About Your Own and Your Partner's Turn-Ons

Nina and Tim's curiosity motivated them to try sexual role plays, which added spice to their sex life together.  They also began exploring other sexual activities they were both curious about, which was pleasurable for both of them.

Conclusion

Aside from guilt and shame, there can be many other reasons why you might hesitate to explore your own and your partner's sexual turn-ons.  

If your initial reaction is to criticize or show contempt for your partner's turn-ons, try to get curious instead.

When you get curious, you allow yourself to be open to new possibilities that could expand your sexual repertoire. This can lead to a more pleasurable sex life for you and your partner.

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy (see my article: What is Sex Therapy?).

Individual adults and couples seek help in sex therapy for many different issues (see my article: What Are Common Issues Discussed in Sex Therapy?)

There is no sex, nudity or physcial exams in sex therapy (see my article: What Are Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex-positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.