One word, several professions
Sexology is the study and care of human sexuality — its functions, its difficulties, its place in the couple. The words “sex therapist” or “sexologist”, however, do not designate a single profession. Depending on the country, they cover doctors with additional training in sexual medicine, specialised psychologists or psychiatrists, trained midwives and physiotherapists, and people who hold only a private certificate from a few weekends. In many countries the title is not protected: anyone can display it (see the situation country by country). That is the first thing to know, and the reason one always asks about the original training.
- The medical sexologist (family doctor, gynaecologist, urologist, psychiatrist or endocrinologist trained in sexual medicine) examines, orders tests and prescribes medicines, and liaises with other specialists. This is who to see when a physical cause is possible.
- The psychologist or psychiatrist sex therapist works on what belongs to anxiety, personal history, the couple; the psychiatrist, a doctor, also prescribes.
- The psychosexual therapist or sexual health counsellor, often coming from social work, health care or relationship counselling, supports functional and relational difficulties through education, exercises and talk; they do not prescribe and must refer to a doctor at the slightest suspicion of a physical cause.
What sex therapy treats
The most frequent complaints, in decreasing order in most practices: desire discrepancy between partners and low desire; erectile dysfunction once the doctor has ruled out a physical cause or alongside treatment; premature ejaculation; absent or difficult orgasm; pain and vaginismus, together with the gynaecologist and the pelvic-floor physiotherapist; blocks, performance anxiety, avoidance; sex after a birth, an illness, cancer, at menopause; the aftermath of an assault; questions of identity and orientation; and, increasingly, compulsive sexual behaviour. Sex therapy is not reserved for couples or for people “with a problem”: many come alone, or with one question, once.
What a sex therapy consultation looks like
The first session is a conversation, alone or as a couple, of forty-five minutes to an hour. The therapist asks since when, in what circumstances, what has already been tried, current treatments, alcohol, tobacco, sleep, the state of the relationship. There is usually no physical examination — and if the therapist is not a doctor, they will refer you to one at the slightest suspicion of a physical cause. Care is short for most complaints, from a few sessions to a few months, often with exercises to do at home. Cost, reimbursement and protection of the title vary a great deal from one country to another: check the training, and prefer professionals registered with a learned society or a professional body.
The methods
Modern sex therapy is short and practical. It almost always starts with information — a large share of difficulties comes from false ideas about what a body or a couple “should” do —, then proposes exercises to do at home, alone or together: the best known is “sensate focus”, which forbids penetration and orgasm for a few weeks so as to relearn contact without a performance goal. Depending on the complaint, there are also learning techniques for premature ejaculation, gradual desensitisation for vaginismus and phobias, cognitive behavioural therapy for performance anxiety, mindfulness for desire and pain, and couple work when the sexual symptom is the symptom of something else. When the therapist is a doctor, medicines — for erection, ejaculation, hormones — are added, never alone. Approaches that promise a result in one session, an energetic “unblocking” or a secret method are not sex therapy.
How many sessions, and at what pace
For the most common complaints — premature ejaculation, performance anxiety, desire discrepancy, vaginismus without a physical cause — count in general five to fifteen sessions, one to three weeks apart to leave time for the exercises, that is two to six months. Complex situations — trauma, chronic pain, sex after cancer — take longer. A good sign: the therapist sets out, from the first or second session, a framework, goals and an approximate duration, and agrees to review progress regularly. A bad sign: endless sessions with no goal, or a practitioner who discourages any parallel medical consultation.
Preparing the appointment
- Since when, and whether it came on gradually or all at once.
- In which situations: always, only with the partner, only in certain positions.
- For a man, morning erections: present or gone — the single most useful clue.
- The full list of your medicines, including over-the-counter ones, and when each was started.
- Tobacco, alcohol, cannabis and other substances, honestly: they are among the leading causes.
- What you want: to understand, to be reassured, to treat, or only to talk — saying it at the outset saves time.
Choosing a sex therapist
- Ask about training: which original profession, which qualification in sex therapy, issued by whom — a university or a learned society rather than an unknown private body.
- Prefer a registered practitioner, with an association or society of sex therapy recognised in your country, which imposes a code of ethics and continuing training.
- Check the framework: announced length and price of sessions, the possibility of coming alone or as a couple, professional confidentiality.
- Be wary of practitioners who propose physical contact, guarantee a result, sell products, or never refer to a doctor.
- Cost and reimbursement vary a great deal by country and by the practitioner’s status: a covered medical consultation, partially reimbursed psychologist sessions, or entirely at your expense. Find out before the first appointment.
To know whether it is a sex therapist you need, or first a urologist, a gynaecologist or a psychologist, the page Who to see, and when goes through the symptoms one by one.
Sex therapy country by country
Quebec is the only jurisdiction in this list that reserves the title by law. Everywhere else, what is regulated is the underlying profession — doctor, psychologist, in some places counsellor — and that is what decides reimbursement. The table sums it up; a full page covers the countries where there is enough to say, and otherwise the link leads to the country's mental-health page, which shows where to find a psychologist or psychiatrist.
| Country | Protected title? | Reference training | Cost and cover | Read more |
|---|---|---|---|---|
| European Union | Protected in no member state | European certifications FECSM (doctors) and ECPS (non-physicians) | Depends on the country of insurance; cross-border care reimbursed at the home rate | Full page |
| United Kingdom | Not protected; nor are counsellor or psychotherapist | COSRT-accredited postgraduate courses; Institute of Psychosexual Medicine for doctors | NHS psychosexual services in some areas by referral; private £60–£120 a session | Full page |
| Ireland | Not protected; CORU registers not yet open | UK COSRT courses; IPM for doctors | No public reimbursement; Accord and Relationships Ireland at reduced fees | Full page |
| United States | Unregulated except Florida; state licence required to practise therapy | AASECT Certified Sex Therapist (licence plus 90 h, 60 h, 300 supervised hours) | Insurance covers licensed clinicians under a diagnosis; $150–$300 out of network | Full page |
| Canada | Reserved in Quebec (OPSQ, 2013); unprotected elsewhere | Bachelor's or master's in sexology (UQAM); ASTO certification in Ontario | Provincial plans cover physicians only; workplace benefits cover private sessions | Full page |
| Australia | Unregulated; not an AHPRA profession | Society of Australian Sexologists accreditation; university sexology programmes | Medicare rebates only for registered psychologists under a mental health plan | Full page |
| New Zealand | “Sex therapist” unprotected; “psychotherapist” registered | Overseas sexology training on a registered profession | Sexual health clinics free; ACC after sexual abuse; otherwise private | Full page |
| India | Unregulated; sexology not a recognised specialty | Psychiatrists, urologists, gynaecologists; RCI clinical psychologists | Public outpatient departments for nominal fees; insurance rarely covers outpatient care | Full page |
| Pakistan | Unregulated; widespread quackery | Psychiatrists and urologists of teaching hospitals; no national training | Out of pocket; public hospitals at low fees | Mental health: where to go |
| Singapore | Unregulated; psychologists and counsellors on voluntary registers | Overseas sex-therapy training | Subsidised public hospitals by referral; private S$150–S$300 | Full page |
| Malaysia | Unregulated; “counsellor” protected, clinical psychologists registered | Overseas training on a registered profession | Public hospitals at nominal fees with referral; private RM150–RM400 | Full page |
| Philippines | Unregulated; psychologists and guidance counsellors licensed | Overseas sex-therapy training on a PRC licence | PhilHealth covers little outpatient therapy; private ₱1,500–₱4,000 | Full page |
| Hong Kong | Unregulated; doctors licensed, psychologists on accredited registers | HKASERT certification | Family Planning Association subsidised service; private HK$1,000–2,500 | Full page |
| South Africa | Unregulated; HPCSA registration required for accountability | SASHA accreditation on a registered profession | Medical aids fund registered psychologists within a session cap; private R900–R1,600 | Full page |
| Nigeria | Unregulated; no statutory register of psychologists in force | Psychiatrists and urologists of teaching hospitals | Teaching hospitals at modest fees; insurance rarely covers therapy | Full page |
| Kenya | “Counsellor” and “psychologist” protected since 2022; “sex therapist” not | Licensed counsellors and psychologists with sexology training | Social Health Authority in empanelled facilities; private KSh 2,000–6,000 | Full page |
| Ghana | Unregulated; psychologists registered under the Health Professions Regulatory Bodies Act | No national training; teaching hospitals | NHIS excludes outpatient psychotherapy; public hospitals at low fees | Mental health: where to go |
| Uganda | Unregulated | No national training; psychiatrists of regional referral hospitals | Out of pocket; public hospitals free or at low fees | Mental health: where to go |
| Zambia | Unregulated; underlying professions registered with the Health Professions Council | No national training; university teaching hospitals | Out of pocket; public hospitals at low fees | Mental health: where to go |
| Jamaica | Unregulated; no statutory register of psychologists yet | Overseas training; university and public hospital psychiatry | Public hospitals free; private out of pocket | Mental health: where to go |
| Trinidad and Tobago | Unregulated | Psychiatrists of public hospitals; overseas-trained therapists | Public hospitals free; private out of pocket | Mental health: where to go |
This topic is also covered for French-speaking countries · German-speaking countries.
Frequently asked questions
Do I need a referral to see a sex therapist?
In most countries, no: you can book directly. Cover by health insurance, however, often depends on the practitioner’s status (doctor or not) and sometimes on a referral from the family doctor. Find out before the first appointment.
Can we go as a couple?
Yes, and for many complaints it is preferable: premature ejaculation, gaps in desire, pain that has led to avoidance. Sex therapists see couples; the first session can be as a pair, the following ones can alternate.
Sex therapist or psychologist?
If the difficulty is sexual and recent, and the rest is fine, the sex therapist is more direct: they know the specific techniques. If sex is only one symptom of a wider distress — depression, generalised anxiety, trauma —, the psychologist or psychiatrist comes first, and many of them are trained in sex therapy.
Does sex therapy work?
For premature ejaculation, vaginismus, performance anxiety and anorgasmia, studies show high improvement rates within a few months, provided the exercises are done. For desire discrepancy, results depend mostly on the state of the couple. For problems of physical origin, it complements medical treatment without replacing it.