The title and how it is regulated
In the United States, health professions are licensed by each state. Psychologists, marriage and family therapists, clinical social workers, mental health counselors, physicians and nurses all need a state licence to practise; “sex therapist”, by contrast, is not a licensed profession, and in almost every state anyone may use the words. Florida is the exception: licensees under its mental-health chapter may not hold themselves out as sex therapists without a board certification requiring specific training and supervision.
The national benchmark is certification by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). A Certified Sex Therapist must already hold a graduate degree and a state licence in a mental-health or medical field, then complete 90 hours of human sexuality education, 60 hours of sex-therapy training, at least 300 hours of supervised clinical work with sexual concerns and 50 hours of supervision over at least eighteen months. It is a private credential, but a demanding one. Physicians specialising in sexual medicine are found in urology, gynaecology and endocrinology, often through the Sexual Medicine Society of North America or the International Society for the Study of Women's Sexual Health.
Insurance follows the licence, not the specialty. A session with a licensed therapist is billed as mental-health treatment under a diagnosis code; federal parity rules require most plans to cover it like other medical care, but many plans pay only in-network providers, and some exclude codes for sexual dysfunction or relationship counselling. Since January 2024 Medicare also pays marriage and family therapists and mental health counselors. A large share of certified sex therapists work out of network, at roughly $150 to $300 a session, with partial reimbursement depending on the plan.
Medical evaluation of erectile dysfunction, pain or hormonal problems is covered as ordinary medical care, subject to deductibles and copayments.
Key points
| Title | Unregulated in every state but Florida; underlying licence required to practise therapy |
|---|---|
| Licensed professions | Psychologist, marriage and family therapist, clinical social worker, mental health counselor, physician, nurse — state by state |
| Reference credential | AASECT Certified Sex Therapist: licence, 90 h sexuality education, 60 h sex-therapy training, 300 h supervised practice, 50 h supervision |
| Florida | Board certification required to use the title “sex therapist” |
| Insurance | Covers licensed clinicians under a diagnosis; network and exclusions vary; Medicare covers MFTs and counselors since 2024 |
| Typical fee | $150–$300 a session, often out of network |
In practice
- Verify the state licence on the state board's website, then the AASECT certification in the association's directory.
- Ask the practice how sessions are billed and whether the diagnosis used is covered by your plan; request a superbill for out-of-network claims.
- For physical symptoms, start with a physician: the work-up is covered as medical care.
- University training clinics and community mental-health centres offer sliding-scale therapy, sometimes with sex-therapy supervision.
Cost and reimbursement
Licensed therapist in network: your copayment. Out of network: $150–$300 a session with partial reimbursement or none. Medical evaluation: covered as ordinary care.
What has changed recently
Medicare began paying marriage and family therapists and mental health counselors on 1 January 2024, widening access for older patients. AASECT certification requirements were tightened over the last decade, with more supervised hours now required.
Where to go
- AASECT: directory of certified sex therapists, counselors and educators.
- State licensing boards: licence verification and complaints.
- Sexual Medicine Society of North America; International Society for the Study of Women's Sexual Health.
- Community mental-health centres and university clinics: sliding-scale fees.
Worth knowing
A licence matters more than the words “sex therapist”: an unlicensed “sex coach” is not bound by confidentiality rules, cannot bill insurance and answers to no board. Any practitioner proposing physical contact should be reported to the state board.
Frequently asked questions
Is a sex therapist a licensed profession?
No. The therapist must hold a state licence in another field — psychology, counseling, social work, marriage and family therapy, medicine — and then trains in sex therapy. Only Florida restricts the title itself.
Does insurance cover sex therapy?
It covers therapy by licensed clinicians under a diagnosis, subject to network rules and exclusions. Couples counselling as such is rarely covered. Ask before the first session.
What does AASECT certification prove?
Graduate degree, state licence, specific coursework, 300 supervised clinical hours and 50 hours of supervision. It is private, but it is the most rigorous credential available.
Official sources and links
- AASECT — certification requirements and directory of certified sex therapists
- Sexual Medicine Society of North America — sexual-medicine physicians
- USA.gov — official guide to government services
- Congress.gov — federal legislation