People often go to therapy to find someone who won’t be judgmental when they spill the uncomfortable feelings they’ve buried. Or they might want to find someone who can help them unearth those feelings they’ve stuffed down deep.
So when you start seeing a therapist, you might promise yourself that you’ll hold nothing back—you’ve found a safe space, and you’re committed to “doing the work.” Sometimes, however, that’s easier said than done, especially when those feelings revolve around sex. Sex is something many people don’t discuss with their closest friends or even their partners. So as much as you want to be an open book in therapy, talking to your therapist about sex might still feel awkward. Is it okay to talk about sex if your therapist isn’t specifically a sex therapist? How can you even start the conversation? And what will you get out of it if you do?
To help you out, we spoke to several people who’ve had sex-related breakthroughs in “regular” therapy without seeing a dedicated sex therapist at all. Here’s what they have to say, followed by some tips for starting this conversation with your own therapist if you’re feeling ready.
“I’m realizing that internalized anti-fatness has really messed with the way I think about sex.”
“I’m a fat woman,” Julie B., 29, tells SELF, adding that she does identify as fat, though people might not be comfortable with the term. “Through therapy, I’m realizing that internalized anti-fatness has really messed with the way I think about sex.”
She explains that, when a partner doesn’t make the first move, she assumes they’re not attracted to her. “My current partner has a low libido, and even though she’s told me that she doesn’t usually get turned on until I’m turned on, I constantly feel like she…doesn’t actually like having sex with me.”
Julie’s therapist is helping her realize that anti-fat culture has made her believe she’s not attractive. Her therapist has also encouraged her to notice all the other ways her partner shows love and desire. “With my therapist’s help, my partner and I have scheduled special intimacy time during which we might have sex, but we might also just make out a little or talk about how we each experience sexual desire,” Julie says. “So I can understand her perspective when my brain spirals.”
“I had been so in my own head, I didn’t consider external factors.”
When the pandemic hit and Abigail G., 24, suddenly wasn’t as interested in sex, she asked her therapist for solutions. “I felt so disconnected from my identity—plus, I felt a huge weight that I wasn’t able to please my partner sexually. I was putting a lot of pressure on myself to feel aroused and just couldn’t get there,” she tells SELF.
Abigail’s therapist asked her to take a moment to consider how her overall circumstances might be impacting her libido. She and her partner had moved in with his parents for six months, and then, after they went home, her sister crashed on the couch in their one-bedroom apartment for three months. “Thin walls and family are certainly the antitheses of setting the mood,” Abigail explains. “But I had been so in my own head [about my sex drive], I didn’t consider those external factors.”
Instead Abigail’s of putting pressure on herself, her therapist “gave concrete tips on how to relax in the moment, how to talk about this more with my partner, and ideas for reintegrating regular sex back into my routine,” she says. “It helped me get excited about intimate moments with my partner rather than fear my own arousal (or rather, my lack thereof).”
“I came to the realization that I use sex in relationships to try and provide worth.”
John D.*, 36, started going to therapy after a divorce. Through the therapeutic process, he recognized patterns in his marriage and from other relationships throughout his life. “I came to the realization that I use sex in relationships to try and provide worth, to try and keep my partner around,” he says.
John’s therapist helped him realize that what he often wanted was intimacy. “In my 20s, I would have sex with women but feel terrible about myself afterward. I didn’t know why. I was a dude. We’re supposed to be thrilled to be smashing and dashing,” he says. After processing these patterns with his therapist and realizing he actually wanted love, John feels more aware of what he truly wants from a partnership.
“It’s natural for people who have sexual trauma to shy away from physical touch and be hesitant about intercourse.”
When Ally S., 30, was 14 years old, a man she met in an online chat room raped her in her family home. “I still can’t go home, let alone go a night, without thinking about it,” she tells SELF. At first Ally was seeing a social worker and counselor, but when her sexual trauma came up in sessions again and again, her therapist referred her to someone who specializes in sexual trauma.
Ally’s new therapist helped her reach several breakthroughs. First, Ally has come to realize that being raped was not her fault. Ally’s therapist has also helped her figure out relationships with her family. “My mother did not handle it well, and there was no legal process,” she explains.
Eventually, through therapy, Ally was able to heal over her mother’s reaction. Her therapist helped her write a letter to her mother—a letter she never sent but that helped her process her emotions. She also helped Ally tell her older sister, who didn’t know about the sexual assault. “Sharing the experience with [my sister] brought us closer together and sealed the bond that we already share,” she says.
Finally, therapy helped Ally understand that people who have sexual trauma tend to shy away from touch and are often hesitant about sex. Ally is still seeing her therapist, who continues helping her work through her sexual trauma.
“Don’t have sex with people who don’t give a fuck about you.”
The most significant breakthrough Amber L.*, 27, had in therapy about sex is, “Don’t have it with people who don’t give a fuck about you.” Amber and her therapist worked up to this realization through many conversations about unsatisfying relationships. “All the time, I’d be dating these guys, and we’d have really great sex, but I never felt happy,” she tells SELF. Amber’s therapist helped her recognize little behaviors that might be potential red flags. “One guy would never introduce me to his friends, even though I asked. One would send a booty call text a few times a week but never wanted to just go out,” she says. Now Amber is starting to recognize when someone is only interested in sex.
So, how do you bring up sex with your therapist?
For some of the people we spoke to, talking to their therapists about sex was no big deal. Abigail, who considers herself to be sex positive, says that bringing sex up with her therapist was seamless. But for other people, sex can feel like an awkward topic. If you’re nervous, take comfort in knowing that sex discussions are probably completely normal for your therapist. In fact, therapist Emily Fogle, LMSW, who practices in New York, tells SELF that talking to your therapist about sex during sessions is “almost inevitable.”
Depending on your specific situation, you might want to talk about anything from concerns about how medications might impact libido to exploring sexuality, gender identity, or body image, Fogle says. “It’s not awkward or abnormal at all.”
And because there are so many different reasons people want to talk about sex in therapy, there are also many ways that people bring it up. Some try to be indirect and ease into the topic or distance themselves from it, therapist Sienna Chu, LMHC, who practices in New York, tells SELF. “Sometimes clients talk about their feelings about sex by talking about another person,” she says. It’s perfectly normal to say something like, “My partner doesn’t think we have enough sex…” to get the conversation started.
You can also be more direct and ask your therapist something like, “Are you comfortable talking about sex?” Or on the flip side, you can start with your discomfort. You might take a deep breath and say, “I want to talk about sex, but I’ve been really nervous about bringing it up.” Sharing your emotional process, even if you can’t talk about sex yet, helps your therapist know what type of support you need. For example, a therapist who hears you’re feeling uncomfortable might get the signal that you need permission to bring the topic up, Chu says. Or they might ask you what you need to feel more comfortable and safe.
Ultimately there’s no one right way to start a sex conversation with your therapist. How you decide to bring up sex with your therapist depends on how comfortable you are talking about sex and how comfortable you are talking to your therapist overall. “Good therapy is kind of like good sex,” Fogle says: In both situations, it’s best to have a baseline level of safety and trust before you dive in.
When should you see a sex therapist instead?
Most therapists are comfortable talking about sex, but if you find that the bulk of your sessions revolve around issues like sexual orientation, identity, or pleasure—especially to the point where you’re not getting to other things you’d like to explore—you might benefit from seeing a sex therapist. Additionally, if you have physical symptoms, such as struggling to reach an orgasm or difficulty getting aroused, your therapist might refer you to both a doctor and a sex therapist, Fogle says.
Although Chu works with couples and individuals on various topics, including sex, she says she’d refer someone to a sex therapist if they need more focused support. That might include someone who has sexual issues that have a psychological component, Chu says. She might suggest a sex therapist to someone with post-traumatic stress disorder from sexual trauma, couples considering an open relationship, and anyone interested in exploring their sexuality on a deeper level.
As SELF previously reported, you can find a sex therapist by searching the American Association of Sexuality Educators, Counselors and Therapists website and using their directory. Additionally, databases like Psychology Today and Zocdoc should allow you to search for sex therapists who specialize in topics like gender identity or body image. And of course, you can talk openly with your therapist about getting a referral if you feel comfortable.
While having conversations about sex can be intimidating, the important thing is that you find the safety and support you need. Whether that’s from a sex therapist, your regular provider, or even an online support group, the breakthroughs that might come from speaking openly can increase your capacity for joy, pleasure, and self-knowledge.
*Name has been changed.
Related:
- 15 Tips for Having Actually Good Phone Sex
- 5 Ridiculously Common Worries Sex Therapists Hear All the Time
- How to Get Back in Touch With Your Sexual Side If You Miss It