By AlphaterapiaSex Therapy: What It Is For and When to Seek It
Few topics carry as much silence as sex life. It is common for someone to live for years with a complaint — lack of desire, pain, difficulty reaching orgasm, physical distance from a partner — without ever saying it out loud to a professional. Not because the problem is small, but because naming it seems bigger than it is. The shame, in this case, usually weighs more than the difficulty itself. In sex therapy, this is discussed without judgment.
If you’ve ever thought “is this something for therapy?” and gave up on the question before reaching an answer, this text is for you.
What is sex therapy, in practice?
Sex therapy is a space to treat difficulties related to desire, arousal, pleasure, or pain during your sex life — individually or as a couple. It differs from couples therapy because the focus specifically enters the sexual dimension, although, in clinical practice, it is common for the two to intertwine: sexual difficulties affect the relationship, and difficulties in the relationship affect the sex life.
An important and rarely discussed point: sexuality is not an isolated compartment of mental health. A Brazilian study conducted at the Sexuality Studies Program (ProSex) of the Institute of Psychiatry at USP, with men seeking treatment for sexual issues in São Paulo, found a consistent association between symptoms of anxiety, depression, and sexual difficulties (Scanavino et al., 2018). In other words: in many cases, the sexual complaint is also a symptom of something broader — and treating it in isolation, without looking at this emotional context, tends not to solve the root of the problem.
Why “desire” is not as simple as it seems
For a long time, sexuality was described through a linear model: desire leads to arousal, which leads to orgasm, which leads to resolution — a single sequence, the same for everyone. However, clinical practice (and research) shows that this is not quite the experience for most people, especially women.
Psychiatrist Carmita Helena Najjar Abdo, also from ProSex/USP, discusses in her work an alternative model — developed by Canadian researcher Rosemary Basson — in which desire does not always come first. It often arises after intimacy has already begun, motivated by emotional closeness, context, and the body’s response, not as a spontaneous “initial trigger” (Abdo, 2010). Understanding this completely changes how a complaint of “lack of desire” is evaluated: sometimes the problem is not a true absence of desire, but the expectation that it should appear in a way that, for that person, has never worked like that.
Want to understand this model in depth? I wrote an article dedicated solely to it — see “Read also” at the end of this page.
How I work
In my practice, my work is guided by Cognitive-Behavioral Therapy and the resources of third-generation contextual therapies, which broaden the perspective on how thoughts, emotions, and behavior also connect in the field of sexuality.
I arrived at this field in a way that might be similar to many colleagues: gradually, I noticed how much sexuality appeared — often indirectly — in the issues people brought up. This perception turned into curiosity, and curiosity turned into study: specializations, training, congresses, constant reading. I continue in this movement today, because sexuality is a living field, and the demands that arrive at the clinic change all the time, intertwined with other aspects of life — the relationship, the body, personal history, emotional health.
In the office, my commitment is to a welcoming and non-judgmental listening, treating every complaint — however small it may seem — as legitimate, and seeking to understand the person (or the couple) in the real complexity of life, not just the symptom that brought them here.
Read also: Why can’t you stop? The science behind dopamine addiction
You don’t need a “severe dysfunction” to seek help
A common misunderstanding is thinking that sex therapy is only for those with a formal diagnosis of sexual dysfunction. In practice, a large part of those seeking this type of support are dealing with something more subtle: a sex life that “works” but does not satisfy, difficulty communicating what they like or dislike, an unnamed discomfort, or simply curiosity about their own sexuality.
There is no complaint too small to deserve a space for conversation. If something in your sex life bothers you — or makes you curious — that is already reason enough to seek help.
Continue reading about this topic:
- Responsive sexual desire: why it doesn’t always come before sex
- Couples therapy or sex therapy: what is the difference and which should I seek?
- Anxiety, depression, and sex life: is there a real connection?
Frequently Asked Questions
Is sex therapy only for those with a diagnosed sexual dysfunction?
No. A significant portion of those who seek this type of counseling are dealing with something more subtle: a sex life that works but doesn’t satisfy, difficulty communicating what they like or don’t like, an unnamed discomfort, or simply curiosity about their own sexuality. There is no complaint too small to deserve a space for conversation.
Does sex therapy replace couples therapy?
Not exactly — they have different focuses, although they usually intertwine in practice. Sex therapy specifically addresses the dimension of desire, arousal, pleasure, or pain during sex life, while couples therapy treats the relationship more broadly. Sexual difficulties affect the relationship, and relationship difficulties affect the sex life — which is why the two processes often go hand in hand.
Is a lack of sexual desire always a problem to be treated?
It is not always a true absence of desire — often it is the expectation that desire should arise spontaneously before intimacy, when in practice it usually appears after emotional closeness and the context have already begun. Understanding this difference completely changes how a complaint of “lack of desire” should be evaluated.
Can sexual complaints be linked to anxiety or depression?
Yes. Brazilian research has found a consistent association between symptoms of anxiety, depression, and sexual difficulties in people seeking treatment. This means that, in many cases, treating the sexual complaint in isolation, without looking at this broader emotional context, tends not to solve the root of the problem.
References
ABDO, Carmita Helena Najjar. Considerações a respeito do ciclo de resposta sexual da mulher. Diagnóstico & Tratamento, São Paulo, v. 15, n. 2, p. 88-90, 2010.
SCANAVINO, Marco de Tubino et al. Sexual compulsivity, anxiety, depression, and sexual risk behavior among treatment-seeking men in São Paulo, Brazil. Brazilian Journal of Psychiatry, [s. l.], v. 40, n. 4, p. 424-431, 2018. DOI: 10.1590/1516-4446-2017-2476. Disponível em: https://doi.org/10.1590/1516-4446-2017-2476. Acesso em: 26 ago. 2026.