Words by: Kate Zhang

Sex therapists can be mysterious. Maybe this is the first time you’ve heard about them. Maybe Dr Jean Milburn in Sex Education is the first and the only sex therapist you know. Maybe your knowledge about them is based on assumptions, or even imagination.

Here, we unpack nine commonly held assumptions about sex therapists. If you’ve ever thought any of them, let Chelsea Liley and Lauren French — sex therapists from the Australian Institute of Sexology and Sexual Medicine — tell you what they actually do!

Assumption #1: Sex therapists only deal with people who have trouble having sex, or those who have a diagnosed issue (like erectile dysfunction and premature ejaculation). 

Chelsea Liley: Sex therapists can look at a whole range of issues. Some of the common physical issues I address day-to-day include erectile dysfunction for men, and vaginismus,  painful penetration and painful insertion of tampons for women. Psychological issues can also include trauma, low self-esteem or dwindling sex drive. Sexuality is emotional. It’s physical. It’s mental. It’s spiritual.

Lauren French: I help people with sexual pain, and work closely with pelvic floor physios. I also work with people around exploring sexuality and sexual orientation.

People can come to me or any sex therapist  whenever they want to have a better sex life with their partners, or unpack the shame around sex. It doesn’t have to be a diagnosed issue.

Assumption #2: Sex therapy would be my last resort. If it’s just a small problem, no big deal, I would just let it go.

LF: The earlier, the better.

A lot of clients wait for years before they come to me for help, just hoping the problem would resolve itself. But instead, the problem has nearly always grown, which makes it harder to find a solution.

CL: It doesn’t have to be a big problem. A lot of people do come to sex therapists after trauma, relationship breakdown or when they are experiencing painful sex. But sexuality can always be explored a bit deeper, and you can come to a sex therapist any time you want to just get in touch with what sexuality means to you.

Assumption #3: I don’t need to carefully pick the sex therapist that suits me. They’re all the same, anyway.

CL: There’s a whole different array of specialists and different fields of sexual health. You need to figure out what you want, do your research and find someone that aligns with your understanding of sexuality. For example, if you’re wanting therapy that’s a little bit more spiritual, maybe with links to tantra or yoga or body-based practices, then it makes sense to find someone who specialises in those areas. If you’re wanting to understand a bit more of the psychology behind sexuality, then seek a more psychosexual therapist. Finally, if you’re wanting to understand the physical sexual functions of your own body, there’s also sexological body work. The Society of Australian Sexologists can be a good starting point to find a therapist, as they have a list of their registered sexologists. But they are usually heavily focused on the psychosexual dimension of sex therapy. 

Assumption #4: In the first session, sex therapists can immediately start addressing my issue.

CL: In the first session with me, a list of questions is worked through so I can get a thorough understanding of your needs. These questions might include your general health history, menstrual history, relationship and sexuality history, as well as any concerns such as painful penetration, or issues with erections. 

LF: The first session is for the sex therapist to get to know you. We want to gain a broader understanding of who you are, because sex doesn’t happen in isolation. We won’t just go through your sexual history, but also things like family, work, religious beliefs, and childhood. 

Assumption #5: Sex therapy is just talking. It sounds boring.

CL: Sex therapy sessions run quite similarly to a regular therapy session — there’s a lot of talk, yes, but it also involves different exercises. I only do online sessions at the moment, since I live in Perth but work from a Melbourne clinic. Online, I can still  run different types of meditation and exercises in my sessions, such as embodiment practices, authentic movement and mindfulness — it just depends on my client’s needs. In person, we can use models, tools and objects during the session, often to demonstrate different parts of the vulva or other anatomy. This kind of visualisation can help tap into what it is that you are feeling in your body, and its connection to your thoughts around sex. 

LF: However, it’s important to remember that sex therapists don’t do any physical touching. Clothes will always stay on.

Assumption #6: I’ve heard that sex therapists would give me homework. I hate homework, so I won’t like sex therapy.

LF: With homework, you can explore and be reflective outside of the sessions, so that sex therapists can unpack ideas and thoughts better during the sessions.

For example, to treat issues with a painful pelvic floor, the first task I would give is to stop having sex. Many people try to push through painful sex, but this just keeps you stuck in a pain cycle. 

The next step  would be starting with small things like mindfulness practice, getting in touch with your body, or starting to think about how pleasure is part of life — not just sexual pleasure, but pleasure in food and work, too. We will never jump to something overwhelming. We want to make sure that our clients are feeling really confident and comfortable before we move to the next step. .

Slowly, through these small steps, the client can move on to pelvic floor physio exercises at home, including things like stretching, breathing, and dilator work.

The homework is not maths! Some people even find it fun.

Assumption #7: I trust sex education from school to guide me through my sexuality journey, so I don’t need sex therapists.

LF: “Sex hurts if it is your first time”; “penetration is the only way to have sex”; “masturbation is not okay if you have a vulva”… these stereotypes coming from the media and outdated education systems are pushed onto us, and can bring with them a lot of shame and stigma.

CL: A lot of sex education has a negative focus, because it’s based on physiology  instead of pleasure. Traditional sex education focuses on the risk behaviours of sex, like sexually transmitted infections (STIs), unwanted pregnancies, unwanted sexual encounters and sexual trauma.

It’s very heteronormative. It insinuates that women or female-bodied people are the gatekeepers of sex, and positions them as either a means of male sexual pleasure or reproduction. And that’s the two lenses that sex education presents to us throughout high school.

Sex therapists can broaden our views of sex, and guide us to explore our own understanding of sexuality with their professionalism. 

Assumption #8: Medication can be more effective than sex therapy.

LF: There is no such thing as an increased libido straight off the bat. Medication can be helpful for certain people in certain instances, but it can’t solve everything. There’s no medication that I can prescribe that would get rid of sexual pain entirely, or magically make you capable of the kind of sex you want to have.

Sex therapy should be completed alongside any offer of medication, because a problem is rarely 100% caused by biology alone.  Medication might be helpful, but it doesn’t solve the actual underlying problem. Stuff like anxiety, stress and shame surrounding sex, that doesn’t get fixed with a pill.

Assumption #9: I still feel awkward coming to a sex therapist.

LF: The specialists are there for a reason.If you have back pain, you might go to an osteopath, and no one would see this as a waste of time. In the same way, there’s nothing wrong with going to a sex therapist. 

It’s normal to realise that you don’t know how to have a successful, healthy relationship. No one has taught you that. You assume you’ve learned it just from watching the adults around you, but maybe they are not good examples. Therefore, it is not awkward to ask for help from the professionals.

CL: Sex therapists are open to everyone’s sexuality. Good therapy isn’t infuenced by the sexologist’s own attitudes towards sex. 

Every single person has a different understanding and a different connection to sex. I don’t work in a way that leads my clients down a path to sexuality based on my understanding of what good sex is. It’s based on what they understand as good sex, what they want from their own sexuality.

Expectation: We talk about sexuality!

LF: I hope everyone feels a little bit more confident and comfortable to reach out to a sex therapist if they need to, or to even start looking into sexology and what that looks like. 

CL: Sexuality is a really important part of wellbeing and our psyche, our identity, our emotional and physical health. It should be something that isn’t that awkward or taboo to talk about, but I know that the world has a long, long way to go before we get there. But if people can at least start having the conversation, start understanding their own sexuality, start talking to sex therapists and removing that feeling of awkwardness or taboo around sex, I think the world will be a better and more accepting place.