You may have joked to friends that you don’t need therapy—you have them. But sometimes working through the hard stuff requires help from a neutral party who happens to be a licensed professional. If your hard stuff is about sex, a sex therapist may be your best option. Here are eight signs a sex therapist could be a great addition to your life, and after that, advice on actually finding one.
1. You’re experiencing pain or physical difficulty when you try to have sex.
It’s important to see a medical doctor first to rule out any physical conditions behind this, somatic (body-based) psychologist and certified sex therapist Holly Richmond, Ph.D., tells SELF. Unfortunately, a ton of things can cause horribly painful sex, like cervical inflammation from a sexually transmitted infection, endometriosis, and uterine fibroids. In that kind of situation, medical treatment may help ease difficulty having sex.
If you see a medical doctor and there is no physical issue at the core of your trouble with sex, that doesn’t make what you’re dealing with any less significant. Seeing a sex therapist to discuss any psychological components at play can be helpful, Richmond explains.
For instance, vaginismus, which causes painful vaginal muscle spasms during penetration, can stem from anxiety about having sex, according to the Cleveland Clinic. (That could include anxiety about it being painful even if any condition causing the pain has been treated.) It can also happen due to issues such as post-traumatic stress disorder from a sexual assault. Stress is one of many possible psychological causes behind erectile dysfunction, too.
Point is, the mental and physical are often so closely intertwined that painful sex is a very valid reason to see a sex therapist.
2. You’re processing sexual trauma.
It’s a misconception that trauma leaves all survivors incapable of being sexual beings. Enjoying sex after an assault is possible, and a sex therapist might help you get there.
Of course, recovering from a sexual assault is a different process for everyone. But for some people, a sex therapist is a better option than a more generalized mental health professional. “Oftentimes therapists will talk about the trauma, but there’s no resolution on how we move forward as our sexual selves,” says Richmond, who treats many survivors. “[Sex therapists] process the trauma and move forward to help you have sex with your partner. We can help you move from survivor to thriver.” That’s not to say a therapist who doesn’t specialize in sex can’t help you heal after an assault. But if you’d like to specifically focus on the sexual aspect, a sex therapist may be ideal.
3. You’re in a partnership with mismatched desires.
This can mean many things, like one person having a higher libido than the other or being interested in exploring a kink such BDSM, sex therapist Liz Powell, Ph.D., who often sees partners with mismatched desires, tells SELF.
While having a kink is generally becoming more accepted, disclosing one can still be scary. This is where a sex therapist can help. For instance, Richmond recalls a couple who came to her because the male partner was struggling with the female partner’s urge to explore her submissive side in a specific way. “She wanted to be called a slut, a whore, and her partner just could not do it. So, we had to figure out other ways for her to work within her fantasy,” Richmond says.
If necessary, a sex therapist can also guide you through the realization that the partnership isn’t working due to incompatible desires. “So many people are just petrified of breakups [and] they choose to stay even when they’re not happy,” Powell says. Seeing a therapist together may help you figure out whether to salvage the relationship or bring it to a respectful end.
4. You want to explore opening up your relationship.
This is another scenario Powell, who specializes in LGBTQ+ communities along with kink and polyamory, sees quite often. A sex therapist can help a couple in this situation craft a relationship format that allows both of them to feel safe and fulfilled. That can mean everything from the freedom to have a one-night stand once a year while in another country to dating multiple partners.