Psychosexual Therapy

What is psychosexual therapy?

Psychosexual therapy, also called sex therapy, is a talking therapy for sex and intimacy. It looks at how your feelings, your body and your past affect your sex life.

Everything in the room happens by talking. There is no touching and no physical check.

You can come on your own or with a partner, and you do not need to be in a relationship.

Sources: COSRT: therapies, Relate: FAQs

Why a GP check comes first

Some sexual problems have a physical cause, such as diabetes or a heart condition. The College of Sexual and Relationship Therapists, or COSRT, says a doctor should check for that first.

If erection problems keep happening, the NHS says to see a GP or a sexual health clinic. The problem can be a sign of a health condition that can be treated. The NHS gives the same advice for vaginismus.

Sexual health clinics are free and open to everyone. Many have a walk-in service, so you may not need an appointment.

COSRT says therapy can still help when there is a physical cause. You can learn to adjust, and find the kinds of sex that work for you. Our sexual difficulties page covers the physical checks in more detail.

Sources: COSRT: how therapy works, NHS: erectile dysfunction, NHS: vaginismus, NHS: sexual health clinics

How it works

In the first session, your therapist asks what has brought you and what the problem is. They are likely to ask about your health and any medicines you take.

You set the pace. You decide which questions to answer and which exercises to try.

Between sessions, you work at home. Your therapist designs exercises for you to do in private. In each session, you talk about how they went and what to try next.

A partner can take part in the work if you have one.

One set of exercises you may meet is sensate focus. Partners take turns to touch and be touched for an agreed time. They notice how it feels, without trying to force arousal.

In the early stages, intercourse is usually set aside.

The researchers Masters and Johnson pioneered sensate focus. They set it out in their 1970 book, Human Sexual Inadequacy.

Sources: COSRT: how therapy works, Relate: FAQs, NHS: ejaculation problems, Brotto et al. 2025, LPT: sensate focus, Frühauf et al. 2013

What sessions look like

Sessions usually last 50 minutes. They may be weekly, or every two or three weeks to leave time for the exercises. The first session is sometimes longer.

At Relate, a couple's first assessment includes time with each of you alone and time together.

Your therapist should explain the contract they work to, and give you a copy. You do not have to do any exercise you do not want to.

Sources: COSRT: how therapy works, Relate: initial assessment

Who it may suit

Problems with sex are common. In a large British survey, about one in ten sexually active people felt distressed or worried about their sex life.

It can be a good fit if:

• Desire has changed, whether it has faded or feels out of step with a partner's
• Erections, orgasm or ejaculation have become hard to rely on
• Vaginismus has made sex something you avoid
• An illness, a treatment or a disability has changed your sex life
• Your sexual behaviour feels out of your control
• Sex has become a source of distance between you and a partner

The NHS points to this kind of therapy for vaginismus and early ejaculation. It also says therapy can help when erection problems have an emotional cause.

COSRT gives a longer list of the issues its therapists work with. Not every therapist works with every issue, so ask at the start.

Sources: Mitchell & Mercer 2013, NHS: vaginismus, NHS: ejaculation problems, NHS: erectile dysfunction, COSRT: issues

Not the same as psychosexual medicine

Psychosexual medicine is a different thing. The Institute of Psychosexual Medicine trains doctors and other healthcare professionals in it. They can talk through your worries, and examine you when that is right for you.

A psychosexual therapist works by talking only, and does not examine you. If something physical needs checking, they can refer you back to your GP.

Sources: IPM: about, IPM: find a specialist, COSRT: therapies, COSRT: how therapy works

Finding a psychosexual therapist

Anyone in the UK can call themselves a psychotherapist or a counsellor. The title sex therapist is not protected by law either.

COSRT keeps a voluntary public register of psychosexual and relationship therapists. Its register has three levels, from registered member up to senior accredited member. The NHS says sex therapists should belong to COSRT or the Institute of Psychosexual Medicine.

The Professional Standards Authority does not accredit COSRT's register. You can ask a therapist whether they are also on one of those.

Some areas offer sex therapy on the NHS, but it varies widely by where you live. Most NHS services need a GP or another healthcare professional to refer you. Waits of several months are common.

Relate offers sex therapy online. In England and Wales, its fees depend on household income, and you do not need a GP referral.

Sources: POST: regulation of professionals, HCPC: protected titles, COSRT: PRT register, COSRT: registered membership, NHS: erectile dysfunction, PSA: accredited registers, NHS: ejaculation problems, Sheffield Partnership: psychosexual, Sexual Health West Sussex: therapy, Relate: choosing a service, Relate: FAQs

The evidence

NICE has no guideline on sexual problems in general. Its Clinical Knowledge Summaries, written for GPs, do cover erection problems.

For a cause in the mind or the relationship, they say to arrange a referral. That can be to psychosexual or relationship counselling.

A 2013 review pooled 20 trials that compared talking therapy with a waiting list. The evidence varied a lot from one problem to another. It was clearest for women with low desire or with orgasm difficulties.

A 2025 review by international experts found strong evidence for some problems, such as low desire in women. For erection problems, it called the evidence for talking therapy alone limited. It says talking therapy plus medicine is now the preferred approach.

For early ejaculation, it found the high success rates of the first studies have not been repeated. Sensate focus has been in use since the 1970s, but few studies test it on specific problems.

For vaginismus, a Cochrane review compared desensitisation with a waiting list and other options. It found no clear difference. It warned that the evidence is limited, so any conclusions should be drawn with caution.

If your question is about identity, our LGBTQ+ and gender identity page may suit you better.

Sources: NICE CKS: erectile dysfunction, Frühauf et al. 2013, Brotto et al. 2025, Melnik et al. 2012