What to Expect in Your First Sex Therapy Session
By Simon Wilson, Psychotherapist and Clinical Sexologist
Booking a first sex therapy session can bring a mixture of relief and apprehension. You may have lived with a difficulty for some time, tried to manage it privately, or reached a point where it is affecting your confidence or relationship. Even when you want help, finding the words can feel difficult.
Your first appointment is an opportunity to begin making sense of what is happening and consider what support would be appropriate. You do not need a diagnosis, a complete explanation or a clear idea of what treatment should involve before making contact.
Sex therapy, also known as psychosexual therapy, considers sexual concerns within the wider context of your physical health, psychological experience and relationships. People seek help with erection or ejaculation difficulties, changes in desire, discomfort, sexual anxiety, loss of confidence and difficulties with intimacy. Sometimes the concern is specific. Sometimes several experiences overlap.
We begin with what has brought you to therapy now. You might describe a recent change, a recurring difficulty, or the effect the situation is having on you. The conversation can start simply: “I have become anxious about sex,” or “Something has changed, and I don’t understand why.” From there, I can help you put the experience into words.
Assessment may include questions such as:
When did you first notice the difficulty, and has it changed over time?
Does it happen consistently or in particular situations?
How is it affecting your confidence, wellbeing or relationships?
What have you already tried, and what happened?
What would you like to understand or change?
We may also discuss relevant aspects of your relationships, earlier experiences and ways of coping. The aim is to develop an understanding of your situation and whether I am the right person to help. The first meeting is also your opportunity to ask questions about the approach. UKCP explains the purpose of an initial therapy session.
You can say when a question feels difficult, ask why it is relevant, or explain that you are not ready to discuss something. If earlier experiences were traumatic or distressing, it is possible to acknowledge their importance without describing every detail immediately. We can attend to what helps you feel sufficiently settled to continue. UKCP’s guidance on preparing for therapy encourages people to discuss their worries and share at their own pace.
Sex therapy sessions are conversations. You remain fully clothed, and there is no sexual contact or physical examination as part of the psychotherapy session. Where practical exercises are appropriate, they may be discussed for you to consider privately between appointments. Their purpose and suitability should be clear, and participation is your choice. An exercise is not automatically the starting point for every difficulty. COSRT describes these professional boundaries and what clients can expect.
Your physical health matters too. Sexual difficulties can involve several contributing factors, including medication, illness, stress and relationship experiences. Erection difficulties, for example, can be associated with anxiety but can also indicate a treatable physical health condition. Persistent erection problems warrant a GP or sexual-health assessment. Where medical input is appropriate, therapy can sit alongside it. NHS guidance explains the possible causes and assessment of erection difficulties.
You can seek help as an individual, whether you are single or in a relationship. Attending with a partner may be useful when a difficulty affects both of you or when communication and intimacy are central concerns. We can discuss the most appropriate arrangement when you enquire. If you attend together, each person’s experience matters; differences in desire or expectations need space to be understood.
Confidentiality and its limits should be explained at the outset. This includes how information is handled, the role of confidential clinical supervision, and circumstances involving serious risk or a legal requirement to disclose information. If you attend with a partner, we also need clarity about how information shared separately will be managed. You can ask about these arrangements before discussing something particularly sensitive. UKCP sets out the importance of clear therapeutic agreements.
As the assessment develops, we consider what you would like therapy to help with and what an appropriate next step might be. That may involve focused psychosexual work, a broader exploration of anxiety or relationship experiences, or another form of support. It may take more than one appointment to develop a sufficiently detailed understanding. The proposed approach, frequency of sessions and arrangements for reviewing progress should be discussed with you.
Preparation can be simple. It may help to note what prompted you to make contact, any relevant medication or medical assessment, and questions you want to ask. For an online appointment, arrange a private space where you can speak without being overheard. You might also leave a little time afterwards to reflect on the conversation and how you felt during it.
I offer sex therapy in London and online, working particularly with men while also supporting individuals and intimate partners across different sexual identities and relationship structures. Individual sessions normally last 50 minutes and cost £120. Arrangements for attending with a partner are confirmed before booking.
You can make an initial enquiry even if you are unsure how to describe the difficulty. A brief explanation of what is concerning you is enough to begin a conversation about whether a consultation would be helpful.
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