Your sex drive disappeared months ago and you haven’t told anyone. Sex hurts and your doctor said it’s probably stress. Your partner wants it; you don’t. You used to want it. You don’t anymore. You can’t finish. You finish too fast. You’ve never finished. You started a medication and your libido fell off a cliff. You have a desire you’ve never said out loud to anyone. You can’t stay in your body during sex because you’re too busy worrying about how it looks. You’re in a relationship structure most therapists don’t understand and you’re tired of explaining it. There was an affair and you don’t know what comes next. You’re lying awake next to someone you love wondering what’s wrong with you.
Sex problems are common. Therapists who can actually help with them are not.
Most general therapists are perfectly capable, kind people who get visibly uncomfortable the second the conversation gets specific. That’s the whole problem. You can’t fix something you can’t talk about plainly. At The Therapy Gal, we talk about sex the way we talk about anything else. Direct. Specific. Without flinching, without judgment, and without making it into a bigger deal than it needs to be.
We work with people across Philadelphia and the surrounding suburbs, online across PA and NJ. We help with desire, arousal, pain, orgasm, communication, shame, body image, trauma, identity, non-monogamy, kink, affair recovery, and the dozen other things nobody warned you would be part of being a sexual adult. We work with all genders, orientations, and relationship structures without making you explain yours first.
What Sex Therapy Actually Is
Sex therapy is talk therapy. That’s it. You sit in a chair (or on a couch, or in your kitchen on a video call), fully clothed, and you talk to a licensed therapist who has additional training in human sexuality. Nothing physical happens in the room. You’re never asked to do anything sexual in front of your therapist. There’s no examination. There’s no nudity. Your therapist is not a sex surrogate.
What makes it sex therapy and not regular therapy is the training. A sex therapist has studied sexual anatomy, sexual function, the medical conditions that affect sex, the medications that affect sex, the psychological patterns that affect sex, and the specific evidence-based techniques that move sexual concerns. They’ve worked through their own stuff enough to not get weird when you bring up your stuff.
The other thing that makes it different is the goal. Regular therapy might touch on sex when it comes up. Sex therapy is built around it. You don’t have to spend twenty minutes warming up to the topic before you can talk about what you came to talk about.
Sex therapy can be done individually or as a couple. Many clients start solo and bring in a partner later. Some never bring in a partner at all. Both are normal.
Clients come from across the full spectrum of identities, orientations, and relationship structures. The work itself doesn’t change shape based on who you are or who you’re with. Our job is to meet you where you are, not to translate you first.
Sexual concerns rarely arrive as one clean problem. That’s exactly what sex therapy is built for.
The Sexual Concerns We Treat
Sexual concerns almost never arrive with a label. Your body isn’t doing what you want it to. Or there’s something underneath that you’ve been carrying for years. Or the dynamic with your partner has shifted in a way you can’t quite name. Usually it’s some combination of all three, and you can’t tell where one thing ends and the next begins.
We treat sexual concerns in three categories. The body and what it’s doing. The stuff underneath. The dynamic with the people in your life. Most clients are working on more than one at the same time. Figuring out which mix you’re actually in is the first real piece of the work.
Functional
What the body and mind are doing during sex — the clinical sexual-functioning categories.
- Desire. Wanting it more than your partner, less, not at all anymore, or only in certain contexts. The most common reason people come in, and the most misunderstood. We separate what’s hormonal, relational, psychological, and cultural, then work the piece that’s actually moving the needle.
- Arousal. Erectile difficulties, lubrication issues, the disconnect between wanting and being ready. Usually a medical layer worth ruling out plus a psychological layer that keeps things stuck even after the medical piece is handled.
- Orgasm. Can’t get there, takes too long, finishes too fast, only alone, never has. Each has a different treatment path. Most respond to a mix of psychoeducation, parts work, and easing the anxiety layered on top.
- Pain. Vaginismus, vulvodynia, dyspareunia, pelvic floor dysfunction. Sexual pain is a big-picture issue that usually needs more than one specialty. Pelvic floor PT and medical workup do the physical work. We do the psychological piece: how the fear of pain keeps the pain itself going.
Emotional & Identity
What’s underneath sex — the stuff that doesn’t show up in a medical workup but drives the bedroom.
- Sexual shame. Religious, cultural, family-of-origin messages you absorbed before you could question them. The shame outlasts whatever caused it, and most clients don’t realize how much it’s been running the show until they start the work.
- Identity & orientation. Who you are, who you’re attracted to, what you want. Coming out later in life, exploring gender, sexual fluidity, or what sex means to you on the asexual spectrum.
- Body image & presence. So in your head about how your body looks that you can’t be in your body. The link between body image, dissociation during sex, and the lost pleasure that gets mistaken for low desire.
- Trauma & its aftermath. What happened, how it shows up now, and what healing looks like when sex is one of the places the body remembers. Single-incident, complex, medical, and the slow accumulation of small unsafe moments.
Relational
What’s happening between you and the people you’re being sexual with. Concerns that live in the dynamic.
- Communication. How you talk about it, or how you’ve stopped. The fights you keep having. The conversations you’ve avoided for months. The gap between what you want and what your partner thinks you want. Sometimes the work is teaching one of you to ask and the other to actually answer.
- Infidelity & trust. Whether there’s a way back, what staying actually requires from both of you, and what it takes to repair the part of intimacy that broke. Sometimes the answer is repair. Sometimes it’s something else. Either way, what you need is the real conversation, not the same loop.
- Non-monogamy & structure. Open relationships, polycules, relationship anarchy. We treat your structure as the starting point, not the problem to solve. The work is what’s actually happening inside it: jealousy, scheduling, and the thing one partner won’t say.
- Kink & desire. Working with your kinks rather than against them. Communication and negotiation in kink relationships. We don’t pathologize what turns you on, and we don’t make you justify it before we can help.
The Treatment Approaches We Use
Real, named modalities. Not “evidence-based” hand-waving.
IFS & parts work
Most sexual concerns involve parts of you that disagree. Parts work gives both a seat at the table instead of letting one shut the other down. Central to how we approach shame.
Somatic & body-based
Sex happens in the body. Breathwork, grounding, nervous-system regulation, and body mapping help you reconnect to physical experience rather than override it.
EFT
For couples and polycules, Emotionally Focused Therapy works the emotional bond underneath sexual disconnect — which is usually downstream of emotional disconnect.
CBT for sexual concerns
Targets the thought patterns that keep things stuck. Catastrophic predictions. Spectatoring during sex. Perfectionism. All-or-nothing thinking about what counts as sex.
Narrative therapy
Examines which stories about sex are yours and which got handed to you by family, religion, culture, and past partners — and gives you tools to write something different.
Experiential & creative
When talk hits a wall: body mapping, art-based exploration, structured role play. Especially good for clients stuck on the same issue for years.
Psychoeducation
Filling in the education you didn’t get. How desire actually works (often responsive, not spontaneous). How medication affects response. The information itself is often half the work.
Mindfulness & presence
Present-moment awareness pulls you out of your head and back into your body during sex — the antidote to spectatoring, performance pressure, and dissociation.
Affirming-care positioning
Explicitly affirming of kink, non-monogamy, polycules, body neutrality, neurodivergence, and sex work. We center pleasure and connection, not performance.
Coordinated medical care
We work with pelvic floor PTs, urologists, gynecologists, and prescribers across Philadelphia. Most sexual concerns benefit from a both/and approach.
The right modality matters. The right therapist matters more.
Meet Your Sex Therapy Team in Philadelphia
What to Expect in Your First Session
The first session is usually the one people are most nervous about. Here’s what actually happens.
You’ll meet your therapist (in person at our Center City office or on video), say hi, sit down. They’ll ask what brought you in. You don’t have to have a script. “I don’t really know how to talk about this” is a perfectly fine place to start.
The first session is mostly history and goal-setting. Your therapist will ask about your sexual concerns, when they started, what you’ve tried, what your relationships look like, what your medical situation looks like, what you’d want to be different. They might ask things that feel personal early. You can decline to answer anything. You can say “I’m not ready to talk about that yet” and it’s a complete sentence.
You will not be asked to do anything sexual in the room. You will not be asked to undress. You will not be touched. The whole thing is verbal. If you’re coming with a partner (or partners), each person will be invited to share their perspective, and your therapist will help you do that in a way that doesn’t turn into the same fight you’ve been having.
By the end of the first session, you should have a basic sense of what working together would look like. How often you’d meet. What the focus would be. You won’t have a complete plan. But you should leave with the feeling that you’re in the right room.
What Brings People In
These are the things we hear, almost word for word, from people who come in for sex therapy. If you read one of these and it sounds like you, you’re not the only one. You’re in the right place.
“I can’t reach orgasm during sex with a partner.”
“My partner wants sex all the time and I never want it.”
“Sex hurts every time and every doctor says everything looks normal.”
“I haven’t wanted sex since having a baby.”
“I started a new medication and my sex drive completely disappeared.”
“I dissociate during sex without meaning to.”
“I can’t stop using porn even though I want to.”
“My religious upbringing has tangled my relationship with sex.”
“I have desires I’m too ashamed to say out loud, even to my partner.”
“I’m in my 50s and my body doesn’t respond the way it used to.”
“I think I might be on the asexual spectrum.”
“My erections aren’t reliable and I’m too young for this.”
“I finish too fast and the anxiety is making it worse.”
“I’ve been faking it for years and don’t know how to stop.”
“I can’t stay present because I’m in my head about my body.”
“I’m afraid of sex because of something that happened years ago.”
“I love my partner but I’m not attracted to them anymore.”
“There was infidelity and we’re trying to find a way back.”
“I’ve never had an orgasm.”
“I’m trans and most therapists don’t know how to talk to me about sex.”
“I’m into kink and need a therapist who won’t treat me like I’m broken.”
“We’re in an open relationship and keep hitting the same wall.”
“We’re polyamorous and need a therapist who treats that as the starting point.”
“Sex feels like a chore I have to perform.”
Sex Therapy FAQs
How do I know if I need sex therapy?
You may benefit from sex therapy if concerns about desire, intimacy, arousal, pain, or communication around sex are causing distress or confusion. Many people seek support when sex feels stressful, disconnected, or different than they want it to be. If you are unsure, learning more about how to know if you need sex therapy can help clarify next steps.
Is sex therapy awkward?
It is common to worry that sex therapy will feel uncomfortable at first. Talking about sex openly can feel vulnerable, especially if you have never done it before. Most clients find that once they understand what sex therapy actually looks like, the awkwardness fades quickly.
Can I go to sex therapy alone?
Yes. You do not need to be in a relationship or bring a partner to sex therapy. Many people go to sex therapy on their own to explore desire, confidence, sexual identity, past experiences, or personal concerns. You can always decide later if involving a partner feels helpful.
What should I expect in my first sex therapy session?
Your first session usually starts with simple questions about what brought you in and what feels most important right now. Your therapist will ask about your concerns, history, relationship, and goals so they can understand the full picture and how to help. It’s a chance to get comfortable, share at your own pace, and start shaping what therapy might look like for you. Learn more about what to expect in your first sex therapy session here.
How long does sex therapy take?
Most people see meaningful progress in sex therapy within 8 to 20 sessions, but there’s no one‑size‑fits‑all timeline. It depends on what you’re working on and how long the concern has been present. Some issues resolve more quickly, while others that involve deeper patterns, relationship dynamics, or trauma may take longer. You can read more about how long sex therapy takes.
Can sex therapy be done online?
Yes, sex therapy can be done online through secure video sessions. Many people find it easier to open up when they are at home. Online therapy also makes it simpler to fit sessions into your schedule. Both online and in-person sessions can be effective when you work with a therapist you trust.
How much does sex therapy cost?
Sex therapy in Philadelphia typically costs between $120 and $300+ per session, depending on the therapist’s experience, training, and whether you’re coming alone or with a partner. Many sex therapists are out of network with insurance, but they often provide a superbill that you can submit to your insurer for possible reimbursement. For a more detailed breakdown, check out are page on how much sex therapy costs in Philadelphia.
Do you take insurance?
We are a private pay practice and don't bill insurance directly, but we provide superbills for out-of-network reimbursement. Many of our clients get back a significant portion of their session fees from their insurance company. Check out our therapy rates and insurance FAQ for details.
What's the difference between insurance and private pay therapy?
Insurance therapy has lower copays but limits your options and requires a mental health diagnosis on your permanent medical record. Private pay costs more upfront but gives you more control over your treatment, better privacy, and access to therapists who might not take insurance. We wrote a full breakdown of insurance vs private pay therapy here.
Is sex therapy worth it?
For most people dealing with sexual concerns, sex therapy can be very helpful if sexual concerns are affecting your relationship, confidence, or overall quality of life. Whether it’s worth it for you depends on your goals, how motivated you are to work on the issue, and whether you find a therapist who feels like a good fit. Read more about whether sex therapy is worth it.
Philadelphia Sex Therapy Office
Our Center City office is at 255 S. 17th Street, with sex therapy available in person and online across Pennsylvania and New Jersey. We offer early morning, lunch hour, and evening appointments because fitting therapy into an already-packed schedule is part of what keeps people from going. Removing that obstacle matters.
Offering Online Counseling In
Resources About Sex Therapy in Philadelphia
You’re Allowed To Want More From This
You don’t have to be in crisis. You don’t have to have a diagnosis. You don’t have to have a clean way of explaining what’s going on. You just have to want something different than what you have right now. Schedule a free 15-minute consultation. We’ll talk about what’s going on, what you’re looking for, and whether we’re a fit. No pressure.
Clinically reviewed by Leeor Gal, LMFT