Sexual difficulties are among the most common human experiences, and among the least talked about.

Estimates suggest that at any given time, around 40–45% of adults in the UK are experiencing some form of sexual problem—difficulties with desire, arousal, pain, intimacy, body image, or the emotional dimensions of a sexual relationship. Yet most people wait years before seeking help, if they seek it at all.

The silence around sexual difficulties makes them feel more shameful than they are, and more permanent than they need to be. This guide explains what sex therapy and psychosexual counselling in London involves, what conditions it can help with, and how to find the right therapist.

What Is Sex Therapy?

Sex therapy—more formally called psychosexual therapy—is a form of talking therapy that addresses sexual difficulties, concerns, and the emotional and relational dimensions of sexual experience. It is not a medical treatment, and it does not involve any physical contact or sexual interaction between therapist and client.

Sex therapy is provided by trained counsellors, psychotherapists, or psychologists with specific postgraduate training in psychosexual work. The professional body for UK practitioners is COSRT (College of Sex and Relationship Therapists), and registration with COSRT indicates specific training in this area.

Sex therapy can be offered to individuals or to couples. It often involves an integration of talking-based work with psychoeducation (information about sexual function and psychology), and may include exercises or practices to try at home—always agreed voluntarily and collaboratively, never as a prescription.

What Sex Therapy Can Help With

Low or Mismatched Sexual Desire

Loss of sexual desire (low libido) is the most common sexual problem reported by adults in the UK. It can arise from many sources: stress, depression, hormonal changes, relationship dynamics, unresolved conflict, body image concerns, trauma, or simply a mismatch between partners' natural desire levels.

Desire is not purely physiological—it is deeply influenced by emotional safety, self-image, the quality of the relationship, stress levels, and many other psychological factors. Therapy can explore what is affecting desire and develop a more honest and workable understanding of what each person actually needs.

Mismatched desire is particularly common in long-term relationships—two people with genuinely different libidos, trying to find a shared sexual life without resentment, coercion, or disconnection. Therapy can help couples navigate this honestly and with compassion.

Erectile Difficulties

Erectile difficulties can have medical causes, psychological causes, or (very often) a combination of both. A GP appointment is worth having to rule out cardiovascular or hormonal contributions. But psychological and relationship factors—anxiety, performance pressure, concerns about a partner's response, past negative experiences—play a significant role in most erectile difficulties, even when physical factors are also present.

Anxiety about erections tends to be self-perpetuating: a difficult experience leads to anxiety about the next experience, which makes erection physiologically harder to achieve, which increases anxiety. Therapy can break this cycle by addressing the underlying anxiety and developing a different relationship with sexual experience.

Vaginismus and Pelvic Pain

Vaginismus is the involuntary tightening of the pelvic floor muscles that makes penetration painful or impossible. It can be primary (has always been present) or secondary (develops after a period of comfortable sexual function). It's often connected to anxiety, fear, past painful experiences, or unresolved concerns about sexuality or the body.

Therapy for vaginismus typically combines psychosexual counselling with physiotherapy (to address the physical component). The talking-therapy element addresses the psychological factors—anxiety, trauma responses, negative beliefs about sex or the body—that contribute to the muscle response.

Vulvodynia, dyspareunia (painful intercourse), and other forms of genital or pelvic pain also benefit from integrated psychological and physiotherapy support.

Anorgasmia

Difficulty reaching orgasm—either never experiencing orgasm, or difficulty with orgasm in partnered sex—is common and treatable. Psychological factors often include anxiety, difficulty relaxing or being present, insufficient stimulation (and difficulty communicating about this), past trauma, or cultural messages that created shame or disconnection from sexual pleasure.

Sexual Anxiety and Performance Anxiety

The anxiety that surrounds sexual performance—worry about how you're coming across, what your body is doing, what your partner thinks, whether you're "doing it right"—is one of the most reliable inhibitors of sexual pleasure and function. This kind of anxious self-monitoring ("spectatoring," as Masters and Johnson called it) takes you out of present experience and into your head, where arousal and connection cannot thrive.

Therapy works with the anxiety itself—its origins, its specific content, the beliefs it reflects—and helps develop a more present-focused, less self-critical way of inhabiting sexual experience.

Compulsive Sexual Behaviour

Some people experience sexual behaviour as compulsive or out of control—using pornography in ways that feel addictive, engaging in sexual activity that conflicts with their own values, or finding that sexual behaviour is serving to manage emotions in ways that cause harm. This territory is complex and benefits from a therapist who can approach it without moralising or pathologising, while still taking seriously the distress involved.

Sexual Difficulties After Trauma

Sexual trauma—assault, childhood sexual abuse, coercive experiences, or medical trauma involving the body—often affects sexual experience in adulthood. Therapy can address both the trauma itself and its specific impact on sexual life, combining trauma-informed work with psychosexual support.

Identity and Sexuality Exploration

Questions around sexual identity, orientation, gender, kink, non-monogamy, or sexual interests that feel confusing or shameful are all appropriate territory for psychosexual counselling. A good sex therapist offers a genuinely non-judgemental space to explore these questions—free from any agenda about what the "right" outcome is.

What Sex Therapy Sessions Look Like

Many people imagine sex therapy as more confronting or clinical than it is. In practice, sessions with a good psychosexual therapist feel similar to other forms of talking therapy—you sit together and talk. The specific content is more explicitly sexual, but the quality of the conversation—warm, curious, non-judgemental—is the same.

First sessions typically involve:

Understanding what brings you to therapy
Taking a brief sexual and relationship history
Clarifying your goals and hopes for therapy
Beginning to explore the specific difficulty from multiple angles

Subsequent sessions build on this—exploring the psychological, relational, and historical factors at play, introducing psychoeducation where helpful, and (for couples) facilitating conversations between partners that may be difficult to have alone.

Home exercises, when offered, are agreed collaboratively, explained carefully, and adapted to your situation. They are never prescribed without discussion, and you always have the right to decline anything that doesn't feel right.

Finding a Sex Therapist in London

When looking for a psychosexual therapist in London:

Look for COSRT registration: The College of Sex and Relationship Therapists registers practitioners with specific training in psychosexual work. This is the clearest indicator of specialist training. Find practitioners at www.cosrt.org.uk.

Also check BACP or UKCP registration: Sex therapists who are primarily counsellors or psychotherapists should also hold general therapeutic registration.

Ask about training explicitly: "What specific training do you have in psychosexual therapy?" is a perfectly reasonable question. A good therapist will welcome it.

Consider comfort over geography: Unlike other specialisms, comfort with the therapist matters especially for sex therapy—the material is inherently intimate. An online therapist you feel genuinely comfortable with may serve you better than an in-person therapist you don't.

Online vs. in-person: Online sex therapy is effective and often more accessible. Some people find it easier to discuss sexual topics when not in the same physical room as the therapist.

Typical Costs in London

COSRT-registered practitioner: £80–£130 per session
Senior or specialist practitioners: £120–£180 per session
Reduced-cost options: Some therapists offer concessionary rates; relationship charities like Relate offer lower-cost psychosexual counselling

When to Seek Help

The right time to seek sex therapy is whenever sexual difficulties are causing you or your relationship genuine distress—regardless of how long the problem has been present, how serious it seems, or whether you think you "should" be able to resolve it yourself.

Many people wait years before seeking help, often through embarrassment, the belief that it should resolve itself, or not knowing that effective help exists. In the majority of cases, psychosexual therapy can make a meaningful difference—and the sooner it's sought, the easier the difficulties are to address.

You don't need a referral. You don't need a medical diagnosis. You don't need to be in a relationship. You just need to notice that something is affecting your sexual wellbeing and decide that you'd like support with it.

I work with sexual and intimacy concerns as part of integrative humanistic therapy. While I'm not a COSRT-registered specialist, I work from a sex-positive, non-judgemental perspective with anxiety, relationship dynamics, trauma, and the emotional dimensions of sexual difficulty. For specific psychosexual concerns requiring specialist input, I can provide a referral. Get in touch for a free 15-minute consultation to discuss whether therapy might help.

Sex Therapy London: A Calm Guide to Psychosexual Counselling and Intimacy Issues