In short
A structured programme for couples and individuals where the problem has more than one moving part, and where a single prescription was never going to be enough.
- Both partners are considered, because one partner’s difficulty measurably affects the other’s function.
- Non drug treatment comes first. 65 per cent of 365 couples in one study described sex therapy as successful.
- Goals are set before treatment starts, and progress is measured against them rather than against a hormone level.
Expect trial and error. Most sexual concerns have no quick or single fix.
Treatment Overview
Who is this for?
People with problems affecting more than one aspect of sexual function, couples where both have a difficulty, and anyone for whom a prescription alone has already been tried and has not resolved it.
Most people with a sexual concern do have issues affecting more than one aspect. A complaint of low desire often turns out to include arousal problems or pain.
The structure
| Evaluate fully first | All current issues identified before any treatment starts, then prioritised and coordinated |
| Goals set | Yours, stated at the outset, and used to judge progress |
| Treat associated conditions | Pain, incontinence, anaemia, mood, and medication effects |
| Non drug first | Counselling, sex therapy, physiotherapy where relevant |
| Medication last | Reserved for those who meet the criteria for a disorder and for whom non drug options have not worked |
Why the partner is part of the plan
Because the evidence is explicit. A partner’s erectile dysfunction has a negative impact on the other person’s sexual function, and men whose partners have no sexual difficulty are more likely to recover erectile function.
That means treating the partner’s problem, agreeing common goals, improving communication and addressing relationship issues are all part of the treatment rather than adjacent to it.
What sex therapy actually involves
- Education about the sexual response cycle, which corrects a surprising number of false expectations
- Addressing cultural or religious concerns about sexuality
- Negotiating a mutually acceptable frequency where levels of interest differ and that difference is causing conflict
- Specific exercises, including sensate focus, which shifts the goal away from intercourse and orgasm
- Instruction in the use of vaginal dilators, which is highly effective for most cases of provoked pelvic floor hypertonus and painful sex
A sex therapist is referred to where the concerns are specifically about sex. A couples counsellor is referred to where the concerns are about communication and conflict.
Who else is involved
With your consent, care is coordinated with your other clinicians, which may include a cardiologist, psychiatrist, gynaecologist, oncologist, urologist, pelvic floor physiotherapist or psychotherapist.
These conditions are complex and treating them well is time intensive and often needs more than one kind of expertise.
Who Is a Good Candidate?
- More than one aspect of sexual function has changed
- Both you and your partner have a difficulty
- A prescription alone has already been tried and has not resolved it
- There is an underlying condition, such as pain, incontinence or a mood disorder, in the picture
- You want a plan with defined goals rather than a single appointment
- Any sexual activity that is not fully consenting, or that you feel pressured into
- A history of physical or sexual abuse or intimate partner violence, which deserves proper support and is screened for
- Untreated depression or thoughts of self harm in either partner, which need addressing first
What Happens During the Consultation
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1
A full evaluation before any treatment
Every current issue identified, in both partners where relevant, and then prioritised. Treating the wrong problem first is the most common way these situations stall.
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2
Your goals, and realistic expectations
Goals stated at the outset and used to judge progress. Expectations set honestly, including that most sexual issues have no easy or immediate treatment and that there will be trial and error.
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3
Associated conditions and medication
Pain, incontinence, anaemia, arthritis, mood disorders and medication effects. Treating any of these can improve sexual interest and response on its own, before anything sexual is treated directly.
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4
The referrals that do the work
Sex therapist where the concerns are specifically sexual, couples counsellor where they are about communication and conflict, pelvic floor physiotherapist where there is pain. Arranged as part of the plan rather than as a last resort.
Program Structure & Follow-Up
Sequencing
Improving one problem often improves another, so the order is deliberate.
- Pain first, where there is any. Treating it often improves interest, arousal and orgasm at once
- Remove a cause, such as a medication or an untreated condition
- Non drug treatment, which for most people means sex therapy or couples counselling
- Medication, only where criteria are met and the above has not worked
Review points
| Pain treatment | Six to eight weeks, then reassess desire and arousal separately |
| Medication change | Four to six weeks, judged for both sexual function and the original condition |
| Therapy | Measured against your goals rather than at a fixed interval |
| Overall | A formal review of whether the plan is working, and a change of approach if it is not |
How long does it take?
Longer than a prescription and usually worth it. Most sexual issues do not have an easy or immediate treatment, and there is generally a period of trial and error before function improves.
Saying so at the beginning is part of the treatment, because unrealistic expectations are one of the most common reasons people abandon a plan that was working.
What is measured
Progress against the goals you set, and where useful a validated questionnaire score. Not a hormone level, which correlates poorly with sexual function in women and only partly in men.
Benefits, Limits & Safety
What has the strongest track record
- Sex therapy. 65 per cent of 365 couples treated for a range of sexual dysfunctions described their treatment as successful
- Vaginal dilator instruction for provoked pelvic floor hypertonus and painful sex
- Local oestrogen for genitourinary syndrome of menopause
- PDE5 inhibitors for erectile dysfunction, with successful intercourse in 68 to 69 per cent against 33 to 35 per cent on placebo
- Treating the associated condition, whether that is pain, anaemia, incontinence or depression
The honest limits
Drug treatment for female sexual dysfunction, other than the approved treatments for vaginal atrophy, has limited efficacy and carries side effects. Delayed ejaculation in men has limited options, all off label.
The evidence base is also weaker than it should be: studies use different measures, and most conditions and most treatments affect more than one aspect of sexuality, which makes isolating effects difficult.
Where a mismatch is not a dysfunction
If you are content with your own level of interest and the distress comes from a difference with a partner, that is a relationship problem rather than your sexual problem. It is often effectively managed by couples counselling and sex therapy, and it is worth naming rather than treating as an individual disorder.
What is not offered
Compounded hormone mixtures, saliva hormone testing, systemic DHEA in people without adrenal insufficiency, shockwave or platelet based therapies marketed as regenerative, and drug treatment before non drug options have had a fair trial.
What works best
Sex therapy, described as successful by 65 per cent of couples in one study, alongside treatment of pain and of the underlying condition.
Measured against your goals
Goals set before treatment starts, pain reviewed at six to eight weeks, medication changes at four to six, therapy against progress rather than a calendar.
Not part of the programme
Compounded hormones, saliva testing, systemic DHEA without adrenal insufficiency, regenerative marketing therapies, and medication before non drug options.
Cost & Program Investment
Each appointment and test is quoted individually, and there is no fixed package price, because the right components depend on what is actually wrong. Referrals to a sex therapist, couples counsellor or pelvic floor physiotherapist are a normal part of the plan and their costs are explained before you commit. Medication, where it is eventually used, is an ordinary prescription at pharmacy prices.
Frequently Asked Questions
No, but it usually helps. A partner's own difficulty measurably affects your sexual function, and shared goals and better communication are part of the treatment rather than adjacent to it.
Because non drug approaches work well and are safe, and because a consultation with a sex therapist is generally considered a prerequisite before trying drug treatment for sexual dysfunction.
Longer than a prescription. Most sexual issues have no easy or immediate treatment and there is usually a period of trial and error. Pain responds fastest, often within six to eight weeks.
A sex therapist has specific expertise in sexual function and is right where the concerns are specifically about sex. A couples counsellor is right where the concerns are about communication and conflict.
Not necessarily. If you are content with your own level of interest and the distress comes from the difference, that is a relationship issue rather than a sexual dysfunction, and it responds well to couples counselling.
With your consent, yes, and it usually improves the result. These conditions often need more than one kind of expertise, and coordinating with a cardiologist, psychiatrist, gynaecologist or urologist is normal.
The programme applies just as much. Sexual function concerns can be a barrier to forming relationships, and dissatisfaction with sexual function outside a partnership is a legitimate reason to seek help.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.