Sexual difficulties rarely exist in isolation. Anxiety, relationship dynamics, past experiences, and beliefs about sex all shape how our bodies respond — and how we feel about intimacy. Psychosexual counselling addresses these psychological dimensions, often alongside medical treatment, to help you achieve lasting improvement.
As a urologist specialising in andrology with a personal interest in psychosexual medicine, I know that effective treatment often means looking beyond the physical. That's why I work closely with specialist psychosexual therapists to provide comprehensive care that addresses both body and mind.
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What is psychosexual counselling?
Psychosexual counselling is a specialised form of talking therapy. It focuses on sexual difficulties and their psychological dimensions. It is delivered by trained professionals — often called psychosexual therapists or sex therapists — who understand both the psychology of sexual function and the physical mechanisms involved.
Let me be clear about what it is and isn't. Psychosexual therapy involves talking and sometimes homework exercises to practise at home. It does not involve physical examination, touch, or observation of sexual activity. Legitimate psychosexual therapists registered with bodies like COSRT (College of Sexual and Relationship Therapists) never engage in physical contact as part of therapy.
When does psychosexual counselling help?
Psychosexual therapy can be valuable as a standalone treatment or combined with medical intervention. Research supports its effectiveness across a range of presentations.
Many men with erectile dysfunction (difficulty getting or keeping an erection firm enough for sex) have both physical and psychological factors contributing. Even when there is a clear vascular cause, performance anxiety often develops as a secondary problem. Psychosexual therapy addresses the anxiety cycle while medical treatment addresses the physical component.
Research shows that combining PDE5 inhibitors (medicines that help increase blood flow to the penis, such as sildenafil or tadalafil) with psychosexual therapy often produces better outcomes than either treatment alone. The medication provides reliable erections, reducing anxiety, while therapy addresses underlying beliefs and patterns.
Psychosexual therapy is considered first-line treatment for premature ejaculation by most guidelines. Techniques such as the stop-start method and squeeze technique have good evidence. Addressing anxiety about lasting longer often improves ejaculatory control significantly.
I often combine behavioural approaches with medical options (dapoxetine, topical anaesthetics) when needed. Many men achieve satisfactory control through therapy alone.
This under-recognised condition — difficulty reaching orgasm despite adequate stimulation — often has psychological roots. Factors such as anxiety, relationship concerns, or excessive masturbation patterns can contribute. Psychosexual therapy explores these factors and introduces graduated exercises to rebuild the sexual response.
I always check for hormone deficiencies and other medical causes. However, low libido frequently involves psychological and relational factors. Stress, relationship dissatisfaction, depression, and life transitions all affect desire. Psychosexual therapy can help you understand what is driving low desire and explore whether — and how — you want to address it.
Importantly, some men genuinely prefer less frequent sex and are not distressed by this. Therapy can help clarify your own values rather than imposing external expectations.
Cancer treatment, surgery (including prostatectomy), chronic illness, and medication changes can all affect sexual function. Even when physical recovery is complete, men often need psychological support to rebuild sexual confidence. Partners may also need guidance on how to adapt to changed circumstances.
Sexual problems do not happen in isolation. Communication breakdown, unresolved conflicts, mismatched expectations, and lack of emotional connection can all affect intimacy. Couples-focused psychosexual therapy can address these dynamics, helping both partners understand and respond to each other's needs.
Past sexual trauma, adverse childhood experiences, or negative early sexual encounters can shape adult sexuality in profound ways. Specialist psychosexual therapists are trained to work sensitively with trauma histories. They can help you process past experiences and develop healthier patterns.
Psychosexual counselling provides a confidential space to explore questions about sexual identity, orientation, or preferences. This is not about changing who you are — it is about understanding yourself better and addressing any distress or confusion you are experiencing.
What happens in psychosexual therapy?
If you've never seen a psychosexual therapist, you might wonder what actually happens in sessions. Here's what to expect.
Initial assessment
The first session covers your sexual history, relationship context, general health, and the specific difficulties you're experiencing. The therapist will ask direct questions about sex — this can feel awkward at first, but they discuss these topics every day. Nothing you say will shock them.
This assessment identifies which factors are contributing to your difficulties and guides the therapeutic approach. You'll agree on goals together from the outset.
Ongoing sessions
Sessions are usually weekly or fortnightly, lasting 50 minutes to an hour. Content varies by need but typically involves:
- Exploring thoughts, feelings, and beliefs about sex
- Identifying unhelpful patterns and their origins
- Learning specific techniques and strategies
- Processing emotions related to sexual difficulties
- Improving communication with your partner (if relevant)
Homework exercises
Most psychosexual therapy includes exercises to practice between sessions. These might be sensate focus exercises (structured touching with your partner), mindfulness practices, or specific behavioural techniques. The homework is essential — therapy works through practice, not just talking.
Duration of therapy
This varies considerably. Some men reach their goals in 6–8 sessions; others benefit from longer work. Complex issues involving trauma or deep-rooted patterns typically take more time. Your therapist will review progress regularly and adjust the approach as needed.
Evidence-based therapeutic approaches
Psychosexual therapy draws on several established therapeutic models. Different therapists may emphasise different approaches, and many integrate multiple techniques.
CBT addresses the thoughts and beliefs that influence sexual function. For example, a man with performance anxiety might hold beliefs like "I must get an erection every time or I'm not a real man" or "My partner will leave me if I can't perform." CBT helps identify these thoughts, examine the evidence for and against them, and develop more helpful alternatives.
CBT for sexual dysfunction has good evidence, particularly for erectile dysfunction and premature ejaculation. Meta-analyses show significant improvements compared to waitlist controls.
These are specific exercises designed to change problematic patterns. Examples include:
- Sensate focus:
- Structured touching exercises as described above
- Stop-start technique:
- For premature ejaculation — learning to recognise approaching orgasm and pause stimulation
- Squeeze technique:
- Applying pressure to reduce arousal and delay ejaculation
- Graduated exposure:
- Slowly approaching anxiety-provoking situations
Mindfulness involves paying attention to present-moment experience without judgement. Applied to sex, this means focusing on physical sensations rather than worrying about performance or outcome. Research shows mindfulness-based interventions can improve sexual function and satisfaction, particularly for arousal difficulties.
Practically, this might involve meditation exercises, body awareness practices, and learning to notice when your mind wanders during sex and gently redirecting attention back to sensation.
When sexual difficulties exist within a relationship, systemic approaches examine the dynamic between partners. This might explore communication patterns, power dynamics, unspoken expectations, and how each partner's behaviour influences the other. Both partners typically attend sessions together.
Psychodynamic therapy explores how unconscious processes, early experiences, and relationship patterns shape current sexual difficulties. This approach is often helpful when there's no obvious trigger for sexual problems, or when difficulties seem to stem from deep-rooted patterns.
Evidence for psychodynamic sex therapy is less robust than for CBT-based approaches, but some men prefer this style of working and find it valuable.
The GGO Med integrated approach
At GGO Med, I take a comprehensive approach to sexual health. That means investigating physical factors thoroughly while recognising that psychological aspects often need attention too.
How we work together
I conduct thorough medical assessment — examining physical causes, running appropriate tests, and providing medical treatments where indicated. When psychological factors are significant, I refer to specialist psychosexual therapists I know and trust. We communicate about your progress (with your consent) to ensure your care is coordinated.
My referral network
I maintain relationships with several experienced psychosexual therapists in London who accept referrals from my patients. All are registered with COSRT (College of Sexual and Relationship Therapists) or equivalent bodies, ensuring they meet professional standards and work within ethical boundaries.
I match referrals to your specific needs. Some therapists specialise in particular areas — trauma, LGBTQ+ issues, couples work — and practical factors like location and availability matter too.
When I suggest psychosexual therapy
I'll discuss psychosexual therapy when I think it would help, but I won't push it. Situations where I typically recommend it include:
- Erectile dysfunction with significant performance anxiety
- ED where physical findings don't fully explain the severity of symptoms
- Premature ejaculation (often alongside medication)
- Sexual difficulties causing relationship strain
- Adjustment to changed sexual function after illness or treatment
- When medical treatments haven't worked as well as expected
- When you want to reduce reliance on medication long-term
You're always free to decline a referral. I'll still provide whatever medical treatment is appropriate regardless of whether you pursue psychological support.
Finding the right therapist
If you'd prefer to find your own psychosexual therapist — or if you're not my patient but want guidance — here's what to look for.
Qualifications and registration
In the UK, look for therapists registered with:
- COSRT (College of Sexual and Relationship Therapists) — the specialist body for psychosexual and relationship therapists
- BACP (British Association for Counselling and Psychotherapy) with additional psychosexual training
- UKCP (United Kingdom Council for Psychotherapy) with relevant specialism
COSRT maintains a public register of qualified therapists, searchable by location. It is the most reliable way to find a legitimate practitioner.
Warning signs to avoid
Be wary of anyone who: suggests physical contact as part of therapy; isn't registered with a recognised body; makes promises about guaranteed results; pushes expensive package deals before assessment; or operates from untraceable premises. Legitimate psychosexual therapy never involves touch.
Practical considerations
Frequently asked questions
Completely normal. Most people feel awkward initially — psychosexual therapists understand this and are skilled at putting you at ease. They discuss sexual matters professionally every day, so nothing you say will shock them. The awkwardness typically fades after the first session or two once you realise you're in a non-judgemental space.
It depends. Some approaches, particularly for relationship-related difficulties, work best with both partners present. Others can be done individually. Your therapist will discuss options during assessment. If your partner is reluctant, individual therapy can still be valuable — and sometimes a partner's willingness to attend increases once they see positive changes.
This varies significantly depending on the issue and its complexity. Some men notice improvements within 4-6 sessions; others need longer-term work. Your therapist should review progress regularly. If you're not seeing any benefit after 10-12 sessions, it's worth discussing whether a different approach might help.
NHS provision is patchy. Some areas have excellent psychosexual services; others have minimal provision or long waiting lists. Ask your GP what's available locally. If NHS options are limited, private therapy is an alternative, though this involves out-of-pocket costs.
Absolutely — in fact, this combination often produces better results than either alone. For example, taking sildenafil while also working on performance anxiety in therapy addresses both the physical reliability and the psychological factors. I coordinate with therapists to ensure treatments complement each other.
If investigation shows a clear physical cause — say, significant vascular disease causing ED — medical treatment is the priority. However, even men with physical causes often develop secondary psychological factors (anxiety, avoidance, relationship strain) that benefit from attention. We'll discuss whether psychological input would help in your specific case.
Yes, with standard exceptions (risk of harm to yourself or others). Your therapist won't share information with me, your GP, or anyone else without your explicit consent. If you want your therapist and me to communicate about your care, we'll ask you to sign a consent form specifying what can be shared.
Yes. Many men seek psychosexual therapy for individual issues — performance anxiety about future relationships, difficulties with masturbation or arousal, processing past experiences, or preparing for dating after a period of avoidance. You don't need a partner to benefit.
Legitimate psychosexual therapists work with clients of all sexual orientations and gender identities. If you'd prefer a therapist with specific LGBTQ+ expertise, look for this when choosing, or ask me for recommendations. COSRT therapists are bound by ethical standards requiring non-discriminatory practice.
Taking the next step
Sexual difficulties are common, treatable, and nothing to be ashamed of. Whether your problem is mainly physical, mainly psychological, or — as is often the case — a mixture of both, effective approaches are available.
If you're experiencing sexual difficulties and want a comprehensive assessment, I'm here to help. I'll investigate physical factors thoroughly and, where appropriate, connect you with psychological support. The goal is satisfying sexual function — whatever that looks like for you.
