You do not need a diagnosis to ask for help
Many people wait for a sexual concern to become serious enough to justify help. There is no threshold you have to reach. Mayo Clinic notes that there is no magic number that defines low sex drive, and that even when a problem does not meet a medical definition, you do not have to meet it to seek help. The same is true of most intimacy concerns: what matters is whether it bothers you, or your partner, and whether it is getting better on its own.
MedlinePlus notes that occasional sexual problems are common, and suggests seeing a health care provider if a problem lasts more than a few months or causes distress for you or your partner. That is a reasonable guide for considering therapy as well.
Signs it may be time
There is no checklist that decides this for you, but people often reach out when they notice some of the following:
- The concern has lasted months, and talking about it at home has not helped or has made things worse
- You dread or avoid intimacy, or go along with sex while feeling far away
- Arguments, silence or resentment about sex are spilling into the rest of the relationship
- Anxiety before or during sex has become a pattern of its own
- A medical issue has been treated, but tension or fear around sex has stayed
- Shame, guilt or past experiences keep surfacing when you try to be close
- You feel unwanted, rejected or alone with the problem
- You and your partner want very different things and cannot find a way to talk about it
The ISSM suggests that when a difference in desire between partners becomes a consistent issue, it is a good idea to consult a therapist who works with sexual concerns or with couples. The NIDDK notes that counseling may be suggested when emotional issues are affecting erections, and that counselors can help lower anxiety and stress about sex.
When to see a doctor first, or at the same time
Pain during sex, a change in erections, lubrication or orgasm, bleeding, or a change that followed a new medication all deserve a medical evaluation. A primary care doctor, gynecologist or urologist can look for physical causes, and some are simple to treat. Do not stop or change a prescribed medicine on your own; the NIDDK advises talking with your health care professional first.
Therapy does not need to wait for every test result. Many people see a physician and a therapist in parallel, each working on a different part of the problem. Who to See for a Sexual Problem describes the options.
What therapy can and cannot offer
Therapy for a sexual concern is a conversation. It does not involve a physical exam, and it cannot treat a medical condition. What it can offer is a private place to understand what has been happening: how stress, history, beliefs and the relationship feed into the difficulty, and what keeps it going. For some people that means easing anxiety or shame. For others it means learning to talk with a partner without the conversation collapsing into hurt or blame.
Progress looks different for everyone, and there is no fixed timeline. Some people come for a handful of sessions around one specific worry; others find the concern connects to wider patterns they want to work on over a longer period. What to Expect in Therapy for Intimacy and Sexual Concerns describes the process in more detail.
Reasons people wait, and what to know
- "It is too embarrassing." Therapists who work with intimacy concerns hear these topics regularly, and you choose how much detail to share and when.
- "It will pass." Sometimes it does. When it has not after several months, waiting longer can let avoidance and resentment settle in.
- "My partner won't come." You can start on your own. When Your Partner Won't Come to Therapy About Sex covers that situation.
- "It is not serious enough." If it matters to you, it is worth talking about.
- "I am worried about cost." Fees, insurance and reduced-fee availability are explained on the Fees & Insurance page.
When it is more urgent
Some situations call for help sooner rather than later: if you feel pressured or forced into sex, if you are afraid of your partner, if a past assault is resurfacing in ways that feel overwhelming, or if low mood has turned into hopelessness. The resources in the box below are available around the clock. A therapist can help with what follows, but immediate safety comes first.
Taking the first step with Dr. Lehmann
Dr. Lehmann is a licensed clinical psychologist who offers therapy for intimacy and sexual concerns at her office in Franklin, in Oakland County, and by telehealth for clients who are located in Michigan at the time of the session. Appointments are during the day, Monday through Thursday.
These concerns can be part of individual therapy or couples therapy. When you call, you can describe the concern in a sentence or two and ask which format makes sense for your situation. You do not need to have the words worked out in advance. The New Clients page explains how to reach the office and what happens next.