What Happens in Sex Therapy? A Guide to Your First Session
Allura Sex Therapy Centre | Sex therapy in downtown Vancouver and online across Canada
The short answer: Sex therapy is a specialized form of talk therapy that helps individuals and couples with concerns about sex, intimacy, desire, and relationships. Sessions look a lot like regular counselling: you talk, your therapist listens and asks questions, and together you work toward what you’d like to change. There is never any nudity, touching, or sexual activity in session. At Allura, you can see a sex therapist in person at our downtown Vancouver office or online from anywhere in Canada.
Maybe you’ve been thinking about sex therapy for a while. You’ve Googled it late at night, closed the tab, and come back to it a few weeks later. Part of you knows it could help. Another part of you is wondering what actually happens in that room, whether it’ll be awkward, and whether your concern is “big enough” to bring to a specialist.
Those questions are completely normal. Most people feel at least a little nervous before their first sex therapy session, and almost everyone says afterward that it felt far more comfortable than they expected.
Here’s what you can expect.
What is sex therapy?
Sex therapy is talk therapy focused on sexual health, intimacy, and relationships. A sex therapist is a licensed mental health professional, such as a Registered Clinical Counsellor, psychologist, or social worker, who has additional specialized training in human sexuality and sexual concerns.
Sex therapy looks at the whole picture: your body, your emotions, your relationship, your history, and the messages you’ve absorbed about sex along the way. It can be practical and goal-oriented, and it’s also a space to be curious and honest about parts of your life that may never have had room to be talked about.
If you’ve been to counselling before, sex therapy will feel familiar. Sessions follow the same structure, the same ethics, and the same confidentiality as any other therapy. The difference is that your therapist is comfortable going wherever you need to go, including the parts of your life that involve sex, and has the training to understand how those parts connect to everything else.
Sex therapy isn’t only about sex
This surprises a lot of people: the sexual concern that brings you into sex therapy often isn’t where the work ends up focusing.
Sex doesn’t happen in isolation. It’s shaped by how much you’re sleeping, how stressed you are at work, how you feel in your body, how safe and connected you feel with your partner, what you learned about sex growing up, and what you’ve been through. When those things are strained, sex is often one of the first places it shows up.
So someone might come in for low desire and discover that what’s really draining them is burnout and resentment about an uneven load at home. Someone else might come in for erectile concerns and find that anxiety, which shows up in every part of their life, is doing most of the work. A couple might come in because they’ve stopped having sex and realize they’ve also stopped feeling like a team.
In cases like these, addressing the anxiety, the grief, the relationship pattern, or the old story about what sex is supposed to be is what allows the sexual concern to shift. Sometimes the most effective sex therapy session barely mentions sex at all. That isn’t a detour. It’s often the most direct path to change.
And when the concern is more specifically sexual, your therapist has the tools to work with that directly too. Good sex therapy holds both.
What do people see a sex therapist for?
People come to sex therapy for a wide range of reasons, including:
Painful sex, vaginismus, or vulvodynia
Erectile concerns or early ejaculation
Difficulty with arousal or orgasm
Sexual anxiety or performance pressure
Intimacy after a baby, illness, or major life change
Rebuilding trust and intimacy after infidelity
Questions about sexual orientation or gender identity
Navigating open, polyamorous, or non-monogamous relationships
Kink and sexual interests you’d like to explore without judgment
Shame or discomfort around sex rooted in upbringing, religion, or past experiences
Healing sexually after trauma
You don’t need a diagnosis or a crisis to come in. Some people come because something feels off; others simply want to understand themselves or their relationship better.
What happens in the first sex therapy session?
Your first session is mostly about getting to know each other. Your therapist will ask what brought you in, what you’re hoping will change, and a bit about your background. If you’re coming as a couple, they’ll want to hear from each of you.
At some point, your therapist may ask about your sexual history, health, and relationships. You’re always in control of how much you share and when. A good sex therapist moves at your pace, explains why they’re asking what they ask, and makes it easy to say “I’m not ready to talk about that yet.”
By the end of the first session or two, you’ll usually have a clearer sense of what’s going on and what working together might look like.
Does sex therapy involve touching or nudity?
No, never. Sex therapy is talk therapy. Your therapist will not touch you, ask you to undress, or observe any sexual activity. Professional ethics codes for sex therapists are clear on this.
Sometimes your therapist may suggest exercises to try privately at home, on your own or with a partner. These are always optional, always at your own pace, and always something you can talk through and adjust together.
Will it feel awkward to talk about sex?
It might, at first, and that’s okay. Sex therapists talk about sex every day, so nothing you say will shock or embarrass them. Many people find that the awkwardness fades within the first session, once they realize their therapist is genuinely comfortable and not judging them.
It can help to remember that you don’t need perfect words. “I don’t really know how to say this” is a perfectly good place to start.
Should I come alone or with my partner?
Either works. Some concerns are best explored individually, some together, and many people do a mix of both. If you’re in a relationship and your partner isn’t ready to come in, you can still start on your own. Your therapist can help you decide what makes sense as things unfold. However, we often find that sexuality based concerns are relational, so often, having your partner join you in sessions results in more movement towards your goals.
In-person sex therapy in Vancouver
If you’re in Metro Vancouver, you can see a sex therapist in person at our downtown Vancouver office. Some people find that being physically in the room helps them feel more connected and focused, and that having a dedicated space away from home makes it easier to open up. We’re located in the heart of downtown Vancouver on the corner of Howe & Nelson – our office is warm, private, and cozy and not too far from the Burrard Skytrain station or Granville Street.
Online sex therapy across Canada
You can also see an Allura sex therapist online from anywhere in Canada. Online sessions take place over secure video, and for many people they feel even more private, since there’s no waiting room and no commute.
Online sex therapy is especially helpful if:
There’s no sex therapist in your area, which is common outside major cities
You’d feel more comfortable talking about sex from your own home
You have a busy schedule, young kids, or mobility or health concerns that make travel difficult
You want to work with a therapist who has specialized training in sex therapy, not just whoever is closest
When you reach out, let us know which province you’re in so we can match you with a counsellor who can see clients there.
How do I choose a sex therapist?
“Sex therapist” isn’t a protected title in Canada, so it’s worth asking a few questions before you book. Look for a therapist who is registered with a regulatory or professional body, who has substantial training specific to sex therapy (not just a single workshop), and who works affirmingly with all genders, orientations, and relationship structures.
Fit matters just as much as credentials. You should feel like you can say difficult things out loud with this person. Many therapists offer a brief consultation so you can get a sense of whether they feel like the right match. All of our sex therapists offer free 20-minute phone or video consultations for you to meet with them to ask questions, and decide if they feel like the right fit for you!
Sex therapy at Allura
Allura Sex Therapy Centre is a group practice dedicated to sex, intimacy, and relationships. We see clients in person at our downtown Vancouver office and online anywhere in Canada. Our team works with individuals and couples of all genders, orientations, and relationship structures, and when it’s helpful, we coordinate with physicians, pelvic floor physiotherapists, and other providers, including those in your own community.
Getting started is simple. You can choose the counsellor who feels like the best fit from our Meet Our Counsellors page and connect with them directly, or our Clinic Manager can help match you based on your concerns, preferred style, availability, and whether you’d like to meet in person or online through our Counsellor Connection Form. Allura brings together experienced sex therapists under one clinic. Each manages their own practice independently, and all of us share a commitment to specialized, ethical sex therapy.
Frequently asked questions
What is the difference between sex therapy and couples counselling?
Couples counselling focuses on the relationship as a whole. Sex therapy focuses specifically on sex, intimacy, and sexual concerns, whether you come alone or as a couple. Many sex therapists are also trained in couples therapy and can work with both.
Is sex therapy different from regular therapy?
Not really. Sex therapy follows the same approach, ethics, and confidentiality as any other counselling. The difference is that your therapist has specialized training in sex and intimacy, so they can work with sexual concerns directly while also looking at the other parts of your life, like stress, anxiety, relationships, and past experiences, that so often affect them.
How long does sex therapy take?
It depends on the concern and your goals. Some people find a few sessions are enough to make meaningful change; others prefer longer-term work. Your therapist will check in with you regularly about how things are going.
Is sex therapy confidential?
Yes. Sex therapy follows the same confidentiality standards as any other counselling, with the standard legal exceptions your therapist will explain at your first session.
Can I do sex therapy online if I live outside BC?
Yes. Allura offers online sex therapy to clients across Canada. Let us know which province you’re in when you reach out so we can match you with the right counsellor.
Where is Allura’s in-person office?
Our office is in downtown Vancouver, you can find more information about our office here.
Is sex therapy covered by extended health benefits?
Many extended health plans across Canada cover sessions with Registered Clinical Counsellors, Registered Social Workers, or Canadian Certified Counsellors. though coverage depends on your plan and sometimes your province. It’s worth checking with your provider before your first session.
Do I need a referral to see a sex therapist?
No. You can reach out to us directly.
What if my concern feels too small, or too embarrassing?
No concern is too small, and nothing you bring will surprise your therapist. If it matters to you, it’s worth talking about.
Reaching out about sex can feel like a big step, and it’s often the hardest part. Whether you’d like to meet us in Vancouver or online from wherever you are in Canada, our team is here when you’re ready. See which counsellors are currently accepting new clients.