Sex therapy (Japanese: セックスセラピー, seiryōhō) is the umbrella term for professional psychological and medical help addressing sexual dysfunction, sexual dissatisfaction, sexual anxiety, and sexual problems with a partner. It is distinguished from physical treatment (drugs, surgery), though contemporary practice often combines the two. A central ethical line separates it from sex work: the therapist never participates in or demonstrates sexual acts.

History: Masters and Johnson

The field’s foundation was laid by the American gynaecologist William H. Masters and the psychologist Virginia E. Johnson. Their 1966 Human Sexual Response experimentally systematised a four-stage model of sexual response (excitement, plateau, orgasm, resolution), establishing human sexual behaviour as an object of scientific study. Their 1970 Human Sexual Inadequacy presented short-term, intensive treatment programmes for erectile difficulty, premature ejaculation, anorgasmia, and low arousal. Its greatest innovation was “sensate focus,” an approach beginning with non-sexual touch between partners and relearning sexual contact in stages; it remains a basic technique of sex therapy worldwide.

Main techniques

Sensate focus, the core technique developed by Masters and Johnson, begins with practising “touching and feeling” without the goal of penetration or orgasm, dissolving performance anxiety while rebuilding sexual contact. Cognitive behavioural therapy (CBT) identifies and corrects negative or distorted cognitions about sex (“I will fail sexually,” “I cannot satisfy my partner”); it is highly effective for sexual and performance anxiety. Couples therapy treats sexual problems as relationship problems, working on communication, the relationship, and attachment style rather than individual function alone. Mindfulness-based approaches help the person leave a state of “spectatoring,” observing and evaluating from inside their head during sex, and refocus on bodily sensation, with researched benefit for women’s arousal and orgasm difficulties.

Qualifications and ethics

Internationally, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) issues a certified sex-therapist credential, with a code of ethics, training hours, and supervision requirements. The foremost ethical principle is that sex therapy is a verbal therapy: the therapist participating in or demonstrating sexual acts is never permissible. This is the clear line separating it from prostitution and sexual services.

Adoption in Japan

The history of sex therapy in Japan is short. In the 1970s and 1980s gynaecologists introduced and presented Western sex therapy. It is now often conducted as an adjunct to sexual-function clinics in urology, gynaecology, and psychiatry, but an independent specialist credentialing system is not in place. Private providers calling themselves “sexual counselling” vary widely in quality, and some grey trades are confused with physical services, so distinguishing legitimate medical and psychological institutions matters. The Japanese Society for Sexual Science and the Japanese Society for Sexual Medicine work on training and public education.

Main problems addressed

The main targets include erectile dysfunction, premature and delayed ejaculation, vaginismus, anorgasmia or low arousal, orgasmic disorders, mismatched sexual desire, breakdowns in sexual communication, rebuilding a sex life after childbirth, and the aftereffects of sexual trauma.

See also

• Erectile dysfunction
• Vaginismus
• Anorgasmia / low arousal
• Orgasmic disorder