Fact vs. Fiction: The Realities of Sex Therapy

Adriana Lorenzo

It’s been 25 years since Salt-N-Pepa released their empowering hit “Let’s Talk About Sex.” And most people still aren’t ready to talk about it.

Keeping sex under the covers means too many people would rather give it up entirely than admit they need help. And for couples who think it might be time to see a sex therapist, myths and a ‘What Am I Getting Into’ wariness can hold them back.

Do you have to get undressed?

Do couples have to have sex in front of the therapist?

How do you even know when it might be time to see a sex therapist?

The SmartSex team enlisted two therapists,Dr. Madeleine Castellanos and Dr. Erica Marchand, to help separate sex therapy fact from fiction. (You can listen to the full interview here)

Fact: Your therapist will ask a ton of personal questions, but you’ll leave with a fun homework assignment!




“I’m going to ask you about things that are very personal and things you probably wouldn’t discuss with anybody, anywhere and they can be very anxiety provoking. However, I can only help you with what you bring into the session,” Dr. Castellanos said.

Questions that are sure to make you blush may include:

  • How do you feel about yourself and your own body?
  • What are your attitudes toward sex?
  • How did you learn about sex?

LA-based therapist Dr. Marchand asks couples to list words that come to mind when they think about sex: pleasurable, easy, happy, playful, spontaneous.

The purpose of all these tough questions? Sexual mindfulness according to Dr. Castellanos. You’ll learn to empathize with your partner when he’s sending you a signal that it’s Sexy Time. .

Fact: Anxiety can literally get you down


Relax: performance anxiety is completely normal. According to Dr. Castellanos it’s the #1 cause of sex dysfunction. Anxiety in the bedroom can be triggered by a lot of different things. The most surprising one? Truly caring for your partner.

“I see men who have no trouble having erections with women that they care very little about,” Castellanos said. “And the moment they meet a woman that they are so, so crazy about they are so anxious because they just want it to go so well, that that’s when they get erectile dysfunction and they’re like ‘I don’t understand! I really like her’ and it makes perfect sense to me when you think about how it’s the anxiety aspect that is shutting down the arousal.”

Fiction: Your sex life will change overnight


There’s no magic wand a therapist can wave to fix your sex life. It’s going to take time. Dr. Marchand sees her clients for an average of 6-9 months.

“Some people come and have a relatively specific concern and not a lot of other relationship issues going on and for those people it might be a shorter term therapy,” Dr. Marchand noted. “Other people come in and have more stuff going on….and that’s longer term work.”

Fact: Dry spells are normal


Haven’t had sex in awhile? In a really, really long time? You are not alone.  “It’s not uncommon for people to show up not having sex for a year or more sometimes…. It happens a lot,” Dr. Marchand said.

In fact, according to Dr. Laurie Watson, author of “Wanting Sex Again”, within a couple of years together, a third of all couples find themselves in a sexless marriage.

And the list of why people stop having sex is as long as their dry spells:

  • Busy schedules
  • Having kids
  • Lack of spontaneity
  • Conflict & disagreement

Fact: Your health is affected by your sex life


According to Dr. Castellanos, here are just a few ways your sex life can positively impact your health:

  • 50% less heart attack risk
  • Protection against dementia
  • Better looking skin
  • Better stress levels
  • Lower blood pressure

Fiction: It’s going to be just like Masters of Sex


“I’ve had a fair number of people wondering if there’s actually sexual stuff that happens in the session,” Dr. Marchand said.

Yep.  A lot of people think they’re going to have to do it in front of their therapist. Not going to happen, but maybe we got that idea from a show like Masters of Sex.  The lead actors, Michael Sheen and Lizzie Caplan, portray William Masters and Virginia Johnson – two real-life pioneers of the science of human sexuality.  And if you’ve seen the show you know all about that two-way mirror into the clinic’s bedroom.  But that was first-of-its-kind academic research in the 1950’s.

Instead, your sex therapist is likely to give you some sexy homework: Try touching your partner in new ways, something therapists call sensate focused exercise.  Or change the way you masturbate.  

And for some Extra Credit: Try SmartSex’s Pillow Play with your partner. Slip a card under a pillow, hide one in a pocket, or use one as a bookmark. Be creative!

Intrigued but still a bit squeamish about sex therapy?  Dr. Laurie Watson says the hardest part is making that first appointment. “But joyful, meaningful, erotic sex can be–and is meant to be–yours.”