Sexual Health: Areas of Focus
The concerns I work with —
and what's actually happening.
This page covers the sexual health concerns I work with most often: what they are, how they develop, and what treatment involves. It's meant as a reference for people trying to understand their situation and figure out whether working together makes sense.
If you're looking for information about my clinical approach and treatment methods, that's on the Sex Therapy page. If you're ready to get in touch, reach out here.
Sexual & Pelvic Pain
Real conditions. More common than most people realize. And treatable.
Sexual and pelvic pain conditions (including vulvodynia, vaginismus, vestibulodynia, and dyspareunia) are diagnosable, have neurological, physiological, and psychological components, and are not inevitable. They do not have to define your life or your relationships.
For a full breakdown of each condition, what's actually happening, and what treatment involves, see the Sexual & Pelvic Pain page →
How I Work With Pelvic Pain
Psychological treatment for pelvic pain is not about suggesting the pain is in your head. It's about addressing the very real ways that chronic pain reshapes the nervous system, affects how you relate to your body, and creates patterns of avoidance, fear, and relationship tension that take on a life of their own.
I work alongside physiotherapists, gynecologists, and other specialists when appropriate, helping clients understand their diagnosis, navigate a healthcare system that often fails this population, and build a life that isn't organized around pain.
Online Workshop
Sexual Pain: A Psychological Approach
A five-module video course covering the psychology, physiology, and treatment of sexual pain. Developed from 15 years of clinical work. Available anywhere, at your own pace.
Explore the Workshop →Working with a specialist in pelvic pain makes a real difference. Reach out to get started →
Desire & Arousal
Among the most common concerns I see, and among the most responsive to treatment.
Low desire, mismatched libido, and arousal difficulties affect a significant portion of adults at some point in their lives. They're also among the concerns most likely to go unaddressed, because people assume it's just how things are, or because they haven't found a clinician who takes it seriously.
Low Desire
A persistent absence of interest in sexual activity that causes personal distress or relationship difficulty. Low desire has physiological, psychological, and relational contributors, often more than one at a time. Effective treatment starts with understanding which factors are actually driving it for this particular person.
Stress, hormonal shifts, medication side effects, relationship dynamics, unresolved conflict, and a history of negative sexual experiences can all play a role.
Mismatched Libido
Desire discrepancy, where one partner consistently wants sex more than the other, is one of the most common sources of relationship tension I see. It creates a dynamic where the higher-desire partner feels rejected and the lower-desire partner feels pressured, which makes desire decrease further.
This is a relational issue as much as an individual one, and it benefits from being addressed in that context. I work with both individuals and couples navigating this pattern.
Performance Anxiety
Worry about how you're performing during sex: maintaining arousal, satisfying a partner, doing things "right." This kind of self-monitoring is incompatible with genuine arousal and tends to create the very outcomes it's trying to prevent.
Anticipatory Anxiety
Dreading sex before it happens, often because of past negative experiences. When past pain, embarrassment, or disconnection gets encoded as a prediction about the future, avoidance becomes a reasonable-feeling response that keeps the anxiety intact.
Body Image & Self-Consciousness
Difficulty being present during intimacy because of preoccupation with how your body looks or what your partner is thinking. More common than people realize, and responds well to approaches that address both the thought patterns and the underlying beliefs driving them.
Anxiety Following Difficult Experiences
Sexual anxiety that develops after a painful experience, illness, relationship rupture, or sexual trauma. This often has a strong neurological component: the nervous system has learned to treat intimacy as a threat. It benefits from trauma-informed approaches like EMDR or ART.
Erectile Concerns
Frequently psychological in origin, even when it doesn't feel that way.
Erectile difficulties are among the most distressing sexual health concerns men experience, and among the most likely to be addressed only medically, if at all. Medication can help with the mechanics. It doesn't address the anxiety, the relationship tension, or the meaning a man has made of what's happening.
What's Actually Happening
Erection depends on a complex interplay of vascular, neurological, hormonal, and psychological factors. Anxiety alone is sufficient to interfere with arousal, and a single difficult experience can create an anticipatory anxiety cycle that makes future difficulties increasingly likely.
Psychological erectile difficulties often begin with one difficult experience (illness, stress, alcohol, a new partner) and develop a life of their own. The brain starts predicting failure, the body responds to that prediction, and the cycle becomes self-reinforcing. This is a well-understood neurological pattern, not a character flaw.
How I Work With This
I work with men and couples navigating erectile concerns with honesty and without judgment. That means understanding the full picture: what's contributing, what's been tried, what the relationship context looks like, and developing an approach that addresses the actual drivers rather than just the symptom.
For couples, this is relational work as much as individual work. A partner's response, however well-intentioned, can either maintain the anxiety cycle or help disrupt it. I bring both people into that conversation when it's appropriate.
Orgasm Difficulties
More common than people expect —
and more treatable than they assume.
Difficulty reaching orgasm is one of the most common sexual health concerns I see, and one of the least talked about. Most people who experience it have either never mentioned it to a clinician or been told there's nothing to be done. Neither of those things is accurate.
Anorgasmia in Women
Primary anorgasmia (never having experienced orgasm) and secondary anorgasmia (difficulty reaching orgasm that developed after a period of normal functioning) are both common and both respond well to psychological intervention. Contributing factors include anxiety, inadequate stimulation, relationship dynamics, negative beliefs about sexuality, and a history of painful or unsatisfying sexual experiences.
Treatment typically involves a combination of education, anxiety reduction, directed self-exploration, and for couples, communication work around what actually produces pleasure.
Delayed Ejaculation in Men
Difficulty reaching orgasm or ejaculation during partnered sex (sometimes despite having no difficulty alone) is more common than most men realize, and carries a significant amount of unnecessary shame. It is frequently driven by anxiety, performance pressure, pornography-influenced expectations, or relationship factors, and responds well to approaches that address those underlying drivers.
The anxiety patterns that accompany orgasm difficulties (anticipation of failure, self-monitoring during sex, avoidance) are well understood and treatable. Most people see meaningful improvement relatively quickly once the cycle is clearly identified.
Porn & Compulsive Sexual Behaviour
One of the most stigmatised areas I work in.
One of the most misunderstood.
When pornography use or sexual behaviour starts to feel out of control, causing harm to relationships, work, or self-esteem, it's worth exploring what's underneath it. Shame tends to make everything worse and makes it harder to seek help. I approach this work without judgment and without a predetermined moral framework about what healthy sexuality should look like.
What Brings People In
Most people aren't looking to be told they have an addiction. They're looking to understand why a behaviour that started as manageable has started to feel unmanageable, and what to do about it. Common concerns include pornography use that feels compulsive or is interfering with real-life intimacy, a gap between values and behaviour that produces significant shame, and difficulty being present with a partner.
Partners also come in, sometimes alone and sometimes together, to navigate the impact of a partner's behaviour on the relationship and their own sense of self.
How I Work With This
The clinical evidence on compulsive sexual behaviour has moved away from straightforward addiction models toward understanding these patterns as often driven by underlying anxiety, depression, attachment wounds, or dysregulated stress responses. That means the most effective treatment addresses what's underneath the behaviour, not just the behaviour itself.
I don't work from a position that all pornography use is harmful or that abstinence is the only goal. I work from the position that the person in front of me gets to define what they want their relationship with sexuality to look like, and I help them get there. The absence of shame in the clinical relationship is not just nice to have here. It is clinically essential.
Also Within Sexual Health
Other areas I work in —
with the same depth.
Identity & Orientation
Questions around sexual identity and orientation deserve thoughtful, unhurried space. I work with people across the full spectrum of gender identity and relationship structure, without a predetermined framework or agenda about what the answers should be.
Sex After Illness or Injury
Cancer treatment, chronic illness, injury, and major surgery can profoundly affect sexuality and intimacy. I've delivered workshops at cancer centres and worked directly with individuals navigating these transitions, bringing clinical expertise into a space where it's often missing.
Hormonal Changes & Medication
Menopause, contraception, and hormonal treatments can significantly affect desire, arousal, and comfort during sex. Medication side effects, particularly antidepressants, are among the most common and least-discussed contributors to sexual dysfunction. Both are areas I work in regularly.
Intimacy After Relationship Rupture
Infidelity, betrayal, and relationship trauma leave marks on intimacy that don't resolve on their own. Rebuilding, whether in the same relationship or a new one, often requires deliberate work on the patterns, beliefs, and nervous system responses that formed in response to what happened.
Getting Started
These conversations are
hard to start.
Start here.
You don't need a diagnosis, a clear presenting problem, or certainty that therapy is what you need. A brief message describing what's going on is enough. I respond to everything personally within one to two business days.