Frequently Asked Questions: Online Sex Therapy & Intimacy Counseling

General Questions about Sex Therapy

  • Sex therapy is a specialized, evidence-based form of psychotherapy designed to address personal, physical, relational, and psychological concerns surrounding sexuality, sexual function, and intimacy.

    As Doctors of Clinical Sexology and AASECT Certified Sex Therapists, Dr. Ashley Sweet, PhD and Dr. Danielle Armour, PhD utilize talk-based therapeutic modalities—including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), somatic approaches, and Emotionally Focused Therapy (EFT). Sessions focus on identifying root causes, improving communication, processing trauma, and providing practical, personalized guidance for individual or relational growth.

  • No. Sex therapy is strictly talk therapy. There is never any physical touch, body exposure, or physical examination involved during sessions or between clinicians and clients.

    When physical symptoms are present (such as pelvic pain, erectile issues, or hormonal imbalances), we work collaboratively with medical professionals—including pelvic floor physical therapists, gynecologists, urologists, and endocrinologists—to ensure you receive holistic, multi-disciplinary care. Home practice suggestions ("homework") may involve non-demand touch exercises, mindfulness, or communication tools practiced privately in the comfort of your home.

  • While general talk therapy addresses broader mental health challenges like depression or daily anxiety, specialized clinical sexology and AASECT-certified care focus directly on the complex interplay between physical sexual function, emotional intimacy, relationship dynamics, body shame, and reproductive health.

    If your primary concern involves sexual pain, desire mismatches, orgasmic difficulties, purity culture deconditioning, or navigating non-monogamy, working with a credentialed sex therapist ensures you receive non-judgmental, scientifically grounded care.

  • An AASECT Certified Sex Therapist (CST) is a licensed mental health professional who has completed extensive post-graduate clinical training, supervision, and rigorous certification requirements specifically in human sexuality, sexual dysfunctions, and relationship dynamics. While general therapists receive minimal to no formal coursework in sexual health during graduate school, AASECT Certified Sex Therapists possess specialized expertise to treat complex sexual pain, desire conflicts, trauma, and identity exploration directly and effectively.

  • The duration of sex therapy varies depending on your specific goals, the complexity of the concern, and your engagement outside of sessions, but many clients notice meaningful shifts within 8 to 12 sessions. Highly focused concerns like performance anxiety or sex education gaps may resolve relatively quickly, whereas long-standing pelvic pain, severe trauma, or deep-seated purity culture deconditioning often involve longer-term work.

  • No, you do not need a referral to begin therapy with us. Because SWELL Co., LLC operates as a direct-pay, out-of-network practice, you can schedule an initial consultation or intake session directly with our team at any time without pre-authorization or a physician’s referral.

    However, many of our clients are referred to us by medical specialists—such as pelvic floor physical therapists, OB-GYNs, urologists, or primary care providers. This often happens when a medical team identifies that pelvic pain, muscle tightness, erectile challenges, or sexual dysfunction has an underlying psychological, somatic, or relational component that medical interventions alone cannot fully resolve.

Clinical & Sexual Health FAQs

  • Vaginismus is an involuntary contraction or spasm of the pelvic floor muscles that makes vaginal penetration, intercourse, or pelvic exams painful or impossible. Yes, specialized sex therapy is highly effective in treating vaginismus by addressing the underlying fear-avoidance cycle, anxiety, and somatic muscle guarding. Working alongside pelvic floor physical therapists, AASECT Certified Sex Therapists use gradual desensitization, somatic awareness, and cognitive exercises to help clients retrain their nervous system and achieve comfortable, pain-free penetration.

  • Pain during intercourse (dyspareunia) can stem from physical causes like pelvic floor muscle tension, endometriosis, or vulvodynia, as well as psychological factors like stress, past trauma, or sexual anxiety. When the body anticipates pain, pelvic muscles reflexively tighten, creating a cycle of pain and muscle guarding. A specialized sex therapist helps identify the physical, relational, and emotional roots of sexual discomfort while guiding you through somatic exercises to restore ease and pleasure.

  • Desire discrepancy (when one partner desires sex more or less frequently than the other) is one of the most common reasons couples seek therapy.

    We help couples move away from blame, guilt, and dynamic standoffs. Together, we explore responsive vs. spontaneous desire, identify emotional or lifestyle barriers, improve erotic communication, and broaden the definition of intimacy so both partners feel valued and fulfilled.

  • Purity culture trauma and rigid religious upbringing can leave lasting impacts, including deep-seated guilt, sexual anxiety, body dissociation, and difficulty experiencing pleasure—even within committed adult relationships.

    Our practice provides a safe, affirming space to evaluate inherited beliefs, separate personal values from fear-based conditioning, reclaim bodily autonomy, and foster healthy, shame-free pleasure.

  • Traditional sex education focuses primarily on reproduction, anatomy, STI prevention, and risk avoidance, whereas pleasure education focuses on arousal dynamics, somatic awareness, boundary setting, and sexual satisfaction. Pleasure education fills critical knowledge gaps by teaching individuals how their unique nervous system responds to touch, how to navigate sexual communication, and how to cultivate satisfying intimate experiences free from performance pressure.

  • Vulvodynia is chronic, unexplained pain or burning localized around the vulvar opening (including the labia, clitoris, and vaginal introitus) lasting at least three months without an identifiable active infection or neurological disease. It can be provoked (triggered by touch or pressure) or unprovoked (spontaneous burning or stinging). Specialized sex therapy helps manage vulvodynia by addressing nerve hypersensitivity, reducing the emotional distress and sexual anxiety that exacerbate symptoms, and introducing pacing techniques to rebuild sexual confidence without triggering pain.

  • Hypoactive Sexual Desire Disorder (HSDD) is characterized by a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. Unlike situational low desire—which can stem from stress, fatigue, or relationship conflict—HSDD reflects an imbalance in the brain's sexual excitation and inhibition systems. Sex therapy treats low desire by evaluating neurobiological, hormonal, and relational dynamics, helping clients shift from expecting spontaneous desire to cultivating responsive desire in low-pressure environments.

  • Anorgasmia is the persistent difficulty, delay, or inability to achieve orgasm despite adequate sexual stimulation and arousal. It can be primary (never having experienced an orgasm), secondary (previously able, but currently unable), or situational (occurring only under specific conditions or with specific partners). Root causes often include performance anxiety, spectatoring (monitoring oneself during sex), cultural or religious shame, medication side effects (such as SSRIs), or lack of accurate clitoral/pleasure education. Sex therapy utilizes mindfulness-based sex therapy, targeted body mapping, and communication tools to help clients bypass overthinking and access bodily climax.

  • Erectile Dysfunction (ED) and Premature Ejaculation (PE) are common sexual performance concerns that often carry a heavy burden of performance anxiety, shame, and avoidance. While medical evaluation rules out cardiovascular or hormonal factors, psychological ED and PE are primarily driven by sympathetic nervous system overload (the "fight-or-flight" response during intimacy). Sex therapy provides practical behavioral techniques, non-demand sensual touching frameworks (like Sensate Focus), and cognitive tools to down-regulate the nervous system, eliminate pressure, and restore sexual confidence.

  • Sexual aversion disorder involves a severe, persistent fear, disgust, or emotional avoidance of genital contact or sexual intimacy. It frequently develops as a protective mechanism following sexual abuse, assault, medical trauma, or severe purity culture conditioning. Pelvic guarding occurs when the somatic nervous system holds trauma memory directly in the pelvic musculature, leading to reflexive clenching whenever intimacy is initiated. Sex therapy provides a slow, trauma-informed roadmap to heal the nervous system, re-establish firm bodily boundaries, and rebuild a sense of safety and agency.

Appointments, Telehealth & Licensing

  • Individual therapy sessions are $225 for a 50-minute session. Couples/Relational therapy sessions are $265. Pricing for coaching and consultation services varies—please reach out directly for more information.

  • Our practice operates as an out-of-network provider. We do not bill insurance companies directly. Payment is due at the time of service.

    Upon request, we can provide you with an itemized monthly superbill (receipt of health services) that you may submit to your insurance company for potential out-of-network reimbursement, depending on your plan's mental health benefits. We encourage you to contact your insurance carrier directly to inquire about out-of-network teletherapy coverage.

  • No, we do not offer sliding scale rates at this time for therapy, but we commonly offer low or no-cost worksheets, workshops and speaking engagements. Follow our social media or subscribe to our mailing list to learn more about these offerings.

  • Telehealth laws require therapists to be licensed in the state where the client is physically located at the time of the appointment:

    • Dr. Ashley Sweet, PhD: Accepts clients physically located in Maine (ME), Massachusetts (MA), Vermont (VT), Connecticut (CT), Virginia (VA), and Florida (FL).

    • Dr. Danielle Armour, PhD: Accepts clients physically located in Maine (ME), New Hampshire (NH), Massachusetts (MA), Vermont (VT), Connecticut (CT), Virginia (VA), and Florida (FL).

  • All sessions take place through a secure, confidential, HIPAA-compliant video portal. You can participate from the comfort and privacy of your home, office, or private location using a computer, tablet, or smartphone with a stable internet connection.