Online sex therapy usually begins with an intake session where the therapist asks about your concerns, goals, relationship history, relevant medical or mental health history, and what you hope will change. You do not have to share every detail right away. Many people begin with broad concerns and become more specific as trust develops.
Sessions are conversation-based. Your therapist may help you identify patterns, talk through difficult emotions, improve communication with a partner, reduce shame, build confidence, or better understand how stress, trauma, anxiety, body image, health changes, or relationship dynamics may be affecting intimacy.
If you attend with a partner, sessions may include guided conversations about expectations, desire, boundaries, emotional safety, trust, and communication. If you attend individually, therapy may focus on your own experiences, beliefs, fears, needs, identity, or relationship patterns.
Some therapists may suggest between-session reflection, communication exercises, mindfulness practices, journaling, or non-explicit intimacy-building exercises. Any suggested practice should be collaborative, consent-based, and appropriate to your comfort level.
Because some sexual concerns can involve medical factors, a sex therapist may also encourage you to speak with a physician, gynecologist, urologist, pelvic floor physical therapist, psychiatrist, or other healthcare provider when symptoms may benefit from medical evaluation or coordinated care.