Mental Health and Sexual Health are Connected. (Does Your Therapist and Doctor Know?)

Posted by Joe Kort, Ph.D., LMSW on March 14, 2023 at 12:00 AM
Joe Kort, Ph.D., LMSW

7 minute read

sexual health and mental health are connected

Do you and your therapist feel comfortable discussing sexual health and sexual pleasure in your therapy sessions? If not, do you know why? The answer may surprise you!

Here's a long-running joke among sex therapists that gives you a glimpse into what's going on:

  • Client: “Doctor, you know there are just some things I don't tell you.”
  • Doctor/Therapist: “And I want you to know, Mr. So-and-So, that I really appreciate that.”

Unfortunately, the joke reveals so much about our culture, and some therapists never receive training on how to work with clients about sexual issues.

Because we're pretty uncomfortable talking about sex, including many of our mental health professionals. When sex comes up in a therapy session, many therapists squirm and quickly move the conversation to something else, such as - what sexual health looks like from their point of view and not the client's perspective on the topic. So, you can imagine that the conversation rarely includes erotic pleasure.

As someone who has trained in and practiced sex therapy for more than three decades, not discussing it is a tragedy because it fails to acknowledge sex, sexual identity, and eroticism as central to someone's mental health and general well-being.

The irony of not discussing sex with your therapist is that sex is central to every person's life. Regardless if you're a couple, an individual, celibate or non-sexual, abstinent to hypersexual, or have a high sex drive.

Why Aren't Honest and Open Conversations Happening Between Clients and Therapists About Sexuality? (It's a big part of our lives)

honest and open conversations about sex

Because talking about sexuality—especially pleasure—remains taboo, or, at the very least, it's uncomfortable. Primarily, the mental health field has consciously or unconsciously not included training and teachings on sexual health. Only in the last few years have some clinicians begun to bring the two together. For those therapists untrained in the importance of bringing sexuality into the therapy room, their clients are underserved.

Sadly, even those in the medical field, including gynecologists and urologists, are not trained in sexual health or pleasure.

Why is talking about sex so challenging for many therapists and doctors? In many cases, it's because they are uncomfortable with their own sexuality. Most mental health therapists haven't done the hard work of looking at the following:

  • Their feelings about sexuality
  • Their individual sexual history
  • If they had any sexual abuse
  • What are their sexual judgments, and why do they feel judgmental?

What remains - many therapists with unexamined biases about what erotica should be and what it should look like in their opinion. For example, to address a client's sexual nature, the therapist must learn to manage their own strong response. Training is required to maintain an unconditional attitude in the face of personally challenging information.

The goal is to protect clients from their therapist's experiences and feelings around sexuality. It's also to help clients get it right for themselves and further explore their own erotic thumbprint. Such as does the client:

Then, explore the sexual code of the client and the therapist individually. So, the therapist can focus on allowing the client to feel they are permitted to fully explore and fully understand that every person has their own sexual identity and erotic identity.

What are the Nuances Within Healthy Sex and Sexual Health?

sexual health and healthy sex nuances

Words matter! Words make a significant difference in the health of ourselves and others.

In Sex Therapy, we do not use the term “healthy sex” because that implies there is unhealthy sex. Of course, this has only to do with consent. Non-consent isn't about sex but power, control, and removing someone's agency.

The term sex-positive” is what we use in sex therapy. It's vital to understand this isn't like saying anything goes.” Sex-positive is simply about being positive and letting clients learn they can allow themselves permission on what they define as erotic and sexual health.

One of the Sex Therapists' goals is to help clients go from trauma to triumph. We do this by not automatically pathologizing someone's sexual and erotic interests, as it's nearly impossible for any therapist to help a client triumph over sexual trauma if they don't know what that specific client defines as their own sexual health.

What is Sexual Orientation Vs. Erotic Orientation?

sexual orientation vs. erotic orientation

The first thing to know is that there's a difference between sexual orientation and erotic orientation.

  • Sexual orientation is who you're attracted to
  • Erotic orientation is what you get off on, such as fantasies, turn-ons, etc.

Sexual Orientation Doesn't Always Align with Fantasies.

For example:

  • Straight Men, even though you identify as such, it does not mean your preferences, behavior, and fantasies will be that of women. Some fantasies or turn-ons may include that of men.
  • Straight women, your fantasies may include some women and not all men.
  • Gay men, your fantasies may include women and not men.
  • Lesbians, you may feel turned on by a straight man.

The same school of thought applies to any sexual orientation or erotic orientation, they do not always align. Therefore, therapists must not view clients who come in feeling sexual shame or low self-esteem regarding confusion about how they self-identify and who they are attracted to as if something is wrong with them.

If the client asks the question(s):

  • “What's wrong with me?”
  • “Am I damaged?”

That is the exact moment when therapists can help clients heal and discover more about themselves in terms of the nuances of sexual orientation and erotic orientation.

Because our culture doesn't openly talk about sex, therapy clients often come in feeling depressed, anxious, and ashamed without knowledge about the difference between sexual orientation and erotic orientation. What they are seeking is a sense of safety, health, and well-being; they shouldn't need to justify how they think and feel about sex to an expert.”

Mental Health and Sexual Health Discussions: The Words we use Matter!

words matter in sexual health and mental health

For more than 20 years, I was a Sex Addiction Therapist, and there was NO TRAINING in all-around sexual health. So, I helped clients understand their traumas and out-of-control behaviors, but I couldn't help them understand what sexual health meant. I have since rejected much of what I learned as a sex addiction therapist since it did not help me work with clients on sexual pleasure and was not sex-positive.

In order to help clients shift their self-perception about desires and erotic orientation, the first words we use with them are about “sexual health.” Simply by changing the words used when we speak about sex with clients can help them remove some of the long-built-up shame and confusion.

Here's an example of small word shifts that make a HUGE impact. Using the terms “sex work” vs. a loaded word such as prostitution. Much too often, therapists are uncomfortable about work centered around sex, so they want to label it as “exploitative.”

If the work is exploitative, one should share they are being exploited, such as underage sex work, migrant sex work, or human trafficking - use those specific terms vs. a generic term that does not apply to all. There must be room for terms that apply to all types of sex work - not old terminology established in the late 16h Century.

Important Consensual Terms That Need to be Used

Consensual Sex Terms

  • Sexual Imagery vs. Pornography: Instead of saying “pornography,” we can talk about sexual imagery in the field, such as erotic media, sexually explicit material, erotica, etc.
  • Cliterature and Masturbation: Many women masturbate because graphic romance novels turn them on. So, the term “cliterature” was created to eliminate any shame.
  • Watching Porn vs. Using Porn: I also must make the point here that porn is not the problem. Lots of good research shows that the problem is porn illiteracy. That is, porn stars are actors and usually more generously endowed than regular folks, and thinking that what one sees on screen is authentic, that this is how sex is supposed to look, can be harmful. Instead of saying someone is using porn, we say they are watching porn.
  • Is Kink Harmful? Being into kink” is not a diagnosis. People in the mental health field automatically think that if you're into kink, you must've had some bad childhood or trauma. It might be true, but not for someone who's been vanilla. Sex therapists know the research on kink as its own erotic orientation, and some people have their own erotic identities around this.
  • Alternative Lifestyle vs. Community: For the LGBTQ+ community, we never say alternative lifestyle.” Instead, we say community.” The term alternative lifestyles” can be used for swingers, kink, fetish, and BDSM.
  • Monogamy, Non-monogamy, and Polyamory: Most therapists see all of this as sexualized and cheating. Cheating, however, is when there is a break in the agreement, not just having an open relationship. Most people with open relationships have many agreements, dialogue, and discussions. When someone tells me they're monogamous, I ask them, “Have you negotiated your monogamy?” They may not have and don't think they have to, but they do. All agreements must be made clear.

*We Need to Move Away From Terms That are Harmful to Others and Ourselves*

*We Need to Move Away From Harmful Thinking*

The bottom line is that therapists genuinely want to help their clients get rid of shame, their mental health fight, and the struggle around sexuality.

Therapists want clients to embrace the following:

  • Who you are
  • What you are
  • What you're into

The most important quote I've learned as a sex therapist and a mental health therapist is:

“If you go to war with your sexuality, you'll lose and end up in more trouble than before you started.”

There's hope for change in therapy around the connection between sexual health and mental health! Increasingly more and more therapists are understanding these two areas are KEY to a person's health and well-being and must be openly discussed to help clients live authentically and fully.

If you are struggling with mental health, sexual health, and connecting with your doctor or therapist, we are here to help.

Check out our virtual and in-person Imago Relationships Workshops and Imago Relationships Therapy.

Discover more about Imago with our Imago Professional Membership, Imago Professional Facilitators, Imago Professional Training, and Imago Educational Webinars.

Connect. Transform. Thrive.


This blog post was written by Joe Kort, Ph.D., LMSW, Imago Certified Relationship Therapist and AASECT Certified Sex Therapist & Supervisor of Sex Therapy.

Joe is a leading expert on sex and relationships. He specializes in Out-of-Control Sexual Behaviors (OCSB)/“sex addiction,” Relationship Problems and Marital Conflict, Sex Therapy, Sexual Identity Concerns, Depression, Anxiety and Post Traumatic Stress Disorder (PTSD). His practice is located in Royal Oak, Michigan, and he welcomes clients from all over the Metro Detroit area. Joe is also available for long-distance coaching and consultation. His practice is mixed with straight, gay, lesbian, bisexual, and transgender individuals and couples.

Joe graduated from Michigan State University with dual Psychology and Social Work majors. At Wayne State University, he earned his Master's in Social Work (MSW), then a Masters (MA) in Psychology, and has received his Doctorate (Ph.D.) in Clinical Sexology from the American Academy of Clinical Sexologists (AACS).

In addition, Joe is also the founder and director of The Center for Relationship and Sexual Health (his associate's biographies can be found here), teaching faculty at the University of Michigan Sexual Health Certificate Program, a Board Certified Sexologist, a member of the Academy of Certified Social Workers, a member of the National Association of Certified Social Workers, a member of EMDRIA Eye Movement Desensitization and Reprocessing (EMDR) Basic Training, and a licensed clinical social worker in the state of Michigan.

Joe has also written a book to help couples and individuals on called Erotic Orientation: Helping Couples and Individuals Understand Their Sexual Lives.

Topics: Sex Therapy, Sex Myths, Relationship Therapy, Erotic Intelligence, Sexual Desire, Sexual Trauma, Erotic Language, Sexual Communication, Sexual Identity, therapy, Monogamy Agreement, Sexual Pleasure, Sex Issues, Sex Therapy 101, Sexual Problems, Sex Problems, Sexual Health, Sex Education, Sex Positive, Trauma Therapy, Consensual Nonmonogamy, Sexual Intimacy, Erotic Orientation, sexual orientation, Kink, Erotic Identity

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