How is Sex Therapy Better in the 21st Century?

couple in counseling

More than 50 years ago, Masters and Johnson began research on sexuality and sexual dysfunction that laid the foundation for modern sex therapy. Some of their techniques are still being used today.

But today’s researchers have found new ways to view sexuality and innovative ways to treat sexual problems.

Here are some recent developments:


A Canadian clinical psychologist, Lori Brotto, pioneered the use of mindfulness for sexual dysfunction in the early 2000s.

She first encountered mindfulness during her psychology residency working with people engaging in non-fatal self-harm activities.

Simultaneously, she was studying the sexual problems of women who had experienced gynecologic cancer. She saw the groups as similar: both had a damaged sense of self and felt disconnected from their bodies. Brotto wondered: If mindfulness could help people with suicidal thoughts, could it also help cancer survivors feel present during sexual activities?

Brotto developed an intervention whereby patients learned to tune in to erotic sensations, and to integrate the techniques into sexual encounters. In a series of controlled trials, she and her colleagues demonstrated the effectiveness of mindfulness-based sex therapy for people with a range of sexual disorders—including hard-to-treat low sexual desire and arousal.

This kind of therapy is now used worldwide.

Psychotherapy over Medication

Viagra hit the market in 1998. Twenty-three years on, there’s still a big focus on treating sexual problems with drugs.

Pharmaceutical  companies have introduced Viagra competitors, and in 2015, the FDA approved a drug to treat low sexual desire in premenopausal women.

Meanwhile, psychologists have demonstrated that psychological interventions are just as effective—and often more so—than pills in treating sexual problems.

Even when male sexual dysfunction can be treated with a medication like Viagra, a man may have emotional concerns that need to be addressed in order for him to have  satisfactory sexual encounters. Issues of self-esteem, confidence and intimacy can all be part of the picture.

Sexual dysfunction in women is complex. It’s a common saying that “men just need a place to have sex and women need a reason.” That may help explain why sales of Flibanserin (the female Viagra) have been low—and why cognitive behavioral therapy and mindfulness are great choices for women.

Both genders should rule out biological causes of sexual dysfunction. But pharmaceuticals alone won’t cure most sexual disorders. Psychology, culture and relationship are all involved.


Historically, sex therapy has been about heterosexual encounters between one man and one woman—mostly available to higher-income married couples. In recent years, however, sex researchers and therapists are including the full span of human sexuality and gender identity.

The Role of the Couple

Most studies have focused on sexual problems at the individual level. But more and more, researchers are looking at the role of the partnership.

When one partner has sexual dysfunction, it can make sex less pleasurable for their partner. Among heterosexual women who experience pain during intercourse, for example, sympathetic partners might normally stop the encounter. Yet research shows that women with these “solicitous” partners have worse pain and poorer sexual satisfaction compared to women whose partners encourage them to find ways to create sexual intimacy without the painful activity.

These findings are beginning to influence how sex therapists work with clients.


We still have a lot of anxiety around sex culturally in the United States. Popular culture inundates us with ‘good sex’ messages that can create a lot of stress.

Many people still balk at the idea of seeking in-person help for sexual problems. Teletherapy and web-based interventions are helping.