Sex Therapy

Most people who find their way to this page have been carrying something alone for a while. A question they haven’t known how to ask. A concern they’ve minimized or pushed aside. Something about their sexual experience that has felt too private, too complicated, or too loaded to say out loud.

Maybe desire has quietly disappeared and you don’t know why. Maybe something shifted – hormonally, physically, relationally – and what used to feel natural no longer does. Maybe you’ve never fully connected with your own sexuality and you’re only now giving yourself permission to look at that. Maybe sex has started to feel like pressure, obligation, or something you dread rather than something you want.

Or maybe you’ve spent years wondering if something is wrong with you. Most people find they’re far more normal than they imagined – and that there’s usually a story underneath worth understanding. That’s where the work begins.

Who Comes to Sex Therapy

Both individuals and couples. Some people come alone – wanting to understand their own desire, their relationship to their body, their sexual history, or something they’ve never felt safe enough to explore. Some come as a couple when the sexual piece of the relationship has become complicated, loaded, or simply absent.

You don’t have to have it figured out to start. You just have to sense that something could be different – more alive, more connected, more honest, more you.

What’s Actually Going On

What looks like a sexual problem is rarely just about sex.

Desire doesn’t disappear randomly. Arousal doesn’t shut down without reason. Pain, avoidance, disconnection, and lost desire are almost always telling a story – about stress, resentment, changing bodies, relational patterns, burnout, the ways we learned to take care of everyone except ourselves, and sometimes old experiences that never fully healed. For couples, that story often shows up as a recognizable dynamic: one person pursuing while the other withdraws, pressure building on one side and shutdown on the other, resentment quietly reshaping attraction before anyone has named what’s happening. For individuals, the picture is different but the principle is the same – desire is shaped by everything, including history, identity, stress, biology, and the stories we’ve absorbed about who we’re supposed to be sexually and what we’re allowed to want.

Understanding that story is where things start to shift.

What We Work On

Why don’t I want sex anymore? Low or absent desire is one of the most common concerns I see and one of the most misunderstood. Desire doesn’t just switch off – there’s almost always a reason underneath, whether that’s stress, hormones, relational distance, resentment, burnout, or something older. We slow things down to understand what’s actually driving it, because that’s what changes things rather than just managing the symptom.

We love each other but have mismatched libidos. Desire differences between partners can quietly reshape an entire relationship – who initiates, who avoids, who feels rejected, who feels pressured. We work on understanding the dynamic between you, not just negotiating the numbers. That means looking at what each person is bringing to the equation and what’s built up between you over time.

I can’t orgasm – or I used to be able to and now I can’t. Difficulty with orgasm is incredibly common and rarely talked about honestly. We look at what’s getting in the way – whether that’s anxiety, insufficient stimulation, disconnection from your body, relational tension, or something else – and work toward change practically and without pressure.

Sex is painful or uncomfortable. Physical pain during sex has both physical and psychological dimensions and rarely resolves with medical treatment alone. I work on the psychological and relational piece – the anxiety that builds around anticipated pain, the avoidance patterns that develop, the way intimacy can start to feel unsafe even after the physical issue has been addressed – and collaborate with gynecologists, pelvic floor physical therapists, and other medical providers for the physical piece.

I worry about how things will go. The anxiety that builds around sex – about whether your body will cooperate, about disappointing a partner, about initiating and being turned down – can become its own obstacle. We understand where that anxiety is coming from and work on creating conditions where sex feels less like a performance and more like something you can actually be present for.

I have desires or questions I’ve never talked about. Things you’ve never said out loud because you weren’t sure how they’d land. Curiosities you’ve pushed aside. Questions about who you are sexually and what you actually want. Nothing is off the table here and nothing will shock me.

Something feels out of control around sex. When sexual behavior feels secretive, compulsive, or at odds with your values, that’s worth exploring carefully – without shame and without judgment.

Past experiences are affecting intimacy now. Old experiences – including ones that were never labeled as trauma – can shape how safe your body feels in intimacy. We go slowly and carefully here, at whatever pace feels manageable.

Midlife, Menopause, and Intimacy Changes

This is territory I know well and work in specifically.

Perimenopause and menopause can change desire, arousal, physical comfort, body image, and the entire experience of intimacy – sometimes gradually, sometimes all at once. Many women arrive feeling confused by what’s happening in their bodies, or quietly grieving a version of their sexuality they’re afraid is gone.

It isn’t gone. But it may need to be rediscovered on different terms.

Men experience their own version of this too – shifting testosterone, changing arousal patterns, concerns about erections, a body that no longer responds the way it once did. These changes are real and worth addressing directly rather than pushing aside.

Bodies change throughout adulthood and sexuality changes with them. That’s not the end of a sexual life. For many people it’s the beginning of a more honest one.

What Sex Therapy Actually Looks Like

Sex therapy is talk therapy. Nothing physical happens in session and nothing is required of you that feels unsafe or uncomfortable.

What does happen is that we talk – openly, directly, and without the shame or avoidance that usually surrounds these conversations. Many people tell me it’s the first time they’ve spoken honestly about their sexual experience with anyone.

Beyond the conversation itself, I often suggest structured exercises to do outside of session – not homework in the graded sense, but guided experiences designed to help you reconnect with your body, rebuild intimacy gradually, or practice something we’ve been working on together. This might look like structured touch exercises that take the pressure of performance off entirely, specific ways of communicating with a partner about desire and boundaries, or simply paying attention to what conditions help you feel more open and available. These aren’t things you’re left alone to figure out – we debrief them together and adjust as we go.

I often think about sexuality like a menu. When relationships are new we tend to explore widely – trying things, staying curious, discovering what we like. Over time most couples narrow that menu down to a handful of familiar options. Then bodies change, life gets complicated, and even those options start to feel harder to reach. Part of the work is asking: what’s on your menu now? What could be? What have you never brought up because you didn’t know how?

For individuals the same question applies – just turned inward. What do you actually want? What would your sexual life look like if you designed it for yourself rather than around everyone else?

How I Work

I’m Dr. Kristin Zeising, a licensed clinical psychologist and AASECT certified sex therapist with 23 years of experience helping adults and couples navigate desire, intimacy, and sexual wellbeing.

AASECT certification requires specialized training and supervised clinical hours specifically in human sexuality – it’s a meaningful distinction in a field where anyone can claim to do this work.

I’m direct. I use clinical language without being cold or distancing. I won’t flinch at what you bring in and I won’t make you feel like you should have kept it to yourself. I also work collaboratively with medical providers when the picture calls for it -gynecologists, urologists, pelvic floor physical therapists, prescribing NPs – because sexual health doesn’t exist in isolation from physical health.

I work via Zoom with clients throughout California and am also licensed in Florida, Idaho, and Vermont. I see clients internationally as well, including through a virtual office in Hong Kong. Sessions are 50 minutes.

Questions People Ask Before They Call

Is what I’m experiencing normal? Almost always yes – or at least far more common than you’d think. Most of us learned about sex from incomplete or inaccurate sources and have been filling in the gaps with worry ever since. One of the most quietly powerful things that happens in this work is realizing that what you’ve been carrying alone is actually quite human.

What’s the difference between a sex therapist and a regular therapist?

A certified sex therapist has specialized clinical training in human sexuality beyond standard therapy licensure. Most therapists aren’t trained to address sexual concerns directly – they may acknowledge the issue but won’t go there clinically. I’m AASECT-certified, which is the gold standard credential in the field. You won’t be redirected elsewhere for this part of the work.

Does sex therapy work online?

Yes. All sessions are via telehealth on Zoom. Online sex therapy is equally effective as in-person for the issues most people bring – desire, intimacy, sexual concerns, and relationship dynamics.

Why don’t I want sex anymore? The most common question I hear. The answer is almost never “something is wrong with you.” Desire is shaped by stress, hormones, relationship dynamics, body changes, emotional history, and more. Finding out what’s actually going on is the first step.

How often should we be having sex? There’s no right number. What matters is whether both people feel satisfied – not whether you’re hitting some imaginary benchmark. Usually the question underneath this one is about feeling wanted, connected, or understood. That’s what we actually work on.

Can you fix my partner? No. And any therapist who tells you they can is misleading you. What sex therapy can do is help both people understand what’s happening and find a way forward together. Usually both partners have something to look at – not just the one who got dragged in.

Why can’t I orgasm? Difficulty with orgasm is incredibly common – especially for women – and rarely talked about honestly. There are many reasons it happens and most of them are addressable. You don’t have to keep pretending it’s fine or assuming it’s just how you’re made.

Are my fantasies okay? Almost certainly yes. Having fantasies – including ones that surprise or confuse you – is completely normal. Thinking about something doesn’t mean you want to do it. This is a space to explore those questions without judgment.

Can menopause affect desire and intimacy? Yes, significantly. Hormonal shifts, physical changes, and the psychological weight of midlife transitions all affect sexuality in real ways. This is one of the most underaddressed areas in women’s healthcare and one I work with specifically.

Do I need to come with my partner or can I come alone? Either. Some of the most important sexual work happens individually – understanding your own desire, your own body, your own history – before or alongside couples work.

What if I’m embarrassed to talk about this? You probably will be, at least at first. That’s expected. Most people find the embarrassment fades quickly once they realize nothing they say will shock me. I’ve heard it all – and I mean that in the most reassuring way possible.

Ready to Talk?

I offer a free 15-minute consultation – enough time to get a sense of how I work and whether this feels like the right fit.

Dr. Kristin Zeising, PsyD, CST | Licensed Clinical Psychologist | AASECT Certified Sex Therapist | San Diego, CA | Telehealth via Zoom