# Counseling and sex therapy for ED: what the studies show

> Sex therapy for ED is talk-based therapy, often with a partner, that works on anxiety, unhelpful beliefs and avoidance. Small trials found group therapy helped more men than a waiting list, and therapy added to an ED medicine often did better than the medicine alone. A licensed, AASECT-certified therapist is one place to start.

_Last updated: 2026-10-17_

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**In short:** counseling for erectile dysfunction is a conversation-based
treatment, sometimes [with a partner](/talking-to-your-partner-about-ed/) in the room, that works on the thoughts,
worries and relationship patterns that can keep ED going. Sex therapy is a
specialized form of psychotherapy that goes deeper. The research behind it is real but modest: the trials
are mostly small and some are decades old. Taken together, they suggest that
therapy helps some men on its own and that adding it to an ED medicine tends
to do better than the medicine alone. This page covers what a course of
counseling involves, what the trials actually measured, and how to check a
therapist's training.

| Type of help                  | Who usually provides it                         | What the studies show                                                                                        |
| ----------------------------- | ----------------------------------------------- | ------------------------------------------------------------------------------------------------------------ |
| Counseling                    | A counselor or other mental health professional | Support, guidance and limited advice; a first level of help                                                  |
| Sex therapy (often CBT-based) | A therapist with sex therapy training           | Group psychotherapy beat a waiting list in pooled small trials                                               |
| Couples sex therapy           | A therapist working with both partners          | Added to an ED medicine, improved both partners' satisfaction in one small trial                             |
| Therapy plus an ED medicine   | A therapist and a prescriber together           | Better than either alone for ED symptoms in a 2014 meta-analysis of 8 studies                                |
| Internet-based sex therapy    | A therapist working online, with homework       | One randomized pilot reported benefit for ED, with a borderline main result; dropout was high in one program |

## What is sex therapy for erectile dysfunction?

Sex therapy is a type of psychotherapy that focuses on sexual experiences, and
for ED it targets the psychological and relationship side of the problem. The
European Society for Sexual Medicine (ESSM) draws a line between counseling,
which gives support, guidance and limited advice to help a man manage ED, and
psychotherapy, which looks at long-running, recurring emotional and thinking
patterns;
it places sex therapy within psychotherapy
([Dewitte et al., ESSM position statements, 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).
The same statements note there is no clear evidence on which type of
psychological treatment suits which type of ED, so most research is reported
as "psychological treatment" in general.

Counseling is part of the standard menu, not a fringe option. The NIH's
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists
it alongside lifestyle changes and medicines, and says a health care
professional may suggest it when mental health or emotional issues are
affecting ED
([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)).
For the full list of options, see our overview of
[ED treatment options](/ed-treatment-options).

## What happens in counseling for ED?

Counseling usually moves in steps, starting with talk and information and
going deeper only if needed. ESSM recommends the PLISSIT model: the therapist
first gives permission to talk openly, then limited information about what is
going on, then specific suggestions such as homework assignments, and finally
intensive therapy when deeper underlying issues are involved
([Dewitte et al., 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).

The building blocks ESSM lists for a typical program include:

- **Education** about how erections and ED work, so both partners understand
  the problem and can talk about it more comfortably.
- **Anxiety reduction**, often through sensate focus: a graded series of
  touching exercises in which intercourse is set aside for a while and
  brought back step by step.
- **Cognitive work** that tests unhelpful beliefs and unrealistic
  expectations, such as the idea that sex always has to be perfect.
- **Couple work** on communication: what ED means to each partner and how any
  medical aids fit into the couple's sex life.

ESSM also advises checking early whether the push for treatment is coming from
you, your partner or the relationship, and tackling unrealistic expectations,
to help prevent dropping out and dissatisfaction
([Dewitte et al., 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).
If anxiety about performance is the main issue, our guide to
[working through performance anxiety](/overcoming-performance-anxiety) goes
deeper on CBT and sensate focus.

## What did CBT and couples-therapy trials find?

The trials lean in favor of therapy, but they are small and of mixed quality.
A Cochrane review pooled 11 trials with 398 men. In five of them, group
psychotherapy cut the number of men whose ED persisted compared with a waiting
list, and the benefit held at six months in the trials that followed men that
long; therapy compared with injections or vacuum devices showed no difference
([Melnik et al., Cochrane, 2007](https://pmc.ncbi.nlm.nih.gov/articles/PMC8852803/)).

A systematic review of 20 controlled trials in men with sexual dysfunctions (ED
and others, such as premature ejaculation) found that psychosocial treatments
improved sexual function overall, that 12 of the 20 used either a
Masters and Johnson style program or CBT, and that most approaches worked about
equally well. It also flagged the rather low methodological quality of the
studies, and noted that one trial found therapy did better than sildenafil
while another found sildenafil did better
([Berner and Günzler, J Sex Med, 2012](https://pubmed.ncbi.nlm.nih.gov/23088533/)).
A wider meta-analysis across all sexual dysfunctions found psychological
treatment beat a waiting list, but said the strongest evidence was for two
conditions in women and more research was needed for the rest, ED included
([Frühauf et al., Arch Sex Behav, 2013](https://pubmed.ncbi.nlm.nih.gov/23559141/)).

Couples trials point the same way. In a randomized pilot of 53 couples where
the man had psychogenic ED, after four weeks 48% of men given sildenafil plus
CBT-based sex therapy met the study's success mark for erectile function,
against 29% on sildenafil alone
([Banner and Anderson, J Sex Med, 2007](https://pubmed.ncbi.nlm.nih.gov/17627724/)).
A pilot from Seattle randomized couples to sildenafil alone or sildenafil plus
brief couple sex therapy and reported support for the combined approach in men
whose ED had mixed causes
([Aubin et al., J Sex Marital Ther, 2009](https://pubmed.ncbi.nlm.nih.gov/19266381/)).

## Can therapy be combined with ED medicine?

Yes, and the combination has the best support of anything on this page. A 2014
meta-analysis of 8 studies with 562 men found combined treatment worked better
for ED symptoms than either an ED medicine or psychological treatment alone,
and better than the medicine alone for sexual satisfaction. The medicine and
therapy on their own did about equally well. The authors called the combination
promising but said stronger trials are needed
([Schmidt et al., J Sex Med, 2014](https://pubmed.ncbi.nlm.nih.gov/24641632/)).

The added value often shows up beyond the erection itself. In a small Italian
trial of 30 couples, vardenafil alone and vardenafil plus CBT-based sex therapy
both improved erectile function, but only the combined group saw gains in both
partners' sexual satisfaction
([Boddi et al., Andrology, 2015](https://pubmed.ncbi.nlm.nih.gov/26311340/)).
A follow-up of 20 men in Pakistan 15 to 18 months after treatment found those who had CBT
alongside their medicine kept improving, while those on medicine alone did not;
the authors note dropouts limit how far this can be generalized
([Khan et al., J Sex Med, 2019](https://pubmed.ncbi.nlm.nih.gov/30770073/)).

Sticking with treatment is part of the reason. ESSM cites research that more
than half of couples are no longer sticking with medical aids for erections
after the first year of treatment, and it rates combined medical and psychological treatment as more
effective than either alone
([Dewitte et al., 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).
The American Urological Association (AUA) guideline says that for men being
treated for ED, referral to a mental health professional should be considered
to promote treatment adherence, reduce performance anxiety and integrate
treatments into a sexual relationship. That is a moderate recommendation
resting on grade C evidence, meaning the guideline panel has low certainty in
the underlying studies
([AUA Erectile Dysfunction Guideline, Statement 6]()).
Whether a medicine fits you is a prescriber's decision.

## Does online sex therapy work for ED?

It may, though the evidence is early. In a randomized pilot, 98 men took part
in an internet program based on sensate focus and cognitive restructuring, with
no face-to-face contact, compared with a waiting list. The authors concluded it
worked for ED, though the main comparison with the waiting list fell just short
of the usual cutoff for statistical significance; for premature ejaculation it
was no better than waiting
([van Lankveld et al., J Sex Med, 2009](https://pubmed.ncbi.nlm.nih.gov/19493295/)).
ESSM rates internet-based therapy as promising, notes that it can get around
shame, cost and distance, and points out that dropout was high in one program
([Dewitte et al., 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).
Premature ejaculation has its own evidence base; see our guide to
[premature ejaculation treatment](/premature-ejaculation-treatment).

## Does a partner have to take part?

No, but it often helps when there is a willing partner. ESSM recommends
including the partner where possible, because positive involvement helps solve
the problem and keep treatment going, and because partners may need support of
their own: ED can leave them feeling unattractive, guilty or rejected
([Dewitte et al., 2021](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/)).
NIDDK notes that a counselor may ask you to bring your partner to sessions
([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)).
One of the group-therapy trials in the Cochrane review enrolled only men
without a steady partner, so therapy is not only for couples
([Melnik et al., 2007](https://pmc.ncbi.nlm.nih.gov/articles/PMC8852803/)).

## How do you find a qualified therapist?

Start with a referral from the clinician treating your ED, then check the
therapist's license and training. The American Association of Sexuality
Educators, Counselors and Therapists (AASECT) describes its certified sex
therapists as licensed mental health professionals who have specialized in
sexual concerns
([AASECT, Certified Sex Therapist](https://www.aasect.org/aasect-certified-sex-therapist-0)).

To be certified, AASECT requires that a therapist:

- holds a state license to practice psychotherapy independently in
  psychology, medicine, social work, counseling, nursing or marriage and family
  therapy;
- has at least 90 hours of sexuality education and 60 hours of sex therapy
  skills training, plus couples counseling training if they have not had it
  already;
- has completed at least 50 hours of supervision with an AASECT-certified
  supervisor over at least 18 months, covering 300 hours of treating clients
  with sexual concerns;
- has read AASECT's code of conduct for certified members, and renews certification every three
  years.

Those details come from AASECT's published requirements
([AASECT, Sex Therapist Certification Requirements](https://www.aasect.org/aasect-requirements-sex-therapist-certification)).
AASECT keeps a referral directory on its website, searchable by country or
U.S. state
([AASECT, Referral Directory](https://www.aasect.org/referral-directory)).
Certification is one useful signal, not the only one: a licensed psychologist
or counselor with experience in sexual problems can also help. When you first
contact someone, it is reasonable to ask whether they work with ED, whether
they see couples, and whether they offer sessions online. Our guide to
[talking to a doctor about ED](/talking-to-a-doctor-about-ed) covers how to
raise the subject and ask for a referral.

## When to talk to a clinician

See a clinician before or alongside counseling, because a therapist cannot do
the medical checks that ED calls for. The AUA says men with symptoms of ED
should have a thorough medical, sexual and psychosocial history, a physical
exam and selective lab testing
([AUA Erectile Dysfunction Guideline]()).
If low mood, loss of interest or hopelessness is part of the picture, mention
it; our guide to [depression and ED](/ed-and-depression) explains how the two
affect each other. If you are unsure whether worry or a physical cause is
behind the change, our explainer on
[telling ED and performance anxiety apart](/ed-vs-performance-anxiety) is a
good next read. Do not stop a prescribed medicine on your own; ask the
prescriber first
([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)).

## Sources

- [American Urological Association, Erectile Dysfunction Guideline](): Statement 1 (medical, sexual and psychosocial history) and Statement 6 (referral to a mental health professional; moderate recommendation, evidence grade C).
- [NIDDK, Treatment for Erectile Dysfunction](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment), last reviewed October 2024: counseling, partner sessions, not stopping medicines on your own.
- [Dewitte M et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine. Sex Med. 2021;9:100434](https://pmc.ncbi.nlm.nih.gov/articles/PMC8766276/): counseling versus psychotherapy, PLISSIT, treatment components, adherence, combined treatment, partner involvement, internet-based therapy.
- [Melnik T, Soares BG, Nasello AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007;CD004825](https://pmc.ncbi.nlm.nih.gov/articles/PMC8852803/): 11 trials, 398 men.
- [Schmidt HM et al. Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis. J Sex Med. 2014;11:1376-1391](https://pubmed.ncbi.nlm.nih.gov/24641632/): 8 studies, 562 patients.
- [Berner M, Günzler C. Efficacy of psychosocial interventions in men and women with sexual dysfunctions, part 1: male sexual dysfunction. J Sex Med. 2012;9:3089-3107](https://pubmed.ncbi.nlm.nih.gov/23088533/).
- [Frühauf S et al. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013;42:915-933](https://pubmed.ncbi.nlm.nih.gov/23559141/).
- [Banner LL, Anderson RU. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: a pilot study. J Sex Med. 2007;4:1117-1125](https://pubmed.ncbi.nlm.nih.gov/17627724/).
- [Aubin S et al. Comparing sildenafil alone vs. sildenafil plus brief couple sex therapy on erectile dysfunction and couples' sexual and marital quality of life: a pilot study. J Sex Marital Ther. 2009;35:122-143](https://pubmed.ncbi.nlm.nih.gov/19266381/).
- [Boddi V et al. An integrated approach with vardenafil orodispersible tablet and cognitive behavioral sex therapy for treatment of erectile dysfunction: a randomized controlled pilot study. Andrology. 2015;3:909-918](https://pubmed.ncbi.nlm.nih.gov/26311340/).
- [Khan S, Amjad A, Rowland D. Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction. J Sex Med. 2019;16:300-306](https://pubmed.ncbi.nlm.nih.gov/30770073/).
- [van Lankveld JJ et al. Internet-based brief sex therapy for heterosexual men with sexual dysfunctions: a randomized controlled pilot trial. J Sex Med. 2009;6:2224-2236](https://pubmed.ncbi.nlm.nih.gov/19493295/).
- [AASECT, Certified Sex Therapist](https://www.aasect.org/aasect-certified-sex-therapist-0), [Sex Therapist Certification Requirements](https://www.aasect.org/aasect-requirements-sex-therapist-certification) (requirements version 2026.T.1) and [Referral Directory](https://www.aasect.org/referral-directory), checked 2026-10-17.

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