There are very few places where a man can think about his own sexual life out loud without it being a joke or a symptom. This is one, with someone who can also assess the medical side, so you are not sent elsewhere for half of it.
Men have very few places to talk about sex. There is banter, which is not talking. There is the ten minutes with a GP, where sex arrives as a problem to be fixed and leaves as a prescription. What there is almost nowhere is a room where a man can think about his own sexual experience out loud, at length, and have it taken seriously.
So most of the men I see have never said any of it aloud before. That includes men in long marriages, men who would describe themselves as open, and men who have been carrying a difficulty for twenty years. What they say at the end of a first appointment, more often than anything else, is that they had not realised how much they were holding.
This is a room where male sexuality is treated as something worth understanding, rather than something to be managed, apologised for or fixed.
Which means no judgement of what you want, who you want it with, how often, or what you have already done. Not judgement politely withheld, but genuine clinical interest in your erotic life as it actually is. Sexual shame is one of the most reliable things standing between a man and getting better, and a room that quietly adds to it is not much use to anyone.
The majority of the men I see are straight, and many are gay, bisexual or queer. Being a gay man myself brings a particular perspective on sexuality and shame, and straight men often find they can speak more freely here than they expected to. Gay and bi men find they do not have to explain or justify anything before getting to the point.
Sex therapy itself is a structured, talking-based psychotherapy focused on sexual difficulty, desire, intimacy and the psychological and relational side of sex. There is no physical contact, no nudity and no examination in a session. If a medical examination is ever clinically useful, that is arranged separately, explained fully, consented to in writing, and can always be declined.
Some men arrive knowing exactly what the problem is. Plenty arrive with a general sense that something is not right, or with a difficulty that has already been treated medically without much changing. That last group is the commonest I see: Viagra, testosterone or something else, with partial improvement or none. It usually means something psychological, relational or erotic is holding the difficulty in place, alongside a physical cause or instead of one.
The range is wider than most men expect, and several of these are the reason a man never books at all.
Particularly where the difficulty is psychological, or where anxiety is sustaining something that started physically.
Mood, medication, the relationship, or a shift in what you actually need erotically. Usually several at once.
Premature and delayed, both of which respond well to behavioural work alongside whatever else is going on.
Pain on penetration or receptive sex, where bracing and anticipation are usually part of what keeps it going. There is a fuller page on pain.
Sex that has quietly stopped, mismatched desire, or one person's difficulty becoming both people's problem.
Opening a relationship, working out what the agreement actually is, and the jealousy and renegotiating that follow. The structure is not the thing being treated.
What turns you on, whether you have ever said it out loud, and how to bring it into a relationship rather than keep it in a separate compartment.
Working out what your desires mean, coming out late or not at all, and shame absorbed long before you had words for any of it.
Whether it is a problem at all, what it is doing for you, and the conviction that it is damaging you, which is more often the difficulty than the porn.
Performance anxiety, sexual shame, and a difficulty anchored to an earlier experience.
Not feeling like enough, and what that does in bed. Common in men, rarely raised, and rarely separate from everything else.
Sexual rehabilitation after cancer treatment, pelvic surgery or other illness, which men are very often given no conversation about at all.
Arousal runs on the parasympathetic nervous system, the rest-and-digest side, which only comes forward when a body feels safe. It sits in constant balance with the sympathetic side: adrenaline, fight or flight, fear. When fear is driving, the parasympathetic side stands down and so does the blood flow. Some men describe sex as going into battle, full of threat and risk, and when that is the experience the sex is rarely good. If you are running from a lion, you do not need an erection.
Underneath the threat, almost universally, sits a harsh internal critic: the voice that has already decided what last night meant about you as a man. It is at the root of a great deal of both sexual difficulty and mental health difficulty, and it is strikingly resistant to reassurance, including reassurance from a partner who means every word of it.
Then there is the loop. Anxiety pulls a man out of the moment and into watching and judging himself, which is the one position from which arousal cannot actually be felt, and the watching reliably produces the outcome it was scanning for. Sex needs three things at once: being present rather than in your head, physical responsiveness, and psychological turn-on. Anxiety disrupts all three.
Arousal is not something you can make happen by trying harder. Trying harder is usually the thing preventing it.
Which of those is doing the work in your case is what the assessment is for. The approach follows from the formulation, rather than the other way round. In practice I work integratively, and five things make up most of what I do.
The core of it. Understanding your erotic world, and structured work on responsiveness and on what happens between you in bed.
The developmental model, applied to the relationships you actually have: one partner, several, or a shape with no standard name.
Stepping back from the thought rather than wrestling with it, and moving towards what you actually value, in sex and well beyond it.
Working directly on the internal critic and the shame, because a body being criticised will not let go.
Reprocessing a specific experience that is still holding the difficulty in place, where talking has not reached it.
This is the discipline the rest sits inside, and the part that is genuinely specialist. It starts with your erotic world, which is the thing almost nobody has ever been asked about: what actually turns you on, how that was formed, whether you have ever said it out loud, and whether the sex you are having bears any resemblance to it. A surprising number of sexual difficulties turn out to be a mismatch between a man's real erotic template and the sex he has decided he is supposed to be having.
Alongside that sits structured behavioural work, which is where sex therapy differs from talking therapy in general. Sensate focus, developed by Masters and Johnson and still the backbone of the field, deliberately takes intercourse and orgasm off the table for a period so that touch can be experienced without a result attached to it. It sounds modest and it is often the single most powerful thing in the work, because it removes the test. Where the difficulty is ejaculatory there are specific approaches: stop-start and the squeeze technique for premature ejaculation, and retraining an idiosyncratic masturbation pattern where that is driving delayed ejaculation.
Most of that happens between sessions rather than in them. What you take away and try is usually where the change occurs, and the session is where we work out what it meant.
Sexual difficulty rarely stays in one person. Men often arrive having had it placed squarely on their shoulders, when what is actually happening is being held between people: unspoken tension, mismatched desire, a difficulty that has quietly reorganised the whole relationship around avoiding it. Sexual shame is very often learned somewhere other than a bedroom and is still being enforced there.
For relational work I use the developmental model, developed by Ellyn Bader and Peter Pearson, which treats a relationship as something that passes through stages rather than as something that either works or does not. Relationships tend to begin merged, in what the model calls symbiosis, where closeness depends on being the same and difference feels like a threat to the bond. The task of the next stage is differentiation: being able to hold onto yourself while staying connected, to say what you want and to hear that the other person wants something else without either of you collapsing or attacking.
That matters more for sex than almost anything else in relational work, because everything erotic depends on the capacity the model is describing. Desire needs two separate people, and a couple settled comfortably in symbiosis will often have a warm relationship with no sex in it at all, which is one of the commonest presentations I see.
You cannot say what you want in bed if difference is dangerous. You cannot hear a no without it becoming a verdict.
None of that assumes one partner. A great many of the men I see are in open relationships, ethically non-monogamous arrangements, polyamorous constellations, or configurations that have no standard name and do not need one. The developmental model travels perfectly well into all of them, because differentiation is a capacity rather than a structure, and if anything these arrangements ask for more of it: more negotiation, more tolerance of difference, more capacity to hear something you did not want to hear and stay in the room. The structure is not the thing being treated.
Couples therapy and sex therapy are not the same thing. Couples therapy works on the relationship: communication, conflict, connection, the dynamic between you. Sex therapy works specifically on sexual difficulty, desire and intimacy. They overlap heavily once a difficulty has been in a relationship for a while, and I am trained in both, so the work can be individual, joint, or some combination that changes as it goes.
No. A lot of men come alone and the work is effective individually, whether you are single, partnered, or in a non-monogamous relationship. Where a partner is involved and willing to attend we can discuss whether some joint sessions would help. That is a conversation, never a requirement. If you do want to come together, mention it when you book so I can allow enough time, since a longer first assessment is usually useful with more than one person in the room.
Compassion-focused therapy was developed by Paul Gilbert out of a clinical observation worth sitting with: people can know a self-critical thought is untrue and still feel its full force, because knowing and feeling run on different systems. CFT works with three of them. A threat system, which is fast and protective. A drive system, which pushes for achievement and reassurance. And a soothing system, which in self-critical men is often barely developed at all.
Sexual difficulty sits almost exactly on that fault line. The threat system is running the sex. The drive system responds by trying harder, researching more, buying something. And there is nothing on board capable of settling either of them. Shame, which is the emotion most reliably present in this work and least reliably mentioned, keeps the whole arrangement in place by making the difficulty into evidence about the man.
The work is not positive thinking and it is not telling yourself it does not matter. It is deliberate, practised, and frequently uncomfortable at first, because self-criticism feels like the thing keeping standards up. It is central to how I work, for a straightforward reason: a body that is being criticised will not let go enough to become aroused.
Some sexual difficulties are not held in place by pressure or by belief but by a specific experience that was never processed. The model behind EMDR, eye movement desensitisation and reprocessing, is that a memory can be stored in a raw and unintegrated form, still carrying the emotion, the body sensation and the belief that were true at the moment it happened.
That is why talking about it so often fails to reach it. A man can know perfectly well that he is safe, that his partner is not judging him, that one bad night years ago means nothing, and his body will carry on responding as though none of it were true. That is not a failure of insight. It is what an unprocessed memory network does, and it is why so many men describe the problem as being in the body rather than the mind.
In session the target is usually something specific. The first time it happened and what that felt like. A partner's reaction. An assault. A humiliating adolescence. A painful examination. Shame absorbed from family, school or religion long before any of this started. Holding that in mind alongside bilateral stimulation allows it to be reprocessed and filed properly. The event stays. The charge attached to it does not, and arousal needs the absence of threat more than it needs anything else.
It is not right for everyone and it is not a substitute for the medical side of an assessment. Where it earns its place is with men who have done everything else: tablets that worked partly, a course of therapy, sometimes thousands of pounds of shockwave, and a body still braced against something nobody has ever named.
ACT begins somewhere counterintuitive for a man who has come to get rid of a symptom: the effort to control an unwanted internal experience is often the thing keeping it in place. So the work is not on the content of the thought but on your relationship to it. Noticing the thought that you are about to lose it, and registering it as a thought passing through rather than as a bulletin about reality. Being willing to have the anxiety in the room and carry on anyway, which is a different thing from making it go away.
Trying not to be anxious during sex is itself a form of monitoring, and monitoring is the problem.
None of this is a menu, and men are not sorted into one of five boxes at the first appointment. It is one integrative therapy, and the sequencing is the clinical skill in it.
A common shape, though every case differs: the assessment produces a formulation, and the early work is usually compassion-focused, because a man whose internal critic is running at full volume cannot look honestly at his own sexual life, and shame makes everything else unworkable. ACT then takes the pressure off the performance itself, which is what allows behavioural work to be attempted at all, since sensate focus asked of a man still trying to produce a result simply becomes another test. Psychosexual work rebuilds responsiveness and opens up the erotic world. Where a couple is involved, differentiation work runs alongside it, because the new conversations have to happen somewhere. And where something specific stays stuck no matter what else moves, that is the point at which EMDR earns its place.
The medical side runs through all of it rather than beside it. Because I can assess and treat the physical contributors myself, a hormonal or vascular finding does not interrupt the therapy or hand you to someone new halfway through. It gets dealt with, and the work carries on with the same person.
Porn, hook-ups, chemsex, or a pattern you have tried to stop and have not. It has a section of its own here because men looking for help with it are usually offered either a moral position or a twelve step programme, and often want neither.
What matters is the pattern: whether it is costing you time, money, work or a relationship, whether it is escalating, and whether stopping feels like something you can actually choose. The addiction framing is often less useful than it looks, because it puts the focus on the porn rather than on what the behaviour is doing for you. Usually it is regulating something: anxiety, low mood, loneliness or shame.
There is no number that counts as too much, and I take no moralising view of porn or of how much sex anyone wants.
So the work tends to be less about the sex than about what sits underneath it. What the behaviour is managing, what triggers it, what else could do that job, and the shame that has built up around it, which is almost always part of what keeps the pattern running rather than anything that helps break it. Where a relationship has been affected, some of that is often better done together. Nobody here is going to be shocked.
For some men, and it doesn't have to become the only thing we talk about. What the drugs do to erections and to being able to come, sex that starts to feel impossible without them, the days lost afterwards, and the shame around all of it. I won't make stopping the price of being helped. There is more on the gay, bi and queer men's health page.
Fifty minutes of conversation. The first is mostly assessment: your history, the current difficulty, what has and hasn't worked, and the relational and erotic context around it. After that, sessions are shaped by what we are working with. Sometimes structured work of the kind described above, sometimes exploring patterns and dynamics, sometimes specific things to try between sessions. Nothing physical happens in the room.
For performance anxiety, or a specific difficulty where the anxiety loop is fairly recent, most men make meaningful progress within six to twelve sessions. Some need only a handful. Where shame is more entrenched, or earlier experiences need processing through EMDR, or where the work is relational, it takes longer. I will tell you what I think is likely before we start and check in on how it is going. Nothing continues past the point where it is useful.
£250 for a 50-minute session, individual or couples. EMDR is charged at the same rate and runs at either 50 or 90 minutes, so £250 or £450, and which length suits depends on what we are reprocessing rather than on a rule. There is also a bespoke intensive: two or three ninety-minute sessions in one day, to make progress fast, with a quote on request. I keep a small number of reduced-fee appointments for people on lower incomes. There is a waiting list at the moment, realistically into November, and a first consultation is still the way in.
An assessment rather than a session of the work. Sixty minutes: what is happening now, when it started, what was going on in your life at the time, what you have already tried and what came of it. Then your sexual history and your erotic world, which is the part almost nobody has been asked about before. At the end I tell you what I think is driving it, whether therapy is the right route, and roughly what it would involve. If something medical needs ruling out first I can do that myself rather than sending you away for it.
You don't need to have the right words ready. Most men have rehearsed a sentence before they arrive and it rarely comes out the way they planned. That's fine.
Only as much as is useful, and you control what you share and when. Most men find it easier than they expected. Having spoken with a great many men about their sexual lives there is very little I haven't heard, and you can come back to something in a later appointment.
Yes. Nothing is shared without your consent except in the rare circumstances required by law, for example a serious risk of harm to you or someone else. Updating your NHS GP is your choice rather than a requirement, and I will always tell you if that situation arises.
Most sex therapists cannot assess the physical side, and most doctors cannot do the therapy. That split is why men so often get half of an answer, or get sent round a loop: a prescription that helps a bit, then a referral six months later to someone who starts the history again. I am a GP and a sexual medicine specialist as well as a registered psychosexual therapist, so if it turns out something hormonal or vascular is in the picture, that gets dealt with here, and the therapy carries on with the same person. You only tell the story once.
The clinic is at Central Health London, 23 Devonshire Place, Marylebone, a quiet and discreet address a short walk from Regent’s Park. Most men arrive anxious and leave relieved. You will be welcomed by reception, offered tea or coffee, and given time to settle before we start.
A first consultation is usually an hour. We go through your symptoms, your medical and family history, and your sexual experience, relationships and lifestyle: the medical, psychological and relational picture together rather than one at a time.
I will ask you a lot of questions. You do not have to answer any of them: saying "I would rather not answer that" is a complete answer and nothing follows from it. A physical examination is sometimes useful, particularly for erection problems, and it is always optional. You stay in control of the appointment throughout.
If you have had recent blood tests, send them ahead. If not I will arrange them, and I will tell you which ones need taking before 11am.
If you are in your fifties or sixties, have no GP you know well, do not much like going to the doctor, but recognise it is time to take your health seriously, this is a reasonable place to start. I often find things that matter and have been missed.
If you want help but are wary of seeing someone who is not comfortable talking about gay or queer sex, you can come to someone who does not need it explained, and who will not judge or shame you.
Men who have tried quick fixes, or had a purely medical or purely therapeutic approach that did not help. I see a lot of men for second opinions. And men of any age and in any kind of relationship who want to understand what is going on rather than be handed a prescription.
I am a GP, a sexual medicine specialist and a COSRT-registered psychosexual therapist, working at 23 Devonshire Place, Marylebone, central London, alongside NHS general practice in Hackney.
Most men reading a page like this arrived from a search rather than my homepage, so this is probably the first you have heard of me. The short version: I hold the medical, the psychological and the relational picture together in one appointment, rather than sending you to three people who each see a third of it.
More about how I workThese rarely arrive on their own. If one of these sounds closer to what you’re dealing with, start there instead.
If something doesn’t feel right, it’s worth understanding why, before deciding what, if anything, to treat.
Booking and availability