Start with a thorough, confidential sexual history to map concerns: low or mismatched desire, arousal/orgasm difficulty, pain (e.g., vaginismus/dyspareunia), performance anxiety, erection/ejaculation issues, the impact of trauma, compulsive patterns, identity/orientation questions, and values or faith conflicts. Treatment is skills-first: accurate education (anatomy, non-linear arousal), communication scripts, sensate-focus/progressive intimacy exercises, CBT for unhelpful beliefs and anxiety, mindfulness/embodiment work, and graded exposure to reduce avoidance. Expect concrete at-home assignments and clear boundaries around consent and safety. Medical coordination is available (PCP/GYN/urology/endocrinology), including medication review (e.g., SSRIs, hormones) and pelvic-floor PT when indicated. For couples, we negotiate desire differences, rebuild trust, and create workable agreements around transparency and porn use. For trauma, stabilization and pacing come first. Inclusive of all bodies, orientations, and relationship structures. Progress is measured by comfort, pleasure, function, and mutually chosen intimacy—not by a quota of sexual activity.