Therapy for Sexual Pain & Sexual Functioning Issues
Online sex therapy for individuals and couples in California & Oregon
This page covers two distinct areas of my work: sexual pain conditions, and sexual functioning issues. While they can be very different issues, there’s some overlap in how I approach both of them. The sexual functioning issues I’ll address are erectile dysfunction, premature ejaculation, delayed ejaculation, lack of orgasm, difficulty with arousal and sexual avoidance.
I'm Jen Joseph, an AASECT Certified Sex Therapist with extensive experience in both areas, working with individuals and couples across California and Oregon. My approach is direct, warm, compassionate and clinically grounded.
Sex shouldn’t hurt.
And yet, for a significant number of people it does — sometimes occasionally, sometimes every time, sometimes so reliably that they've stopped trying altogether. Estimates suggest that somewhere between 10–20% of women experience pain during sex at some point in their lives, and many never receive adequate treatment. Vaginismus, vulvodynia, and other pain conditions are frequently misdiagnosed, dismissed, or simply never addressed in medical settings.
Being told "nothing is wrong" when something clearly is doesn't mean you're imagining it. It often just means you haven't yet found the right support.
What I treat
—Vaginismus — involuntary muscle contractions that make penetration painful or impossible
—Vulvodynia — chronic vulvar pain with no identifiable cause, including vestibulodynia
—Dyspareunia — pain during or after intercourse, for any gender
—Genito-pelvic pain disorders — including pelvic floor dysfunction that intersects with sexual function
—Pain after medical events — returning to a sexual life after illness, surgery, cancer treatment, menopause, or significant bodily change
A note on pelvic floor physical therapyFor many sexual pain conditions — particularly vaginismus, vulvodynia, and dyspareunia — an integrated approach works best. I often collaborate with pelvic floor physical therapists and will refer when appropriate. If you're already working with a pelvic floor PT, sex therapy can be a powerful complement to that work.
What's often getting in the way
Sexual pain is almost never purely physical — and it's rarely purely psychological either. Even when there's a clear anatomical or physiological cause, the emotional and nervous system dimensions matter enormously for treatment.
When sex has been painful, the nervous system learns to brace in anticipation. That bracing — tightened muscles, shallow breathing, a body preparing for threat — can make pain more likely even when the original cause has been addressed. Add in the shame that tends to accumulate silently over years of difficult or avoided sex, the relational strain of a partner who doesn't know how to help, or a history of medical trauma or early messages about the body, and you have a picture that requires more than a physical intervention alone.
This is what I look at: the full picture. The body, yes — and also the nervous system, the history, the relationship, and the way shame has shaped your relationship to your own experience.
What we might work on together
—Understanding what's actually driving the pain — and why it's persisting
—Interrupting the anticipatory anxiety and bracing cycle
—Working through any history — medical, relational, or personal — that's wrapped up in the pain
—Addressing the shame that has built up around your body and its responses
—Helping couples navigate the relational dynamics that have formed around the pain
—Gradually reintroducing physical intimacy in a way that actually feels workable
—Collaborating with pelvic floor PTs, gynecologists, or other providers as part of an integrated approach
SEXUAL FUNCTIONING ISSUES
When your body isn't responding the way you want it to.
Sexual functioning issues — erectile difficulties, problems with ejaculation, anorgasmia, arousal that won't come — are extremely common, frequently misunderstood, and often carry a weight of shame entirely disproportionate to how treatable they actually are.
You don't need a diagnosis to seek help. What matters is that something is getting in the way of the sex life you want — and that you're ready to look at it directly.
What I treat
—Erectile dysfunction (ED) — difficulty achieving or maintaining erections, including performance anxiety-driven ED
—Premature ejaculation — ejaculating sooner than desired, and the shame and relational strain this often creates
—Delayed ejaculation — difficulty reaching ejaculation during partnered or solo sex
—Anorgasmia — difficulty reaching orgasm, or never having experienced orgasm
—Arousal difficulties — trouble becoming physically aroused despite genuine interest or desire
—Sexual avoidance — when anticipated failure, embarrassment, or frustration has led to avoiding sex altogether
What's often getting in the way
Functioning issues are rarely just mechanical. Even when there's a medical component — and sometimes there is — the psychological and relational layers almost always need attention alongside it. A prescription can only do so much if the nervous system is in a state of vigilance, the mind is watching from the sidelines instead of being present, or the dynamic between partners has quietly reorganized around the problem.
The most common thread I see is anxiety — specifically, the self-monitoring that kicks in when someone has experienced difficulty before and is now anticipating it again. That watchfulness is exactly what makes arousal, erection, and orgasm harder to access. It's a feedback loop, and it tends to tighten over time without intervention.
Beyond anxiety, I look at what else might be contributing: sexual history and early experiences; relationship dynamics that have built up around the issue; shame and self-judgment about what the difficulty "means"; and, where relevant, medical factors worth evaluating — hormonal, vascular, neurological — through collaboration with a physician or urologist.
What we might work on together
—Getting specific about what's actually driving the difficulty — and what's maintaining it
—Interrupting the self-monitoring and performance anxiety cycle
—Working through relevant history — relational, sexual, or otherwise
—Addressing the shame and self-judgment that's accumulated around the issue
—Helping couples untangle the dynamics that have formed around the problem and find a way forward together
—Practical sex therapy exercises ("homeplay") to work with between sessions
—Coordinating with physicians, urologists, or other providers where a medical evaluation would help
My approach
I'm a depth-oriented, AASECT Certified Sex Therapist — which means I'm not just here to give you permission to talk openly about sex, though that matters. I'll invite specific conversations about your physical and sexual experiences so I can understand clearly what you're working with. Where it's useful, I'll offer sex education and homeplay exercises to try between sessions. And when the difficulty goes deeper than information or technique — when there's an emotional, psychological or relational root that's running the show — that's where we'll go. I work at that level not because I'm looking for complexity, but because that's often what's needed for stuck issues to substantively change. I am LGBTQIA+, kink, ENM, and neurodivergent affirming, and I welcome all body types, genders, and relationship structures into this work. For more on my general sex therapy practice, see here.