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Where do I go for help for female sexual problems?

There are so many options for seeking help, and they all have benefits and risks. For example, if you have some sex positive friends or family, these may be a good starting point for discussing sexual concerns, as you will be more comfortable with them and they may be able to provide you with accurate information, helpful resources, or even recommendations about sex positive healthcare providers. While your local sexual health clinic is unlikely to be able to provide you with direct help, they may also be able to recommend some resources or healthcare providers to you. (Look for the links that say “Sexual Health Services” or “Sexual and Reproductive Health” on this page.)

Family doctors, general practitioners, and primary care physicians may be personally able to help you with your sexual function complaints. They can provide you with referrals to the right places but only if these places exist and your doctor knows about them. It may also be important to go to your doctor first because you may need a referral to see certain specialists. For example, you may need a referral from your family doctor in order to go to a specific pelvic floor clinic (e.g., Calgary Pelvic Floor Clinic), to get your health insurance or Alberta Health Care to cover a test or treatment (e.g., MRI, pelvic floor physiotherapy), or even to go to an out-of-province provider (e.g., BC Centre for Sexual Medicine).

Alberta Health’s website has a page with general information about sexual problems in women. It recommends that a woman seek out a family doctor, gynecologist, sex therapist, psychologist, or urologist if she has a sexual function problem. It is difficult for me to tell you where to go for help without knowing all of your symptoms (and without being a doctor), but I can give you an idea of how to choose a professional and where to seek help for some issues.

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How do I choose a professional?

Dr. Lindsey Doe of the YouTube channel Sexplanations has a great video on How to Choose a Professional. Here’s my take on Dr. Doe’s recommendations on how to choose a professional:

1. Identify the kind of professional help you need.

Is it a physical problem or a mental problem? Or do you need help figuring out which? Below is a list of possible professions from whom you could seek help. You can click the links below to find out more about what these professionals do.

This list isn’t exhaustive, but it should help you consider the possibilities. If you’re not sure, a family doctor is a good place to start. They should be able to direct you to a professional who can help you. Otherwise, the list below will give you a general idea of where to seek help.

Desire and arousal disorders

  • Counselling and therapy
    • Seek out someone who does sex therapy, cognitive-behavioural therapy, or mindfulness-based approaches.
  • Sexual medicine specialists

For orgasm disorders

  • Counselling and therapy
    • Seek out someone who does sex therapy, cognitive-behavioural therapy, or systemic desensitization.
  • Sexual health education
  • Yourself
    • There are things you can try on your own. (Check out the self-help resources… but masturbation and vibrators are the main ideas.)
  • Sexual medicine specialist
    • Especially if your problem is about pleasureless or painful orgasms.

For pain and penetration problems

  • Counselling and therapy
    • Seek out someone who uses mindfulness-based approaches, cognitive-behavioural therapy, or biofeedback.
  • Sexual medicine specialists
  • Pelvic floor physiotherapists

2. Make a list of specific professionals you could see in that field.

At least three! Don’t just make an appointment with the only person you know. Check out Alberta Referral Directory to see what referrals are available. You can search by keywords (e.g., female genital pain, orgasm disorder, painful orgasm) or profession. Be sure to use “keyword match” if you include words that could apply to other conditions (e.g., “orgasm disorder” will include results for “disorder” if you don’t use keyword match).

Below are some recommendations for some of the professions listed above or how to find more professionals.

Pelvic floor physiotherapy

Be aware that not all pelvic floor physiotherapists are trained in sexual dysfunction, so you should investigate the qualifications and training of the physiotherapist before you make an appointment—some of them may only be trained in dealing with other issues, such as urinary incontinence and prolapse. Below are some of the pelvic floor physiotherapists in Alberta.

Sex therapy and mental health

The title “sex therapist” is not regulated anywhere in North America except for Florida. As a result, anyone can call themselves a “sex therapist.” However, the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) provides certification for sex therapists, sexuality counsellors, and sex educators. If possible, I recommend finding someone who is affiliated with AASECT and has the title “Certified Sex Therapist” (CST).

  • Lethbridge
    • Erin Musick, Registered Psychologist. Erin is Lethbridge’s first and only AASECT-Certified Sex Therapist.
    • L. Marie Damgaard, Canadian Certified Counsellor. Marie’s master’s thesis was on female sexual experiences and her fees are on a sliding scale (which means her fees are based on your income).
    • Kate LaRocque (me!), Canadian Certified Counsellor. This website is my master’s final project.
  • Calgary
  • Edmonton
    • Tami-Lee Duncan, Registered Psychologist.
    • Jessica Blake, Registered Psychologist.
    • Dr. Jason Jones, Registered Psychologist, Certified Sex Therapist, at Loving Choices Psychology.
    • Venessa Farn, Registered Psychologist, Canadian Certified Counsellor (CCC), and Certified Sex Therapist has competency in treating FSD. Please contact me for Venessa’s email address.
  • Outside Alberta
    • Danielle Doucet is a Registered Psychologist, Certified Clinical Sexologist with the American College of Sexologists. She is an adjunct professor at Adler University in Vancouver and also works at Shanti Counselling Centre. She lives in BC but can provide online services for clients in Alberta. She has competency in addressing female sexual challenges.
    • Dr. Lori Brotto is an expert in many sexual difficulties including issues with desire, arousal, pain, and orgasm. You can see Dr. Brotto via her private practice.
    • Carlen Costa is a Canadian psychotherapist and sexologist. She offers free consultations for you to figure out which of her services you need. She does psychotherapy and cannabis coaching.

You can also check out which psychologists in your area list “sex therapy” as an issue they treat on Psychology Today. This does not mean they are a certified sex therapist, but they do have some sex therapy experience and sexual health training. If you are pursuing sex therapy, please check out Dr. Joe Kort’s article on How to Pick the Right Sex Therapist to help with this decision—his recommendations are specific to choosing a sex therapist.

One final note on sex therapists: Some people mistakenly believe that clients will be asked to have sex in front of a sex therapist or even have sex with a sex therapist. This will never be asked of you, as it goes against all mental health codes of ethics and it would cause a therapist to lose their license to practice. There are other professionals called sex surrogates who may either help a couple have sex (e.g., if one partner has mobility issues) or who may have sex with a person for a specific reason (e.g., the client wants to explore their sexuality with an experienced partner), but these are completely different from sex therapists. A sex therapist might suggest that you see a sex surrogate (and you can choose whether or not to do so), but sex therapists will only ever talk to you. In sex therapy, everyone keeps their clothes on, and the only touching that might occur is a handshake, a hug, or a pat on the arm.

Gynecologists

As gynecologists often help people with vaginal infections, pelvic exams, pelvic pain, and fertility issues, they are not necessarily able to help with problems with desire, arousal, orgasm, and pleasure. However, if you wish to see a gynecologist, check out the Alberta Referral Directory.

Urologists

  • Dr. Magali Robert is a urogynecologist at Foothills Medical Centre – Pelvic Floor Clinic. You’ll probably need a referral from your family doctor to see her, but it should be covered by Alberta Health Care.
  • Dr. Theresa McCallum is a female urologist in Leduc.

I am reluctant to recommend urologists because of urologists’ heavier focus on male bodies and because there are few female urologists in Alberta. You can find urology services through the Alberta Referral Directory. You can also find private urologists by checking out the surgeons at the Alberta Urology Institute and the physicians at the Southern Alberta Institute of Urology and see if the list has been updated to include anyone more appropriate than Dr. Gary Grey, who lists female urology as a sub-specialty.

Sexual medicine specialists

  • Foothills Sexual Function Clinic in Okotoks helps people with many sexual function problems, including menopause, low desire, genital pain, arousal problems, orgasm problems, and more. To go here, you will need a referral from your family doctor, but they do accept self-referrals when referrals aren’t possible.
  • Jablonski Health at Peak Specialty and Pinnacle Medical Centre in Calgary helps people with sexual function problems such as orgasm problems, desire problems, arousal problems, sexual pain, and more.

There are limited sexual medicine services in Alberta, so it’s possible you won’t be able to find the help you need in Alberta, but that does not mean hope is lost. If you feel you’re not getting the help you need in Alberta, here are some options within Canada and the United States.

  • BC Centre for Sexual Medicine may accept patients from outside British Columbia. You will need to be referred by your doctor using the referral form on the website.
  • BC Centre for Vulvar Pain only accepts referrals from BC physicians for residents of BC but you may want to keep this place in mind, should you ever move to BC!
  • San Diego Sexual Medicine allows you to schedule a 10-minute courtesy call to discuss your symptoms and possible treatments with Dr. Irwin Goldstein, one of the world’s experts in FSD.
  • IntimMedicine is a medical care team that helps women, men, and couples with sexual health and sexual function problems. Dr. Rachel Rubin and Dr. James Simon are some of the world’s experts in FSD. They are located in Washington, DC.
  • You can also check out the Find a Provider webpage for the International Society for the Study of Women’s Sexual Health (ISSWSH). Unfortunately, most of the providers listed live in the United States, but that may change in the future.

3. Read reviews

Be sure to read the reviews on professionals’ business webpages and the webpages they don’t control (like RateMDs.com). Read the best and worst reviews and see how they responded to the worst reviews.

4. Interview the professionals

If at all possible, interview anyone you’re considering seeing, and take notes. Mental health providers often provide consultations at no charge, as do some other professionals (e.g., pelvic floor physiotherapists). Here’s Dr. Doe’s step-by-step recommendations:

  1. Don’t give your last name yet and make sure they respect that. You could say, “Hi, my name is _____. I’m calling to ask some questions about your services.”
  2. Ask them if they are taking new patients or clients. If they are quite booked, ask if they will call you when they have a cancellation.
  3. Do the Vagina Test before you make an appointment: Ask some questions related to your concerns using words like vulva, clitoris, vagina, anus, or sex. This gives you an idea of how they respond to discussions about these topics, and whether they are sex positive. Being sex positive simply means that a person is nonjudgmental about people’s sexuality. Ideally, every person you seek help from will be sex positive.
  4. Choose someone who will tell you when your thinking is flawed (e.g., “It’s unfair to expect yourself to orgasm from vaginal intercourse alone”) and whom you feel comfortable correcting (e.g., “Please touch me very gently” or “I use she/her pronouns”).
  5. Does the professional think they can help you, even if they haven’t treated someone with your problem before?
  6. Are they aware of other local services they could refer you to or collaborate with? Are they willing to collaborate or make referrals? Will they make referrals if they can’t help you or if someone else could help you better?
  7. Find out about cost. Do they take insurance? Do they have payment plans? Do they have a sliding scale? Many mental health professionals have sliding scales, which means that you pay less if you have a lower income.

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Where should I be careful seeking help?

Be careful seeking help for sexual concerns from anyone whose specialty is not sexual concerns. For example, you may have a church counsellor who is eager to help you, but these counsellors (like most counsellors) are frequently uneducated about sex therapy or even rely on misinformation.

While Alberta Health has a fair number of sexual and reproductive health services, but few, if any, of these services are likely to deal with FSD and none are exclusively for FSD (most of them are for pregnancy and STI prevention and response). For example, Lethbridge has an excellent sexual health clinic, but none of its services relate to FSD. As I mentioned earlier, you can ask them for information or referrals, but they are likely unable to help you directly with sexual function complaints.

Pelvic floor physiotherapists are specially trained to work with the pelvic floor muscles. It is unclear whether all pelvic floor physiotherapists are trained in treating sexual dysfunctions, so I would check out their website and search for words like “vulva,” “vagina,” “sex,” “pain,” “intercourse,” or other words that describe your symptoms.

A meme depicting one barrier women face when seeking help for sexual dysfunctions from gynecologists. Created by Twitter User @TightLippedPod. Permission granted by creator.

Gynecologists deal with female sexual organs, but more so for reproduction than for issues with desire, arousal, orgasm, pain, and pleasure. The memes above and below explain the problem: female sexual dysfunctions are often outside the scope of gynecologists. You can try seeking help from a gynecologist, but do not get discouraged if they are unable to help you. Ask where they might refer you for help.

Which healthcare provider cares for the clitoris? Apparently, none of them. This image is my recreation of a slide from a research podium presentation by Dr. Rachel Rubin at the 2017 ISSWSH Meeting, recreated based on a photograph from this tweet, using a screen capture of this video by The Try Guys.

The above meme also addresses the problem with seeking help from many urologists. While urologists may deal with women and FSD, they are more likely to deal with male sexual dysfunction than FSD (e.g., Calgary’s Southern Alberta Institute of Urology or Edmonton’s Alberta Urology Institute). If you’re interested in seeing a urologist, or if your doctor wants to refer you to a urologist, check out their website first and search for terms like “women,” “vulva,” and “vagina” (as opposed to “men,” “penis,” and “prostate”) to see if they treat women.

While your sex positive friends and family are good starting points, be careful about taking any direct advice from them about how to treat yourself. Basically, don’t take treatment advice from anyone who is not a medical professional or mental healthcare professional and be careful taking advice from anyone whose specialty is not sexual medicine.

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What if I want help from within my culture?

Glad you asked! While it can be more challenging to find FSD help that is within your culture or religion, I have tried to find some appropriate practitioners and self-help resources for some of the larger cultural groups within Alberta.

Christian

Because Christianity is one of the dominant religions in Alberta, most healthcare providers are familiar with its general beliefs. However, I am happy to share resources that will help you find specific Christian healthcare providers.

  • ChristianDoctors.net allows you to submit a request to see a pre-screened Christian doctor in Alberta who matches your search criteria.
  • For mental healthcare, you can probably just Google “Alberta Christian mental health” or “[your city] Christian mental health.” Some options that come up are:
  • Sex, God, and the Conservative Church: Erasing Shame from Sexual Intimacy by Tina Schermer Sellers – Amazon.ca or Amazon.com
  • Good Christian Sex: Why Chastity Isn’t the Only Option-And Other Things the Bible Says About Sex by pastor Bromleigh McCleneghan – Amazon.ca or Amazon.com | Publisher
    • She is a liberal Christian minister who advocates that sex before marriage is okay and is to be enjoyed guilt-free.
  • The Great Sex Rescue: The Lies You’ve Been Taught and How to Recover What God Intended by Sheila Wray Gregoire – Amazon.ca or Amazon.com | Publisher
  • Advancing Sexual Health for the Christian Client: Data and Dogma by Beverly Dale and Rachel Keller – Amazon.ca or Amazon.com
    • For any healthcare providers reading this web-based guide: this is for you! It is written by an ordained Christian clergy member and a certified sexologist.

Post-Christian

  • Purity Culture Dropout – “an eight-week intensive sexuality education and coaching program for folks who were raised in purity culture”

Indigenous

  • Your best bet may be to email the Alberta Health Services Indigenous Health Program at the email below. They will help connect you with the most appropriate physician for you.
  • Indigenous Physicians Association of Canada is a group of Indigenous doctors, residents, and medical students whose goal is to support Indigenous pursuit of medical training. They recommended the doctors below when I asked if they could provide me with the names of Indigenous physicians who have some competency in FSD.
    • Dr. Cassandra Felske-Durksen, MD CCFP, Otipemisiwak GP, has a practice focused on women’s and gender diverse sexual and reproductive health. Call the Indigenous Wellness Clinic (780-735-4512) at the Royal Alexandra Hospital (10959 102 St NW, Edmonton, AB T5H 3V9) for more information about the referral process.
    • Dr. Cayla Gilbert, MD CCFP, is a Métis physician at the Battle River Medical Clinic in Ponoka (Phone: 403-783-3399; Fax: 403-783-8722). Referral required.
    • Dr. Janelle Syring is a Métis soon-to-be family physician graduating from the Indigenous Family Practice program at UBC. She will be based out of Calgary at the end of summer 2021 and has a background as a pelvic physiotherapist, seeing many patients with vulvodynia, vaginismus, and dyspareunia.
  • Dr. James Makokis, Two-Spirit Cree physician. Dr. Makokis attracts a lot of transgender patients, but may be appropriate for patients who are seeking culturally sensitive care for other sexual concerns.
  • Alberta Indigenous Virtual Care Clinic allows any First Nations, Métis, or Inuit person in Alberta to see a doctor through their phone or computer, and they specifically list “sexual health” as a reason you can make an appointment. All their family physicians have some competency in FSD and are able to and required to make appropriate referrals when the patient’s concern is outside of their scope. You can also specifically request to be seen by either a First Nations or Métis doctor when you call.

Jewish

Latter-day Saint (LDS)

Alberta has the highest percentage of LDS people in Canada, and Southern Alberta has the highest percentage of LDS people in Alberta. There are many talented healthcare providers who are familiar with the LDS faith in Utah, but those practitioners are only able to see people who live in Utah. Here are some options that are accessible to you in Alberta:

  • Facebook group: Improving Intimacy in Latter-day Saint Relationships, run by Daniel Burgess, an LDS sex therapist. It is a very open-minded, co-ed group, open to discussions of masturbation and pornography use.
  • Happy, Healthy Sexuality: LDS Women’s Discussion Group is a little more conservative and does not allow the promotion of pornography or erotica.
  • Dr. Jennifer Finlayson-Fife (Chicago) is a relationship and sexuality educator and coach. She wrote her dissertation on LDS women and sexuality and offers coaching and counselling. She also contributes to many LDS-themed podcasts. She is quite expensive but she also has many glowing reviews.
  • The Mormon Mental Health Association is a professional association for mental health providers, educators, and researchers who offer ethical and culturally competent services and information to people in any stage of involvement (pre-baptism, active member, post-LDS) with the LDS church. While the providers are mostly from the United States, there are a few who serve Albertans/Canadians (though their sexual health expertise may be limited).
    • Debra Brown Gordy does intimacy counselling and relationship coaching with women and couples in the United States and Canada (licensed in Colorado).
    • Verlyne Christensen (Calgary) does couples counselling.
    • Zac Erickson (Edmonton) treats adult ADHD and can use an approach similar to EMDR to work with clients’ internalized trauma and shame.
  • You can check out “LDS Therapists in Alberta” on Psychology Today.

Muslim

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