Patient-Reported Barriers to Sex Therapy for Men Referred by Their Urologist: A Pilot Study

Sex therapy is recommended for a range of male sexual dysfunction-including erectile dysfunction, ejaculatory disorders, and low libido-but utilization remains low even when men are referred by their urologist. Here we aimed to identify patient-reported barriers and facilitators to sex therapy attendance and predictors of both compliance and perceived benefit. Men referred to sex therapy by their urologist for sexual dysfunction were surveyed. The cohort comprised 106 cisgender males (median age 43), of whom 49% were commercially insured, and 52% had ≥1 psychiatric diagnosis, especially anxiety and mood disorders. Overall, 59% attended their initial consultation. Patients with psychiatric comorbidities were more likely to attend (p < 0.001), whereas commercially insured individuals were less likely than Medicaid recipients (p = 0.002). Of the 23 patients who completed a follow-up survey, 17 attended their consultation, and most (71%) found sex therapy helpful and would recommend it to others. Barriers included shame, embarrassment, perceived dismissal by providers, scheduling conflicts, and low expected benefit; facilitators included provider credibility, personal motivation, partner support, and ease of scheduling. While stigma remains a significant barrier, patient motivation, provider expertise, and streamlined referral processes may improve attendance and integration of sex therapy into sexual health management.