Why It’s Important to Use the Right Words in Sex Therapy

I spend my days with my clients talking about arousal, orgasm, and erections (along with other, non-sexual topics too!) We talk kink, awkward moments, eroticism, fantasy, and more.  My professional speciality is sex and there isn’t much that really embarrasses me anymore— at least, as a professional.

But last month my elementary schooler asked me “Mom . . . you know how babies get made? I just have a question about that. How does the sperm get to the eggs?” And it was like for a second the world stopped turning and I forgot all the words I know so well. I took a deep breath and got through the conversation then, but it was a good reminder of how it feels to be caught off guard and stumble over your words in a critical moment. 

How to Build Your Sex Therapy Vocabulary 

So few of us had the benefit of learning about sex from people who were able to talk about it directly, without fear, embarrassment, or titillation. And as a result, it’s so normal to feel a little caught off guard and unsteady if sex comes up in therapy in a way that you don’t feel prepared for. One of my professional passions is helping other professionals get confident addressing sexual concerns with their clients. I think that an important part of talking about sex in therapy is the actual talking—the words we use and our confidence and ownership of them. 

Know the Words

The world of sex is cloaked in the dual shadows of intriguing mystique, shame, or fear, and our language reflects that. The slang terms for our genitals and for sexual acts are as colorful and creative as they are plentiful. In your personal life, you might prefer to gesture anxiously down at your own genitals or you might use all the colorful, explicit vocabulary you can. Either way, in the professional realm it’s important to step it up and learn the words for the parts that you would expect a professional to use. 

A recent study out of the UK showed that less than half of people know that women (or, more specifically, people with vulvas) have “three holes down there.” This means that if you have gaps in your sexuality education, you aren’t alone. In fact, if you learned that half the homes in your neighborhood had such a shaky foundation, you might take that as a reminder to inspect your own! 

For Instance, Vulva vs. Vagina

This particular twist of language seemed worth its own bullet point. To paraphrase the smart, funny, and puberty-focused show Big Mouth, most people call all sparkling wine champagne, even though we know that champagne is only really champagne if it comes from a specific region in France. Many people refer to all of a woman’s genitals as the vagina, when the more accurate word would be vulva. 

Most of the time, this is just a matter of personal comfort and preference. However, there are times when being able to refer to the specific parts of your body by name and understanding your own anatomy is really important. Imagine trying to talk to your doctor about a toothache when the only word you have for the whole area of your mouth is “tongue.” My recommendation is to avoid playing language police and correcting anyone else’s use of these terms, but to be thoughtful and precise with your own use of language in your professional life. 

Use Your Client’s Language 

In psychotherapy, it can often be powerful and validating to use a client’s own words when we speak with them. In sex therapy, this might feel a little dicey. What if the words they are using are so explicit they make you blush? What if they don’t have any words at all for what they are trying to say, or the words they are using are strange or childlike?  

Sometimes the client’s own words are exquisitely important, such as when using trans-affirming language with a transgender client. If a trans man refers to receiving oral sex as, “getting a blowjob,” use that language too, even if you don’t normally associate the phrase with a vulva. To point out the discrepancy would be unnecessary, hurtful, and focused on your own understanding of the term and not what it means for the client. If your client prefers to use a euphemism such as “making love” or “grown-up time,” and the discussion doesn’t require more specifics, support them in using the phrases that they’re comfortable with. 

On the other hand, sometimes it’s useful to offer the client words to use and to convey that you are comfortable addressing the topic. For example, the client might say “You know, sex feels good and everything, but you know my husband… finishes? and I haven’t, but maybe I could? I don’t, you know, I know it’s not the only thing that matters. I just never have? I think?” You might find it helpful to offer, “I think you’re saying that you haven’t had an orgasm before, and that’s something you’re interested in exploring. Do I have that right?” 

You might also notice that when clients are talking to you about sex, they seem to be translating from the words they are familiar with (words like “cum” or “boobs”) to words they think might be more appropriate for you (words like “semen” or “breast”), and it can be helpful to directly give them permission to use the words that are easiest and most comfortable for them.

Offer Comfort, Not Judgment

We also have to be careful to avoid censoring our clients, or implicitly conveying that we disapprove of their actions—or of the fact that they brought them up in therapy. We can imagine a client who says, “He always wants to give me oral, but I just don’t like the way it feels when he goes down on me. I don’t want to hurt his feelings, but it’s really not doing anything for me.” Then let’s say the clinicians responded to such a statement by backing away from any specifics, and giving a general response like, “Oh, it’s very common for men to be more interested in making love than their wives.”

In this situation, it’s unlikely this client is going to feel comfortable exploring this concern anymore, considering their clinician didn’t seem all that interested in engaging in the conversation. By contrast, imagine how much more open this client might feel if the clinician had engaged in active listening, validation, asking questions, and conveying an interest in the client’s experience. 

This kind of response might look like, “I’m glad we’re exploring this! It sounds like you and your husband are both invested in sex being pleasurable for you, which is great, but communication about what works for you has been tricky, and you really are not enjoying receiving oral sex right now. How would you say communication is between the two of you during sex overall?” This kind of response will hopefully open the door for a more fruitful and useful conversation for your client. 

While this all might sound confusing or contradictory, it’s important to remember that your clinical judgment will guide you. Is your client feeling awkward and searching for words? Are they laughing and joking as they explain exactly their concern? The important thing is that their therapeutic needs and your professional work are guiding your choices, and that you have equipped yourself with the self-awareness and linguistic tools to effectively respond.   

Practice Your Pronunciation 

Circling back to my story about talking about sex with my own kids, I think we all face forks in the road when the topic of sex is on the table. We can embody an awkward gym teacher from our childhood, conveying a deep sense of discomfort with all things sexual and pushing our conversation partner to try to seek help elsewhere. On this road, our own discomfort is front and center, and we and our clients feel unsettled and uneasy after the conversation.

On the other road, we can embody a competent, reassuring presence, which will help our client get information or process their experiences, and our knowledge and skill in supporting them is front and center. To speak from that supportive and confident voice, practice makes perfect. This is an area where audio mediums have a huge advantage— listening to other people talking about sex openly and comfortably pronouncing words related to sex and sexuality is invaluable. So, go listen to some audiobooks, some podcasts, watch some Netflix specials, and practice saying “clitoris”, “orgasm”, “anal sex” and “nipple stimulation.” Your inner middle schooler will forgive you, I promise.

Talking about sex in therapy is not just an okay thing to do—it’s an important part of our job. It’s a fraught subject for many people, which is exactly the reason clients may want to talk to their therapist about it. At the same time, it’s also a subject that many therapists fear. This may be for a lot of reasons, like their own unsettled feelings, or their unfamiliarity with what to say and how to say it. It may also be that the therapist wants to present a certain way professionally, and they fear that broaching the topic of sex with clients might somehow bring their own sexual selves inappropriately to their clients. 

As part of your ongoing work on your ethical practice, work on improving and embracing your professional vocabulary around sex. When we speak about sex in a way that is calm, confident, and appropriately clinical, it conveys our comfort in addressing all the parts of human sexuality with professionalism. Remember, our role as a clinician is not to titillate, shame, shut down, or seduce our clients. It’s to address their sexual concerns within the scope of our professional role with them. Using language that is accurate, welcoming, and therapeutically appropriate can make all the difference in setting our clients and ourselves at ease to effectively and professionally do that work.