Sex is probably one of the most fundamental things we do – and one of the last things we talk about. We sweep it under the covers and whisper behind our hands. And while social sex revolutionary Cindy Gallop is trying to change that (listen to her discuss Indian sexual values and sex ed with The Swaddle!) cultural sea changes don’t happen overnight (unless you forget protection).

So, what do you do when you’ve got a problem in the bedroom?

Sex therapy in India is a relatively nascent field, mainly because so many people feel uncomfortable opening up about their sex lives, even to an objective professional. Some might be put off by the name, too; ‘sex’ is indecent, and the stigma attached to ‘therapy’ of any kind is widespread. It’s doubly taboo.

Which makes it difficult to figure out for those who need or are interested in it. As it happens, sex therapy is frequently only tangentially about sex.

“In most cases, sex therapy deals with emotive issues,” says Dr. Rajan Bhonsle, head of the Department of Sexual Medicine at KEM Hospital and Seth GS Medical College.

One big problem for couples today, says clinical psychologist Nandita Sharma, is the feeling that the real-life experience of sex isn’t what it should be.

“The way we perceive sex is usually coloured by the media and so we often have unrealistic expectations of what our sex lives will and should be like,” Sharma says.

From studies that tell us how frequently the happiest people get it on, to the indelible, skewed images of hard core pornography, the pressure on people mounts. Sharma said her clients range from newlyweds to older couples.

“This idea that we are supposed to be having a certain amount of sex and a certain kind of sex can often lead to a disconnect between reality and our own imaginations,” Sharma said. “An emotional expectation like this can lead to a physical manifestation, which is when a sex therapist can be of help.”

Unfortunately, in India, there is no board license or certification required in order to call oneself a sex therapist. This leaves already vulnerable people trying to muddle through the difference between other, more controversial forms of sexual counsel, like sexual surrogacy, or at the mercy of charlatans.

Sharma advised looking for a qualified counsellor or psychotherapist who has additional training in helping people with sexual concerns and, ideally, at least a few years of experience in couples counselling. Dr. Bhonsle stressed the minimal qualifications of a legitimate sex therapist would be an MBBS followed by specialized sex therapy training through an international institute. Certified clinical psychologist who specialize in sex therapy by going through additional training or international qualifications such as the American Association of Sex Educators, Counselors, and Therapists (AASECT) also count, he said.

“Most people who label themselves as sex therapists are unqualified to do so,” Dr. Bhonsle said. “There is a distinction between emotional and physical sexual problems though they are often very closely interconnected.”

A good sex therapist should be able address both, should be able to provide intimacy therapy for couples, sexual dysfunction counselling, sexual relationship counselling for individuals and more. Dr. Bhonsle said psychologists who have worked at medical institutes and infirmaries or who are also qualified as gynaecologists or urologists could also have the necessary experience to provide sex therapy.

With so many possible backgrounds, there is no single way of providing sex therapy in India, though there is a general outline to how sex therapy works: The first step is for the therapist to understand a client’s area of concern and take a history of each partner (in the case of a couple). This would include details about childhood, family life, relationship history and other personal details. Activities after that could range from scientific explanations of the reproductive system, to talk therapy, to behavioural exercises.

One activity that won’t be part of sex therapy? Any kind of sexual contact with the therapist. Nor will the therapist ever ask a client to do anything they are uncomfortable with.

In the end, sex therapy isn’t that different from regular therapy, Sharma said. Perhaps there’s no double taboo after all.

“All couples go through phases where you don’t have the time or the energy to engage in regular sex/physical intimacy,” she said. “Sex therapy can apply to newlyweds and older couples alike because our sex lives change with us as we grow older. Our relationships are dynamic and so are our sexual preferences and feelings.”