The Role of Physiotherapy in Sexual Health

I’ve been in several situations where I’ve seen people’s eyes grow wider and wider as I explain to them what pelvic floor physiotherapy entails. I don’t think it’s because they were scared of the treatment itself, but rather because it was totally new to them. They didn’t know what to expect, or that it even existed at all.

In my experience, going to see a pelvic floor physiotherapist feels more or less the same as when you need to visit a gynaecologist. I cannot speak for men, but I think they get a similar feeling when they need to see a urologist. Having anyone near your genitals can make you feel vulnerable!

What does a pelvic floor physiotherapist do?

We treat conditions such as urinary and faecal incontinence, sexual dysfunction, pelvic and perineal pain, constipation, and over- or under-active pelvic floor muscles in men, women and children.

Common problems we treat include conditions such as pelvic organ prolapse (the descent of the pelvic organs through the vaginal walls) and erectile dysfunction, especially post-prostatectomy (removal of the prostate).

The pelvic floor muscles play a huge roll in most of these conditions, but it’s not the only thing we focus on during assessment and treatment. With all conditions, we follow a bio-psycho-social approach to treatment, which is patient-centered.

What does the pelvic floor physiotherapist look for?

We assess (and treat where indicated) different components that may contribute to a certain condition or dysfunction.

This may involve physical components, such as posture, breathing, general fitness, functioning of the peripheral, central and autonomic nervous systems, and contraction and relaxation of the pelvic floor muscles, diaphragm, abdominal muscles, or other muscles we might think are involved.

This usually includes assessments of the joints, specifically in the pelvic, lumbar and hip region. It is also important for us to note how these muscles, nerves and joints work together and coordinate their movements, as it may cause imbalances and problems in other areas – contributing to the dysfunction.

What does the pelvic floor physiotherapy treatment entail?

We have several ways of investigating and treating the pelvic floor muscles, sometimes using devices that can assist us, as these muscles are located quite deep and are not always visible or palpable from the outside of the body.

Examples of these devices include electromyography, ultrasound, and neuromuscular electrical stimulation. We may also use these in our treatment plan, together with appropriate exercises which usually forms a large part of the treatment plan. The type of exercises done will mainly depend on the aim of the treatment, be it to relax or strengthen the applicable muscles.

We always work as part of a team

As physical therapists we obviously focus a lot on the physical aspects of the treatment, but we also need to address any environmental, social or health factors that may be contributing significantly to the condition.

If we are concerned about medical or psycho-social factors, or have severe cases, we refer appropriately.

The multi-disciplinary team is crucial in the management of pelvic floor dysfunctions, as they can often be quite complex due to different contributing factors. We work closely together with social workers, psychologists, dietitians, general medical practitioners, gynaecologists, urologists, sexologists, gastroenterologists, orthopaedic surgeons, physicians and nurses.

As a team we can provide our patients with the best possible treatment plan and get the best results.

Pelvic floor dysfunction is not something you should be ashamed of

Going to your first pelvic floor physiotherapy session can make you feel anxious and vulnerable, but believe me – by the end of the session, you will feel so much better about it.

Pelvic floor dysfunction is not something to be ashamed of. Help is available for you. By talking about it, you can get the help you need, and stop suffering in silence.


Dr Corlia Brandt (SASHA Executive Committee)
Pelvic Floor Physiotherapist, Senior Lecturer, Researcher.
South African International Urogynaecology Association Physiotherapy Representative.
Chairperson of Pelvic and Women`s Health Physiotherapy (South African Society of Physiotherapy).



what does a sexologist do

Becoming A Sexologist

Sexology, despite having been around for nearly sixty years, is still a relatively misunderstood area of health care. According to the World Association of Sexual Health (WAS), “sexologists work in a wide variety of disciplines” and they have specialist post-graduate training, but could have a background in psychology, medicine, public health, research or nursing.” In South Africa, the term sexologist is used according to this definition.

How to become a Sexologist

A sexologist must have an initial qualification that will lead to registration with reputable and accrediting healthcare bodies, such as the health professions council of South Africa (HPCSA).

In South Africa, a healthcare provider who has obtained specialist postgraduate qualifications in human sexuality can call themselves a sexologist, which entails training in the broad spectrum of human sexuality and includes the multiple factors that influence our behaviour and feelings about our sexuality.

A sexologist should also have undertaken sexual attitude reassessment seminars (SARs) as a fundamental part of their training.

They could have an initial qualification in psychology, medicine, nursing, public health or research, but they can only use the title of clinical sexologist if they have completed a postgraduate qualification, obtained the relevant accreditations to practice as a registered healthcare provider with a legitimate body and are practicing clinically.

Unfortunately, there is currently no postgraduate qualification available in human sexuality or sexology in South Africa that would enable a qualified and registered practitioner to become a sexologist. Therefore, a practitioner has to qualify internationally in order to become a sexologist at this time.

What does a Sexologist do?

A sexologist works to understand what people do sexually and how they feel about what they do. For example, a clinical sexologist may offer sex therapy (a form of talking therapy) to help people understand and accept themselves as sexual beings, overcome sexual challenges they might be facing and meet their sexual goals.

Sexology should never (and will never) involve patients interacting sexually with or in front of their sexologist.

It can be offered to individuals, to partners or in a group setting, and could take place weekly (for example for therapy) or less frequently depending on the patient’s needs (such as monthly for medical purposes).

When a patient consults with a sexologist, the sexologist should always maintain a ‘sex-positive’ and non-judgmental approach to their patient and their concerns. Like with any healthcare provider, the success of the patient’s treatment rests heavily on the dynamic between them and the practitioner. They should feel that they can trust their sexologist and open up to them about their concerns, without the fear of criticism, prejudice or rejection. A strong rapport between the patient and the practitioner has been found to be one of the single most important predictors of successful treatment.

A sexologist should uphold a broad perspective on sexuality by taking biological, psychological, sociological, anthropological and cultural factors into consideration when addressing a patient’s concerns. Education is a large part of process, and a sexologist should use an educational approach as part of treatment to help their patients meet their goals; without holding any preconceptions of what a patient’s sexual experience and sexuality ‘should’ look like. Sexual growth is facilitated by helping them to identify their sexual goals and by offering education, resources, tools and techniques to help them meet those goals and ultimately manage their own sexual development.

The PLISSIT model (Anon, 1976) is the foundation for sex therapy, but the treatment of sexual concerns by other healthcare providers also utilises this model. The PLISSIT model is based on the following premise: giving patients explicit and implicit permission to ask and explore their sexuality, offering the patients limited information regarding their specific concerns (often in the form of educational resources), making specific suggestions to the patient based on their needs and concerns, and either referring for or offering the patient intensive therapy when their concerns have psychology origins.

When should a Sexologist refer a patient?

If sexual difficulties appear to be rooted in deeper issues that require intensive therapy, a clinical sexologist with a background in psychology will be able to undertake this work with a patient. If they feel that a patient requires further treatment from another practitioner who is part of the multidisciplinary team, they will provide a referral to an appropriate specialist, and it is advised that this be someone whom the referring clinician has a working relationship with and who’s expertise are known.

In the treatment of sexual issues, it is common practice for a sexologist to work closely with a multidisciplinary team of healthcare providers. These might include, but are not limited to:

  • A medical doctor practicing in sexual health
  • A psychologist
  • A pelvic floor physiotherapist
  • A urologist
  • A gynaecologist
  • An endocrinologist
  • A psychiatrist


Catriona Boffard (SASHA Member)

Clinical Sexologist, Psychotherapist, Sex Researcher & Educator and Speaker

BA (Hons) (WITS, SA)
MA Psychology (WITS, SA)
Masters of HIV, STIs & Sexual Health (MHSSH) – (USyd, AUS)
European Certified Psychosexologist – European Society of Sexual Medicine/ European Federation of Sexology.
Postgraduate Diploma in Cognitive-Behavioural Therapy – (RHUL, UK)


How Do I Know If I Need A Sex Therapist? What Can I Expect During Sex Therapy?

My experience is that most of us don’t realise that our sexual health can have a significant impact on our overall health and wellbeing. Sex is an integral part of health and wellness which is why the WHO defines Sexual Health as a HUMAN RIGHT!

Sexual Health refers to everything about you and your sexuality. The lens of Sexual Health encompasses your mental, physical and social wellbeing as it relates to your sexuality. Sexual Health is premised on your right to sexual pleasure and your right to safe sexual expression and experiences.

Because most people never even think about whether they need a Sex Therapist or not, they live with a host of issues that can affect them negatively on all these levels – when indeed there are people like us Sex Therapists who can help with such a wide range of these issues!

So what is Sex Therapy all about?

Well there is the stuff about your sexual identity, like:

  • Your sexual orientation – who do you find yourself sexually attracted to?
  • Your romantic orientation – who do you find yourself developing romantic feelings for? (The answers to these 2 questions don’t have to be the same and don’t have to remain static over time!)
  • Your gender – now this goes way beyond whether you are a man or a woman but extends to how you like to present yourself to the world, and also how you feel about yourself in terms if your gender – and this too does not have to remain fixed or static over time

Then there’s stuff about the act of sex:

  • What kind of sex do you like? And by ‘what kind’ I mean – when, how, with whom, with what, how often, if at all?
  • What turns you on?
  • What grosses you out?
  • Does sex hurt sometimes?
  • Is there anything you wish you could try, but feel totally weirded out by the idea?
  • Have you ever been aroused by something that took you completely by surprise because it’s just “not normal”?
  • Are you happy with your current level of sexual satisfaction?

Then there’s your sexual relationship with others:

  • What do your sexual relationship structures look like, and what do you wish they could be?
  • How important is monogamy to you in a sexual relationship? And to your partner/s?
  • How do you talk to your kids about sex?
  • How are you feeling about the sex with your current partner/s?
  • What kinds of things did you learn and experience about sex growing up? How do you think this may be influencing your expectations and experiences of sex and sexual relationships now?

These are just a few of the things that a Sex Therapist can help you explore, this list is by no means exhaustive.

As Sex Therapists we can help you whether you are experiencing extreme distress and dysfunction relating to the kinds of topics listed above, or if you are just wanting to find out if there’s more to the sex that you are currently experiencing.

Most people have questions about sex that they find difficult to explore within their social circles, so they google it and often don’t find answers, or just live with the uncertainty, disappointment, or distress that the issue causes.

What can I expect from Sex Therapy?

Sex Therapists are typically trained in Psychology or Social Work, and have obtained further training and or experience working in the field of Sexual Health. Much like general counselling, Sex Therapy does NOT involve any touching, bodily exposure or manipulation of any kind! It’s all “talk therapy” based on general counselling techniques, where we would explore topics that relate to your sexual health.

We may give you homework that can involve you and/or your partner exploring various physical techniques and exercises, which we would then talk about at the follow up sessions.

*You should NEVER allow a Sex Therapist to engage with you in any physical way, unless they are a qualified medical practitioner, and qualified to do what they are offering! It is also very important that you check the credentials and registrations of the professional that you seek help from before you see them.

Besides social or psychological problems relating to your sexual health, there can often be problems of a physical nature as well.

Sex Therapists are qualified to assess whether this might be the case, but we can’t diagnose or offer medical treatment. We thus work closely with medical health professionals who have training in sexual health, and will refer you to them if deemed necessary. We may also do this just to rule out any organic cause for dysfunction. Most often we work hand in hand with the medical practitioner to help you achieve resolution.

So how do you know when you need a Sex Therapist?

Everybody needs to talk about sex. You may not need to talk to a professional, but talking to one, can help you talk about sex to the people in your life who influence your sexual health.

There is a strong link between sex and psychology because sex is often about relating to others and requires a level of vulnerability that many other social interactions do not.

I have had many clients who have found that just having a space to talk about sex freely and without judgement, knowing that all is kept 100% confidential, has given them freedom and insights that have helped them experience sex in a much more positive way than they had prior to therapy.

So the simple answer would be, if you are unhappy, unsure or experiencing distress about any area on your sexuality, an assessment by a Sex Therapist can give you clarity about your issue and also afford you the opportunity to claim your right to live a more sexually healthy and fulfilling life.


Chantal Fowler (SASHA Executive Committee)
Clinical Psychologist
Psycho-Sexologist – European Society of Sexual Medicine (ESSM)
PHD candidate – UCT school of Public Health and Family Medicine



Mobile: 076 586 9857

A Sexologist Vs Sex Therapist

The question is frequently asked – What is a Sexologist? What qualifications do you need to be a Sexologist? There is further confusion between what differentiates a Sexologist to that of a Sex Therapist. The following synopsis aims to clarify these differences.


Sexology is the general term for the scientific study of human sexuality and sexual behaviour. The people who study this field, are generally referred to as Sexologists.

Some people think Sexologists and sex therapists are one and the same. There is a difference with reference to Sexologists who choose to pursue a career as a sex therapist by working directly with patients in a clinical setting, whilst others may explore careers such as researching sexual behaviour, or sexual health.

Additionally, these persons may choose to become a sex educator helping in expanding sexual knowledge in the general public domain, or a medical doctor specialising in sexual health and treating diseases associated with sexual behaviour, like sexually transmitted infections and other physical symptoms.

Lastly another group of individuals working in Sexology are able to act as public policy activists regarding sexually related issues, such as legalising prostitution, LGBTQI&A rights and building on the general rights of marginalised individuals allowing everyone to have fulfilling sexual relationships.

How do you become a Sexologist?

A small number of Universities in the world offer degrees in sexology, or human sexuality at undergraduate and post graduate levels. It is common that people who do choose to pursue the academic process to become Sexologists, have
educational backgrounds in disciplines such as sociology, psychology, biology, medicine, public health (nursing) or anthropology.

Sexologists generally have a master’s or doctoral degree, although some individuals have another type of advanced professional degree. Although a board certification is not required to call yourself a Sexologist, many students in this field seek credentials from professional organisations such as the American Board for Sexology, or the International Society for Sexual Medicine.

To be certified, you typically need to show a relevant advanced academic degree, relevant work experience in the field and completion of a certain number of training hours. These requirements however may vary based on the certification.

Sex Therapist

Sexologists who are also sex therapists work with clients, either individually or as a couple, to improve and address problems and aspects contributing to distress in their sexual functioning. This might include sexual education for couples who may experience problems such as mismatched libidos, difficulties reaching fulfilling orgasms, sexless relationships, sexual trauma
and other issues specific to personal problems regarding sexual identity and problematic sexual behaviour like pornography addiction.

Sex therapists should have specific qualifications such as an advanced degree in either psychology, psychotherapy or counseling, and specific courses in sex therapy training and clinical experience. Unfortunately, these terms are not currently regulated, so anyone is able to call themselves a Sexologist or a sex therapist. It is good practice when you are looking for
someone to help you in this area, to check their qualifications first.

Do not expect any physical contact during a sex therapy session with a Sexologist!

People sometimes think that a sexologist would do ‘hands-on’ work. This would be regarded as unethical conduct within the profession and is defined as such by the professional boards situated under the Health Professional Council of South Africa (HPCSA). An HPCSA registered practitioner can be charged by the HPCSA, in the event of unprofessional behaviour. Therefore it is rather a matter of “All talk, No action”.

This would clearly differ from being a sex surrogate, which is a different profession all together by involving actual sexual contact with clients.
Thus, if you are in need of, or you are interested in consulting with a certified Sexologist or professional sex therapist, the SASHA website would be able to direct you to a list of professionally qualified Sexologists and sex therapists in South Africa.


Dr Eugene Viljoen (Past President of SASHA)

Clinical Psychologist
B.Sc. Hons. (Physiol. & Bioch.)
B.Sc. Hons. (Psych.); M.Sc. (Clin. Psych.)
Dipl Aviation Psych & Physiol. (USA) Ph.D
ISSM/EFS Certified Clinical Sexologist (European Federation for Sexology)

Phone: 012 346 4760

How do I know I must see a sexual health physician

How Do I Know If I Need To See A Sexual Health Physician?

First things first. In order to answer that question, we need to know: What is a sexual health physician?  A sexual health physician is a medical doctor who specialises in the management of sex-related problems. So basically anything and everything that involves sex and your health.

The aim is to have safe, disease free and pleasurable sex.

To achieve that we need to break things up in different areas of sexual health. The first involves sexually transmitted infections (STI) and diseases, including HIV.

Your doctor will help test for and treat STIs and HIV, as well as discuss STI and HIV prevention strategies with you.

HIV prevention strategies that you should definitely know about is pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP).

The next area of sexual health is related to relationship and sexual problems, things like low libido, sexual pain or erectile dysfunction.

The third area of sexual health relates to family planning or contraception.

So how do you know you need a sexual health physician?

If you are having sex (any type of sex with any gender) you should consider seeing a sexual health physician.  

What can I expect during the consultation?

Seeing a sexual health physician might sound scary but let me break it down so that you know what to expect.

History taking

Your sexual health physician will start by just talking and taking a full medical and sexual history.

I know it is not easy talking about your intimate and private issues, but it is important as a doctor to get a full picture.

If you suspect that you might have sexual transmitted infection your doctor will ask about the symptoms that you are experiencing, the number of sexual partners you have, the type of sex you are having, whether you use protection etc. This will help to understand your risks and what infections to consider.

If you are struggling with a sexual problem, such as erectile dysfunction, premature ejaculation, low libido, orgasmic problems or painful sex, your doctor will ask about the specific problem in detail.

Questions can include: How long have you been struggling with this? Are you taking any chronic medication? What is your obstetric and gynaecological history? What contraceptives are you using? How is this problem affecting your relationship?


Depending on your presenting problem, it is likely that your doctor will need to do a quick general examination followed by a genital examination. Again, the examination will be focused on what your specific complaint is.

If you are worried about a possible STI your doctor will do a genital examination and do some tests.

The tests might involve:

  • Taking a urine sample
  • Taking blood for STI testing
  • Taking a vaginal swab or doing a pap smear when indicated

Testing for chlamydia, gonorrhoea and trichomoniasis usually requires a urine sample or a vaginal swab for woman. And testing for HIV, hepatitis B & C and syphilis will need a blood sample.

Women struggling with painful sex will also need an examination. A genital and pelvic examination will shed some light on where the pain is originating from which will help guide the management.

I know how intimidating it can be to see a sexual health doctor. I understand that it is not easy discussing your sexual practices and sexual problems.

By seeing a sexual health doctor you will:

  • Know whether you have an STI
  • Have information on safe sexual practices
  • Know about HIV prevention options
  • Have all your vaccines up to date
  • Be on the the right contraceptive for you
  • Know that your sexual problems can be managed
  • Know that you can have safe and pleasurable sex going forward.


Dr Jireh Serfontein (SASHA Member)

Medical Doctor and Sexual Health Physician

MBChB(UP), DipHIVMan(CMSA), MMed HIV & Sexual Health (Aus)

Instagram: @dr_jireh



Phone: +27(0) 12 816 8240