AASECT Certified Sex Therapy for Gay Men and Gay Male Couples/Polycules
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Many gay men—whether single, partnered, or in non-monogamous relationships—reach a point where sex starts to feel more complicated than it should.
Desire changes. Confidence wavers. Shame creeps in. Conversations about what you want—or don’t want—become harder. And too often, men aren’t sure where to turn for help that actually feels affirming, adult, and respectful.
I provide sex therapy specifically for gay men, couples, and polycules who want thoughtful, sex-positive support around the realities of gay male sexuality—without judgment, moralizing, or outdated ideas about what sex is “supposed” to look like.
I’m an AASECT-Certified Sex Therapist and a licensed psychotherapist with over three decades of experience working almost exclusively with gay men. My work is grounded in an affirming, progressive approach to sexual health—one that understands desire, fantasy, kink, monogamy, non-monogamy, and identity as parts of a full adult life, not problems to be fixed.
Clients work with me around issues such as:
sexual confidence and performance anxiety
desire, libido, and mismatched needs
erectile concerns and aging
kink, fantasy, and consent
navigating monogamous, open, and poly relationships
reconciling sexuality with spirituality or cultural background
concerns about sexual behavior that feel confusing or out of control—without shame-based “sex addiction” labels
Sex therapy is talk therapy. There is no physical contact. Sessions are conducted privately via secure telehealth.
If you’re looking for a sex therapist who understands gay male sexuality from the inside—and approaches it with experience, depth, and respect—you’re in the right place.
To schedule a free 15-minute consult, call/text 310-339-5778.
About Me
About Me
I’m Ken Howard, LCSW, CST — an AASECT-Certified Sex Therapist and California-licensed psychotherapist who has worked almost exclusively with gay men for over three decades. I’m also a gay man living with HIV since 1990, which gives me both clinical depth and lived understanding of the medical, emotional, and cultural realities gay men navigate around sex, intimacy, and identity.
My work is sex-positive, consent-centered, kink-aware, and inclusive of monogamy, open relationships, and polycules. When “sex addiction” language shows up, I take a sexual-health approach, grounded in the sexual health model developed by Doug Braun-Harvey and Michael Vigorito, which emphasizes consent, responsibility, and wellbeing rather than shame or moral judgment.
Licensed Clinical Social Worker (CA #LCS18290) • AASECT Certified Sex Therapist • Telehealth throughout California
Common concerns include:- erections, desire and mismatched libido, topping/bottoming confidence, orgasm issues, porn concerns, STI/PrEP anxiety, kink/BDSM questions, and relationship agreements (monogamy/CNM/poly).
- erections, desire and mismatched libido, topping/bottoming confidence, orgasm issues, porn concerns, STI/PrEP anxiety, kink/BDSM questions, and relationship agreements (monogamy/CNM/poly).
When gay men usually think of sex therapy, or therapy for sexual issues, their first thought is probably that that’s something to work on in couple’s therapy with a partner or spouse. For the most part, they would be right; when I work with gay couples, assessing the current status of their sex life is part of the work, and then discussing strategies and ways to improve it if either partner, or both, has complaints about their sex life.
What you might be overlooking is the role, value, and purpose of therapy for sexual issues, topics, and challenges that affect you that might be a part of individual therapy. In my practice, I focus on gay-affirmative therapy; that’s my specialty area of expertise that sets me apart from most licensed psychotherapists in my local community (West Hollywood, Los Angeles, Beverly Hills). You might not be aware of some of the sexual topics that might apply to you, that I help a lot of individuals with.
Below are some of the sexual and relationship concerns that often come up in therapy with gay men — whether you’re single, partnered, or part of a polycule. See which of these resonate for you, and consider whether it might be helpful to talk with someone about them.
Validation for a Gay Male Identity
Many gay men tell me that one of the most meaningful parts of therapy is simply not having to translate their experience.
Working with a therapist who understands gay male sexuality, relationships, and culture from the inside can reduce the self-consciousness and hesitation that often show up when discussing intimate topics. Instead of worrying about being misunderstood, over-explaining, or managing someone else’s discomfort, clients are able to speak more freely and focus on what actually matters to them.
As a gay male therapist who specializes exclusively in working with gay men, I bring both clinical depth and lived cultural understanding to the work. Very few sexual concerns are new to me — not because I minimize them, but because I’ve spent decades helping men navigate the full range of sexual questions, anxieties, identities, and relationship structures that show up in real life.
That combination of professional experience and shared cultural fluency creates a therapeutic environment where many men feel safer being honest, more confident exploring sensitive topics, and more grounded in their own sexual identity.
The result isn’t just insight — it’s relief.
Relief from having to edit yourself.
Relief from feeling different in the room.
Relief from carrying sexual questions alone.
Dating and Sexual Choices
There’s no single “right” way to approach dating or sex as a gay man. What feels authentic, satisfying, or comfortable for one person may feel completely wrong for another — and that’s not a problem. It’s simply the reality of adult sexuality.
Some men want sex only in the context of dating or partnership. Others feel most alive through casual connections, ongoing play partners, or more adventurous settings. Many men move between these worlds over time. In sex therapy, you don’t have to defend or explain your preferences — you get space to understand them, own them, and decide what truly works for you.
I often describe this part of the work as sexual self-empowerment:
having full agency over your body, your choices, and your boundaries — saying yes when you mean yes, and no when you mean no, without guilt, shame, or pressure.
For men who are survivors of sexual abuse or assault, this work can be especially powerful. Therapy can help you reclaim a sense of safety, control, and integrity in your body after experiences that took those things away.
For others, it’s about learning to honor what you genuinely desire — emotionally, physically, and erotically — and finding ways to express those desires that feel both safe and fulfilling. A sex life that reflects who you truly are doesn’t just affect your relationships; it supports your confidence, self-respect, and overall quality of life.
Sexual Performance and Other Anxiety
Many gay men carry unspoken anxiety into their sexual lives — even when everything appears “fine” on the surface.
Concerns about performance, erections, topping or bottoming confidence, or difficulty reaching orgasm can quietly turn sex into a source of pressure rather than pleasure. Over time, some men find themselves relying on alcohol or other substances just to feel relaxed enough to be sexual — not out of recklessness, but as a way of managing anxiety and self-consciousness in the moment.
Sex therapy offers a more sustainable, supportive approach.
In our work together, we look beyond technique and focus on the emotional, psychological, and relational factors that shape your sexual experience — including expectations, self-judgment, past experiences, and patterns of stress or avoidance. For many men, part of this process involves learning how to feel more present, confident, and connected during sex without needing substances as a bridge to intimacy.
The goal isn’t sexual “performance.” It’s sexual ease — feeling more grounded, more authentic, and more at home in your body and in your relationships.
PrEP, Condoms, and HIV Prevention
PrEP, Condoms, and HIV Prevention
Conversations about HIV prevention still carry a lot of emotion — even in an era of extraordinary medical progress.
As a therapist who has lived with HIV since 1990, I bring both professional expertise and personal understanding to these discussions. Over the years, I’ve worked closely with public health leaders, physicians, and thousands of gay men navigating questions about risk, prevention, disclosure, and long-term wellbeing. That perspective allows me to approach HIV not with fear or outdated assumptions, but with realism, compassion, and clinical clarity.
Today, prevention looks very different than it once did. Tools like PrEP have transformed how many people protect themselves, and for some men, have eased long-standing anxiety around HIV and intimacy. At the same time, effective prevention isn’t just about a single strategy — it’s about informed decision-making, regular testing, access to knowledgeable medical care, and feeling supported in the choices you make about your sexual health.
In therapy, I help clients sort through both the practical and emotional sides of these decisions. Some men come in carrying deep anxiety about risk. Others are adjusting to a new HIV diagnosis and need space to process what that means for dating, disclosure, and self-image. Still others want to talk honestly about pleasure, safety, and how to build a sex life that feels both responsible and fulfilling.
My role isn’t to tell you what to do.
It’s to help you make informed, grounded choices — and to feel supported in living fully, whether you are HIV-negative, HIV-positive, on PrEP, or somewhere in between.
STD Prevention and Management
For many men on PrEP, HIV no longer feels like the central concern it once was — but other sexually transmitted infections still require thoughtful attention.
Most non-HIV STDs are not life-threatening, but they can carry emotional weight: embarrassment, anxiety, frustration, or uncertainty about how to talk with partners. While diagnosis and treatment are primarily medical matters, the psychological side of sexual health is just as important — especially when it comes to shame, disclosure, and navigating responsibility in real-world dating and relationships.
In sex therapy, clients often want support around how to handle these situations with more confidence and less self-judgment. That may include talking through how to disclose to partners, how to manage anxiety after an exposure, or how to think realistically about risk without falling into fear or avoidance.
The reality is simple: if you are a sexually active adult, it’s likely that at some point you’ll need treatment for an STD. That doesn’t reflect carelessness or failure — it reflects being human in a sexual world.
Part of sex therapy is helping separate medical facts from emotional reactions, so that sexual health can be approached with responsibility and self-respect — rather than shame.
Coping with Erectile Dysfunction
Erectile concerns are one of the most common — and most emotionally charged — topics men bring to sex therapy.
ED can have psychological, relational, and medical contributors, and often it’s a combination of all three. Stress, anxiety, relationship tension, hormonal changes, medical conditions, or the effects of illness or injury can all affect sexual response in real and understandable ways.
In my work, I take a comprehensive approach. That means supporting men who want to improve erectile function through appropriate medical and psychological care — while also helping them challenge the cultural idea that the only “real” sex is penetration leading to orgasm.
For many men, part of healing is learning that confidence and intimacy don’t disappear when erections are inconsistent. There are many ways to experience pleasure, closeness, and connection — and sex therapy helps men expand their options without giving up their goals.
The aim isn’t just better erections. It’s a sex life that feels confident, flexible, and truly your own.
Sexual Struggles, “Sex Addiction,” and a Sexual Health Framework
Many men are told they suffer from “sex addiction” when they feel distressed about their sexual behavior. In my clinical experience, that label often increases shame without offering real clarity or healing.
In my work, I approach sexual concerns through a sexual health framework rather than a pathology-based one — specifically, the model developed by sex therapists Doug Braun-Harvey and Michael Vigorito, which emphasizes wellbeing, responsibility, and self-respect over fear or moral judgment.
This framework focuses on core principles of sexual health such as consent, honesty, non-exploitation, protection of physical and emotional wellbeing, and pleasure that is not driven by secrecy or shame.
When sexual behavior feels out of control, the question isn’t, “What do we call this?”
It’s, “What is this behavior trying to manage?”
For many men, compulsive patterns develop in response to stress, loneliness, trauma, depression, anxiety, or long-standing shame — not because they are addicted to sex, but because sex has become a coping strategy.
Sex therapy focuses on helping you build a relationship with your sexuality that feels intentional, ethical, and aligned with your values — so that sex becomes a source of connection and vitality, not conflict or self-criticism.
Working to Get Sexual Needs Met — In Relationships, Polycules, and Beyond
Many gay men in long-term relationships — including couples and polycules — notice that sexual frequency and desire shift over time. That change is common, and it doesn’t automatically mean something is wrong.
In my work with individuals, couples, and multi-partner relationships, I help men talk openly about what they need sexually and emotionally, and about the options available to them. For some, that means working to deepen intimacy within a primary partnership. For others, it may involve thoughtful conversations about expanding relationship structures, renegotiating agreements, or exploring outside connections — always with attention to trust, communication, and emotional safety for everyone involved.
Research consistently shows that honest conversations about sexual needs strengthen relationships, even when the solutions are still evolving. What matters most is not choosing the “right” structure, but choosing one that reflects your values and supports the wellbeing of all partners.
Sometimes this work happens in couples or polycule therapy.
Sometimes it happens in individual therapy — when someone needs a neutral, experienced space to clarify priorities, think through options, and decide how to move forward.
And for men who are single, sex therapy can also help explore how to build a satisfying sexual life alongside meaningful emotional connection — whether through partners, close friendships, or chosen family.
The goal isn’t to fit into one model of sexuality or relationships.
It’s to build a life that feels honest, connected, and sustainable for you.
Quality of Sex — Intimacy, Expression, and Responsible Boundaries
Many men notice that sex can serve different needs — sometimes emotional connection, sometimes physical expression. In sex therapy, clients often want a safe place to talk about interests such as kink, fetish, BDSM, or curiosity about trying something new, without fear of judgment.
All of this work rests on one essential foundation: consent and adult partners.
At times, men also seek therapy because they feel concerned about thoughts, impulses, or behaviors that fall outside those boundaries. When that happens, it becomes a different kind of clinical conversation — one that requires careful assessment, clear limits, and, in some cases, specialized treatment or referral.
My primary focus is supporting gay men in building sexual lives that are healthy, consensual, and emotionally grounded — while approaching more complex concerns with professionalism, clarity, and responsibility.
Sex and Relationships Over Time — Navigating the Phases
Every relationship changes over time — including its sexual life.
That’s true for couples, polycules, and anyone building long-term connection.
Early passion, settling in, periods of distance, renewed closeness, changing bodies, shifting priorities — these are not signs of failure. They are normal phases of relational life, each with its own emotional and sexual challenges.
In sex therapy, I help individuals, couples, and multi-partner relationships understand where they are in that cycle and what kind of support fits this stage — whether that means deepening intimacy, renegotiating expectations, rebuilding trust, or simply learning how to talk about sex in a new way.
The goal isn’t to force a relationship to stay the same.
It’s to help it grow in a way that feels honest, sustainable, and true to who you are now.
Why Gay Sex Therapy Matters
One of the greatest strengths of gay sex therapy is the experience of validation.
In this space, nothing about your sexuality has to be hidden, softened, or defended. Topics that often feel awkward, stigmatized, or misunderstood elsewhere are treated here with respect, clarity, and care — without moralizing, judgment, or shame.
When men feel more confident and at ease with their sexual lives, the impact reaches far beyond the bedroom. Sexual self-acceptance supports emotional wellbeing, healthier relationships, and a stronger sense of self — especially in a world that has not always affirmed gay men’s needs, desires, or dignity.
Sex therapy for gay men is not just about solving problems.
It’s about reclaiming wholeness.
I’m proud to offer this work as a specialized professional service, grounded in both lived experience and decades of clinical practice.
Professional Foundations
My approach is informed by ongoing training and engagement with the field of contemporary sex therapy. I am a long-standing member of the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) and regularly participate in advanced professional education with leaders in sexual health, including David Ley, PhD, Chris Donaghue, PhD, LCSW, and Justin Lehmiller, PhD.
This means the work you do here is not based on trends or pop psychology — but on thoughtful, evolving, evidence-informed practice that respects both science and lived experience.
If you’re looking for a thoughtful, affirming space to talk about your sexual life, I invite you to reach out.
Get the help you need and deserve.
See how I can help. Call/Text (310) 339-5778 to schedule a no-charge, 15-minute phone consultation, or click on button below to complete contact form.