Couples and Sex Therapy

Specialized support for intimacy, desire, sexual concerns, and relationship challenges.

You may be here because something feels stuck.

  • Intimacy has become a source of tension or disappointment

  • You feel more like roommates than partners

  • Desire has changed

  • Medical changes have affected your relationship, confidence, and sense of self

  • Conversations about sex feel difficult

  • Something feels stuck, but you're not sure why

Often, people arrive believing they're seeking help for a sexual concern. More often, they're also trying to understand what that concern has come to mean about themselves, their partner, and their relationship. Whether the concern stems from a medical condition, a life transition, or something less easily defined, this work creates space to better understand what is happening and identify a path forward.

How I Can Help

  • Understanding how health conditions, medications, hormonal changes, and medical trauma can shape sexuality, desire and, and intimacy.

    Common concerns include chronic illness, cancer survivorship, pelvic pain, neurological conditions, medical side effects, and changes following medical treatment.

  • Exploring changes in desire, arousal, and orgasm with curiosity rather than judgement.

    Whether desire feels absent, mismatched within a relationship, or difficult to access, therapy can help identify the factors influencing sexual interest and satisfaction.

  • Supporting individuals and couples navigating changes in erections, confidence, and sexual connection.

    Erectile difficulties can create frustration, shame, avoidance, and distance between partners. Therapy focuses on understanding what is happening, reducing pressure, and creating opportunities for meaningful change.

  • Strengthening emotional and sexual connection in relationships affected by distance, conflict, or life transitions.

    Many couples find themselves caught in cycles of avoidance, misunderstanding, or loneliness that impact both emotional and sexual closeness.

  • Navigating changes in identity, relationships, sexuality, and the body across life's transitions.

    Support may include menopause, postpartum adjustment, aging, caregiving, grief, health changes, or other experiences that reshape intimacy and sexuality.

  • Developing a more compassionate relationship with your body, sexuality, and experiences of pleasure.

    Together we explore the impact of body image, shame, self-criticism, and cultural messages on sexual well-being and self-confidence.

  • Supporting individuals and partners navigating consensual non-monogamy, LGBTQ+ identities, and diverse relationship structures.

    Therapy is affirming of diverse identities, relationship agreements, and ways of experiencing connection, intimacy, and sexuality.

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Finding a Path Forward

Many people come to therapy looking for a solution. More often, they first need a clearer understanding of what is happening. Together, we identify the factors contributing to the concern, explore the meanings that have developed around it, and develop a thoughtful plan for moving forward. The goal is not simply insight, but helping individuals and couples direct their energy toward the conversations, experiences, and changes most likely to create meaningful movement.

Meet Madelyn

Madelyn Esposito is an AASECT-Certified Sex Therapist and Supervisor, Licensed Professional Counselor, and founder of Esposito Sexual Health Consulting. She specializes in helping individuals and couples navigate the intersection of sexuality, relationships, and health.

Madelyn's work is grounded in the belief that sexual concerns rarely exist in isolation. What begins as a change in desire, a medical diagnosis, pain during intimacy, or difficulty with arousal often becomes intertwined with questions about identity, connection, confidence, and meaning. Her approach integrates relational, psychological, and medical perspectives to help clients better understand what is happening and identify a path forward.

In addition to private practice, Madelyn has extensive experience developing interdisciplinary sexual health programs, training future sex therapists, and collaborating with medical providers across specialties. This work informs her approach to concerns that often exist at the intersection of sexuality, relationships, and health.

Sexual concerns are rarely just about sex. More often, they become questions about identity, connection, confidence, grief, or meaning. Madelyn helps individuals and couples understand not only what is happening, but what it has come to mean about themselves, their relationships, and their lives. Together, this work creates space to identify a path forward that feels thoughtful, realistic, and sustainable.

Fees & Consultation

Services are private pay and are not billed through insurance.

Individual and couples therapy sessions are $400 per 60-minute session.

A complimentary 15-minute consultation is available to discuss fit, answer questions, and determine whether this approach is appropriate for your needs.

Availability is intentionally limited.