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.

Her approach integrates relational, psychological, and medical perspectives, with particular attention to how sexual concerns intersect with identity, connection, confidence, and quality of life. Her work is informed by extensive experience developing interdisciplinary sexual health programs, training clinicians, and collaborating with medical providers across specialties.

Learn more about Madelyn

Fees & Getting Started

$400 / 60-minute session
Individual and couples therapy

Complimentary 15-minute consultation
A brief opportunity to discuss fit, ask questions, and determine whether working together makes sense.

Private pay
Insurance is not accepted. Superbills are available upon request for clients who wish to seek possible out-of-network reimbursement.

Availability is intentionally limited.

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Frequently Asked Questions

  • Many clients seek my services after working with therapists, medical providers, or other professionals who were unable to fully address the intersection of sexuality, relationships, and health. My approach integrates relational, psychological, and medical perspectives to better understand complex concerns and identify practical paths forward.

  • Yes. I work with individuals, couples, and partners seeking support around sexuality, intimacy, relationships, and sexual health concerns.

  • Common concerns include desire and arousal difficulties, erectile and ejaculatory concerns, pelvic pain, menopause, chronic illness and sexuality, out-of-control sexual behavior, relationship concerns, body image, and sexual confidence.

  • Sex therapy is a specialized form of counseling that addresses concerns related to sexuality, intimacy, relationships, sexual functioning, and sexual wellbeing. Sessions focus on conversation, education, skill-building, and collaborative problem-solving. Sexual activity does not occur during therapy sessions.

  • I offer a complimentary 15-minute consultation by phone or video, based on your preference, to discuss your concerns, answer questions, and determine whether my services are likely to be a good fit for your needs.

  • The frequency of therapy varies based on your goals and concerns. Some clients attend weekly, but most benefit from biweekly or consultation-style appointments. Together, we will develop a plan that makes the most effective use of your time and energy.

  • There is no universal timeline. I view therapy as episodic, with different concerns and life transitions calling for support at different times. Some clients seek help around a specific issue and attend for a relatively brief period, while others return periodically as new challenges arise. My goal is to help clients identify meaningful paths forward and develop tools they can continue using long after therapy ends.

  • Yes. Virtual services are available for clients located in Wisconsin.

  • No. I do not accept insurance, and Esposito Sexual Health Consulting, LLC is an out-of-network practice. If you have out-of-network benefits, I’m happy to provide a superbill upon request that you can submit to your insurance company for possible reimbursement.

  • Therapy sessions are $400 per 60-minute session. Payment is due at the time of service.