Breaking taboos: SLaM’s Psychosexual Service on sex and mental health
“Sexual wellbeing is an important human right that needs to be acknowledged and supported by everyone in healthcare. We should aim to eliminate shame and taboo” – Clinical Service Manager, Dr Sylvia Hejda-Forde.
Sexuality is a key aspect of people’s health and wellbeing, but it’s a topic many feel uncomfortable raising - in healthcare settings and in everyday life. South London and Maudsley’s Psychosexual Service is helping to change this by working towards breaking down stigma and supporting people with the complexities of sexual and psychological wellbeing.
SLaM's Psychosexual Service team
Specialist support for persistent psychosexual issues
The service supports people facing complex, long-standing sexual difficulties - from problems with arousal and pain during sex, to distress around certain preferences, sexual trauma, compulsive behaviours and more. The service bridges a gap - where sexual health services often aren’t equipped to address mental health, and mental health teams may lack the expertise to manage sexual concerns.
Psychosexual issues can ripple across relationships, identity, and mental health but rarely get openly addressed. Counselling Psychologist, Marvin Blake says: “People feel like they have a secret that they can’t share. Without the appropriate support people can be left feeling isolated, misunderstood, or unsure where to turn”.
Meeting a critical and overlooked need
“Patients tell us that when they’ve tried to talk about sex in other services, it’s often shut down or met with awkwardness or discomfort. For some, coming to our service might be the first safe space they’ve ever had to speak about sex” - Senior Counselling Psychologist, Dr Miriam Grant.
Miriam explains that patients may present with depression, anxiety, or psychosis, but deeper exploration sometimes reveals unresolved sexual shame, distress or trauma. These links are often missed, partly because sex remains a deeply taboo subject. “People may receive support for anxiety or depression it may not be effective because they don’t feel able to express the real issue,” says Dr Miriam.
The Psychosexual team meets this need by creating a safe, comfortable space where people can speak openly.
The service is also actively working toward becoming more accessible and visible – reflecting on challenges like accessibility, cultural competency, health inequalities and other barriers that prevent people, particularly minoritised groups, from seeking help. This ensures that regardless of background, everyone can access the same high-quality support.
Transforming lives and relationships
With a broad treatment offer, including CBT, sex therapy, and behavioural approaches, the team ensure care is deeply person-centred; tailored to an individual’s unique needs and goals. Early sessions build trust and safety, before introducing practical exercises, mindfulness and body-based techniques to try at home.
The outcomes are transformative.
“Couples who couldn’t have intercourse have gone on to start families. Others are finally able to attend smear tests, use tampons, or start relationships. People gain confidence, feel more at home in their bodies, and learn to talk openly with partners about sex. People also become more assertive; able to express their needs and navigate intimacy with safety and respect. And underlying many of these changes is a reduction in shame” - Clinical Psycholgist, Dr Leng Song.
System-wide change
Stigma doesn’t just affect clients of the Psychosexual service - it also impacts the wider healthcare system. “Clients don’t feel like they’re able to talk about sex in other services” - Counselling Psychologist, Alice Bingham.
“When we speak to clinicians, many have expressed feeling unsure, untrained, or uncomfortable broaching the subject. Everybody says it’s not their area of expertise, but you don’t have to be an expert to talk about sex” – Dr Sylvia.
That’s why the team deliver training, offer consultation, and co-design research - to help upskill staff so they feel confident and competent addressing sexual issues.
“Every mental health professional should feel equipped to talk about sexual wellbeing openly and sensitively - and every client should feel safe bringing it up” - Dr Sylvia.
They’re also working to set up a psychoeducation group for patients with little or no sexual education - a need that’s becoming increasingly clear from their referral data.
Their hope is that by breaking down shame and silence, promoting sex education, and by tackling sexual difficulties early - before they escalate into more complex mental health problems - people get the support they need, when they need it. Through this work, they’re shaping a future of preventative care.
Sexual health is mental health: A future of more joined-up care
As the NHS moves towards more integrated, person-centred care, services like this show how complex needs can be supported more holistically. Instead of treating sexual wellbeing and mental health as separate concerns, the team brings them together in one place - offering care for difficulties that often fall between existing pathways.
Services like this show what’s possible when stigma is challenged and silos are broken down, helping to create more joined-up, compassionate mental health care.
Sexual wellbeing shouldn’t belong in the shadows of healthcare – and SLaM’s Psychosexual Service is helping to bring it to the light. When we break the stigma, we open the door to better care for everyone.
The team at the Psychosexual service are keen to build new collaborations with clinicians, academics, researchers and NHS teams with an interest in psychosexual health. If you’re interested in learning more about their work or collaborating get in touch with the Psychosexual service at psychosexualservice@slam.nhs.uk .
