What to expect

What happens in the first Sex med or sex counseling appointment?

Every appointment is unique and tailored to your needs, but all first appointments have a few main components.
  • Holistic medical evaluation: One goal in a first appointment is to explore your history with you to determine if there are any treatable physical contributors to your sexual concern.  This includes reviewing your medical history, medications, and other so-called lifestyle factors to see where there may be opportunities to better optimize your sexual experience. For some clients this is the main focus of the appointment; for others, it is less relevant.  Depending on the issue, the medical evaluation may involve a physical exam.
  • Discussing your concerns: This may be the first time you have ever described what is bothering you or it may be your hundredth.  Either way, it's important to have the space to really tell your story
  • Exploring your background: Once you have had a chance to describe all the details about the problem at hand, we will usually turn to getting to know you more about you in general with a focus on anything that might be relevant to your concern.  Yes, this does involve talking about your family history 
  • Education: Where it may be helpful, I will take some time to educate about the new science of sexuality, offering new ideas or perspectives on what may seem like intractable problems. 
  • Developing a relationship:  Getting to know each other, creating a safe and comfortable container, and developing a relationship upon which to build our work going forward.
  • Making a plan: By the end of the first appointment we will develop a plan for going forward, including writing any orders or prescriptions where relevant.  We will also make a plan for how often to meet and when to meet again.

How long are the appointments?

All individual appointments are 50 minutes long.  A first couples appointment is 110 minutes long.

Will there be a physical exam?

Depending on your concern, a physical exam might be helpful.   The most common reason I would recommend a physical exam is for sexual pain.  In that case a pelvic exam is needed to provide a diagnosis and recommend treatment.  Need for a physical exam is otherwise determined on a case by case basis with your input of course.

I am nervous about having a vulvovaginal exam or I have bad experiences in the past.  Are your exams trauma informed?

First of all, I am sorry that you may have had bad experiences in the past.  You deserve better.

Vulvovaginal exams are generally set up more for the comfort and ease of the provider rather than the client.  This leads to discomfort, fear, dread and at times traumatic experiences.

In my practice, I offer a feminist, trauma-sensitive exam.  First and foremost this means that you are in charge and that your experience is my primary concern.  This means we will take time before the exam to explore your past experiences and adjust our plan to offer you whatever support is needed.  This means taking the exam slowly and checking in frequently along the way.  It also means we can leave extra time at the end of the exam to support you in regulating your nervous system and coming out of the experience.

On a practical level, all exams are performed on a soft massage table.  I do not use stirrups for any exam.  The table is covered with cloth sheets, no crinkly paper is used.  You will be asked to undress from the waist down only and can cover yourself with a sheet.  I do not use uncomfortable gowns that leave you feeling exposed. 

If you have any special needs for your exam, please feel free to contact me to discuss before hand.

Do you do pap smears?

Yes, I perform vulvovaginal exams and pap smears for folks who have a history of pain or trauma with medical exams.  I have advanced training and experience in helping folks with a wide range of trauma that affects sexuality and bring this to bear as needed for the vulvovaginal exam.  This includes primarily slowing down and offering space for you to take ownership of the experience where possible.  Please see above for more details on the feminist, trauma-sensitive exam.

Can you prescribe medications?

Yes, I am licensed to prescribe medications for folks living in New York or Vermont.

Can you order labs or radiology studies?

Yes, I can order labs and radiology studies for clients who live in New York and Vermont.  In most cases, labs and radiology studies are covered by insurance.  However, I cannot guarantee this coverage.  In the event that I recommend labs that are definitely not covered I will review this cost with you before hand.  

Is there any sexual touch involved in your practice?

No.  As a counselor and coach I do not engage in sexual touch with clients at anytime.  

Do you see clients in person and via telehealth?

Yes, I see clients in person in my office in lovely downtown, Ithaca, NY.  I see clients via telehealth from anywhere in the world! 

How do i schedule appointments?

To schedule a first appointment, please book a free consult so that we can take 10 minutes or so to see if working together would be a good fit. 

After your consult call, you will be invited to the client portal where you can schedule and change appointments as needed.

How do you maintain confidentiality and privacy?

Confidentiality is essential to my practice.  I follow all federal regulations as outlined in the Health Insurance Portability and Accountability Act (HIPAA) to ensure your privacy is maintained at all times.

To ensure confidentiality, I ask that all communications outside of our appointments take place in the client portal as it is fully HIPAA compliant.

How often will we meet?

For ongoing counseling/coaching with individuals and couples, I recommend that we meet every other week. In some instances, meeting even once a month can be supportive towards making the change you are seeking in your life.  

How many sessions will I need?

Of course, each situation is unique. Clients looking for support with menopause often only need a couple of visits to address their symptoms. Similarly, clients needing strictly medical support for a problem may only need a couple of visits. I often work with clients for sex counseling for 3- 6 months.  

How can I prepare for my first appointment?

Please fill out your intake form before your appointment. This form is easily filled out online and provides me with great information that I can review before you arrive.

Beyond that, I encourage you to build in a small buffer around the appointment if possible.  Take 10-15 minutes (or more if you can spare it) to slow down and begin to let your mind/body settle some.  Maybe take some time to follow your breath and let your experience turn inward a bit, allowing yourself to let go of your daily cares and worries; they will be there for you to pick back up later.  Just notice how you are feeling and take a little time to take care of yourself.  Drink a big glass of water, shake off extra energy.  After the appointment, take a few minutes to let what we discussed settle and integrate before heading back into life.  Give yourself a few minutes to see what you need--a big glass of water, a stretch, to journal? 

How do I access the client portal?  What if i forgot my password?

You can access the client portal, here.

You can reset your password, here.

Fees and Insurance

What are your fees?

My fees vary based on the work we are doing together.  As an example, I charge $150 an hour for individual counseling/coaching and $180 an hour for couples counseling/coaching.  Please reach out to learn more about my fees and to see if working together is a good fit. 

Do you take insurance?

I do not participate with any insurance companies. In some select circumstances, I will be able to give you a superbill which you can submit to your insurance company for out of network benefits.  

Can I get a superbill to submit to my insurance company?

I do not take insurance.  However in the following circumstances I may be able to provide you with a superbill to submit to your insurance company for potential out of network benefits.
  • You reside in New York or Vermont.
  • You have insurance through a private company.  I cannot provide superbills for Medicare or Medicaid.
  • I am seeing you for a well-defined medical problem for which I am providing services as a nurse practitioner (diagnosis and treatment).

Do you offer a sliding scale?

I do not offer a sliding scale at this time.

If cost is a barrier for you to work with me, please contact me to discuss further. 

When is payment due?

Payment is due at the end of your appointment.  I accept cash, check or credit card.

What is your policy for missed appointments?

In my experience, clients almost always have a great reason when they need to miss an appointment or reschedule.  My only request is that you let me know as soon as possible if you need to make a schedule change.

In the unusual circumstance where appointments are missed and I am not notified beforehand, I will charge the full appointment fee.

In State vs Out of State

Which states are you licensed In?

I am licensed as a nurse practitioner in New York and Vermont.  I can provide diagnosis and treatment, including performing a physical exam, ordering labs, ordering radiology, and writing prescriptions for clients in these states. 

I can provide counseling or coaching to clients to folks outside of NY and VT.

Can we work together if I live outside of new york and vermont?

Yes, I offer sex coaching one the same fee schedule above. The only difference is that I will not be able to offer a physical exam, labs or imaging, diagnosis, or prescriptions for medications. I can offer coaching that can help you work directly with a licensed medical professional in your state when needed.  

Can I submit your bill to insurance outside of new york or vermont?

Superbills are only provided when I am working with you to treat a medical concern.  I cannot see clients for medical concerns outside of New York or Vermont, so I cannot offer superbills for any counseling/coaching done with clients living outside NY or VT.

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