✕
About Specialties Anxiety & Depression Burnout Relationships & Couples ADHD Trauma & PTSD Sexual Health & Intimacy Philosophy Fees & Insurance Speaking Contact Request Consultation →
Practice / Sexual Health & Intimacy
Psychiatrist & Therapist · San Francisco

Sexual health therapy in San Francisco — a clinical space without deflection or shame.

Andrew addresses sexual health and intimacy concerns at his Pacific Heights office in San Francisco, works with clients throughout the Bay Area, and offers telehealth across California. Sexual health is one of the areas people are most reluctant to bring into a clinical space — and one of the areas where shame and silence do the most damage. Andrew creates an explicitly non-judgmental environment for these conversations: individual and couples work addressing desire, intimacy, sexual function, and the relational dynamics around sex. He treats the medical and relational dimensions as inseparable, because they are.

Request a Consultation
What It Looks Like

When sexual health
is affecting your life.

Low or absent sexual desire that feels out of character

Mismatched desire between you and your partner

Difficulty with arousal, orgasm, or sexual function

Avoidance of sexual intimacy — pulling back without fully understanding why

Sexual anxiety — worry, self-consciousness, or dread around sex

Pain or discomfort during sex

Questions about sexual identity, orientation, or desires

Intimacy that feels disconnected or mechanical even when technically functional

The effects of trauma, shame, or past experiences on your sexuality

Why sexual health rarely
gets the clinical attention it deserves.

Most clinical training spends remarkably little time on sexual health. Clinicians often deflect, refer out, or simply don't ask. The result is that people carry these concerns silently — often for years — because they don't know who to bring them to, or because the people they've tried to bring them to have responded with discomfort or dismissal. The gap between need and care is significant: population-based research estimates that 43% of women and 31% of men experience some form of sexual dysfunction, yet the majority never raise these concerns with a clinician (Laumann et al., JAMA, 1999).

"Sexuality is not a peripheral aspect of wellbeing — it's central to how people experience connection, pleasure, identity, and intimate relationships. Treating it as taboo in a clinical setting just moves the shame around."

The medical and the relational.

Sexual health sits at the intersection of the medical (hormones, medications, nervous system function, physical health), the psychological (desire, anxiety, identity, history), and the relational (dynamics between partners, communication about sex, shared meaning). Andrew doesn't separate these — he holds all three. This integrated approach is what allows him to address sexual concerns in ways that purely psychological or purely medical approaches typically don't.

Individual and couples work.

Andrew sees individuals working through sexual health questions — desire concerns, identity questions, the effects of trauma on sexuality, or simply a long-standing concern they haven't had a safe place to discuss — and couples addressing sexual dynamics between partners. Both formats are available; the right one depends on what you're working on and what you're ready for.

Andrew sees patients for sexual health and intimacy concerns in person at his Pacific Heights office — conveniently located for those coming from Presidio Heights, Cow Hollow, the Marina, and Nob Hill — and via telehealth throughout California.

You don't have to
navigate this alone.

Andrew is accepting new patients in San Francisco. The first call is complimentary — no paperwork, no commitment.

Request a Consultation
Questions

Common questions
about sexual health therapy.

Anything else — the complimentary phone call is the right place to ask.

Andrew works with individuals and couples on a wide range of sexual health concerns: low or mismatched desire, difficulties with arousal or orgasm, pain during sex, sexual anxiety or avoidance, questions about sexual identity or orientation, the effects of trauma on sexuality, and relationship dynamics around sex and intimacy. He approaches each of these as legitimate clinical concerns deserving thoughtful, non-judgmental care.
Yes — and this is frequently underaddressed. Many psychiatric medications, particularly SSRIs and SNRIs, affect sexual desire, arousal, and function. Andrew is attentive to these effects when prescribing and managing medications, and works proactively with patients to find approaches that treat the underlying condition without unnecessarily compromising sexual wellbeing.
Not necessarily. Andrew sees individuals working through sexual health questions independently, and couples who want to address these issues together. Individual work often focuses on understanding your own experience, history, and patterns; couples work focuses on the dynamic between partners. The format depends on what you're working on.
Sexual trauma — and trauma more broadly — can profoundly affect desire, arousal, the ability to be present during sex, and the capacity for intimacy. The nervous system's protective responses can activate in sexual situations long after the original threat has passed. Andrew has specialized trauma training and addresses the intersection of trauma and sexuality directly, using EMDR and other evidence-based approaches alongside the therapeutic relationship.
Sex therapy is a specific specialization, and Andrew is not a certified sex therapist. What he offers is something broader: a clinical space where sexual health is treated as a legitimate part of overall wellbeing, addressed by a psychiatrist and therapist who understands the medical, psychological, and relational dimensions — and who won't deflect these conversations or refer you elsewhere. For concerns requiring more specialized sex therapy, he can provide a thoughtful referral.
Related Concerns

Conditions that often overlap.

Relationships & Couples

Sexual health concerns rarely exist in isolation from the relationship. Desire, communication, and intimacy are relational — not just individual.

Learn More → Trauma & PTSD

Sexual trauma and relational trauma can profoundly shape desire, arousal, and the ability to feel safe during intimacy. Andrew has specialized training in both.

Learn More →
Clinically reviewed by Andrew Chacko, MD · March 2026

Last reviewed: March 2026