If it's rare to hear people unabashedly discussing sexual problems, it may be because they've got another outlet: an online sex therapist.

Sex therapists have joined the Internet age and are figuring out how to counsel people through e-mail, chats and videoconferencing. The new form of therapy is still in its infancy, but may be working for people who can't or won't seek face-to-face counseling. 

"For years we've been saying that there are certain kinds of people that are in need of 'e-therapy' who we can pretty much guarantee aren't going to get therapy any other way," said virtual community psychology expert Storm King. "They are typically people who live in remote places like Alaska, and agoraphobics who can't leave their houses; I would add sex addicts and people with sexual problems to that list because of the humiliation factor." 

Even though online sex therapy encapsulates all that Web surfers love about the Internet — speed, anonymity, convenience and low (or no) fees — the new form of therapy comes with its own problems. 

"I think people have to realize that it requires new skills, and therapists aren't trained for that in school yet," said John Grohol, of HelpHorizons.com, a Web site that provides therapists with tools to communicate securely. 

In the Beginning 

Sex therapy sites started popping up in 1997, with names like "Ask the Sex Doc," "Ask Me Anything," and "Ask Dr. Love," and received almost no traffic at first, according to Webmasters. But the numbers grow every year, said Martha Ainsworth, editor of metanoia.org, a site that independently evaluates online therapists. 

 
'The anonymity of the Internet is a tremendous asset. It is the saving grace for some of these people' — Dr. William Fitzgerald 
 

The big attraction for Web-based sex therapy is that people don't have to be humiliated about asking intimate sexual questions. "The anonymity of the Internet is a tremendous asset. It is the saving grace for some of these people," said Dr. William Fitzgerald, founder of sexdoc.com. 

The people who use online sex therapy sites fall into several categories, he said. Many are simply embarrassed to bring up sexual matters with their doctors. "Others are women who have asked everyone else — including their OB/GYN and other doctors — and can't find a solution to their problem," he said. "Then there's the small percentage of guys who have erection problems that thank God for the anonymity of the Internet." 

Analysts point out the information given over e-mail and chats is no substitute for face-to-face therapy in more serious cases. "Online therapy is a good initial exposure to therapy, but e-therapy is not therapy," said King, a former president of the International Society for Mental Health Online. 

Fitzgerald limits what he will discuss online, referring everyone with significant problems to traditional therapists. Face-to-face therapy also allows patients to verify a doctor's credentials, helps foster a therapeutic relationship and makes it more difficult to breach doctor-patient confidentiality. 

Beware Sex Hackers 

Some people fear their therapy e-mail could be intercepted, that family, friends or co-workers could accidentally see the communications, or that scammers could give them bogus advice. Although none of these dangers have become a major problem, people should be careful when choosing a therapist and when e-mailing back and forth, according to Dr. Robert Hsiung, a past member of ISMHO. 

 
'Online therapy is a good initial exposure to therapy, but e-therapy is not therapy' — Storm King 
 

With no certification board for online therapy, a sex therapy home page could be run by a real doctor or by someone looking to make a quick buck. 

To prevent quacks from posing as qualified therapists, the ISMHO recommends that every therapy-oriented Web site follow the group's "Suggested Principles for the Online Provision of Mental Health Services," which include information about confidentiality and communication. 

"The sex therapist should present his name, brief information and credentials clearly on the Web site," said Grohol. "If someone isn't sure about a therapist's qualifications, make a phone call. I would encourage people to do that anyway." 

Business Is Booming 

For all of the dangers and risks, people seem determined to seek help for their psychosexual problems online: After a slow start, Fitzgerald receives an average of 30 legitimate e-mails a day. And some sex therapists think online communication can be just what the patient needs. 

 
'You can be empathic online. You can learn about someone's life. You can learn about their past. You can make connections.... If all that's possible, why wouldn't therapy be?' — Dr. Robert Hsiung 
 

"The issue is the nature of the relationship. If you can establish a connection, I don't care how you get the therapy, you could use walkie-talkies," said Dr. Turndorf, also known as Dr. Love. 

The success of singles chat rooms prove it is possible to have a strong emotional connection online. Sex therapists hope they can form a similar bond with their patients. 

"If you can fall in love online, there's certainly the potential for powerful relationships," Hsiung said. "You can be empathic online. You can learn about someone's life ... If all that's possible, why wouldn't therapy be?"