Mosaic Mental Healthand WellnessBook an appointmentSexual health is part of mental health.
Low desire, the sexual side effects of psychiatric medication, arousal and orgasm concerns, pain with sex, and the changes that arrive with perimenopause. These are treatable, and they belong in the same visit as your mood, your sleep and your anxiety.
Book the initial evaluation
Sixty minutes, in person in Katy or by secure video. If it is easier to write it down first, send a message and we will route you to the right first visit.
Book an appointmentCall or text (713) 987-7828Send a message insteadFor adults 18 and up. Discussed privately, documented like any other medical visit.
The concerns people bring here.
If what you are dealing with is not on this list, it is still worth a visit. Sexual concerns rarely have one cause, which is why the evaluation covers medication, hormones, sleep, pain and history together.
Low desire
Desire that has faded, or a difference in desire between you and a partner. We look at your medications, thyroid and hormone labs, sleep, pain, stress and the beliefs you carry about sex, then treat what is actually driving it.
Sexual side effects of psychiatric medication
Antidepressants often lower desire, blunt arousal, or make orgasm difficult. This is one of the most common reasons people quietly stop a medication that was otherwise working. There are several ways to address it, and none of them require you to choose between your mood and your sex life. Please do not stop a psychiatric medication on your own.
Arousal and orgasm concerns
Trouble becoming aroused or staying aroused, orgasm that takes far longer than it used to, orgasm that has stopped, or orgasm that arrives sooner than you want.
Perimenopause, menopause and sex
Dryness, pain with sex, and the drop in desire that can arrive with the hormonal transition. Hormone therapy for uncomplicated perimenopause is part of Mosaic MoodHaus™, and local treatment is coordinated with your gynecologist.
Erectile concerns and performance anxiety
The loop where worry about performance becomes the obstacle itself. We treat the anxiety, review your medications and labs, and coordinate with urology or primary care when a physical cause needs to be ruled out.
Pain with sex
Pain has a reason worth finding. We screen for it, treat the fear and avoidance that build up around it, and refer to pelvic floor physical therapy and gynecology while staying involved in your care.
Sex after trauma
Internal Family Systems and Acceptance and Commitment Therapy give us a way to work with shame, numbness and the parts of you that learned to protect you. You are never asked to tell the story before you want to.
Sex, identity and relationships
Care that does not ask you to explain or defend your orientation, your gender, or how your relationships are structured. Single, partnered or something else, the clinical work is the same.
When your body or your life changes
After a birth, on contraception, through weight change, with a chronic illness, or with the sensory differences that come with ADHD and autism. What worked before may need to be rebuilt.
A plan that adjusts as you do.
Sexual concerns respond to careful adjustment rather than a single prescription, so the plan is built to be revised.
A 60-minute evaluation
We take a full history: mood, sleep, medications, medical history, hormones, relationships, and what you want to be different. You set the level of detail.
Labs, when they will change the plan
A full thyroid panel, hormone levels and metabolic labs when your history points there. Results are reviewed with you, not just filed in your chart.
A plan you actually agree with
Medication changes, hormone therapy when it is clinically appropriate, supplements when they help, and therapy skills in every visit. You decide what you are willing to try.
Follow-ups that adjust
Visits of 30 or 60 minutes. Sexual side effects and hormonal shifts need tuning, and tuning takes more than one visit.
What this is
Psychiatric evaluation and diagnosis for sexual concerns
Medication management, including preventing and correcting sexual side effects
Hormone therapy for uncomplicated perimenopause, thyroid treatment, and men’s hormone health when labs support it
Therapy skills in every visit, drawing on Internal Family Systems, Acceptance and Commitment Therapy, Cognitive Behavioral Therapy and Motivational Interviewing
Referral and co-management with gynecology, urology and pelvic floor physical therapy
What this is not
Certified sex therapy. This care is provided by Elizabeth Macshadiya, PMHNP-BC, as a psychiatric nurse practitioner. When a concern calls for a certified sex therapist, we refer and stay with you on the medication side.
Couples or marriage counseling, which we refer out
Fertility treatment, surgical care or imaging
Forensic or court-ordered evaluations, and any evaluation or treatment related to sexual offending
Care for minors. This service is for adults 18 and up.
Before you book.
Do I have to go into detail?
No. You set the pace and the level of detail, and you can stop at any point. Plenty of first visits begin with one sentence, and that is enough to work with.
Will this be in my medical record?
Yes. This is medical care, so it is documented and protected the same way the rest of your chart is. You are welcome to ask what is written and why.
Can I do this by video?
Yes, in Texas, Colorado, Iowa, New Mexico, Utah and Washington. Many people find this easier to raise from their own home.
Does insurance cover it?
It is billed as a psychiatric visit, the same as any other visit here. Self-pay rates are $250 for the initial evaluation and $155 for each follow-up. Labs, medication and hormone therapy are separate costs.
What if my partner is the one with the concern?
We treat the patient in front of us. If the work belongs with both of you in the room, we refer you to a clinician who does couples work and stay involved on the medication side.
Do you prescribe medication for low desire?
Sometimes. There are medications approved for low sexual desire in premenopausal women, there are hormonal options where labs support them, and there are several ways to offset the sexual side effects of antidepressants. Whether any of it fits you is decided after an evaluation, not before it.