Sex Therapy for Couples

Who Sex Therapy for Couples Is For

Sex therapy helps couples at all stages of their relationship who are experiencing challenges with sexual intimacy, desire, or connection.

• You and your partner have mismatched libidos or different levels of sexual desire
• Sex has become infrequent or has stopped entirely and you don't know how to restart
• One or both of you is experiencing sexual dysfunction (erectile issues, pain during sex, difficulty with arousal or orgasm)
• You're dealing with performance anxiety or insecurity about your sexuality
• Intimacy disappeared after having children and you can't seem to reconnect
• You're recovering from infidelity and struggling to rebuild sexual trust
• Past trauma or sexual abuse is affecting your ability to be intimate
• You want sex to feel more connected and less mechanical or routine
• Medical issues, medications, or aging are impacting your sexual relationship
• You have different sexual preferences or desires and need help negotiating them
• Communication about sex feels impossible or leads to conflict
• You're in a sexless marriage and want to understand why and how to change it
• You're dealing with shame or negative beliefs about sexuality
• Life stress, work pressure, or mental health issues are affecting intimacy

Sex therapy isn't just for couples in crisis. Many couples seek support to deepen their sexual connection, explore new dimensions of intimacy, or address concerns before they become significant problems. Wherever you are in your relationship, if sex is creating distance or dissatisfaction, therapy can help.

How Sex Therapy for Couples Works

Sex therapy is a specialized form of couples counseling focused on sexual intimacy and the factors that influence it. The approach is holistic, addressing physical, emotional, psychological, and relational aspects of sexuality.

Understanding Desire Discrepancy: When Partners Want Different Things

One of the most common reasons couples seek sex therapy is desire discrepancy—when one partner wants sex more frequently than the other, or when partners have different preferences about the type of intimacy they desire.

This dynamic can create a painful cycle. The partner with higher desire might feel rejected, undesirable, or unloved. They might pursue more aggressively, which ironically pushes their partner further away. The partner with lower desire might feel pressured, guilty, or broken. They might avoid situations that could lead to sex, creating more distance. Both partners end up hurt and frustrated, and neither feels understood.

Sex therapy helps couples understand that desire discrepancy isn't about someone being wrong or deficient. Desire naturally fluctuates based on stress, health, relationship dynamics, life stage, and individual differences. The problem isn't the discrepancy itself—it's how couples navigate it.

You'll learn to communicate about desire without blame or defensiveness, understand what increases and decreases desire for each of you, remove pressure and expectation from intimacy, find ways to connect physically that feel good for both partners, and rebuild intimacy without making sex the only goal.

The aim isn't to make both partners want the same things at the same frequency—that's rarely realistic. It's to create a sexual relationship where both people feel heard, respected, and satisfied, even with different baseline desires.

Sexual Dysfunction: When Bodies Don't Cooperate

Sexual dysfunction—erectile difficulties, pain during sex, problems with arousal or orgasm, premature ejaculation—can feel like a personal failure, but these issues are incredibly common and often highly responsive to therapy.

Understanding the Mind-Body Connection

While some sexual dysfunctions have purely physical causes (and may require medical consultation), many are influenced by psychological factors like anxiety, stress, relationship dynamics, past experiences, or negative beliefs about sexuality. Often, it's a combination of both physical and psychological factors creating a feedback loop.

For example, one incident of erectile difficulty can create anxiety about future performance, which makes the problem more likely to recur. Pain during sex might initially have a physical cause, but the anticipation of pain can create tension that makes the pain worse. Understanding these patterns is the first step to breaking them.

How Sex Therapy Addresses Dysfunction

Sex therapy takes a comprehensive approach to sexual dysfunction by addressing psychological factors contributing to the problem, reducing performance anxiety through gradual exposure, improving communication so both partners feel supported, teaching techniques to manage specific dysfunctions, coordinating with medical providers when needed, and rebuilding confidence and sexual self-esteem.

The focus shifts from "performing" to experiencing pleasure and connection without pressure. Paradoxically, when you stop trying so hard to make sex work a certain way, it often becomes easier.

Intimacy After Betrayal: The Path to Sexual Healing

Sexual intimacy after infidelity or betrayal is one of the most complex and painful challenges couples face. The violation of trust doesn't just affect the emotional relationship—it profoundly impacts physical intimacy, often in ways that surprise both partners.

The Betrayed Partner's Experience

For the partner who was betrayed, attempting sexual intimacy can trigger intense emotional and physical responses. Intrusive thoughts about the affair during sex, mental images of your partner with someone else, physical revulsion or inability to be touched, hypervigilance about your partner's attraction or honesty, feeling like you're competing with the affair partner, or complete shutdown of desire as a protective mechanism—all of these are normal trauma responses, not signs of weakness or inability to move forward.

Your body remembers betrayal even when your mind wants to forgive. The nervous system learned that closeness equals danger, and it takes time and safety to unlearn that association. Many betrayed partners struggle with shame about their sexual responses after betrayal, believing they "should" be over it by now or feeling broken for not being able to reconnect physically.

The Unfaithful Partner's Struggle

The partner who had the affair faces their own challenges with intimacy. Overwhelming guilt that makes initiating feel wrong, fear of triggering their partner or causing more pain, confusion about how to express desire without seeming insensitive, frustration at the loss of physical connection on top of everything else, or their own shame affecting sexual confidence and performance are common experiences.

Some unfaithful partners withdraw from initiating entirely, believing it's respectful to let their partner lead. Others push for sexual reconnection as a way to prove the affair is over or feel forgiven. Neither extreme typically helps—what's needed is honest communication about where both partners are and what they need.

How Sex Therapy Helps After Betrayal

Rebuilding sexual intimacy after betrayal requires addressing the trauma, rebuilding safety, and creating new patterns of connection. Sex therapy provides a structured approach by processing how the betrayal specifically impacted sexual trust, identifying triggers and developing strategies to manage them, rebuilding physical and emotional safety step by step, learning to communicate about needs without pressure or obligation, addressing the betrayed partner's trauma responses with compassion, helping the unfaithful partner understand their role in creating safety, and eventually reconnecting sexually in ways that feel authentic and healing.

This work doesn't happen quickly. Sexual healing after betrayal often takes longer than other aspects of recovery because physical intimacy requires profound vulnerability. You can't rush or force it—the betrayed partner's nervous system needs time to learn that closeness is safe again, and the unfaithful partner needs to demonstrate consistent trustworthiness not just with words but with actions over time.

Stages of Sexual Reconnection After Infidelity

Sexual reconnection after betrayal typically happens in stages, not all at once. Early stage involves creating safety, often with no pressure for sexual activity while you rebuild emotional trust. Middle stage includes gradual reintroduction of non-sexual physical affection, touch without expectation, and rebuilding comfort with closeness. Later stage allows for exploring sexual intimacy slowly, with clear communication and the freedom to stop or slow down at any time. Integration stage is when you can engage in sexual intimacy without constant intrusive thoughts or triggers, though occasional setbacks are normal.

Some couples never return to exactly what they had before—and that's okay. The goal isn't to recreate the past but to build something new, something that might actually be deeper and more authentic than what existed before the betrayal. Learn more about how betrayal affects relationships through our resources on attachment and betrayal.

When to Seek Sex Therapy for Couples

Many couples wait months or years before seeking help for sexual issues, often hoping the problem will resolve on its own or feeling too embarrassed to discuss it. However, the earlier you address sexual concerns, the easier they typically are to resolve.

Consider seeking sex therapy if sexual intimacy has decreased significantly or stopped, one or both partners is avoiding sex or physical intimacy, sex has become a source of conflict or resentment, you're experiencing physical pain or dysfunction, communication about sex leads to arguments or shutdown, you're dealing with the aftermath of infidelity affecting intimacy, past trauma is interfering with your sexual relationship, life transitions have significantly changed your sex life, you want to deepen intimacy or explore new dimensions of sexuality, or you're contemplating ending the relationship due to sexual incompatibility.

You don't need to wait until things are in crisis. Some couples seek sex therapy preventatively—to strengthen their intimate connection, address small concerns before they grow, or simply learn more about building a fulfilling sexual relationship together.

Integrating Sex Therapy with Couples Counseling

Sex therapy often works alongside broader couples counseling because sexual intimacy is deeply connected to the overall relationship. Issues like poor communication, unresolved resentment, power imbalances, or lack of emotional intimacy will inevitably affect your sex life.

Sometimes couples start with general couples counseling and discover that sexual issues need specific attention. Other times, what seems like a purely sexual problem reveals deeper relationship dynamics that need to be addressed. An integrative approach addresses both the sexual concerns and the relational context in which they exist.

We also offer premarital counseling for couples who want to build a strong foundation for sexual intimacy from the beginning of their marriage.

Frequently Asked Questions About Sex Therapy

Is sex therapy awkward or embarrassing?

It's natural to feel nervous about discussing intimate details of your sex life. However, sex therapists are trained professionals who discuss sexuality in clinical, compassionate terms every day. Most couples find that once they start talking, the embarrassment quickly fades, replaced by relief at finally being able to discuss these concerns openly.

Do we have to do anything physical during sessions?

Absolutely not. Sex therapy sessions are talk therapy—conversation, education, and planning. Any exercises involving physical touch are done privately at home, at your own pace, with clear instructions and the option to modify or skip anything that doesn't feel right.

What if one partner wants sex therapy but the other is reluctant?

It's common for one partner to be more eager for help than the other. Sometimes the reluctant partner fears being blamed, feels embarrassed, or doesn't believe therapy can help. A consultation can help address these concerns and clarify what sex therapy actually involves. Once both partners understand the process, most find they're willing to try.

How long does sex therapy take?

The duration varies based on the nature and complexity of your concerns. Some couples see significant improvement within a few months, while others with long-standing issues or trauma may need six months to a year or longer. Your therapist will discuss realistic timelines based on your specific situation.

Do both partners need to attend all sessions?

For couples sex therapy, yes, both partners typically attend all sessions. The sexual relationship exists between you, so both perspectives are necessary. Occasionally, individual sessions might be helpful to address specific personal issues, but the majority of work happens together.

What if we discover we're sexually incompatible?

Sexual incompatibility is rarely about fundamental differences—it's usually about poor communication, unmet needs, or misunderstanding what the other person wants. Sex therapy helps you understand each other better and find creative solutions. However, if true incompatibility exists, therapy helps you recognize and address it clearly rather than struggling indefinitely.

Is everything we discuss confidential?

Yes. Everything discussed in sex therapy is protected by the same strict confidentiality standards as any mental health counseling. Your therapist cannot share any information without your explicit consent, except in rare situations involving safety concerns.