Sexuality in Couples Therapy

Talking about sex in therapy can feel uncomfortable, even for couples who have been together for years. But sexuality is an important part of relational health, and avoiding it often leaves couples feeling disconnected or misunderstood. In couples therapy, exploring sexuality means moving beyond assumptions and creating space for honest, informed, and compassionate dialogue.

As a psychologist, I often encourage couples to approach these conversations with curiosity rather than judgment. The goal isn’t to assign blame or “fix” anyone, but to understand each person’s experience, needs, and expectations. Drawing from Mark Blechner’s work, this process involves gathering accurate information, clarifying goals, and addressing both the behavioral and emotional layers of sexual dynamics.

In this post, we’ll look at how couples therapy can help normalize sexual discussions, debunk myths, and build deeper intimacy: both emotionally and physically.

Talking About Sex Without Assumptions

Sexuality is often surrounded by silence, shame, and misconceptions. Many couples enter therapy unsure how to talk about sex or assume their concerns are “abnormal.” The truth is, sexual desire fluctuates, and that’s okay.

One of the first steps in therapy is gathering accurate information and encouraging open, respectful conversations about sexual experiences, preferences, and barriers. Using the couple’s own language (rather than overly clinical terms) helps normalize the topic while maintaining sensitivity.

It’s also essential to take seriously what each partner hopes to gain from therapy. Does one partner want to feel more connected? Does another want to reduce anxiety or understand changes in desire? Understanding these goals provides the foundation for collaborative work.

As Blechner notes, therapists should remain “suspicious of common sense” — meaning, don’t rely on cultural assumptions about what sex should look like. Each couple’s sexuality is unique, and therapy helps uncover what’s true for them.

Modeling Open Communication and Clarification

Therapists play an important role in modeling communication about sex. If we feel discomfort discussing it, our clients will too. When we don’t know, we ask. This modeling shows that sexual discussions can be curious, direct, and safe.

In early sessions, clarification and data gathering are key. Some clinicians even assign readings or educational exercises, such as exploring sex-positive literature or anatomy guides, to desensitize the topic and spark conversation.

Behavioral interventions, like sensate focus exercises, can also help couples rebuild physical connection. These focus on texture, temperature, and sensation rather than performance or orgasm. When these structured activities surface frustration, avoidance, or shame, that’s often when the deeper relational work begins. This can look like exploring what those reactions reveal about intimacy, vulnerability, and trust.

Normalizing Desire Differences and Debunking Myths

One of the most common challenges in couples therapy is discrepant desire — when one partner wants sex more often than the other. It’s important to normalize this. Differences in desire don’t mean one partner is “broken” or “unattracted.”

Therapy can help clarify what attraction means for each person. For some, sex represents closeness or reassurance; for others, it may be about playfulness, anxiety relief, or connection. All of these reasons are valid, but when unspoken, they can create misunderstanding.

A helpful intervention is redefining what “spontaneous” sex really means. Many couples romanticize the early days of their relationship, when intimacy felt effortless. But “effortless” doesn’t mean “better.” As desire naturally evolves, planning and communication become part of keeping intimacy alive.

Providing psychoeducation about the sexual response cycle , from arousal (a physiological and mental response) to desire (the motivation or “wanting”) to satisfaction, helps couples understand that desire often follows arousal, not the other way around. In other words, connection grows through doing, not just through waiting to “feel in the mood.”

Moving Past Polarization

Sexual conflicts can easily become polarized, meaning that one partner pushes for closeness while the other withdraws, reinforcing the very distance they’re trying to close. Blechner reminds clinicians to ask: Is this polarization serving to keep the status quo? When couples frame sexual issues in overly simple, opposing ways, therapy helps them look beneath the surface to identify what each person truly needs.

By clarifying misunderstandings, unpacking unspoken sexual scripts, and reintroducing curiosity, couples can shift from performance-based pressure to mutual exploration and connection.

Conclusion and Call to Action

Sexuality is deeply tied to identity, emotion, and relationship patterns, which means talking about it requires care and courage. When couples learn to approach these conversations with openness and empathy, they often discover that the problem isn’t “sex” itself, but the layers of anxiety, expectation, and unspoken need surrounding it.

Therapy offers a space to normalize these discussions, replace shame with understanding, and rediscover intimacy on your own terms.

If you and your partner are struggling with sexual disconnection, mismatched desire, or difficulty communicating about intimacy, you don’t have to face it alone.

I’m Dr. Victoria Navarro, a licensed clinical psychologist in New York specializing in trauma-informed and relational care. I help couples and individuals navigate intimacy challenges, rebuild trust, and create relationships that feel emotionally and physically fulfilling.

Reach out today to learn how couples therapy can help you deepen your connection, both in and outside the bedroom.