Is it OK to talk about sex in couples therapy?

YES, it is OK to talk about sex in your couples therapy. To be more precise, you should be able to talk about sex in your couples therapy especially if your couples therapist is a psychosexual therapist/sex therapist as well as a relationship therapist. The two are mutually exclusive.

It is not only OK to bring sex issues to couples therapy, but also encouraged. This is why couples therapists are encouraged to not only train in relationship issues but also psychosexual issues. We know that if a couple is experiencing relational issues, they are also very likely to be experiencing sexual difficulties. In fact, many couples don’t bring it up even when it’s a core issue—and that can slow down real progress in therapy.

Why so? I hear you ask..

Sex is not just physical, it is not just an act of physicality or bodies coming together. Sex is part of emotional intimacy as much as it is physical intimacy. Our sexuality is tied to vulnerability, connection, safety and communication/expression of needs, wants and desires.

Couples that struggled with emotional intimacy are also likely to struggle with physical intimacy. Talking about your sexual relationship with your couples therapist is going to help you understanding your needs and boundaries (that might be the root of your communication/relational issues), explore the unmet emotional needs showing up in both your sex life and relational domain. It can also lead to building a healthier and more satisfying connection and bond in your relationship.

Avoiding the topic of sexual difficulties in your relationship can be due to your feelings of embarrassment or fears of judgment. However, when sex is not addressed this can lead to many ruptures in the relationship such as built up resentment (that contribute or exacerbate the emotional issues/relational problems), misunderstandings, gradual erosion of intimacy and emotional connection. With your couples therapist, you have the opportunity to explore these sensitive issues in a safe and non judgmental space

What kind of sexual difficulties can I bring to couples therapy?

A couples therapist who is also a qualified sex therapist can help you with any aspect of your sexual life and sexuality. The common and main areas of sexual difficulties are:

• Mismatched libidos

• Sexual dissatisfaction

• Performance anxiety

• Shame or trauma-related blocks

• Infidelity and sexual trust

• Desire differences over time

Sex therapy is as important as the relationship therapy.

There are female-specific and male-specific sexual difficulties, see below for the respective issues.

Female Sexual Dysfunctions:

• Vaginismus

• Dyspareunia

• Low sexual desire/libido

• Sexual arousal disorder

• Genito-Pelvic Pain/Penetration Disorder

• Orgasmic disorder (Anorgasmia)

Male Sexual Dysfunctions:

• Erectile Dysfunction

• Premature/Rapid Ejaculation

• Delayed or Absent Ejaculation

• Low sexual desire/libido

• Sexual arousal disorder

If your couples therapist tells you that they are not specialised in these areas, they should be able to refer you to someone who is (such as a qualified sex/psychosexual therapist). Whilst the number of qualified psychosexual therapists in London (and the UK in general) are still relatively low, there are good therapists out there that you can find. COSRT has a list of qualified psychosexual and relationship therapists in London and in the UK.

Finding a couples therapist in London can be difficult, it is overwhelming to know what to look out for. Generally I would encourage that you look for a therapist who is able to work with both the relational/emotional problems of your relationship and the sexual issues. Even if you wish to not bring sexual issues to the couples therapy work, it can be a huge benefit to have a couples therapist who is also trained in psychosexual issues.