Sex is often the white elephant in the therapy room. One or both partners may be aware of its presence, but refuse to acknowledge it or its impact on the relationship. Sex plays a significant role in committed relationships and is often an avoided topic due to embarrassment, shame, and defensiveness. Many people refrain from discussing sexually related concerns with even their closes confidants.

The inclusion of sex and/or physical intimacy is one of the defining characteristics that distinguish romantic relationships from platonic ones. Sex can help generate a sense of closeness, trust, and affection.

Sex is also a significant stressor in many relationships, as it is rare for both partners to feel completely satisfied with their sex lives. Quite often, especially in the case of women, difficulties in one area of the relationship can negatively impact a couple’s sexual relationship. For example, it is common for issues of mistrust, past trauma, domestic violence, illness, child rearing differences, and financial stressors to significantly impact the quality and quantity of sexual encounters. Hence the saying, “If there are problems in the living room, there are problems in the bedroom”.

Common sexual concerns presented by couples include:

• Lack of interest or desire
• Painful intercourse
• Erectile difficulties
• Lack of arousal
• Lack of orgasm
• Sexual addictions
• Fetishes
• Concern about ‘abnormal’ sexual behavior or desires

One important element identified as essential to improving a couple’s sex life is that of psychoeducation. Many sexual difficulties arise from a lack of understanding or misinformation regarding the body, the range of sexual behaviors, and sexual techniques that may provide both partners with pleasure. Another critical aspect of couple counseling/ sex therapy is that of communication: Partners need to learn to talk directly about what does and does not work for them. This may also require some willingness for individuals to explore and experiment with different exercises to increase self-knowledge in this area. The resources below address many of the common concerns presented in therapy regarding sex and intimacy, as well as encourage open discussion and exploration of new ways of relating.