Discussing Sex in Therapy: Why and How it’s Helpful
Talking about sex, even with those nearest and dearest to us, can be uncomfortable, raw, or emotionally charged. It’s no surprise, then, that there are few things that many of us would dread more than sitting down on a couch, looking their therapist in the eyes, and sharing their feelings, fears, experiences, or longings for their sex life.
You’re not alone in this experience. Many people avoid discussing their sexuality or sexual health with their therapists; it can be scary to be vulnerable in this way. There’s oftentimes a fear that therapists will confirm our worst fears about ourselves with sex: “no one else experiences what I do,” “there’s something wrong with me,” and “I should feel ashamed of myself.”
Unfortunately, this is an area where the mental health field has failed or harmed clients at times in the past. Due to some therapists’ own discomfort with discussing sex or their fears about being competent or trained enough, they can shut down discussions about sex, avoid it like the plague, or immediately refer clients to a sex therapist when the word “sex” surfaces in a session. This hesitancy only intensifies the shame that so often comes with intimacy issues, as it sends the message that there is something so wrong or abnormal going on that my therapist can’t handle this - only a sex therapist can help. To be clear - this message is unhelpful and only drives us further into shame and hiding. While in some cases it is helpful to get the specialized support of a sex therapist, your therapist should be able to openly converse with you about sex without discomfort, assess for what may be impacting your experience with sex, understand what you may need in terms of support, and offer help for what is within their scope. Sex and sexuality are important parts of your life, and being able to talk about this openly with your therapist is valuable.
The question, “Why should I talk to my therapist about sex?”, may be crossing your mind as you read this, especially if sex is not the primary reason you reached out to initiate therapy. It’s understandable that sex may not be top of mind to discuss when you have a session with your therapist, and you may want to prioritize discussing your mental and emotional health instead. However, here are some reasons that highlight why this is important and can be helpful to explore in therapy.
All humans are sexual beings; sex is a part of our overall health and well-being, both as individuals and for our relationships. By ignoring sex in discussions of your life in therapy, your therapist misses out on understanding a big part of your life and experience!
Everyone has the right to experience sexual health, and discussing sex in therapy can help aid you in achieving this. Just like discussing any other issue in your life, therapy can help you get relevant education, be heard, validate that what you are experiencing is normal, connect with your feelings and needs, get a new perspective on the issues, challenge unhelpful beliefs or assumptions, learn new skills, and find some ways to get unstuck. All of these things can help you achieve a satisfying sex life by removing blocks that get in the way (that you may not even realize are there).
Talking about sex does not have to only occur in a couples therapy setting. Either individually or as a couple, you can experience the benefits listed above when addressing the topic of sex with your therapist.
Just like with any problem in life, ignoring it, avoiding it, or spinning your wheels by trying the same things to fix it often worsens it by making you feel more stuck, overwhelmed, and discouraged. By simply bringing the issue into the open and beginning to discuss it in a safe environment, you can feel hope for the future.
What can I get out of discussing sex in therapy?
One of the main benefits of discussing sex in therapy is understanding what may factor into any sexual issues you may be experiencing. Due to the shame around this topic and the pain that can surface around sexual difficulties, we oftentimes zoom in on only one factor that may be influencing us to find a solution - without understanding that many factors may be at play. Therapists should explore and discuss factors showing up in the following categories with you:
Biological and hormonal factors
These factors include things like hormone levels (testosterone, estrogen), side effects of medications, illnesses, fatigue, and normal processes of aging. For example, starting a new depression medication can cause a sudden decrease in sexual desire. Rather than feeling confused and blaming yourself for having a lower level of desire than in the past, a therapist can help you see the connection between this external factor and the symptoms you’re experiencing.
2. Lack of appropriate stimuli
Due to sexual myths or lack of education, clients can have high expectations for themselves surrounding the ability to experience arousal, pleasure, or orgasm with minimal stimulation. For example, a woman might enter therapy concerned about her inability to experience an orgasm. After exploration, the therapist discovers that her partner experiences erectile dysfunction and has hurried intercourse due to his own anxiety. The therapist can educate the client on how the majority of women (roughly 75%) do not have orgasms from intercourse alone and can help the client discover and communicate her needs with her partner.
3. Interpersonal factors
Interpersonal factors are those that occur between those in a relationship, like chronic conflict, lack of emotional intimacy, impacts of past relationships on present engagement, partner sexual problems, or difficulty communicating effectively. A couple may enter therapy reporting that they have sex here and there, but that it is not connective or pleasurable. After assessment, the therapist learns that they have been drifting apart and experiencing increasing resentment for years. The therapist can educate on how a lack of emotional intimacy creates an environment without the safety to communicate, give feedback, be vulnerable, and reach out sexually, which all impact the ability to feel close and sexually satisfied.
4. Intrapersonal development history
Intrapersonal factors are those that influence the individual when it comes to sex. These can include experiences of trauma, whether directly related to sex or not, mental health factors like anxiety and depression, sleep issues, body image, or past experiences with divorce, betrayal, or abandonment that can cause lack of trust. These intrapersonal factors (along with interpersonal factors) can morph into a negative cycle of sex that can leave clients feeling stuck, confused, and deflated. With the support of a therapist, this negative cycle can be identified and shifted into a more positive one that alleviates disconnection and pressure with sex.
5. Contextual factors
Contextual factors are broader dynamics at play in your life that can influence sex. These include lack of privacy in your home or environment, lack of emotional safety or connection, experiencing infertility, having and raising children, becoming empty nesters, work stress, caring for sick or aging family members, or experiencing financial difficulties. All of these factors, while not directly connected to sex, certainly influence an individual’s and/or a couple’s openness to sex, access to desire, and anxiety levels, which often plays a role in sexual dysfunction.
6. Expectations of negative outcomes
Shame, anxiety, and disappointment are all emotions that can become associated with sex when experiencing difficulty or disconnection. As a result, a powerful negative cycle can form in which the more clients associate these emotions with sex, the more they anticipate the same experience in the future, which only heightens these emotions. Sex can become scary, intimidating, and overwhelming - which inhibits the ability to feel safe, be present, and experience pleasure.
Typically, clients who come into therapy to discuss sexual problems experience factors surfacing in several, most, or all of the above categories. Understanding that sexuality is complex and can be influenced by many different pieces may feel overwhelming; but likely also validating. I like to tell clients that if the solution was linear and simple, you would have already figured it out! The fact that sex is complex and that solutions can come from many different areas of life can feel reassuring for those who have felt stuck. After assessing, determining what is influencing sex in your life, and normalizing this (because you are more than likely not alone in your experience), your therapist can also help you find a path forward to address these concerns.
There is no “magic fix” for sexual difficulties, but there is hope! Discussing your experiences, thoughts, feelings, fears, and longings for your sex life can help organize your experience, understand more about yourself, face fears and feelings, and find ways to remove blocks to help you experience authentic, safe, and pleasurable sex.
Citations:
Nagoski, E. (2021). Come as you are: the surprising new science that will transform your sex life. Simon & Schuster trade paperback edition, revised and updated. New York, NY, Simon & Schuster Paperbacks, an imprint of Simon & Schuster.
Needle, R., & Siegel, R. (2021). Overview of Sexual Response and Taking a Sexual History. Lecture, Modern Sex Therapy Institutes.
We hope this blog post inspires you to talk about sex more during therapy. To find out if our programs are right for you, contact us for a free phone consultation. Our team of Certified Sex Addiction Therapists (CSAT) and Certified Partner Trauma Therapists (CPTT) are licensed, experienced, and specifically trained in treating betrayal, trauma, addiction and relationships.
About the Author
Kirstin Franklin is a Licensed Marriage and Family Therapist and a Certified Clinical Trauma Professional. Kirstin helps individuals and couples examine relational patterns, get in touch with their needs, and express those needs in vulnerability during the healing process.