Talking About Sex in Therapy: Why It Feels Awkward—and Why It Helps
Have you ever considered talking with your therapist about your sex life? Or discussing intimacy with a couples therapist while your partner is present? Gasp — the awkward discomfort!
Some people can talk with their therapist or best friend about their relationship, but the sex part? That feels too personal. Maybe they literally don’t have the words. They can talk about politics, sports, or emotions, but feel stuck when it comes to describing what is — or isn’t — working in their sex life.
Some people feel defective or defeated because sex is difficult, or even physically painful. Others grew up in families where sex was talked about in a healthy way — but their partner didn’t, and now they’re not sure how to navigate that difference.
If you’re reading this, you might be wondering how talking about your sexuality or sex life with a therapist could help. Sometimes both clients and therapists avoid the topic. Therapists may not want to pry or cause discomfort, and clients may not know how to bring it up.
Here are a few insights from a couples therapist with specialized training in sex therapy — someone who helps people talk about sex — to help you consider what these conversations might offer.
1. Talking About Sex Reduces Shame
love the idea expressed by Mr. Rogers: “Anything that’s human is mentionable, and anything that is mentionable can be more manageable.”
Sexuality is part of the human experience — it’s part of how we were created. When we avoid talking about something or keep it hidden, it can become a source of shame or begin to feel unmanageable within us.
Sigmund Freud similarly observed, “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”
Talking about sex can help reduce shame and create space to examine unhealthy or inaccurate beliefs we may hold — beliefs often shaped by cultural messages, upbringing, past experiences, and sometimes trauma.
2. A Good Relationship Doesn’t Guarantee Great Sex
A common belief among couples is that if their relationship is strong and connected, their sex life will naturally be good. In reality, this isn’t true for most people.
Sexual intimacy doesn’t just happen. And if it’s not going well, it doesn’t mean you don’t love each other or that something is wrong with your relationship.
For some, sex begins as passionate and fun, but that ease doesn’t always last. In marriage or any long-term relationship, sexual intimacy is impacted by stressors like parenthood, work, health, and emotional disconnection. Some people assume sex will naturally become less satisfying or less important.
But sexual intimacy can actually deepen over time. Learning to talk about disappointment, hurt, and disconnection can help couples navigate change and reconnect more meaningfully.
Sexual experiences are highly individual, shaped by both body and mind — including hormones, arousal patterns, physical comfort or pain, and differences in body shape and size, as well as insecurities, self-consciousness, body image, and a variety of external stressors.
Intentional, caring, and open communication about your sexual experiences — as well as your concerns — can help you work through challenges together.
3. Most of Us Weren’t Taught Healthy Sex
Most of us weren’t taught how to have healthy, enjoyable sex. In some cases, we were taught that it’s taboo, dirty, or only acceptable in very specific ways.
Even well-intentioned messages — like those from purity culture — can make sexual intimacy in marriage more challenging. Let’s be honest: it’s hard to go from believing sex is sinful one day to knowing what feels good and how to experience pleasure the next.
Add in how accessible pornography is, and it’s easy to pick up misleading or harmful ideas.
Talking with a therapist can help untangle these messages and replace them with healthier, more realistic beliefs.
4. There Is No “Normal” — And That Includes You
One big eye-opener from both research and clinical experience is that there is no single “normal.” That includes you and your partner.
Comparing yourselves to others is often unhelpful and unreliable.
Sex is normal. Difficulties with intimacy or performance are also normal — and often very workable.
What’s more helpful is exploring what’s true for each of you:
What feels good
How your intimacy has changed
What patterns you tend to fall into
These conversations can feel awkward to initiate, which is where a therapist can help — by facilitating the dialogue and reminding you that you are, in fact, normal.
A Dessert Analogy for Sex and Therapy
Recently, I was enjoying dessert with a co-worker. There were warm churros with custard, and my friend wanted seconds. I remembered I had dark chocolate peanut butter cups at home, and dairy sometimes upsets my stomach.
It got me thinking about sex and therapy — hang in there with me…
Imagine you’ve only ever had vanilla ice cream. You might love it, but if it starts upsetting your stomach, you might avoid dessert altogether.
Or someone offers flan, sorbet, or strawberry shortcake. You assume you won’t like them — but you won’t really know unless you try.
It’s similar with sex. If we don’t explore our likes and dislikes, we may make inaccurate assumptions and miss out on meaningful experiences of pleasure and connection.
Talking openly with your therapist can help you:
Understand what works and what doesn’t
Explore discomfort
Clarify preferences
Sometimes a medical provider’s input is also important, and a skilled therapist can help you discern when that’s needed.
Growth and healing in your sexual relationship are possible. There can be more openness, connection, and even enjoyment than you might expect.
And often, that growth begins with simply putting words to what has gone unspoken.
And if your partner prefers vanilla while you prefer chocolate? Sharing can create a swirl that works for both of you.
Talking about sex may feel uncomfortable at first, but it can also open the door to greater understanding, connection, and freedom. What feels awkward to name can often become more manageable — and even meaningful — when it’s brought into the light.
Book recommendations:
Come As You Are; The Surprising New Science That Will Transform Your Sex Life, Emily Nagoski, Ph.D
Passionate Marriage; Keeping Love and Intimacy Alive in Committed Relationships, David Schnarch, Ph.D
Sheet Music; Uncovering the Secrets of Sexual Intimacy in Marriage, Dr. Kevin Leman
Podcast recommendations:
Come as You Are with Dr Emily Nagoski
Pillow Talks with Vanessa and Xander Marin
The Trouble with Sex with Dr. Tammy Nelson
