When people see the word “sex” they often associate it with sexual intercourse only. Sex is your biological anatomy or the act of sex (often thought of as penetrative intercourse), while sexuality dictates connection with others. Just like intercourse does not define sexuality, it doesn’t define intimacy. Many people struggle to speak about intimacy — even in therapy. Shame, fear of judgment, and cultural taboo can make these dialogues difficult for clients to bring up, even if its hugely effecting their lives.
I’m here for it. It’s my job as your therapist to help you look at all areas of your life that may serve as barriers to you feeling like the person you want to be. So, whether clients bring up intimacy of not, I always ask about it at some point in our relationship because intimacy is closely connected to emotional health, relationships, self-esteem, trauma history, stress, and communication.
What Intimacy Issues Come Up Most in Counseling
While I’d like to offer an expansive list, it’s helpful to know that the most common topics as they relate to sex and intimacy in session are:
- Sexual anxiety and performance pressure
- Lack of sex over the course of time despite one or both partners wanting change
- Lack of closeness due to relationship conflict
- Erectile dysfunction related to stress (men)
- Libido or hormonal issues, especially in perimenopause (women)
- Sexual trauma recovery
- Shame surrounding sexuality
- Difficulty communicating sexuality desire with a partner
Therapy is not a magic pill. Nor is ‘the magic pill’ often a cure all.
In sessions, we focus on both (1) education and normalizing your concerns and (2) strategizing behavioral shifts to help you have a much healthier life!
Couples Counseling
Often, emotional disconnection shows up in physical intimacy before it becomes obvious elsewhere in the relationship. Couples therapy helps identify unhealthy patterns while improving emotional safety and communication. I often practice Gottman Therapy with couples around sex, using research-based exercises from The Gottman Institute to help the two of you talk to one another. You talk about the problem with planned questions and prompts and, me, a therapeutic mediator. In counseling, I’ve seen this approach work wonders!
In couples work, I often find struggles as a result of:
- Mismatched libidos
- Emotional distance
- Communication issues
- Parenting stress
- Infidelity recovery
- Loss of trust
- Avoidance of conflict
When it comes to anxiety in relationships, there is an underlying component of difficulty communicating about uncomfortable topics in the relationship. Here, it can be incredibly useful to have a facilitator. One of the therapeutic suggestions I give early on is that more time without any sort of intimacy will make any sort of sexual anxiety worse, not better. Avoidance and time are a killer of closeness.
Next, we work on specific ways to connect both with words and physically. Often, I help you expand your sexual repertoire through simply getting more comfortable being nude around your partner or lying in bed nude together with zero expectation of sex. Depending on where your comfort level is as a couple and how long it’s been since you’ve had sex, I’ll often start with fully clothed ways of reconnected.
Sex Anxiety versus Changing Bodies
Many individuals experience anxiety surrounding sexual performance or emotional vulnerability. Much of these issues come up for people who appear confident and in control. Other times, they may retreat completely, as a result of resigning to the idea that “sex is just not part of my life anymore.” Again, aside from individuals who are asexual and want to remain that way, sexuality is a healthy part of adult life. It is not amoral to talk about sex.
Barriers to Sex for Women
Perimenopause & Menopause
As women’s health has gained momentum, talking about decreased libido has become more commonplace in therapy. Now, we have more of an understanding why and more resources as to how to deal with it! I defer to medical professionals to define whether or not a woman may be, for example, dealing with early signs of perimenopause or menopause. Medications, like hormone replacement, pelvic floor exercises, lubrication and other topics are discussed in therapy. I can help you develop a basic level of knowledge and we can discuss outside professionals (Eastern and Western practitioners, physical therapists, experts in retail settings) that may be able to help in a major way.
Social and Self Stigma
Believe it or not, in 2026, the social stigma around women as sexual beings still exists! You may be surprised that in therapy for women, this occurs in my younger female clients, as well as more mature women. We are still socialized to believe that a “good girl” does not talk openly about sex. It’s of very little surprise to me when women come to therapy petrified to bring the idea that they haven’t had sex with their husband in 10 years. It is a good therapist’s job to build connection, provide resources and create a safe space to have a dialogue about your sexual desires or lack thereof. I often try to lighten the mood by telling people that talking about sex in therapy is as normal to me as thinking about what I’ll be eating dinner later that evening.
Self stigma has a lot to do with body image. Most women struggle with body image at some point in their lives, and it makes good sense that changes in sexual desire would perpetuate that. Conversations about feeling less desirable as women age often common up. I support these conversations often with components of Acceptance and Commitment Therapy, especially practicing the skill of acceptance. In practicing expansion (the mindfulness skill synonymous with acceptance), we explore how we don’t have to like the changes in our bodies whatsoever, but fighting them all of the time creates even more discomfort. What changes do you need to make to feel more comfortable? Let’s get you there. What do you need to accept about your changing body to feel like a sexual being? Let’s discover that too.
Therapy for Men and Sex
Breaking Stigma Around Men’s Mental Health
Many men struggle silently with emotional intimacy, relationship fears, or sex anxiety because they were taught to suppress vulnerability. No wonder emotional concerns like fear of rejection, performance anxiety, shame connected to intimacy lead to erectile difficulties! As with women, I am well resourced to support men in finding practitioners like physicians or holistic health providers. Simultaneously, we work on the ideas that perpetuate sexual anxiety, often old stories about how “men should be” and practicing emotional openness. Improving emotional communication also improves sex and overall relationship satisfaction
Therapy for men increasingly focuses on emotional awareness, communication, and relationship health. Many men were never encouraged to openly discuss emotions, which can contribute to isolation and shame. Here are more mental health resources focused on men’s emotional wellbeing.
Trauma and Sexual Health
How Trauma Affects Intimacy
Trauma can significantly impact a person’s relationship with sex and emotional connection. Survivors of abuse, neglect, assault, or toxic relationships often experience a slew of outcomes, including:
- Fear of intimacy
- Emotional numbness
- Dissociation during sex
- Hypervigilance
- Difficulty trusting partners
- Shame surrounding sexuality
Trauma survivors did not “ask for” these results, no more than they ever asked for abuse. Ever. Emotional numbness and other outcomes are protective nervous system responses developed through painful experiences. Trauma-informed therapy helps individuals rebuild emotional and physical safety while reducing shame and self-blame.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers educational information on trauma-informed mental health care. I offer a variety of trauma based therapies, but particularly rely on somatic body work and polyvagal and nervous system therapy to support trauma survivors on their healing journeys, which include sex. Historically, intimacy is one of the last topics covered in trauma therapy, but we can start discussing it right away and develop a therapeutic treatment plan tailored to your goals.
Substance Use Recovery and Sexual Health
Rebuilding Intimacy During Recovery
Substance use often affects emotional and sexual relationships. Some individuals use substances to reduce anxiety, escape emotional pain, or avoid vulnerability.
Over time, addiction may create:
- Emotional distance
- Shame and secrecy
- Relationship instability
- Difficulty with trust and communication
Recovery counseling frequently includes discussions about intimacy, boundaries, emotional connection, and rebuilding trust.
For many individuals, recovery involves learning how to experience closeness and vulnerability without relying on substances.
Final Thoughts on Sex in Counseling
I am not a sex therapist, meaning I am not licensed in this specific expertise. I am, however, a couples and individual therapist who has received training in healthy sexuality and incorporates it with all of my clients to some capacity. I am also someone clients often find comforting in talking about difficult topics.
If specialized care, by way of therapist who specializes only specifically in sex or specific niche sexual concerns, I will help you discern this and try to connect you to a therapist through AASECT.
Many people worry that talking about sex in therapy will feel awkward or embarrassing. Ethical therapists approach these conversations professionally, respectfully, and without judgment.
Sexual concerns are treated as valid mental health topics — not taboo subjects.