Why Couples Therapy Needs To Talk About Sex

If I had a dollar for every time I’ve heard of a couple in couples therapy with a therapist who never asked about sex, let’s just say I’d have many, many dollars.

Yes, therapy should begin where the client is, and if a couple goes to therapy for a specific issue supposedly unrelated to sex, the therapist should go with that. However, when a therapist does not even ask a couple about their sex life—an aspect of relationship functioning that is very significant—it has numerous ramifications on the therapeutic process and the treatment efficacy.  Here are a few reasons why it’s important for a therapist to ask about sexual functioning early on:

  • Sex can be awkward for couples to bring up. If the therapist asks about it, even if there are no sexual issues or there are and couple is not ready to talk about them, there is a clear message sent that this is a safe place to talk about sex.
  • Sexual functioning affects the whole relationship. Problems in the bedroom rarely stay in the bedroom; they show up in perpetual tension and resentment that manifest in conversations that may seem unrelated to sex.  Thus, asking about sex opens up dialogue that helps clarify sources of conflict in the relationship.
  • Sex is an aspect of a couple’s sense of vibrancy and passion.   Leaving sex out of the equation when assessing a couple’s perception of their connectedness is glossing over a big piece of the relationship puzzle.

I tend to look at sexual functioning as part of relationship “vitals”.  Just as when you first see a doctor, they typically will ask or check on your heartrate and blood pressure–regardless of the presenting issue—asking about a couple’s sex life is important in assessing the health of the relationship, the issues that may be contributing to presenting symptoms (and making appropriate referrals when necessary), and most of all, creating a safe space to be open and vulnerable.


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