Most Common Struggles I See As A Sex Therapist

1. Desire Discrepancy

This is by far one of the most common struggles I see in couples. One partner wants sex more often than the other and that gap creates tension, misunderstanding, and sometimes deep hurt.

Desire discrepancy isn’t a problem because it exists because SPOILER desire discrepancy almost always exists at some point in every relationship. It becomes painful when couples don't have the tools to talk about it with empathy and curiosity. Often, both partners feel misunderstood: the higher-desire partner may feel rejected or unwanted, while the lower-desire partner may feel pressured, broken, or guilty.

In therapy, I help couples unpack the meaning they’re assigning to their partner’s desire level and find ways to reconnect emotionally and physically whether that’s through scheduling intimacy, redefining what sex means, or healing blocks that have built up over time.

2. Sexual Shame and Religious Trauma

Many people enter adulthood having internalized harmful or confusing messages about sex from religion, family, or culture. Phrases like “sex is sinful,” “good girls don’t,” or “men should always want it” can leave deep scars.

Clients raised in purity culture often feel ashamed of their desires or disconnected from their bodies. Others feel "broken" because they can’t match what society says sex should look like. This kind of shame often shows up as anxiety, avoidance, or even physical discomfort during sexual activity.

Part of my work in sex therapy is helping clients unlearn shame-based beliefs and rebuild a relationship with sexuality that feels safe, consensual, and self-directed.

3. Asexuality and Low Desire

Some clients come to therapy asking, “Am I asexual, or do I just have a low sex drive?” Others are in relationships where one partner may identify as asexual, and they’re navigating how to stay connected and respected across a sexual difference.

These conversations require nuance, compassion, and the freedom to explore identity without pressure to perform or conform. My job isn’t to “fix” low desire it’s to help people understand themselves, communicate openly, and co-create relationships that honor everyone’s needs.

4. Painful Sex and Medical Concerns

Sex should never hurt, but for many people, it does. Conditions like vaginismus, pelvic pain, endometriosis, or chronic illness can make sex feel uncomfortable, frightening, or physically impossible.

It’s heartbreaking how many clients have been dismissed by doctors or told, “It’s all in your head.” While I don’t provide medical care, I often work in collaboration with pelvic floor therapists, gynecologists, or other specialists to support a client’s full healing.

Therapy can also be a space to address the emotional impact of pain; grief, fear, frustration, and how it can ripple into body image and relationships.

5. Erectile Concerns and Performance Anxiety

Another common struggle especially for men is difficulty with erection, stamina, or orgasm. These concerns are often deeply tied to shame, fear of failure, or internalized expectations around masculinity.

I often hear clients say, “I used to be fine, and now I’m not, what’s wrong with me?” Whether it’s age, stress, medication, or anxiety, erectile changes are incredibly common and very treatable, with the right support.

Therapy helps untangle the pressure to “perform” from the opportunity to connect. It can also reframe sexual experiences as collaborative and pleasure-focused, rather than goal-oriented.

6. Communication Breakdowns

It’s nearly impossible to have a healthy sexual relationship if the emotional connection and communication between partners is strained. Many couples struggle with being honest about their needs, fears, or fantasies—not because they don’t care, but because they’ve never had a model for that kind of vulnerable dialogue.

Misunderstandings build, partners make assumptions, and resentment grows. Sex becomes another battleground instead of a source of connection.

In sex therapy, I teach couples how to have conversations about sex in ways that feel less awkward and more attuned. That includes learning to listen without defensiveness, respond without blame, and express needs without fear of judgment.

7. Division of Labor and the Mental Load

It might not sound like a "sex therapy" issue on the surface—but trust me, it is.

When one partner feels overwhelmed by the invisible labor of running a household, raising children, or managing logistics, desire often disappears. This is especially common in heterosexual partnerships where women often shoulder more of the emotional and domestic load.

I frequently hear things like:

• "By the end of the day, I’m so touched out from caring for everyone else that I have nothing left."

• "If I have to ask one more time for help with the dishes, the last thing I want to do is be intimate."

Sex doesn’t live in a vacuum—it’s deeply impacted by fairness, stress, and feeling like a team. Addressing this in therapy can bring major relief and open the door to more connection in all areas of the relationship.

8. Food and Body Image Struggles

Body image has a direct impact on how people show up sexually. Many clients come to therapy feeling uncomfortable being seen naked, touched intimately, or even discussed as sexual beings. This is especially true for people recovering from disordered eating, diet culture, or body shaming experiences.

Some avoid intimacy altogether because they feel too self-conscious. Others push through but feel dissociated or numb. Sex therapy can be a space to heal these deep wounds and rebuild trust with your body and reclaiming pleasure as something you’re allowed to experience.

9. Mental Health and Trauma History

Anxiety, depression, PTSD, and trauma histories can all profoundly impact sexual desire, arousal, and comfort with intimacy. Some clients feel disconnected from their body due to past abuse or boundary violations. Others experience numbness, intrusive thoughts, or fear in otherwise safe relationships.

Trauma-informed sex therapy provides a safe, grounded space to gently explore what feels scary or shut down and to reestablish safety, agency, and consent in the sexual experience.

Therapy Isn’t Just for “Big Problems”

Sex therapy isn’t only for couples on the brink or individuals in crisis. It’s for anyone who wants to feel more comfortable in their body, more confident in their communication, and more connected in their relationships.

Whether you're healing from past pain, navigating desire differences, or just want to feel less alone in your questions, therapy can be a powerful space of growth and self-acceptance.

As a licensed therapist and sex therapist offering virtual sessions throughout Texas, Tennessee, Oklahoma, Louisiana, and Colorado, I’m here to help you explore these parts of yourself with curiosity, compassion, and without judgment.

You're not broken. You're not alone. And you don’t have to figure it all out by yourself.

Let me know if you’d like a free consultation or if you’re ready to begin this work—at your pace, and in your own way.