Few topics carry as much weight as intimacy and sex. They touch on vulnerability, identity, connection, power, pleasure, pain, and love. When things are going well, we rarely think about them. When they're not, they can consume us—and yet remain almost impossible to discuss.

Sexual and intimacy difficulties are remarkably common. Research suggests that around 30-40% of people experience sexual problems at some point. Yet shame keeps most people silent, suffering alone with problems that respond well to help.

This guide explores what intimacy issues involve, how therapy can help, and what to expect if you decide to seek support.

What Are Intimacy Issues?

Intimacy involves closeness, vulnerability, and genuine connection. While often associated with sex, intimacy is broader—emotional intimacy (sharing inner worlds), physical intimacy (non-sexual touch and comfort), and sexual intimacy are all connected but distinct.

Intimacy issues might include:

Difficulty with Emotional Closeness

Struggling to let others truly know you
Keeping partners at a distance
Difficulty expressing vulnerable feelings
Fear of dependency or being needed
Shutting down during emotional conversations
Feeling unable to receive love or care

Physical Distance

Discomfort with non-sexual touch or affection
Avoiding physical closeness
Feeling tense when held
Not initiating physical connection
Preferring to maintain physical space

Sexual Difficulties

These encompass a wide range of experiences that we'll explore in more detail below.

Patterns in Relationships

Repeatedly choosing unavailable partners
Sabotaging relationships as they become close
Moving from relationship to relationship
Intense beginnings followed by withdrawal
Difficulty maintaining long-term connection

Common Sexual Difficulties

Sexual problems vary widely but often include:

Desire Issues

Low desire: Little interest in sex, rarely initiating or responding to a partner's advances.

Desire discrepancy: When partners have significantly different levels of desire—extremely common and often distressing for both people.

High desire: Sometimes desire becomes compulsive or interferes with life and relationships.

Arousal Difficulties

Physical arousal problems: For men, difficulty achieving or maintaining erection. For women, difficulty with lubrication or physical readiness.

Subjective arousal: Feeling disconnected from one's body during sex, going through the motions without feeling genuinely engaged.

Orgasm

Difficulty reaching orgasm: Taking much longer than desired or being unable to climax despite adequate stimulation.

Premature ejaculation: Reaching orgasm faster than wanted, often within minutes of penetration.

Anorgasmia: Inability to reach orgasm at all.

Pain

Dyspareunia: Pain during intercourse.

Vaginismus: Involuntary tightening of vaginal muscles making penetration difficult or impossible.

Vulvodynia: Chronic vulval pain.

Other Concerns

Sexual anxiety or performance pressure
Difficulties related to sexual identity or orientation
Recovery from sexual trauma
Concerns about sexual behaviours or fantasies
Pornography use and its impact
Lack of satisfaction despite functional sex
Mismatched preferences or interests

The Connection Between Intimacy and Sex

Sexual difficulties often connect to broader intimacy patterns. Understanding this connection matters:

Fear of vulnerability: Sex requires being seen—literally and emotionally. If vulnerability feels unsafe, sexual difficulties may follow.

Relationship issues: Unresolved conflict, resentment, or distance often appear in the bedroom. It's hard to be sexually connected when emotionally disconnected.

Past experiences: Previous relationships, early experiences of intimacy, or trauma shape current patterns.

Body image: Feeling uncomfortable in your body affects willingness to be seen and to experience pleasure.

Stress and mental health: Anxiety, depression, and chronic stress commonly affect desire and function.

This isn't to dismiss physical factors—hormones, health conditions, medications, and ageing all affect sexuality. But even physically-rooted problems have psychological dimensions that therapy can address.

How Therapy Helps with Intimacy and Sexual Issues

Therapy for intimacy and sexual concerns typically works on several levels:

Understanding What's Happening

First, developing a clear picture:

What exactly is the difficulty?
When did it start?
What makes it better or worse?
What have you tried?
What are your hopes and concerns?

This isn't clinical interrogation—it's building understanding together.

Exploring Contributing Factors

Sexual difficulties rarely have a single cause. Therapy explores:

Personal history: Early messages about sex, first experiences, past relationships, any trauma.

Relationship context: What's happening in your current relationship? What patterns exist?

Psychological factors: Anxiety, depression, body image, stress, beliefs about sex.

Medical factors: Ruling out or accommodating physical contributors.

Challenging Unhelpful Beliefs

Sexual difficulties often involve beliefs like:

"Good sex should happen spontaneously"
"Real men are always ready"
"I should orgasm from penetration alone"
"Wanting sex means something is wrong with me"
"My body is wrong or broken"
"If I say what I want, I'll be judged"

Therapy helps identify and update these beliefs.

Developing Skills and Communication

Sex is a skill—and communication about sex is a skill most people never learn. Therapy helps with:

Talking about sex with your partner
Expressing needs and boundaries
Giving and receiving feedback
Understanding your own responses
Expanding your repertoire if desired

Sensate Focus and Exercises

Many sex therapists use structured exercises, often beginning with sensate focus—a technique developed by Masters and Johnson. This involves:

Taking penetration and orgasm off the table temporarily
Focusing on giving and receiving pleasure through touch
Gradually reintroducing sexual contact without pressure
Building awareness and reducing performance anxiety

These exercises happen at home, not in the therapy room.

Processing Trauma

When sexual or relational trauma underlies current difficulties, trauma-focused work becomes necessary. This requires a therapist trained in trauma therapy, not just sex therapy.

Working with the Relationship

For couples, the relationship itself often needs attention:

Rebuilding emotional connection
Addressing resentments or conflicts
Developing new patterns of relating
Learning to talk about sex together

Types of Professional Support

Sex Therapists

Therapists with specialised training in sexual issues. In the UK, look for members of:

COSRT (College of Sexual and Relationship Therapists)
BACP with sex therapy specialisation

Sex therapy is a talking therapy—you keep your clothes on, and there's no physical contact with the therapist.

Psychosexual Therapists

Often refers to the same specialisation, though the term "psychosexual" emphasises the integration of psychological and sexual aspects.

Relationship Therapists Working with Sexual Issues

Many couples therapists work with sexual difficulties as part of broader relationship work, though they may not have specialist sex therapy training.

General Therapists

Therapists without sex therapy specialisation can still help with underlying issues—anxiety, trauma, relationship patterns—that affect intimacy. They may refer for specialist sex therapy if needed.

Medical Professionals

Sometimes medical consultation is important:

Urologists for erectile dysfunction
Gynaecologists for pain or vaginismus
GPs for hormone issues, medication effects
Pelvic floor physiotherapists for pain or tension

Medical and psychological approaches often work best together.

What to Expect in Therapy

Initial Sessions

Your therapist will want to understand:

The presenting difficulty
Relationship history and current relationship
Sexual history (sensitively explored)
Medical history
What you hope to achieve

This is information-gathering, not judgment.

Ongoing Work

Depending on your situation:

Exploring contributing factors
Challenging unhelpful thoughts
Building communication skills
Practicing exercises at home
Processing difficult experiences
Working on the relationship

Individual vs Couples Therapy

Some issues benefit from individual therapy:

Processing personal trauma
Exploring sexual identity
Working on deep-seated patterns

Others are better addressed as a couple:

Desire discrepancy
Communication problems
Rebuilding intimacy together

Many people benefit from both.

Frequently Asked Questions

Is sex therapy appropriate for unmarried people or people without partners?

Absolutely. You don't need to be in a relationship to work on sexual difficulties or intimacy patterns.

Will I have to talk in explicit detail about my sex life?

You'll need to share enough for the therapist to understand your situation, but a good therapist works at your pace and respects your comfort level.

What if the problem is physical, not psychological?

Physical and psychological factors often coexist. Even physically-rooted problems have psychological dimensions—how you feel about it, what you believe it means, how it affects your relationship. And psychological therapy can help you adapt, cope, and sometimes improve physical symptoms.

How long does sex therapy take?

Varies enormously. Some focused issues improve within 6-12 sessions. Complex or long-standing difficulties may take longer.

My partner won't come to therapy. Can I still get help?

Yes. While some issues are best addressed together, individual therapy can help you understand your patterns, improve communication, and shift dynamics even without your partner present.

Is it normal to feel embarrassed talking about sex?

Completely normal. A good therapist expects this and creates safety. Most people find that embarrassment diminishes as they experience being heard without judgment.

What if my concern feels weird or shameful?

Sex therapists have heard a wide range of concerns and are trained to respond without judgment. Whatever you're worried about, you're unlikely to shock them.

When to Seek Help

Consider seeking support if:

Sexual difficulties are causing significant distress
The issue is affecting your relationship
You've tried to address it yourselves without success
The problem is persistent, not a temporary blip
You're avoiding intimacy or relationships because of it
Past experiences are affecting current sexuality
You're uncertain whether your experiences are "normal"

You don't need to have a serious problem. Many people seek therapy for enhancement—wanting more satisfying intimacy even when things are basically working.

Finding the Right Support

When choosing a therapist for intimacy or sexual issues:

Check qualifications (COSRT membership indicates sex therapy specialisation)
Ask about their experience with your specific concern
Ensure you feel safe and respected
Consider individual vs couples therapy needs
Ask about their approach

The therapeutic relationship matters enormously. Trust your instincts about whether someone feels right.

Moving Forward

Intimacy and sexual difficulties can feel isolating—problems that set you apart, flaws to be hidden. But they're remarkably common, and they respond to help.

The courage to seek support opens possibilities: not just fixing problems, but developing deeper connection, greater self-understanding, and more fulfilling intimacy.

While I work with intimacy and relationship issues as part of my general therapeutic practice, I can recommend specialist colleagues for specific sex therapy needs. If you're unsure what kind of support would help, I offer a free initial phone call to discuss your situation.

Whatever you're experiencing, you don't have to figure it out alone.

Intimacy Issues and Sex Therapy: What to Know