Sex Therapy vs. Couples Therapy: What’s the difference?

Written by Seth Taylor, ALMFT

Maintaining a healthy and satisfying relationship is an ongoing process that can involve seeking guidance from professionals. Two common therapeutic modalities that people turn to for relationship issues are sex therapy and traditional couple's therapy. In this blog post, we'll delve into the key distinctions between these two approaches, address common questions people have about them, and explore whether sex therapy can help with specific sexual issues such as erectile dysfunction (ED) or sexual pain. We'll also shed light on what couples can expect when they begin either of these therapies.

What is Sex Therapy?

Sex therapy is a specialized form of counseling that focuses on issues related to sexual dysfunction, intimacy, and sexual well-being. Sex therapists are trained to address a wide range of sexual concerns, including but not limited to erectile dysfunction, desire discrepancy, sexual pain, and performance anxiety. When practiced effectively, sex therapy can help individuals and couples understand and overcome sexual challenges to achieve a more fulfilling and satisfying sex life.

What Happens in Sex Therapy?

In sex therapy, clients can expect a safe and non-judgmental space where they can openly discuss their sexual concerns and desires. The therapist may use a variety of techniques, including communication exercises, psychoeducation, and behavioral homework assignments to help clients work through their issues. The primary goal is to enhance sexual communication, improve intimacy, and resolve sexual problems within the relationship.

What is Traditional Couples Therapy?

Traditional couples therapy, also known as marriage or relationship counseling, addresses a broader range of relationship issues. While sex may be a part of the discussion, the focus extends beyond sexual concerns to include communication problems, conflicts, trust issues, and overall relationship dynamics. Couples therapy is also an empirically validated treatment for these types of relationship issues.

Differences Between Sex Therapy and Couples Therapy

Specialization

The most significant difference is the specialization. Sex therapy is typically focused on sexual concerns, while traditional couples therapy covers a broader spectrum of relationship issues.

Depth of Exploration

Sex therapy delves deeply into sexual matters, addressing sexual dysfunction and intimacy problems with a high degree of specificity. In contrast, couples therapy explores a wide array of relationship dynamics, including non-sexual aspects of the partnership.

Approach

Sex therapy often includes a practical and skills-based approach, including behavioral exercises and psychoeducation. Couples therapy, on the other hand, focuses more on communication techniques and conflict resolution.

Therapist Expertise

Sex therapists receive specialized training in human sexuality and treating sexual issues, while couples therapists typically have more general training in relationships and psychology.

Treatment Duration

Sex therapy is often more short-term and solution-focused, aiming to address specific sexual concerns. Traditional couple's therapy may be more long-term, focusing on overall relationship improvement.

Choosing the Right Therapy for Your Needs

The choice between sex therapy and couples therapy depends on the specific issues you are facing within your relationship. If sexual problems are a significant concern, sex therapy might be the most appropriate choice. However, if your relationship issues encompass broader aspects of communication and connection, couples therapy may be a better fit. Remember that both forms of therapy can be conducted as a couple, so it's essential to communicate openly with your therapist about your goals and expectations.

Takeaway

Sex therapy and couples therapy serve distinct purposes within the realm of relationship counseling. Understanding their differences and knowing when to seek each type of therapy can significantly benefit couples striving to strengthen their bond and enhance their overall well being. Whether it's addressing low desire or erectile dysfunction, improving communication, or reigniting passion, the support of a skilled therapist can be a valuable asset on your journey to a more fulfilling relationship.

Curious About Differences in Desire? Here Are 3 Tips to Address Desire Discrepancy

Desire discrepancy is when the libidos of people in a relationship do not align. The two types of libido are responsive and spontaneous which differ in how your desire for sex is initiated. People with responsive desire experience physical arousal before mental desire, whereas those with spontaneous desire experience mental desire first and then the physical arousal. Mental desire is being turned on in your mind and wanting (either hypothetically or literally) sexual stimulation, while physical arousal manifests in your body such as getting an erection.

This binary of responsive versus spontaneous is helpful for understanding how one’s personal experience of libido compares relative to others; however, that is not to say that this type of libido is fixed or exists strictly in black or white. While many people do tend towards one or the other, libido is flexible and can change with time, age, relationship status, and more. Neither type is better or worse, nor anything that needs to be fixed, but having this information about oneself can be helpful in successfully navigating a healthy sex life.

Though there is nothing inherently wrong with either type, it of course can be frustrating if your desire type doesn’t align with the person/people you’re having sex with. This is what we call desire discrepancy. If this is something you’re struggling with, consider some of these approaches:

Explore non-sexual intimacy

• Physical intimacy can take many, many forms and getting creative is a good way to feel more physically connected with your sexual partner(s). Massages, cuddling, backscratching, and hugging are all great options for non-sexual physical touch.

Consider an open relationship

• If you’re in a monogamous relationship and therefore only have sex with your partner, desire discrepancy can be a major obstacle to sexual satisfaction. Opening up your relationship is a much bigger deal than just saying you want to, but it could be a good option in instances where desire discrepancy is the root of major tension in the relationship. Here is an Embrace Sexual Wellness article that goes into detail about how to open a monogamous relationship.

Talk to a sex therapist (either as an individual or as a relationship)

• Sex therapists are an amazing resource for sorting through sexual obstacles like desire discrepancy. They have knowledge about potential root causes of someone’s libido type, how to diffuse tension related to desire discrepancy, and creative problem solving that takes everyone’s needs into account. Working with a dedicated therapist also has the capacity to increase empathy on all sides, improving communication overall. If you live in Illinois, reach out to Embrace Sexual Wellness for a consultation.

Desire discrepancy does not mean anyone is at fault and will require patience and empathy on all sides to work through. This issue, like all other relationship issues, isn’t person versus person; it’s you all against the problem.

Why Does It Hurt Down There? Here's How to Address Pelvic Pain

The pelvic floor muscles refers to the hammock-like musculature that supports your pelvic organs and therefore they are an essential part of executing bodily functions like ridding of stool and pee, and having sex. Like anything else in your body, they can weaken throughout the normal aging process leading to concerns like incontinence, or general pain and discomfort.

Differences between people assigned female versus male at birth

Everyone has a pelvic floor regardless of their gender or reproductive anatomy. Pelvic floor health has different implications depending on the type of anatomy it’s supporting. For people assigned female at birth (AFAB), the pelvic floor muscles support the uterus, bladder, and bowel, and the anus, vagina, and urethra all pass through this group of muscles. The pelvic floor is strongly involved in pregnancy and this is a common cause of pelvic floor dysfunction. For people assigned male at birth (AMAB), the pelvic floor muscles support the bladder and bowel, and the anus and urethra pass through them. Unfortunately, there is next to no research or information about transgender and intersex people and their pelvic floor health.

Common Pelvic Floor Concerns

Having pelvic muscles that are too weak or too tight can cause concern; the idea is to find a balance. Pelvic floor concerns might be the cause of additional problems but it can also be a symptom of conditions like endometriosis, pelvic inflammatory disease, and menstrual cycle cramping.

If untreated, pelvic floor imbalances can cause:

• Sexual dysfunction

  • Sexual dysfunction conditions relating to pelvic floor health include dyspareunia (AFAB people) and erectile dysfunction (AMAB people).  

• Pelvic pain

  • Pelvic floor dysfunction (PFD) is “the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement.” It’s more commonly experienced by people assigned female at birth. Symptoms associated with it in addition to pain (usually exacerbated by sexual intercourse or certain movements) are incontinence, bloating and constipation, and lower back pain. 

• Bladder concerns

• If your pelvic muscles are too weak, you may struggle with a frequent urge to pee or an inability to hold in pee. This is often an aftereffect of pregnancy and giving birth. 

• Bowel problems

• Similar to bladder concerns, weak pelvic muscles sometimes struggle to hold in gas or poop, leading to bowel incontinence. On the other end, you might also experience constipation and straining pain when trying to poop. 

Options for Addressing Pelvic Floor Concerns

• Medication

  • Medication options will differ depending on the root cause of pelvic floor concerns. Hormonal based therapies like GnRH, Progestin, and oral contraceptives may be used to treat pelvic floor concerns associated with reproductive conditions such as endometriosis. For pain, over the counter medications like Tylenol can be used. If an infection is the source of pain, you may be prescribed antibiotics. Before starting any medication, discuss with your doctor to make sure it’s the right route for you and that it won’t cause adverse effects.   

• Relaxation techniques

• If your pelvic floor is too tense, you might want to try relaxation techniques such as diaphragmatic breathing and pelvic girdle stretches. 

• Physical therapy

• If your effort with pelvic floor exercises at home don’t work for you or if you’re just seeking professional guidance, physical therapy is a good option. 

• Pelvic floor exercises

• Kegels are the most well known pelvic floor exercise and they’re a great way to strengthen those muscles. Click through on the link above to get more details on how to properly do pelvic floor exercises.

Pelvic floor health is a buzzy topic on social media these days, especially on TikTok. We would caution you against taking any of that advice prior to speaking with a qualified health professional who knows you personally. If your pelvic floor concerns are causing mental distress, consider seeing a sex therapist. For those located in Illinois, reach out to Embrace Sexual Wellness to see if we’re a good fit for you.