While you can find insinuations and conversations about sex in countless adult TV shows, movies, and songs, how comfortable are you talking about sex with your partner? Even in long-term romantic relationships, partners report only knowing 62% of what their partners find sexually pleasing and 26% of what their partners find sexually displeasing. So that’s the bad news: many people have difficulty discussing intimacy with their partner. The good news: there are lots of supportive resources to help you keep the conversation and exploration going.  

We sat down with Liz Mallers, Sexologist and Sexual Wellness Specialist of In Session Psych, to talk about all things sexuality, intimacy, and sex. From managing differing sex drives to addressing issues of pleasure and orgasm, our conversation sheds light on the common concerns that couples bring to the therapy room and why working with a sexologist can benefit your relationship. 


How common or normal is having different sexual expectations, including sex drives, in a relationship? 

Liz: It is unrealistic that any long-term intimate relationship would go without any issues in the bedroom.

When I tell couples that it is unrealistic to think that they will be a perfect sexual match from the moment they meet until the end of time, they usually respond in one of two ways. The first way is feeling a sense of relief. Things change over time, including our needs and sexual abilities. The second response I get from some couples is a sense of panic. They wonder if their sex life will continue to be a struggle for them. 

But once the freak-out moment subsides, we can talk about realistic solutions and normalize the ebb and flow of sexual intimacy. Couples tend to adjust and accept that there is a way out of their sexual difficulties, and then they experience feelings of hope.     


What are some common mismatches couples bring to your sessions? 

Liz: Mismatched libidos is a very common issue that many couples face. One wants greater frequency in sexual connection, while their partner is satisfied with the amount of sexual connection they are having. There are a variety of reasons for differing sex drives, and there are various ways to express sexual connection. It doesn’t have only to be intercourse.

Another libido difference is when one partner desires more sexual exploration while the other partner is content with their “normal routine.” My goal isn’t to judge which partner is “right” but to help partners see each other’s desires and explore what those desires are. This allows each partner to explain where they are coming from. 

I help my couples start the conversation with more openness and curiosity. From there, we might do some internal exploration, like where they learned what is good and not good. We may examine their biases to determine what change could look like or what compromises each is willing to make. I see dissatisfaction or differences in sexual desires as an “us” problem, not as an individual person’s problem. 

My hope is that these discussions act as an open invitation for couples to explore and be curious together rather than criticize each other and just focus on what isn’t working.


How do you help a couple explore their feelings and help them express their sexual dissatisfaction or discomfort in a safe and supportive environment? 

Liz: In the U.S. we don’t have great education about sexuality. People understand sexuality through the lens of their peer group, pornography, or media, to name a few. Those limited sources of information can create false beliefs such as stereotypes or stigmas, like I should be having sex a certain way or feel a certain way. If we don’t fit within those boxes, people can experience feelings of insecurity, doubt, and self-criticism. 

What I find valuable in working with clients is normalizing their lived experiences and validating their feelings. Clients often compare themselves to what they believe they “should” be doing or feeling, based on what they hear from friends or media. This can lead to internalized guilt, anger, shame, and other negative emotions.

The question I get most often is, “Is that normal?” Typically my reply is, “Yes, as long as it is not hurtful to you or someone else or non-consensual.” In those scenarios, I find it very helpful and necessary to educate my clients with specific research to help them feel more at ease with their concerns. From there, we work on communication skills, such as giving and receiving feedback, to help create a safe and supportive environment. 

If couples don’t have those necessary skills, giving feedback could come across as critical and feel hurtful to their partner. Thus, the initial partner isn’t heard, and they continue to feel stuck or unable to share their wants, fantasies, and needs.   


What are the specific benefits of working with a sexologist rather than a couples therapist? 

Liz: There is a lot of overlap between what a couple would experience in a couples therapy appointment versus an appointment with me. We [sexologists] do many of the same things from a process perspective, like how things get discussed (e.g., communication) and managing feelings. However, the content distinguishes my work from a couples therapy appointment. I have the expertise and knowledge to take my couples into deep explorations and specific discussions around sexuality. 

I offer couples the permission and knowledge to explore their sexual options by offering up various ideas, exploring sexual behaviors, and then helping them talk through what they want to try together. We discuss their personal hang-ups and what causes them discomfort (real or perceived). I also have the expertise and feel comfortable bringing up topics and talking about the way bodies work and change, the noises bodies make, the fluids that bodies produce, penetration, and foreplay. Those subjects are totally normal and vitally relevant. Without the content-specific information, communication strategies alone might not meet the couple’s needs. 

I help take the taboo out of talking about sex. I broach the topics in a non-abrasive, non-offensive, or non-crass way. I listen to clients’ use of language, and, in turn, I use anatomically correct ways of describing clients’ situations. For instance, some clients meet with me knowing something isn’t feeling great but don’t have the knowledge or vocabulary to precisely name what they are lacking or getting too much of. 

For example, using the metaphor sexuality is like needing a new pair of jeans. You’ve had the same pair of jeans for as long as you can remember. But as comfortable as they may seem, you realize by looking around there isn’t only one pair of jeans in the world. So you go to a retailer that specializes in all things jeans. They help you learn about different styles, fit, cut, color, and texture in a non-shaming and non-judging environment. You can fully explore what you like in a safe and enjoyable way. 

Applying that same metaphor to a couple, they can shop together. They might find things that complement each other or better understand why one person might like one pair of jeans over another. They’re able to respect each other’s likes and dislikes. 


How do you provide support and guidance to a client who is having difficulty achieving orgasm? 

Liz: It’s so contextual. We must consider any physical or medical barrier, such as medication side effects, so get a physician’s help to rule out any of those. I can help with mental blocks or find the root of the cause. For instance, if one partner has trouble climaxing, I help explore the contextual factors that could be contributing to the difficulty. 

Part of the block could be debunking the myth that having an orgasm is the only goal of sex, which can take pressure off intercourse. Other goals I help couples explore are what sex is for (e.g., for the orgasm, for connection, for security), where they learned the script of sex, and what they are getting out of sex. Does the couple need each other for their sex purpose, or could they satisfy themselves individually to accomplish the goal? Do their goals work together or against each other? Does sex have to end after ejaculation? 

I see sex encompassing more than just intercourse, like prep, cuddling, and cleaning up (grab those wipes!). I help my couples define sex and rewrite the script of sex based on their reality, not what they learn from the big screen. We spend time focusing on the meaning and take context into account.    


How do you help clients normalize the idea that sexual satisfaction and pleasure can evolve as their relationship progresses? 

Liz: I talk about sexuality being ever-evolving. Just like your tastes change over time, so can your sexual preferences. It doesn’t have to be extreme, but there can be subtle changes such as, “I used to like this being stimulated, but not anymore.” Different life stages, such as having kids, can affect your needs, body, and time investment.

For example, before having kids, you had an entire day to explore your kink. Post kids, you have to squeeze in connecting with each other amidst catch-up tasks like laundry, email, or cleaning. Sexuality can be impacted by life stages, physical changes, or shifting priorities over time.   


Talking about physical changes or different stages of life, how does menopause change sexual desire? 

Liz: Menopause differs from person to person, but generally speaking, there can be a peak in libido at the beginning and end stages, all due to hormones. Another distinct physical change is vaginal dryness, and I find it to be one of the main reasons women seek support during this time. From the physical perspective, it can be painful, and therefore, some women are apprehensive about using lubrication or toys, what I call “outside help.” 

Using store-bought lube can feel shaming to some women. But without enough lube, you are more susceptible to microscopic tearing, which puts you at greater risk for developing infections and contracting STIs. So we work on reframing the idea of using outside help as a tool to enhance their pleasure, overall comfort, and safety. From a psychological perspective, some women feel helpless about their bodies changing and not performing in the way they used to.

Some women may even internalize a sense of failure or feel less attractive during this time. I use a lot of validation and education to help them normalize the natural transition of their body and its impact on their sexual health. 

The woman doesn’t always know the exact pattern of this transition. Often, their male partners do not know what to expect or what to ask, so I help couples understand the transition. I invite couples to make menopause and its effects part of common conversation. I encourage them to discuss the impact on their sexual experiences and to be non-shaming and more understanding of the aging process. 


How do you help couples navigate new sexual desires (kinks) that one partner has brought up?

Liz: I help couples explore kinks. Kink is something they would like to integrate into their sexual experience — it isn’t necessary, but it is desirable. There are specific questionnaires I go through with couples to assess not only likes but also readiness. I love exploring this topic with couples because it explores curiosity, pleasure, and novelty. It’s usually very exciting! 

First and foremost, I integrate discussion around consent and safety. I work with couples to be very thoughtful about what they want to explore and consider before jumping in and trying something. For example, if a couple wants to try bondage, we talk about boundaries, such as creating a safe word, having safety scissors readily available, and comfort level. 

I also highly encourage both partners to get educated about the kink. We talk further about fears, nervousness, and enthusiasm. I distinguish if it is something they want to make a reality or if it’s just a fantasy. Taking the necessary steps to educate and talk helps with trust, understanding values, and working towards compromise. If, however, I don’t know everything about a specific kink, then I help couples find quality resources.   


My relationship’s sexual health needs help

Addressing issues of sexual satisfaction within intimate relationships can be challenging but crucial for fostering healthy and fulfilling connections. By partnering with Liz, we ensure that our clients receive specialized support and guidance in navigating the complexities of their sexuality. This collaboration allows for more comprehensive care, enabling our couples to explore and address their unique needs and challenges with confidence and understanding.

If you find navigating discussions around your sexual satisfaction difficult or you want support around your sexual curiosities, don’t hesitate to seek professional support from a sexologist who has sexual expertise. You do not have to settle for mediocre sex or intimacy. You can find Liz at In Session Psych and join her online group for couples who want to strengthen their sexual connection. 

Our practice offers in-person appointments in Charlotte, NC, and Carefree, AZ. We also have virtual sessions available for those who live in Arizona, Florida, North Carolina, South Carolina, or Texas. Contact us to get started.

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