Why is Sex Still a Taboo in Therapy?

Sex is a core part of human experience, yet many therapists struggle to address it in sessions. Maybe you were raised in a home where sex wasn’t discussed, or your graduate program only covered it in the context of trauma. Whatever the reason, if you feel awkward bringing up sex with clients, you’re not alone.

That’s exactly why we invited Dr. Erika Miley, a clinical sexologist and expert in mental and sexual health, to talk about why sex needs to be part of every therapist’s toolbox. And no, we’re not talking about boring, outdated, or shame-based sex ed—this is about helping clients connect with their identity, pleasure, and relationships in a meaningful way.

The Problem: A Lack of Sex Education

Let’s be real—the U.S. is behind when it comes to sex education. Unlike some Nordic countries that start comprehensive education early, many Americans grow up with minimal, fear-based, or just plain incorrect information about sex. By the time they reach adulthood, they’ve often pushed their sexuality aside due to misinformation, shame, or trauma.

Dr. Miley sees this firsthand. “80% of my caseload has religious trauma associated with sex,” she shares. That trauma manifests in long-term relationships, marriages, and various relationship structures where people struggle with desire, identity, or intimacy—without ever having been given the tools to understand or navigate them.

Why Therapists Must Get Comfortable Talking About Sex

Therapists will inevitably encounter clients dealing with sex-related concerns, whether it’s trauma, body image struggles, neurodivergence, or religious shame. Yet many clinicians avoid the topic, leaving clients feeling isolated and unsupported.

Here’s why sex should be a part of therapy:

• Sex is connected to mental health – Desire, pleasure, and identity are deeply tied to our emotional well-being.
• Shame thrives in silence – Many clients carry internalized messages that sex is bad or wrong. A therapist’s openness can be healing.
• Therapy is about the whole person – If we ignore sexuality, we miss a huge part of our clients’ lives.
• Ignoring it doesn’t make it go away – Clients are already dealing with these issues. Addressing them directly provides relief and clarity.

The Common Issues Sex Therapists See

According to Dr. Miley, some of the most frequent reasons clients seek sex therapy include:

• Desire Discrepancy: One partner wants sex more often than the other.
• Initiation Struggles: Clients feel stuck in patterns where no one knows how to initiate intimacy.
• Religious Trauma: Shame-based messages from childhood still impact their sexual identity.
• Neurodivergence & Sex: ADHD, autism, and sensory sensitivities can affect sexual desire and experience.
• Pain & Medical Issues: Conditions like endometriosis or erectile dysfunction are often overlooked in traditional therapy.

How Therapists Can Start Addressing Sexuality in Sessions

If you’re thinking, Okay, but where do I even begin?—don’t worry. Here are some simple ways to start:

1. Make Sexuality a Routine Part of Intake
   
   • Instead of waiting for a client to bring it up, include a question about sexual health and satisfaction in your intake process. Normalize it from day one.
2. Build Your Own Comfort First
   
   • If talking about sex makes you squirm, your clients will pick up on that. Seek out continuing education for counselors that covers sexuality, join a peer discussion group, or read books like Come As You Are by Emily Nagoski.
3. Use a Neutral Approach
   
   • When introducing the topic, start with open-ended questions like: “How do you feel about the role of sexuality in your life?” or “How comfortable are you talking about your sexual health?”
4. Normalize the Spectrum of Sexuality
   
   • Be aware of biases or assumptions you may have about gender identity, sexual orientation, or relationship styles. A client may not feel safe sharing unless they sense true acceptance.

Final Thoughts: Sex Therapy is Just Therapy

Sex isn’t separate from mental health—it is mental health. As therapists, our job is to create space for our clients to be fully seen, understood, and supported. Addressing sexuality in therapy doesn’t mean you need to become a certified sex therapist, but it does mean getting comfortable with the conversation.If you’re looking for engaging, practical, and not boring continuing education for therapists, consider checking out CE courses on sexuality. Your clients (and your confidence as a clinician) will thank you for it.