Many times when I see patients, a person’s unexpressed or unprocessed long simmering anger, resentment, or hurt towards his or her partner is a piece of the puzzle.

There are many different theoretical approaches to sex therapy, and members of the public tend to think of sex therapy as mostly involving standard, behavioral exercises that are assigned by the therapist based on whatever the sexual dysfunction or problem is.

But often, a huge part of our role as sex therapists involves uncovering old wounds and repairing the damage that was done.

Relational approaches to treating couples make a huge amount of sense in many cases, because like an iceberg, much of what the therapist is dealing with is beneath the surface.

Partners cannot deal with the deep issues on their own, either because neither recognizes what is wrong or because it feels too dangerous to bring up what may turn out to be an explosive topic.

Sex is not simple, and being sexual with a partner — even a long term partner — requires vulnerability. If you have been deeply hurt or disappointed by your partner, it can feel too unsafe to express your sexual and emotional needs to someone you no longer trust.

You can do some exploring about whether old hurts or resentments might have a role in your sexual problems simply by taking this couples quiz. 

No sex therapist can guarantee that uncovering and healing hidden wounds will knit the sexual relationship back together. But in most cases, it does.