Inclusive Intimacy: Therapeutic Use of the Term “Good Sex” with Neurodiverse and LGBTQIA Couples
Couple Together
In the media, among friends, and even with other therapists, I often hear about the value of “good sex” in a relationship or marriage. Of course, sex is an important aspect of intimacy. However, there are exclusive, unrealistic, and ultimately harmful expectations that inform narratives on “good sex,” traditionally understood as frequent and passionate sex, a standard that many couples do not or may never live up to. In fact, unlearning societal constructs of “good sex” is part of what helps some clients to connect in an authentic fashion. For men, women, neurodivergent, non-binary, trans people, and those of all sexual orientations, a client-centered definition of intimacy can be a productive aspect of the therapeutic relationship.
The unquestioned connection between intimacy and sex is reinforced by the term “good sex.” While describing a period of sex becoming less frequent in her marriage, the infertility and healthy sexual intimacy expert Mary Bruno made the following statement, “While it can be a beautiful expression of intimacy, a couple doesn’t have to have sexual intercourse to experience it. And this is what is often lost in the language around sex from our culture-both religious and not. Sexual intimacy is meant to be far more than a physical experience, a gift for our entire self which-if we are being honest- is not always available even through our best efforts” (Bruno, 2025) Sometimes, we are not ready to give our entire selves on multiple emotional and spiritual levels, and may not be fully ready for sex. However, Bruno also comments on the undervalued role of romantic connection and intimacy outside of sex (Bruno, 2025), and the truth is that not everyone feels the most connected through sex, with the asexual community being a prime example.
The pressure to have “good sex” creates expectations for couples rather than fostering love, exploration, and curiosity. The Canadian Sex Educator Shan Boodram comments on the “socially acceptable sex life,” expressing that “People who live outside of that narrative in terms of their desires, their sexual identity, their orientation…They don’t have the luxury of seeing what feels good for them reflected back to them” (Williams, 2022). Some of the couples I work with feel inadequate because their sex life doesn’t meet societal expectations due to their neurological and sensory needs, medical challenges, or orientations. For them, the term “good sex” means a goal that they don’t live up to, not a process of exploring mutual intimacy.
While women, men, non-binary, and trans folks can all feel the pressure to have sex, there are some specific kinds of pressures that bring clients to therapy. It has been well documented that men have a particularly sensitive relationships with their erections, feeling as though their virility depends on them, with men with ED facing serious psychological consequences (Allen, 2023). What is less known is that men also face pressure to feel that they must take advantage of every opportunity around sex, sometimes resulting in unwanted sexual encounters(Cera, 2017). Women also report the pressure to orgasm but can learn that letting go of that is freeing and at times ultimately results in better sex and intimacy (Ashley, 2019). Transgender and nonbinary people may experience fetishization and rejection that can cause some to feel uncomfortable disclosing their gender history when dating and may lead to challenges forming romantic and sexual relationships (Perez. J & Pepping, 2024). Neurodiverse couples may also have challenges forming intimate relationships due to sensory, communication, and experiential differences. Therapists should be aware that using the term “good sex” may set up unrealistic expectations and exclude asexual and neurodivergent individuals.
A lot of my work as a couple’s therapist involves unlearning the traditional constructs of what “good sex” is, or that sex must exist to make a relationship whole. Instead of asking couples if they have a good sex life, I ask what intimacy looks like for them, what helps them to feel desired and connected to their partner and to feel good in their relationships. Some couples may need regular sex, but for others, intimacy may consist of other ways of connecting, such as affectionate touch, DSM, or different types of penetrative and non-penetrative erotic acts. By speaking about their true desires and unlearning restrictive and neurotypical expectations, couples can become closer and happier in their relationship.
Therapists may benefit their clients by refraining from the term “good sex” and instead of asking clients what “good intimacy” is for them. It is wonderful and healthy when couples enjoy a frequent and robust sex life, but caution should be used when repeating a term that historically implies heteronormative and neurotypical norms. As therapists, if we empower our clients to define what good intimacy means for them, we are more likely to help them connect in a more authentic fashion.
Bibliography
Allen, M. W. (2023). The Psychology of Erectile Dysfunction. Current Directions in Psychological Science, 32(6). doi:https://doi.org/10.1177/09637214231192269
Ashley, B. (2019, August 10). Are We Under Too Much Pressure to Orgasm. Retrieved from Redacted : https://restlessnetwork.com/are-we-under-too-much-pressure-to-orgasm/
Bruno, M. (2025, January 30). Clash and captivate: Saying ‘no’ to sex within marriage. Retrieved from Natural Womanhood: https://naturalwomanhood.org/saying-no-to-sex/#:~:text=Marital%20intimacy%20doesn%27t%20start,they%20consider%20engaging%20in%20sex.
Cera, M. F. (2017, August 28). Social Pressure to Appear Masculine Leads Straight Men To Have Unwanted Sex. Contexts . Retrieved from https://contexts.org/blog/social-pressure-to-appear-masculine-leads-straight-men-to-have-unwanted-sex/
Perez. J & Pepping, C. (2024). Relationship experiences of transgender and non-binary adults: exploring dating goals, relationship structures, minority stress, sexual fetization, and relationship victimization. International Journal of transgender Health, 1-20. doi:https://doi.org/10.1080/26895269.2024.2316690
Williams, I. (2022, March 18th ). What's 'good sex,' anyway? Retrieved from CBC: https://www.cbc.ca/life/culture/what-s-a-good-sex-life-anyway-1.6389909#:~:text=The%20biggest%20misconceptions%20about%20%27good,%27good%20sex%27%20conversation.%22
