Couples Therapy for Mismatched Sexual Desire & Desire Discrepancy ● AASECT-Certified Sex Therapist ● Practicing Therapy Since 1988
Sex Therapy for Couples with Mismatched Sexual Desire
Online Sex Therapy for Couples in Oregon, Washington, New York, Massachusetts, & Florida
What the Sexual desire Difference has been like for each of you
If you’re the partner who wants more sex…
You know how long it’s been since you last had sex without checking a calendar. You’ve done the math on birthdays and vacations, and you remember the last time more clearly than your partner seems to.
When you reach over in bed, your partner tenses up. You pull your hand back before they have to say no out loud.
You check the signs before you ask: whether they seem tired, whether the day went badly, and whether asking tonight will end in another no.
Maybe you’ve stopped asking at all, because not asking hurts less than hearing no again.
The question that keeps you up is bigger than sex: you want to know whether your partner still wants you.
You may have tried to talk about the problem calmly, and the talk turned into a fight, or your partner apologized, but the two of you still didn’t have sex any more often.
You don’t tell your friends that the two of you have stopped having sex. The subject feels too private and too embarrassing, so you just deal with the disappointment alone.
If you’re the partner who wants less sex…
Every touch now comes with the same silent question: am I about to be asked for sex again?
A hand on your shoulder while you’re cooking, or a kiss that goes on a second too long, and you already know what your partner is hoping for, and you dread having to say no.
So you go to bed earlier than your partner, or later, or you keep your child or a screen between you.
You’ve avoided physical affection because it can turn into a request for sex, and then into a frustrating talk about why not tonight.
Sometimes you agree to sex you don’t want. Your mind is somewhere else from start to finish, and afterward you feel worse than if you’d said no.
You’ve wondered whether something is wrong with you, whether you’re defective, and whether you’ll ever want sex again.
Feeling relieved when your partner falls asleep first, then guilty about the relief, has become a normal night for you.
Desire Discrepancy: When Your Sex Drives Don’t Match
Desire discrepancy is the clinical term for a difference in how much sex two partners want. It’s one of the most common reasons couples seek sex therapy, especially when the difference has led to years of rejection, pressure, arguments, or growing distance.
There isn’t one explanation for why couples develop differences in sexual desire.
Sometimes it’s connected to medication, health changes, stress, or sexual experiences that have become less pleasurable. Sometimes unresolved relationship difficulties make it harder to want sexual intimacy with a partner. And sometimes the difference involves how each person experiences desire in the first place.
Two kinds of sexual desire: spontaneous and responsive
For some people, sexual desire seems to arrive on its own. They might find themselves thinking about sex in the middle of a workday and hoping to be intimate with their partner that evening. This is called spontaneous desire.
For others, desire tends to develop after something pleasurable or intimate has already begun. They may enjoy a kiss or affectionate touch before they begin feeling interested in sex. This is called responsive desire.
Many people experience both kinds of desire, depending on their circumstances.
When partners misunderstand how the other experiences desire, they may begin interpreting ordinary differences as rejection or pressure. Over time, those reactions can create another difficulty on top of whatever contributed to the original desire difference.
That’s one way couples can develop the sexual desire discrepancy cycle.
The desire discrepancy cycle
Whatever first contributed to your difference in sexual desire, the way you and your partner respond to that difference can make it harder to feel close to each other.
For some couples, one partner initiates sex and the other turns them down. The partner who initiated may hear something more painful than “I don’t want sex tonight.” They may begin wondering whether their partner still finds them attractive or wants them sexually.
Meanwhile, the partner who wants less sex starts anticipating another request. They pull away from physical affection because they’re worried that accepting it will create an expectation for sex.
The partner who wants more sex notices the withdrawal and feels increasingly rejected. They may initiate more often, hoping to reconnect, or stop initiating altogether because they don’t want to be turned down again.
Now both partners are protecting themselves from something painful. One is trying to avoid rejection, while the other is trying to avoid unwanted sexual pressure.
Physical affection becomes less frequent, and conversations about sex become increasingly difficult.
Some couples try to solve the problem by agreeing to be more affectionate. But if one partner hopes the additional touch will lead to sex while the other worries about exactly that, the same difficulties can return.
How mismatched desire turns into a sexless relationship
When the difference in desire has led to repeated arguments or avoidance, you may find yourselves having the same exhausting conversation about sex, or avoiding the subject altogether because you already know how the conversation will go.
The two of you still manage the household, raise the kids, and laugh at the same jokes. But physical affection has become rare, and sex even more so.
Couples describe the situation like this: we love each other, but we live like roommates.
I’m Kate McNulty, LCSW, LICSW | AASECT-Certified Sex Therapist & Certified Gottman Method Couples Therapist
I’ve helped couples with sexual desire discrepancy for more than fifteen years.
I work with couples in New York, Massachusetts, Florida, Oregon, and Washington to understand what’s contributing to their differences in sexual desire and develop a sexual relationship that feels satisfying to both partners.
I’m an AASECT-certified sex therapist and a Certified Gottman Method Couples Therapist. I also train other therapists as an AASECT Approved Supervisor and Gottman Method trainer. My background in both specialties allows me to address sexual difficulties and the relationship problems that contribute to them.
During our sessions, I’ll assess how your sexual relationship has changed, what may have contributed to the difference in desire, and how each of you has responded.
Sometimes a health change, medication, or an unsatisfying sexual experience is involved. Other times, unresolved conflict or emotional distance has made sexual intimacy less appealing.
After years of disagreeing about sex, you may also have begun responding to each other with criticism, defensiveness, or withdrawal, making it even harder to address the original problem.
I’ll help you understand which difficulties need attention and how they affect each other. That might mean addressing longstanding disagreements, changing how you approach physical intimacy, or finding ways to make sex more pleasurable and appealing to both of you.
Here’s what you can expect from me as your sex therapist:
We’ll talk about sex directly, in plain words, including what each of you wants, what you enjoy, and what about sex has become difficult to talk about.
I’ll help you address the relationship difficulties that are interfering with sexual intimacy, using my training in couples therapy to make difficult conversations more productive.
When physical touch has become associated with pressure or rejection, I can help you develop agreements about affection and intimacy that both of you feel comfortable trying at home.
I’ll take both of your experiences seriously. Wanting more sex doesn’t make one partner unreasonable, and wanting less doesn’t mean the other partner needs to be fixed. We’ll work toward a sexual relationship that feels satisfying to both of you.
How your relationship changes after sex therapy with me
A desire difference that lasts for years raises a question: can we stay together like this?
The partner who wants more sex has pictured thirty more years of being turned down, and wondered whether they can live with so much rejection.
The partner who wants less sex has wondered whether the relationship can survive how often they say no.
During our sessions, I’ll help you address the issues contributing to your desire difference, including sexual satisfaction, physical health, unresolved relationship difficulties, and how you respond to each other when sex becomes a source of tension.
As we address those concerns, we’ll work toward meaningful changes in your sexual relationship.
You Can Talk About Sex Without Another Argument
Instead of avoiding the subject or waiting until one of you becomes upset, you learn to raise concerns about your sexual relationship before resentment builds.
The partner who wants more sex learns to explain what they’re missing without criticizing the other. The partner who wants less learns to talk about what makes sex difficult or unappealing without feeling obligated to apologize for their desire.
You learn to disagree about what you want while still having a productive conversation about what to do next.
Physical Affection Can Feel Comfortable Again
When physical touch has become associated with pressure or rejection, we’ll address the expectations that have made affection uncomfortable.
The partner who wants less sex learns to enjoy physical closeness without feeling that every affectionate moment creates an expectation for sex. The partner who wants more learns to express affection without treating every interaction as another test of whether their partner desires them.
Together, you develop ways to be physically close that respect both partners’ comfort and interest.
You Can Discover What Makes Sex More Enjoyable for Both of You
When sexual experiences have become unsatisfying, we’ll examine what each of you enjoys, what has changed, and what needs attention to make intimacy more appealing.
We’ll address difficulties communicating about sexual preferences, discomfort during intimacy, and differences in the kinds of sexual experiences you enjoy.
Rather than assuming one partner needs to increase their desire to match the other’s, we’ll work toward sexual experiences that both of you genuinely want.
You Can Feel Secure in Your Relationship Even When Your Desires Differ
When one partner wants sex and the other doesn’t, you’ll learn to respond without returning to rejection, guilt, anger, or withdrawal.
You’ll develop ways to discuss differences, make decisions about intimacy, and maintain connection even when your desires don’t align.
A difference in desire no longer has to determine how loved, wanted, or secure either of you feels in the relationship.
You Can Make Informed Decisions About Your Sexual Future Together
For some couples, treatment leads to a more satisfying sexual relationship.
For others, it brings greater clarity about their needs, preferences, and what each partner is willing and able to change.
Instead of continuing the same arguments or silently wondering whether the relationship can survive, you’ll have the tools to discuss what you both want your sexual relationship to become.
How I treat Couples’ mismatched Sexual desire
First, I Assess What’s Contributing to Your Difference in Desire —
During our initial sessions, I’ll assess when your sexual desire began to differ, what was happening in your lives at the time, and how your sexual relationship has changed since.
We’ll discuss physical health, medication, hormonal changes, pain during sex, sleep, stress, and whether sex has been pleasurable for both of you. I’ll also assess how you communicate, manage disagreements, and respond to each other outside the bedroom.
When I find indications that a medical concern is contributing, I’ll recommend consulting an appropriate healthcare provider alongside our sessions.
Once we have a clearer understanding of what’s contributing to the problem, I’ll recommend where to begin. For some couples, that means addressing unresolved relationship difficulties or sexual dissatisfaction before focusing on physical intimacy. For others, we’ll begin by changing how they initiate sex and respond to differences in desire.
Then, We Address What’s Making Sexual Intimacy Difficult —
When physical touch has become associated with pressure or rejection, I’ll help you create agreements that make affection more comfortable for both of you.
Many couples have already tried agreeing to take sex off the table temporarily or be more affectionate. Those attempts often break down because the agreement is unclear, one partner begins counting down until sex is expected again, or the couple hasn’t decided how to handle situations where one partner wants more intimacy than the other.
In our sessions, I’ll help you negotiate specific agreements about which kinds of physical affection feel comfortable, what each of you can expect, and how to handle differences in desire without returning to the same arguments.
We’ll review how those agreements are working and adjust them based on your experiences at home. As you become more comfortable with physical intimacy, we’ll discuss which additional forms of touch or sexual activity you’re both interested in exploring.
When the primary difficulty involves sexual dissatisfaction, unresolved conflict, or another concern, we’ll address that directly rather than assuming that increasing physical touch will resolve it.
We Also Improve How You Talk About Sex and Relationship Difficulties —
Conversations about sex often become difficult when one partner feels repeatedly rejected and the other feels pressured or criticized. Sometimes those difficulties extend well beyond your sexual relationship.
As a Certified Gottman Method Couples Therapist, I’ll help you recognize when a conversation is becoming unproductive, express concerns without attacking each other, and respond without immediately becoming defensive.
We’ll practice these skills during sessions, including how to pause an escalating disagreement and return to it, and how to repair after an argument.
You’ll learn to discuss sexual concerns and other relationship difficulties at home without repeating the same hurtful exchanges.
Who is a good fit for sex therapy for Couples with desire discrepancy?
Sex therapy for desire discrepancy works best when both partners attend sessions and both want a more satisfying sex life together.
You don’t have to agree on what caused the desire discrepancy or feel equally motivated to address it. Couples often arrive with one partner more skeptical than the other. What’s important is that both of you are willing to participate in sex therapy together.
Some couples I see haven’t had sex in months or years. Others have sex with some regularity, but one partner feels the frequency is far too low.
For some couples, desire differences developed after a life change, such as new career responsibilities, having a baby, or receiving a health diagnosis. For others, the difference has existed since the beginning of the relationship.
Neurodivergent Couples
I also work with autistic couples and couples where one or both partners have ADHD. These couples bring concerns to sex therapy that go beyond desire discrepancy: certain kinds of touch feel physically unpleasant regardless of how much desire a partner feels, attention differences affect how and whether sex gets initiated, and one partner has sometimes gone years without an autism or ADHD diagnosis, adding a layer of confusion neither of you had answers to.
LGBTQIA+ and Polyamorous/ENM Couples
I also work with LGBTQIA+ couples and individuals. Standard sex therapy frameworks were built on heterosexual, monogamous, cisgender assumptions about what desire looks like, what healthy sexuality means, and the intent of sex therapy.
First, desire doesn’t look the same across all relationships. The research used to build most sex therapy frameworks came primarily from heterosexual and cisgendered couples. For same-sex couples, gender-diverse people, and those in open relationships, what counts as a desire gap and what drives desire can differ from traditional sex therapy.
Second, a conventional approach to sex therapy assumes the goal is improving sex within one monogamous partnership. For polyamorous and open relationships, that assumption doesn’t apply. A therapist working from a monogamy-as-default framework may aim treatment at improving sex with one primary partner when the couple’s situation is more complex. Or, the therapist may treat the relationship structure itself as a problem to be changed.
And third, many LGBTQIA+ and/or polyamorous clients spent years hiding their sexual identity or their relationship structure. That history influences how comfortable a person is talking about sex and their sexual desires. In session it can show up as vagueness or difficulty naming what they want, and a therapist who doesn’t know the history may misread what they’re hearing.
My ongoing study of sexuality and sex therapy covers the full range of human sexual behavior and relationship structures. That means our sessions follow your desires and your relationship arrangement, not assumptions about what your sexuality should look like, who it should involve, or what your therapy goals should be.
Who is not a good fit for sex therapy?
If there is ongoing domestic violence in your relationship, sex therapy is not an appropriate service.
Sex therapy asks both of you to speak honestly in session, and when one partner is being hurt or controlled at home, that honesty can create danger after the session ends. Individual therapy is a safer starting place.
A certified sex therapist and couples therapist with more than 15 years treating desire discrepancy
I’m Kate McNulty, LCSW, LICSW
I’ve been a therapist since 1988. For the past fifteen years, my sex therapy practice has focused on a problem couples often find difficult to discuss: they love each other, but their sexual relationship has become a source of disappointment and distress.
Couples dealing with differences in sexual desire have often been having the same disagreements for years. You know what you feel, but not what to do differently. When I observe how you interact and explain what I’m seeing, you gain a clearer understanding of the difficulties you’ve been unable to resolve on your own.
I’ll make recommendations grounded in research, and you’ll leave sessions with concrete changes to practice at home.
If the description on this page sounded like your relationship, I’d like to help.
Logistics
Pricing, scheduling, and online sex therapy sessions
All sessions are conducted by secure, HIPAA-compliant video. I work with couples and individuals in Oregon, Washington State, New York, Massachusetts, and Florida.
Sessions are private pay, billed at $500 per hour and $750 for 90-minute sessions. Extended sessions (3+ hours) are available for couples who want to make faster progress.
I am not in-network with insurance and cannot bill them directly. For more information about pricing, please see the pricing page.
How to get started in sex therapy
To schedule your first appointment, please choose a day and time on my secure, HIPAA-compliant calendar using the button below.
After I approve your request, typically within one business day, you and your partner will receive new client forms via email, which you’ll both review and digitally sign before we meet.
Questions About Sex Therapy for Couples with Desire Discrepancy
Frequently asked questions —
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Hormone changes, certain medicines, depression, thyroid problems, and pain during sex can all lower desire. Early in our sessions I ask about your health, current medicines, and any physical symptoms. When a medical cause looks likely, I’ll help you find the right doctor or specialist. A medical evaluation and sex therapy can happen at the same time.
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Mismatched sex drives, mismatched libido, and desire discrepancy all describe the same experience. The clinical term is desire discrepancy, and it’s one of the most common reasons couples start sex therapy. If you recognized your relationship in the description on this page, this service is a good fit for your situation.
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Yes, and in ways that most sex therapy training doesn’t cover. Standard desire-gap frameworks were built on research with neurotypical couples, so they often miss two things that matter for neurodivergent couples. First, sensory differences can make certain kinds of touch feel physically unpleasant or overwhelming regardless of desire, and a touch plan built on that assumption treats the wrong problem entirely. Second, attention differences affect how and whether sex gets started, and what looks like low desire or avoidance is often an initiation problem instead.
That gap in standard training is what drew me to this work. I’m autistic, and working with neurodivergent clients on relationships and sex has been a central part of my clinical practice for years. I also train other sex therapists on how to work effectively with neurodivergent clients.
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Yes. Infidelity and disagreements about pornography use can affect a couple’s sexual relationship, including how much each partner wants sex and how comfortable they feel being intimate together.
If trust was broken by infidelity, the hurt and uncertainty that followed may be contributing to your differences in desire. In that situation, I’ll help you address the betrayal rather than assuming that changing how often you have sex will resolve the problem.
Pornography use is a different consideration. Watching pornography doesn't automatically indicate a problem, but disagreements about its use, secrecy, or sexual behavior that feels out of control can affect sexual satisfaction and trust. I’ll help you understand what’s happening before determining which concerns need treatment.
I also offer couples therapy after infidelity and individual therapy for out-of-control sexual behavior. Depending on your circumstances, addressing those concerns may be an important part of improving your sexual relationship.
Still have Questions about sex therapy for desire discrepancy?
Please contact me using the button below. I will respond within 2 business days.