Psychosexual Therapy or Couples Counselling: Which Do You Need?

When things are difficult in a relationship, it is not always clear what kind of help to look for. Couples counselling and psychosexual therapy overlap, but they are not the same, and choosing the right one can save time and frustration.

What couples counselling focuses on

Couples counselling usually focuses on how partners communicate, handle conflict and meet each other’s needs. It is well suited to recurring arguments, feeling disconnected, big life changes, or deciding whether to stay together.

What psychosexual therapy focuses on

Psychosexual therapy focuses on sexual difficulties, such as erectile problems, pain during sex, low desire, differences in desire, or difficulties with orgasm or ejaculation. It can be done individually or as a couple, and it often includes specific structured exercises to try at home.

Signs a sexual issue is at the centre

  • Things feel fine between you except in the bedroom
  • Sex has become painful, anxious or avoided
  • One of you has a specific difficulty, such as erections or penetration
  • Arguments tend to start around sex, or the lack of it

Signs the relationship itself needs attention first

  • There is ongoing conflict, resentment or a breach of trust such as an affair
  • You struggle to talk about anything difficult, not just sex
  • One of you is unsure about the future of the relationship

Often, it’s both

Sex and relationships affect each other. Resentment can switch off desire; a sexual problem left unspoken can create distance and conflict. That is why it helps to see someone trained in both. As a COSRT-registered psychosexual and relationship therapist, I can work with the relationship and the sexual side together, and as a GP I can also consider whether health factors are playing a part.

One important note

If there is any abuse, coercion or fear for your safety in the relationship, couples therapy is not the right starting point. Please speak to your GP, or contact a specialist service such as the National Domestic Abuse Helpline (England) on 0808 2000 247.

Talk to a doctor-led therapist

If you are not sure which kind of help fits, that is exactly what the first conversation is for. Read more about couples and relationship therapy, or book a confidential 30-minute consultation for £60.

Written by Dr Kahverry Rajeswaran MBBS, MRCGP, GMC-registered GP and COSRT-registered psychosexual therapist. Last reviewed: 22 October 2026. This article is general information and does not replace individual medical advice.