A Brief Guide to Discussing Intimacy and Sex in Neurodiverse Couples Therapy

Intimacy and sex are healthy, natural aspects of human relationships. Yet, this topic is often unaddressed by both therapists and couples seeking support. While differences and challenges related to intimate connections are not unique to neurodiverse couples, there are core areas of neurodiversity that frequently arise and can be effectively identified, addressed, and managed in neurodiverse couples therapy. This article aims to normalize challenges related to intimacy and sex in neurodiverse partnerships and assist both therapists and couples in identifying strategies to begin speaking more openly about these areas.

A neurodiverse couple discussing intimacy and sex in therapy

Intimacy and Sex

As a neurodiverse couples therapist, I begin all therapeutic work by having couples establish concrete goals to address throughout our sessions. Sex and intimacy are among the most frequent topics brought up by one or both partners. For neurodiverse couples therapists, it is useful to acknowledge to couples the normalcy of this topic so that it is “on the table” for couples to address. While there are therapists who specialize in talking about sex, all therapists should be able to address this fundamental piece of identity, as every person has a sexuality. Growing research shows “reduced heterosexuality and increased diversity and dysphoria in gender identity in autistic people” (Sala et al, 2020). It is important to recognize that sexual identity falls on a wide spectrum and can be personally identified in many ways, such as gay, straight, asexual, demisexual, and a multitude of others.

In neurodiverse relationships, partners brains are wired differently, which impacts beliefs, thoughts, and opinions. These differences in neurodevelopment can result in varying needs in intimacy and sex within a partnership. For many, intimacy tends to refer to an emotional closeness and connectedness between partners. Sex within a partnership is one way of cultivating intimacy. It often involves sexual contact or an exploration of physical sexuality, which varies greatly from person to person based on preferences, desires, and sexual identity.

Often neurotypical partners express an un/under met need for emotional intimacy when they are looking for communication about emotions and interpersonal experiences. This is rarely a reflection of a neurodiverse partner not wanting, or trying, to meet those needs, but due to neurodiverse couples “speaking different languages” (Myhill & Jekel, 2015). In some partnerships, couples may attempt to achieve closeness by taking opposing routes. One wants emotional intimacy as a way to feel close enough to have sex, and another to use sex to feel connected and derive intimacy from that experience. Regardless of the approach, these areas are distinct and can both come up in a myriad of ways for neurodiverse couples.

Strengthening Communication and Trust

Before a couples therapist can begin working on intimacy and sex, they must address other key neurodiverse couples challenges first. For many couples this is addressing both communication and working to rebuild trust. This requires couples to acknowledge and understand how neurodiversity is impacting their relationship (Myhill & Jekel, 2015). Without a firm understanding of how neurodevelopmental differences are coming up in a partnership, couples can sometimes believe their partners do not have the best intentions for them or the relationship. In neurodiverse couples therapy, this requires psychoeducation about autism and helping couples re-contextualize their relationship through this valuable lens. Once a couple is able to see how the differences in brain wiring are impacting their relationship, they can begin to re-establish trust. Trust is a vital component of a healthy relationship, especially when discussing intimacy and sex. This allows couples to recognize the good intentions that exist from their partner and work on building communication that is clear and concrete so as to have better success in talking about ways to intimately connect. This is particularly important if one partner is feeling more vulnerable about sex or is less interested in this being a primary relationship goal.

Common Challenges

While building communication and reestablishing trust are vital steps, there are additional unique challenges that exist in neurodiverse partnerships related to sex and intimacy. Due to different neurodevelopmental wiring, partners often come into relationships with vastly different experiences and ideas which can present barriers to connecting intimately and sexually. Some areas to be further explored in couples therapy, by either a therapist or a couple, include: past experiences with intimacy and sex, expectations of what relationships “should be,” sensory experiences, social and sexual quota/desire, sexual preferences, executive functioning skills including initiation of intimacy and sex, rigidity about intimacy and sex being a particular way, and other co-occurring conditions such as depression and anxiety. It is crucial to explore these areas within couples therapy to identify if any of them are having an impact on the misses in communication and each partner’s experience of, and satisfaction in, intimacy and sex.

“How To”

One of the most important aspects of neurodiverse couples therapy is for a therapist to translate for each partner and work to build more effective, clear, and concrete communication. This means addressing neurodiversity, working on core relationship challenges, and setting specific goals related to intimacy and sex. In order to effective work on these challenges and differing needs, they have to be brought up within couples work. A neurodiverse couples therapist should facilitate conversations about each partners’ needs, desires, and quota for both sex and intimacy. It requires giving context, or more information than you otherwise may think necessary, to clarify why something is experienced as unfulfilling and the specifics of what is needed for it to improve. Without clear goals around addressing deficits, strategies cannot be identified. This does not mean one partner identifying a need and the other one complying. Rather, it is an exploration of why someone needs a particular thing to feel fulfilled and satisfied based on neurological differences. Then, how their experiences of intimacy and sexual contact may improve with different understanding, tools, and strategies. Mitran (2022) noted that an individual’s ability to consider others’ perspectives increases the likelihood of relational success.” This further reinforces that once couples can see the others’ perspectives by clearly and openly communicating about their needs and desires related to intimacy and sex, they can begin to effectively strengthen this area of their relationship in couples therapy.

Leslie Sickels, LCSW, works with neurodiverse couples and individuals on the autism spectrum in New York. For more information about Leslie’s therapeutic work and neurodiverse couples therapy visit LeslieSickelsLCSW.com.

If you are a therapist and want to learn more about supporting neurodiverse couples, Neurology Matters offers a training and certification program available at aane.thinkific.com.


Mitran, C. L. (2022). A New Framework for Examining Impact of Neurodiversity in Couples in Intimate Relationships. The Family Journal, 30(3), 437-443. https://doi.org/10.1177/10664807211063194

Myhill, G., & Jekel, D. (2015). Neurology Matters: Recognizing, understanding, and treating neurodiverse couples in therapy. FOCUS, NASW Massachusetts Chapter.

Sala, G., Pecora, L., Hooley, M., & Stokes, M. A. (2020). As diverse as the spectrum itself: Trends in sexuality, gender and autism. Current Developmental Disorders Reports, 7(2), 59–68. https://doi.org/10.1007/s40474-020-00190-1

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