Behind the Mask in Neurodiverse Relationships 🎭 Do you wear a mask? Let's be honest, these days we all wear masks. We put on a certain face for the world as we feel the tension of fitting in. For people on the autism spectrum, this tension gets cranked up to the max. Picture this: You're at a party – the music's pumping, laughter fills the air. Mary, who is neurotypical, moves with ease, her personality shining through. 💃 Meanwhile, John, who is autistic, navigates this social maze with a... Behind the Mask in Neurodiverse Relationships 🎭 Do you wear a mask? Let's be honest, these days we all wear masks. We put on a certain face for the world as we feel the tension of fitting in. For people on the autism spectrum, this tension gets cranked up to the max. Picture this: You're at a party – the music's pumping, laughter fills the air. Mary, who is neurotypical, moves with ease, her personality shining through. 💃 Meanwhile, John, who is autistic, navigates this social maze with a rehearsed grace, each smile and nod meticulously planned to camouflage his true self. 🥸 This effort, a profound act of 'masking', isn't just for tonight but is a constant presence, draining John's energy and straining the couple's connection. If left unchecked, this dynamic could threaten the very foundation of their relationship. What does it mean to mask oneself? 🤔 For many with autism, masking is a survival strategy . The goal is not merely to blend in but to avoid the friction of social judgment. This adaptive behavior, while protective in the moment, demands a significant emotional toll, reshaping one's self-expression to meet external expectations, often at great personal cost. 😪 Understanding masking is more complicated than it may appear at first glance. There are different ways to mask: Compensation: This is where one adopts behaviors deemed acceptable , molding their actions to fit a normative social mold. Suppression: Here, natural behaviors are stifled , hidden away to present what is perceived as 'normal.' Assimilation: In this act, one performs scripts that align with societal expectations , often feeling alien to one's nature. Do you recognize these behaviors in yourself? Or in your partner? 💵 The Profound Costs of Masking Now consider the emotional and psychological toll: the constant energy required to maintain this facade can lead to anxiety, depression, and even physical symptoms due to chronic stress. 🤒 Over time, this sustained effort can erode an individual's self-esteem and sense of identity, impacting both personal well-being and the vitality of their relationships. Moreover, misunderstandings that arise from masking can create emotional distance, leaving one partner feeling neglected and the other overwhelmed, complicating their ability to connect and communicate effectively. 💔 What to do? 📊 Measuring Masking with the CAT-Q Taking the Camouflaging Autistic Traits Questionnaire (CAT-Q) is an essential first step for those aiming to explore the extent of autistic masking. CAT-Q Questionnaire Available at no charge on the Adult Autism Assessment website, this tool includes 25 questions and can be completed in 5 to 7 minutes. It assesses various dimensions of masking, breaking down masking strategies so you can gain a deeper understanding of these behaviors' emotional and relational impacts. 🗣️ Have the Right Masking Conversation Instead of focusing solely on the frustrations that arise from autistic masking, let's delve into what's truly happening beneath the surface. Moving away from blame, we can foster a supportive environment by openly discussing the underlying challenges of masking. 💬 Exploring insights from the CAT-Q results allows us to understand the pressures and strategies involved, helping to cultivate empathy and strengthen our connections in a more meaningful and supportive way. 🛠️ Tailoring Social Situations Adapting social settings to reduce the need for masking, whether by choosing less demanding activities or creating signals for needed breaks , can alleviate stress and enhance engagement. Get really specific. Be creative and experiment with new ways of approaching tough situations. This proactive approach allows both partners to feel more in control and less anxious about social interactions, leading to more enjoyable and meaningful experiences together. Couples who try this are amazed at the freedom and relief that they experience. 🏠 Creating a Supportive Home Environment How can we make our homes refuges where unmasking is not just safe but welcomed? By respecting personal space, allowing for stimming or other natural behaviors, and setting clear expectations, we build trust and reduce the daily stress for the autistic partner. A nurturing home environment acts as a foundation for growth and healing, where both partners can truly relax and be themselves, strengthening the bonds of love and understanding. Unveiling the Mask, Not Eliminating It 👫 The key to a healthy relationship in a neurodiverse partnership isn't about eradicating masking entirely. It's about fostering open communication and acknowledging the mask itself. Imagine the mask not as a barrier to intimacy, but as a layer waiting to be understood. Through honest conversations, you and your partner can explore the situations where masking feels necessary and discuss strategies for minimizing it. 🗣️ By discussing the results of tools like the CAT-Q , you can gain a deeper understanding of masking's impact and build empathy for each other's experiences. This awareness allows you to create a safe space at home where unmasking feels natural, fostering genuine connection and a stronger bond. Remember, masking can be a coping mechanism, but it shouldn't come at the expense of your true selves. Let's work together to unveil the masks, not eliminate them, and celebrate the beautiful authenticity beneath. Go deeper: Masking often follows couples into the bedroom too. Module 6 of our Neurodiverse Sex Therapy Program, Energy, Masking, and the Onramp , looks at how it affects intimacy and what helps. Click Here To Match With An Expert All the best, Harry Dr. Harry Motro, LMFT, PsyD Dr. Motro is a registered Marriage and Family Therapist #53452 and the Founder/Clinical Director of the Neurodiverse Couples Counseling Center. Ready to Get Started? Tell us a little about yourself, and our client care team will match you with the neurodiverse specialist who's right for you. Get Started Take an ASD/ADHD Screener Are you curious about whether or not you have autism/ADHD? Want to learn more about yourself and take the first step towards deeper self-understanding? We invite you to visit the Adult Autism Assessment Site and Take An ASD/ADHD Assessment Use our Trait Wheels to better understand your strengths and challenges: Autism Trait Wheel ADHD Trait Wheel AuDHD Trait Wheel

Sex therapy for couples where one or both partners are autistic, ADHD or AuDHD: 24 modules on what happens in each session, and what to do after. Show the full page text The Neurodiverse Sex Therapy Program An introduction to sex therapy, and a companion to it, for couples where one or both partners are autistic, ADHD or AuDHD. Each module walks you through what tends to happen in one session, and then gives the two of you something to do after it. Nothing sexual happens in a session: it is all talk. Anything you try at home happens only if you both agree to it, at the pace of whichever of you needs it slower. Nothing here needs an account, and nothing you write leaves your own device. 24 of 24 modules are published and readable now. Any others are listed by name so you can see the whole shape of the program before you start it. There is a short video at the top of this page. What The Neurodiverse Sex Therapy Program is, who it is for, and what its six parts cover. It runs about 5 minutes. How to read it A framework, not a script. Each module describes one way a session can go. Every therapist at our center is an experienced clinician with their own way of working, and yours will shape each session to the two of you: changing the order, spending longer on some steps, skipping others, or trying something different. Use the modules to know roughly what to expect, not as a checklist your sessions have to follow. Parts One to Four run in order and each assumes the ones before it: starting the conversation, how your two brains shape sex, asking, answering and planning, and touch, one step at a time. Part Five does not: it is a shelf of the things that most often bring couples to sex therapy (Low Desire ; When One of You Wants It More ; Erections and Performance Anxiety ; Pain During Sex ; Porn and Secrecy ; Body Image ; Perimenopause and Menopause ), and you take the ones that are about your life. Where the body may be part of it, we ask you to see a doctor as well. Part Six is about making it yours. You do not have to be in therapy to use any of it. Part One - Starting the Conversation 1A — Your First Sex Therapy Session What to expect, and what never happens, when you first talk about sex. Read Your First Sex Therapy Session 1B — Talking About Talking About Sex Make the subject sayable before you try to solve anything. Read Talking About Talking About Sex 1C — What Sex Is For, for Each of You Hear what sex means to your partner, without a verdict. Read What Sex Is For, for Each of You Part Two - How Your Brains Shape Sex 2A — How Neurodivergence Shapes Sex Name what gets in the way, without blaming either of you. Read How Neurodivergence Shapes Sex 2B — Your Sensory Map Make the room fit both of your bodies. Read Your Sensory Map 2C — Energy, Masking, and the Onramp Save some energy for each other, and time to arrive. Read Energy, Masking, and the Onramp 2D — When “No” Lands Hard Make it safe to ask, and safe to say no. Read When “No” Lands Hard 2E — Orientation, Identity, and Desire Start from who you each are, not from the usual script. Read Orientation, Identity, and Desire Part Three - Asking, Answering, and Planning 3A — Saying It Plainly Plain words you agree on, so nobody has to guess. Read Saying It Plainly 3B — Yes, No, Maybe Find what you both want, with nobody talked into anything. Read Yes, No, Maybe 3C — The Daily Check-In Six numbers a day, so neither of you has to guess. Read The Daily Check-In 3D — Asking and Answering Make it easy to ask, and safe to give any answer. Read Asking and Answering 3E — Scheduling Intimacy Keep a time for each other, with no promise attached. Read Scheduling Intimacy Part Four - Touch, Step by Step 4A — Sensate Focus, One Step at a Time Find your way back to touch, with nothing to prove. Read Sensate Focus, One Step at a Time 4B — Brakes and Accelerators Ease what switches desire off before adding anything new. Read Brakes and Accelerators 4C — Aftercare and Repair Make the minutes after feel as safe as the rest. Read Aftercare and Repair Part Five - When Something Is Wrong 5A — Low Desire Find what is lowering desire, without blaming either of you. Read Low Desire 5B — When One of You Wants It More Plan for the desire you each have, not the one you expected. Read When One of You Wants It More 5C — Erections and Performance Anxiety Step out of the worry loop around sex, together. Read Erections and Performance Anxiety 5D — Pain During Sex Stop pushing through pain, and find help together. Read Pain During Sex 5E — Porn and Secrecy Talk about porn without shame, blame or hiding. Read Porn and Secrecy 5F — Body Image Spend less of sex watching yourself, and more of it feeling. Read Body Image 5G — Perimenopause and Menopause Work out the new rules for sex, together. Read Perimenopause and Menopause Part Six - Making It Yours 6A — Designing Your Own Relationship Keep what fits you both, and plan for the slips. Read Designing Your Own Relationship Working with us The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including on sex, desire and touch. Everything described in these modules is part of how we work, shaped by your therapist to the two of you. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team . Acknowledgments The Neurodiverse Sex Therapy Program was compiled by, and written under the direction of, Harry Motro , LMFT, founder and clinical director of the Neurodiverse Couples Counseling Center. It represents the input of the whole clinical team. Every session it describes is one the center’s therapists run, in the way they run it, and the program exists because they were willing to say, in detail, what they actually do in the room. The clinical team. Our deepest thanks go to the therapists of the center. Their sessions are what these modules describe. Their worksheets, refined over thousands of hours with neurodiverse couples, are what the modules draw on: the Yes / No / Maybe Inventory , the Sensory Map , the Daily Check-In Tracker , the Scheduled Intimacy Agreement , Brakes and Accelerators , the Aftercare Plan , the Designer Relationship worksheet, and many others. Where a module says “we,” it means them. Meet the team . The couples. And to the couples. Everything here that is true was learned from people who sat in the room, tried it, told us when it did not work, and came back the next week. Nobody’s story is in these pages. Everybody’s is. The research. Each module lists its sources, with what each one can and cannot support, at the foot of its page. Across the program, the work we lean on, and are grateful for: Laura Pecora, Gary Mesibov and Mark Stokes on what the research shows about sexuality in autism Sarah Garfinkel and colleagues on how autistic people sense what is happening inside their own bodies Damian Milton on the double empathy problem Laura Hull and colleagues on social camouflaging Gray, Kirby and Holmes on autistic adults' own accounts of the senses, sexuality and relationships Helen Fisher, Arthur Aron and Lucy Brown on the brain systems behind desire, romantic love and attachment Sue Johnson on the conversations that keep couples close Dinah Murray, Mike Lesser and Wenn Lawson on monotropism Ari Tuckman on how ADHD shows up in a couple's sex life van Asselt, Reekers and Roke on rejection sensitivity in autistic adults Teresa Tavassoli and colleagues on sensory over-responsivity in autistic adults MacLennan, O'Brien and Tavassoli on the sensory experiences of autistic adults, in their own words Kathleen Hupfeld, Tessa Abagis and Priti Shah on hyperfocus in adult ADHD Steven Kapp and colleagues on autistic adults' views of stimming Beheshti, Chavanon and Christiansen on emotion dysregulation in adult ADHD Jeroen Dewinter, Hanneke De Graaf and Sander Begeer on sexual orientation and gender identity in autistic adults Varun Warrier and colleagues on autism among transgender and gender-diverse people Bush, Williams and Mendes on asexuality among autistic women Catherine Crompton and colleagues on information transfer between autistic and non-autistic people Emma Kinnaird, Catherine Stewart and Kate Tchanturia on alexithymia in autism Michael Robinson and Gerald Clore on how people report what they feel Ottenstein, Hasselhorn and Lischetzke on how checking in daily makes feelings clearer Paul Schrodt, Paul Witt and Jenna Shimkowski on the demand/withdraw pattern Ye In Hwang and colleagues on anxiety and uncertainty in autistic adults Rosemary Basson on responsive desire William Masters and Virginia Johnson on sensate focus Linda Weiner and Constance Avery-Clark on sensate focus in practice Erick Janssen and John Bancroft on the dual control model of sexual response Emily Nagoski on brakes and accelerators Roy Lewicki, Beth Polin and Robert Lount on what makes an apology work Marita McCabe and colleagues on how sexual difficulties are defined Jan Shifren and colleagues on how common sexual problems and distress are William Masters and Virginia Johnson on the human sexual response Raymond Rosen and colleagues on erections and general health Ronald Pyke on sexual performance anxiety Paris, Lodestone, Houser and Lewis on autistic shutdowns Elke Reissing and colleagues on how pain with penetration is now understood Moniek ter Kuile and colleagues on therapist-aided treatment for vaginismus Al Cooper on sexuality and the internet de Alarcón and colleagues on what is and is not known about online porn Shane Kraus, Valerie Voon and Marc Potenza on compulsive sexual behavior Yasisca Pujols, Cindy Meston and Brooke Seal on body image and sexual satisfaction Alexandra Leedham and colleagues on autism diagnosed in middle and late adulthood Rachel Moseley, Tara Druce and Julie Turner-Cobb on autistic people's own accounts of menopause Ginny Russell and colleagues on the autistic advantage Dora Raymaker and colleagues on autistic burnout Yuthika Girme, Nickola Overall and Simpson Faingataa on what shared time together does for a relationship We have tried to say what each study shows and no more. Where the program goes past the evidence, the module says so.

A sex therapy session for neurodiverse couples about what it is like to talk about sex: what makes it hard, and what makes it easier. Show the full module text Module 2 — Talking About Talking About Sex Make the subject sayable before you try to solve anything. Watch first: the Module 2 video A narrated video of about 4 minutes in a flat illustrated style with flowing ribbons of navy, lavender and mint, opening and closing on the Neurodiverse Couples Counseling Center logo. A couple in two armchairs, with the therapist on a laptop on a small table, talks about talking about sex. On screen: “I am uncomfortable” as a complete sentence, “Observe without fixing,” family, school and faith, the six-part “What makes it hard” chart, and options such as “Plain, direct words” and “Writing thoughts first.” Watch the Module 2 video: Talking About Talking About Sex (MP4, about 4 minutes). The written lesson below covers the same ground in full. The two of you are on the couch, your therapist is on the screen, and the subject is sex. For many couples the hardest part is not sex itself. It is saying anything about it out loud while your partner listens, and this session is about exactly that. A conversation about the conversation Summary: what usually happens in the session 1 Your therapist says what this session is for. What it is like to talk about sex. Not your sex life itself. 2 You each choose how to answer. Out loud, or written down first and then read out. 3 You each notice what happens in your body. As the subject comes up, right then, in the session. 4 You each say what you were taught about sex. At home, at school, from a faith or from friends, in words or in silence. 5 You each name what makes talking about sex hard. Embarrassment, missing words, fear of judgment, missed hints, or being worn out. 6 You each pick what would make it easier. Writing first, plain words, a better time of day, or your therapist there. 7 Your therapist asks how the conversation went. And whether you would like to try a short one at home. One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working. Step 1. Your therapist says what this session is for Your therapist usually starts by saying what this hour is about. You will not be asked what you do in bed, how often, or what is missing. The only subject is what it is like for each of you to talk about sex at all. That may sound like a small thing to spend a session on. For many couples, it is the thing that has kept everything else stuck. Once you can talk about talking, the rest of the work usually gets easier. What this hour is for. Today is not about your sex life. It is about what it is like to talk about it. That is all we are doing. If it feels unsafe, not just awkward. Awkward is expected. Unsafe is different. If saying something about sex in front of your partner could lead to anger, punishment or pressure later, tell your therapist on your own. Work on sex pauses while that is looked at. Step 2. You each choose how to answer Before any question, your therapist may ask how each of you would like to answer. For some people the words come out loud. Others go blank when they try to speak about sex, and find the same words easy to write. Writing side by side. One way is for both of you to write at the same time, each on your own page, with your therapist there. Then you read your answers out, or swap pages. Doing a hard task alongside someone, sometimes called body-doubling, is familiar to many ADHD and autistic people, and here the hard task is the conversation itself. Writing is not a lesser answer. Many people find it easier to say what they mean on paper, and their partner hears it just the same. In the figure: Three ways to answer in the session: say it out loud; write it, then read it out; write side by side, then swap. You can change ways at any point. Choosing a way. Would you rather answer out loud, or write it first and read it to us? You can switch halfway through. Step 3. You each notice what happens in your body Your therapist may then ask a simple question: as the subject of sex comes up, what do you notice in your body? Some people feel their face get hot. Some feel a tight chest, a racing heart, or an urge to make a joke or change the subject. Some go blank. There is no right answer, and nothing to fix yet. Noticing comes first. For some autistic people, the body’s signals are harder to read in the moment,1 so “I am not sure” is a full answer. You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable . That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way. In this session the discomfort is the subject, so saying it is not a detour. It is often the most useful thing either of you says all hour. Noticing. As we start, what are you noticing in your body right now? Not knowing is an answer too. Step 4. You each say what you were taught about sex Next, your therapist may ask where your ideas about sex came from. Most people learned something at home, at school, from a faith, from friends or from screens. Much of it was not said out loud at all. A family that never mentioned sex still taught something by not mentioning it. Your partner is not being asked to agree with what you were taught, or to argue with it. The listening partner’s job is to stay curious, not to be right. A sentence or two is enough. This is a first look, not a full history. What Sex Is For, for Each of You goes further into the beliefs each of you carries. Where it came from. What did you learn about sex growing up, from what people said, or from what nobody said? Step 5. You each name what makes talking about sex hard Then your therapist invites each of you to name what makes this subject hard to talk about. Not what makes it hard for your partner, just for you. Naming a barrier out loud often makes it smaller. Most people recognize more than one of these, and two partners often pick quite different ones. In the figure: What makes talking about sex hard: embarrassment; missing information; what you were taught; fear of judgment; hints that get missed; worn out from masking. The last two often weigh more for neurodivergent partners. Two that often weigh more for neurodivergent partners. Hints, sighs and hidden meanings are easy to miss for many autistic and ADHD people. One influential idea describes this as a two-way gap between different ways of communicating, not a failing in one partner.2 Masking, the effort of adjusting all day to fit in, is the other. Autistic adults in one study described it as exhausting,3 and there is often little left by evening for a hard talk. Both of you may find something on this list. A partner who is not neurodivergent may name fear of judgment, or years of hints that went unanswered. Both experiences are real. Neither of you is the problem. Naming it. What makes this subject hard to talk about, for you? Take your time. You can name more than one. Step 6. You each pick what would make it easier For each thing you named, your therapist may ask what would help. There are no perfect words, and nobody is expected to find them. Practice matters more than getting the words right. What helps is usually small and practical. It might be writing first and reading it out, or plain, direct words instead of hints. It might be a set time earlier in the day, before your energy runs out, or a short note or voice memo to each other instead of a talk at bedtime. Some couples keep the hardest parts for the session, with the therapist there. The bridge does not need to be finished in one session. Each plank you add makes the next conversation a little easier to cross. In the figure: A bridge built plank by plank across a river of what makes talking hard: embarrassment, fear of judgment, missed hints, being worn out. Partner B's planks are plain words and a voice memo earlier in the day; Partner A's are no perfect words and writing it first; in the middle, your therapist there. Each of you lays your own planks. Talking is part of what helps. In first-hand accounts of sex and the senses, autistic people describe talking with their partner as one of the ways they made sex work for them.4 What would help. Which of these would make it a little easier to talk next time? Step 7. Your therapist asks how the conversation went Near the end, your therapist usually asks how this was for each of you. Many people are surprised: it was hard, and it was also less hard than they feared. Some feel tired or raw. All of that is useful to hear. Your therapist may then ask whether you would like to try a short talk at home, in the way that helps you. It is an invitation, not homework you can fail. If either of you would rather wait, you wait. Nothing sexual is part of it, and nothing sexual needs to happen until you both feel safe, clear and unpressured. Closing. What was it like to talk about this today? Is there anything you would like to try before next time, or would you rather wait? After the session If you both agreed to try a talk at home , keep it short, ten minutes or so, at the time of day you picked and in the way that suits you. Keep to the same subject as the session: what it is like to talk, not what you want to change in bed. Either of you can stop at any point, with no reason given. The other leaves it there, and you bring it to your next session. One way it can go. Partner A writes two lines in the afternoon: “When sex comes up, I go blank. It is not that I do not care.” Partner B reads them after dinner and says one thing back: “Thank you. I go quiet too, because I am afraid of saying it wrong.” That can be the whole talk. The workbook below is for after the session. Fill it in on your own first, side by side if that helps. Then, if you both want to, read one answer to each other. Many couples go on to what sex means to each of them, in What Sex Is For, for Each of You . Your therapist will help you choose what comes next. If this is hard to do. If even this is too much right now, there is no need to push through. You can say so in the session, and your therapist will slow down. Or spend a few minutes with your partner on what makes it hard, and share the feelings that come up: embarrassment, shame, or fear of hurting each other. That conversation is part of the work. Why spend a whole therapy session talking about talking about sex? For many couples, the hardest part is not sex itself. It is saying anything about it out loud while a partner listens, and that silence can keep everything else stuck. The session is only about what it is like for each of you to talk about sex. You are not asked what you do in bed or how often. Once you can talk about talking, the rest of the work becomes possible. What if I go blank when I try to talk about sex? You can write your answer first and read it out, or both of you can write side by side at the same time and then swap pages, with your therapist there. Doing a hard task alongside someone, sometimes called body-doubling, is familiar to many ADHD and autistic people. Writing is not a lesser answer, and you can switch ways at any point. Why is talking about sex harder for some autistic or ADHD partners? Hints, sighs and hidden meanings can be easy to miss for many autistic and ADHD people, and this is better understood as a two-way gap between ways of communicating than as one partner's failing. Masking, the effort of adjusting all day to fit in, can also leave little energy by evening for a hard talk. A partner who is not neurodivergent may find it hard too. Neither of you is the problem. What can make talking about sex easier for a couple? What helps is usually small and practical: writing first and reading it out, plain and direct words instead of hints, a set time earlier in the day, or a short note or voice memo instead of a talk at bedtime. Some couples keep the hardest parts for the session, with the therapist there. There are no perfect words, and nobody is expected to find them. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in AFTER the session, on your own first. What it was like for me Answer these on your own. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. When sex came up in the session, what did you notice most in your body? — Heat or blushing, A tight chest or racing heart, Going blank, Wanting to joke or change the subject, Nothing I could name, Something else Which makes talking about sex hardest for you? — Embarrassment, Not having the words or the facts, What I was taught, Fear of being judged, Hints and hidden meanings, Being worn out, Something else Which way of talking suits you best right now? — Out loud, Writing first, then reading it out, Writing side by side, A note or voice memo, Only in the session for now, Not sure yet Overall, how was the conversation for you? — Easier than I expected, About as hard as I expected, Harder than I expected, Not sure yet Two things to share, if you want to Write them here first. Read one to your partner only if you both want to. If something is about your safety, tell your therapist on your own instead. One thing you would like your partner to know about what makes this hard for you One thing that would make the next conversation a little easier Where this comes from Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson. Research discussion The shape of this session comes from our clinical work with neurodiverse couples. It has not been tested in a formal trial. The body-signals study1 is small: 20 autistic adults and 20 others, counting their own heartbeat. It shows that a difference in reading the body exists, not how common it is. The idea of a two-way gap in communication2 began as a short essay, not a study, and researchers are still testing it. The masking study3 gathered 92 autistic adults’ own accounts of masking and what it costs them, including exhaustion. The study of sex and the senses4 gathered first-hand accounts from more than 120 autistic people. Both describe real experiences, but neither can say how often they happen. Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Garfinkel SN, Tiley C, O'Keeffe S, Harrison NA, Seth AK, Critchley HD (2016) Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology, 114, 117-126 . https://doi.org/10.1016/j.biopsycho.2015.12.003 20 adults with autism spectrum conditions and 20 controls, measured on three dimensions: interoceptive accuracy (objective heartbeat detection), interoceptive sensibility (self-reported body awareness) and the metacognitive gap between them. The autistic group showed reduced accuracy alongside exaggerated sensibility, and the discrepancy between them, termed trait prediction error, correlated with deficits in emotion sensitivity and with anxiety symptoms. Limitation: 40 participants and a single narrow measure (heartbeat detection) of a broad construct. 2. Milton DEM (2012) On the ontological status of autism: The 'double empathy problem'. Disability & Society, 27(6), 883-887 . https://doi.org/10.1080/09687599.2012.710008 A current-issues piece introducing the term double empathy problem, critiquing the definition of autism as a deficit in theory of mind and reframing the difficulty as a question of reciprocity and mutuality in interaction. Limitation: a four-page sociological essay, not a study; cited as the origin of the idea. 3. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W (2017) "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534 . https://doi.org/10.1007/s10803-017-3166-5 92 autistic adults described in their own words why they camouflaged, what it consisted of, and its consequences, analyzed thematically into a three-stage model: motivations (fitting in, connecting with others), techniques (masking and compensation), and consequences (exhaustion, challenging stereotypes, and threats to self-perception and identity, including feeling fake or losing a sense of self). Limitation: a qualitative study, so it describes what camouflaging can involve and cost; it cannot say how common any of it is. 4. Gray S, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (72 usernames) plus 49 survey responses, over 120 autistic people in total, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and using substances to dull sensation. Limitation: qualitative and self-selected; cannot say how common any pattern is. When talking about sex is the hard part Many couples we see can talk about almost anything except sex. In our sessions you can write first, go slowly and pass on any question, with a therapist who knows how autism and ADHD shape these conversations. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 3 — What Sex Is For, for Each of You All 24 modules in The Neurodiverse Sex Therapy Program

A private, customized couples therapy retreat for neurodiverse (autism/ADHD) couples. Virtual or in-person in California — 1, 2, or 3 days.

How sex therapy helps neurodiverse couples with who asks for sex: a clear ask, yes, not now or no, and taking the answer calmly. Show the full module text Module 12 — Asking and Answering Make it easy to ask, and safe to give any answer. Watch first: the Module 12 video A narrated video of about three and a half minutes in a soft 3D clay-style animation that opens and closes on the Neurodiverse Couples Counseling Center logo. A couple moves through home life and video-call sessions with their therapist while charts show how to ask and answer: “Partner asks plainly,” three allowed answers (yes, not now with a real next time, or no), and the partner who asked taking the answer with no arguing, no asking again and no withdrawing. It ends on picking one small pattern to practice. Watch the Module 12 video: Asking and Answering (MP4, about 4 minutes). The written lesson below covers the same ground in full. Late in the evening, one of you leans in for a long hug, the way they always do. The other is not sure whether it is a question, says nothing, and the moment passes. It was the same partner who reached out last week, and the week before. Who asks for sex, and how you answer Summary: what usually happens in the session 1 You each describe how sex usually starts now. Who asks, and how: in words, with a look, with touch, with a joke. 2 You each say what a no is like, and why you say it. Being turned down, turning your partner down, and the usual reasons. 3 You look at how the asking has drifted. Often one of you has ended up doing almost all of it. 4 You each say how you would like to be asked. Plainly, and in a way that suits you. 5 You agree on three answers: yes, not now and no. A not now comes with a real next time. 6 You agree how the one who asked takes the answer. Without arguing, asking again or going cold. 7 You agree to take turns reaching out. So the asking no longer rests on one of you. 8 You pick one pattern to change. Small enough to try this week. One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working. Step 1. You each describe how sex usually starts now Your therapist may ask each of you a few plain questions. Who usually starts sex? How do you usually start it: a direct question, a look, touch first, a line or a joke? And how does your partner usually do it? You can write your answers down first and then read them out. Many couples are surprised by each other’s answers. One of you may think you ask clearly every time. The other may not have noticed an ask in months. Honest, not polite. This works best when you each say how it really goes, not how it ought to go. Your therapist is there to keep it curious rather than defensive. The opening questions. When sex starts between you, who usually starts it, and how? Take your time. There is no right answer. Step 2. You each say what a no is like, and why you say it Next, your therapist may ask what it is like on each side. When you are turned down, how do you feel: fine, hurt, angry, relieved, confused? When you turn your partner down, what do you worry they feel? Then, if they would like to, whoever says no more often names their usual reasons. Most are ordinary: tired, stressed, already full of noise and touch, the wrong time of day, not in the mood, or feeling far apart that day. A no is usually about the day. Hearing the real reasons often helps the partner who asks. Most are about energy, the body or the timing, not about the person asking. If a no lands much harder than that, When “No” Lands Hard goes into it in depth. Step 3. You look at how the asking has drifted Your therapist may invite you to step back and look at the years, not the last few weeks. In many couples, the partner who wants sex more often slowly takes on more and more of the asking. Here Partner A is the one who wants sex more often. Both partners end up lonely in the same pattern. In the figure: Who does the asking, over time: early on, both of you reach out; a few years in, Partner A asks most of the time; later, Partner A does all the asking; now, Partner A has almost stopped too. Partner A often feels rejected and unwanted; Partner B often feels pressured and guilty. A common shape, not measured amounts. The one who keeps asking, and keeps hearing no, starts to feel unwanted. The one who rarely asks starts to feel pressured. You are stuck in the same pattern from opposite ends, and in time the asking can stop altogether. There is no fight, just drift. A familiar shape. Couples researchers have long studied a pattern where one partner presses for more and the other pulls back, and it tends to go with less happy relationships.1 In a large survey of couples where one partner has ADHD, most partners with ADHD rated themselves as the more eager for sex.2 A gap like that is often where uneven asking begins. Hints that get missed, and the effort of starting anything, can add to it. Looking at the pattern. Neither of you set out to make it this way. What has it been like to be the one who asks? And the one who is asked? Step 4. You each say how you would like to be asked With the pattern in view, your therapist may ask how each of you would like to be invited. There is no single right way. Some people like words. Others like a touch, a look, or a text earlier in the day, so the question does not arrive out of nowhere. Clear beats subtle. Whatever the form, an ask works best when it is direct. The exact words matter less than making it plain that this is an invitation to sex, so nobody has to guess. Saying It Plainly covers how couples agree on the words, and on whether a touch is sexual. How you like to be asked. If your partner wanted to invite you, what would make it easy to hear, and easy to answer? Step 5. You agree on three answers: yes, not now and no Your therapist may then go through the three answers either of you can give to an invitation. Agreeing on them ahead of time means nobody has to invent an answer on the spot. The three answers. Yes. Let’s go. Not now. With a real next time: later today, or a day this week. No. A full answer. You can offer a hug or time together instead, but only if you want to. Partner A is simply whoever is asking that evening. Either of you can be at the top. In the figure: An ask and three answers: Partner A asks plainly; the answer is yes, not now with a real next time (later today or this week), or no, with closeness offered only if it is meant; Partner A takes the answer, with no arguing, no asking again and no going cold. A real next time. A not now names a time that is meant. That time is an invitation, not a debt. When it comes, either of you can still say no. If a no is not safe. These answers only work in a relationship where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. The work on sex pauses while that is looked at. Step 6. You agree how the one who asked takes the answer Many couples find this the hardest part. Whoever asked takes the answer as it is: no debating it, no asking again later that evening, no sighing or going cold. A short reply is enough: “Okay. Thanks for telling me.” The partner who said no can help by showing the ask itself was welcome. A no is easier to hear when the reaching out was noticed. The point is not to say yes more often. It is to make no so safe that yes becomes real. Each no that is taken calmly makes the next yes easier to trust. Many couples find that once a no is safe, there are more yeses, and they mean more. If this part gets too heated for either of you, it is fine to say so and pause. Your therapist can slow things down. Taking the answer. When your partner says not now, or no, what would you like to say back? Try it out loud once, just to hear it. Step 7. You agree to take turns reaching out Your therapist may suggest sharing the asking, even when sex is planned ahead. If it suits you both, the partner who asks less often reaches out first some of the time, in the way they prefer. Scheduling Intimacy goes into planned times. Taking a turn is not agreeing to more sex. It means the asking no longer rests on one person. Sharing it matters as much as what happens next. Starting sex is something a couple does, not a personality trait, and it can be practiced. Close to level is enough. Equal turns are not the goal; sharing the weight is. In the figure: A picture of a seesaw, Partner A on one end and Partner B on the other, with a small block for each time someone reached out. Now, all the blocks sit on Partner A's end and the seesaw is tipped hard. Shared, each of you reaches out and it sits close to level. If one of you rarely feels like starting sex at all, that is common, and it is not a flaw. When One of You Wants It More looks at why, and at what helps. Sharing the asking. What would it be like to be the one who reaches out first, once in a while, in your own way? Step 8. You pick one pattern to change To finish, your therapist may ask the two of you to choose one thing about how sex starts that is not working, and one small change to try. Specific works best: something you would both notice if it happened. The change is small enough to try this week, and the last answer does not depend on whether sex happens. In the figure: One pattern to change, from the last page of the Initiation Audit , Partner B's answers filled in: the pattern that isn't working, Partner A asks almost every time, late at night, with a long hug; what I want instead, to be asked in words, earlier in the evening; one change this week, Partner A asks in words before 9 pm and I reach out first on one evening; how we will know, asking and answering feel less tense, whatever the answer is. Many couples agree to look at it again in about a month. What shifted? What got easier? The measure is how asking and answering feel, not how often sex happened. After the session Afterward, find the Initiation Audit worksheet on our site. It follows this session: how sex starts now, what a no is like on each side, and the one pattern you want to change. Each of you fills in your own copy privately. Then you swap and read each other’s quietly, curious rather than defensive. Try the change you picked for a week or two , then talk about how it went, at home or in your next session. The workbook below is for each of you on your own, first. If this is hard to do. If this feels like too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard, and share the feelings that come up: the hurt of being turned down, guilt about saying no, or the tiredness of always being the one who asks. That conversation is part of the work. Why have I ended up being the only one who asks for sex? In many couples, the partner who wants sex more often slowly takes on more and more of the asking. Nobody decides this; it builds up one evening at a time. The one who keeps asking starts to feel unwanted, and the other starts to feel pressured. In time the asking can stop altogether, with no fight, just drift. Hints that get missed, and the effort of starting anything, can add to it. What can I say if I want sex, just not tonight? Many couples agree on three answers ahead of time: yes, not now, or no. A not now comes with a real next time, such as later today or a day this week. That time is an invitation, not a debt, so when it comes either of you can still say no. Agreeing the answers in advance means nobody has to invent one on the spot. How should I respond when my partner says no to sex? It helps to take the answer as it is: no debating it, no asking again later that evening, no sighing or going cold. A short reply is enough, such as 'Okay. Thanks for telling me.' The point is not to get more yeses. It is to make no so safe that yes becomes real, and many couples find there are more yeses once a no is safe. Does taking turns mean the partner who wants sex less has to want it more? No. Taking a turn is not agreeing to more sex. It means the partner who asks less often reaches out first some of the time, in the way they prefer, so the asking no longer rests on one person. Starting sex is something a couple does, not a personality trait, and it can be practiced. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in after the session, on your own first. How asking goes for me Answer these on your own first, after the session. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. Who starts sex more often in our relationship? — Me, My partner, About equal, Neither of us, lately How do I usually ask? — In words, A look or a signal, Touch first, A line or a joke, I rarely ask When I am turned down, I mostly feel: — Fine, Hurt, Angry, Relieved, Confused, Not sure My most common reason for saying no is: — Tired, Stressed, Too full of noise and touch already, Not in the mood, The time of day, Feeling far apart, I rarely say no When my partner says not now or no, I take it calmly: — Usually, Sometimes, Rarely, Not sure In your own words Write them here first. You can bring them to your next session, or keep them to yourself. How I would like to be asked The one pattern we chose to change, and how we will know it is working Where this comes from Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson. Research discussion The steps in this session come from our clinical work with neurodiverse couples and from our Initiation Audit worksheet. They have not been tested in a trial. The drift in who does the asking is a pattern we see often, not a measured rate. The finding about one partner pressing and the other pulling back1 comes from a review that pooled 74 studies, mostly of couples and some of parents and children. The pattern went with worse outcomes for the relationship and for each person. The studies looked at conflict in general, not sex. They cannot say which comes first, and none studied neurodiverse couples. The ADHD survey2 is written up in a book for clinicians and couples by a psychologist who works with ADHD. More than 3,000 people in couples where one partner has ADHD answered it online. They chose to take part, so it shows that a gap in eagerness is common among those who answered, not how common it is elsewhere. Who this research was done with. The studies behind this module drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Schrodt P, Witt PL, Shimkowski JR (2014) A meta-analytical review of the demand/withdraw pattern of interaction and its associations with individual, relational, and communicative outcomes. Communication Monographs, 81(1), 28-58 . https://doi.org/10.1080/03637751.2013.813632 Meta-analysis of 74 studies (N = 14,255), mostly of romantic couples, with some parent-child studies. Demand/withdraw showed a moderate, meaningful relationship with overall outcomes (r = .36); wife-demand/husband-withdraw and husband-demand/wife-withdraw were comparable (r = .38 and .39); distressed and clinical samples showed stronger associations (r = .413) than non-distressed (r = .345); relational and communicative outcomes correlated more strongly (r = .42, .42) than demographic and well-being outcomes (r = .24, .25). Limitation: correlational; direction of effect cannot be established, and no neurodiverse samples. Clinical sources and public data 2. Tuckman A (2019) ADHD After Dark: Better Sex Life, Better Relationship. Routledge, New York . https://www.routledge.com/ADHD-After-Dark-Better-Sex-Life-Better-Relationship-1st-Edition/Tuckman/p/book/9780367223939 A book for clinicians and couples built on the author's online survey of more than 3,000 adults in couples where one partner has ADHD (72 questions). Most respondents with ADHD rated themselves higher than their non-ADHD partners in sexual eagerness (desired frequency and related questions). The publisher's page shows copyright 2020; retailers list 2019. Limitation: a self-selected survey, presented as such by its author; not an epidemiological estimate and not a controlled study. Further reading • Neurodiverse Couples Counseling Center (2026) Initiation Audit. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/initiation-audit The practice's worksheet on how sex starts in a relationship: who initiates and how, how it feels to be declined and to decline, the usual reasons for declining, and one pattern to change, with a re-audit a month later. Each partner fills in a private copy first. Limitation: a clinical tool developed in use, not a validated instrument. When one of you always does the asking The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including when asking for sex has turned into a strain for both of you. We help you share the asking and make every answer safe to give. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 13 — Scheduling Intimacy All 24 modules in The Neurodiverse Sex Therapy Program

Monotropism theory suggests that autistic individuals possess a focused attention system and may have specific interests, thoughts, or activities that consume their attention. Our therapists do not see monotropism as a deficit and are here to offer a supportive environment where your individuality is honored. MONOTROPISM < Back IS MONOTROPISM A THEORY? Yes. Coined by autistic scholars Dinah Murray and Wenn Lawson, Monotropism Theory challenges traditional views of autism by reframing autistic behaviors as adaptive responses and assets rather than deficits. Unlike traditional views that pathologize autism as a disorder, monotropism theory suggests that autistic individuals possess a focused attention system, giving them the ability to concentrate intensely on a limited number of interests, thoughts, or activities at any given time. KEY FEATURES OF MONOTROPISM THEORY Recognition of Strengths: Monotropism highlights the strengths associated with intense focus and specialized knowledge in autistic individuals. Rather than viewing their focused interests as restrictive or problematic, monotropism acknowledges these as valuable assets that can be… Show More

Therapy for Parents of Neurodiverse children. Helping exceptional parents with exceptional kids! NEURODIVERSE PARENTING < Back HELPING YOUR CHILD THRIVE Most parents are willing to sacrifice almost anything to see your child happy, independent, and productive. We see parents bend over backwards to support their children. If you are using the wrong approach for them or if mom and dad are not on the same page, everyone in the family can quickly become exhausted and discouraged. You may even start to wonder if you are doing something wrong and making things more difficult. No matter how much you are putting into advocating for and supporting your child, it rarely feels like it is enough. Difficult social situations for your child break your heart. The frustrations spread… Show More

Build a couple's trait wheel together — map each partner's strengths and support needs side by side, then download a worksheet for reflection or therapy. Instructions

Pain during sex for neurodiverse couples: a doctor alongside therapy, how pain and fear feed each other, and what stays in your sex life meanwhile. Show the full module text Module 20 — Pain During Sex Stop pushing through pain, and find help together. Watch first: the Module 20 video A narrated video of about four minutes in a warm, modern flat illustration style that opens and closes on the Neurodiverse Couples Counseling Center logo. Couples appear at home and in video-call sessions with their therapist, and a chart shows “How Pain and Fear Feed Each Other,” from expecting pain and tightening muscles to fear of next time. It gives the partner not in pain a voice, then shows a care team of therapist, doctor and specialist, an “Intimacy Menu” of gentle closeness, and a reflection exercise. Watch the Module 20 video: Pain During Sex (MP4, about 4 minutes). The written lesson below covers the same ground in full. For one of you, sex has started to hurt, or has always hurt. The other may have stopped reaching out, afraid of causing pain, and the subject has gone quiet. This module walks through a session about pain during sex: how to talk about it, who else can help, and what can stay in your sex life in the meantime. When sex hurts Summary: what usually happens in the session 1 Your therapist says nobody pushes through pain. Pain is a reason to stop, at home and in this work. 2 Your therapist asks whether a doctor has examined the pain. A medical check runs alongside therapy, not instead of it. 3 The partner with pain describes it. What it feels like, when it starts, and what has been tried. 4 You map how pain and fear feed each other. The thought before sex, and what the body does next. 5 The other partner says what this has been like. What they have felt, wanted to ask, and may have missed. 6 You agree what comes off the menu for now. And what stays, because closeness does not have to stop. 7 You plan your care team and one small step. Who helps with what, and one thing this week that is not about sex. One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working. Step 1. Your therapist says nobody pushes through pain The session is all talk, the two of you at home with your therapist on screen. Pain during sex can affect anyone, of any body. Much of this module is about pain in the vulva, the vagina or the pelvis, because it is what couples most often bring. If the pain is somewhere else, the same conversation applies. Many people with pain have kept going anyway, sometimes for years: to keep the peace, to feel normal, or because they thought pain was part of sex. Some neurodivergent people learned early to hide discomfort in order to fit in, and that habit can reach into the bedroom. So your therapist usually starts by saying plainly that pain is a reason to stop. Penetration is optional. The aim of this work is not intercourse. It is safety, comfort, choice and pleasure, for both of you. If you do not feel safe. This work is for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. The work on sex pauses while that is looked at. How your therapist may open. If it hurts, you stop. That holds at home and in our sessions. Nobody in this work is asked to push through pain. Step 2. Your therapist asks whether a doctor has examined the pain Pain during sex has many possible causes, and some are physical: dryness, endometriosis, changes after childbirth or surgery, or pelvic floor muscles that tighten without being asked to. If no one has examined the pain yet, your therapist will usually suggest seeing a doctor. That runs alongside therapy, not after it. Pain that is new, lasting or getting worse is worth seeing a doctor about soon. Where dryness comes with midlife changes, Perimenopause and Menopause goes further. The names you may hear. Doctors may use words like vaginismus, vulvodynia or genito-pelvic pain. The main diagnostic manual now groups some of these under one longer name, and some experts think the older names are still useful.1 Which name fits matters less than being examined. It is often treatable. In one trial for lifelong vaginismus, most of the women treated improved, with less pain and less fear.2 Treatment often starts with learning how this part of the body works, and with a pelvic floor physical therapist, before anyone tries penetration again. Some problems need a specialist, and your therapist will help you decide which. The medical question. Has a doctor looked at this yet? If not, that can start now, alongside what we do here. Step 3. The partner with pain describes it Your therapist asks the partner with pain three things. What does it feel like: sharp, burning, pressure, tightening, or something else? When does it happen: in the worry beforehand, at the start, in some positions, afterward, or all the time? And what have you already tried, and did any of it help? Many neurodivergent people find body signals hard to put into words. You can write your answers first and read them out, or choose from words your therapist suggests. Your partner’s part in this step is to listen. Too much, or pain? In autistic people’s own accounts, touch and the other senses can make sex better or worse, and some sensations are distressing.3 Your therapist may ask whether something feels too strong, too sudden, or actually painful. They can feel alike from the inside, and each needs something different. Naming the pain. What does it feel like, and when does it start? Use any words that fit. If you are not sure, that is an answer too. Step 4. You map how pain and fear feed each other Your therapist may describe a pattern many couples recognize. Expecting pain makes the muscles tighten. Tight muscles make it hurt more. The pain leaves fear of next time, the fear leads to avoiding sex, and the next attempt begins with even more expecting. The tightening is the body trying to protect itself. It is not done on purpose, and it usually cannot be relaxed on command. In the figure: How pain and fear feed each other: expecting pain; muscles tighten on their own; more pain; fear of next time; avoiding sex, and sometimes any touch; and round again. Each round makes the next one stronger. This is why pushing through tends to make things worse. Each painful time teaches the body to brace sooner. For many neurodivergent people, not knowing what will happen is stressful in itself, so uncertainty can add to the bracing. The partner with pain maps their own version. What thought runs through your head before or during sex? What does your body do when it arrives? Mapping it. What goes through your mind when it seems sex might happen? And what does your body do then? Step 5. The other partner says what this has been like Your therapist asks the other partner what it has been like to watch this, what you have wanted to ask and have not, and where you think you may have been getting it wrong. Partners often keep feelings quiet so as not to add to the pain: guilt, fear of hurting the person they love, loneliness, or feeling turned away. Some have stopped touching altogether. Both experiences are real, and neither of you is the problem. You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable . That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way. Saying where you may have been getting it wrong, or hearing it, is often the hardest moment in this session. It is a step toward each other, not a judgment of either of you. Your turn. What have you wanted to ask, and not asked? This is a good place for it. Step 6. You agree what comes off the menu for now Together you sort three things: what is off the menu for now, what stays on it, and what might be worth exploring slowly. Many couples take penetration off the menu at first. Sex without penetration is sex. Taking one thing off the menu often lets other touch come back, because nobody is bracing for where it might lead. In the figure: An example of what one couple took off the menu for now (penetration, touch where it hurts, touch without asking) and what stayed on it or was worth exploring slowly (lying close, clothed, a back massage, kissing, sex without penetration taken slowly). Anything you try happens at home, only if you have both agreed to it in a session, at the pace of whichever of you needs it slower. The partner with pain sets the timing, and touch happens only when invited. If pain shows up, you stop. If you both still want closeness, you can move to something that is on the menu. Sensate Focus, One Step at a Time describes one slow way to bring touch back later. Sorting the menu. What would you both like off the menu for now? And what is still there that you would like to keep? Step 7. You plan your care team and one small step Last, you talk about who else is helping, or could be. Your therapist works on the fear, the pacing and the relationship, alongside the people who work with the body. If a first doctor finds nothing, it can be worth asking about a specialist. Pelvic pain is often missed at first. In the figure: Who helps with what, drawn as a three-legged stool with the two of you on the seat: your doctor looks for the cause, a pelvic floor physical therapist works with the muscles, and your therapist works on the fear and the pacing. A dashed fourth leg is trauma-informed care, if past experiences are part of the pain. All the legs hold you up at the same time. If the past is part of it. Pain is sometimes tied to earlier experiences. If that is true for you, you can tell your therapist on your own. Nobody is asked to tell that story in a joint session. Then you each choose one small thing for the week ahead that is not about sex. It might be going to a physical therapy appointment together, a non-sexual touch ritual, a two-minute check-in each day, or an agreement that penetration will not be asked for this week. One small step. What is one small thing you could do for each other this week that has nothing to do with sex? After the session The Pelvic Pain Conversation Guide worksheet on our site follows this conversation in writing. The partner with pain fills in the first two parts, the other partner the third, and you fill in the last two together. The workbook below is for after the session , on your own first. Bring what you notice to your next session, along with anything your doctor or physical therapist has said. If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard, and share what comes up: grief for the sex life you had or hoped for, guilt, or fear of hurting or being hurt. That conversation is part of the work. Should we keep trying to have sex if it hurts? In this work, pain is a reason to stop. Each painful time can teach the body to brace sooner, so pushing through tends to make things worse. Penetration is optional. The aim is safety, comfort, choice and pleasure for both of you, and many couples take penetration off the menu at first while keeping other closeness. Do we need to see a doctor as well as a therapist? If no one has examined the pain yet, your therapist will usually suggest seeing a doctor, alongside therapy rather than after it. Some causes are physical. Pain with penetration is often treatable, and treatment often starts with learning how the body works and with a pelvic floor physical therapist. Your therapist will help you decide if a specialist is needed. Why does expecting pain make it worse? Expecting pain makes the muscles tighten, and tight muscles make it hurt more. The pain leaves fear of next time, the fear leads to avoiding sex, and the next attempt begins with even more expecting. In the session the partner with pain maps their own version of this, so you can both see it. What about the partner who is not in pain? They get a turn too. Partners often carry guilt, fear of causing pain, loneliness or a sense of being turned away, and some stop touching altogether. Your therapist asks what it has been like, what they have wanted to ask, and where they may have been getting it wrong. Both experiences are real, and neither partner is the problem. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in after the session, on your own first. After the session Answer these on your own first. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option. In this work, I am: — The partner with pain, The other partner, We both have pain Has a doctor examined the pain yet? — Yes, An appointment is booked, Not yet, Not sure How much does expecting pain shape our sex life right now? — A lot, Somewhat, A little, Not sure What did we take off the menu for now? — Penetration, Any touch near where it hurts, Nothing yet, Something else, Not sure How do I feel about that? — Relieved, Mixed, Sad, Worried, Not sure yet One small step A few words is enough. If something about safety or the past is part of this, tell your therapist on your own. One small thing I agreed to this week that is not about sex One thing I wish my partner understood Where this comes from Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson. Research discussion The steps in this session come from our clinical work with neurodiverse couples and from our Pelvic Pain Conversation Guide . They have not been tested in a formal trial. The sources below support the reasons behind the steps. The point about names comes from a commentary by a group of researchers and clinicians1 on the diagnostic manual’s decision to fold vaginismus into a broader category. It is an expert argument, not a study. The trial behind “often treatable” randomly assigned 70 women with lifelong difficulty with penetration, and their partners, to a short exposure treatment or a three-month wait.2 After treatment, 31 of the 35 treated women reported having had intercourse, compared with 4 of 35 who were waiting. That trial measured success by intercourse; our aim is broader. The treatment was given in person at a hospital by specialist therapists, which is different from our online sessions, and the study did not look at autism or ADHD. The accounts of sex and the senses come from more than 120 autistic people writing in books, online forums and a survey.3 They show the range of experiences but not how common each one is, and they are not about pain specifically. Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Reissing ED, Borg C, Spoelstra SK, ter Kuile MM, Both S, de Jong PJ, van Lankveld JJDM, Melles RJ, Weijenborg PTM, Weijmar Schultz WCM (2014) "Throwing the baby out with the bathwater": The demise of vaginismus in favor of genito-pelvic pain/penetration disorder. Archives of Sexual Behavior, 43(7), 1209-1213 . https://doi.org/10.1007/s10508-014-0322-2 A commentary by researchers and clinicians on the DSM-5 decision to merge vaginismus and dyspareunia into a single diagnosis, genito-pelvic pain/penetration disorder, arguing that the distinct features of vaginismus risk being lost. Limitation: an expert commentary, not an empirical study. 2. ter Kuile MM, Melles R, de Groot HE, Tuijnman-Raasveld CC, van Lankveld JJDM (2013) Therapist-aided exposure for women with lifelong vaginismus: A randomized waiting-list control trial of efficacy. Journal of Consulting and Clinical Psychology, 81(6), 1127-1136 . https://doi.org/10.1037/a0034292 Seventy women with lifelong vaginismus and their partners were randomly allocated to therapist-aided exposure (up to three 2-hour sessions in one week at a university hospital, with two follow-up sessions) or a 3-month waiting list. At posttreatment 31 of 35 treated participants (89%) reported having had intercourse, against 4 of 35 (11%) controls, with improvements in coital pain, coital fear and sexual distress; no effects on other aspects of sexual functioning. Limitation: a single specialist center, in-person exposure, a waiting-list rather than active comparison, and no data on neurodivergent participants. 3. Gray S, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (72 usernames) plus 49 survey responses, over 120 autistic people in total, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and using substances to dull sensation. Limitation: qualitative and self-selected; cannot say how common any pattern is. Further reading • Neurodiverse Couples Counseling Center (2026) Pelvic Pain Conversation Guide. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/pelvic-pain-gpppd-conversation-guide The practice's structured conversation for couples navigating pelvic pain, in five parts: naming the pain, the fear loop, what the other partner needs to know, what comes off the menu, and the care team with one small commitment. Limitation: a clinical tool developed in use, not a validated instrument. When sex hurts, help for both of you The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including when sex has become painful. We work alongside your doctor and any specialist, at the pace of the partner with pain, and nobody is asked to push through. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 21 — Porn and Secrecy All 24 modules in The Neurodiverse Sex Therapy Program

We are always looking for therapists passionate about working closely with the neurodiverse community. We would love to meet you! CAREERS FOR THERAPISTS < Back POSITIONS OPEN: Click the link below to apply on Indeed.com: Associate Marriage & Family Therapist for Neurodiverse (Autistic + Allistic) Couples Associate Marriage & Family Therapist - Sex Addiction and Support of Betrayed Partners At the Neurodiverse Couples Counseling Center (NCCC), we train the next generation of world-class therapists specializing in neurodiversity. Find Your Career Path Are you intrigued by the idea of counseling couples, particularly neurodiverse couples, but feel unsure where to begin? Do you want to build your skills and gain hands-on experience in a supportive environment that values the unique challenges and strengths of neurodiverse relationships? Working with neurodiverse couples can be a deeply fulfilling way to help partners… Show More

A session about low desire for neurodiverse couples: when it is a problem, the body and health check, what drains you, and the loop between you. Show the full module text Module 17 — Low Desire Find what is lowering desire, without blaming either of you. Watch first: the Module 17 video A narrated video of about four minutes in a soft watercolor-and-ink style that opens and closes on the Neurodiverse Couples Counseling Center logo. Couples appear at home and on video calls with their therapist, guilt and loneliness are shown side by side as “both experiences held & valid,” and gauges track an energy reserve and a sensory tank. “The Desire Loop” traces desire dropping, touch avoided, and partners feeling unwanted or pressured, followed by brakes and accelerators and a preview of the next module. Watch the Module 17 video: Low Desire (MP4, about 4 minutes). The written lesson below covers the same ground in full. One of you used to reach for the other and now rarely does, or never felt much pull in the first place. The other has started to wonder what it means, and each of you may quietly believe that something is wrong with one of you. This module walks through a session about low desire, so you know what we ask and why. When desire is low Summary: what usually happens in the session 1 You each say what has changed. In turn, in your own words, out loud or written down first. 2 You talk about whether it is a problem, and for whom. Wanting sex less than your partner is not a disorder on its own. 3 Your therapist asks about your body, health and medications. And may suggest seeing a doctor as well, alongside therapy. 4 You talk about sleep, stress and what your days take out of you. Including caring for others, masking and the senses. 5 You talk about how things are between you. Old hurts, resentment, and whether you both feel safe. 6 You look at the pattern that keeps low desire going. Who reaches, who pulls back, and how each of you feels. 7 Your therapist suggests working on both sides at once. Your body and the pattern between you, side by side. One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working. Step 1. You each say what has changed Sessions with us are online, with the two of you together at home and your therapist on the screen. Everything is talk. Nothing sexual happens in a session. Your therapist usually starts by asking each of you, in turn, what has changed and when you first noticed it. If it is easier to write your answer down and read it out, that works too. Both experiences are real. The partner with less desire often feels guilty, broken or watched. The other often feels lonely, unwanted, or afraid to ask again. Sometimes desire has faded for both of you. Your therapist makes room for each of you, and neither of you is the problem. The opening question. When did you first notice a change? Tell me what it has been like for you, not what you think is wrong with either of you. Step 2. You talk about whether it is a problem, and for whom Most couples differ in how often they want sex, and the gap can shift over the years. In clinical definitions, low desire counts as a problem only when it causes distress.1 A large survey of women in the United States found that low desire was common, and that being distressed by it was far less common.2 So your therapist is less interested in how often than in three other questions. What makes low desire a concern. Is this a change for you, or has it always been this way? Does it bother you, your partner, or both of you? Is it straining the relationship? Each answer points somewhere different. If one of you has always felt little or no sexual attraction, that may be asexuality, which is an identity, not a symptom to treat. Orientation, Identity, and Desire looks at that conversation. Step 3. Your therapist asks about your body, health and medications Desire often drops for physical reasons, and there is often more than one at once. Your therapist asks about hormones and life stage, such as pregnancy, the months after a birth, perimenopause, menopause or hormonal contraception. They also ask about mood, medications, health conditions, pain, and alcohol or other substances. Your therapist may ask about all three groups. The first is usually checked with a doctor as well, and each of you may recognize different tiles. In the figure: Common things that can lower desire. Your body: hormones and life stage, mood and medications, health conditions, pain. Your days: sleep and stress, caring for others, senses and energy, alcohol and drugs. Your history and the relationship: past experiences, between the two of you. A medical check, alongside therapy. If desire has dropped suddenly, if sex hurts, if erections or arousal have changed, or if hormones may be involved, your therapist will usually suggest seeing a doctor as well. Depression, anxiety and some of the medicines that treat them, especially the antidepressants called SSRIs, can lower desire. If a medication may be part of it, that is a conversation with the doctor who prescribed it, rather than a change to make on your own. Some problems need a specialist, for example a pelvic floor physical therapist, and your therapist will help you decide. Pain During Sex and Perimenopause and Menopause go further into two of these. The health question. Has anything changed in your body, your medications or your sleep since this started? Nothing is too small to mention. Step 4. You talk about sleep, stress and what your days take out of you Your therapist then asks what an ordinary day takes out of each of you: work, broken sleep, the mental load of running a home, young children, a parent who needs care. Desire is often one of the first things that exhaustion switches off. Neurodivergence can add to the load. Autism is not, in itself, a lack of desire. A review of studies of autistic adults describes desire for sexual contact, alone and with a partner.3 But many neurodivergent people spend the day masking, hiding their differences to fit in, or coping with noise, light and touch. By evening there may be little left, and touch can feel like one more thing for the senses to manage. Energy, Masking, and the Onramp goes into this. The energy question. By the time you could be close, how much do you each have left? What used most of it up today? Step 5. You talk about how things are between you Desire is hard to feel in a relationship that does not feel safe. Your therapist may ask about resentment, arguments that never finished, and hurts that still sting. Past experiences matter too, including trauma and shame about the body. Some of this is easier to say alone, and your therapist may offer a separate conversation for it. If you do not feel safe. This work is for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. Work on sex pauses while that is looked at. Your safety comes first. Step 6. You look at the pattern that keeps low desire going Whatever starts low desire, a pattern between you can keep it going. Your therapist may invite you both to describe it, step by step. If one of you is sensitive to rejection, each no can land very hard and speed the loop up. When “No” Lands Hard goes into that. Each move makes sense from the inside. That is why the session looks at the loop, rather than at either of you. In the figure: The loop that keeps low desire going: Partner A's desire drops; Partner A avoids touch, in case a hug leads to a request for sex; Partner B feels unwanted and asks less, or with more urgency; Partner A feels pressured and wants sex even less; and round again. Desire that comes second is not low desire. Many people, especially in long relationships, feel desire only after closeness or arousal has begun, not before.4 That is healthy. When One of You Wants It More looks at it in detail. Naming the loop. Where does each of you come in on this loop? What does it feel like from your side? Step 7. Your therapist suggests working on both sides at once The body and the pattern feed each other, so we usually suggest working on both at the same time. A medical check runs alongside your sessions, not ahead of them. Better communication is unlikely to lift desire if a body or a mood has shut it down. A prescription alone rarely undoes years of a painful loop. Neither oar belongs to one of you. You both row, whichever of you has the lower desire. In the figure: A rowboat with the two of you in it and an oar on each side: one oar is your body and health, checked with your doctor, and the other is the pattern between you, worked on in your sessions. With both oars the boat moves forward; with one oar alone it goes round in circles. Your therapist may help you choose one small step on each side: a doctor’s appointment, perhaps, and one thing that drains desire that you could take away. Many couples find that removing what turns desire off helps more than adding what turns it on. That is the subject of Brakes and Accelerators . Neither of you is broken. Low desire usually has reasons, and reasons can be worked with. After the session If you agreed to see a doctor, try to book the appointment this week, and bring what you learn to your next session. Notice what helps. Over the week, see if you can notice any moment when desire stirs, even a little, and what was around it: rest, time alone, a calm evening, a laugh together. Those moments are clues, not tests. The Brakes & Accelerators worksheet on our site helps each of you list what turns desire off and what turns it on. Fill in your own copy privately, then trade and read in silence. You decide what, if anything, to share. The workbook below is for after the session, on your own first. It takes about five minutes. If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard, and share what comes up: guilt about not wanting more, loneliness at being turned down, or worry about what it means for the two of you. That conversation is part of the work. Is it a problem if one of us wants sex less than the other? Not on its own. Most couples differ in how often they want sex, and the gap can shift over the years. In clinical definitions, low desire counts as a problem when it causes distress. So your therapist asks whether it is a change, whether it bothers you, your partner or both of you, and whether it is straining the relationship. Can antidepressants or other medications lower sex drive? They can. Depression, anxiety and some of the medicines that treat them, especially the antidepressants called SSRIs, can lower desire. If a medication may be part of it, that is a conversation with the doctor who prescribed it, rather than a change to make on your own. A medical check runs alongside therapy, not instead of it. Does being autistic or ADHD mean having low desire? Not in itself. A review of studies of autistic adults describes desire for sexual contact, alone and with a partner. But many neurodivergent people spend the day masking, or coping with noise, light and touch, so by evening there may be little energy left, and touch can feel like one more thing for the senses to manage. A session looks at what your days take out of each of you. Why does low desire keep getting worse between us? A pattern between you can keep it going. When one partner's desire drops, they may start avoiding touch in case a hug turns into a request for sex. The other feels unwanted and asks less, or with more urgency. The first partner feels pressured and wants sex even less. The loop can start anywhere, so the session looks at the loop, not at either of you. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in after a session about low desire, on your own first. What I noticed Answer these on your own first. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. Whose desire are we mostly talking about? — Mine, My partner's, Both of ours, Not sure Is it a change? — A recent change, A slow change over years, It has always been this way, Not sure How much does it bother me? — Not much, Somewhat, A lot, It is straining us Which seems most likely to be part of it? — My body or health, Medications, Sleep, stress or load, Masking or the senses, How things are between us, The loop between us, Not sure yet A medical check: — Booked, Not yet, Already done, Not needed for now To bring next time Write a line or two. If something is about your safety, tell your therapist privately instead. One thing that drains my desire that we could take away A moment this week when desire stirred, even a little, and what was around it What I would like my partner to understand about this Where this comes from Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson. Research discussion The steps in this session come from our clinical work with neurodiverse couples. They have not been tested in a trial. The list of common causes, and the advice to see a doctor, are standard clinical guidance rather than findings of ours. The clinical definitions1 come from an international panel of experts, who agreed that a sexual difficulty should not be diagnosed unless it causes distress. That is expert agreement, not a study of patients. The survey of women in the United States2 asked more than 30,000 women about sexual problems and about distress. Low desire was the most common problem, and far fewer women were distressed by their problems than had them. It asked women only, in one country, once, and did not study couples. The review of autism and sexuality3 brought together 27 studies of autistic adults. Autistic men in them reported more desire for sexual contact, alone and with a partner, than autistic women did. Those studies were mostly surveys of people who chose to take part, and none of them studied couples. The idea that desire can follow closeness rather than come first is a clinical model,4 developed with women in mind, not a trial. Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT (2016) Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015. Journal of Sexual Medicine, 13(2), 135-143 . https://doi.org/10.1016/j.jsxm.2015.12.019 An international expert committee's consensus definitions of sexual dysfunctions in women and men, including hypoactive sexual desire. The definitions require that a difficulty has lasted at least three months, occurs in most sexual experiences and leads to individual distress: without distress, a sexual dysfunction should not be diagnosed. Limitation: a consensus of expert opinion, not an empirical study. 2. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB (2008) Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics and Gynecology, 112(5), 970-978 . https://doi.org/10.1097/AOG.0b013e3181898cdb The PRESIDE survey of more than 30,000 US women aged 18 and over. Sexual problems were commonly reported, with low desire the most common, but problems accompanied by personal distress were much less frequent. Limitation: a one-time survey of women in one country; it does not study couples, men or neurodivergent people. 3. Pecora LA, Mesibov GB, Stokes MA (2016) Sexuality in high-functioning autism: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46(11), 3519-3556 . https://doi.org/10.1007/s10803-016-2892-4 Systematic review of 27 observational and cross-sectional publications, nine of which were eligible for meta-analysis. Females reported higher levels of sexual understanding yet more adverse sexual experiences than males and than non-autistic comparisons; males reported greater desire for and engagement in solitary and dyadic sexual contact. The authors describe the findings as an initial characterization requiring further research. Limitation: cross-sectional and largely self-selected samples throughout; no couples data. Clinical sources and public data 4. Basson R (2001) Using a different model for female sexual response to address women's problematic low sexual desire. Journal of Sex and Marital Therapy, 27(5), 395-403 . https://doi.org/10.1080/713846827 The paper that set out the responsive-desire model: for many people desire follows arousal and emotional intimacy rather than preceding them, so an absence of spontaneous desire is not evidence of a disorder. Developed with women in mind and applied more broadly since. Limitation: a clinical model paper, not a trial; the on-ramp follows from it by reasoning and has not been tested as an intervention. Further reading • Neurodiverse Couples Counseling Center (2026) Brakes & Accelerators. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/brakes-accelerators Each partner privately lists what slows desire down or shuts it off and what speeds it up, then trades and reads, and picks one brake to remove and one accelerator to add. Limitation: a clinical tool developed in use, not a validated instrument. Low desire has reasons, and we can help you find them The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including when desire has faded. We look at the body and the pattern between you side by side, and suggest a medical check where it fits. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 18 — When One of You Wants It More All 24 modules in The Neurodiverse Sex Therapy Program

< Back Quick Guide - Neurodiverse Sex Therapy Tip: Want more resources? 📖 Check out our FAQs section if you have a specific question about sex and neurodiverse couples. Reach out now to get matched with an expert and schedule a free consultation. KEY FACTS Neurodiverse couples often face unique challenges around sex and intimacy , including but not limited to: Desire Imbalance : One partner may want sex more than the other , leading to frustration or shut downs. Sensory Differences : Sensitivity to touch, sound, or smell can make intimacy feel overwhelming or uncomfortable. Communication Barriers: Indirect or nonverbal cues can get misinterpreted, leading to disconnects around affection and desire. Different Experience Levels : Past trauma or limited exploration can create mismatched comfort with sexual closeness. Therapy with a neuro-affirming therapist can help couples explore key areas in order to help them strengthen their intimacy: Define Sex: Couples often hold very different views of what intimacy includes. Therapy creates space to explore these differences, reset expectations, and expand how partners connect. Enthusiastic Consent : Intimacy is only healthy when both partners truly want to be there. We help couples build safety around saying “no” and ensure consent is always clear and respected. You vs. Me: Autistic partners may unintentionally focus on their own needs, but with support, can learn to lovingly shift attention toward their partner’s experiences and desires. Emotional Intimacy: Sexual closeness struggles when non-sexual areas of the relationship feel tense . We work on restoring emotional safety first, so intimacy can thrive again. Your Body: Some sexual concerns are rooted in emotions, others in medical issues . We help couples reduce shame, collaborate with specialists when needed, and adapt intimacy in caring ways. Here are some practical tools you and your partner can use to strengthen intimacy and connection: Use a 1–10 scale to communicate different comfort levels with touch or sensations. Set up safe words to pause or stop when boundaries are crossed. Agree on what counts as non-sexual touch versus sexual touch. Discuss boundaries together and identify what feels off-limits. Break intimacy into step-by-step conversations , including how to explore new ideas or preferences. FREQUENTLY ASKED QUESTIONS (FAQS) 1. What kinds of intimacy struggles are common in neurodiverse relationships? Answer: Many couples impacted by autism or ADHD experience challenges like mismatched desire, sensory differences, communication breakdowns, and emotional disconnection. These issues are real, but they can be addressed through counseling and practical strategies that help both partners feel more understood and connected. 2. How can therapy help if my partner and I define “sex” differently? Answer: It’s common for partners to hold different views of intimacy —for example, one may see sex only as intercourse, while the other includes different forms of touching. Therapy provides a safe space to explore these differences, reset expectations, and create a shared understanding that strengthens connection. 3. What does enthusiastic consent mean in neurodiverse couples counseling? Answer: Enthusiastic consent means both partners are fully comfortable and willing to engage in intimacy. For autistic partners, saying “no” can sometimes feel difficult, especially if they are overwhelmed. In therapy, couples learn how to express boundaries clearly and ensure intimacy only happens when both people genuinely want it. 4. Can emotional struggles outside the bedroom affect sexual intimacy? Answer: Yes. When a relationship is weighed down by frustration, anger, or misunderstanding in daily life, sex often becomes unfulfilling . Therapy works to restore emotional safety first, which lays the foundation for deeper intimacy and more satisfying sexual connection. 5. What are some strategies my partner and I could use to strengthen our intimacy? Answer: In therapy, couples learn practical tools they can also try at home. These include using a 1–10 scale to share comfort levels with touch, creating safe words to pause or stop when needed, negotiating a schedule for intimacy, clarifying boundaries, and discussing step-by-step preferences for new experiences. Last reviewed: Sep 17 2025 • Authors: Dr. Harry Motro, LMFT (Clinical Director) and Jasmyne Mena (Director of Clinical Research & Scientific Communications, Senior Medical Writer, Neurodiversity) REFERENCES Barnett, J. P., & Maticka-Tyndale, E. (2015). Qualitative exploration of sexual experiences among adults on the autism spectrum: Implications for sex education. Perspectives on Sexual and Reproductive Health, 47(4), 171–179. 10.1363/47e5715. https://onlinelibrary.wiley.com/doi/10.1363/47e5715 Hancock, G., Stokes, M. A., & Mesibov, G. (2020). Differences in romantic relationship experiences for individuals with an autism spectrum disorder. Sexuality and Disability , 38 (2), 231–245. https://link.springer.com/article/10.1007/s11195-019-09573-8 Jones, A. C., Robinson, W. D., & Seedall, R. B. (2018). The Role of Sexual Communication in Couples’ Sexual Outcomes: A Dyadic Path Analysis. Journal of Marital and Family Therapy, 44(4), 606–623. https://doi.org/10.1111/jmft.12282 Leitch, D. G. (2024). Towards a Culture of Care and Consent. Sexuality & Culture, 28(5), 1976–1993. https://doi-org.libproxy.csudh.edu/10.1007/s12119-024-10213-3 Mallory, A. B., Stanton, A. M., & Handy, A. B. (2019). Couples’ Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis. The Journal of Sex Research, 56(7), 882–898. https://doi.org/10.1080/00224499.2019.1568375 Mües, H. M., Markert, C., Feneberg, A. C., & Nater, U. M. (2025). Too stressed for sex? Associations between stress and sex in daily life. Psychoneuroendocrinology, 181, Article 107583. https://doi.org/10.1016/j.psyneuen.2025.107583 Polo-Kantola, P., Manninen, S.-M., Vahlberg, T., & Kero, K. (2023). Patients with chronic diseases: is sexual health brought up by general practitioners during appointments? – A web-based study. Maturitas, 173, 33. https://doi.org/10.1016/j.maturitas.2023.04.055 Sala, G., Hooley, M., & Stokes, M. A. (2020a). Romantic intimacy in autism: A qualitative analysis. Journal of autism and developmental disorders, 50(11), 4133–4147. https://link.springer.com/article/10.1007/s10803-020-04377-8 Sala, G., Hooley, J., Hooley, M., & Stokes, M. A. (2024). Comparing Physical Intimacy and Romantic Relationships of Autistic and Non-autistic Adults: A Qualitative Analysis. Journal of autism and developmental disorders, 54(10), 3942–3951. https://doi.org/10.1007/s10803-023-06109-0 Veasey, A. W. (2025). Exploring Experiences of Non-Sexual Physical Touch in Single- and Dual-Trauma Couples: An Interpretive Phenomenological Analysis. ProQuest Dissertations & Theses. https://www.proquest.com/docview/3226025748 Vowels, L. M., & Mark, K. P. (2020). Strategies for Mitigating Sexual Desire Discrepancy in Relationships. Archives of sexual behavior, 49(3), 1017–1028. https://doi.org/10.1007/s10508-020-01640-y . Voos A.C., Pelphrey K.A., Kaiser M.D. Autistic traits are associated with diminished neural response to affective touch. Soc. Cogn. Affect. Neurosci. 2013;8:378–386. https://academic.oup.com/scan/article/8/4/378/1623776 Willis, M., Murray, K. N., & Jozkowski, K. N. (2021). Sexual Consent in Committed Relationships: A Dyadic Study. Journal of sex & marital therapy, 47(7), 669–686. https://doi.org/10.1080/0092623X.2021.1937417 Yew, R. Y., Hooley, M., & Stokes, M. A. (2023). Factors of relationship satisfaction for autistic and non-autistic partners in long-term relationships. Autism : the international journal of research and practice, 27(8), 13623613231160244. Advance online publication. https://doi.org/10.1177/13623613231160244 WHY CHOOSE US? DEPTH OF TEAM — 30+ neuro-informed therapists and coaches. 16,000+ sessions each year. The world’s largest practice dedicated to neurodiverse couples and individuals—so you benefit from deep, proven experience. WE ARE NEURODIVERSE: More than 90% of our clinicians are neurodiverse themselves, bringing a firsthand understanding of autism, ADHD, and related experiences. This lived perspective, combined with professional training, allows us to provide both expertise and genuine compassion to help you thrive. OUR MODEL: We use a neurodiverse counseling model —practical, skills- based, and tailored to each couple. We don’t pathologize difference; we name neurodiverse traits as natural human variations in communication style, sensory needs, social energy, and executive functioning. Together, we map those patterns so both partners can see what’s really happening (not what they’re blaming each other for). From there, we translate insight into action: shared language for signals and needs, simple agreements for sensory fit, clear routines for planning and follow-through, and repair tools that reduce defensiveness. The goal isn’t to make anyone “more normal.” It’s to help you work with your differences—so empathy grows, teamwork strengthens, and your bond gets measurably closer. STRENGTH-BASED: Our neurodiverse counseling model is strengths-based and neuro-affirming because that’s what works—well-supported in couples therapy and even more effective with neurodiverse couples. Instead of fixing “deficits,” we identify and deploy real assets—precision, honesty, loyalty, pattern recognition, creativity, deep focus—so they actively solve problems. This lowers shame, builds safety fast, and turns differences into shared tools: clearer signals and agreements, sensory fit instead of overload, and routines that reduce friction. The payoff is practical—fewer blowups, better follow-through, and a bond that strengthens because you’re using what you already do well, together. OUR TEAM: Our experts are deeply compassionate and dedicated to helping neurodiverse couples thrive. Three things set our team apart: Ongoing Specialized Training – All team members receive weekly training on neurodiversity-focused content, ensuring our approaches stay current and effective. Collaborative Case Support – We hold weekly supervision sessions, including case consultations, so that no couple’s challenges are handled in isolation—your therapist has a full team behind them. Continuous Professional Growth – Every therapist pursues ongoing continuing education in neurodiverse relationships, keeping us at the forefront of best practices. ASSESSMENTS: In addition to providing therapy, many of our clinicians are specially trained in conducting in-depth adult autism and ADHD assessments . If you’re seeking greater clarity or considering an in-depth evaluation, our team can guide you through the process with professionalism and care. INSURANCE — We are insurance-friendly. As an out-of-network provider, we will send you a Superbill for therapy services that you can submit to your insurance company for potential reimbursement. Please know that we do NOT bill insurance directly or participate as an in-network provider. For more information, please visit the "Insurance/Fee" section on our FAQ page. DIAGNOSIS OPTIONAL — You don’t need a diagnosis to get help with us. We can start with what’s happening now—communication loops, sensory needs, executive-function friction, meltdowns/shutdowns—and turn those patterns into clear agreements, better repairs, and real relief. If you’re in California and want a formal autism or ADHD evaluation , our licensed clinicians can provide it—but it’s not required to benefit. Either way, the goal is the same: less blame, more understanding, a stronger bond, and real individual healing. NOT A CRISIS SERVICE — We’re not a crisis service. If you’re ever in immediate danger, call 911. For urgent mental health support, call or text 988 or go to https://988lifeline.org Neurodiverse Couples Counseling Center is part of New Path Family of Therapy Centers Inc. WHO WE HELP We support neurodiverse couples and individuals nationwide through online therapy or coaching. Some common issues we help clients tackle include: Autism/ADHD differences Cassandra Syndrome Support Alexithymia Pathological Demand Avoidance (PDA) Highly Sensitive People Parenting and co-parenting challenges Intimacy (both physical and emotional) Autism and ADHD assessments and self-screeners Obsessive Compulsive Disorder (OCD) Recurring discussions about “tone,” initiative, alexithymia , or intimacy Rejection Sensitive Dysphoria (RSD) Discernment Counseling LEARN MORE 📖 Read our full Article on Neurodiverse Sex Therapy for an overview of challenges, therapy approaches, and more. 📖 Check out our FAQs section if you have a specific question about sex and neurodiverse couples. 📚 Curious what this looks like in practice? Our Neurodiverse Sex Therapy Program goes one step at a time, starting with Module 1, Your First Sex Therapy Session .

Take our free Neurodiverse Couples Check-Up. Answer a few questions and get a snapshot of your relationship's strengths and where support could help. Show the full page text The Neurodiverse Relationship Check-Up A free twelve-question check-up for couples where one or both partners are neurodivergent. It takes three to five minutes. Rather than asking what is wrong with your relationship, it looks at the hidden mechanics of your connection - the patterns, the strengths, and the translation gaps between two people whose brains process the same moment differently. It produces a score out of 100 and identifies which of four dynamics is shaping your relationship right now, then breaks that dynamic down across three lenses: the core pattern, communication, and sensory life. Who it is for Neurodiverse couples, or an individual partner who wants to understand the dynamics better. You do not both need to take it. One person’s perspective is a meaningful starting point, and many people take it alone first and share the results afterwards. It is worth taking if you keep having the same argument in different forms, if one of you reaches for logic while the other reaches for emotional connection, if you have started to feel more like respectful roommates than partners, or if sensory differences create friction you have never quite been able to name. What it asks about Twelve questions, each about a specific everyday situation rather than an abstract feeling: What usually happens when you discuss feelings How you handle household mess and clutter How you recover after a conflict How you manage social events How info-dumping - talking at length about an interest - plays out between you Physical intimacy, or the lack of it Routine versus spontaneity Shared downtime and parallel play How empathy gets expressed Tone of voice, and how it lands Eye contact How the two of you handle a crisis Your check-up score The score runs from 0 to 100 and falls into one of three bands. Needs attention, 0 to 40. You may be navigating real strain across several areas of connection. This is not a verdict on your relationship. It is a signal that focused, neurodivergent-affirming support could help. Moderate strain, 41 to 75. You have a foundation to build on alongside some recurring friction points. Naming those patterns with curiosity can turn a repeated conflict into better translation. Thriving, 76 to 100. You have found ways to work with your differences rather than against them. There may still be room to deepen the connection, but you are clearly doing the active maintenance strong neurodiverse relationships rely on. The four result types Beyond the score, the check-up identifies the primary dynamic shaping your connection right now. Recognising the pattern helps you see what is happening underneath, and where small shifts make the biggest difference. The logic versus emotion loop One partner chases emotional connection while the other retreats into logic and facts in order to feel safe. The core dynamic. Two different operating systems. One partner works bottom-up from facts and details, the other prioritises emotional context. The logic-focused partner tries to solve the problem and it lands as invalidation, so the reach for emotional resonance intensifies, so the retreat into factual safety deepens. Neither person intends the effect they are having. Communication. Literal interpretation misses implied bids for connection, which leaves the feeling-focused partner writing a manual for a person who is right there. Processing delays - sometimes alexithymia, difficulty identifying your own emotions in real time - can look like stonewalling from the outside. Conversation drifts toward the transactional: I did the dishes, why are you still upset. Sensory. Sensory gating differences mean one partner cannot filter light or sound, and the resulting irritability gets read as rejection. Light touch can register as painful or distracting rather than affectionate. Often there is no shared sensory safe zone - no room, no time of day, where both nervous systems are calm at once. Parallel lives Safety is maintained by keeping distance. The peace is real, but it can drift toward emotional loneliness. The core dynamic. Space equals safety, and that is genuinely true - but a coping mechanism that works can calcify into a wall. Co-regulating at a distance, loving each other in the same room while doing separate things, is a real form of intimacy that still needs active bridging. Without it, prioritising peace over passion produces a stable connection with very little in it. Communication. Mutual masking: both partners suppressing neurodivergent traits to avoid friction, which is exhausting in a way neither can quite point to. Conflict avoidance means needs get swallowed rather than raised, and invisible resentment accumulates. Eventually you stop asking, because you assume you already know what the other person would say. Sensory. Conflicting regulation needs - one partner needs silence, the other needs stimulation - resolve into separate rooms by default. End-of-day touch saturation makes physical intimacy feel like an obligation rather than a want. Sleeping separately to protect sleep can be entirely healthy, provided other forms of intimacy are deliberately scheduled. The high-intensity cycle A relationship fuelled by stimulation and intensity, swinging between deep passion and chaotic overwhelm. The core dynamic. The relationship runs on intensity, and conflict can become a subconscious source of stimulation. It tends to be all or nothing: deeply in love and hyper-focused on each other, or completely distant, with little middle ground. The real battleground is rarely the big things. It is the mundane administration - chores, bills, appointments - that neither of you can make interesting. Communication. Interruptions are usually not disrespect. They are the fear that the thought will vanish if it is not said now, which does not make the other person feel any more heard. Fast processing - rapid speech, jumping between topics - generates energy but leaves issues unresolved. Rejection sensitivity means a small comment can trigger a response wildly out of proportion to what was said. Sensory. Visual noise from unfinished projects adds a background hum of anxiety that shortens everyone’s fuse. One or both of you pursues newness constantly, and routine starts to feel like a cage. When executive function fails, the home becomes a source of shame rather than a place to rest. Bridging differences successfully A secure connection where you have stopped trying to fix each other and instead manage your differences with care. The core dynamic. Translation rather than transformation. You have stopped trying to change each other’s brains and accepted two different operating systems as compatible. You presume competence - trusting your partner is not trying to hurt you, even when they get it wrong. And you understand the dynamic takes active maintenance, which you are actually doing. Communication. Curiosity comes first: asking whether someone is regulated rather than reacting to a sharp tone. Explicit clarity - saying exactly what you mean - removes the guesswork that drives so much anxiety in neurodiverse relationships. And you have repair scripts: agreed ways to reconnect after a disconnection, decided in advance rather than improvised while upset. Sensory. Sensory needs are treated as real needs. Headphones at dinner, leaving a party early, low lighting, visual timers, a sensory corner - the home is designed around the brains living in it. Nobody is pushed toward burnout for the sake of a social norm. What this check-up is not This tool helps you understand potential dynamics in your relationship. It is not a diagnostic tool and does not replace professional mental health care or therapy. It cannot tell you whether either partner is autistic or has ADHD, and it does not assess either of you individually. Results are a starting point for a conversation, and are best interpreted with care. What happens after you finish At the end you choose what you would like to happen with your results. You can have them emailed to you and nothing else. You can have them sent to a therapist you are already working with. Or you can ask us about counselling, and we will follow up. If you ask about counselling, we will want to know roughly where you are located (this determines whether you can be matched with a licensed therapist or a coach - assessment and diagnostic services are available in California only), which fee range works for you, and anything you would like us to know before we get in touch. Session fees vary by clinician experience level, and sliding-scale appointments are limited. Our Client Care Coordinator follows up within twenty-four hours. Next steps You can get started with us , meet the therapists , or read our frequently asked questions . Our self-discovery page collects the rest of our free tools, including the rejection sensitivity screener for couples . Our words matter page explains the language we use and why. About Neurodiverse Couples Counseling We work with neurodiverse couples - relationships where one or both partners are autistic, have ADHD, or are otherwise neurodivergent. Our approach is neurodiversity-affirming: we do not treat one partner as the problem to be corrected, and we do not treat a mixed-neurotype relationship as a deficit. We work on the fit between two nervous systems that process the same moment differently. Neurodiverse Couples Counseling is part of New Path Family of Therapy Centers, Inc.

A sex therapy session on body image for neurodiverse couples: the inner critic, comparisons, aiming for neutral, and coming back to sensation. Show the full module text Module 22 — Body Image Spend less of sex watching yourself, and more of it feeling. Watch first: the Module 22 video A narrated video of about three and a half minutes in a soft silhouette illustration style in indigo, lavender and mint that opens and closes on the Neurodiverse Couples Counseling Center logo. An “Inside / Outside” chart links harsh body self-criticism to outward signs like keeping the lights off, often misread as lack of desire. Silhouetted couples sit together at a table and at a laptop, a doctor’s check is paired with therapy, and “Three Ways to See Your Body” (critical, neutral, loving) ends on aiming for neutral first. Watch the Module 22 video: Body Image (MP4, about 3 minutes). The written lesson below covers the same ground in full. One of you keeps the lights off and turns away to undress, and the other has started to wonder whether it is about them. Many people carry a running commentary on how their body looks into sex, and it pulls them out of the moment. This module walks through a session about body image, so you know what we ask and what tends to help. When how you look gets in the way of sex Summary: what usually happens in the session 1 You each say what goes through your mind during sex. What the critical voice says, and when it is loudest. It may be one of you, or both. 2 You look at where that voice comes from. Whose voice it sounds like, and whose bodies you compare yours to. 3 You talk about your body as it is now. Including real changes, and an aim of neutral rather than loving. 4 You talk about how neurodivergence shapes living in your body. Masking, the senses, and finding your way back into your body. 5 You each choose a few sensations to come back to. Somewhere to move your attention when the critic shows up during sex. 6 You tell your partner what you fear they see. And what you would like them to do if they notice. 7 You try saying one kind sentence out loud. Not to believe it yet, but to notice the gap. One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working. Step 1. You each say what goes through your mind during sex Sessions with us are online, with the two of you together at home and your therapist on the screen. Everything is talk, and nothing sexual happens in a session. If this is your first session about sex, Your First Sex Therapy Session describes how we usually begin. Your therapist may ask each of you what goes through your mind during sex, word for word if you can, and when that voice is loudest and when it is quiet. You can write your answer down first and read it out. It can be either of you. Body image worries show up across genders, ages and body types. In one survey of women in sexual relationships, more distracting thoughts about appearance during sex went with lower sexual satisfaction.1 What one partner hides to get through it, the other often reads as rejection. Saying it out loud changes what the outside means. In the figure: Inside and outside. Inside, for the partner with the critical voice: thoughts about how you look, comparing yourself to others, attention leaves the moment. Outside, what a partner may see: the lights stay off, some positions avoided, enjoyment faked, reaching out less. From the outside, this is easy to mistake for not being wanted. The first question. When you are close, what does the voice in your head say about your body? Tell me in its own words, if you can. Step 2. You look at where that voice comes from Your therapist may ask when the voice started, and whose voice it sounds like: a parent, a classmate, a former partner. Knowing where it came from makes it easier to hear it as a voice, rather than as the truth. The bodies you compare yours to. Many of the bodies people measure themselves against, in porn, on social media and in advertising, are edited, staged, filtered, chosen or performed for a camera. Looking at the comparison. Whose bodies do you compare yours to? What do you actually know about them? Step 3. You talk about your body as it is now Shape, weight, age, scars, disability and gender history do not rule anyone out of pleasure, connection or desire. Some changes are real. Disability, pain, hormonal shifts, medications and trauma can change what a body feels, and your therapist will work with that, not talk you out of it. If sex hurts, or arousal, erections or orgasm have changed, they will usually suggest seeing a doctor as well, alongside therapy. Some problems need a specialist, such as a pelvic floor physical therapist, and your therapist will help you decide. Pain During Sex goes further. If eating or weight is part of it. If worry about your body has spread into how you eat, how you exercise, or how much you think about your weight, tell your therapist, on your own if that is easier. They can help you find the right support. Neutral first. You do not have to love your body to enjoy sex. Your therapist may suggest aiming for neutral: a body that works, that feels, and that is yours. Most people move between these from day to day. Neutral is simply a steadier place to start from than trying to love what you see. In the figure: Three ways to see your body: critical (my body is wrong), neutral (a body that works, that feels, that is mine) and loving (I love how my body looks). Aim for neutral first; loving is not needed to enjoy sex. What your body looks like is not the same as how much pleasure it can feel. A different aim. What would it be like to aim for neutral, instead of trying to love what you see? Step 4. You talk about how neurodivergence shapes living in your body Many neurodivergent people feel far away from their bodies. Years of masking, hiding your differences to fit in, can leave you performing rather than living in your body. Autistic adults in one study said camouflaging exhausted them and cost some of them their sense of who they are.2 Sensory differences and questions about gender can add to the distance. Coming back into your body is part of the work. For some people the way back is stimming, movement, a texture or sound they like, or quiet attention. Autistic people describe touch, sight, sound and smell shaping sex for better and for worse.3 The aim is to find what your body welcomes, not to override what it does not. Your Sensory Map goes further. Coming back. What does your body ask for that you have been ignoring? What helps you come back to it? Step 5. You each choose a few sensations to come back to When the critic shows up during sex, it helps to have somewhere else to put your attention. Your therapist may suggest one specific sensation: the warmth where skin meets skin, your breath, a texture, a sound, pressure, or one spot that feels good right now. Many of the people we see find one sensation easier to hold than several. The critic may come back on. Turning the dial again, as often as it takes, is the practice, not a failure. Your stations may be different from these. In the figure: Changing the station, drawn as an old radio: the critic is one loud, crackling station, and three sensations (warmth, breath and pressure) are the others, with the needle resting on breath. When the critic comes on loud, you turn the dial to one sensation. The Body Image During Sex worksheet lists more sensations to choose from. You each pick two or three. Trying them happens at home, only if you both agreed to it in the session, at the pace of whoever needs it slower. Sensate Focus, One Step at a Time offers a structured way to practice this. If you do not feel safe. This work is for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. Work on sex pauses while that is looked at. If the critic comes with panic, shutting down or feeling far away from your body, that is worked with in the session first, not pushed through at home. Choosing. Which of these is already there for you, without having to set anything up? Step 6. You tell your partner what you fear they see Your therapist may invite the partner with the critic, or each of you in turn, to say what you are afraid the other sees. The other listens to the end. What you fear your partner sees is often not what they see, and naming it can shrink it. You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable . That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way. Saying out loud what you fear your partner sees, with them listening, is where people most often want to stop. Using the three words here is not failing. For the partner who listens. Try to say, in your own words, what you notice and value when you look at your partner, not what you think you are supposed to say. Many partners are relieved to learn that the dark room was not about them. You can also say what would help if your partner notices you getting in your head: a word, a pause, a hand held still. For example, Partner A might agree to say “slow”. Partner B keeps a hand still and waits, and Partner A turns their attention to the warmth of that hand. Saying it. What are you afraid your partner sees? Take your time. When you are done, I will ask them what they notice and value. Step 7. You try saying one kind sentence out loud Near the end, your therapist may ask you to say one sentence about your body or pleasure out loud. The point is not to believe it yet, but to notice the gap between what you say and what you believe. That gap is the work. Sentences some people start with. “I am worthy of pleasure.” “My body is allowed to want what it wants.” “Slow is allowed. Pause is allowed.” If it feels fake. Irritation, disbelief or going blank are information, not failure. Your therapist can help you change the words until you could actually say them. Trying one. Say it once, out loud. What did you notice? After the session The Body Image During Sex worksheet on our site walks the same ground in five short parts. Fill in your own copy privately. You decide what, if anything, to share at your next session. The workbook below is for each of you. It takes about five minutes, on your own. If the critic is mostly your partner’s, your answers still matter. If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard: embarrassment, shame, or the fear of being looked at. That conversation is part of the work, and you can bring it to your next session. Do I have to love my body to enjoy sex? No. Your therapist may suggest aiming for neutral first: a body that works, that feels, and that is yours. What your body looks like is not the same as how much pleasure it can feel. Shape, weight, age, scars, disability and gender history do not rule anyone out of pleasure, connection or desire. My partner keeps the lights off and turns away. Is it about me? Often it is not. Thoughts about how you look can pull a person out of the moment, and from the outside that can look like the lights staying off, some positions avoided, or reaching out less. It is easy to mistake for not being wanted. Saying it out loud in a session often changes what it means to both of you. What can I do when the critical voice shows up during sex? Many people find it helps to move attention to one specific sensation: the warmth where skin meets skin, your breath, a texture, a sound, or pressure. One at a time, not all of them. You each pick two or three in the session, and try them at home only if you have both agreed to. Why do some autistic and ADHD people feel disconnected from their bodies? Years of masking, hiding your differences to fit in, can leave a person performing rather than living in their body. Sensory differences and questions about gender can add to the distance. Coming back into the body, through stimming, movement, a texture or sound you like, or quiet attention, is part of the work. Your workbook Your answers save to this device only - we cannot see a word of what you write. Fill this in on your own, after your session about body image. After the session, on your own There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact. Whose body image worries come up most during sex? — Mostly mine, Mostly my partner's, Both of ours, Neither of us, really, Not sure When the critical voice shows up during sex, how loud is it? — It rarely shows up, Quiet, Loud, Very loud When is it loudest for you? — In the light, While undressing, In some positions, After a draining day, Something else, Not sure How connected to your body do you usually feel during sex? — Very, Somewhat, Not much, Hardly at all Which sensation would you try coming back to first? — Warmth where skin meets skin, Breath, A texture, A sound, Pressure, One spot that feels good, Not sure yet Have you told your partner what you fear they see? — Yes, A little, Not yet, I am not ready to Two things to write down A few words is enough. You decide whether to share them. One sentence about your body you could say and almost believe What you would like your partner to do or say if they notice you getting in your head Where this comes from Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson. Research discussion The steps in this session come from our clinical work with neurodiverse couples. They have not been tested in a trial. Aiming for neutral rather than loving, and moving attention to one sensation, are clinical approaches, not tested findings. An online survey of 154 women in sexual relationships found that lower body esteem and more distracting thoughts about appearance during sex went with lower sexual satisfaction.1 It measured women only, at one point in time, so it shows a link, not a cause. In a study of 92 autistic adults describing camouflaging in their own words, the costs they named included exhaustion and threats to their sense of self.2 It was not about sex or bodies, and a study of this kind cannot say how common these experiences are. An analysis of more than 120 accounts by autistic people, from books, online forums and a survey, found that touch, sight, sound and smell shaped sexual experience in good ways and bad.3 Everyone in it chose to write about the subject, so it cannot say how common any pattern is. Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you. Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 7, 2026 Peer-reviewed research 1. Pujols Y, Meston CM, Seal BN (2010) The association between sexual satisfaction and body image in women. Journal of Sexual Medicine, 7(2 Pt 2), 905-916 . https://doi.org/10.1111/j.1743-6109.2009.01604.x Community sample of 154 women aged 18-49 in sexual relationships, surveyed online on sexual functioning, five domains of sexual satisfaction and several body image measures (body esteem subscales, appearance-based cognitive distraction during sexual activity, body mass index). All body image variables correlated positively with sexual satisfaction; in regression, higher body esteem and fewer appearance-based distracting thoughts during sexual activity predicted satisfaction, independent of sexual functioning. Limitation: a cross-sectional internet survey of women only, so it shows an association, not a cause, and says nothing about other genders or about neurodivergent people. 2. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W (2017) "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534 . https://doi.org/10.1007/s10803-017-3166-5 92 autistic adults described in their own words why they camouflaged, what it consisted of, and its consequences, analyzed thematically into a three-stage model: motivations (fitting in, connecting with others), techniques (masking and compensation), and consequences (exhaustion, challenging stereotypes, and threats to self-perception and identity, including feeling fake or losing a sense of self). Limitation: a qualitative study, so it describes what camouflaging can involve and cost; it cannot say how common any of it is. 3. Gray SAO, Kirby AV, Holmes LG (2021) Autistic narratives of sensory features, sexuality, and relationships. Autism in Adulthood, 3(3), 238-246 . https://doi.org/10.1089/aut.2020.0049 Qualitative analysis of publicly available narratives from 5 books and 13 online forums (72 usernames) plus 49 survey responses, over 120 contributions in total, coded deductively against Dunn's model of sensory processing and inductively for further themes. Touch, sight, sound and smell shaped sexual experience in both positive and negative ways; some described distress at particular sensations, others sought more intense sensation or used intimacy to calm and regulate; strategies included talking with partners and changing the setting. Limitation: qualitative and self-selected; cannot say how common any pattern is. Further reading • Neurodiverse Couples Counseling Center (2026) Body Image During Sex. Practice materials, Neurodiverse Couples Counseling Center . https://www.neurodiversecouplescounseling.com/worksheets/body-image-during-sex The practice's worksheet for mapping the inner critic during sex: what it says and when it is loudest, the comparisons it makes, three sensations to move attention to, what to tell a partner, and the neurodivergent layer (masking, the senses, coming back into the body). Limitation: a clinical tool developed in use, not a validated instrument. Body image and sex, talked through with care The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including when worry about how a body looks has crept into sex. Everything in our sessions is talk, and nothing happens at home without two yeses. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing. Talk with our team Up next Module 23 — Perimenopause and Menopause All 24 modules in The Neurodiverse Sex Therapy Program