The Missing Conversation in Eating Disorder Treatment: Sexuality Professional Experience Article
As a sex therapist working at the intersection of eating disorders and sexuality, I often hear clients say, “No one ever talked to me about how my eating disorder affected my sexuality.” Eating disorders can significantly affect sexual functioning, desire, and intimacy. Hormonal changes, malnutrition, and shifts in neurochemistry all play a role, but the impact goes beyond physiology. Eating disorders often train the nervous system to monitor the body rather than inhabit it. Sexuality requires the opposite: presence, sensation, and responsiveness. For someone who has learned to override hunger, suppress needs, and distance from bodily signals, this shift can feel threatening. Yet sexuality is rarely addressed in recovery. Many clients only notice these impacts after other symptoms improve.
They may want closeness but struggle with desire or feel disconnected during intimacy. These experiences are common and deserve space in the recovery conversation. Why Sexuality Often Goes Unaddressed Treatment Models Prioritize Stabilization. Eating disorder treatment understandably focuses on medical and behavioral stabilization. Sexuality can appear secondary or irrelevant. Over time, this creates an implicit message: Food first. Sex later. But sexual functioning and embodiment do not automatically recover once weight is restored. When sexual health is consistently framed as something to address later, it may never get addressed at all. Sexuality Is Seen as Outside the Scope
of ED Treatment. Sexuality training is rarely included in eating disorder specialization programs. Even highly skilled therapists may feel uncertain about how to assess sexual concerns or integrate them into treatment. Without training, clinicians may worry about opening conversations they feel unprepared to address. As a result, sexuality can quietly fall outside the perceived scope of eating disorder care. Cultural Discomfort Around Desire. There is also enduring cultural discomfort around discussing sexuality, particularly with clients who may already feel vulnerable in their bodies. Some clinicians worry that sexual topics may feel too personal, inappropriate, or unrelated to treatment goals. But avoiding the topic can unintentionally reinforce the very disconnection InSession- April 2026 | FMHCA.org | 41