The basic complaint of couples seeking sex therapy is that their sexual relationship is no longer satisfying to them, that they cannot deal with it. Although all couples who seek sex therapy feel that they have sex problems, not all couples experiencing sex problems seek sex therapy. We hypothesized that the way in which couples differ in their reaction to sex problems and their abilities to handle them is an important factor in determining their sexual satisfaction. To investigate this hypothesis, we looked at couples who attended a sex therapy clinic and at a demographically similar group of couples who have not sought sex therapy. The results suggest that factors in their relationship (marital functioning and communication and sexual communication) are a major difference between couples who seek therapy and those who do not.