This may surprise you:

One of the top reasons that couples go to therapy is not money squabbles or conflicts over parenting.

One of the top reasons that couples seek professional help is S-E-X (yep, that short, three-letter word that comes loaded with baggage in between each letter).

In a great many cases, while the sex may be awkward, disappointing, or just downright suck, the sex itself really isn’t the problem. Instead, sexual problems are often symptoms of other relationship issues, such as barriers to emotional connection and deeper understanding of one another. These problems can often impede a couple’s ability to be fully present with one another during sex.

On that note, here are five relationship hang-ups that, when addressed, can often dramatically improve a couple’s sex life:

1. Stress

Some people use sex as a way to de-stress. And, when you consider the physiological relief of the relaxation of muscles after an orgasm, it’s easy to see how sex can be a good release from stress.

But there can also be risks to using sex as a stress management tool. That’s because stress and sex fundamentally don’t mix, according to leaders in couples therapy at the Gottman Institute. Stress can trigger racing thoughts that take you away from being fully present with your partner during sex.

The way to overcome this common hang-up is to find ways to relax before sex. Talk to your partner about what is overwhelming you, and find ways to help lighten each other’s loads. Remove or reduce activities that are unnecessarily sucking up your time and energy. Take time for healthy forms of stress management and self-care.

2. Unresolved and/or suppressed trauma(s)

Sex stimulates the reptilian part of the brain associated with our most basic, primal instinct for survival. The brain is shaped throughout childhood development, where our reactions to real or perceived threats to our sense of safety become programmed into adult behavioral patterns. In times of danger, we learned to survive through fight, flight, or freeze responses.

If we have a history of sexual trauma, then our bodies may respond instinctually, as if we are in imminent danger when we engage in intimate, sexual acts. We may push our partner away when we are touched in a sensitive area, exhibiting a fight response. We may leave our partner alone and cold in bed after sex, because we are in flight mode. We may follow along with what our partner wants during sex, all along disengaged in fantasy in a freeze state.

All of these trauma responses take us away from being physically and emotionally present with our partner. And they are just some of the many ways that trauma and PTSD can negatively impact sex, according to research.

Vulnerability, though scary sometimes, is the key to overcoming this hang-up and achieving closer intimacy and greater satisfaction in bed.

If you’ve experienced sexual trauma, open up to your partner. Don’t suppress the experience and keep it secret. Instead, share your feelings with your partner. In some cases, seeing a trauma therapist may also be helpful for processing and healing from a traumatic experience that may be causing problems in the bedroom.

3. Drugs and alcohol

Alcohol and other drugs have a reputation for enhancing sex and releasing sexual inhibitions. However, mood- and mind-altering substances take us away from having a deep emotional connection with our partner during sex. Alcohol and drugs in fact mask our true emotions and numb feelings of love and connection.

Discuss with your partner what happens when one or both of you partake in alcohol or drugs. Are you less able to focus on how your partner is responding to your touch? Do you lose control over your motor skills and clumsily rush through the act?

Be honest about how a partner’s drug or alcohol use is affecting you in the bedroom. Does the smell of alcohol on their breath make you turn your head away? Does the smell of cigarette smoke in their hair make you nauseous? If so, tell them.

Don’t forget to consider withdrawal effects from substances that may get in the way of enjoying sex with your partner. Having a hangover after a night of drinking, for example, can make you truly embrace the excuse of, “Not tonight, honey. I have a headache.”

4. Untreated mental health issues

Depression and anxiety disorders are killers in the bedroom. The fact that low sex drive can be a sign of depression is well-established in the medical community.

Rather than personalize your partner’s lack of motivation for sex as a reflection of your own negative self-perceptions, consider that this may be a sign of depression. Evaluate if you are seeing other areas where your partner is lacking motivation for activities they used to enjoy, or are isolating from others, excessively irritable, and having problems sleeping that last longer than two weeks.

On the other hand, your partner may have a treatable anxiety disorder if they often have difficulty relaxing and are extremely on edge, think about worst-case scenarios, and/or have panic attacks. Don’t be afraid to talk to your partner about what you are seeing, since oftentimes people with these disorders cannot recognize their symptoms for themselves or are afraid to ask for help.

If you are experiencing these symptoms yourself, share this with your partner so that together you can take a team approach to seeking relief. The next step may be engaging in individual psychotherapy, as a gateway to a better sexual relationship.

5. Childhood taboos and/or values

When we are children, we receive an infinite number of messages about sex from our parents, our schools, our communities, our culture, our religious institutions, and the media. Sex goes beyond the act of sexual intercourse: it encompasses our gender, our roles in the world, and sometimes even our personal identity. All these messages about sex can impact how we express ourselves in adult relationships, and it’s not uncommon for them to come into play in the bedroom in ways that are detrimental to sexual pleasure and intimacy.

It may therefore be beneficial to re-evaluate the taboos and values that you grew up with. Spend some time reflecting upon how sex was or was not talked about in your family upbringing. Take an inventory of your values as they relate to sex. Ask yourself what you want to get out of sex in your relationship (and give!).

At its best, sex can be a tool for achieving deeper spiritual connection with oneself and one’s partner. By revisiting and clarifying our values in adulthood, it’s quite possible that we may begin to see our partner as a sacred being—and every act of intimacy with them as a beautiful, spiritual ceremony.