Sexual intimacy is an essential experience to many romantic relationships, encompassing sexual identities, sexual desires, and sexual behaviors. Historically, people who identify as gay, lesbian, bisexual or questioning have been marginalized, tabooed, and illegalized in many societies, which have significantly shaped sexual minority (SM) couples’ views and experiences of sexual intimacy. When working with distressed SM couples, providing culturally sensitive and affirmative services is both necessary and effective considering the long-existing social stigma against sexual minorities and the imposed expectations by heterosexual norms. With the legalization of same-sex marriage in the U.S., working with SM couples is becoming an increasingly important practice in the U.S. However, many therapists receive little guidance in conceptualizing and treating SM couples and their experiences of sexual difficulties. The narrative therapy model has shown its theoretical advantages in working with couples with minority status, given its non-pathologizing stance in viewing minority experience. This paper proposes using a narrative couple therapy framework as a guide to help both therapists to explore sexual intimacy with SM couples. A case illustration is included.