Someone asked me if I worked with sexual problems as there is no mention of sexual issues on my website or in my blog.  This was someone who had been married for many years and whose sexual life had become non-existent.

Sexual issues are such a basic topic of focus in both couple & individual therapy that it never occurred to me to write about it.  Duh!  That being said, of course I have seen many couples and individuals where intimacy, sexual & otherwise, is a very important issue.  Unless there are obvious physical problems, I usually view sexual intimacy or lack thereof as a combination of various psychological factors.  For couples, lack of sex can be a direct outcome of what is happening in the relationship as a whole.  Sex can be a barometer of the relationship and sex is often one of the first things that go when people are unhappy with each other or even with themselves.  I usually see it as a symptom of problems and not a cause.  That is not always the case.  Sometimes the opposite is true, because feelings of love and desirability for some people are often based on sexual attention.  Rejection feeds relationship problems and insecurities, which in turn makes it difficult for people to approach one another, and you can develop a dynamic which exacerbates and repeats dysfunction.  If the communication and the relationship improve, often the sexual relationship gets better.

Feeling loving and trusting towards each other can stimulate sexual desire.  In couple’s therapy I almost always ask about the sexual relationship.  It is also a good idea to check out each person’s idea of how often they should be having sex.  It  is amazing how couples can differ – from at least once daily to maybe monthly or less.  Libidos are different and can change over time and circumstance.   But resentments, feelings of rejection and undesirability can be a consequence of lack of sex.  “You make me feel unwanted” or ” I am tired of being turned down” are feelings that get expressed a lot.

Body image can be a major obstacle to a satisfying relationship.  “I don’t want to be seen naked” or “I feel fat & ugly” are reasons that I hear expressed regularly and which interfere with desire.  Other common complaints that interfere with sexual intimacy are lack of romance or foreplay.  Timing can be all important and some couples have opposite clocks.  Other reasons for sexual avoidance I hear are “I don’t want to beg for sex” or “You just want to get off & then roll over & go to sleep”.

I am not a sex therapist, but there are many physical problems that can lead to lack of sex, such as erectile dysfunction, premature ejaculation, vaginal dryness, medication reactions, hormone imbalance, menopause, low testosterone – just to name a few.  There are many actions people can take to improve or alleviate these issues – both medical & technical.  But if feelings of resentment and rejection have been going on for some time, taking even the first tentative steps can be difficult.  If there is a physical problem a supportive partner is a huge help.   A supportive partner is a huge help in any circumstance.

Then there are the psychological problems that compound whatever physical problems there might be.  And of course there don’t have to be physical problems to cause sexual dysfunction.  Past sexual abuse is a major factor as are feelings of inadequacy, feeling used and abused, and family history.  Religious upbringing and familial attitudes towards sex can easily interfere with sexual enjoyment.  All in all, a healthy sex life is a blessing!

But before I conclude, I want to point out that diminishing sexual activity or even the lack of it does not necessarily mean that a relationship is not loving or healthy.  Love itself flourishes without sex – and considering the human condition, it would have to.  Every relationship is different and people have different needs.  We all age and our physical selves are fragile.  It is wonderful that love is greater than sex.