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Sexual Problems: 6 Sources and Solutions

Sexual problems can arise for a lot of good reasons.

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Sexual problems in relationships—premature ejaculation, inability to reach orgasm on both sides, erectile dysfunction, differing libido levels, and just one or both feeling bored—are common and never isolated. They combine the perfect mix of mind, body, relationship, stress, and environmental issues. It’s surprising that it often works as well as it does.

Here's a breakdown of some of the common sources of sexual problems:


While some folks use sex as a way of relieving stress, and so push for it when they are, for more of us, sex and stress do not play well—it's hard to get into it when you're obsessing about your year-end report 24/7, or if you are struggling in your relationship. Problems arise when both partners are stressed, and one desires it, the other doesn't.

Performance anxiety

Performance anxiety and stress often go hand-in-hand. The guy is worried about his job, and erectile dysfunction sets in. Have too much to drink, and orgasms for all go out the window. No big deal, but one bad night can set off a cycle of performance pressure. Premature ejaculation or erectile dysfunction for guys, failure to reach orgasm for both, can trigger anxiety about the next big night, which in turn creates a self-fulfilling prophecy. A downward spiral ensures which can be difficult to break out of.

But performance anxiety can also set in when there has been a sexual drought in the relationship. Starting again after a fallow period can create high expectations and, with them, high anxiety.

Libido differences

At the beginning of a serious relationship, oxytocin, the bonding hormone, ramps up in both partners, bringing with it lots of sex, usually overriding everyone's normal libido levels. But over time, those oxytocin levels naturally drop (in evolutionary terms, it's time to stop bonding and get back to work and start building a family), and so does the sex. This can cause some couples to wonder what is happening, worry about the why and the state of their relationship (it’s OK, it’s normal).

Once everyone falls back to their normal libido levels, differences can rear up. Now begins the struggle over how much sex each partner needs, what each thinks is normal (supplemented with Google weblinks), who has a problem, etc.


Take Lexapro—expect delayed ejaculation, reduced libido. Take Paxil—the "monk's" drug—expect no libido. Cocaine can create erectile dysfunction; alcohol can reduce lubrication in women. It isn’t you; medications affect your physiology.

Male-female differences and relationship climate

Guys tend to use sex to connect when they are feeling disconnected. Women often need to feel connected to want sex. A problem ensues. Guys start pushing for sex as a way of reconnecting; the woman wants the climate to change first. Each has different needs and agendas.


If male-female differences are triggered by the relationship climate, this is about the actual physical environment. Kids are up and running around—not going to happen. Ditto when you stay at your parents’ house over the holidays. Each partner has differing needs in order to feel safe and relaxed.

What to do

  1. Check out the medical. Talk to your doc about medications you're taking and possible substitutions. Ask about possible underlying health issues.
  2. Communicate. Time to talk to each other about needs, expectations. Make efforts to repair relationship expectations and problems.
  3. Desensitize to physical contact. If it has been a long time, start slow and simply get used to physical contact—hugs, snuggling on the couch, showering together with no pressure to have sex. This will not only help change the climate in the relationship but also sidestep performance pressure.
  4. Try doing sensate-focus exercises. These exercises were developed by Masters and Johnson and used as a starting point for all varieties of sexual problems. They work like a reboot of your computer. They help break performance pressure, provide a way of knowing what you each like and don’t like, offer behavioral ways of improving each other’s pleasure. You can find instructions on doing these online.
  5. Seek professional help. If your self-help efforts aren’t working, it may be time to call in the cavalry, i.e., a professional. Yes, it can feel awkward and stressful to talk to a stranger about your sex life, but they are professional, and if you find someone older than you, they’ve likely heard it all. They can normalize what you’re struggling with, give you tips on how the break the downward spiral. This can be brief but effective.

Sexual problems can easily become a source of frustration and struggle, but don't need to be. Time to take action?

More from Robert Taibbi L.C.S.W.
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