12 Sex Problems Most Often Discussed in Psychotherapy

When people have sex in the movies, mutual interest always arises at an appropriate time, and each partner participates deeply and passionately in the experience. In real life, though, sexual connection between long-term partners is rarely so straightforward. As many as 20 percent of American couples have sex fewer than 10 times a year — a threshold that is often described as “sexless.” Sex life in couplehood is like any other aspect of a marriage or a partnership, in that it allows the expression of existing conflicts from other areas; not having sex with one’s partner can reflect many other significant marital issues. As a psychologist, I often hear about these issues, and the seemingly insoluble sexual problems that they provoke behind closed doors — even in partnerships that look very happy on the outside.

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Probably the most common sexual conflict I’ve come across is that of mismatched libidos, or the discrepancy of desire between partners. It’s normal to have sex frequently when a relationship is new, and both partners can delight in their growing intimacy. But as a relationship grows and develops over the long term, it’s normal for one partner to want sex more than the other. The one who wants more sex can feel unappreciated, rejected, or even unloved, while the less interested partner may wonder if there is something wrong with him or her. Generally this dynamic resolves into two fixed roles: a pursuing partner and a distancing partner, each of which is equally likely to be a man or a woman.

In my own practice, I’ve also heard a great deal about infidelity. After one partner cheats, even if he or she is repentant, it’s very difficult for the betrayed partner to go on having sex as before. Sex may take on unwanted associations — with anger, deception, concession, or shame — and it may also become tainted with the fear of sexually transmitted disease. Most significantly, however, the loss of trust between partners after infidelity will significantly color their sex life, going forward. To some degree, sex is always about trust — trusting someone else with your feelings, your pleasure, and your body — and when this trust is violated, sexual comfort and openness can be very difficult to develop again.

Sexual dysfunction, in a psychological or a physical sense, also presents significant obstacles to a satisfying sex life. For men, erectile dysfunction or premature ejaculation can diminish confidence in one’s sexual performance and can make men afraid to attempt sex. Men with ED may even worry about its significance for their masculinity. Worse, the very nature of these problems can make them difficult to discuss openly with one’s partner, which can generate unwanted interpersonal distance. But it isn’t only men who experience sexual difficulties with a physical origin. For some women, inhibited orgasm — due to the side effects of medication or other medical conditions — can turn sexual encounters into exercises in deep frustration. These women’s partners, too, may feel insufficient or unable to perform to satisfaction, which can add a relational element to a problem that began in the physical realm. Additionally, sexual dysfunction is not limited to disorders of a sexual nature. Chronic illness or unremitting physical pain can impede what would otherwise be a healthy sexual connection, at any age.

Long-term partners who are parents of young children often find that their daily schedules are not conducive to sexual spontaneity. With the kids waking them up early in the morning, dominating their evenings, and even sleeping in the parents’ bed at night, it’s often difficult to reserve time for sex, and more challenging still to look past persistent exhaustion to find a spark of sexual energy. The demands of a household schedule can turn former romantic partners into full-time child care professionals with little energy left over for the sexual component of their relationship. In these situations, traditional gender roles may also have an inhibiting effect, as they do when mothers find themselves handling the lion’s share of the family’s scheduling, decision-making, and parenting duties. Women in this position can feel overburdened by their husbands’ choices, which can contribute to resentment and a concomitant reduction in sexual desire.

Many other factors can affect a couple’s interest in sex. Addictive behaviors, like the compulsive use of pornography, may affect one partner’s sexual expectations, attuning his or her interest to certain kinds of sexual behavior with which his or her partner isn’t comfortable. Even without the influence of pornography, discrepancies between sexual preferences frequently crop up and interfere with sexual harmony: One partner may enjoy having sex in a certain position that the other partner dislikes, for example. And anything that causes conflict within a marriage or partnership can be enacted in the bedroom, and can generate problems with emotional or physical closeness. People with unsatisfying sex lives often talk about the lack of emotion connection with their partners overall. They’ll point to a sense of having drifted apart, having failed to retain the ability to safely share their feelings with each other. This interpersonal distance will then extend to the bedroom, and thus becomes an established habit over many years. After treating each other this way for such a long time, dysfunctional patterns of behavior can be deeply entrenched and extremely hard to change.

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Maintaining a strong and emotionally close sexual connection with one’s partner, as a relationship grows and changes, can be a significant challenge in some relationships. With the right kind of psychotherapy and sufficient motivation, however, it is possible to overcome some of these sexual conflicts. In a future article, I will shed light on some of the ways therapy can help, and will describe some of the therapeutic techniques practiced by therapists who focus on sexuality.