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Why Some of the Most Satisfied Couples Never Have Sex

“I love my doctor, but can you please tell him that we are fine?”

A couple was referred to me by the wife’s physician, who thought that she was mentally ill and in desperate need of psychotherapy. The physician first consulted a psychiatrist, who confirmed that something must be seriously wrong, but instead chose to send the woman and her husband for marital therapy.

The symptom that caused such a stir was the wife’s lack of interest in having sex with her husband. Specifically, the couple had dated for two years and married for three but had yet to consummate their relationship.

The Session

When the couple arrived for the first session they were in uncharacteristically good spirits—usually, first-time couples are a little apprehensive and stressed. This couple, however, was sitting close, holding hands, and giggling. The couple was in their early thirties and very pleasant.

I was immediately thrown off. This couple did not look as if they needed couple’s counseling. Rather, they looked as if they were still on their honeymoon. In fact, when I asked them, as is customary of me, to tell me in their own words what brought them to treatment, they looked at me and laughed. I asked what was so funny and the woman said: “I don’t know why we are here.”

I then asked the husband if he knew why they came to see me. He said that all he knew was for some reason his wife’s doctor wanted them to get therapy. He shrugged his shoulders. I then turned to the wife that said that her doctor was genuinely concerned because they weren’t having sex. They confirmed this but added that it really was not a problem. The wife said that she respects her doctor but that he was worrying too much about her.

I asked if the couple wanted to bring up any issues and they laughed and said that they were good and only came to see me to appease the doctor. I then directly asked the wife if she wanted to have sex and she said, “Not particularly.” I asked the husband the same and he said, “Not particularly.” I asked if either wanted children and they both looked at each other and laughed: “Not particularly.”

It was clear to me then that this couple was in no need of marital therapy as I define it, nor did they want any. But because they drove quite a distance to get to my office, I asked they would humor me and allow for an evaluation so that I could speak intelligently to their doctor. They agreed.

The Results

In sum, I found no overt sexual dysfunctions in either partner and no history of abuse or anything else that might merit a formal diagnosis. Neither partner was a virgin and neither reported any sexual difficulty performing with past partners. The couple claimed that they found each other attractive and were quite happy together. They shared a lot of interests and appeared affectionate. You could say that they perhaps seemed a bit immature but that rarely stops people from having sex.

In my final analysis, I did think that there could have been one or two things (which I choose not to reveal here) underlying the couple’s choice not to have sex, but I did not think these were beyond the couple’s awareness. I surmised they were not interested in or open to discussing them. And because neither was in harm’s way and claimed to be completely satisfied with their relationship as it stood, I chose to thank them for coming in and I wished them well. I told them that if anything comes up not to hesitate to give me a call.

They chuckled and left, but not before the wife turned to me and asked, “I love my doctor. He’s a great guy who cares a lot about me, and I know he has good intentions. But can you please tell him that we are fine?” I assured her that I would speak with him.

Now, in the business of psychotherapy, it would have been easy to attack this couple’s asexuality (Decker, 2015) or to diagnose the wife with female sexual interest/arousal disorder (SIAD) and the husband with male hypoactive sexual desire disorder (MHSDD) (DSM-5; American Psychiatric Association, 2013). But I did not think this would be proper or accurate, and I prefer to do my best not to inflict my values on the couples I treat.

And while I had to deal with a perplexed physician later in the week, I let him know that from my perspective if a couple agrees on something, and nobody is the worse for wear, and they are not open to treatment—whether they need it or not—they do not qualify for couple’s therapy. You can warn a couple if you think something might be afoot and cause damage in the future, but they must be ready to hear it.

The Moral

It is a frequent problem that many professional helpers feel compelled to treat clients any way they can, but some are overzealous. For example, some physicians are too quick to give out medication such as Viagra (sildenafil citrate) for treating erectile disorder, rather than ask about attraction or compatibility. The result is often less than optimal, even damaging. Other helpers try to push treatment on clients when they are simply not ready to receive it.

I have to say that most of these kinds of cases come from the heart and that the helper means well, but “resistance” is a real thing. If it weren’t, there might not be any need for psychotherapy in the first place. Professionals need to keep an old cliché in mind during treatment: “Don’t try to fit a square peg into a round hole.”

Facebook image: Art disain/Shutterstock


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Decker, J.S. (2015). The invisible orientation: An introduction to asexuality. New York, NY: Skyhorse.