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The Most Common Sexual Problem Couples Face Today

... and why it doesn't take a sex therapist to fix it.

Monkey Business Images/Shutterstock
Source: Monkey Business Images/Shutterstock

Twenty-five years ago, I wrote an article for a professional journal warning of sleep deprivation's impact on sexual functioning. At the time, if 100 sex therapists were asked to identify the most common causes of diminished sex drive and sexual capacity, the majority would answer performance anxiety and/or communication issues. It’s true that, regardless of other etiology, performance anxiety and communication difficulties are almost always present as either a cause and/or consequence of sexual difficulty. However, neither of these factors is the most common cause of sexual distress in the United States: It’s fatigue. Fatigue is an epidemic in our society and can be caused by a number of medical, psychosocial, and environmental conditions.

Moderate daily exercise (especially in the morning) is one of the most frequent recommendations for those with low energy and/or sleep problems, yet excessive exercise can produce fatigue. While not relevant for the majority of people, the most athletic among us should take a moment to check: Is that resting pulse a little too amazing? This may be of special interest to those who in this time of Covid19 are using excessive exercise as a way of coping with being "locked in" and the often alienating requirements of social distancing. Are your athletic regimen and social life producing a level of fatigue incompatible with good sexual experiences?

For almost 100 million Americans, fatigue is the result of sleep debt. Those who work more than 40 hours a week (which is a growing group) are less likely to get enough sleep per night than those who work fewer hours. The Centers for Disease Control and Prevention reported that over 30 percent of American adults (approximately 41 million people) sleep six or fewer hours per day, and night shift workers — particularly those in the warehouse, transportation, and health care industries — are at the most risk of not getting enough sleep. One-quarter of the nation’s workforce labors through the evening. A study published only one week ago documented how men who work nonstandard shifts have poorer erectile function than other men working traditional hours. This is one more negative consequence the excessive time demands and stress that Covid19 has placed on "essential" shift workers, who will be even more vulnerable to sexual disorders.

Others who are not getting enough sleep are people who work more than one job, widows, divorcees, recently separated partners, and of course new moms — especially single mothers. For almost all of us, modern life’s electronics — from simple light bulbs to today’s ubiquitous mobile phones — all encourage delayed bedtimes. Societal pressure to postpone or even skip sleep has increased and accelerated dramatically over the last 20 years since my earlier article was published.

Sleep needs vary by age group and are also variable between individuals. Besides sleep’s impact on sex, insufficient sleep has also long been linked to significant health risks, including but not limited to obesity, high blood pressure, heart disease, diabetes, depression, a weaker immune system, cognitive issues, and daytime fatigue. Alteration of hormonal milieu is often suggested as a mediating culprit. Recommendations on how to monitor (including continuous announcements of new gadgets) and improve your sleep are omnipresent.

The relationship between sleep and sexuality has an important place in the history of sexual science. Measuring erections during sleep was once considered one of the most important diagnostic tests in evaluating whether patients with erectile disorders were suffering from organic illness. Early clinical trials of well-known sex drugs for men (Viagra, Levitra, Cialis, etc.) all incorporated such "sleep studies." Obstructive sleep apnea (OBSA), which causes disrupted breathing in the middle of the night and is suffered by millions, was long known to cause fatigue. Sleep apnea has come to be recognized as an important risk factor for sexual dysfunction for both men and women. Postmenopausal women with OSBA are especially at risk for adverse sexual side effects, and men with OBSA frequently suffer from erectile dysfunction. Sex researchers studying the impact of sleep on sexuality in women concluded in a recent pilot study that women who get one more hour of sleep increase their sex drive by around 14 percent. Those women also reported fewer problems with genital arousal and a more satisfying sexual response than women who had fewer hours of sleep.

Might getting better quality sleep, and making sure the quantity is right for you, be a meaningful way to improve your quality of life generally and sex life specifically? The answer is yes! There are a multitude of physical and psychological factors that require a sex therapist’s skill and intervention; yet for many readers of this blog, what appears to be a complicated situation may have a simple solution. Sometimes you can improve your sex life by simply reducing fatigue. As a bonus, even when sexual difficulties are primarily caused by other factors, you have already begun to improve your situation before you even show up at the doctor’s office.

So, if sleep is great for sex, and also helps us stay fit and maintain a healthy body, and increases resilience to stress and/or disease (even reducing our chance of catching a cold), how do you improve the likelihood of getting what you need? For those with severe insomnia, a medical evaluation is advisable, and Schutte-Rodin et al. (2008) offers a comprehensive summary of evaluation and management options. For others, the following "Top 10" list of the most frequently recommended tips compiled from Internet sites will suffice for a start:

  1. Light. Spend time outside getting daylight, and reduce exposure to light at night, especially blocking nighttime blue/green electronic display light.
  2. Physical activity. Engage in easy to moderate exercise daily.
  3. Temperature regulation. Keep it cold: The ideal temperature for falling asleep is around 65°F (18°C) for most people.
  4. Meditation or yoga on a regular basis. You can also try bedtime breathing and/or relaxation techniques.
  5. Circadian rhythm. Structure life to the extent comfortable, by going to sleep and awakening at the same time each day.
  6. Hot/warm shower and/or bath prior to bedtime
  7. Reserving your bed for sleeping and sex. Leave your bed and read elsewhere if not asleep within an hour. Then return to bed and try to sleep again.
  8. Stop working at least one hour before bedtime.
  9. Reducing excess liquids at bedtime. Modulate use of alcohol, and avoid caffeine and/or other stimulants post-mid-afternoon.
  10. Orgasm. An orgasm may induce sleep. (This tends to work more for men than women.)

Facebook image: Monkey Business Images/Shutterstock


Perelman, M., “Sex and Fatigue,” from Sex Therapy Today column, in Contemporary Urology, Volume 6, Number 4, April 1994.

Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of Healthy Sleep Duration among Adults-United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:137–141.

Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function, Rodriguez KM, Kohn TP, Kohn JR, Pickett SM, Pastuszak AW, Lipshultz LI. Journal of Sexual Medicine, Elsevier Inc, 2020, https:/

Perelman MA. “The History of Sexual Medicine.” In APA Handbook of Sexuality and Psychology [Eds: Diamond, L & Tolman, D]. American Psychological Association, Washington, D.C., 2014.

Andersen ML1, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S. The association of testosterone, sleep, and sexual function in men and women. Brain Res. 2011 Oct 6;1416:80-104.

Ciesla J, Pillai V, Arnedt T, Kalmbach D. The Impact of Sleep on Female Sexual Response and Behavior: A Pilot Study. The Journal of Sexual Medicine. 2015.

Hirotsu, C., Soterio-Pires, J. H., Tufik, S., & Andersen, M. L. (n.d.). Sleep disturbance and sexual dysfunction in postmenopausal women. International Journal of Impotence Research, 29, 126 EP –.

Perelman, MA. Why The Sexual Tipping Point is a Variable Switch Model. Current Sexual Health Reports, 10: 38. 2018

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