Sexual problems in relationships - how they happen and how therapy can help

Published in Blog by Karin Blak and Albertina Fisher on June 7th 2021

What is psychosexual therapy?

Put simply, it is talking therapy aimed at helping couples with their particular presenting issue surrounding their sex lives and intimacy. It is not directly to do with medical issues, rather it focusses on what is going on emotionally between a couple (or in the mind of an individual) that is making one or both in the couple unhappy around sex or physical closeness.

Is it dealing with the physical issues?

Psychosexual therapy is about what is going on between the couple on an emotional and psychological level. Having said that, it is important to state that we can work with people with a medical diagnosis where there may be no medication to treat it - often a doctor can refer them. In summary, we see anyone who is struggling with a sexual issue. There is not really a restriction or a ‘box’ you need to tick. Very often there is a connection between the physical and the psychological.

What are the most common sexual problems?

These are some examples, but they are NOT the only ones.

• Levels of desire difference - A very common problem is where one person would like to have sex more. In that instance it can seem that the partner with the lower level of desire is a gatekeeper. In this case the person with higher desire can feel rejected, while their partner feels guilt.
• Couples not having sex - This can happen for a large variety of reasons, but unless there is agreement on this it very often causes bad feeling.
• Sexual preferences that may not be compatible
• Things not working like they used to - An example here would be men getting or maintaining an erection - an issue that goes to the heart of what it means to be a man - which can absolutely undermine the sense of self and confidence. And for the partner it can feel that they are not attractive enough or doing enough to arouse. In this situation the sex becomes the focus of the issue. The sex then means the couple can say ‘let's do what we need to do to maintain erection’, and the moment becomes goal orientated, when in reality there are other ways couples can connect to de-stress the situation.
• Anxiety- Anxiety and sex are not very compatible, and this can lead to a vicious circle where avoidance of sex to evade the anxiety occurs.

Why is it so important to seek help?

Any sort of sexual difficulty can damage the whole spectrum of intimacy, from holding hands, the lower end, to sex itself. And even the ‘bit in the middle’, hugs and closeness, starts to reduce. Very few couples are happy with this kind of undercurrent occurring.

In general, the quality of the sex life relates to the quality of the relationship and vice-versa.

The challenge of sex is that it is a very emotive subject. Often other issues like money and views on parenting are emotive but the big difference is that these can be easier to discuss. Because of issues like embarrassment and shame, sex can be so hard to talk about.

What happens in therapy for sex and relationships?
In therapy the first step is we encourage intimacy to be free of the myth that all intimacy has to lead to somewhere, maybe to go away.

Creating more opportunities where intimacy has more chance to develop and taking the pressure off sex. Therapy works to show how desire can be rekindled by pointing out where it comes from.

The myth of spontaneous desire.

Research shows that it’s not the spontaneous desire that maintains relationships. In fact, what maintains sex in a long-term relationship is the idea of responsive desire – we tell clients that if you rely on the feeling to come – or even plan sex – as you get older and more familiar, it may not happen. For example, if you are washing the dishes it is not realistic for you to suddenly feel the urge to be together,

This is not about scheduling sex. By creating more intimate, enjoyable moments together, the chance is both parties will be more responsive to the idea, with the right climate emerging to be together in bed.

No one is pretending it is easy. The biggest sign of commitment to your partner can be coming to psychosexual therapy. It is a very brave and bold step, and it can take a long time to make it. Though the idea of coming to pour your heart out on intimacy can be hard, actually what are needed are a recognition that something isn’t right and the desire of both to seek support to deal with it.

Couples or individuals don’t need to work out what the specific problem is, they just need to let the expert therapists in the room talk through that.

So often we see couples on the verge of splitting up, or indeed individuals wanting to understand why things have gone wrong, but really our hope is for all people to take the step as early as possible.

Psychosexual therapy works

The good news is that the success rate of psychosexual therapy is very high! These problems above can be worked on by a skilled practitioner who understands sex and relationships. The benefits of regaining intimacy far outweigh the ‘risk’ of attending sessions, as there is so often joint enterprise in the room aimed at resolving a specific challenge.

When that issue is resolved, as it often is, the joy of intimacy returning can boost the relationship, and the issues that so stressed the couple are made to disappear into the past.

We offer help to couples and individuals with sexual problems. To find out more read here.

Listen to the the full podcast here.