Sexual Difficulties: What They Often Signal and How Therapy Can Help

Sexual difficulties are among the most common reasons people seek therapy, and among the least discussed. They tend to arrive in the consulting room having been carried privately for some time. You may be managing, minimising, or attributing sexual difficulties to stress or tiredness, in an attempt to defer the question rather than address it.

 

What counts as a sexual difficulty

Sexual difficulties cover a wide range of experiences: loss of desire or libido, difficulty with arousal or orgasm, pain during sex, compulsive sexual behaviour, mismatched desire between partners. Physical health conditions or medication can also have an impact on sexual experiences. Sexual difficulties also include the psychological dimensions of sexuality that are less easily named: shame, anxiety, the impact of past experience on current intimacy, and the difficulty of talking about any of this with a partner.

What these experiences share is that they tend to affect not just sexual life but the broader quality of intimate connections in general. Sexual difficulties tend to be more psychologically complex than purely physiological explanations account for.

 

What sexual difficulties often signal

Sexual difficulties rarely exist in isolation. They tend to be connected to other things: the overall state of the relationship, the level of stress being carried, the presence of anxiety or depression, the history of the body and what it has been through. Loss of libido, for instance, is frequently a symptom of burnout, or of a relationship that has accumulated unaddressed resentment, or of a body that is too depleted to allocate resource to desire. Perhaps your body has been through changes and your relationship with yourself has changed. Treating sexual difficulties as standalone problems, tends to miss the point.

There is also, for many people, a historical dimension. The relationship with sexuality is shaped by early experiences, by the messages received about the body and desire, by any experiences of violation or shame. These do not disappear in adult sexual life, they tend to show up in it, often in ways that are not immediately legible.

 

The relational dimension

Sexual difficulties in a relationship tend to affect all parties, even when the difficulty appears to belong primarily to one. The partner whose desire has diminished and the partner who experiences that as rejection are both in difficulty, and both need to be held in any useful therapeutic conversation. Couples therapy can offer a helpful space for all voices to be heard.

 

What therapy can offer

Psychological therapy for sexual difficulties is not sex therapy in the behavioural sense, though behavioural approaches have their place. It is more fundamentally about understanding what the difficulty is communicating (about the body, the relationship, the history) and the conditions under which desire and intimacy can blossom.

Talking about sexual difficulties in therapy can be experienced as a significant relief in itself. For many, these conversations are the first opportunities to name something that has been carried silently.

If you are experiencing any form of sexual difficulty and have not yet found a safe space to address it, therapy may provide what you are looking forward.

Dr Erin Reid is a counselling psychologist offering online therapy to individuals, couples, adolescents, and families across the UK and internationally. Visit drerinreid.com to find out more.