What’s at the root of problems with intimacy? A sex therapist shares her perspective.

Sexual issues and problems with intimacy can be complex, confusing, and frustrating. What gives? Why are these problems so hard to solve?

Wondering about my work with couples in sex therapy? What people struggle with below the surface of “sexual issues” and “problems with intimacy?”

Issues with sex. Problems with intimacy. Desire mismatch. Couples know how to describe their problem and how they got here in great detail, but they don’t know how to fix it. Why is it so hard?

I work with a lot of couples who are not happy with their sex life. It’s a point of tension that never really goes away. They either never got off on the right foot sexually (for myriad reasons and circumstances), or they have a lackluster connection in the bedroom that’s pretty frustrating.

 Others can describe the really great sex they had in the early years of their relationship, only for intimacy and affection to fall off over time due to desire differences, having kids, fertility challenges, perimenopause, or living stressful lives. The list goes on, of things that get in the way… Starting couples therapy can feel like failure, or maybe the last hope.

Below, I’m letting you in on some common themes I see in my couples and sex therapy practice in Chicago. As I tell my clients, this isn’t just a sexual issue or desire problem in a vacuum that brought you here. It’s years of history, a relationship dynamic that becomes stuck and repetitive, and communication skills that you didn’t have at the time, all piling on. Woah, you mean we have to work on ALL of this? This can feel overwhelming and discouraging to hear at first. The good news is – couples therapy with a sex therapist can help with all of this! We have plans and structures in place to address these many factors. To help couples work on disrupting old patterns and implementing intentional changes in their routine.

Many of these couples have a few things in common.

 1) A desire by at least one partner for sex to be different, to feel better in the relationship. Not always both, which is often what leads couples to therapy. One partner often feels bad for not being bothered by the issue, or for not really wanting or needing to have sex, as often or at all.

2) Avoidance of the issue over time, due to not being able to come up with a compromise or solution to the problem. A pretty satisfying relationship and happy mood goes sour when couples start talking about sex again and realize this is the one area we can’t figure out.

3) Significant discomfort, awkwardness, or overwhelm when talking about sex. Maybe not even knowing how to talk about their likes and dislikes, or what sex does and doesn’t do for them. They never learned. This discomfort could be felt by one partner, or both.

4) Getting into fixed, stuck positions about the issue that hinder problem-solving as a team, like:

- I need more sex with you, more intimacy. I want to feel desired, wanted by you, not like you’re just doing it for me, or because we “should.”

- You don’t get that I need to feel emotionally connected with you first before I can even imagine wanting sex or desiring it… You don’t even want to look at how disconnected I feel in our relationship!

5) Anxiety or fear. There might be some anxiety and stress that occurs around sex, related to performance or your level of desire. There can also be larger, distress questions that can sometimes lead to avoidance. What if we can’t figure this out? What does this mean for our relationship and life together? What does this mean for what I need to accept about our relationship, or about my sexuality? It takes a lot of courage to acknowledge these anxieties and fears and share with a partner, let alone a therapist.

I want you to look at this list above again. Each of these items can be addressed, normalized, and improved in therapy relatively quickly when couples are serious about doing the hard work of understanding each other. But what does that LOOK like?

So, what do we do about these issues in therapy? How do we address them?

1) Different motivations or levels of distress about the issue —> We TALK about that and what it feels like for each partner. Are you both willing to work on this for your relationship, to make changes, even if you have different levels of distress or desire?

2) Avoidance of the issue —> We stop avoiding! Simple, but actually a hard thing to do. Weekly, scheduled therapy sessions help with that. The process holds you accountable to discussing the very thing that can sour your relationship or mood. We look and discuss the elephant in the room, and better understand it. I provide you with communication strategies (and practice) and resources to develop the skills and capacity to discuss these things in session with me AND on your own. There’s a lot of relief and self-efficacy that can come from no longer avoiding something hard.

3) Uncomfortable or awkward conversations about sex —> We practice having them, but go at your pace. We explore what is hard, uncomfortable, and why. What you need for it to feel easier, to feel safer. Often, couples need a moderator to get the conversation going. Someone to ask the questions they can’t think of themselves, or the questions they’re afraid of asking. Someone to remind you, “of course this is uncomfortable!” or to suggest ways you could talk about it more effectively.

I’ll happily send thoughtfully curated sex ed and relationship resources your way, if you like that kind of thing. Reading relevant book excerpts and listening to podcasts or short talks can supplement our work in therapy.

4) Fixed, stuck positions and patterns —> We better understand the pattern and what’s happening. We track it, and look for opportunities for the two of you to hear, understand, and empathize with each other. (If you’d like to learn more about my process in doing this, check out Emotionally Focused Therapy). THEN, we identify a different way to approach this problem. As a collaborative team struggling with a problem, not two parties pitted against each other.

5) Anxiety and fear —> We take these seriously and try to better understand them, like all of the above. If you’re struggling with anxiety or fears surrounding sex, different approaches and coping strategies can help. If you’re distressed by larger questions, we have to talk about those rather than stuff them under the rug. They’re likely creating an amazing amount of pressure or concern for either of you.

Woven into all of this…. we have a handful of practical, tangible sex therapy strategies for being more intentional about sex and intimacy in your relationship and in your week. Most of these are introduced in session then done on your own time, then we reflect on what went well or what was hard. Scheduling time to experience fun together. Scheduling time for intimacy, prioritizing it on your busy calendar. Practicing mindfulness exercises that help you tune into your body, which will translate to helping you be more present (or more relaxed, less anxious) during a sexual experience. This is not an all-encompassing list.

I hope this information from my perspective as a therapist has been helpful to you in some way. I’m a couples therapist and certified sex therapist in Chicago and work with clients on a range of sexual concerns. If you’re looking for help and considering starting therapy, feel free to read more about my work or click below to contact me and schedule a free, 20-minute phone consultation.