When sex is difficult

Low desire can be linked with stress, low mood, relationship problems, tiredness, hormones or health changes. It only becomes a concern if it bothers you or your relationship.

Sometimes the body doesn’t respond, even when someone wants to be close. This can include erection problems or dryness. Occasional difficulties are common and often linked to stress, tiredness or alcohol.

Because physical health can play a part, it is important to consult with your clinical provider first. Emotional causes can then be explored with a therapist.

Some people find orgasm delayed or difficult, even when they feel desire and arousal. Worry, pressure and trying too hard can make this harder.

Taking the focus off the “goal” and onto comfort and connection often helps. A sex therapist can guide this gently.

Pain during sex can have physical causes, and also emotional ones like fear, anxiety, a painful past experience, or believing sex is shameful. The body may tense up without you meaning it to.

Pain is a signal to stop and get checked. Please consult with your clinical provider. Psychosexual therapy and sensate focus can help with the emotional side.

Low interest in sex, or none at all, is common with depression. Depression can affect the brain chemicals linked with pleasure, and can change how the body responds to touch and how satisfying closeness feels.

A partner may feel hurt or think you are no longer interested in them. Explaining that the change is part of the depression can protect the relationship.

Some health treatments can also affect desire. If you notice changes, please consult with your clinical provider rather than stopping anything on your own.

Anxiety keeps the body in “fight or flight” mode. That makes it hard to relax, be present and feel pleasure. Worries can also take over the mind during intimate moments.

Talking therapies like CBT can help with anxiety, which often eases sexual worries too.

After trauma, especially sexual trauma, the body may stay on guard. Touch, smells or situations can bring back memories, cause panic or make someone feel numb or far away.

Healing is possible. Trauma-focused therapy and sex therapy can help people feel safe in their bodies again, at their own pace.

Stress, tiredness, caring for a new baby, work pressure and drinking too much alcohol can all lower sex drive. This is the body’s way of saving energy.

Gentle ideas

• Protect a little unhurried time together
• Focus on rest and sleep first
• Enjoy non-sexual closeness like cuddling or holding hands
• Cut back on alcohol

Unresolved arguments, feeling unheard, or growing apart can lower desire. Relationship problems are one of the most common reasons sex drive drops.

Relationship counselling can help couples talk safely and reconnect.

Some people feel anxious about emotional closeness: being seen, being vulnerable, or being rejected. This can come from past hurt, a fear of being let down, or growing up where closeness did not feel safe.

It can show up as keeping partners at arm’s length, ending things when they get serious, or feeling panicky when someone gets close.

Performance anxiety is worry about how you will do, how you look, or whether your partner is satisfied. Occasional difficulties are very common and are often caused by stress, tiredness or alcohol.

Unrealistic images from online or media can add pressure. Real closeness is not a performance. It is about connection, comfort and respect.

What can help

• Taking the focus off “performing” and onto connection
• Slow breathing to calm the body
• Talking openly with your partner about worries
• Sex therapy, which often uses gentle step-by-step exercises

Sensate focus is a set of exercises used by sex therapists to help people relax and enjoy closeness without pressure. It starts with very gentle, non-sexual touch, and slowly builds over time, at a pace that feels safe.

It is done privately at home, by you and your partner, with guidance from a therapist. Therapists themselves never take part in any physical contact.

Allowing plenty of time for arousal, and spending more time on touch and warming up, can make a real difference.

Rushing to the “main event” can leave one person behind. Kissing, touching and talking count as intimacy in their own right, not just a lead-up.

Focusing less on physical acts and more on emotional closeness, and trying sensual touch like massage, can help both desire and arousal.

Ideas

• Time together earlier in the day, not only at bedtime
• Talking, laughing and being playful
• Phones away
• Telling each other what feels good

When the mind is busy judging (“Is it working? What do they think of my body?”), the body often stays on alert. The worry loop in “Intimacy & performance anxiety” explains why.

Try

• Slow breathing
• Noticing one sense at a time: warmth, touch, sound
• Agreeing that there is no goal tonight, just closeness

A partner who isn’t aroused is usually dealing with stress, health, worry or tiredness, not a lack of love. Pressure makes it harder. A warm “No worries, let’s just cuddle” helps far more than disappointment.

Later, at a calm time, ask: “What helps you feel relaxed and close?”

Because physical health can play a part, talk with your clinical provider if arousal problems keep happening, are new, or bother you. Pain is always a reason to stop and get checked.

You and your therapist work together to spot and change the thoughts and patterns that are getting in the way. You may go alone or with a partner. Therapists know talking about sex can feel awkward, and do their best to help you feel comfortable.

You may be given “homework”: exercises to do in private at home, such as activities that build trust and intimacy, alone or with a partner.

They can help with

• Anxiety, fear or shame about sex
• Body image worries
• Communication between partners
• Cultural or religious concerns about sex
• Healing after sexual trauma
• Low or mismatched desire

In the U.S., AASECT (the American Association of Sexuality Educators, Counselors and Therapists) certifies sex therapists. Certification requires a graduate degree with psychotherapy training, at least 90 hours of sexuality coursework, supervised clinical experience and a professional license.

AASECT has a directory of certified professionals on its website, and many offer online sessions. AASECT’s code of conduct forbids sexual contact with clients.

Questions to ask

• Are you licensed and AASECT certified?
• Do you have experience with my culture, faith or identity?
• Do you work with couples, individuals, or both?
• What might sessions look like?

Cleveland Clinic explains that sex therapists use talk therapy for simple or more complex sexual concerns. Sex counsellors take a more action-based approach, offering education and techniques for shorter-term problems.

Sex therapists do not treat physical causes, so a primary care provider or specialist may need to check those first. You can see a sex therapist while also getting medical care.

If you feel uncomfortable with any part of therapy, you can tell your therapist, or stop seeing them and file a complaint.

Keeping track of what you notice in a journal can make it easier to explain at your appointment.

Things to note

• What is happening, and since when
• Anything that changed around that time: stress, a new health issue, a birth, menopause, a loss
• How it is affecting you and your relationship
• Your questions

A provider may ask a lot of questions about your physical and mental health, and about any past experience of sexual abuse or violence. You can share as much or as little as you choose.

If you are a survivor, the Intimacy after sexual harm guide has tips for exams, like asking your provider to explain each step first.

You may be referred to a sex therapist, even while you are getting medical care. Couples therapy or counselling on your own can also help.

You could say

• “Would it help to see a sex therapist?”
• “Is there a specialist in sexual health you’d recommend?”
• “Could stress or mood be part of this?”

If someone close to you is mistreating you or taking advantage of you, you can tell your provider. They may be able to offer resources or referrals.

Talking openly and honestly may help prevent frustration and confusion. Ask how they are feeling, and listen without rushing to solve it.

You could say

• “I love you, and this doesn’t change that.”
• “What would help you feel relaxed and close?”
• “There’s no pressure. We can figure this out together.”

Worry about performing is one of the most common emotional causes of sexual difficulties. A warm “No worries, let’s just cuddle” helps far more than disappointment.

Ideas

• Agree that closeness doesn’t have to “lead” anywhere
• Enjoy non-sexual touch like cuddling or massage
• Focus on connection, not a goal
• Thank them for telling you

Physical health can play a part, so a checkup with a clinical provider is a sensible first step. You could offer to help them prepare, or to go to a couples session together.

It is natural to feel rejected, lonely or frustrated at times. Talking with a counsellor, on your own or together, can help you both.