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Sexual Dysfunction, Dissatisfaction, Infidelity, and Discord

An ongoing series of informational entries

Sexual Dysfunction, Dissatisfaction, Infidelity, and Discord

June 5, 2017

As a sex and gender therapist I work with heterosexual, gay, lesbian, bisexual, transgender, and intersex couples. Each of these groups experience infidelity, dissatisfaction, dysfunction, and/or discord in the relationship for a variety of reasons. Below are a few of my observations and techniques on dealing with the above mentioned issues.

Psychological Shorthand

I have observed more and more that sex is used as a psychological shorthand, allowing people to feel physical close when they can't seem to feel emotionally, spiritually, existentially close. This shorthand also plays itself out in terms of sexual frequency, quality, intensity, and duration. Couples interpret changes in these areas as a commentary on how the other feels about them, the relationship, etc.

Fix My Partner

I also think there is a way in which we as therapists can get caught in the middle, playing referee. One partner often wants us to fix the other. I find it helpful to talk about the couple’s needs as individually equal, and help them hold both as such, instead of their needs as being competitive with the other. I think the key is creating understanding not expecting agreement. If people feel understood they often become flexible, more willing to be sexually intimate. Finally, to manage expectations, I tell clients that the average couple in the US has sex 2-4 times a month (John Gottman research).

Gender isn't an Indicator

I've treated more than a few couples where the male is the sexually disinterested party and the female reacts by feeling unloved. We could just say libidos don't match well, to keep it simple. Gender is no indicator of sexual desire. I've also seen couples where they are, or are not, emotionally or intellectually doing well but the sex is reportedly still frequent and terrific. Yet, there has been an affair. Most people are governed by their intense needs--some of which are hidden from them. Understanding how this happened, making active choices about current and future decisions, then, becomes a holistic path to health. Books have been written about all of this, in more detail. So I'll just say that a lack of sex is not always the agitator pushing for an affair.

Wants Aren't Being Met

I don't necessarily believe that affairs are due solely to lack of sex. I think affairs stem from physical/emotional/spiritual wants and desires not being met. When sexual wants aren't being met in a relationship, I believe that it is then typically a manifestation of some of these above wants not being met. For example: built up emotional/mental resentment of the partner, feeling criticized in the relationship, not heard, not respected etc., being scared of voicing opinions, ideas, feelings - hence these lead to distancing, escalated fights, a way to gain power in a feeling powerless relationship, parental roles of comfort with sexuality, etc. Of course, already ruled out are medical possibilities hindering sexual desire. Then there is the other category of: lack of sex due to fear of judgment, or performance anxiety or past molestation/rape. Also, you may have a person wanting tons of sex and exploring how they feel loved and cared about through this act, or anxiety, insecurity and using sex as the reassurance that they're ok. Also, there may be a fear of opening up sexually due to cultural/societal influences that people receive (shame, taboo, rejection, being ‘labeled’, etc.) - and fear of being "nakedly" vulnerable in an intimate relationship. Finally, aside from one partner trying to increase the number of times they engage in sex and the other partner trying to accept less sex, for the best interest of the relationship (this isn’t a helpful solution).

Person v Relationship

I believe that affairs are more about the person taking part in the affair, than the relationship. The relationship is the stage in this theatre in my view. Redefining the complexity of two psychologies to make a renewed, harmonious relationship is important, but I really think the relationship is not to be faulted always for an affair. Sometimes I think the relationship is sort of like a naive bystander. But it plays a part, nevertheless, and has to be addressed.

Sexual Discrepancies

I have found it helpful to think about sexual discrepancies as:


     1. Problems in and of themselves

     2. Symptoms of other problems (e.g., medical, communication, compatibility, sex-role          differences, intimacy deficits, financial stresses, or power dynamics)

     3. Conditions to be lived with.

Depending on cause/correlates of the problem, difference interventions are available (such as reverse role plays, abstinence, sensate focus exercises, etc.).