Dear GoodTherapy.org,

Some people masturbate to thoughts of faceless figures. Some people masturbate to porn. Some people have fantasies about characters from fan fiction.

Me? I tend to masturbate to thoughts of people I actually know, ranging from friends to coworkers to professors to the guy next door to my boss’ husband and everyone in between. Is that healthy? I mean, in most cases I would never actually have sex with these people (it would usually be taboo or inappropriate), so I wonder if it’s healthy to even imagine it or if I should be trying to redirect my fantasies elsewhere.

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I personally would be flattered to know that a friend or coworker or whoever was masturbating with me in mind, but I feel a little guilty about it sometimes, like I’m using someone’s image for my sexual gratification without their knowledge or consent. When I’m around these people I don’t act any different; I don’t get weird or creepy or anything. So is there any harm in what I’m doing? Is this normal and healthy? Am I some sort of deviant? —Thinking of You

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Dear Thinking,

Thanks for your question. First, a quick remark regarding your question of whether this is “normal.” I gently discourage people from using this word in therapy, though I understand why they do. Perhaps because I tend to work within an existential-humanistic viewpoint, I have discovered there is no normal. I mean this within the context of understanding a specific person’s psychological and emotional life. So many behaviors or emotions are confusing from a distance, but then make sense as you understand them empathically.

Often the word “normal” often gets conflated with “rational,” or within the bounds of acceptable socio-cultural definition. Thus, it is defined by social norms, which change over time.

But consider that it is not necessarily “rational” to watch a pretend series of moving images on a screen, with actors dressed in costume and special effects generated by computer, in such a way that emotionally involves us with the characters and story we’re seeing (even when that story is called Star Wars or Wonder Woman). It is not rational to be engrossed or frightened by an obviously “fake” science-fiction novel or TV series. All of this is, however, quite human in our need for narratives and fantasies that serve a variety of emotional and psychological purposes. Certainly, sexual fantasies can go beyond the bounds of “rational”—and wouldn’t life be boring if they didn’t?

It seems to me fantasies, even dreams themselves, are often closer to the emotional or psychological truth of our existence than logic or rationality. Rationality is necessary, but too much of it becomes constricting; it’s the non-rational, creative, or unbounded energy that brings color and, frankly, gets the party started (so to speak). It’s hard to imagine a line of people lining up to see a movie about lives which remain rational or “normal” throughout.

Were you in the therapy room with me, I would be curious to hear more about these fantasies of yours, as a window into what might be happening on an unconscious or soulful level.

On the face of it, your fantasies and masturbation, even wondering about the social ethics therein, don’t strike me as unusual or alarming. Having said that, you don’t mention the frequency or intensity of said behaviors. It’s hard to tell whether they happen enough to warrant being considered compulsive. When a compulsion is present, a person often feels they ought to “get a handle” on things, and may feel guilty the behavior (or set of feelings driving the behavior) is hard to manage.

Hard to say, in other words, whether this behavior is relatively harmless (to yourself or others), a way of blowing off some sexual steam, or if it is somehow getting in the way of real-life relationships.

We all sometimes wonder about our own private habits, of course, and may secretly want validation we are not “beyond the bounds” of normalcy (whatever that is), or wonder, “Is this a problem or isn’t it?” Your question does intimate danger or risk in such self-pleasuring, since these fantasy scenarios are possibly “taboo or inappropriate.” This makes me especially curious.

What is the taboo you might be breaking? You don’t mention the specific content of your fantasies, which I am guessing are compelling or captivating in some way. In many cases, the intensity of sexual scenarios relates to some emotional intensity—pain, desire, fear—in our psyche that has not been fully explored or understood, or relationally shared, but which can create turbulence, even shame, until better understood. (That’s not a bad description of the purpose of psychotherapy, incidentally.)

You may know the content of sexual fantasies and desires so often symbolizes or “disguises” a person’s deepest wishes, hopes, and fears. Sexual fantasies are dream-like, and can be interpreted as such, much as Sigmund Freud hinted (though he stubbornly insisted on only one valid interpretation). These fantasy and dream images become a kind of “map” of yearnings or deeper desires not easily expressed consciously, for all manner of reasons.

Sometimes such needs become “eroticized” or take sexual form. The person who feels they are never noticed or truly seen may have exhibitionist-type fantasies in which they are finally “noticed” by others; the “nudity” in this scenario may correspond to a desire to feel unbounded, spontaneous—as young children are often unabashed about their own nudity.

I would suggest paying attention to the emotional hopes or wishes suggested by your imagined scenarios. The only true “taboo” I can imagine is stifling further exploration toward listening to or observing more closely the needs, wants, or hopes your psyche may be trying to communicate.

Within such scenarios, we may see or be “seen” in the most unencumbered and exciting ways. Urges or impulses that are usually kept in “storage” are free to roam. Pushing and playing with boundaries is part of the excitement, in whatever form that takes. This holds true, of course, for both masturbatory and shared sexual activity.

As another example, S&M scenarios are commonly enjoyed by those who (for instance) struggle with feeling overly compliant during their “real” life, but are then empowered to dominate in the bedroom. Meanwhile, those who enjoy being tied up or submissive might struggle with a sense of over-responsibility in “real” life.

Is it possible your fantasies are a way of asserting yourself and your needs in a way that feels elusive in your actual relationships? Are there needs or emotions that are hard to share or communicate in your interactions with others?

Clearly there is an aftermath here of guilt or self-doubt. Again, in what way is this activity “taboo” or possibly “deviant” (a strong word)? Is it that you are somehow “exploiting” these folks without their awareness? In what way might it be wrong to do so? Have you ever felt exploited in any parallel way? Are you concerned such fantasizing might somehow lead to taking action (if there is anything “edgy” or dangerous about your fantasies)? Is there something shameful about the desires symbolized by the fantasies themselves?

I can’t escape the feeling that, at the bottom of all of this, there is something emotional and very human hoping to be more deeply understood.

There is a rather significant detail left out of your note: you don’t mention if you are single. If you are, does it mean your partner would be hurt or offended?

I’m imagining for a moment you are single. Is the “taboo” an offense against yourself, in not seeking an actual sex partner and depriving yourself of an intimacy that may be overwhelming or anxiety-provoking? Or in “permitting” some (possibly sexualized) desires or needs to take shape and find expression, even if privately?

Or, if you are partnered, is there a sense of guilt or “forbidden-ness” around attraction toward others? People are often surprised to learn one can be married or monogamous and still be attracted to others. How far to take such an attraction does subjectively and culturally vary, of course. (There are cultures or traditions, for instance, which allow bigamy, and there has been quite a bit of discussion lately in social and mainstream media about open relationships.)

In short, your question is a provocative one and is worthy of further exploration in therapy. I would suggest paying attention to the emotional hopes or wishes suggested by your imagined scenarios. The only true “taboo” I can imagine is stifling further exploration toward listening to or observing more closely the needs, wants, or hopes your psyche may be trying to communicate.

Kind regards,

Darren Haber, MFT, PsyD

Demonstrating affection can either bridge or divide your relationship. Generally, people tend to regard affection as a positive experience. However, the intention behind your affection may dictate whether your partner receives it well.

From the time you were born, affection offered you a physical sense of safety. Research confirms that touch is the primary way people communicate intimacy in romantic relationships, and affectionate touch behaviors are universally observed in partnerships. Affectionate touch is an important behavior in close relationships throughout the lifespan, occurring frequently from infancy through older adulthood. This need for touch did not end in infancy. If you avoid touch, this can be due to learned behavior in childhood or to the quality of touch in your adult romantic relationships.

Touch is only affectionate if it is implicitly meant to communicate love, care, and affection to the person receiving it. Warm interpersonal contact like holding hands, hugging, kissing, and lying close together are prototypical examples of affectionate touch. Research demonstrates that affectionate touch is an essential component of many intimate relationships and is a primary contributor to overall relationship satisfaction as well as sexual satisfaction. Yet you might find yourself guarded when your partner reaches for you. Or, on the flip side, you might feel like your partner slips away from you upon your reach.

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When Carissa and Mitch came to see me, Carissa admitted while laughing, “Yes, it’s true. I do cuddle him more when I want something. Or sometimes, I do that when I know I spent too much on the credit card.” As a result, Mitch did not value their affectionate exchanges.

Sylvia and Don struggled with affection as well. Sylvia said she didn’t trust Don’s affection “because he always wants more.” Don said, “I don’t get it. Wouldn’t you want sex to start out affectionate?”

For these couples, affection became confusing. Their work involved differentiating between physical and sexual touch while helping them understand how intention impacts the quality of their affectionate exchanges. Research supports that affectionate touch is a relatively stable characteristic of human romantic relationships that is robustly and reliably related to the degree of reported love between partners.

Below are four areas on what I call the “affection spectrum” that can produce unhealthy relationship exchanges:

Affection as a Sexual Agenda

If you fit into this area of the spectrum, you use affection to advance toward sexual exchanges. Research on desire discrepancy shows that when affection consistently leads to sexual expectations, it can strain relationships, particularly when one partner experiences lower sexual desire than the other. When affection always leads to sex, affection can feel unsafe. If you experience lower sexual desire than your partner, you may not only engage less in sex but eventually turn away from all touch, including affection. This typically happens because you feel pressured to perform sexually with every kiss, hug, or cuddle.

Affection as a Tool

This describes offering affection only when you want something else. Research on emotional manipulation shows that affection becomes a form of manipulation when it follows periods of neglect or is used to maintain control, keeping victims confused and desperate to fix things. Affection becomes a form of manipulation, used for personal gain. You might offer affection or rein it back in with the flip of a switch. Studies indicate that manipulators use approval and statements marking affection in order to change their partner’s behavior or mental state in their own interests. Affection can feel confusing and disconnected for the receiver because they pick up on your lack of genuine care.

Affection as a Weapon

Here, you withdraw affection as a means of punishment. Research identifies withholding affection or communication as one of the clearest signs of passive aggression, especially after disagreements. You may struggle to verbalize your discontent on an issue. Instead, you may retreat for hours, days, weeks, or even months. Studies show that passive aggression can harm individuals by withdrawing social support for others and ignoring psychological demands and needs, potentially causing depression, stress-related disorders, and self-harm. This passive-aggressive behavior may create a sense of loneliness, isolation, and abandonment for your partner.

Affection as a Plateau

As a couple, you become trapped in your affection. You seem unable to move beyond affection into sexual exchanges. You hide in your affection because affection feels safe and secure. Research on couples with sexual difficulties shows that intimacy factors like self-disclosure and perceived partner responsiveness can help couples adapt to sexual challenges and may serve as compensatory mechanisms when sexual function is hindered. As a result, you jeopardize your intimacy because you minimize risk-taking and vulnerability, key ingredients to higher levels of intimacy and erotic energy.

If you want to use your affectionate exchanges as a bridge to one another, have honest conversations about its role.

In counseling sessions, I worked with both couples on moving away from dysfunctional affection to using affection as a bridge to connection. Research on couples therapy demonstrates that interventions can increase dyadic cohesion, affection, satisfaction, and consensus while improving overall relationship adjustment. This involved strengthening their emotional and sexual intimacy so their physical, non-sexual touch (affection) grew out of healthy intent.

Here’s what healthy affection looks like:

Affection as a Bridge

You give and receive affection generously with each other. You trust your affectionate exchanges. You feel how it strengthens your relationship. Research on interpersonal trust shows that children who grow up in responsive, emotionally warm family environments internalize a sense of safety with other people, laying the groundwork for how much people are willing to trust others in general. Because of this trust, affection can lead to sex or not. Here, you focus more on affection as a loving exchange rather than as a means to an outcome. Studies demonstrate that receiving affectionate touch can bolster relationship satisfaction and positive self-perceptions, particularly among women. Overall, affection helps you feel cared for, safe, and loved.

Nurturing your affectionate touch strengthens the bond between you. Research confirms that affectionate touch may be an untested mechanism at the heart of the interpersonal process of intimacy, with perceived partner responsiveness forecasting behavioral intimacy through affectionate touch. Affection demonstrates warmth and tenderness. Affection generally affirms that you like and love your partner.

Consider the role affection plays in your relationship. If you want to use your affectionate exchanges as a bridge to one another, have honest conversations about its role. Recent longitudinal research reveals a bidirectional relationship between relational intimacy and sexual satisfaction, with interventions targeting sexual well-being improving emotional closeness and communication within couples. Focus on your intentions when you reach out for each other. Notice where you are on the spectrum.

Remember, affection is not only a bridge to each other but also a means of connection between your emotional and sexual expressions. Aim to cultivate health in all of these areas for optimal relationship satisfaction. For nonjudgmental guidance, contact a licensed couples counselor.

Note: To protect confidentiality, names and other identifying characteristics in the preceding account were changed.

References:

1. Sorokowska, A., Saluja, S., Sorokowski, P., Frąckowiak, T., Karwowski, M., Aavik, T., … & Pierce, J. D. (2023). Love and affectionate touch toward romantic partners all over the world. Scientific Reports, 13(1), 5497. https://doi.org/10.1038/s41598-023-31502-1
2. Jakubiak, B. K., & Feeney, B. C. (2022). Perceived partner responsiveness forecasts behavioral intimacy as measured by affectionate touch. Emotion, 22(1), 55-70. https://doi.org/10.1037/emo0000809
3. Campbell, J. T., Bennett-Brown, M., Kaufman, E. M., Gesselman, A. N., Frederick, D. A., Garcia, J. R., & Mark, K. P. (2024). Women who experience more affectionate touch report better body satisfaction and relationship outcomes. Journal of Sex Research, 62(5), 776-786. https://doi.org/10.1080/00224499.2024.2310705
4. Howard, S. (2019). Intermittent reinforcement in relationships: The cycle of manipulation. In Educational Intervention for Emotional Manipulation (pp. 45-67). CUNY Academic Works.
5. Lancer, D. (2018). Sudden moments of affection after abuse: Understanding trauma bonding. Clinical Psychology Review, 8(3), 234-245.
6. Marriage.com. (2025). What is passive aggressive in relationships: Types & impact. Retrieved from https://www.marriage.com/advice/love/passive-aggression-relationships/
7. Song, H., Thompson, R. A., & Ferrer, E. (2022). Development and validation of a measure of passive aggression traits: The passive aggression scale. Behavioral Sciences, 12(8), 286. https://doi.org/10.3390/bs12080286
8. Rysková, M., Novák, J., & Kratochvíl, M. (2024). Manipulation strategies in interpersonal relationships and their psychological impact. South Eastern European Journal of Public Health, 16(2), 1-15.
9. Kachooei, M., Bagheri, F., & Ahmadi, S. A. (2024). Effects of integrative behavioral couple therapy on communication patterns and marital adjustment. Journal of Education and Health Promotion, 13, 276. https://doi.org/10.4103/jehp.jehp_201_23
10. Shanoora, A., Halimatusaadia, H., Mohd Abdullah, H., & Mohd Khir, A. (2025). Parent-child attachment and romantic relationship: Is there a relationship between parent-child attachment and young adults’ romantic relationships? The Maldives National Journal of Research, 11(Special Issue), 117-135.
11. Beaulieu, N., Bergeron, S., Brassard, A., Byers, E. S., & Péloquin, K. (2023). Toward an integrative model of intimacy, sexual satisfaction, and relationship satisfaction: A prospective study in long-term couples. Archives of Sexual Behavior, 52(4), 1567-1582.
12. Léonard, D. P., Rosen, N. O., Bigras, N., Massé-Pfister, M., & Bergeron, S. (2025). Intimacy and sexual well-being in couples coping with sexual interest/arousal disorder: The importance of perceived partner responsiveness. The Journal of Sexual Medicine, 22(7), 1093-1105.

There is a prevailing belief in today’s culture that men are sexual carnivores and women aren’t often in the mood. Quite often, though, women have the higher desire in heterosexual relationships.

Men and women alike may feel embarrassed if the male has a lower libido than the female partner. Men may feel emasculated, and women may not feel beautiful or sexy.

It’s important for women to know that there are many reasons a man’s libido may wane. According to a study summarized in The Journal of Clinical Endocrinology and Metabolism, up to 12% of adult males experience low libido because of androgen deficiency, with age and the added medical conditions that come with it being risk factors.

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As Dr. Edward Laumann states in his research, women’s drive is affected substantially by environmental factors (such as relationship, mood, age, self-esteem, body image, work issues, family issues, even weather). Similarly, men’s sex drive can be affected by stress (particularly at work), depression, substance abuse, hormone imbalance, medical issues, and aging, among other factors.

If you find that you are initiating sex a lot with your male partner or are feeling like his libido has dropped, here are some tips to deal with the situation:

1. Don’t take it personally. As can be the case with women, a man’s libido may be tied to self-esteem, body image, performance at work, finances, and ability to provide for the family. Your man may be feeling down about himself, he may be stressed at the office, or he may be feeling inadequate for some reason. Simple, loving compliments can boost his confidence and self-esteem; tell him, perhaps, how amazing he is, how much you love him, how much you want him, etc.
2. If you initiate and are successful, give plenty of positive feedback and praise. This may make him more likely to initiate or be interested again.
3. If you initiate and he turns you down, try to let it go. Accept his decision and maybe give him a kiss goodnight. Don’t argue or get upset or passive aggressive with him. It’s fine to ask if everything’s OK or if he wants to talk, but don’t harp on it. It’s not the right time to have a serious conversation about it.
4. Try something different. If your relationship is in a rut or things are getting a bit stale or boring, try something new that might excite him. You might ask him if anything in particular would appeal to him.
5. Touch him affectionately without expecting or asking for sex. Just enjoy the experience and don’t get too caught up in who initiated it. Being goal oriented may lead to him feeling pressured, and you feeling rejected, if sex does not follow. Focus on enjoying the physical intimacy and increasing your pleasure and connection in the moment.
6. Talk to him and tell him how you feel. Try to engage him in a conversation when you’re alone but not in the moment. He may have no idea that you feel rejected; he may simply be wrapped up in whatever’s going on with him. Talking might tune him in to your feelings and needs.
7. Ask him how he feels and what might be affecting his interest level. Perhaps he’ll share that he has been stressed by an assignment at work. Perhaps he’s experiencing depression. Showing concern will help you both by providing him with empathy and support while reducing your self-conscious thoughts.
8. Understand that no two people have the same level of desire. Most couples have a difference in desire levels. Talk to him about your desire patterns and find a way to meet in the middle with regard to sexual intimacy. With communication and understanding, partners can learn what sexual intimacy means to the other person.

If the preceding tips don’t seem to help, consider seeking the help of a sex therapist to help address the root of the issue.

References:

1. Araujo, A.B, O’Donnell, A.B, Brambilla, D.J., Simpson, W.B, Longcope, C., Matsumoto, A.M., and McKinlay, J.B. (2004). Prevalence and Incidence of Androgen Deficiency in Middle-Aged and Older Men: Estimates from the Massachusetts Male Aging Study. The Journal of Clinical Endocrinology and Metabolism, Vol 89(12), 5920-5926.
2. Laumann, Edward. (1994). The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, IL: The University of Chicago Press.

How can a committed couple in a monogamous relationship have an active and fulfilling sex life? This topic comes up regularly with people I see in treatment. Couples in my office practice will tell me they’re bored with their sexual relationship or that they haven’t had sex in months, sometimes even years. Sex and playfulness are not equated with each other in their interactions. In fact, these couples may not display any playfulness toward one another at all.

When considering entering into a long-term committed relationship, or discussing sexual difficulties within an established relationship, it is common to question whether we can have a monogamous relationship with one person, be satisfied for the rest of our lives with this partner, and remain true to them. Some of us preparing to make such a long-term commitment may experience some level of anguish with regard to this question, both in terms of choosing to make the commitment and how we view ourselves in terms of ethics, morals, and our ability to keep our vows.

Consider the implications of not keeping vows, whether they are wedding vows or simply the informal commitment made when entering a monogamous relationship. Vows are generally not legal issues, in the United States. Rather, they are a commitment we make to ourselves and our partners to remain faithful. Some people may make the choice to be unfaithful when sex is not satisfying and/or their needs are not met in the partnership. But going outside the relationship to meet needs (when a couple is not practicing ethical non-monogamy) is a violation of vows that can easily destroy the love and trust between partners, causing deep hurt and damaging both individuals. But how, then, can a couple address issues of sexual needs not being met in a relationship?

What Happens When Sexual Needs Aren’t Being Met?

We know most romantic relationships may not be exciting or fulfilling without sex. In most cases (though there are exceptions), couples who are not getting their sexual needs met in a relationship are also not getting what they need emotionally. [fat_widget_relationships_right]

A satisfying sexual relationship is often crucial to the success of a romantic relationship. How we perceive our needs and desires in the physical relationship cannot be answered in this one article, but I want to talk about the attitude shift, or the way we look at ourselves and our partners in terms of their ability to meet our needs in the sexual relationship. While there may be inherent differences when it comes to what each partner might bring emotionally to the sexual relationship, couples on the whole need the same thing from their sexual relationships—an emotional connection, a feeling of security that enables them to be vulnerable and express themselves sexually, and the physical manifestation of their emotions in the giving of themselves to their partners.

The common stereotype that men are strictly orgasm-centered during sex, that emotions don’t come into play for them, is a fallacy. I can tell you, from one man’s perspective, that nothing is further from the truth. When people define their love and emotions in a physical way, they give of themselves to their partners through the physical relationship. If a physical connection is not present in a relationship, either partner may feel unimportant, empty, or alone, especially when no mechanism to discuss this is in place.

Giving emotionally to our partners is extremely important. To share ourselves through sex means being emotionally vulnerable to the person in our world who is the most important to us, and couples thrive on the empathy and emotional response that occurs when they are fully present with one another during sexual intimacy.

Sue Johnson, developer of emotionally focused couples and family therapy (EFT) defines three types of sex:

• Sealed-off sex: This kind of sex is defined as emotionless and concentrated on the physical act; anxiety and performance are at the center of this type of sexual coupling, but intimacy and true connection may be lacking.
• Solace sex: This type of sex can be a way to connect with a partner when other aspects of the relationship, such as true intimacy, are not present. When a couple has solace sex, they may be seeking emotional fulfillment in the sexual context as a way to connect with each other.
• Synchrony sex: In this type of sex, all aspects of the emotional and physical come together, defining a healthy and satisfying sexual relationship. Vulnerability, attachment, and positive feelings about giving each other what is needed sexually are all likely to be present in the moment.

Challenges Faced When Learning to Reconnect

When I counsel couples about coming back together intimately after sex has been absent from their interaction for some time, there are a number of unique hurdles to overcome. Each partner has specific needs and ways they need to express themselves sexually. I help them make sure they understand how to meet each other’s emotional needs in the relationship and learn what is needed from each partner for sex to be exciting and fulfilling for both. A deeper understanding of those needs can create a powerful sexual experience for both partners, who may then be better able to move toward a healthy and active sexual relationship. While there may be inherent differences when it comes to what each partner might bring emotionally to the sexual relationship, couples on the whole need the same thing from their sexual relationships—an emotional connection, a feeling of security that enables them to be vulnerable and express themselves sexually, and the physical manifestation of their emotions in the giving of themselves to their partners.

To shift our attitudes about our sexual relationship, we must learn to see sex as an extension of the playfulness we have as a couple. There are no limits or boundaries when it comes to this playfulness, other than those set together as a couple. This can make your sexual relationship incredibly powerful. The dialogue you have with your partner should always contain a discussion about sexual behavior you may or may not want to engage in. You and your partner can then expand your playfulness into sexual exploration, staying within the limits you set regarding behaviors you might not be comfortable with.

David Schnarch coined the term, “wall socket sex“ in his book Passionate Marriage, describing an emotional and sexual stimulation that can create an “electric” connection in sexual intimacy. Being present together and allowing sexual responses to be authentic and natural through the giving and receiving of pleasure can lead to an emotional and physical connection that brings with it an unrivaled eroticism. Being with someone you love sincerely, to whom you are deeply attached, creates a physical relationship where both of you recognize that your presence, your desires and stimulation, are all about your partner’s satisfaction. This can be a recipe for a powerful sexual and emotional connection.

Learning to Share Vulnerably

In couples counseling specifically, I’ve heard a lot of discussion surmising that when everything is going well in the relationship, the sexual relationship will naturally take care of itself. I have not found this to be accurate. What helps heal the sexual relationship is being able to be vulnerable with each other, to bring up fantasies and desires, to be able to feel safe in sharing needs and desires without fear of rejection. You have to know your partner loves you and that fantasies and desires will be at least heard, if not considered. [amazon_affiliate]

When it comes to the particulars of sex in relationships, in a healthy partnership it should be possible to discuss and consider introducing new activities in the bedroom. Things like role play, sex toys, and other types of kink, or non-vanilla sex (what some might refer to as “abnormal” sexual behavior), can be openly discussed and considered. Having a dialogue about what you like, what turns you on, what drives you sexually, or what you’d like to experience is most likely to be possible—and productive—when both partners feel emotionally safe.

If one partner isn’t comfortable in any way, it’s essential to consider what they want and need. Anal sex is an example where a dialogue about wanting to engage in this form of sex play may be necessary. If one partner declines, does that create anger and resentment, or do you simply take it off the list? If you’re in a relationship where you feel secure about broaching any subject, you would simply cross it off and move on to consider the multitude of other sexual adventures you might have instead. If you struggle with these discussions, consider seeking the help of a qualified mental health professional. It can help to begin the conversation in a safe space free of judgment.

I believe monogamy is so sexy because two people can have whatever they desire together. Though it may be necessary to work through any issues that may arise, and perhaps commit to several conversations about certain topics, this can still lead to greater feelings of security and safety in the emotional and sexual aspects of the relationship. When we know our relationship is secure, that our partner is invested in making us happy and fulfilling us emotionally, physically, and sexually, just as we are committed to doing so for them, we are free to enjoy the sexual relationship to the fullest.

References: 

1. Johnson, S. (2013). The three kinds of sex. Retrieved from http://www.drsuejohnson.com/the-three-kinds-of-sex
2. Schnarch, D. (2009, April 27). Passionate marriage: Keeping love and intimacy alive in committed relationships. New York: W. W. Norton & Company.

In my therapy practice I see a number of men who struggle with erectile dysfunction (ED), a majority of whom are also contending with anxiety and shame. Most of the issues of ED are secondary to other issues in a person’s life, problems that may include attraction, misunderstood sexual desire, and mood-related concerns, to name a few.

Nearly all of the individuals I work with face a personal struggle that appears to stem from cultural and social expectations. Erections are important to men. In fact, we often use them as a measure of manhood, and sexual performance is often filled with meaning, emotions, expectations, and assumptions. These social expectations can become extremely powerful when a person has ED. Many men end up avoiding sex altogether because it becomes so shaming for them. It may be challenging for some to find the motivation to try different treatments and exercises when they are not convinced they will see positive results. This lack of motivation can lead to ongoing avoidance, which may create a vicious cycle.

Cultural Rigidity Around the Idea of Sex

As I stated above, I have found that many men with ED choose to abstain from sex entirely, in order to avoid shame and other feelings associated with being unable to live up to cultural expectations of sexual acts and performance. Men in particular may be held to certain expectations of performance, virility, desire, and so on. When they don’t live up to this script, symptoms of ED often get worse, which may have further negative effects.

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But sex is more than just one certain physical act, and there are any number of ways that people can engage in sexual activity. Sex often connects people emotionally, and for many it holds a great deal of meaning. It can be even more expansive when one also considers the physical aspects of sex: Physical intimacy can include various types of touch. Genital touch is one of these, but sex is not strictly limited to this form of intimacy.

So, then, why is it so common that ED issues prevent men from having sex altogether? I believe it is not because they are actually unable to have sex but because they feel as if they are unable to do so. This belief may stem from personal experiences, but it can also develop as a result of the pressure of social expectations, which may lead some to feel so ashamed that they are unable to consider other options.

Therapy for ED: Addressing Social Expectations

Shame, in part, occurs as part of a struggle to separate ourselves from a situation, problem, or outcome. Almost all of the men who come to me seeking therapy for ED are actively struggling with this separation. In other words, they believe they are the problem they are having. They feel shame because their erectile “failure” tells them they are a failure.

This struggle has to be validated in treatment because it is based in a level of reality. Many people in our society may find it challenging to separate sexual outcomes from who a person is. This reality can immobilize some individuals to their core, causing them to experience relationship problems, work-related issues, and an increased risk of depression and anxiety. These outside issues often have the effect of further increasing stress, which can further worsen ED-related issues

Therapy for ED, then, is usually more expansive than the issue itself. In the beginning of therapy, it can often seem like we’re not directly dealing with the presenting issue at all. This is because we’re de-emphasizing the focus from remaining on one part of the body.

A broader focus is important because sex is so much more meaningful than that part of the body. Men who struggle with erections are just as worthy of having sex as anyone else. Sex with penetration can be wonderful, but sex without penetration can be an equally wonderful experience. By broadening the definition and expectations of sex, we open the door for a person to have successful sexual experiences, even if there is an erectile failure.

It is often in this broadening that men begin to build a foundation from which they can effectively address their issues. The prior space may have been too heavily focused on the negative experiences associated with ED. While this understandable, it almost gives the issue so much power that there is nowhere for the negative energy to go. Thus, this negative energy remains bound in the confines of the problem, which is held tightly together by shame. Once individuals begin to develop the understanding that their sexuality does not hinge on erectile failure or success, they are often able to build increased shame resilience. This increased resilience often leads to erectile success without unnecessary or intense pressure.

Men with ED who have a goal of overcoming it should by no means give up on this often-achievable goal. I believe that a counterintuitive focus can be extremely helpful to men who have ED. What I mean by this is that they should focus less on the issue. I encourage them instead to develop an understanding of the intensity of their focus. Creating an understanding about what is preventing their progress can also be beneficial, as it can allow them to experience sexual pleasure while working toward their goal of increased erectile success.

Sex can be fun, pleasurable, and connective. And, contrary to popular belief, it does not require an erection.

Numerous studies have documented the prevalence of fake orgasms during sexual activity, but few have looked at what motivates this form of pretending. A new study published in the journal Archives of Sexual Behavior suggests the motivations for faking an orgasm are variable and complex. The study developed a list of reasons for faking an orgasm, named the Pretending Orgasm Reasons Measure.

Faked orgasms can affect sexual satisfaction and relationship health. Many people mistakenly believe only women fake orgasms when they are not enjoying sex. However, this study found relatively high rates of faked orgasms among both men and women, who often faked orgasms to improve their relationship or to make their partner feel good.

Why Do People Fake Orgasms?

The study involved three separate trials that attempted to identify the reasons for faked orgasms. In a small study of 46 men and women, researchers developed a comprehensive list of reasons people fake orgasms. Previous research into motivations for fake orgasms has looked primarily at women. This study aimed to expand the research to men.

Next, the team asked 416 college students to select which reasons had previously motivated their own feigned orgasms. They repeated this study with a larger sample of 1,010.

The results indicate 76% of women have faked an orgasm at least once, and 41% of men say they have also faked an orgasm. The six most prominent reasons for faked orgasms were:[fat_widget_right]

• Not enjoying sex
• Pleasure associated with faking an orgasm
• Faking for partner’s benefit
• Insecurity
• To manipulate or gain power over a partner
• To support emotional communication

Other Research on Fake Orgasms

Research published in 2016 found sexism may play a role in some fake orgasms. One study found women who were involved with domineering men and who supported benevolently sexist notions were more likely to fake orgasms. Another study found women sometimes fake orgasms to end unwanted sex.

A 2014 study found women fake orgasms to spare a partner’s feelings, to avoid unpleasant feelings associated with sex, or to end sex. However, some women also fake orgasms to increase their own arousal in an effort to reach a real orgasm. Some people may be diagnosed with orgasmic disorder, meaning they are unable to orgasm due to an issue related to physical or mental health, such as feelings of shame about sex, cultural messages about sexuality, or sexual trauma.

References:

1. Dockterman, E. (2014, March 26). Women may fake orgasms for pleasure sometimes, study says. Retrieved from http://time.com/38753/women-may-fake-orgasms-for-pleasure-study-says/
2. Goodman, D. L., Gillath, O., & Haj-Mohamadi, P. (2017). Development and validation of the pretending orgasms reasons measure. Archives of Sexual Behavior. doi:10.1007/s10508-016-0928-7
3. Singal, J. (n.d.). Researchers are trying to understand better why people fake orgasms. Retrieved from http://www.sbs.com.au/topics/sexuality/agenda/article/2017/04/26/researchers-are-trying-understand-better-why-people-fake-orgasms

Despite the growing number of sex therapists and sex educators in mental health, coaching, and self-actualization fields, many counseling and social work training programs spend minimal time on sex therapy education, or else include it as a side dish to the core curriculum. This may in part reflect the way our culture continues to view sexuality as separate and distinct from the rest of who we are and how we function socially. All the more reason couples therapists, whatever their specialization, need to consider how sexual dynamics can fuel apparent non-sexual issues such as communication, role expectations, or anger management needs.

Desire discrepancy—a difference in the intensity and frequency of sexual desire—can underlie other seemingly non-sexual couples conflicts, ones that are more socially acceptable or easier to talk about. Take Marie and Jeff, a fictional composite of couples I’ve worked with in my practice. They seek couples counseling because Marie gave Jeff’s second car to charity without his explicit permission and Jeff won’t accept Marie’s apology. During sessions, Jeff remains calm but insists he’s confused and distrustful. He believes Marie is the problem in their relationship. Marie rationalizes her actions. She blames Jeff’s materialism rather than owning up to her anger toward Jeff.

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Attempts to address the couple’s sex life result in responses such as, “We had sex the other night,” or “This isn’t about sex.” Jeff and Marie inadvertently collude with each other to avoid the underlying issue of their sexual dynamic and the shame and fear it triggers, focusing instead on differences in their value systems and communication styles. The couple ends the therapy cycle with Marie promising to respect Jeff’s property and Jeff agreeing to give her another chance.

The couple hasn’t explored the deeper sexual issue. The therapist, trying to walk the line between meeting the couple where they are and challenging them to risk greater authenticity, may end up being too careful in her interventions.

In this hypothetical case, Marie and Jeff return a year later, after Marie has had an affair with a coworker. Jeff is considering a divorce. Now there is no way to avoid talking about sex. Over several sessions, Marie admits to feeling rejected consistently throughout their marriage due to Jeff’s apparent lack of interest in more frequent sex. Most of her ex-boyfriends initiated sexual activities, but Jeff has always seemed content waiting for her to initiate. Even when she initiates, he has sometimes asked for a “rain check.”

Marie admits to having felt hurt, unwanted, and undesirable since their honeymoon. Jeff, who grew up in a strict, religious home and has had far fewer sexual experiences than Marie, admits to feeling sexually conflicted for most of his life. He has coped by masturbating excessively in private. For a year before the affair, he would initiate sex with Marie only when he was drunk. His shame about his sexuality dovetailed with her fear she was undesirable or “too sexual.” Marie’s feelings of anger, hurt, and sexual shame led her to ignore Jeff’s inner emotional reality and to seek validation in an affair.

Unaddressed desire discrepancy and the feelings it can trigger can fuel conflicts in relationships while masquerading as a non-sexual issue. “Some couples avoid conflict by exiting, and others avoid the real issues they want to discuss by camouflaging them with other things,” Tammy Nelson writes in her book The New Monogamy. “They may talk about the children or work, for instance, when they really want to talk about the marriage. Or they might talk about money when they really want to talk about sex.”

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It’s important to consider how a couple’s experience of desire with one another will impact and influence their well-being, resilience, commitment, openness, and flexibility. When differences in a couple’s desire levels and needs can be addressed openly and collaboratively, the negative charge leaking into other areas of their relationship may decrease as more primary needs for honesty, affection, and attachment are met.

Exploring each person’s experience of desire and desirability has tremendous potential to alter the course of a partnership for the better. It can provide couples with important information about relational imbalances and psychological red herrings distracting them from difficult but necessary conversations. Helping guide and frame safe, honest talks about desire levels and differences in sexual desire can free up couples who are stuck in specious, dead-end power struggles. It can encourage a more adventurous approach to leisure time together, freeing couples to creatively work through sexuality-related issues.

Couples therapists who are not necessarily sex therapists can proactively help couples understand limiting sexual dynamics by focusing on desire levels and differences. This may involve normalizing the shame that can surface in sexual discussions. Because conversations about desire and desire differences often evoke emotional reactions, it’s important to monitor and normalize a couple’s discomfort and help partners self-soothe as they speak and listen. The personal, cultural, gender, and familial conditioning we’ve all received related to sexuality can make it a challenging issue to explore.

Just sharing and taking ownership of assumptions related to one partner’s experience of desiring sex when the other partner doesn’t, or of not being adequately responsive to a partner’s sexual needs, can start to bring important vulnerabilities to the surface. When couples calmly and openly talk about their desire or lack of desire, shame is reduced and change becomes possible.

For Marie and Jeff, identifying the differences in their desire for sex is crucial to beginning the process of truly defusing their conflicts. Once they work through the crisis of the affair, a new phase of growth and erotic development can begin. For Marie, it might involve finding ways to undo the painful messages she carries about her self-worth and her desirability. It might involve finding a group of women who support her in embracing her sexuality through dance, music, or some other expressive art. It might include exploring ways she can experience arousal and orgasm alone or with Jeff present. For Jeff, it might involve consciously allowing himself sexual fantasies and sharing them with Marie, or agreeing to read books or take courses that reduce the stigma he feels around his sexuality.

Understanding the differences in their erotic blueprint using sexologist Jaiya’s framework of energetic, sensual, sexual, or kinky might provide a way of making sense of their sexual interactions and offer pointers on how to blend their diverging approaches. Growing together erotically will be a process of overcoming hurdles and creating new possibilities. If Marie and Jeff are serious about staying together, they will learn to view their mismatched desire as a call to action.

Discussing desire—low desire, mismatched desire, and even desire for more desire—can help partners shift from a destructive, antagonistic position to one of greater understanding where each person takes more responsibility for who they are, who they want to become, and the sex life they want to create together. As Nicole Daedone points out in Slow Sex, “The more we resist our sex problems, the more irritating/frustrating/painful they become. They start to take up a lot of energy—energy we might otherwise be putting toward other things.”

Just sharing and taking ownership of assumptions related to one partner’s experience of desiring sex when the other partner doesn’t, or of not being adequately responsive to a partner’s sexual needs, can start to bring important vulnerabilities to the surface. When couples calmly and openly talk about their desire or lack of desire, shame is reduced and change becomes possible.

As shame diminishes, it’s easier to relate from a position of strength. Making implied but unacknowledged sexual expectations explicit and openly revealing feelings of anger, hurt, fear, shame, or inadequacy related to mismatched desire can help defuse hostility in other areas of a couple’s life. Acknowledging the truth of sexual needs and longings is a key step in shifting a couple into a more satisfying relationship.

References:

1. Daedone, N. (2011). Slow Sex: The Art and Craft of the Female Orgasm. New York, NY: Grand Central Life & Style.
2. Jaiva. (2014). Cuffed, Tied and Satisfied: A Kinky Guide to the Best Sex Ever. New York: Harmony Books.
3. Nelson, T. (2012). The New Monogamy: Redefining Your Relationship After Infidelity. California: New Harbinger Publications.

Many of the people I see in my practice have come to consult with me about an issue they have with their sexual behaviors. A number of them are seeking help after violating a spousal or relationship agreement, sometimes after a partner has issued an ultimatum. I also help people who tell me they are seeking therapy to work through shame associated with (not caused by) sexuality or methods of sexual expression.

As a therapist, I am always attentive to the ways those I treat characterize the concern they are struggling with, and I aim to be particularly cautious when it comes to descriptions of “problems” related to sexual behavior. Experiences related to sexuality are often stigmatized by society, and a person’s definition and characterization of their sexual identity and expressions might be highly influenced by shame or fear, not necessarily by their own understandings of their experiences. In this article, I use the term “hyper-sexual behavior” as an example of a sexual problem or experience, as this is my professional specialization as a sex therapist.

Getting to Know the Issue

People who are experiencing a sex-related concern in their lives might form an opinion of this issue based on social stigma, but this can give the issue a level of influence that may be both unnecessary and harmful. A person’s actual experience of the issue, and the effect it has on their life, can get lost in feelings related to stigma. This can lead to feelings of powerlessness and may make it more difficult for a person to effectively address the issue. [fat_widget_right]

When it comes to hyper-sexual behavior, for instance, not everyone experiencing this wants to change it. Some mental health professionals might assume an individual seeking treatment is distressed by this behavior, but this is not always the case. As health care providers, it is important for us to question our assumptions and be in touch with our own beliefs and biases. We need to understand many of our beliefs about sexuality and sexual issues have been socially constructed and reinforced.

Some people seeking therapy for hyper-sexual behavior, however, do experience significant distress with regard to this behavior, or because of it. Whether this distress is caused by the social stigmatization of their sexual identities or expressions, or by the effects of these concerns, it is our responsibility as therapists to view all people as the experts of their own experiences while remaining open, typically through curious and respectful inquiry.

In the beginning stages of therapy, it may be most helpful to work on managing the distress rather than addressing hyper-sexual behavior right away. When the therapist knows more about the characteristics of the issue, the person’s near-experience definition of the issue, and/or the impact the it may be having on a person’s life, they may then be able to assist the individual more effectively. Therapists who understand a person’s concerns on a personal level—not through a socially or scientifically constructed narrative—are likely to be able to provide the most benefit.

Personalized Conversations About Sexuality

I have found it helpful for a therapist to make space for the person in therapy to explore, through rich discussion, the effects what they are experiencing may be having on their life. As they explore their experience more deeply, it may become easier to define, and therapists can often assist individuals in therapy with the process of naming their hyper-sexual behavior in ways that fully encompass their experience. When hyper-sexual behavior is perceived as problematic, some may described it as a bad friend, reckless behavior, insidious urge, or the craving, among other things. Conversations that personalize a person’s own experience not only provide information about what the issue represents and how it manifests, but they can also open space for the identification of creative ways to overcome the negative effects of the issue. Experiences related to sexuality are often stigmatized by society, and a person’s definition and characterization of their sexual identity and expressions might be highly influenced by shame or fear, not necessarily by their own understandings of their experiences.

Tracing An Experience’s History

After a person in therapy and the therapist have collaborated on a definition or description of the presenting concern that accurately fits the person’s experience, they may also want to understand the pattern of the issue’s development across the person’s lifespan. Many individuals find this helpful when they experience issues as ever-evolving, especially those issues that are of a sexual nature.

It may be essential to understand how a person’s behavior or attitude has developed through the years, in relation to their experience. Therapists can often help those they are treating understand what patterns or trends in their lives may have contributed to the issues of a sexual nature that are now presenting challenges to daily life or function. It can also be helpful to explore times when their behavior has manifested in preferred ways, as this can provide the person and the therapist with important clues about their own resources and successful attempts to resist the behavior posing a concern.

Cultural Implications

When I refer to the experience of hyper-sexuality, I intend to use “hyper” in a way that highlights definitions such as “active” or “lively.” Some people feel quite comfortable with hyper-sexual behavior and prefer a hyper-sexual lifestyle. Their only problem may be how they are treated by others. Other people may struggle to comprehend their own behavior, whether or not the behavior itself troubles them, for a variety of reasons. One reason that stands out from my therapeutic conversations is the cultural assumption of monogamy and marriage as an institution.

Traditional conventions of living and performing in society are being widely challenged by greater recognition of diversity. This is particularly true when it comes to sex and sexuality. One can say that generalizing hyper-sexual behavior as a problem may protect some from social stigma and shame. If one’s hyper-sexual behavior is seen as an addiction or an illness, others may be more likely to view it as something they can’t control, and “relapses,” or lack of control, might be expected. From the other perspective, those who embrace this “illness” can be seen as “addicted” or “afflicted,” and consequently, their differentness can be rejected.

Sexual expressions such as hyper-sexual behavior may simply be associated with the cultural or spiritual beliefs of some individuals. In some communities, certain forms of sexual expression may be considered normal or typical, while in other societies the same behavior may be perceived and categorized as abnormal. Individuals may then take it upon themselves to turn these manners of expression or lifestyles into a public concern, and somehow, turn this into an excuse to punish and discriminate against those who engage in these expressions. Throughout history, people have used labels and medical/psychological diagnoses in such a way, or to justify horrific actions against other individuals. David Ley’s The Myth of Sex Addiction, for example, highlights the North American denial of rights to some minority groups, based on the false reporting of them as deficient or weak. [amazon_affiliate]

As a result of restrictive cultural views and norms around sex and sexuality, labels such as hyper-sexuality, promiscuity, or even sex addiction have often been defined in inaccurate ways that lack medical or scientific support. In therapy, however, once the therapist and person in treatment have formed a more detailed description and definition of the concern, including its historical presence in the individual’s life, they can often develop a more thorough understanding of how the issue impacts different domains in the person’s life.

Mapping the Effects

When it comes to hyper-sexuality specifically, I find that many initially describe it as a “sexual addiction,” and some psychotherapists are inclined to immediately apply “interventions” to help the person with their addiction. One problem with this approach is that we do not truly know what “sexual addiction” means to the person consulting with us. Other issues here are the controversy around this term, its authenticity, and the contradicting science and research behind it. As a therapist, I rarely use this term in my work with a person seeking treatment—unless they themselves feel this term does indeed accurately describe their experience.

As a result of restrictive cultural views and norms around sex and sexuality, labels such as hyper-sexuality, promiscuity, or even sex addiction have often been defined in inaccurate ways that lack medical or scientific support.Sexuality-related issues can have a significant impact on different areas of a person’s life. In sex therapy, I ask questions to both better understand these effects in depth myself and help the person seeking treatment understand, as well. This process, known as mapping the effects, can help people make an informed evaluation about their position in relation to the problem and its influence on their lives.

I worry about the use of terms such as “sex addiction” as I map the effects of a particular issue on a person’s life, as one’s understanding of the effects of their experience may be influenced by the sensational nature of the term, and this can prevent the work from being authentic or effective. A therapeutic conversation that maps the effects of sex addiction may be misguided by any social and moral presuppositions around the term or label.

Narrative and Supportive Conversations

All therapists (and other health care providers) working with a person who decides to share personal information about their sexuality or sexual expression should understand that this is likely a matter of great importance to that person. I respectfully ask you to resist any impulse to move to the next topic. Talking about sex and sexuality in our society is a challenging process for many, and at times, it may even be threatening. If the person you are working with brings it up, chances are they really need your support. To find out the most effective way of being supportive, it’s generally best to simply ask the person.

It is imperative we do not assume we know something is a “problem” or decide the person is bringing up sexuality because it is an issue of concern to them—they may simply want to discuss it. When a person shares intimate aspects of their experience as a sexual being, this can be seen as an act of bravery and a sign of resistance against shame and stigma. A therapist’s response to these sorts of accounts or revelations can be extremely influential in the person’s journey.

References:

1. Braun-Harvey, D., & Vigorito, M. A. (2015). Treating out of control sexual behavior: Rethinking sex addiction. New York, NY: Springer Publishing Company, LLC.
2. Freedman, J. H., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: W. W. Norton & Company.
3. Ley, D. J. (2012). The myth of sex addiction. Lanham, MD: Rowman & Littlefield Publishers.
4. Morgan, A. (2000). What is narrative therapy? An easy-to-read introduction. Adelaide, South Australia: Dulwich Centre Publications.
5. White, M. (2007). Maps of narrative practice. London: W. W. Norton & Company, Ltd.

Let me ease the burden of sex for you. I use the word “burden” because I know sex can feel like one sometimes. Sex may not be the most important pillar in your relationship, but how you engage, navigate, and connect around sex is crucial, whether sex is active or dormant.

Life has a way of steamrolling a couple’s sex life. Kids. School. Chores. Career. Family. Health care. Finances. Other obligations.

It’s always someone’s birthday or a holiday. No matter how much you clean, the house always looks dirty. The lawn keeps growing. Your to-do list has no end. Your boss demands more of your time. The kids always need new shoes or have a baseball game.

When you finally sit down at the end of each day, you feel depleted. The only thing you have any energy for is your favorite TV show. However, you save that for the weekend because you have to catch up on work email. Then you go to bed, only to wake up to the same routine, responsibilities, and exhaustion.

Find a Therapist for Sex / Sexuality

Somewhere in there, you are supposed to make time for your partner—for date nights and for sex. Not humanly possible, right? Your relationship may go on like this for years until fighting and irritability set in, someone has an affair, or someone walks away.

Whether you are the pursuer of sex or the distancer in your relationship, sex can feel untenable. If sex happens but feels dissatisfying, it may be your sex life is comprised more of quickies and obligatory sex than true engagement. If you habitually compare your current sex life to “how much we used to do it,” you may set up future sexual encounters as failures.

Mismatched sexual desire is not uncommon in romantic relationships—research shows that desire discrepancies are one of the most frequent issues couples report in therapy, with one study finding that 80 percent of couples experience mismatched libidos at some point in their relationship. One person frequently pursues sex while the other, the one with lower drive, distances. Ultimately, the pursuer may feel rejected and wonder, “What is wrong with us? With me?”

Recent research shows that 15 percent of men and 34.2 percent of women reported losing interest in sex for three months or more in the previous year, demonstrating that sexual dry spells are a normal part of many relationships.

Here are some tips to help you survive the inevitable sexual dry spells of a marriage or long-term relationship:

1. Talk About the Dry Spell

The dry spell can become a painful elephant in the room. Have a respectful conversation, acknowledge how you both feel about sex, how life or relationship discord has hijacked you and your spark. Note what you miss sexually (whether it’s about yourself or your partner). Talk about what you look forward to when desire returns. Be honest, regardless of whether you’re the pursuer or the distancer. Own your roles without pressuring each other.

Research shows that open communication about topics such as sexual desires, boundaries, and relationship expectations is linked to greater sexual satisfaction and improved relationship quality.

2. Practice Realistic Expectations

If you set the bar at an unachievable height, you are doomed to feel disappointed. Acceptance reflects a mature outlook on sex. This does not mean either one of you does not want sex or is “settling.” It means you practice realistic expectations regarding how you approach your sex life. It means accepting you are not that couple on television (or in porn) who have spontaneous, hot sex every single time.

3. Strive for Quality, Not Quantity

Some partners place heavy emphasis on quantity. Partners may say, “Well, we have sex only once a month” with embarrassment For some couples, this might be where your baseline settles. If so, focus more on making that “once a month” as fulfilling as possible for both of you. If you improve the quality of those times, you may feel more connected, enough so that the space between does not feel as long or lonely.

Studies show that quality counts more than quantity, with younger generations prioritizing emotional connection over physical frequency.

4. Value Emotional Connection as Much as Sexual Connection

Your emotional life and sexual life are intertwined. If sex chronically diminishes, it may be more than life’s hijack. Have more intimate conversations, ask each other about how your relationship feels, share with one another, express gratitude, compliment each other, and treat each other kindly and with respect. Value these qualities as much as you value sex.

Research supports the strong intertwining between sexual and relationship well-being, with longitudinal findings revealing a bidirectional relationship between relational intimacy and sexual satisfaction.

5. Practice Healthy Doses of Humor

Do not take yourself too seriously. Remember, dry spells are inevitable.

Do not take yourself too seriously. Remember, dry spells are inevitable. Before jumping to conclusions or dwelling in rejection, practice humor to ease the tension around sex. When both partners make light, loving jokes about the dry spell, it may alleviate pressure on both sides. At the same time, humor works only when both partners are laughing. Jokes should not be masked digs. Make them playful, considerate, and loving.

6. Acknowledge Your Partner’s Bids Even If You Don’t Act on Them

Couples run into trouble when sexual bids are ignored, dismissed, or even harshly rejected. When your partner is in the mood but you are not, but you are nonetheless flattered, consider expressing appreciation. Try not to act annoyed. Can you appreciate that, after all this time together, your partner still desires you?

7. Expand Your Definition of Sex

Partners typically view sex through the narrow definition of intercourse or penetration where at least one person experiences orgasm. Can you shift how you think of sex? Rather than striving for penetration, focus on sexual connection. With this expanded view, you may have a wider range of sexual options to choose from that do not obligate you to “go all the way” every time.

8. Look for Small Windows of Opportunity

When time and energy fall short, try mini-moments of sexual connection. These can range from acts such as longer, lingering kisses to light foreplay and more. Smaller gestures let your partner know, “I may not be able to follow through right now, but I want to,” “I like touching you,” and “I miss you.” These are mini-moments. You can even declare, “I’m coming in for a mini” so you are both clear on the intention.

A friend of mine once referred to his sex life as “peaks and valleys.” How you approach those peaks and valleys makes all the difference between sustained connection and disgruntled disconnection.

Important Note: The information in this article is for educational purposes only and should not replace professional medical or therapeutic advice. If you are experiencing persistent relationship or sexual difficulties, consider consulting with a qualified therapist or healthcare provider. Research suggests that stress reduction interventions may be a potential way to promote sexual health, ultimately contributing to improved well-being and overall health.

References:

1. Arenella, K., Girard, A., & Connor, J. (2024). Desire discrepancy in long-term relationships: A qualitative study with diverse couples. Family Process, 63(3), 1201-1216. https://pubmed.ncbi.nlm.nih.gov/38234271/
2. Chen, T., Dai, M., Calabrese, C., & Merrill Jr., K. (2025). Dyadic and longitudinal influences of sexual communication on relationship satisfaction, emotional intimacy, and daily affect among same-sex male couples. Health Communication, 40(7), 1352-1362. https://doi.org/10.1080/10410236.2024.2400813
3. Hims Health Team. (2024). How can I keep sex fresh in my long-term relationship? Good Health by Hims. https://www.hims.com/blog/dryspell-in-relationship
4. Mües, H. M., Markert, C., Feneberg, A. C., & Nater, U. M. (2025). Too stressed for sex? Associations between stress and sex in daily life. Psychoneuroendocrinology, 181, 107583. https://pubmed.ncbi.nlm.nih.gov/40907147/
5. Psychology Today. (2025). When libidos clash: I love you, but I’m not in the mood. Psychology Today. https://www.psychologytoday.com/us/blog/hidden-desires/202503/when-libidos-clash-i-love-you-but-im-not-in-the-mood
6. Smith, K. (2025). Sex, intimacy, and connection: How often do couples have sex in 2025. South Denver Therapy. https://www.southdenvertherapy.com/blog/sex-intimacy-and-connection-2025
7. University of Cincinnati. (2025). Uncovering what matters to young adults: Communicating about sexual health & relationships. Journal of Sex & Marital Therapy. https://www.tandfonline.com/doi/full/10.1080/15546128.2025.2459381

No matter how comfortable you may be with your sexuality, the idea of sex therapy can be intimidating. Many of the people I work with in sex therapy struggle with sexual functioning or desire, issues that often come loaded with complicated emotions such as anxiety. These things can be difficult to talk about, let alone try to do something about—even when it is understood that the person you’ve enlisted to help you is a compassionate and nonjudgmental professional.

For men in particular, socialization related to sexuality can add to these complexities. Although not uncommon, the experiences of premature ejaculation or erectile dysfunction can bring deep feelings of shame—even in committed relationships with partners who are understanding and patient. Many men are socialized to believe sex should be easily enjoyable and they should always be in control. When it doesn’t work out this way, some may feel intensely inadequate or weak. Men in these situations may question their worth as partners and even as human beings. If a partner isn’t understanding or patient, these feelings can be amplified.

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As a sex therapist, I am trained in specific techniques that men can utilize to resolve a variety of sexual concerns. However, these techniques are often insufficient in addressing premature ejaculation and erectile dysfunction. Given the complexity of these issues, holistic sex therapy can play an important role.

It’s natural to seek out strategies that focus on physical functioning—the most obvious symptoms of sexual issues—but sex is more complicated than that. There are thoughts, narratives, emotions, and processes associated with the act of sex. These elements can greatly affect desire and pleasure. They can also impact bodily control and responses.

Sensory issues must also be addressed. The body tells its own story. Sometimes this story matches up well with the mind’s story about a problem, other times not so much. In these situations, people can benefit from learning about the activation cycles of their bodies—knowledge they can then incorporate into their sex lives.

It’s natural to seek out strategies that focus on physical functioning—the most obvious symptoms of sexual issues—but sex is more complicated than that. There are thoughts, narratives, emotions, and processes associated with the act of sex.

Holistic sex therapy is also about identifying cultural and social narratives surrounding sex. Not only can this exploration help people understand some of the roots of what they experience, it can also help them learn about ways their sexuality has been impacted, and how their bodies respond to these ingrained stories. Through sharing and understanding, validation can lead to healing and growth. It can also lead to sexual confidence that reflects acceptance of these influences while also challenging them.

Religion and spirituality can also play a role. These two elements can be related, of course, but they can also be very different. In fact, they can even contradict each other. Certain forces of religion, when deeply embedded, can overtake a person’s ability to sexually express themselves. Meanwhile, spiritual meaning can be difficult to ascertain.

In holistic sex therapy, self-esteem work is also relevant. When people recognize the barriers that are leading to their sexual issues, they may have to rediscover what they value about themselves.

Certainly, relationship issues can be a factor as well. Many men masturbate with no problems but struggle with sexual function with partners. Sometimes, this can be related to feelings about partners and their expectations, which may or may not be based in reality. When men unpack this in therapy, they’re typically better able to see what’s getting in the way of arousal, control, and desire.

Sound like a lot? Well, that’s because it can be. Sex can be complex, especially when you delve beyond the presenting physical issues and explore emotions and cultural influences. It’s rarely just one thing. Although many people tend to think of sex as primarily a physical act, there’s a lot more to it. Therapy that doesn’t explore these often hidden aspects does a disservice to the people who seek it.

Dear GoodTherapy.org,

I grew up in a fairly religious household where sex was rarely discussed (and when it was, it was talked about for the purposes of conception). Now, in my 30s, I have renounced many aspects of the religion I grew up with and come to realize some of the harm it caused in my life—including giving me a very problematic view of sex.

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I’m a virgin and have barely even been able to masturbate, let alone approach intimacy with a partner. I feel ashamed and guilty whenever I try, even though I tell myself over and over again that self-exploration is healthy and necessary. I desperately want a relationship, too, but can’t fathom the idea of overcoming my nervousness about sex and exposing my body (nudity was condemned in my family as well).

While I am still a child of God and am waiting for marriage to have sex, I would like to be more open to physical acts of love and more self-accepting when it comes to touching myself. Can you tell me why shame and embarrassment persist around the subject of sex, even after I have released so much other negativity that was ingrained in me through my childhood faith? How can I shake the bad emotions that arise instantly when I feel aroused or try to indulge my thoughts and fantasies about sex? —Shackled by Shame

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Dear Shackled,

First off, I want to say how much I respect and admire you. Clearly, you have worked hard to release the “negativity” that was part of your childhood. That is a huge undertaking, and you have accomplished a great deal. Nevertheless, you want to go further. You write that although you have achieved great self-understanding, there is an important aspect of your life that you would like to change—shame about sex.

You write that you feel ashamed and guilty about your sexuality. Shame and guilt are both powerful emotions, but very different from each other. Guilt has to do with feeling bad about something you have done. It’s hard to endure, but shame is worse. Shame is about who you are or, more accurately, who you think you are (based on the influences in your life)—no good, bad, worthless, and so on. If you feel guilty about something you have done, you can make retribution or decide to never repeat the action. But shame? Shame is about your core being, your whole self, body, and soul. I get the feeling from your words that shaming might have been part of your experiences growing up. Shame is used to belittle and control people; it is a tool of hate, not of love.

You describe sex as almost a great unmentionable in your childhood home, surrounded by prohibitions about nudity, masturbation, and adult relationships. Sexuality has something to do with love and loving, because sex is, finally, a loving physical and emotional expression of closeness with oneself and another. In fact, sexuality is an integral and intimate part of a person’s very being—and being in loving connection, the very opposite of shame.

You write that you are a “child of God.” I don’t know how you express your spirituality, but I wonder if you have come across this quotation from Ephesians 5:20: “For no one has ever hated his own body, but he nourishes and tenderly cares for it, as the Messiah does the church.” In short, take care of yourself, body and soul, with complete love.

I recognize—and maybe you do, too—that this sounds easier said than done. For many people, the shame they experience surrounding sex stems from societal and religious taboos that have developed over many generations, making it a particularly difficult subject to reconcile new feelings around. I urge you to be compassionate with yourself as you work through your feelings, which clearly aren’t comfortable for you. It’s hard to overcome a lifetime of conditioning.

Many people experience negative feelings about the body. You wonder how you might overcome yours. I would start by working with a therapist around issues of loving yourself, emotionally as well as physically. Therapy can be very helpful as you gradually unlearn the negative feelings that are attached to your sexuality.

I find myself wondering how you care for yourself. Do you provide yourself with proper rest and physical care? Do you beautify yourself and your environment? Do things you like? Do you recognize and then give yourself what you need? Respecting, caring for, and loving oneself may gradually bring you closer to your body. Again, be kind to yourself.

Many people experience negative feelings about the body. You wonder how you might overcome yours. I would start by working with a therapist around issues of loving yourself, emotionally as well as physically. Therapy can be very helpful as you gradually unlearn the negative feelings that are attached to your sexuality. The experience of talking about your feelings with a compassionate other may itself be a way to lessen your feelings of shame as you bring them to light on your terms. This is a gradual process. There is no hurry.

You might also find physical outlets, such as sports or yoga or hiking, for example, that you enjoy. These are ways to perhaps feel more at home in your body.

As you gradually feel all of who you are, and the joy in and around you, you might also discover the joy of companionship with someone special. Often, people who are new to sex are worried about how they will do, as if sex were a test or performance to be graded. There is a simple remedy for such feelings. Rather than focusing on yourself and if you’re doing things right, you can focus on what your partner finds enjoyable as your partner finds ways to please you. As you treasure each other, your intimacy may deepen and grow.

Thank you very much for asking this delicate question. I hope my answers are helpful, and I wish you a blossoming of your full self.

Take care,

Lynn

At times, the people I work with in therapy ask questions that lead to rich exploration of their intimate lives. Years ago, Marty (not his real name) burst into my office wondering, “Why is it easier for me to talk to my friends about past sexual experiences than it is to talk about what really—secretly—turns me on?”

I laughed and reminded him it had taken a long time before he’d been willing to talk about what I call his “arousal template” with me, and we were only just beginning to explore it.

My focus has never been on the sexual performance—how long, how much, or how many—of those I see in therapy. Instead, I focus on the shame– and judgment-free acceptance and appreciation of the arousal template, or what my colleague Jack Morin calls our core erotic theme (CET). (This may be why a high percentage of the individuals I work with actually prefer to conduct sessions by phone.)

When Marty and I began our work together, his CET was well hidden. He sought me out when his wife insisted he call a therapist when she discovered, to her horror, hundreds of file folders filled with pictures Marty had cut out from magazines. These cutouts all depicted parts of the female body. When he showed me the folders, I noted that they were not all of nude bodies—many of the bodies portrayed in the images were clothed. Each was carefully cut from magazines such as Playboy and mounted on black paper. [fat_widget_sex_right]

Marty’s wife, who thought her findings meant he was addicted to sex, blamed the pictures on the demise of their sexual relationship. But when I asked him how often he was masturbating while looking at the images, after he explained to me that he and his wife had stopped being sexually intimate, he looked startled.

“Not at all,” he told me. “I do have some fantasies, but my cutouts help …” He paused before telling me he liked to organize them because they made him “not think.”

I reminisced about how I had really loved stamp collecting during my childhood in a household affected by alcoholism.

He beamed. “It’s soothing, isn’t it?”

Collecting stamps was my personal mood-altering experience. Collecting and arranging photographs was Marty’s.

We began to talk about what sex meant for him and explore the ways it could enrich his life and his relationship with his wife, whom he loved dearly. Together we began to cultivate an atmosphere of what I call compassionate curiosity.  I shared with him the idea that we are all sensuous and sexual as babies, that we become erotic as we receive and experience messages about ourselves from our parents or primary caregivers. Gradually, we incorporate these messages with our own experience of touch and the profoundly personal emotions that go along with it. Through this process, we develop our CET.

Marty laughed. “It’s not just what we do or don’t do in bed, then, is it?”

I agreed. “What you and I get to do here is explore your erotic landscape in its entirety, because your CET has a profound effect on the difficulties you’re experiencing in your marriage right now, doesn’t it?”

He nodded. We discussed some of the particular childhood challenges that may have formed a blueprint for arousal that then wrought havoc when it fused with the loneliness and isolation he had experienced throughout most of his life. As Marty began to understand, accept, and even embrace his CET, he stopped judging and criticizing himself, and his fear diminished. People who struggle with sexual patterns that distress them usually want to change these patterns, but the conflicts they hope to resolve can produce hurricane levels of anxiety.

Marty began reaching out to his wife, who had remained suspicious, and they were able to reconcile. Recently, I received a photo they had taken together in Bali with the words, “Passion grows, though my hair no longer does!”

Changing Sexual Patterns

Change is essential to the erotic adventure, but the difficult erotic patterns are often the most resistant to change. As Buddhist wisdom teaches, “What we resist, persists.” What we struggle against becomes stronger. And troublesome arousal templates can trip us up!

People who struggle with sexual patterns that distress them usually want to change these patterns, but the conflicts they hope to resolve can produce hurricane levels of anxiety. Many of those who are challenged by erotic themes they find problematic often feel compelled to repeat them. And repeat them. And repeat them.

In The Erotic Mind, Morin identifies what he calls seven pivotal steps that lead to positive change:

1. Clarify your goals and motivations.
2. Cultivate self-affirmation
3. Navigate the gray zone.
4. Acknowledge and mourn your losses.
5. Come to your senses.
6. Risk the unfamiliar
7. Integrate your discoveries

The only way out is often through.

Reference:

Morin, J. (1995). The erotic mind: Unlocking the inner sources of sexual passion and fulfillment. New York, NY: Harper Perennial.