In a long-term committed relationship, sexual ebbs and flows are entirely normal. (Not that I like that word “normal”–I think it’s often the enemy of mental health and relationships, since chronic comparison tends to erode both.) But when it comes to sex, the number one question people have is, “Am I normal?”

Read on to find out when it might be time to seek the assistance of a trained professional around a sex and intimacy issue.1) You or your partner are feeling distressed about what’s going on (or not going on) in the bedroom.

Behavior isn’t the key determinant of a mental health problem; how you feel about the behavior is the determinant. What that means is, it’s okay not to want sex, UNLESS you’re bothered by the lack of desire. Or if your partner is bothered and it’s become an issue between you, then it’s a problem.

Focus on what’s normal for you, and on what you really and truly want, not what you think you’re supposed to want.

2) You haven’t felt able to communicate with your partner, or when you do communicate, you wind up feeling further apart rather than closer.

Talking about sexual issues can be incredibly sensitive and make you feel vulnerable. While you might think it would be easier when it’s just you and your partner, you might find the opposite is true: it feels too threatening, and fraught. Or you might have felt when you do try to talk about your sex life together, you’re not saying what you really mean for fear of hurting the other person. Or perhaps the discussion becomes heated and out of control.

That’s when experienced professionals can help create a safe space and facilitate dialogue. They’d work to control the pacing and to process any revelations.

Also, if you don’t really know what you want to express–if you’ve never had the opportunity or given yourself permission to explore your desires–then a therapist can provide support and encouragement.

3) You’ve prioritized the problem, educated yourself about healthy sexuality, and tried various solutions, yet you’re still struggling.

Sometimes having a vibrant sex life comes naturally. But often, it takes work and effort and consideration and perhaps, most of all, prioritization.

If you’re not setting aside time, if you’re just waiting for it to happen like it once did, then it might be your expectations that need realignment with reality: the realities of a long-term relationship, or of growing older, or of physiological changes, or of emotional changes.

If you’ve been trying and feeling increasingly frustrated, that can become part of the problem. For example, if a man is having problems with erections or ejaculation, he can then begin to experience reduced desire, and his partner can feel less attractive and rejected. This can lead to a negative feedback loop where sexual activity is avoided.

There are so many factors that impact sexual desire and performance. Some of these can be biological; some stem from unresolved childhood issues or negative messages received about sex. It might have to do with dynamics in the relationship (for example, one person is holding onto power by withholding sex.) You might be holding onto unreasonable expectations, and anxiety is magnifying all of it.

So if you haven’t been able to make progress on your own, then having a full evaluation is key: first with a doctor experienced with sexual issues (a gynecologist or a urologist, who can then make referrals to other specialists if needed, such as a specially trained physical therapist) and then with a therapist experienced with sex and intimacy issues. Ideally, you would have a team that collaborates to provide you with the most comprehensive care.

Sexuality is complex, but it is also very responsive to treatment. Making your relationship one where sensuality and eroticism can flourish, rather than focusing only on performance, can help. Many people have found greater fulfillment, and you can, too.

***Holly Brown is a marriage and family therapist in the San Francisco Bay area. She has a private practice in Alameda (http://hollybrownmft.com/ ) where she specializes in couples issues, including sex and intimacy. She’s also the author of–what else?–psychological thrillers (http://hollybrownbooks.com/ ).

 

Photo by Ben Zvan