The impact of sexual problems on a relationship can be significant. Painful sex (dyspareunia), problems with libido, physical changes such as menopause can all impact on your sex life and your relationship. Consider having an open discussion with your partner and/or a health professional about how you feel. If you've been avoiding sex this can be especially difficult. But if you do find support, it can build intimacy and help you to manage your sexual relationship more honestly. The good news is there are strategies to help you.
Feeling stressed, self-conscious about your body, depressed or anxious about intimacy can make sex uncomfortable, and even painful.
Sometimes dyspareunia (painful sex) begins as a physical problem, but then has a flow-on effect to your psychological wellbeing and relationships, causing stress and anxiety.
A vicious cycle can develop where past experiences of painful sex cause anticipatory fear of more pain. This fear creates stress, tension and reduces libido and arousal and as a result, sex becomes painful. For some women their past experiences may include sexual or emotional abuse, which can a be a trigger for experiencing painful sex, even in good relationships with an understanding partner.
For women approaching menopause who are experiencing sexual problems in a relationship, it is helpful to sort out how much is due to the physical symptoms of menopause rather than other sexual issues. It can be difficult to know if menopause influences your relationship with your partner, or if the relationship you have with your partner influences your experience of menopause.
There are many ways two people can be sexual, or sensual, with each other that do not involve vaginal penetrative sex. Think of all the things you did before you had sex for the first time. We sometimes call this 'outercourse', and refers to kissing, hugging, fondling, touching etc.
The right treatment depends on the cause of the pain, but almost all treatment options will include a combination of individual and couples sexual and relationship counselling. If you are in a relationship, encourage your partner to be involved in your treatment, particularly the counselling sessions. Women and their partners often experience feelings of rejection, confusion, helplessness and frustration and the sooner these feelings are discussed the better the outcome for all concerned.
It can also help if both partners read relevant books and seek out other resources together. It's okay (and a good idea!) to have some fun with sexual exploration. Sometimes couples get into a 'routine' for sex that's no longer working for one or both partners. Self-help books can be easily bought over the internet, so there's no need to be shy.
For single women, dyspareunia can prevent them from approaching partners or entering new relationships. Talking to a health care professional about your feelings can help to stop the negative pain cycle.
It is quite common for women to experience a decline in spontaneous sexual desire with age, or when you have been in a long-term relationship.
Chronic low libido can sneak up on you. Initially, you may feel like it's just another dip in your sexual interest and manage it the way you have in the past; explaining it away as a normal response to the stresses of life. But, if low libido has been happening for a long time and it is distressing, or causing relationship disharmony, you should examine your real reasons for not wanting to have sex. Is it about short-term or recent events, or is it beginning to look like a way of life? Is it a way of life you want or is it distressing you? How does it impact on your partner?
For couples, differences in sexual desire can create significant problems. A pattern of avoidance and resentment can build up especially if sex is initiated by one partner and refused by the other over and over again. The partner with lower libido may feel bothered by sexual overtures and the partner with higher libido may feel frustrated, rejected and unloved. Some couples stop being affectionate and loving with each other and negative feelings become more and more overwhelming. These difficult feelings, if not talked through, can impact negatively on the relationship.
Solving the problem of desire difference in a relationship can be challenging. There is no magic wand (or pill, potion or cream) that will create sexual desire. And it's not about just having sex whenever your partner wants.
The exercises below assume you have the building blocks of a workable relationship and the ability to work together on this issue. There are many things that may turn someone off sex. It's not possible to discuss them all on a webpage. It is important to understand that if there is conflict or abuse in your relationship; it may not be possible to solve a sexual problem. Sometimes a sexual problem is a symptom of an unhealthy relationship.
Good sex can give a well-grounded relationship a really positive boost, but it won't solve serious relationship problems. Relationship counselling might be an important first step in building trust and communication before working on a sexual problem.
More complicated personal reasons can also underlie low libido, so seek counselling if you think this is the case.
Make a list of all the things that are:
about sex for you.
For example:
Anything at all that's good about sex needs to go on the list. Don't worry about any bad things that counter the positives at this point. They will go into their own list and be dealt with separately.
This list of good things about sex is part of your motivation for having sex. If you have good reasons for having sex, you can use these reasons to examine and influence sexual desire, and sometimes have 'decision driven' sex, rather than 'desire driven' sex.
Think about all your reasons for not wanting to have sex and write them down too. You don't need to show anyone your list so be honest (with yourself).
For example:
Try to be explicit about what it is that's putting you off so you have something to work with. If your reasons don't seem very concrete think about the feelings you have during sex or when your partner approaches you sexually.
Do you feel:
Feelings like this will be off-putting, so recognising and understanding them is a first step towards getting them out of the bedroom.
Stress is part of life. It may be related to day-to-day 'busyness' with too much to do, and never enough time. Or it may be a more serious and recent event such as job loss, illness or death of a loved one.
It is not always reasonable for some people to feel like having sex around the time of serious stress. But if normal day-to-day stress is getting on top of you, it's probably worth considering some strategies that might help you get on top of it.
Some people want more sex at difficult or sad times; to help them relax, as a comfort or a distraction, or to feel alive and joyful. Everyone is different, especially when it comes to sex.
Think about the sort of things that make you feel tense or stressed and not sexual:
Can you make a decision to give yourself some time each day where you will make the effort to relax and not focus on the stressful things?
Letting go of stress may not be easy, but if you can find a way to relax, it may give you the energy and the focus you need to enjoy life and maybe sex as well.
Physical pain is a good reason not to desire sex.
If you anticipate pain during sex, you will be anxious and this will reduce libido and arousal. Talk about the pain with your partner so they know how you are feeling.
You should not experience pain during sex so don't ignore it if you do. See our webpages on painful sex for more information.
Frightening as it can seem, consider having an open discussion with your partner about how you feel. If you've been avoiding sex this can be especially difficult. But if you do it well, it will build intimacy and help you to manage your sexual relationship more honestly.
The aim of this exercise is not to have you swinging from the chandelier every night of the week. It's to enhance honesty, intimacy, fun and pleasure in your relationship and hopefully help you manage differences in sexual desire instead of using excuses to avoid the issue.
It's also not to encourage you to have sex when you don't want to. Use it as a pathway to understanding each other and finding a middle ground that is more satisfying to both of you.
Don't forget that it will take ongoing commitment and revisiting the discussion to keep it working in the long-term. And if you get stuck, talk to a trained sex therapist.