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Wednesday, July 29, 2020

How to Talk to Your Partner About Sex - Part 2

I began a discussion on how to talk to your partner about sex in my prior article with suggestions, including do's and don'ts to introduce the topic with your partner. In this article, I'm providing a clinical vignette to illustrate typical sexual problems in a relationship and how a couple is able to work through these problems in couples therapy.

How to Talk to Your Partner About Sex

A Common Problem: It Can Be Hard to Talk About Sexual Problems With a Partner
As an experienced therapist who works with individuals and couples, I have found that many people have difficulty talking to their partner about sex, especially when there are problems.  Even in relationships where people have been together for many years, they often feel shy or awkward to talk about sex with a partner.

Why Is It Hard to Talk About Sex With a Partner?
There are many reasons why people feel uncomfortable and avoid talking about sex, including:
  • Cultural or Religious Taboos: It's not unusual for people, who were raised in a particular religion or culture where talking about sex is taboo--even with a spouse of many years, to experience difficulty in expressing their sexual needs or talking about sexual problems.
  • Family History: For people raised in a family where sex was seen as "dirty" or secret, talking about sexual problems can be challenging. Also, in families where there were poor boundaries around sex (e.g., parents walking around naked in front of children or having sex in front of or within earshot of children), these children often grow up to be adults who experience problems with sex in their relationship.
  • Sexual Trauma: When there is unresolved sexual trauma (for either a man or woman regardless of sexual orientation), it's often difficult to separate out the traumatic experience from the current relationship.  The act of being sexual in the current relationship can trigger memories of being sexually abused, which makes it hard to talk about sex or to even engage in sexual activities with a partner.
  • Body Shame: Many people, especially women, feel ashamed of their body. There are many reasons for this, including a history of being shamed about their body, sexual abuse, popular and unrealistic images of men's and women's bodies, etc. So, talking about sex, which involves the body, feels too embarrassing.  
  • Fear of Being Rejected: For many people the idea of initiating a discussion about sex with their partner brings up fears of being rejected. Their fear might involve an outright rejection of them or a fear that their partner might also have things they don't like about them with regard to their sex life. This fear often inhibits people from bringing up the topic of sex.
There are also countless other reasons why people avoid talking about sex with their partner.  This avoidance ensures that the problem probably won't be resolved with the possible effect that the couple grows apart (see my article: Relationships: How to Get Closer When the Two of You Have Grown Apart).

Clinical Vignette: How to Talk to Your Partner About Sex
The following fictional vignette is a composite of many different cases so that there are no identifying features of any one person or couple. This case illustrates the sexual presenting problem, the effect of the problem on the relationship, and how it gets resolved in couples therapy.

Amy and Joe
By the time Amy and Joe came to couples therapy, they were already considering divorce.  In their mid-40s and married for 20 years with children, they decided to try couples therapy to see if they could salvage their relationship before they filed for divorce.

Just like many other couples who come to couples therapy, Joe and Amy told their couples therapist that they had "communication problems."  For many couples, presenting their problem to the couples therapist as a communication problem takes away some of the shame and awkwardness they feel about coming to couples therapy (see my article: Mental Health Awareness: Reducing the Stigma of Going to Therapy).

Their couples therapist recognized that, in a general way, they did have communication problems, but this description of their problem was too vague.

Knowing that many couples come to couples therapy because they're either having problems with sex or money (or both), the therapist normalized this by asking each of them specific questions, including questions about their sexual satisfaction in the relationship.  She had already informed them, when they called for the consultation, that a sexual assessment was part of the initial stage of therapy, so they were aware that they would be asked these questions.

Initially, both Amy and Joe hesitated before they responded.  They looked at each other awkwardly as if to get a response from the other as to what they should say.

In response, the therapist told them that problems with sex is a common reason for coming to couples therapy for many couples.  Once again, this was a way of normalizing the topic of sex by letting them know that it's a common problem for many couples.

In response, Amy laughed nervously, "Gee. I didn't know that. I always assumed that everyone else is having 'swinging off the chandeliers' sex every night."

With a reddened face and looking down at the floor (rather than at Amy or the therapist), Joe said, "So, you think everyone else is having more and better sex than we are?"

Amy just looked away rather than respond, so Joe, who was sitting right next to Amy on the therapist's couch, said, "You're not saying anything, so I'm guessing that you have a problem with our sex life that you haven't told me about. Is that right?"

Looking away from Joe, Amy winced, "Well..."  And then she stopped and looked at the therapist as if for guidance.

So, the therapist stepped in at that point and said, "It seems to me that you both still care about each other--otherwise, you wouldn't be here. When you contacted me for the consultation, I mentioned to you that I get a sexual history from each person in the relationship for every couple that I see.  Why don't we start with me getting a sexual history from each of you" (see my article: Why It's Important to Talk to Your Therapist About Sexual Problems).

Based on the sexual history assessment that the therapist did for Joe and Amy, she found out the following salient facts:
  • Neither Joe nor Amy had much sexual experience with each other or with others before they got married.
  • Despite their limited sexual experience prior to marriage, each of them assumed, before they got married, that their sex life would work out on its own without having to talk about sex and without having to put in any effort.
  • Both of them felt awkward talking about sex with each other and would prefer to avoid it if they could.
  • Amy's family was very religious and neither parent ever talked to her about sex. Sex was considered a taboo subject in her family. She found out about sex by reading books when she was a teenager, but she never discussed what she read with anyone.
  • Amy didn't get her period until she was almost 14 years old. She was self conscious at school because all the other girls had already developed breasts, but she was "flat chested" (her words). As a result, the boys in her junior high school often teased and body shamed her about this, which made her feel even more ashamed. She never told anyone about this until now.
  • Joe's family was the opposite of Amy's family: His parents had very loose boundaries. They often walked around naked in front of Joe and his siblings.  They would also have sex in the living room after they thought Joe and his siblings were asleep.  But, in fact, Joe and his brothers and sisters would hear them and feel uncomfortable and embarrassed.
  • Ever since he entered into puberty, Joe felt ashamed of his penis size.  When he was in high school, the other boys in the locker room would brag about having big penises and about their sexual conquests. This made Joe feel ashamed.  The few times that he was sexual with other women, before he met Amy, he never wanted women to see his penis, so he always insisted on having sex in the dark.  He secretly feared that, due to the size of his penis, he couldn't satisfy women sexually, which contributed to his shame about sex and his sexual awkwardness--even with Amy.
  • Both of them denied a history of sexual trauma or abuse.
  • Joe had a vague sense that he wasn't satisfying Amy sexually, but he felt too ashamed to talk to her about it.
  • Amy often "zoned out" during the rare occasions when she and Joe had sex. She rarely had an orgasm, and she usually couldn't wait until it was over.
  • Neither of them felt comfortable talking about sex initially, but answering the therapist's questions from her sexual assessment made each of them realize that they weren't the only couple who had these problems.
  • Both denied any extramarital affairs during the marriage.
  • Both of them eventually admitted that they were dissatisfied with their sex life together, but both felt too ashamed to discuss it before coming to couples therapy.
Gradually, Amy and Joe were able to open up more about their sex life in couples therapy.  Amy was the first one to broach the topic of their almost nonexistent sex life in the last several years.  After hearing Amy speak, Joe said, "I thought you didn't want to have sex, so I didn't want to bother you."  In response, Amy turned to Joe and said, "That's weird--because I thought you weren't interested and I didn't want to bother you about it."

Over time, they were able to talk about being somewhat satisfied with their sex life when they first got married.  Each of them acknowledged that this changed after they had their second child.  They often felt too exhausted to have sex and they also stopped prioritizing their sex life--until it dwindled to having sex, on average, once every few months.

The more they were able to talk about their sexual history, the freer each of them became to talk about the problems in their sex life.  Prior to this, they weren't sure what caused them to drift apart (leading to talk about a divorce).  Each of them just assumed that the other wasn't interested in the marriage anymore.

They each said that they still felt sexually attracted to the other.  They also agreed to go away on a relaxing vacation to rekindle their relationship.

When they returned, they seemed much closer. They also told their couples therapist that they made love several times while they were away on their weeklong vacation.

Amy talked about being bold enough to bring sex toys on their vacation, which they had fun using. She said she had more consistent orgasms while they were away.  In addition, she told their couples therapist that she had developed a new appreciation for her body, including her small breasts, and sh realized that Joe still found out attractive.

Joe talked about being more sexually adventurous about exploring different sexual positions.  He also discussed that they engaged in oral sex for the first time, both fellatio and cunnilingus, and they found it fun and enjoyable.

Using Emotionally Focused Therapy (EFT) For Couples, their therapist helped them to identify and change the patterns in their relationship that were causing problems for them.  They continued to make progress and they each made a commitment to save their relationship by continuing in their couples therapy.

Conclusion
Regardless of sexual orientation, age, race or other identifying factors, sexual problems are common in many relationships.

There can be many factors that contribute to the problems, which can be addressed and overcome in either individual or couples therapy.

The fictional vignette presented above gave a particular set of problems, but there are many other types of sexual problems.

Getting Help in Therapy
If you and your partner are having sexual problems, rather than avoiding the problems, you owe it to yourselves to get help.

Resolving the sexual problems in your relationship can rekindle and salvage your relationship.  So rather than waiting, get help from an experienced therapist who works on these issues so you can have a more satisfying relationship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Therapy).

I work with individual adults and couples.

I have helped many individuals and couples overcome problems related to sex, including sexual trauma.

I am currently providing teletherapy, also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online Therapy).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.


































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