Sexual Health: What is Arousal Nonconcordance?

This article was updated on September 19, 2026.

Most people do not understand arousal nonconcordance because they never learned about it in sex education. This mismatch between mind and body often causes deep confusion and relationship conflict.

Arousal nonconcordance occurs when the mind and body are out of sync—a common experience that specialized couples therapy can help resolve.

What is Arousal Non-Concordance?

Arousal non-concordance is a mismatch between physical genital responses and mental or emotional feelings of sexual excitement. Your body might react physically without mental desire, or your mind might feel turned on while your body does not react.

Arousal Concordance vs. Non-Concordance

• Arousal Concordance: Emotional, mental, and physical sexual arousal happen at the exact same time and match each other.
• Arousal Nonconcordance:
  One or more of these aspects are out of sync.

Common Examples of Nonconcordance

• Mental Desire without Physical Response: A person feels emotionally turned on or wants sex, but does not experience vaginal lubrication or an erection.
• Physical Response without Mental Desire: A person’s body has a physiological reaction (like lubrication or an erection) from physical stimuli, but they feel no emotional desire or interest in sex.

Physical Arousal is Not Consent

Physical arousal is an automatic nervous system reaction, not a sign of choice.

Verbal Consent Matters: Clear verbal consent is the only true indicator of a person's desire to engage in sexual activity.

Never Assume: Do not assume a physical reaction means your partner wants to have sex. Always ask and rely on your partner's clear words.

Frequently Asked Questions:

Is arousal nonconcordance normal?

Yes. Research shows that arousal non-concordance is a completely normal human experience experienced by both men and women.

Why does my body get wet or hard when I am not turned on?

Genital blood flow and lubrication are reflexive responses to touch, context, or neutral physical stimuli. They do not automatically mean your brain is experiencing emotional desire.

How can couples cope with arousal non-concordance?

• Talk openly about how your body changes with age, stress, or fatigue.
• Use supplemental lubricants without assigning emotional meaning to physical changes.
• Rely on clear verbal communication rather than guessing based on physical signs.

A Case Study in Arousal Non-Concordance: Mary and Bob

The following clinical vignette is a composite of common cases with all identifying information removed to protect confidentiality.

The Relationship Presentation

Mary and Bob sought sex therapy after 23 years of marriage because they were experiencing severe intimacy issues. Bob felt highly discouraged and rejected during sex. Even though Mary would verbally tell him she was in the mood, Bob noticed she was not experiencing natural vaginal lubrication.

The Misunderstanding

Because Bob did not understand how arousal works, he assumed Mary was lying to appease him. He believed that if she were truly turned on, her body would automatically lubricate. As a result:

• Bob stopped initiating sex out of fear of rejection.
• When Mary initiated sex, Bob turned her down because he felt anxious about her lack of physical response.
• Mary felt deeply frustrated because she genuinely loved Bob, found him attractive, and wanted to be intimate. However, because she was postmenopausal, her body naturally produced less lubrication—a common biological shift.
• Mary suggested using store-bought lubricant, but Bob refused, viewing the lubricant as proof that he could no longer turn his wife on.

The Sex Therapy Breakthrough

During our therapy sessions, I introduced the concept of arousal nonconcordance to the couple. Once Bob understood that a lack of physical lubrication did not equal a lack of emotional desire or attraction, his perspective completely shifted.

Realizing this was a normal, common experience relieved his anxiety. Bob accepted the use of supplemental lubrication, the fear of rejection dissolved, and their sexual relationship dramatically improved.

Therapist Takeaway for Couples

Physical signs of arousal (like lubrication or erections) fluctuate due to age, hormones, stress, and medications. Never use physical responses as a test of your partner's love or desire. Instead, rely on their clear verbal communication and keep tools like high-quality lubricants readily available.

Ready to Bridge the Gap Between Your Mind and Body? 

Arousal nonconcordance and intimacy blocks are incredibly common, but you don't have to navigate them alone. Let’s talk about how individual or couples therapy can help you reclaim a fulfilling sex life. 

Take the Next Step Toward Healing and Connection

If you or your partner are struggling with arousal nonconcordance, low desire, or relationship conflict, you do not have to struggle in silence. 

As a certified sex therapist and licensed psychotherapist in New York City, I provide a compassionate, sex-positive environment to help individuals and couples thrive (visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist).

• Couples Therapy: Rebuild intimacy, resolve communication breakdowns, and untangle misunderstandings about physical arousal.
• Individual Therapy: Understand your personal sexual accelerators and brakes, heal from sexual anxiety, and feel confident in your body.

📞 Contact Josephine Ferraro, LCSW

• Office Location: Greenwich Village, NYC (10011) and Telehealth available
• Phone: (917) 742-2624 during standard business hours
• Email: josephineferraro@iCloud.com
• Next Step: I offer a complimentary 15 minute phone call before setting up an appointment.

 

Many Women Don't Tell Their Male Partners When They Have Pain During Intimacy

Painful intercourse is a common problem for many women of all ages. Unfortunately, instead of telling their partner about the pain, more than 50% of women endure the pain without ever mentioning it (see my article: Getting Help in Sex Therapy For Painful Sex).

Why Women Don't Talk About Painful Intercourse

Why Don't Women Tell Their Partners They're Having Pain During Intercourse?

When researchers asked women why they didn't tell their male partners about painful sex, they received the following responses from women:

• They thought pain was "normal" during sex (it's not).

• They felt pain wasn't worth mentioning because the pain wasn't severe.

• They were concerned that if they told their male partner they had pain during intercourse, it would mean they wouldn't have intercourse at all.

Why Women Don't Talk About Painful Intercourse

• They prioritized their male partner's pleasure over their own discomfort--even if it meant they would keep experiencing painful sex every time.

• They felt too embarrassed to talk about painful sex with their partner, so they would rather endure the pain than talk about it.

• They didn't want to make their partner feel uncomfortable.

• They didn't want any awkwardness between them and their partner.

• They thought they just needed to "power through" intercourse--even though it's painful.

• They didn't know they could engage in other sexual activities that could be just as sexually satisfying for them and their partner and that sex involves more than just intercourse.

What Causes Painful Intercourse For Women?

There can be many reasons why a women experience painful interourse.  

To determine the reason for the pain in their particular case, women need to consult with a knowledgeable sexual health professional (not all primary care doctors or even gynecologists are knowledgeable about painful sex).  

Some potential causes for painful sex include:

• Lack of sufficient lubrication during sexual intercourse, which cause irritation and pain

• Insufficient sexual arousal because women and their male partners rush through sex without taking the time to ensure women are sufficiently aroused for sexual intercourse

• Longstanding resentment due to relationship conflict which gets in the way of sexual pleasure and, in turn, can result in painful intercourse

• Undiagnosed vaginismus, resulting in muscle spasms at the entrance of the vagina which either restrict entrance or clamp shut the vagina

• Pain around the vulva, the outer part of women's genitals, which is called vulvodynia which can result in pain, irritation, a burning sensation, soreness or rawness.

• Vaginal infections, including a yeast infection or bacterial infection (vaginosis)

• Vaginal dryness due to menopause

• Vulvar Vestibulitis, an inflammation of the vestibular glands just outside the vagina

• Birth control pills as a cause of sexual pain due to biochemical changes

• Other medical conditions, such as uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome (IBS) and other gynecological problems can lead to painful sex

• Other medical problems 

What Can Women Do to Deal With Painful Intercourse?

• Talk to your partner (see my article: How to Talk to Your Partner About Sex - Part 1 and Part 2

Talk to Your Partner About Painful Intercourse

• Seek help from a knowledgeable gynecologist or a sexual health professional

• Seek help from a pelvic floor specialist

• Seek help from a sex therapist, especially if the problem involves sexual anxiety, unresolved resentment toward a partner or other unresolved emotional issues, including a history of sexual abuse

Getting Help in Sex Therapy

Sex therapy is a form of talk therapy that focuses on sexual issues for individuals and couples (see my article: What is Sex Therapy?)

Seek Help in Sex Therapy

Individual adults and couples seek help in sex therapy for a variety of reasons (see my article: What Are Common Issues Discussed in Sex Therapy?).

There is no sex, nudity or physical exams during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can have a more fulfilling sex life.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, trauma therapist (including EMDR, AEDP, Somatic Experiencing), Emotionally Focused Therapy Couples Therapist and Sex Therapist.

I work with individual adults and couples.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Treating Sexual Compulsivity in Sex Therapy - Is It a Sexual Addiction or Out of Control Sexual Behavior (OCSB)?

Language matters, especially in the field of mental health.  When mental health professionals pathologize compulsive sexual behavior by defining it as a "sexual addiction," they do clients a disservice.  

This article will focus on the difference between treating sexual compulsivity as out of control sexual behavior (OCSB) as defined by Doug Braun-Harvey, LMFT and Michael A. Vigorito, LMFT in their book Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and treating the problem as a "sexual addiction," as in the work of Dr. Patrick Carnes (see my article: What is Sexual Health?).

Treating Sexual Compulsivity in Sex Therapy

What is Sexually Compulsive Behavior?

Let's start by defining sexually compulsive behavior.

Sexually compulsive behavior is an excessive preoccupation with sexual thoughts, urges and behavior where this behavior is disruptive and has a significant negative impact on a person's health, relationships, work and other important areas of life, including (but not limited to) the following issues:

• Recurrent sexual thoughts, urges and behaviors take up a lot of your time.

• These thoughts, urges and behaviors feel out of control to you.

• Despite repeated attempts, you have been unable to reduce or control these thoughts, urges and behavior on your own.

• Despite serious consequences, you continue to engage in out of control sexual thoughts, urges and behavior.

• You have problems establishing and maintaining relationships, jobs or other important areas in your life because of your sexually compulsive behavior.

Sexual Addiction vs Out of Control Sexual Behavior (OCSB)

As of this writing, there is a heated debate in the mental health field about whether sexually compulsive behavior should be seen as a sexual addiction or as out of control sexual behavior (OCSB).

Treating Out of Control Sexual Behavior in Sex Therapy

Proponents of the sexual addiction perspective see compulsive sexual behavior as similar to other forms of addiction, including alcoholism and drug addiction.  In this model people who engage in compulsive sex are seen as "powerless" over their behavior.  Dr. Patrick Carnes, who has written extensively about "sexual addiction" is one of the biggest proponents of this view.

The main proponents of the out of control sexual behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT.  They define six principles of sexual health in their book, Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.  Instead of viewing this behavior as an addiction, they see it as sexual behavior that is out of control.  In their view it is a sexual problem but not a sexual disorder or an illness.

Treating Out of Control Sexual Behavior in Sex Therapy

Other proponents of the OCSB view, like Dr. Neil Cannon, see sexual compulsivity as being related to unresolved trauma, unresolved mental health issues, relationship issues and problematic habits.

Treating Out of Control Sexual Behavior in Sex Therapy

OCSB is not a diagnostic term.  The term OCSB refers to problems with self regulation of sexual thoughts, urges and behavior despite negative consequences.

Why Does It Matter How Compulsive Sexual Behavior is Labeled?

In my opinion (and the opinion of many others in the sex therapy field), labeling someone who engages in compulsive sexual behavior as an "addict" is harsh and shame inducing.  

Treating Out of Control Sexual Behavior in Sex Therapy

People who are labeled in such a shame-inducing way are often too embarrassed to admit they have a problem or to get professional help.

Unlike drug and alcohol misuse, people who engage in sexually compulsive behavior cannot be expected to give up having sex so labeling behavior as a sexual addiction is counterproductive to resolving the problem.

Getting Help For Sexually Compulsive Behavior

If you are struggling with sexual compulsivity, you're not alone.  Help is available to you.

Depending upon the particular circumstances, sexually compulsive behavior can be treated in individual sex therapy or in couples therapy with a sex therapist.

Working with a sex positive sex therapist who treats sexual compulsivity as out of control sexual behavior (OCSB) rather than as an addiction is affirming to your sexual health and overall well-being.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples (see my article: What is Sex Therapy?).

I have helped many clients to overcome psychological trauma (see my article: What is Trauma Therapy?

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

What is Sexual Health?

According to Doug Braun-Harvey, LMFT, co-author with Michael A. Vigorito, LMFT of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and co-founder of The Harvey Institute, sexual health is comprised of six principles which include safety as well as pleasure.  

These six principles will be the focus of this article.

Sexual Health includes Safety and Pleasure

The concept that sexual health includes both safety and pleasure is different from what is taught in most sex education programs in the United States.

Unfortunately, most education programs limit sex ed to protection against sexually transmitted infections and unwanted pregnancy.  

But sexual health is so much more than that--it includes sexual pleasure.

The Six Principles of Sexual Health

The Harvey Institute identifies six principles of sexual health:

• Consent: Sexual health must be consensual.  Consent means that sex is voluntary between willing partners who are of age and able to give enthusiastic consent to sex.  Non-consent involving children often occurs in the home with relatives or family friends in the form of sexual abuse, sexual assault and rape.  With regard to consenting adults, it's important to establish consent at each step of sexual activity so that there can be safety and pleasure for everyone involved (see my article: What is Sexual Consent?).

• Non-Exploitative: Sexual exploitation is when someone uses their power and control over someone else to have sex.  Exploitation includes unwanted harsh behavior to dominate and take sexual advantage of someone who is unable to give consent, including children and people who have physical or cognitive disabilities.  Exploitation often involves alcohol or drugs to coerce people to have sex.

• Honest: Sexual health requires honesty between sexual partners. Communication is open and direct with all sexual partners.  Honesty involves being open about sexual pleasure, health, sexual experiences and sexual education. 

• Shared Values: Sexual values identifies a person's ethics and sexual standards which can differ based on a person's culture.  For instance, a person's values can differ with regard to the first sexual experience based on their particular culture.  When people get involved sexually, each person can have different values regarding particular sex acts or sexual turn-ons.  Sexual health involves people having open and honest communication about their sexual values.  It's also important for children and teenagers to get accurate answers to their questions about sex without adults communicating shame or discomfort.

• Protected Against Sexually Transmitted Infections (STIs), HIV and Unwanted Pregnancy: Anyone engaging in sexual activity needs to be protected from STIs, HIV and unwanted pregnancy.  Protection includes the use of condoms, birth control, adherence to HIV medication, taking PrEP (pre-exposure prophylaxis). Sex education about these issues needs to be medically accurate (fewer than 20 states in the United States requires sex education to be medically accurate).  

• Pleasure: Whether sex involves solo activity or partnered sex, sexual pleasure is a primary motivator to have sex.  Throughout the lifespan sexual health is a matter of balancing safety/responsibility with pleasure.  Sexual pleasure includes remaining curious about different ways of enjoying sex.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapy.

I am a sex positive therapist who works with individual adults and people in relationships.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.