Sexual Problems That Can Arise in Long-Term ... Features

Sexual Problems That Can Arise in Long-Term and Committed Relationships
Sexual issues arising in long-term relationships as they present
in the therapeutic setting are examined in this paper. These
include the role of sexual desire and its relationship to the cycle
of limerence, therapeutic treatments of sexual problems, sexual
and non-sexual communication and the impact illness can
play, both as a contributing factor to sexual problems and in
the process of sexual rehabilitation.
Sexual Desire in Long-Term Relationships
Clinical experience shows that clients in committed, long-term
relationships often present with complaints relating to reduced,
low or non-existent sexual desire. Multiple physiological,
psychological, emotional and social factors may contribute
to this phenomenon. Unresolved problems relating to sexual
desire can prove catastrophic to both the sexual and non-sexual
aspects of a relationship. It is not uncommon that clients seek
counselling only after years of conflict regarding one partner’s
sexual desire and/or availability.
Sexual Desire Defined
There is no consensus on a definition of sexual desire. DeLamater
and Sill (2005) discuss two main frameworks in the literature. The
first and most common framework suggests that sexual desire is
an innate biological drive that motivates individuals to seek out
sexual stimuli or activity. The second framework sees sexual desire
as an external force that manifests in the potential partner rather
than from an internal need within the desiring self (Verhulst
& Heiman, 1979). Clinical experience has shown that clients
can exhibit both innate and external desire, which may occur
interchangeably within their relationships.
Sexual Desire and Limerence
Clients often cite a reduction in sexual desire for their partners
after the relationship has passed from the initial phase (as early
as three months) into the committed and long-term phase
(up to two years and beyond). A common complaint, it can
nevertheless be a baffling and unsettling change within a
relationship. The cycle of limerence explains the initial wave of
relationship euphoria and ensuing dissatisfaction experienced
by many people.
‘Limerence’ attempts to describe the enigmatic state of ‘being
in love’. Individuals in the state of limerence may experience
feelings of joy—happiness accompanied by an emotional
high—and have a heightened focus on and longing for the
other person that may, at times, be obsessive and include
intrusive thoughts and fantasies about that person. They feel a
longing for reciprocation of these feelings by the object of their
desire. A physical manifestation may be felt as pain in the chest
area. At the height of limerence, the individual is unconcerned
with any defects in the other; rather, he or she can see only the
positive aspects of her or his partner (Tenor 1979). When the
process of limerence is explained to clients, their relationship
experience is normalised, and any feelings of guilt related to
changed sexual desire can be dispelled.
The cycle of limerence is not the only factor contributing
to waning desire in long-term relationships. Individual clients
may report additional factors: long working days, exhaustion,
children, lack of privacy in the family home, relationship
problems such as anger at the other partner, or a significant life
event. Mansell, Salinas and Sanchez (2011) cite other factors
including communication problems, substance abuse, anxiety
and depression, certain medications, prior sexual abuse,
gynaecological problems, or even a primary medical problem
such as Hypoactive Sexual Desire Disorder (HSDD). It is
therefore crucial that the health practitioner take a full sexual
and relationship history of both partners in order to fully
identify and understand all the factors contributing to sexual
desire problems.
Clients may experience the distancer/pursuer pattern in their
relationship. This occurs when one partner, the pursuer, seeks
sexual intercourse with the other, the distancer, who avoids or
refuses the sexual interaction (Betchen, 1991). The more the
pursuer pursues, the more the distancer distances and so on. It
is important that the counsellor works with the couple on the
causes of this pattern.
Treatment of Sexual Desire Issues
A number of techniques can be used to address sexual desire
issues. General education incorporating the anatomy and
physiology of the body and sexual techniques can be very helpful
for couples who have limited or no knowledge of lovemaking
(DeLamater & Sill 2005; Mansell, et al. 2011; Brotto, et al.
2011). Sensate focus exercises can be given as homework to help
recapture intimacy between partners (Albaugh & KelloggSpadt 2002). These involve touching, caressing and noncoital massage—a powerful tool for couples working towards
rebuilding their physical connection, which may have been
neglected due to the distancer/pursuer relationship and/or other
relationship problems. Developing clients’ communication
skills to improve their ability to negotiate their needs and wants
more generally within the context of the relationship as well
as in the sexual relationship is also an important influencing
factor in increasing sexual desire (Mansell et al. 2011). These
suggestions are by no means exhaustive, and each couple will no
doubt benefit from individualised and client-centered therapy.
The Role of Communication in
Long-Term and Committed Relationships
Clients often present in the moment of crisis when communication
on all levels has broken down. Sexual as well as non-sexual
communication can be regarded as crucial to many relationships.
When communication fails, the relationship is at risk. The ability
to communicate about issues in long-term relationships is a key
skill that all clients can benefit from learning.
Communication is not only verbal. Couples can also
communicate through body language and touch. In long-term
relationships, non-verbal intimate communication can involve
CQ: The CAPA Quarterly
both sexual touch (stroking genitals, penetrative sex, oral sex)
and non-sexual touch (cuddling, holding hands, spooning).
Communication can either increase or decrease intimacy
Hence it is important that the therapist understand the role
communication plays in the dynamic of the relationship in
order to best facilitate the clients’ work.
It is common that clients lack the skills and attitudes
required for discussing sensitive issues such as the specifics of
their sexual relationship with their partners (Bienvenu 1980).
Furthermore, research has shown a positive relationship
between the frequency and quality of a couple’s talk about sex
(both men and women) and their level of sexual satisfaction
(Timm & Keiley 2011, Baus, 1987, Metts & Cupach 1989,
Sprecher & McKinney 1993). This highlights the need for
counsellors to address and facilitate communication in the
therapeutic session.
The Link Between Relationship Issues
and Sexual Difficulties
It is important to remember that working with sexual issues also
involves working with relationships. Sexual and relationship
issues can exist independently of one another, but relationship
problems can cause sexual problems and sexual problems can
cause relationship problems.
Links between relationship and sexual problems are not
always easy to identify, hence the importance of taking detailed
histories of both individuals and couples.
lllness and Sexual Rehabilitation in
Long-Term and Committed Relationships
A number of illnesses can affect a client’s physical, mental and
emotional health. It is important to understand that a diagnosis
of illness can disrupt both emotional intimacy and physical
sexual function. Many couples experience relationship stress
from a diagnosis of illness and, generally, couples who were
experiencing relationship problems before a diagnosis are more
likely to continue to have problems afterwards. Relationship
support should ideally begin at the onset of diagnosis, and should
occur alongside conventional medical support. Disappointment,
isolation and poor quality of life can result if sexual issues are not
identified, understood and counselled.
Men can present with conditions—including cardiovascular
disease, diabetes, depression, prostate cancer and post
prostatectomy conditions—that can directly affect the
physiological functioning of the male genitalia, namely erectile
dysfunction (ED), and may cause distress to both the individual
and the relationship. A number of therapies can be used in order
to improve erectile function, depending on the severity of the
client’s condition. Common therapies used include the use of
PDE5 Inhibitors—more commonly known as Viagra, Levitra
and Cialis (Martínez-Jabaloyas 2010)—vacuum pumps,
intracavernosal injection therapy (ICI) and, in extreme cases,
penile implants. When used properly, these physical therapies
May 2012
Christina Spaccavento
can often alleviate feelings of disappointment and improve selfesteem while also restoring confidence in the couple’s ability to
have penetrative sex.
Women often present for counselling when recovering from
mastectomies, or during the course of other chronic conditions
like chronic fatigue syndrome, depression, and cancers of the
female reproductive system: breast, ovarian, uterine or cervical.
Permanent injury or disability and chronic conditions
significantly impact a client’s ability to function sexually.
The therapist will need to work with the couple in exploring
alternative ways to achieve sexual intimacy, which may require
the couple to broaden their sexual repertoire.
In good case management, the therapist liaises in a
collaborative effort with the clients’ other health practitioners,
increasing the possibility of achieving a lasting resolution to
both the individual’s sexual difficulties (McCabe, et al. 2010)
and laying the foundation for the couple to resume their preillness sexual relationship.
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Christina Spaccavento, MSc (Health Science), is a qualified and
experienced sex therapist and relationship counsellor, educator
and supervisor. She runs her own clinical practice in Surry Hills
and Potts Point and has made various expert contributions
to media publications and television in the area of sexology., [email protected]