What Happens When Sex Falls Flat?

Let’s start by imagining a common scenario, one that plays out every day in bedrooms around the world. A couple—let’s call them Laurie and Mark—are having a fun, sexy encounter, and Mark begins to lose his erection.

Mark feels embarrassed by his loss of erection. He’s ashamed and feels sure that Laurie is judging him, or at least finding him to be a turn-off. He withdraws a bit, goes quiet, and stops making eye contact.

Laurie notices Mark’s loss of erection, and also that his attitude is changed. He looks preoccupied and disinterested. She starts to think he’s not as attracted to her as he used to be. Does she look bad in this position? She pulls the covers over her body and becomes shy.

Mark takes this as a signal that she’s not interested in continuing, and assumes she is turned off by his unmanly loss of erection. He really can’t blame her, as he finds it to be a turn off too. He rolls over, pushes down his feelings and thoughts, and goes to sleep.

Laurie feels deeply sad and abandoned. She tries to make sense what went wrong. They were having so much fun a few minutes ago. Now everything is ruined. She feels like crying. She knows she will have difficulty falling asleep. She’s annoyed that Mark can fall asleep just like that, and doesn’t care enough about how she feels to stay up and talk. She can’t really blame him, though. She knows it can’t be fun to talk to her when she’s upset and crying. She vows to go to the gym in the morning, to really get serious about losing a few pounds. Having an action plan that will make the problem go away feels a little better, and she is finally able to go to sleep.

Both partners feel disappointed, disconnected, and dissatisfied. They would both agree this was a negative interaction, and one they would go to great lengths to avoid repeating. Neither is interested in discussing it. It’s too fraught and confusing.

If it happens again, they may start to build a narrative around it:

Last time wasn’t just a fluke. So he IS losing his interest in me.

This is just like last time. Laurie must be so disappointed in me. I can’t give her what she wants, and what any real man could give her.

I always knew our sex life wouldn’t last. This is the beginning of the end.  I can’t live in a sexless marriage.

As this narrative snowballs, both partners get increasingly anxious about sex. They have sex less often, and disconnect more easily. They start to regard themselves or their partner as broken or abnormal, and resentments over desire, initiation, and “communication” start to take hold. When they do have sex, they hurry up in order to avoid any “cooler” moments that might result in loss of erection. Their new style of quick, business-like sex starts to feel mechanical very quickly.

What’s the core issue here? If you asked the couple, they would probably say “communication issues” or “erection issues.” If you asked a doctor, they might say the same thing, but they can’t help with “communication issues”; very likely they would write a prescription for Viagra.

I have a different perspective. I would argue that, even if you could somehow ensure that Mark never loses his erection again, the core issue would remain unchanged–because the core issue is not the loss of erection, it’s the meaning the partners are making from it, and the damage to their intimate connection that has been done by that meaning-making.

The most important thing to remember with a situation like this is that meaning making is optional. Events happen and are often outside of our control. Emotions arise unbidden too. What we can control are the stories we tell ourselves in order to make sense of events and emotions.

With sex issues, there is so little access to accurate information that sometimes facts alone can make a huge difference.

Fact: erections come and go throughout sexual interactions. This is not only normal, it is expectable, usual, and common. The sexual interactions where that isn’t the case are usually pretty short and business-like—definitely not the luxurious, memorable type of interaction people dream about.

Fact: anxiety kills arousal, and an erection is a physiological sign of arousal. When meaning-making leads to anxiety, the meaning-making itself will create erectile dysfunction. This is what I mean when I say that our most common ways of thinking about sex actually create sexual dysfunction.

Next time you talk about a sex issue with one of your clients, look for the interactional sequence. Identify:

  • For each partner, what event touches off negative meaning-making? (There may be several.)
  • What meanings are the participants making, exactly? What stories do they each tell themselves to make sense of events?
  • Are they checking their meaning-making out with their partner, using direct questions or statements about their own feelings or perceptions?
  • If not, why not? What is preventing them from checking their assumptions or sharing their internal struggles in a straightforward, vulnerable manner?
  • Can each partner identify ways it might benefit them to have a more accurate understanding of what goes on for their partner in these situations?

Armed with a solid understanding of the meaning your clients make out of any given sexual disappointment, you can begin helping them fact-check with their partner. From there, it is a short step to identifying opportunities to respond differently in the moments when things don’t go as planned.

Of course there is one small hitch: to help effectively in this kind of situation, you will need to be comfortable enough to have a frank and detailed discussion about the sexual interaction. If you relegate this to a “communication problem”, and don’t discuss the sexual dynamics specifically and in some detail, you will never get the information you need in order to help. So don’t be afraid to ask for a very specific interactional sequence. Without it, you won’t know what misconceptions are causing mischief, or what assumptions are undermining the intimate connection.

In the next installment, we’re going to dive into exactly where and why the interaction fell apart. Plus, I’ll show you what you can do to reframe the situation, and how to help your clients identify and focus on what they really want out of a sexual encounter. Keep your eyes out for part two!

Desire Discrepancy Lesson #2: Look for the Blocks

I’m continuing my series on desire discrepancy this week. If you missed last week’s post on normalizing variation, you can find it here.

What do you do if you’re seeing a couple with a big desire discrepancy, their marriage is on the rocks, and you recognize that you can’t wave a magic wand and make one partner want just as much sex as the other one? Sometimes there are things you can do that will increase desire for the lower desire partner, and other times there are not. The good news is, even if you can’t directly affect desire, you can certainly help your clients remove obstacles that prevent desire from blooming.

There are lots of factors that can impede or inhibit desire, and often they fall right into your wheelhouse as a therapist. Whether or not you’ve had training in sex therapy, I’m certain you have the skills to work with issues like anxiety and depression, both of which strongly inhibit desire.

My Will Lily assessment will help you identify some very common blocks–for instance, sex pain, which is, quite understandably, a major inhibitor of desire. If your client is experiencing sex pain, they absolutely must resolve it if they are going to have any kind of positive experience of desire.

Similarly, internal or external pressure is a common inhibitor of desire. Even without full-blown coercion, it’s very common for people to feel subtly pressured into having sex they don’t really want to have, for a variety of reasons–fear of disappointing their partner, for instance, or a belief that once a sexual interaction starts, they don’t have a right to stop or redirect the activity. Over time, subtle pressure can really put a damper on desire and do lasting damage to a relationship. Will Lily can help you identify cases like this in the very first session.

As I continue this series, I’m going to be talking in more detail about some of the factors that can inhibit desire. In the meantime, keep looking for the blocks. They can take all kinds of forms. Are your clients dealing with intensely demanding, stressful work schedules? Are they listening with one ear for the baby crying in the next room? Are they dealing with grief, or working through past trauma?

Identifying and working with factors that inhibit desire is absolutely necessary to increasing desire. No matter how much desire there is, these factors will stop the action.  Helping your clients remove obstacles is what creates space for desire to blossom.

Putting Clients At Ease With Sensitive Topics

A lot of my clients come to me specifically to work on sex-related issues. Nonetheless, I find that even those clients are often quite uncomfortable talking about their sex lives.

That’s perfectly understandable. Most people were taught not to talk about sex openly–not even with lovers, in some cases, let alone strangers or therapists. Because of this, lots of people don’t have comfortable or accurate language to discuss sex, and some don’t know enough about sex to be specific about what is going on when things go amiss.

At the same time, I am a much more effective helper when my clients are comfortable enough to share unreservedly.

I’ve developed a few strategies that help put my clients at ease when talking about sensitive topics, including but not limited to sex. Whether or not you frequently work with sex issues in your practice, these tips may come in handy with clients who struggle to discuss topics that are sensitive, emotionally charged, and/or somewhat taboo.

  • Remind clients that you’re comfortable. Often, a client’s discomfort comes from a fear of freaking you out or putting you off. I see this all the time, even when the thing they’re afraid of sharing is far from freaky! I can’t tell you how many clients have told me that they were too afraid of being judged by their previous therapists to bring up the topic of sex. That, to me, implies that you need to be proactive. Reassure your clients that you want to hear whatever they have to tell you, or else they are likely to assume otherwise. Personally, I like to tell my clients that I’ve pretty much heard it all, and that they’d have to work pretty hard to shock me. That might be more true for me than it is for you. But even if you think your client MIGHT tell you something that could shock you, get clear in your mind why it is important for you to create a safe space for honest disclosure, and don’t make a big fuss. Probably you will hear things that are very easy for you to hear, but in case you hear something that rocks you a little, control your facial expressions, stay calm and normalize (or at least remain neutral and don’t pathologize). Get some consultation or supervision if you need to (certainly before deciding there is a problem). If you can tell you’re way out of your depth, you can always refer the client to a certified sex therapist.
  • Focus on the process, not the content. This is one of the most useful strategies in my toolkit. Focussing on process–by which I mean how an interaction plays out, and how both participants feel about it, rather than what specific activity is involved–keeps clients from feeling pathologized, while also keeping therapists from getting overly unsettled by uncomfortable explicit information. It also means that often clients can share just as much as they’re comfortable with, telling you everything you need to know about a sexual interaction, without going into details that feel too personal.
  • Ask permission before asking a question about specifics. Although focussing on process rather than content means that I let clients determine how much they’re comfortable sharing, sometimes I need to know something really specific in order to understand an interaction or figure out what the problem is. In those instances, it helps to gain consent for the deeper conversation, and explain why I need the information. I might say something like, “Would it be ok with you if I ask you some very specific detailed questions about this? This is a situation where some specific information will help me figure out what is going on, and then I’ll be more likely to be able to help”. Once in a while, a client is quite reserved and says they don’t feel comfortable. I always let them know that is fine with me. We can continue in vague terms, and focus on process, and probably make some good progress. However, this doesn’t stop me from gently inviting deeper or more specific disclosures, never with any pressure. My comfort with the topic, combined with this absolute permission not to tell me anything they don’t want to reveal, often ends up making my client comfortable enough to open up.