As mentioned throughout our discussion on sexual dysfunction, it is not uncommon for a couple to present themselves for treatment, eagerly seeking a quick fix to their sexual difficulties. In fact, many men present alone, without ever having discussed their quest for treatment with their partner only to return frustrated, as the quick fix to the sexual dysfunction did not resolve their relationship difficulties. It is important to be aware that while there is an individual component to sexuality, for most people there is also a partnered component. Thus, sexual problems or concerns are best approached from a "couples" perspective as it affects both individuals in the relationship.
Wincze, Bach, and Barlow (2008) discuss several risk factors for the development of sexual dysfunction and certainly these risk factors can contribute to the maintenance or worsening of sexual symptoms. These factors include: 1) couple distress, 2) poor communication, 3) lack of physical attraction, and 4) restricted sexual repertoire. It may be useful to think of these factors as circular instead of linear: the presence of sexual dysfunction can negatively impact a couple's relationship by causing distress and poor communication. But the opposite is also true: couple distress and poor communication can lead to sexual problems.
Sexual problems may result from couple distress within the relationship. Oftentimes couples seeking help will report their primary concern is a sexual one. Upon further investigation, it becomes apparent that there are a multitude of relationship difficulties and that the sexual concern is just one expression of those relationship difficulties. If you and your partner are experiencing sexual problems, it may be worthwhile to ask yourselves if there are other problematic issues within the relationship that might be contributing to the sexual problem. It might be useful to explore how these other issues may be impacting the sexual aspect of the relationship. On the other hand, experiencing a sexual dysfunction can certainly cause distress within the relationship. Because sexual dysfunction can cause frustration and feelings of failure within the individual and the partner, it is not uncommon for some tension to be present when a sexual disorder surfaces.
Poor communication can wreak havoc on the relationship as a whole, and certainly the sexual aspect of the relationship can be impacted. Individuals who cannot effectively communicate their feelings may feel angry, resentful, or hostile. Needless to say, negative feelings can interfere with sexual functioning. If the communication difficulties are general (not specific to sex) it may be helpful to review your communication style or attend couple's therapy with your partner to develop better communication skills. Assertiveness is a necessary component for effective communication. Assertiveness is achieved when both partners communicate their own thoughts and feelings while demonstrating mutual respect for their partner's thoughts and feelings. This is particularly important when differences arise.
Another important aspect of communication is empathy (i.e., putting yourself in another's shoes) and expressing your compassion and understanding toward your partner. Often times we feel attacked and immediately go on the defensive. The problem with this approach is that it does not allow us to listen. Effective communication is about being able to express ourselves and being able to listen. An excellent communication exercise is to focus on what your partner is saying and then paraphrase what they are saying and repeat it back to them (i.e., "It sounds as though you are saying…). You will want to avoid interpreting what they are saying, or defining what you think they meant to say. Instead, simply try to repeat what it is that they are saying. While this exercise seems incredibly simple, it is actually quite difficult and many couples take a long time to master it.
When the difficulty with communication is specifically related to sex, it may be helpful for you to think about why it is difficult to communicate about sex. Certainly we live in a fairly conservative society where talking about sexuality is still somewhat taboo. Thus, it is not a complete surprise that some couples have a hard time talking about sex. If you are having trouble talking to your partner about sex, you may want to ask yourself if your difficulty is because you are uncomfortable with the topic, or perhaps you are afraid of hurting your partner's feelings. In either case, couple's therapy can be helpful as it provides a safe place to practice effective communication about a sensitive topic. Previously we described an exercise called sensate focus. Sensate focus is another technique that may assist couples to become more comfortable about discussing their sexual relationship in general.