t’s not uncommon to worry about your sex life and how it affects your relationship. Often, this becomes a flashpoint that motivates couples to come to therapy. Sex frequently becomes the symbol for deeper issues.
The thing is, addressing sexual struggles alone is not an all-in-one solution for relationship conflict. There are often other foundational patterns that need to be addressed before revisiting sexual compatibility.
Desire mismatch and conflict around sex can feel deeply personal or even vindictive, but as you might guess, it’s hard to reach “sexy time” when other conflicts are looming. What I’m saying is: we often need to do a relationship evaluation before diving straight into solving sexual health complaints.
Next week, I’ll dive deeper into communication snafus, but for now, let’s talk about them more broadly.
As a therapist, it’s important to discuss hormones, medications, aging, neurodivergence, illness, and fatigue to determine what’s affecting sexual health. As you can tell, there’s a wide variety of reasons sexual struggles show up.
Factors affecting your sex life can be roughly simplified into three categories:
A. Biological & Physiological Factors
- Hormones, medications, illness, fatigue
- Neurodivergence and sensory processing
- Aging and body changes
B. Psychological & Emotional Factors
- Stress, anxiety, depression, burnout
- Trauma history or sexual shame
- Performance pressure and fear of disappointing a partner
C. Relational & Contextual Factors
- Unequal labor, resentment, unresolved conflict
- Lack of emotional safety or attunement
- Life transitions (parenthood, grief, job changes)
- Feelings of pressure
Once these factors are identified, we begin exploring what each person has been taught about sex. This includes questioning the “shoulds,” expanding education around sexual health, safety, and pleasure, and committing to addressing unmet needs.
What we often learn through this process is that society has shaped how we think about sex in ways that can harm us and our relationships. Cultural scripts tell us how often couples should have sex and what sex should look like. When those expectations go unmet (which is very reasonable), blame, avoidance, and shutdown often follow.
And once that happens, people spiral.
But sexual health issues are not a moral or relational failing. This is not a you vs. them problem. Sexual health is more like a muscle — one that requires consistent attention and care.
The brain has two primary systems for processing sexual stimulation: an accelerator and a decelerator (or brakes). (See: Emily Nagoski’s Come As You Are.)
If flirting, massages, and making out are part of your accelerators, it makes sense that someone simply saying, “Let’s have sex now,” doesn’t really get things going. Add brakes on top of that — like a dirty home, pressure, or any of the factors listed in categories A, B, or C — and desire can shut down even more.
We have to address the brakes, the accelerators, and the other factors at play. Doing that requires learning how to talk about sex without triggering defensiveness. It means naming needs without demanding outcomes (or orgasms), asking curious questions instead of making assumptions, and redefining what sex, frequency, and initiation mean for you and your partner(s).
Lastly, watch out for using sex as your only connection builder. Sex shouldn’t be the sole form of intimacy in a relationship.
When sex becomes a stand-in for connection, reassurance, or power, it can create more pressure. While sex can be a point of connection for some, it doesn’t eliminate the need for connection in other areas. Assuming sex will fix the problem can unintentionally create pursuer-distancer dynamics — one partner pushing for sex while the other pulls away.
Encouraging compassion, flexibility, and ongoing dialogue is essential. Healthy sex lives adapt — they don’t stay static.
And if you feel like all avenues have been thoroughly explored and you’re still unsure how to resolve the conflict, seeking support may be the best next step. This article and the tools discussed here are not one-size-fits-all solutions. There are many valid reasons to seek guidance in rebuilding connection — don’t sell yourselves short.
If you’d like to explore sexual health coaching, you can book a session with me here.
Lifewflo 
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