How Lack of Sex Affects Your Relationship

Phyllis Wong, Professional Counsellor
Singapore Counselling Centre

Why is Sex and Intimacy Important?

Sex is core in every intimate relationship and is inseparable from intimacy. Although sex is linked to closeness, there is more to it than sexual activity. Emotional, physical and sexual aspects of a relationship are all linked to intimacy, and intimacy requires a certain degree of proximity and kinship.

Although sex is not the only aspect of an intimate relationship or marriage, it can be affected when partners struggle with certain issues. This includes [1]:

  • Miscommunication,
  • Friction,
  • Lack of trust, and
  • Differing sex drive

Conversely, the sexual dissatisfaction can affect non-sexual aspects of the relationship, causing relationship dissatisfaction [2].

Sexual and Relationship Satisfaction

Almost 60% of Singaporean women report having low sex drive, increasing the likelihood of developing sexual problems [3]. These women have been reported to take longer to conceive and are less likely to try to get pregnant, due to “unpleasant sexual experience and difficulties with intimacy”.

Sexual problems may affect non-sexual components of a relationship. These include:

  • Low sex drive,
  • Sexual troubles such as
    • Persistent pain when having sex,
    • Difficulties having sex for the first time after marriage, and
    • Difficulties having penetrative intercourse;
  • Sexual dysfunction.

This can cause relationship challenges, and other mental health symptoms like sadness, anxiety and poor self-esteem [4].

Such problems can make one’s relationship vulnerable if unremedied. For instance, one could experience rage, insecurity, jealousy, sexual unhappiness, or even perceive that their partner is no longer sexually interested in them. Proper sexual communication is essential for improving relationship pleasure [5].

How Much Sex Is Enough Sex?

Sexual practices, such as the quality of sex and the frequency of sex a couple has, is often determined by themselves as it varies across every relationship. It is important to remember that sexual frequency may not be an indicator of sexual satisfaction. Some couples practise sex outside marriage to determine sexual compatibility before marriage, while others observe sex abstinence until they are married. Thus, sex is an act jointly performed by partners in an intimate relationship.

Frequently Asked Questions (FAQ)

Sexual issues are sexual concerns someone may have and the psychological issues that may follow. Common sexual issues include managing sexual issues of [6]:

  • Performance,
  • Dysfunction,
  • Gender issues,
  • Abuse,
  • Disorders,
  • Addiction,
  • Trauma,
  • Shame and intimacy issues 

Sexual dysfunction is when an individual has problems responding sexually or experiencing sexual pleasure. These symptoms must meet the following criteria [7]:

  • Experienced at least 75% of the time,
  • Experienced for at least 6 months,
  • Not due to:
    • Substance abuse or medications,
    • Psychiatric conditions,
    • Severe relationship distress (e.g. intimate partner violence), or
    • Other significant stressors,
  • Causes significant distress

The four major categories of sexual dysfunctions include [8]:

  1. Disorders of sexual desire / interest
  2. Disorders of sexual arousal
  3. Orgasm disorders, and
  4. Sexual pain

There are 3 main categories of female sexual dysfunction:

  1. Genito-pelvic pain/penetration disorder (GPP/PD)
  2. Sexual interest/arousal disorder, and
  3. Female orgasmic disorder

There are also 4 categories of male sexual dysfunctions [9]:

  1. Hypoactive sexual desire disorder
  2. Erectile disorder
  3. Premature ejaculation, and
  4. Delayed ejaculation.

Sexual issues and sexual dysfunction can be related (but not limited) to the following [10]:

  • Pain or discomfort in genitals during sexual intercourse or medical procedures
  • Chronic medical conditions (e.g. coronary artery diseases, obesity)
  • Acute illnesses (e.g. stroke) 
  • Gynaecological issues (e.g. menstrual disorders) / treatment, (e.g. post-cancer, post-pregnancy)  
  • Male sexual dysfunction (e.g. erectile dysfunction)
  • Male health issues (e.g. male infertility) / treatment
  • Arousal, desire or orgasm issues
  • Couple intimacy and relationship issues  
  • Emotional difficulties 
  • History of sexual abuse / assault

Sexual dysfunctions should be diagnosed by medical doctors trained in this area.

Sexual issues become a concern when both partners have not been sexually active for a prolonged period of time, and it has an effect on the relationship. In such cases, it is important for partners to come to terms and acknowledge that it is affecting their relationship.

How Can Couple Therapy or Relationship Counselling Help?

The treatment of sexual problems requires tackling physical, psychological and interpersonal aspects of each partner, and the couple as a whole, with the help of healthcare experts. 

Couple therapy or relationship counselling can facilitate healing in a relationship through an integrative approach focusing on five areas [11]:

  1. Partners’ individual biology
  2. Partners’ individual psychological aspects, including sexual narratives and their impacts
  3. Intergenerational history (e.g. family trees)
  4. Couple relationship, and
  5. Environmental impacts.

Having trouble in your relationship?

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References

[1] Crowe, M. (2021). Couple Relationship Problems and Sexual Dysfunctions: Therapeutic Guidelines. Advances  in Psychiatric Treatment, 18: 154-159.  

[2] Byers, E. S., (2005). Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long term relationships. The Journal of Sex Research, 42(2): 113-118.  

[3] Loy, S.L., Chee, W.K., Yin, B.C., Godfrey, K.M., Yap, S.C., Shek, L.P.C., Kok, H.T., Yap, F.K.P., Bernard, J.Y., Chen,  H., Chan, S.Y., Tan, T.Y., & Chan, J.K.Y.. (2021). Fecundability in reproductive aged women at risk of sexual  dysfunction and associated risk factors: a prospective preconception cohort study. BMC Pregnancy and  Childbirth, 21:444.  

[4] Quinn-Nila, C.. (2019). Relationship and sexual satisfaction: A developmental perspective on bidirectionality.  Journal of Social and Personal Relationships. 

[5] Roels, R., & Janssen, E..(2020). Sexual and Relationship Satisfaction in Young, Heterosexual Couples: The Role  of Sexual Frequency and Sexual Communication. The Journal of Sexual Medicine, 17(9): 1643-1652.

[6] LoFrisco, B. M., & Hicks, B. (2012). Barriers and Facilitators to Addressing Clients’ Sexual Issues in Supervision.  Unpublished manuscript.

[7] American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual for Mental Disorders. 5th  edition. American Psychiatric Press, USA. 

[8] Hatzimouratidis K, Hatzichristou D. Sexual dysfunctions: classifications and definitions. J Sex Med. 2007  Jan;4(1):241-250. 

[9] American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual for Mental Disorders. 5th  edition. American Psychiatric Press, USA. 

[10] KK Women’s and Children’s Hospital. (2018, April 2). . Singhealth. Retrieved August 7, 2022, from https://www.kkh.com.sg/news/medical-news-singhealth/sexual-dysfunction-in-women  

[11] Weeks, G.R. & Gambescia, N. (2015). (5th ed). Couple Therapy and Sexual Problems. In Gurman, A.S. (Ed).,  Lebow, J.L. (Ed). Clinical Handbook of Couple Therapy. (pp 635-656). New York: The Guilford Press.