How to talk to your partner about a sexual problem

Sexual problems are common

Sex is often portrayed in TV shows, film, erotica and online porn as adventurous, uncomplicated and trouble-free. Yet in reality, sexual problems are a common issue that will affect many of us at some point in our lives.

While 75% of men always reach orgasm during sex, only 29% of women report the same according to a 2017 National Health and Social Life Survey. Another studio, published in 2017, surveyed nearly 7,000 British women, aged 16 to 74, and found that one in 10 experience pain during sex. And according to The Merck Manual, an estimated 50% of men aged 40 to 70 experience erectile dysfunction at one time or another.

Sexual problems can develop as a result of medical, physiological and psychological factors - for example, infezioni sessualmente trasmissibili, chronic pain conditions, the ageing process, and emotional response.

Krystal Woodbridge is a psychosexual and relationship therapist, and media lead for the College of Sexual and Relationship Therapists (COSRT). She explains that whether the issue is a personal one or a partner's, managing the situation successfully requires mutual understanding and support:

"Making it about 'your issue' or 'my issue' is never a good starting point," she points out. "It’s something that affects the sex life of both partners and both sides create the dynamic. I see various couples who both have a sexual issue yet they have no problem with intimacy, they've discovered what works for them and they communicate well."

If you're going to talk about a sexual issue, Woodbridge advises choosing your moment carefully; don’t initiate the conversation when you're in a sexual scenario (or about to be) and avoid times when you and your partner are tired, rushed, distracted or moody:

"Don’t just spring it on them, especially if it's something where resentment has been building. If someone is frustrated because their partner has low sexual desire it can come out as snide remarks and so on and that's not helpful. Negotiate a time to talk that suits both of you, but don't make it a big deal - offer reassurance that you care about them and that this is a positive conversation which is going to help your relationship."

One of the common questions Woodbridge is asked by patients is: 'When I meet a new partner, how soon should I tell them about my issue?'

Dating culture demands a level of confidence and that we present our best selves; if you have a sexual issue that makes you feel vulnerable, understandably you may not want to reveal it early on. How and when you discuss the issue depends on what it is and what the possible implications are for your partner. Acting with honesty and integrity, while also retaining your confidence and self-esteem, is key. Woodbridge also adds:

"It's reflective of our culture that people tend to expect sex quite quickly when they begin a relationship, before getting to know each other. Obviously it depends on the context, but if you're looking for a life partner, you want to choose someone who's empathetic; if they react badly to the issue, they're not right for you."

Be clear about how a sexual issue affects you, but also be willing to listen to your partner's perspective and validate their feelings. Focus on positives and set parameters for sexual activity that you both agree to. This will help build trust and closeness. Woodbridge explains:

"Don’t focus on the one thing you can't do; there's more to sex than just penetration or orgasm or the area where the issue lies. Problems arise when there's avoidance of sexual activity completely because one or both partners believe that any kind of intimacy will lead to sex and having to deal with the issue. Avoidance can become chronic and then couples are living almost as flatmates in a platonic way and the relationship breaks down."

Reassure your partner that, despite the issue, you still desire them, and that desire can be expressed in other creative ways as well as the standard sexual norms. Don't slip into critical mode or start blaming your partner (or yourself); instead, look for common ground. Woodbridge comments:

"If you find intercourse painful or impossible but are sexually expressive, open, creative and intimate, the majority of partners I see would prefer that than penetrative sex with someone who is sexually unadventurous, doesn't enjoy it and is not that into sex. It's the reassurance that you desire each that is so important - how you express that is your own creative adventure."

Some common sexual issues have clinical causes which can be treated effectively in primary care - for example, secchezza vaginale, menopausal factors, vulvodinia, thrush, sexually transmitted infections and difficoltà erettile. In the first instance, visiting your GP, or the clinica di salute sessuale at your local hospital, can be a useful starting point. Attending the appointment with your partner is a practical way to build mutual support.

Overcoming a chronic sexual issue often requires a multidisciplinary approach and a managed treatment plan. Attending psychosexual counselling (either alone, or together with a partner) can be a useful part of the process. Contact COSRT for a nationwide list of accredited sexual and relationship therapists.