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Sexual Problems That Can Arise in Long-Term and Committed Relationships Christina Spaccavento

Sexual issues arising in long-term relationships as they present The cycle of is not the only factor contributing both sexual touch (stroking genitals, penetrative sex, oral sex) can often alleviate of and improve self- in the therapeutic setting are examined in this paper. These to waning in long-term relationships. Individual clients and non-sexual touch (cuddling, holding hands, spooning). esteem while also restoring in the couple’s ability to include the role of sexual desire and its relationship to the cycle may report additional factors: long working days, exhaustion, can either increase or decrease intimacy have penetrative sex. of limerence, therapeutic treatments of sexual problems, sexual children, lack of privacy in the home, relationship Hence it is important that the therapist understand the role Women often present for counselling when recovering from and non-sexual communication and the impact illness can problems such as at the other partner, or a significant life communication plays in the dynamic of the relationship in mastectomies, or during the course of other chronic conditions play, both as a contributing factor to sexual problems and in event. Mansell, Salinas and Sanchez (2011) cite other factors order to best facilitate the clients’ work. like chronic fatigue syndrome, , and cancers of the the process of sexual rehabilitation. including communication problems, substance , It is common that clients lack the skills and attitudes female reproductive system: breast, ovarian, uterine or cervical. Permanent injury or disability and chronic conditions Sexual Desire in Long-Term Relationships and depression, certain medications, prior sexual abuse, required for discussing sensitive issues such as the specifics of gynaecological problems, or even a primary medical problem their sexual relationship with their partners (Bienvenu 1980). significantly impact a client’s ability to function sexually. Clinical experience shows that clients in committed, long-term such as Hypoactive Sexual Desire Disorder (HSDD). It is Furthermore, research has shown a positive relationship The therapist will need to work with the couple in exploring relationships often present with complaints relating to reduced, therefore crucial that the health practitioner take a full sexual between the frequency and quality of a couple’s talk about sex alternative ways to achieve sexual intimacy, which may require low or non-existent sexual desire. Multiple physiological, and relationship history of both partners in order to fully (both men and women) and their level of sexual satisfaction the couple to broaden their sexual repertoire. psychological, emotional and social factors may contribute identify and understand all the factors contributing to sexual (Timm & Keiley 2011, Baus, 1987, Metts & Cupach 1989, In good case management, the therapist liaises in a to this phenomenon. Unresolved problems relating to sexual desire problems. Sprecher & McKinney 1993). This highlights the need for collaborative effort with the clients’ other health practitioners, desire can prove catastrophic to both the sexual and non-sexual Clients may experience the distancer/pursuer pattern in their counsellors to address and facilitate communication in the increasing the possibility of achieving a lasting resolution to aspects of a relationship. It is not uncommon that clients seek both the individual’s sexual difficulties (McCabe, et al. 2010) counselling only after years of conflict regarding one partner’s relationship. This occurs when one partner, the pursuer, seeks therapeutic session. with the other, the distancer, who avoids or and laying the foundation for the couple to resume their pre- sexual desire and/or availability. The Link Between Relationship Issues refuses the sexual interaction (Betchen, 1991). The more the illness sexual relationship. and Sexual Difficulties Sexual Desire Defined pursuer pursues, the more the distancer distances and so on. It References There is no consensus on a definition of sexual desire. DeLamater is important that the counsellor works with the couple on the It is important to remember that working with sexual issues also Albaugh, JA and Kellogg-Spadt, S 2002, ‘Sensate Focus and its Role in involves working with relationships. Sexual and relationship Sexual Dysfunction (Intimacy Issues)’, Urologic Nursing 22(6): 402 and Sill (2005) discuss two main frameworks in the literature. The causes of this pattern. Baus, PD 1987, ‘Indicators of Relationship Satisfaction in Sexually Intimate first and most common framework suggests that sexual desire is issues can exist independently of one another, but relationship Relationships’, paper presented at the Iowa Conference on Personal Relationships, Treatment of Sexual Desire Issues problems can cause sexual problems and sexual problems can Iowa City, IA an innate biological drive that motivates individuals to seek out Betchen, SJ 1991, ‘Male Masturbation as a Vehicle for the Pursuer/Distancer sexual stimuli or activity. The second framework sees sexual desire A number of techniques can be used to address sexual desire cause relationship problems. Relationship in ’, Journal of Sex & Marital Therapy 17(4): 269-78 as an external force that manifests in the potential partner rather issues. General education incorporating the anatomy and Links between relationship and sexual problems are not Bienvenu, MJ 1980, Counselor’s and Teacher’s Manual for the Sexual Communication physiology of the body and sexual techniques can be very helpful always easy to identify, hence the importance of taking detailed Inventory, Saluda, NC: Family Life Publications than from an internal need within the desiring self (Verhulst Brotto, LA, Petkau, AJ, Labrie, F and Basson, R 2011, ‘Predictors of Sexual Desire & Heiman, 1979). Clinical experience has shown that clients for couples who have limited or no knowledge of lovemaking histories of both individuals and couples. Disorders in Women’, The Journal of Sexual Medicine 8: 742-753 (DeLamater & Sill 2005; Mansell, et al. 2011; Brotto, et al. DeLamater, J and Sill, M 2005, ‘Sexual Desire in Later Life’, Journal of Sex Research, can exhibit both innate and external desire, which may occur lllness and Sexual Rehabilitation in 42: 138-149 2011). Sensate focus exercises can be given as homework to help interchangeably within their relationships. Long-Term and Committed Relationships McCabe, M, Althof, SE, Assalian, P, Chevret-Measson, M, Leiblum, SR, Simonelli, recapture intimacy between partners (Albaugh & Kellogg- C and Wylie, K 2010, ‘Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction’, The Journal of Sexual Medicine, 7: 327–336 Sexual Desire and Limerence Spadt 2002). These involve touching, caressing and non- A number of illnesses can a client’s physical, mental and emotional health. It is important to understand that a diagnosis Mansell, D, Salinas, GD, Sanchez, A, Abdolrasulnia, M 2011, ‘Attitudes Toward Clients often cite a reduction in sexual desire for their partners coital massage—a powerful tool for couples working towards Management of Decreased Sexual Desire in Premenopausal Women—National after the relationship has passed from the initial phase (as early rebuilding their physical connection, which may have been of illness can disrupt both and physical Survey of Nurse Practitioners and Physician Assistants’, Journal of Allied Health, sexual function. Many couples experience relationship stress 40(2): 64-71 as three months) into the committed and long-term phase neglected due to the distancer/pursuer relationship and/or other Martínez-Jabaloyas, JM, Moncada, I, Rodríguez-Vela, L, Gutiérrez, PR, Chaves, (up to two years and beyond). A common complaint, it can relationship problems. Developing clients’ communication from a diagnosis of illness and, generally, couples who were J 2010, ‘Evaluation of Self-Esteem in Males with Erectile Dysfunction Treated experiencing relationship problems before a diagnosis are more with Viagra. Analysis of a Spanish Patients Group Selected from a Multicenter, nevertheless be a baffling and unsettling change within a skills to improve their ability to negotiate their needs and wants International Study’, Actas Urol Esp., 34(8): 699-707 relationship. The cycle of limerence explains the initial wave of more generally within the context of the relationship as well likely to continue to have problems afterwards. Relationship Metts, S and Cupach, WR 1989, ‘The Role of Communication in Sexuality’, support should ideally begin at the onset of diagnosis, and should in K McKinney and S Sprecher (Eds.) : The Societal and relationship and ensuing dissatisfaction experienced as in the sexual relationship is also an important influencing Interpersonal Context, Norwood, NJ: Ablex Publishing (139-161) by many people. occur alongside conventional medical support. Disappointment, Reynolds, S 1983, ‘“Limerence”: A New Word and Concept’, Psychotherapy: Theory, factor in increasing sexual desire (Mansell et al. 2011). These Research and Practice, 20(1): 107-111 ‘Limerence’ attempts to describe the enigmatic state of ‘being suggestions are by no means exhaustive, and each couple will no and poor quality of life can result if sexual issues are not identified, understood and counselled. Sprecher, S and McKinney, K 1993, Sexuality, Newbury Park, CA: Sage in ’. Individuals in the state of limerence may experience benefit from individualised and client-centered therapy. Tennov, D 1979, Love and Limerence: The Experience of Being in Love, New York: Stein feelings of — accompanied by an emotional Men can present with conditions—including cardiovascular and Day The Role of Communication in disease, diabetes, depression, prostate cancer and post Timm, TM and Keiley, MK 2011, ‘The Effects of Differentiation of Self, Adult high—and have a heightened focus on and longing for the Attachment, and Sexual Communication on Sexual and Marital Satisfaction: A other person that may, at times, be obsessive and include Long-Term and Committed Relationships prostatectomy conditions—that can directly affect the Path Analysis’, Journal of Sex & Marital Therapy, 37(3): 206–223 intrusive and fantasies about that person. They feel a Clients often present in the moment of crisis when communication physiological functioning of the male genitalia, namely erectile Verhulst, J and Heiman, J 1979, ‘An Interactional Approach to Sexual Dysfunctions’, American Journal of Family Therapy, 7: 19-36 longing for reciprocation of these feelings by the object of their on all levels has broken down. Sexual as well as non-sexual dysfunction (ED), and may cause distress to both the individual desire. A physical manifestation may be felt as in the chest communication can be regarded as crucial to many relationships. and the relationship. A number of therapies can be used in order area. At the height of limerence, the individual is unconcerned When communication fails, the relationship is at risk. The ability to improve erectile function, depending on the severity of the with any defects in the other; rather, he or she can see only the to communicate about issues in long-term relationships is a key client’s condition. Common therapies used include the use of Christina Spaccavento, MSc (Health Science), is a qualified and positive aspects of her or his partner (Tenor 1979). When the skill that all clients can benefit from learning. PDE5 Inhibitors—more commonly known as Viagra, Levitra experienced sex therapist and relationship counsellor, educator process of limerence is explained to clients, their relationship Communication is not only verbal. Couples can also and Cialis (Martínez-Jabaloyas 2010)—vacuum pumps, and supervisor. She runs her own clinical practice in Surry Hills and Potts Point and has made various expert contributions experience is normalised, and any feelings of related to communicate through body language and touch. In long-term intracavernosal injection therapy (ICI) and, in extreme cases, to media publications and television in the area of sexology. changed sexual desire can be dispelled. relationships, non-verbal intimate communication can involve penile implants. When used properly, these physical therapies www.sydneysextherapists.com.au, [email protected]

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