Healthy ideas for your inbox
So you’re having trouble in the bedroom — or not getting there at all. Almost everyone struggles with sex at some point in their lives. Still, it can be hard to figure out whether your lack of desire or difficulty reaching orgasm is caused by an underlying health condition, a medication you’re on or just the stress and exhaustion of a hectic life.
Whatever is causing your difficulties with sex, the most important thing is to be able to talk about it — with your partner, your doctor and maybe even a therapist. Here are some questions to start these conversations and get back to business.
Are your expectations for sex realistic?
Here’s something to consider: Could you be disappointed by your sexual experiences because you have unattainable expectations of what they should be like?
“A lot of people have such wildly unrealistic ideas about what sex and orgasm and genitals should look like that they are self-diagnosing themselves with issues when actually they just need a reality check,” says Nicole McNichols, an associate teaching professor in the Department of Psychology at the University of Washington, who teaches a popular course on human sexuality.
For example, if you’re a guy who can only last four or five minutes — that’s actually normal and not considered premature ejaculation. And if you’re a couple who is not having sex every day, that doesn’t mean something is wrong with your sex life.
Dr. John Amory, a physician at the General Internal Medicine Center at UW Medical Center – Roosevelt, agrees. “The depictions of sexual activity that people see in porn or in movies are not a reality for 99% of people,” he says. “If you watch movies, you think people are having sex all the time, and that’s not most people’s experience.”
So, the first step for many people might just be letting go of the expectations you have in your head for what things should be like between the sheets.
When you are having sex, are you enjoying it?
If you’re finding it hard to get in the mood, think back to the last time you did it. Was it good?
If not, it could be that bad sex is the culprit for your low libido. “One of the things that’s been found to be really effective in increasing desire is just focusing on increasing the amount of pleasure during the sex that you’re having,” says McNichols.
A good place to start? Only about half of women say they can orgasm by intercourse alone. “If you are a woman and you can’t orgasm from penetrative sex, you’re not broken,” says McNichols.
The hard part is leaving preconceived ideas of what sex should be behind, and communicating with your partner. “We’re taught that sex is something that you’re just innately good at or not,” says McNichols. “We’re not taught that sex is a skill that takes really good sexual communication.”
It might feel awkward or challenging at first, but starting a conversation about what is working — or not working — for both of you is worth it. You’ll likely learn a lot about what feels good for the other person. Still having a hard time talking about it? Don’t be afraid to seek help from a couple’s counselor or a sex therapist.
Have you been feeling stressed?
One of the most common causes of lack of sexual desire is simply exhaustion.
“We’re all under so much stress, we’re all so busy, we’re on our phones all the time,” says McNichols.
If you’re in a relationship, especially a heteronormative one, it might be worth looking at who is taking on more things like household work and the cognitive load of keeping up a social calendar.
“I think you have a lot of people, especially women, who are just burnt out and exhausted,” says McNichols. “The number one factor that leads to sexual decline in middle-aged women is just exhaustion.”
As for men, stress and anxiety can make it hard to, well, get hard.
Anxiety and depression can create self-fulfilling prophecies where anxiety about not being able to perform or depression related to not having a sex drive can then cause issues with sexual performance and arousal. So, it’s important to address any underlying mental health issues.
Are you on an SSRI or birth control?
One unfortunate reality for many people is that the medication they’re on to address depression or anxiety is itself causing sexual dysfunction. More and more reports are coming out about people on serotonin selective reuptake inhibitors (SSRIs) like fluoxetine (Prozac), fluvoxamine (Luvox) and sertraline (Zoloft) who are suffering from low libido or even losing feeling in their genitals, making it impossible to orgasm. Women on hormonal birth control often report experiencing low libido, as well.
If you suspect a medication is affecting your sex life, don’t hesitate to ask for help. It’s possible that a smaller dose or a different medication altogether could improve things — or that the side effects might go away over time.
“It’s important to treat the depression or anxiety, but at the same time, hopefully you can treat it without having the sexual side effects,” says Amory.
There are options available for birth control, too. “Maybe it’s switching to an IUD, maybe it’s switching to a lower dose, maybe it’s switching to something that has a higher relative level of estrogen or progesterone,” says McNichols.
Are things not working or feeling painful when you are aroused?
If you’re getting in the mood, but things are off down below when you’re ready to have sex, you’re far from alone.
Erectile dysfunction (ED), for example, is nothing to be ashamed of — studies have found more than half of men deal with it at some point in their lives. Meanwhile, 3 out of 4 women experience pain during sex due to everything from an STI to menopause causing vaginal lubrication issues.
Don’t be afraid to ask for help. “Women who are suffering with sexual pain: that should not be something that you just sit back and suffer with,” says McNichols. “You should be able to talk freely with your OB-GYN and find a solution.”
Men, especially, can have a hard time bringing up these kinds of issues because of embarrassment.
“It can be a little bit uncomfortable, but this is a super important part of people’s lives, and we want to help,” says Amory.
If you’re a guy who’s having a hard time saying “I can’t get an erection” to the nurse on the phone, it’s perfectly fine to say something like “a private issue” or “an intimate matter.”
Once you’re willing to reach out for help, great tools exist. For men, it could be as easy as a Viagra or Cialis prescription, or if those don’t work, injections or even implants exist and are very effective at helping you get hard. For women, dilators — plastic or silicone tubes — can stretch the vaginal tissue and make it more flexible.
If you’re a man with ED, you might also have a more significant underlying issue, making it even more crucial to bring it up with your doctor. Testosterone deficiency is not as prevalent as advertisements for testosterone replacement therapy will have you believe, but it does affect 3 to 5% of men. An even more likely culprit is vascular disease, which causes the vast majority of ED cases and could lead to much more serious problems — such as heart disease and stroke — if not addressed early.
The bottom line? Speak up.
It’s easy to let shame and embarrassment stop you from talking about sexual dysfunction. Amory sees this, for example, with patients who have premature ejaculation.
“They are so full of self-hatred about it,” says Amory. “But it’s super common; it’s nothing to be ashamed of.”
In fact, you can rest assured you’re far from alone in dealing with whatever issues you’re having around arousal or sexual performance.
“Sex should be pleasurable, and it should be fun, but it can be challenging at times,” says Amory. “Just know that it’s challenging for a lot of people, and you’re not alone.”
The first step to getting back to pleasure and fun? Opening up about it.
“If you are having an issue, go talk to somebody about it,” says McNichols. “This is not something that you should have to struggle with silently alone. It really is something that you should feel very confident talking to your doctor about and having trust in them. If you don’t, then find a new doctor.”
