Is It Sexual Dysfunction or Incompatibility?

Intimacy

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Maybe you’ve been wondering if dissatisfaction with your sex life is sexual dysfunction or actual incompatibility with your partner. Sexual contact in your relationship may not be happening as frequently as it once did, or maybe not al all. You may be in a situation in which you both engage and are interested but are unable to get started or finish the way you would like. If you haven't talked to your partner about these issues it may just be time to open up a conversation.

Research, by Keith Montgomery, among others, makes it clear that sexual dysfunction is an underrecognized issue with which many couples struggle. They may feel uncomfortable bringing it up with their doctor, or their doctor may feel uncomfortable asking or suggesting treatment. The Montgomery study called for continued research but did find that, with treatment, most people did report improvement with their sex lives.

Sexual dysfunction falls under several categories:

1. Desire disorders: lack of sexual desire or interest in sex.
2. Arousal disorders: an inability to become physically aroused.
3. Orgasm disorders: a delay or absence of orgasm.
4. Pain disorders: pain during sexual contact.

These categories relate to the stages of the sexual response cycle, the four phases of which include excitement, plateau, orgasm, and resolution. All genders experience these phases but they can look different and occur differently for each individual. If you can identify in which phase of sexual intimacy your problem occurs you can potentially narrow down what type of dysfunction is occurring.

A range of physical and osychological issues can cause sexual dysfunction, including:

• Antidepressants or other medications. This can be a common side effect from several medications. There may be a medication addition or change your doctor can make to offset this side effect.
• Aging. It is normal for our bodies to have trouble with arousal as we get older.
• Pelvic floor dysfunction (for women). This can occur for several reasons including childbirth, a pelvic disorder, or injury. It can affect pain and orgasm issues. It can be treated with physical therapy.
• Change in hormones- this can be due to aging, a medical disorder, or medication. It can affect, desire, arousal, and orgasm.
• Anxiety and/or depression. Anxiety or depression can lead to any of the four forms of sexual dysfunction, but it can be treated with therapy and or medications.
• Trauma. Trauma, but especially sexual trauma, can lead to any of the four forms of sexual dysfunction, but it can be treated with individual and couples therapy.
• Alcohol or drug use. Substance overuse or abuse can lead to desire, arousal, and orgasm dysfunction. Therapy can help with addiction issues.

All forms of sexual dysfunction can be treated with medical or mental health intervention depending on the cause, as confirmed by research dating back to Master’s and Johnson’s classic early work in Human Sexual Response, based on treatment focused on communication, couples therapy, and sensate-focused treatment. A much more recent study from 2020 showed positive results with cognitive behavioral therapy as the primary modality of treatment. Another treatment, based on group therapy and psychoeducation, also showed itself to be successful in a separate 2020 study. Research published by Offman and Matheson in 2005, and Mettz and Epstein in 2002, concluded treatment was best when it included both individual and couples counseing.

Sexual Incompatibility

Is there really such a thing as sexual incompatibility? I would say yes—if partners are unwilling to work through their mismatch. But in couples therapy, most mismatches can be worked on and resolved as couples generally can find their way to an agreeable compromise. Of course, there are times when a compromise can’t be reached because a core need cannot be met in the relationship. In a 2005 study on sexual compatibility, it was found that partners who had persistent issues with communication and level of functioning in the relationship were more likely to be deemed sexually incompatible.

Following are some examples of common problems that lead to incompatibility:

• The most common sexual mismatch surrounds frequency or timing of sex. Some people have higher, or lower, sex drives than a partner, or are interested in sex at different times of days. You and your partner may need to look at ways to meet your sexual needs so you can both be happy. This could include finding a new time of day you both feel interested in, or agreeing on different intimate forms to engage in more frequently.
• Another mismatch centers on the type of sex or specific sexual acts desired. Some partners may have a preference that the other doesn’t feel comfortable with: a fetish, oral sex, or a particular position. It would be important to have an open conversation in which you explore understanding why your partner feels interest in, or fulfillment from, their specific preferences. There may be a way to explore this desire so you both feel comfortable.
• Sexual orientations or identities may be a mismatch. If couples find they develop, or begin to openly express, different sexual orientations during their relationship, it can be especilly difficult to find compatibility. Similarly, if one partner has identified as transgender, the other's sexual orientation may no longer fit with them. Identifying as asexual may also be a hard mismatch to breach.

So Which Is It?

Sexual dysfunction can be measured by assessing problems in the sexual response cycle to see what type of dysfunction one is experiencing. Once that is identified the medical or behavioral cause can hopefully be identified and treated. When the issue is incompatibility the problem doesn't occur in the sexual response cycle and may instead be a gridlock the couple may struggle to open up and communicate about. Therapy can help a couple find out if their problem is resolvable or if there is a viable compromise.

If you and your partner are experiencing sexual dysfunction or incompatibility individual and couples counseling can be a great resource. Your therapist can help you identify the problem and find appropriate medical treatment if applicable.

To find a therapist, visit the Psychology Today Therapy Directory.