As a sex and relationship therapist in Manhattan, almost every working day for the last three decades, I’ve done something few men ever get to do: I’ve listened to women tell me about their lives.
We men don’t usually cross gender lines in private conversation. But I highly recommend it. As I’ve written elsewhere, Freud’s famous unanswered question, “What does a woman want?”, isn’t so hard to answer if you just simply ask.
Men and women still don’t understand each other very well. As an NYC sex therapist working mostly with heterosexual couples, I’ve seen first-hand the mischief that can cause.
So in the hope of promoting better understanding, here’s my short list of the 10 women’s sex concerns I hear the most.
1. Situational Loss of Desire
When I was a young sex therapist, a national study claimed to have discovered an epidemic of loss of sexual desire in adult American women, with roughly 40% reporting no desire at all.
This turned out to be both true and untrue. The figure 40% was more or less valid. But the implication – that there was something wrong with these women – was for the most part incorrect.
In fact, a woman’s level of sexual desire is often simply a response to her life situation. I see many women in NYC lose desire simply because the partnered sex they’ve been having just isn’t very desirable.
The secrets to good sex are largely emotional. But many couples aren’t yet aware of this.
(If you’re one of them, you may want to look at Chapter 1 of my book, Love Worth Making – free pdf available here).
Sometimes a woman’s loss of sexual desire points to some other factor – such as physical exhaustion, body image concerns, painful sex, depression, sexual side effects of medications, or chronic marital unhappiness. Or, most commonly, lots of these factors in combination.
As a solution-focused NYC sex therapist working with over 2,500 individuals and couples, I’ve spent decades researching ways for women to reclaim desire. Desire problems can be simple or complex. It’s a good idea to make sure your therapist knows how to distinguish one from the other.
2. Non-Situational Loss of Desire
A good sex therapist should be able to help you address most of the psychological causes of low desire. But sex is both psychological and biological.
Many women have perfectly good sex for years, in perfectly good marriages, then hit a point where desire just seems to disappear – presumably for reasons that are at least in part biological.
In my NYC sex therapy practice, this commonly happens after the birth of a child. Often no specific cause can be found.
Truth is, we understand very little yet about the biological underpinnings of desire. As a sex therapist, though, I’ve learned to pay close attention when a woman tells me, “Something’s been lost.”
For years, people have wondered whether the subtle biological changes that often accompany women’s life events might respond to biological treatments.
In 2015, the FDA approved the first such treatment – flibanserin, more commonly known as Addyi.
Does Addyi work? Yes, in about half the women who try it. It’s not a magic bullet. But as an NYC sex therapist who’s also an MD, I’ve seen Addyi and other biological treatments for loss of desire sometimes be a useful adjunct to sex therapy.
Every woman is different. Often you don’t know in advance what’s going to work for whom.
3. Mismatched Sexual Desire
In a perfect world, you’d each fill out a questionnaire before the first date. With questions like, “How important is sex to you? How many orgasms a week do you need to feel happy and fulfilled?” But many couples fall in love knowing nothing about each other in this regard.
There’s a bell curve when it comes to desire, as with most human attributes. People on the high end of desire tend to use sex as an all-purpose tool to help regulate their emotions. For most folks on the low end, that makes no sense at all.
Happily, there are good work-arounds. In my practice, I encourage couples to get specific about what they really need, in the moment. Physical touch? Reassurance? An orgasm? To feel desired? There are lots of ways to get these things, short of full-on sex.
Achieving happiness as a mixed-desire couple is a bit of an art. I’ve spent decades helping couples honor each others’ sexual natures and avoid common mistakes that can get in the way.
4. Not Feeling Desired
Most women assume men automatically want sex – so when a man loses desire, it tends to be highly confusing.
Every day I get calls from women whose male partners have “gone missing in bed.” Most often, it turns out he hasn’t lost desire at all. Often he’s simply become sexually avoidant.
Male sexual avoidance is a growing problem these days. Maybe it’s related to men’s and women’s changing gender roles and expectations.
Whatever the reason, once a man starts avoiding his female partner in bed, it often prompts vicious cycles of hurt and recrimination that can be hard to stop. Best to have him seen quickly, before too much damage has been done.
By the way, if you’re hoping to convince your man to get help, keep in mind that most men don’t like the word “therapy.” Better to call it a “consultation.”
If he still refuses to go, tell him you’re going for a consultation anyway. Tell him the longer he waits to come in, the more expensive it will be in the long run. That often gets the ball rolling.
5. Inability to Orgasm with a Partner, or Under Any Circumstances
Penis-vagina intercourse was never an efficient way for women to climax. Many heterosexual women have historically struggled to reach orgasm during partner sex.
But great strides have been made lately in bringing the latest climax-enabling technologies to an eager public. I like to remind people that sex should be easy. And with vibrators just getting better every year, there’s no reason getting an orgasm should ever again feel like work.
By the way, the best way to use a vibrator during partner sex is to control it with your own hand – just like when you’re by yourself.
Don’t worry about your partner feeling left out. Most men find female orgasms intensely erotic, no matter how they’re obtained.
Your chances of reaching orgasm will also most likely depend on how sexually aroused you are. So before you start trying to climax, best to make sure you’re authentically turned on.
If you’re someone who’s never had an orgasm under any circumstances – even by yourself – relax, you’re in good company. In fact, there’s never been a better time to learn. Best to consult with a sex therapist who can introduce you to the most effective resources and techniques.
See also:
- The GOOP Interview: Sex Therapist on Vibrators, Intimacy, and Pleasure
- The GOOP Podcast: Why Sex Therapists Don’t Care About Orgasms
- PsychologyToday: Two Roads to Orgasm
- PsychologyToday: Saying Yes to Female Orgasm
6. Painful Sex
No, it’s not in your head.
Most women have, at some point, experienced pain with intercourse. Many experience it on a consistent basis. Some tell their partners. Many don’t.
A number of common medical conditions can cause sexual pain – from endometriosis, to pelvic floor muscle dysfunction, to vulvar vestibular inflammation and Mast Cell Activation Syndrome (MCAS). Proper diagnosis usually requires the input of a sexual pain specialist. Your general gynecologist may not have adequate training or experience.
Women in New York City are lucky to have access to specialized sexual pain treatment that’s not available in many parts of the country.
I keep an active rolodex of specialists in the NYC area, collaborate with them as needed, and work with couples to keep their erotic connection alive during times when intercourse is simply not practical.
Fortunately, with state-of-the-art treatment, most women with sexual pain can now be helped.
7. Effects of Sexual and/or Psychological Trauma
I hear many NYC women describe feeling emotionally or physically numb during sex. This often points to a past experience of sexual or emotional trauma. Trauma often has wide-ranging effects on a woman’s erotic life.
For one, trauma tends to distort how you think about sex. For example, thinking that sex is something you do for other people, not for you.
Trauma also tends to affect how you think about yourself as a sexual person. For example, assuming you must have done something shameful or bad to make the trauma happen.
Trauma also tends to produce automatic negative reactions, often when you least expect them. During peak arousal, you can suddenly feel frozen, panicked, overwhelmed, or unreal.
Automatic reactions can sometimes start at the most inopportune times – such as when you fall in love with someone wonderful, and life is looking good. Very paradoxical. No one knows why.
The traditional explanation is that you feel safe enough to confront painful memories. I’m not sure. As a sex therapist who sees a lot of people with trauma, I think sometimes it’s your unconscious paradoxically trying to make sure you don’t get too happy.
Talk therapy has its place in the treatment of trauma, but often it’s best to bring the body into the conversation as well. Most often through dance, art, movement, or specialized treatment approaches such as Somatic Experiencing.
8. Infidelity
I frequently see couples whose sexual and emotional troubles have been quietly simmering for years until an episode of infidelity suddenly brings things to a boil.
In the long run, most couples affected by infidelity do end up staying together, so it’s well worth the time and energy to do it right.
Traditional accounts of infidelity often feature cheating husbands and betrayed wives. That made sense when women were economically dependent and punishments for female infidelity more severe. But recently, as women have more fully entered the workforce, there’s been more discussion of what happens when it’s the wife who’s unfaithful.
As an NYC sex therapist, I’ve spent decades helping couples heal from infidelity. First, by being honest about what happened. Then, by being clear about what you each need in order to stay together.
Infidelity ranks high on anyone’s list of the most severe stresses a relationship can sustain. Relationship guru Esther Perel famously likens it to finding out you have cancer. But with honesty, perseverance, and faith, many couples eventually move beyond infidelity to a better marriage than they had before.
9. Dealing with a Partner’s Neuro-Atypicality
Sooner or later, many women in heterosexual relationships come to the realization that their male partner’s mind works in unexpected ways. Maybe he has an astonishing ability to remember facts, but can’t remember a conversation you had an hour ago. Or he lacks the ability to put feelings into words, or has no idea people he’s talking to might be bored, or can focus so intently on something that he doesn’t hear you call his name.
We mental health folks refer to such individuals as “non-neurotypical,” “neuro-atypical,” or just “atypical.” Some turn out to have a mild form of Autism Spectrum Disorder (ASD). Some have Attention-Deficit/Hyperactivity Disorder (ADHD) – often combined with ASD and/or OCD. Others have forms of atypicality that science has yet to classify.
Many women are neuro-atypical as well. But women ordinarily have more ability to “mask” atypicality, due to gender-related advantages in empathy and language ability.
Neuro-atypical men, on the other hand, tend to be in “double jeopardy” from being both male and atypical. As an NYC sex therapist, I see many, many atypical men brought in by their exasperated wives – and very few atypical women brought in by their exasperated husbands.
Neuro-atypicality in a male partner can have far-reaching consequences for a relationship – both in and out of the bedroom. Often the first step is to realize his quirks are more neurological than psychological. Once this is recognized, sex and relationship therapy with such couples can often be quite productive and rewarding.
10. Trouble Finding a Good Partner
Why do women freeze their eggs? No, it’s not to prioritize career over childbearing. Most women who freeze their eggs do so because they haven’t yet been able to find a good partner.
For the first time in history, the majority of adult American women are unmarried. And no, it’s not from being “too picky.” Most single women I see have tried over and over again to find a workable compromise with men who were far from perfect.
The stark reality is it’s not easy to find someone whom you desire, who desires you back, and who’s truly ready for a life partnership.
Most women I see tend to work hard on themselves. Often too hard. Most men tend not to work hard enough. The results speak for themselves. Sure, things were simpler when we had less choice and stronger communities. But I believe finding a good man has always been a bit of a challenge.
As a male therapist, I’ve seen enough young men in my practice to know the species very well. And I’m often sought as a guide by single women trying to find a good man who’s also real, reliable, and ready.
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I hope the above survey gives you a sense of the wide range of sex and relationship issues confronted by women and their partners today.
Being a sex and relationship therapist requires a diverse set of skills that can take a lifetime to master. I’ve spent decades developing cost-effective, solution-focused approaches to the most important sex and relationship concerns faced by women and their partners.
If you’re suffering from a sex or relationship issue in your life, contact me, and let’s discuss the best approach for your needs.
© Stephen Snyder MD 2024
New York City