Can it ever be too late?  Unfortunately, yes.  Some couples wait so long that one partner is already about to walk out the door.  The other will say, wait, let’s go to counseling.  They enter my office, one motivated, one dejected.  If the dejected partner can’t be motivated, if they feel as if they’ve already tried everything imaginable, or if they are so angry and disgusted that they just don’t care any more, yes, it can be too late.  And I have to say, those are the saddest cases that I see in my office.

I can’t say that every marriage like this could have been saved if they had come in sooner; that would be unrealistic.  But what I can say is that the likelihood that the marriage might have endured is increased when there have been fewer years of damage to undo.

How do you know when it’s time to make a call to a sex or couples therapist?  Here are some reasons to call:

• You continually have the same fight about the same topic without any resolution.
• The problem is one that has long roots back into early adulthood or childhood, and you’ve never gotten help for it.
• You don’t talk about the problem, but there is a lot of tension in the relationship.
• You feel unhappy or dissatisfied with your relationship most days.
• You worry that your partner has a mental illness such as depression or bipolar disorder.
• You bicker constantly.
• You dread spending time alone with your partner.
• You fantasize about being single again.
• You’ve contemplated having an affair, or you’ve had or are involved in an affair.
• You have an unusual problem and don’t know where to turn.

There are times when taking a wait-and-see approach makes sense.  If you’ve had a major argument or your partner’s behavior has disappointed you, then time may heal the problem.  Or if you agree to make and implement a change, you may want to have a reasonable time line, such as 6 months, to see if you can remedy things on your own.

Seeing a therapist may be problematic, I know.  Admitting that you have a problem that you haven’t been able to solve, letting someone–a stranger–see you at your worst, and trusting someone is going to give you good value for your money all make going to therapy a tough call.

But consider the alternatives:  Years of arguing, emotional pain, and despair.  Separation or divorce.  The loss of dreams and potential as a couple.

Of course, there is no promise that even if you do contact a therapist sooner rather than later your marriage or relationship will endure.  Sometimes partners hide their motive for coming to therapy, such as making sure that there is someone (the therapist) to take care of their partner if they choose to leave.  Or, they come in so that they can say, “We tried therapy and it just didn’t work out.”  But for most couples, seeing a therapist is the key to staying together–especially if they call before it’s too late.

But before talking about the role of feelings, here is a bit of general information about premature ejaculation (also known as rapid ejaculation).  Often the first question I ask is, “How long do you actually last?”  When a man answers three or four minutes, I tell him that he’s doing fine, because on average men last from three to 10 minutes.  However, the caller is often unhappy with this answer.  Generally, the partner is disappointed because she cannot have orgasm within the time that the couple has intercourse, or he once enjoyed better control but has noticed a change.  Some men have control for a minute or two, if that, which leads to the most frustration.

What to do?  It depends on the cause as well as perspective.  Some people, including many medical doctors, see premature ejaculation as a physical problem.   The thinking goes that a man’s penis and his mental responses to stimulation are overly sensitive, causing ejaculation before the man and his partner want it to occur.  When the medical model is used to explain and treat the symptom, then a medical treatment is used, such as a numbing cream or an antidepressant.  (Antidepressants can have the side effect of delaying ejaculation.)

However, premature ejaculation can also be a psychological problem.  Anxiety and stress are common culprits.  When a man is anxious about how long he will last, whether or not he will please his partner, or about some other aspect of sex, then his brain is primed to react quickly to stimuli.  Stress does the same thing by causing the body and mind to be “keyed up” in high alert, making it difficult to stay focused and manage all the sensations going to the brain.

But feelings can also contribute to premature ejaculation.  If a man is feeling sad, for example, about his relationship, he may find it difficult to last as long as he’d like while being intimate with his partner.  Men often contact me about this problem after the breakup of a relationship.  The problem starts seemingly for “no reason,” but upon reflection, the relationship was actually on shaky ground for quite some time.  Fears about one’s ability to please a woman not just sexually, but emotionally, can be subtle but still create an effect in the bedroom.

Anger can also disrupt a man’s sexual performance, as can feeling exploited or used by his partner.  He may not feel like being close to his partner under such circumstances, even though he mostly wants to please her.  He also may be too distracted by his negative feelings, unable to push them aside.  Though it may be a stereotype, men do tend to pride themselves on their ability to put aside feelings in favor of thought.  But try as a man might, if his negative feelings are strong enough, or if he is under stress or tired, they will make themselves known through various symptoms, including premature ejaculation.

When feelings are absent, there can also be problems.  If a man is with a sexual partner with whom he has little emotional connection, he doesn’t have an incentive to last a long time.  He also may not want to have a long period of intercourse because he doesn’t want to seem or become interested or involved with his partner.  Though there are some men who want to appear as “studs,” able to last a long time under any circumstance, the truth is that feelings do play a role in sex for most men.  After all, men are simply human; they shouldn’t dismiss the important information that their feelings hold for them, including when it comes to sex.

Vaginismus happens for many reasons.  A woman may be highly nervous about having intercourse, particularly for the first time; she may feel shame or guilt about sex, or she may have performance anxiety.  Or, past trauma such as date rape may be to blame.  Repeat infections, such as yeast infections, or dryness during menopause uncomfortable intercourse can also cause vaginismus.  Finally, treatments for gynecological cancers, such as cervical cancer, can also cause vaginal atrophy.

Because it can be so embarrassing, many women fail to talk to a physician about treatment.  Unfortunately, even women that do mention the problem to a doctor often receive a pat on the knee and advice to “just relax.”  Of course, that is much more easily said than done.  There is much more that can be done to help a woman and her partner overcome vaginismus, including the following steps:

1. Find a physician that specializes in sexual medicine.  This is usually a gynecologist or a urogynecologist (a urologist that specializes in women’s problems).  You can ask your own gynecologist or general physician for a referral.
2. Work with a psychotherapist who specializes in problems of a sexual nature.  This may be a sex therapist, or it may be a marriage therapist who has some training in sexual dysfunction.  Identify what makes you fearful, guilty, or shameful about sex, process it, and let it go.
3. Consider a program of dilator use.  A dilator is a cylinder-shaped object that is inserted into the vagina to desensitize a woman to having something “in there.”  Dilators start with a small size and increase to something comparable to a man’s penis.  The physician or sex therapist can give you guidance on how to use them.
4. Try a program of overall physical relaxation.  You can find many relaxation recordings online.  Or do yoga, meditation, or other form of regular relaxation.  Listening to relaxing music can also be helpful.
5. Learn more about sexual pleasure.  You can learn a lot about your own body through self-massage.  Let your partner know what you do and do not like when it comes to touch.
6. Always use lubricant for any type of genital contact.  Water-based lubricants tend to dry out and need to be reapplied, but they can be used with condoms.
7. Don’t give up on sex altogether.  There are definitely couples that have a rich sex life that just doesn’t include intercourse.  (Often it is the wish to become pregnant that brings them into treatment.)

Women with vaginismus shouldn’t give up on the desire to have “normal” sex with their partner.  It may take some time and lots of encouragement, but with the right assistance most every woman can resolve the problem and enjoy sex.

In my view, women who have a problem with orgasm often have one or more of the following issues:

1. They don’t understand their own bodies.  They never masturbate, which is unusual, especially in these times when you can buy a sex toy and a bottle of lubricant at many local pharmacies.  Since they don’t know their own bodies, they can’t communicate to a partner what it is that arouses them and might bring them to orgasm.
2. If they do masturbate, they focus exclusively on their genitals.  They don’t realize that orgasm requires arousal.  They don’t explore their bodies to see what feels good and gets them excited.
3. They often come from a very religious background which puts the breaks on sexual pleasure, so much so that even when married and in a safe relationship, they cannot let go and allow themselves to experience orgasm.
4. They are in denial about stress in their lives or relationship.  Women may not allow themselves to believe that being with a partner who belittles them or abuses them in anyway, who is neglectful, or who has unacceptable behaviors like frequently drinking to excess, can have any effect on their ability to get turned on.

All of these barriers to sexual pleasure can be overcome.  There are many books available on how to achieve orgasm.  The basic approach is the same.  A woman begins by understanding her own body, both how it is made for pleasure and how to generate sexual energy and excitement.  Next, she begins exploring her body.  She needs to become comfortable with sexual touch and to discover what areas of her body bring her pleasure.

Then she begins to explore her genitals.  She can experiment to find out what kind of pressure, where she needs it to be applied, and how sensations travel through her body and mind.  She needs to overcome fears and anxiety about what will happen if she has an orgasm, because she will know that the answer will simply be she will have a sense of release and a warm glow.

If a woman is unable to experiment with these steps on her own, then a qualified psychotherapist with training in sex therapy can help.  Together with the therapist, a woman can discover her mental blocks to feeling pleasure.  She can learn how to relax during sex, not just with her partner, but with herself.  She can gain confidence in her ability to experience her body and learn to communicate her discoveries. And if there are relationship problems or other stress that get in the way, she can work those through and make changes.

Most of all, what she may learn is that orgasm is only a small part of sex.  A woman’s relationship with her own body and an understanding of her mental attitudes about sex are what can make a true difference between being non-orgasmic and orgasmic.

I understand that some women really do have trouble with blood flow to the genitals.  That’s because for women the brain needs to send a signal that the woman is excited about sex.  Of course, lots of women aren’t very excited about sex. So there’s no blood flow.  Hence, the pill.

Let me share with you some of the many reasons that women are uninterested in sex:

• they worry excessively about things that are unimportant, such as laundry and other chores
• they think of sex as an obligation, instead of a pleasure for themselves
• they don’t communicate what they want to their partner, so they don’t get aroused
• they feel guilty if sex feels good, so they suppress sexual thoughts and feelings
• they don’t take care of themselves–don’t exercise, eat right, or get enough sleep
• they lack education about their own bodies and don’t realize that they may need direct stimulation to the genitals to get blood flow going, leading to orgasm

How will a pill help with such things?  Imagine, if you will, the day that a man and a woman both need to take a pill to have sex with each other.  It’s a New Yorker cartoon waiting to happen.  Now imagine a couple pleasuring each other in a sensual way.  They know if they have intercourse, that’s great.  If that don’t, that’s okay, too.  No pressure, just pleasure.  Think you need a pill if you make love like that?

It’s different for men.  Men do have medical problems that cause erectile dysfunction, such as diabetes or chronic tobacco use.  And I suppose that there is a very small percentage of women that could use a medication to stimulate blood flow, perhaps a woman who has had cancer and radiation treatment.  But those women who commented on the story who are on antidepressants?  No, not likely.  What needs to happen is to get psychotherapy, get off the pills, and then see where things are at, because there are some people that never regain sexual function after antidepressant treatment. But why bother learning how to stop being depressed / anxious / stressed, when you can just take a pill?

Except we aren’t cave people.  Tch.  I’ve written about this before.  If we were to imitate our cave ancestors, we’d all smell bad, have no teeth, and have hair in all kinds of places we really don’t find attractive any more.  (I’d also not exist, as I am completely blind without contacts and would surely be eaten.)  We’d have sex like this:  Man clubs woman, drags her into the tall grass, has rear entry sex as quickly as possible to avoid being dragged off by a saber tooth tiger, then they both go back to doing what they needed to do to survive (and it isn’t making microwave kettle corn).

Look, if a couple has an agreement to be polyamorous, or have multiple partners, I’m not interested in judging their behavior.  But when a couple agrees to be monogamous, then each partner should have an expectation of honesty.  Better to have open discussions about the challenges of monogamy than to pretend and lie.

I enjoy monogamy.  I’ve been married to my husband for 24 years and have been monogamous for nearly 30.  Being monogamous gave me much needed stability after growing up in an unhappy home.  It helped me learn how to make a healthy, loving attachment to another human being, which in turn allowed me to give that to our child.  Monogamy lets me explore my sexuality fully because I am always with a safe partner that I trust.  Monogamy pushes me to keep growing and developing into a better person for my partner.

Maybe monogamy isn’t for anyone, but the idea that we should dump monogamy because our ancestors didn’t practice it doesn’t seem like much of a reason to screw around.

There are so many stereotypes when it comes to sex and the mature adult.  I always remember a man in his 30s telling me, “My wife and I need to hurry up and start having a lot of sex, because we’ll be done by the time we’re in our forties!”

You’ve gotta be kidding.

Just because you don’t move as quickly or forget your glasses are on top of your head occasionally doesn’t mean that you aren’t spry enough to have sex.  The body may not be as beautiful, but feelings of love and desire may grow even stronger with a couple that has been bonded for years.  And for couples experiencing romance in their later years, the sparks can still fly pretty high.

Enjoy the article, and let me know what you think!

Sometimes marriages naturally go through dry spells.  A partner might be sick, be pulled by care-giving demands, or absent due to military or other job obligations.   But when couples go for a year or longer without connecting in the bedroom, there’s a problem.

What causes a sexless marriage?  Many couples stop having sex during the last part of pregnancy and during the first months they have a newborn.  They struggle with finding time, but also with feeling sexy when there’s an infant in the house with all the demands of parenting.  Other couples struggle with sex from the beginning.  One partner may have been raised in a very strict religious home and can’t let enjoy sex, even though they’re married.

There can be serious issues that get in the way of a couple having regular sex.  If one member of the couple has been sexually abused or assaulted, then they may avoid sex because it triggers bad memories.  Other problems, like depression or substance abuse, can get in the way of sexual pleasure.

What can you do about a sexless marriage?  First, it’s important that you and your partner acknowledge there is a problem.  Try to talk it out together to figure out what the root cause is.  When you do try to restart your sex life, be realistic.  Though it may not seem romantic, you may need to schedule times for making love.

Many people are unaware that there is a type of professional called a sex therapist that is available to help couples that have a sexless marriage.  A sex therapist is a psychotherapist that specializes in sexual problems.  It is talk therapy.  If you do decide to see a sex therapist, check with your state’s licensing board online to ensure that they are licensed to help you.

Sometimes couples disappoint each other in the bedroom and have trouble with forgiveness.  A man’s female partner can’t have an orgasm and he berates her for being unresponsive.  A woman’s male partner ejaculates too quickly and she becomes caustic and critical.  The couple may just have different expectations about their sex life, but be unable to discuss it; they may quietly suffer for years.  The angry partner may also become critical, sometimes, in other parts of the couple’s relationship; at other times, the couple may put a lot of energy into putting up a front to the world that their relationship is really much better than it is.

Can you forgive your partner for their sexual shortcomings, be a good friend, and support them toward change?  Can you let go of your resentment and become compassionate, realize that your partner may be hurting, too?  Sexual forgiveness takes maturity, too.  Your partner perhaps didn’t learn how to be a long-term sexual mate.  You can learn together.  If mistakes or missteps have been made, be patient and above all be forgiving.

But foreplay isn’t just about orgasms.  It is also a way to connect with your partner.  You can take turns giving one another pleasure.  You can choose to be passive and let your partner give to you, or to be active and please your partner.  Or, you can have mutual foreplay, both giving and receiving pleasure at the same time.  It’s more about sharing an intimate, fun experience than about preparation for intercourse.

If foreplay is imaginative, there may be no need for intercourse; orgasms may be experienced in other ways.  Foreplay can also allow you to explore one another’s bodies, to understand what is erotic for each of you.  It is a time to free yourself and be creative, to try out scenarios that turn you on.  You may find out that you enjoy some of the same things, or that you need to make adjustments so that your fantasy is fun for both of you.

Foreplay builds a sense of connection and intimacy.  When someone doesn’t want foreplay, for me as a therapist, I am always curious about whether they are able to be truly intimate with a partner, to let a partner get into what they are really about in the bedroom and to get into their partner’s thoughts and feelings.  Foreplay is one of life’s great free experiences, right there in the privacy of your own home.