Is a Mental Health Issue the Cause of Your Sexless Marriage?

Sexual problems are one of the most common presenting issues in couples therapy. However, problems in the bedroom are often the symptom, or byproduct, of an underlying mental health or relationship issue. Therefore, the best way to improve your sex life is to address the core issue. After more than 20 years of counseling individual adults and couples, the following are the primary mental health issues I believe affect a couples’ sex lives.

How mental health issues can impact sex life

Depression lowers self-esteem and libido, causes sleep disturbance, weight changes, etc.
Anxiety causes performance anxiety, nervousness, fear, phobias, etc. Stress makes you irritable,  
Grief and sadness lower desire.

Eating disorders lead to self-esteem issues, poor body image, self-consciousness, low confidence, etc. Sex addiction leads to an excessive fascination for pornography, strippers, prostitution, and infidelity. The trauma of past abuse or assault or combat impairs the ability to feel safe and comfortable having sex. 

Alcoholism leads to poor health, sexual impairment, violation of trust, etc. Unexplored gender identity or unexamined sexual orientation issues may impact attraction and authentic connection.

Postpartum issues may lead to exhaustion, delayed physical recovery, breastfeeding impairs the ability to see the breast as sexual, etc.

The best way to address these issues is to speak with a counselor

Support and assistance are available and effective. Therapy is often covered by insurance and services are offered on a sliding fee scale at community mental health centers. A skilled therapist will be able to tell you whether individual or couples therapy or a combination of both, would be most effective for you. In some cases, medication such as an antidepressant or antianxiety medicine can also be helpful.  

Seeking therapy doesn’t mean you are crazy or that your relationship is in crisis.  It’s a routine, preventative, proactive form of healthcare like going to the dentist or the doctor.  

I believe we all deal with mental health issues at different points in our lives as part of the human condition, and we can all benefit from counseling or therapy.  
If you believe you are dealing with a mental health issue, tell your doctor or contact a therapist.  If you suspect your partner is dealing with a mental health issue, here are some suggestions for how to recommend therapy.  
If it’s not a mental health issue that is the underlying cause of your sexual disconnection, perhaps it’s a relationship issue that has gone unaddressed. Here are some examples:

Relationship issues

Violations of trust, infidelity, lack of reliability, dishonesty, etc. Erosion of trust which is the foundation of a relationship, Disconnection, lack of intimacy emotionally, relationally or spiritually.

Resentment leads to hardened anger, building walls that are barriers to intimacy. The phase of life issues, young children, empty nesting, etc. leads to changes in identity and lifestyle.  
Again, the best way to resolve these issues is to address them. Ignoring them will often widen the gap between you and your partner.

Seeking professional assistance will provide you with information, tools, and resources to improve your relationship.  

Some people think that couples therapy is just the stop before breaking up, but it can be an extremely healing and positive experience that will build on your relationship strengths and help you recreate intimacy emotionally, relationally and sexually.I encourage you to stop blaming sex as the issue.  Shatter the silence and start talking about the real issues.  Do this in a way that is kind, loving and honest.Consider scheduling a time to talk about your relationship when you are in a private setting and aren’t pressured for time. Perhaps start the conversation by saying things like, “How are you feeling about our relationship?  Do you ever wonder if we would benefit from counseling?”

Restating the end goal is important

If your partner is resistant or reluctant to go the therapy, I recommend making the appointment, putting your foot down and saying, “I care too much about you and about us to not address these issues that are impacting our relationship.”  

Restating that the end goal is to improve your sex life can also be a powerful motivator!

What other mental health and relationship issues have you seen the impact a couples’ sex life? How do you recommend addressing them?