Q My husband and I have been struggling with physical intimacy in our relationship for the past six months. On many occasions we have wanted to make love, but my husband was unable to maintain his erection long enough for the experience to be satisfying for both of us.

We have not experienced this kind of problem before, and are wondering whether his difficulty is related to emotional factors, as there has been some stress in our marriage this past year, or whether he may actually have a medical problem.

Could you clarify the difference, how we would go about understanding the cause, and getting help?

Stressed Partner

Dear Stressed Partner:

Once a general practitioner has ruled out medical causes such as side effects from medication, the main question is whether the sexual problem is regarded as being primary, which may be related to desire and/or arousal or biological reasons, or whether it is due to secondary emotional reasons.

These may be related to issues with which a couple is struggling such as procreation, depression, power, hostility, control, retaliation, communication or intimacy. In the majority of cases, a sexual problem embedded in emotional reasons is usually found to be secondary, in other words, it is a symptom of a relationship problem.

Psychology generally regards the partner with the symptoms as representing a difficulty within the relationship system, and a trained counselor can assist the couple with emotional healing.

Sexuality is connected with sensuality (mind/body pleasure, touching and cuddling), intimacy (emotional and physical closeness, trust, communication and disclosure), identity (femininity, masculinity, societal norms, gender orientation and partner choice) and power (control, exploitation, manipulation, domination, violence and neglect).

Many of the above topics and the ways in which they have influenced your particular relationship will be discussed and explored in counseling sessions.

However, if a sexual problem is diagnosed as being the primary problem, it is usually understood as being based on the individual's past sexual history.The focus is then on individual therapy, before the relationship can be assisted.

The understanding among mental health practitioners is that sex therapy alone is not a sufficient approach to resolving the problem if it is rooted in relationship difficulties.

A comprehensive approach to helping a relationship is often needed, and intervention may be required in areas of problem solving skills, individual autonomy and demonstration of love, care, and affection.

Jodie MacKay, Clinical Psychologist