Guide
Intimacy and Sexual Concerns Guide
A plain-language guide to desire, sexual difficulties and closeness in relationships: what is common, why it happens, how to talk about it, and when to get help.
Problems with sex and closeness are common, and they are among the hardest things to talk about, even with a partner. This guide is meant to make them easier to understand. It is organized in three parts: what may be happening and why, how couples talk about it and reconnect, and how to decide whether and where to get professional support.
Sexual difficulties often have physical and emotional causes at the same time. Anything involving pain, a change in how your body works, or a new medication belongs with your physician, gynecologist or urologist first. The emotional and relationship side is what therapy for intimacy and sexual concerns with Dr. Lehmann, a licensed clinical psychologist in Franklin, Michigan, focuses on, in the office or by telehealth for clients located in Michigan.
You do not need to read this in order. If desire is the issue, start with Low Sexual Desire or Mismatched Desire. If talking is the hard part, try How to Talk With Your Partner About Sex. Related reading: How Emotional Safety and Communication Affect Intimacy and Intimacy and Sexuality After Cancer.
Part 1
Understanding what is happening
Low or mismatched desire, anxiety, erection and orgasm difficulties, pain, shame, life stages and medications. What is common, what can cause it, and why the body and mind are usually both involved.
Low Sexual Desire: Common Physical and Emotional Causes
Low sexual desire is common and usually has several causes. The physical, emotional and relationship factors that can lower libido, and where to begin.
Read the guideMismatched Desire: When Partners Want Sex at Different Times
Desire differences are common in couples. How a gap in wanting sex turns into a cycle of pressure and rejection, and what helps partners work with it.
Read the guideSpontaneous vs. Responsive Desire: Why Wanting Doesn't Always Come First
Desire doesn't always come first. What spontaneous and responsive desire are, where the idea comes from, and why it can ease pressure on couples.
Read the guideWhy Desire Changes in Long-Term Relationships
Desire often shifts after years together. How familiarity, routine, life stages and resentment shape it, and what couples can do to keep curiosity alive.
Read the guideThe Sexless Relationship: How Couples Drift There
Few couples decide to stop having sex. How a sexless relationship develops, the cycle of avoidance that keeps it going, and how to begin breaking it.
Read the guideSexual Performance Anxiety: Why It Happens and How It Feeds Itself
Sexual performance anxiety is common in all genders. Why it starts, how worry and sexual difficulty feed each other, and what can help break the loop.
Read the guideErectile Problems: The Emotional and Relationship Side
Erectile problems need a medical check, and they also affect confidence and relationships. The emotional side for men and partners, and where therapy fits.
Read the guideEarly Ejaculation: Causes, Anxiety, and What Can Help
Early ejaculation is among the most common sexual concerns. Its physical and psychological causes, how anxiety keeps it going, and what treatment involves.
Read the guideDifficulty Reaching Orgasm: Common Causes and What Helps
Trouble reaching orgasm is common in people of every gender. The physical, emotional and relationship causes, delayed ejaculation, and what can help.
Read the guidePain During Sex: Why It Deserves Medical Attention and Emotional Support
Pain during sex is common and treatable. Why a medical evaluation comes first, how fear of pain can feed the problem, and where emotional support fits.
Read the guideHow Depression, Anxiety, and Stress Affect Sexual Desire
Depression, anxiety and stress are common reasons desire fades. How they affect interest and arousal, and what can help both mood and closeness.
Read the guideAntidepressants and Other Medications That Can Affect Sex
Antidepressants and other medicines can affect desire, arousal and orgasm. What is known, why not to stop on your own, and how to talk to your prescriber.
Read the guideSexual Shame: Where It Comes From and How It Affects Intimacy
Sexual shame is the sense of being flawed as a sexual person. Where it often comes from, how it can affect desire and closeness, and what may help it ease.
Read the guideBody Image and Sexual Confidence
How you feel about your body can shape desire, arousal and closeness. Why body image matters in intimacy, what research suggests, and what may help.
Read the guideHow Past Sexual Trauma Can Affect Intimacy
Past sexual trauma can affect desire, touch and trust, even in a loving relationship. Common reactions, pacing intimacy, and trauma-informed support.
Read the guideIntimacy After Having a Baby
Why sex and closeness often change after a baby, what is common, the signs of postpartum depression to know, and when to talk with a doctor or therapist.
Read the guidePerimenopause, Menopause, and Changes in Intimacy
How perimenopause and menopause can change desire, comfort and closeness, what belongs with your doctor, and how couples can talk about it together.
Read the guideSex and Intimacy in Later Life
How sex and intimacy can change with age, which changes are common, what to raise with a doctor, and how couples can stay close in later life.
Read the guideChronic Illness, Chronic Pain, and Intimacy
How chronic illness and chronic pain can affect desire, comfort and closeness, what to raise with your medical team, and how couples can adapt together.
Read the guideCompulsive Sexual Behavior: What the Term Means and When It Is a Concern
What compulsive sexual behavior disorder means in ICD-11, how it differs from a high sex drive or moral guilt, and when it is worth getting help.
Read the guidePornography in a Relationship: When It Becomes a Concern
A balanced look at pornography in a relationship: what research sources say, values differences between partners, and signs that use has become a concern.
Read the guide
Part 2
Talking, reconnecting and sorting out causes
How to raise the subject with a partner, handle rejection and avoidance, rebuild closeness, think about consent and values, and work out which kind of professional fits which part of the problem.
How to Talk With Your Partner About Sex (Including a Problem)
Practical ways to raise sex with a partner, including a problem: choosing the moment, words that lower defensiveness, listening, and when to get help.
Read the guideWhen One Partner Avoids Sex
Why a partner may start avoiding sex, from stress and pain to anxiety and resentment, and how either partner can respond without pressure or blame.
Read the guideHandling Sexual Rejection Without Building Resentment
How to cope when a partner turns down sex, how to say no kindly, and how couples can keep a no from turning into hurt, scorekeeping and resentment.
Read the guideRebuilding Intimacy After a Long Dry Spell
After months or years without sex, getting close again can feel awkward. How couples restart intimacy gradually, without pressure, and when to get help.
Read the guideNon-Sexual Touch and Affection: Why It Matters
Why everyday affection matters in a relationship, how it can fade when sex becomes tense, and practical ways couples bring non-sexual touch back.
Read the guideDoes Scheduling Sex Actually Help?
Scheduling sex can protect time for intimacy and ease the guesswork, or it can feel like a chore. When it helps, when it backfires, and how to do it well.
Read the guideWhat Is Sensate Focus?
Sensate focus is a set of structured touch exercises used in sex therapy. What it involves, what it is used for, and why a therapist usually guides it.
Read the guideRebuilding Intimacy After Infidelity
After an affair, sex and closeness can feel impossible or urgent. How couples may approach physical intimacy again, at a pace that respects both partners.
Read the guideConsent and Sexual Boundaries in a Committed Relationship
Why consent still matters in marriage and long-term relationships, how to talk about boundaries, and how to recognize sexual and reproductive coercion.
Read the guideFaith, Religious Upbringing, and Sexuality
How religious upbringing can shape feelings about sex, why guilt can linger even within your values, and how people reconcile faith and intimacy.
Read the guideIntimacy Concerns in LGBTQ+ Relationships
LGBTQ+ couples face the same intimacy concerns as anyone, plus stigma and minority stress. How those pressures can affect closeness, and where help fits.
Read the guideIs It Physical or Emotional? How Sexual Problems Usually Involve Both
Sexual problems rarely have one neat cause. How the body, emotions and the relationship affect each other, and why medical and emotional care both matter.
Read the guideWho to See for a Sexual Problem: Doctors, Pelvic Floor Physical Therapists, and Therapists
Primary care, gynecologist, urologist, menopause specialist, pelvic floor PT, psychologist or sex therapist: who handles which part of a sexual problem.
Read the guideSex Therapist, Couples Therapist, or Psychologist: What Is the Difference?
What a psychologist, a couples therapist and an AASECT-certified sex therapist are, how their training differs, and how to choose one for a sexual concern.
Read the guide
Part 3
Getting support
When it may be time to see a therapist, what therapy for sexual concerns looks like, individual or couples sessions, privacy, cost, telehealth in Michigan, and what to ask before you start.
When Is It Time to See a Therapist About a Sexual Concern?
Signs a sexual or intimacy concern may be worth bringing to a therapist, why you do not need a diagnosis to ask for help, and how to take the first step.
Read the guideWhat to Expect in Therapy for Intimacy and Sexual Concerns
What happens in therapy for intimacy and sexual concerns: the first call, early sessions, what is and is not involved, and how it fits with medical care.
Read the guideIndividual or Couples Therapy for a Sexual Concern: Which Fits?
When a sexual concern fits individual sessions, when it fits couples sessions, why some people combine them, and when couples work is not the right place.
Read the guideHow to Talk About Sex in Therapy When It Feels Embarrassing
Feeling embarrassed to talk about sex in therapy is common. What a therapist may ask, ways to start when words fail, and how to keep control of the pace.
Read the guideHow Private Is Therapy for Sexual Concerns?
What stays private when you talk about sex in therapy: confidentiality and its legal limits, HIPAA rights, insurance, couples sessions, and email.
Read the guideDoes Insurance Cover Therapy for Sexual Concerns?
Whether insurance covers therapy for sexual or intimacy concerns depends on your plan. What to ask your insurer, Good Faith Estimates, fees and options.
Read the guideTelehealth Therapy for Intimacy Concerns in Michigan
Video therapy for sexual and intimacy concerns: the Michigan location rule, privacy at home, couples sessions by video, and when the office fits better.
Read the guideQuestions to Ask Before Starting Therapy for a Sexual Concern
What to ask a therapist before starting work on a sexual or intimacy concern: license, training, approach, individual or couples format, privacy and cost.
Read the guideWhen Your Partner Won't Come to Therapy About Sex
Why a partner may refuse therapy about a sexual problem, how to ask without pressure, and how going on your own can still help you and the relationship.
Read the guide
Dr. Laura Lehmann, PLLC
Schedule your next visit
Call, email, or send a short message to ask about availability. Dr. Lehmann will reply to talk through whether she is a good fit for what you need.