The same concerns, with added pressures
Couples of every orientation and gender identity can drift apart, want sex at different times, struggle to talk about what they need, or feel the effects of illness, aging, stress and parenthood. Most of the articles in this guide apply to LGBTQ+ relationships as written.
The International Society for Sexual Medicine (ISSM) notes that sexual difficulties can affect anyone, and that for LGBTQIA+ people they often come with added challenges: social stigma, discrimination in medical settings, and research that has overlooked their needs. Naming those added pressures can make it easier to see that a problem is not simply a personal failing.
Minority stress and closeness
The ISSM describes minority stress as a form of chronic stress that comes from discrimination, violence and lack of social acceptance, and links it to poorer health outcomes, including sexual difficulties. It also notes that internalized stigma, meaning negative messages a person has absorbed about their own identity, can be one reason for lower desire.
A separate ISSM article points out that discrimination is linked to higher rates of depression and anxiety, both of which can lower desire and arousal, and that rejection, or the fear of it, from family, work or community may keep people from feeling comfortable expressing who they are or being with the partner they choose.
In a relationship, these pressures can show up as:
- Partners who are out to different degrees, with tension over who knows and who does not
- Holding back affection in public, and finding it hard to switch that guard off at home
- Old messages about sex or bodies that surface during intimacy
- Strain around holidays or family events where the relationship is not fully welcomed
- Worry about how a doctor or therapist will react, which delays getting help
Orientation, identity and change within a relationship
Planned Parenthood describes sexual orientation as who you are attracted to and want relationships with, and notes that it is different from gender identity, which is about who you are. Keeping the two apart can help when a relationship changes: when one partner comes out, questions their orientation, or begins a gender transition. Each partner may need room to grieve, adjust and rediscover what closeness means without either one being treated as the problem.
Planned Parenthood also lists asexual among sexual orientations. Little or no interest in sex is not automatically something to fix. What matters is whether it causes distress for you, and whether partners can find an arrangement that respects both people.
Medical care that feels safe
Any change in physical function, pain during sex, or a question about how a medication or hormone treatment affects desire belongs with a physician first. The ISSM notes that LGBTQ+ people often face distinct health risks and barriers to care, and that transgender people may avoid sexual health services out of fear of discrimination. It also notes that gender-affirming hormone therapy can affect sexual function, which is worth raising with the clinician who prescribes it rather than changing anything on your own.
If a past experience with a provider was dismissive, it is reasonable to look for someone else, to bring a partner or friend to an appointment, or to ask about a clinician's experience before you book.
What can help
The ISSM notes that LGBTQIA+ people who have support from community and family report better health outcomes. For many people, chosen family, friends and community groups provide some of that support. Within the relationship, it can help to talk about the outside pressures directly, so that tension created by the world is not mistaken for a problem between the two of you.
Some couples also find it useful to talk about what sex and intimacy mean to each of them, since scripts borrowed from other relationships may not fit. How to Talk With Your Partner About Sex offers a starting point, and Mismatched Desire covers one of the most common concerns for any couple.
Questions some couples find useful to talk through:
- What does intimacy look like for each of us, sexual and non-sexual?
- Which pressures from outside the relationship are we carrying into it right now?
- Are there messages we absorbed growing up that still shape how we feel about sex?
- What would make it easier for each of us to say what we want, or do not want?
These conversations do not need to happen all at once. Short, unhurried talks at a calm moment, rather than right after a disappointing night, tend to go better.
When partners are in different places
Sometimes the strain comes from the two partners being at different points: one fully out and one not, one comfortable with their body and one struggling, one wanting more physical closeness after a hard period and one wanting less. None of these mismatches means the relationship is failing. They usually call for patience, curiosity about each other's experience, and agreements that respect both people's pace. If old hurts or family conflict keep resurfacing, outside support can help keep those conversations from turning into blame.
Finding a therapist who fits
Feeling understood matters in any therapy, and it matters more when you have had to explain or defend your identity elsewhere. The American Psychological Association encourages people to interview potential therapists about their training and experience with problems like theirs. It is reasonable to ask any therapist, directly, about their experience working with LGBTQ+ individuals and couples and with the specific concern you are bringing.
Dr. Lehmann is a licensed clinical psychologist whose therapy for intimacy and sexual concerns focuses on the emotional and relationship side of these difficulties. If you are considering working with her, you are welcome to ask about her experience with your situation when you call.