A Therapist Answers Your Questions About Sex – Part I

A marriage and family therapist answers YOUR questions about sex.

By Aimee Heffernan

This post is part 3 of the series:  Improving Intimacy
Part 1: How to Agree on How Often to Have Sex
Part 2:   Waiting for Sex Until Marriage- Can I Really Do It?


Today’s post comes from a good friend of mine, Aimee Heffernan. Aimee, who is LDS, is a certified, licensed marriage and family therapist from Seattle and is right now in the process of becoming a certified sex therapist.  As she said, “I get lots of clients on my couch needing to talk about sex issues!”

Last month we asked people to submit questions or concerns they might have regarding sex. I approached Aimee with those (your) questions and she immediately said that she’d have a lot she could talk about. I took notes during her answers, and a modified transcript is which is what is presented here. Besides specific answers to the questions there are some fantastic insights about sexual intimacy that are applicable to everyone!  It’s so clear that Aimee is enthusiastic and anxious to help people create a safe, supportive, desirable sexual relationship with their spouses.

And I think she also helps provide an idea, especially for couples who might never consider it, why professional marriage or sex therapy could be very worthwhile! During our talk, Aimee said this about counseling:

“As a counselor, it’s my job to be someone who is ‘neutral.’ I’m not a sister or a girlfriend. I’m someone you can spill the beans to, but who you could, if you needed to, never see again!

“Coming in for counseling is all about getting emotionally organized. It’s like an overflowing, messy closet. Every time you open it up, it spills out and it gets everywhere. What I tell people is, ‘I’m a therapist, but just think of me as an emotional organizer.’ And so with that messy, emotion closet I say, ‘Let’s get it all out, let’s look at it and decide if this is working for you guys.’ A good counselor is going to be able to see patterns of communication and behavior that don’t work and say, ‘How can we get you guys out of those patterns?’”

I hope you all get as much out of these answers as I did! Stay tuned for Part II
– Rich

*Everything below are Aimee’s responses to these questions as transcribed by Rich

Question: What to do when it’s the wife who wants more intimacy, but the husband isn’t as interested in sex?

Right away, I’m noticing that there are a few things that overlap in these questions. First off, a lot of them deal with the topic of “desire.” Desire is a big, BIG part of sexuality.

Couples will come to me and say, “We just want to have better sex!” And my response is, “Well, what kind of sex do you want to have better of?” My job is to ask them, and help them find out the answer to the question, “What does your sexuality mean to you as a couple?” They’ll say, “We need to be having sex more often,” but the ideal answer to that question is going to look different to each person. It’s something you need to figure out.

Probably the biggest thing to note: when it comes to sexual intimacy, every relationship will always have a HIGH desire partner and a LOW desire partner. So it’s a perfectly normal thing for the woman to have more desire than her husband. That’s just how their relationship works.

So you’ll need to have a discussion about who is the “high” or “low” desire member of the marriage. Negotiating that is really the most important issue here. Marriage, and sexual intimacy in particular, is all about learning how to talk about hard things and is about “negotiations.” What are the needs or priorities of each spouse? What is each one willing or not willing to do to help meet those needs? This is what needs to be discussed. Some couples do this well and some don’t. It’s why counseling can be a really good thing [Note from Rich: this comes up again later on!]

So, right away I’m also noticing that it’s hard to be concise in answering these questions. Because if this couple was coming to me, I’d want context! I’d ask about their history. It makes answering like this a little difficult, but I hope these answers help.


Question: How can I increase my sex drive?

This might sound simplistic, but … more sex brings more sex! Does that make sense? I like to make the comparison of going to the gym, or going out for a run. You know you should, that it’d be a good thing to do. But sometimes the hardest part is getting on your gym clothes and actually getting out the door. And then after your exercise you think (or sometimes anyway), “That felt so good! I should do that more!” With sexual intimacy, a lot of times you really just have to get in the game. Be doing it more so you can be doing it more!

But of course, like we already talked about, each couple needs to decide what is “normal,” because, as I said, what’s “normal” is that there will be a high-desire and low-desire partner. So if you are the low-desire partner do you increase it to match your partner? That might not happen, but could you increase to meet in the middle?

There’s a lot to be said about the topic of female desire. Another Mormon sex therapist,Jennifer Finlayson-Fife has a lot of WONDERFUL, really fascinating research all about women and desire. She actually wrote a dissertation about LDS women’s sexuality and teaches an online class about it. So I’d highly recommend anything from her about that! [Note from Rich: We’ll be reviewing an online class from Jennifer Finlayson-Fife later on in this series!]
But I’ll say this: In a lot of cultures, men are taught to desire, whereas women are taught to BE desired, and often not really TO desire. Women tend to be more … in their heads when it comes to sexuality and their desires. Doing things to actively promote that can help. For example, talking to your spouse (in a safe, supporting space) about your fantasies, things you might want to try out, can be titillating!

[Another note from Rich: Aimee has a lot more great advice about having these kinds of conversations coming in Part II]

It’s been shown, it really happens, that marital satisfaction and frequency of sex decreases when you have children. But it’s also been shown that scheduling when you are going to be sexually intimate means that you will have more sex! And if you know when it is going to happen, it can help you take time during that day to get into the mood. Think about it, make a plan. Send texts about it to each other!
These are all surface level answers. In person, I would want to talk about a lot of things, try to understand any underlying issues or concerns, but those are a few ideas.

Question: How can you tactfully and lovingly approach the issue of your husband becoming so unhealthy that not only is his sex drive shockingly low, but his ability to have sex is also impaired? How can you bring this up, especially if you are trying to conceive?

What this question screams to me right now, what the first thing I would say if this couple came to me right now, with the male having NO desire, is I would tell them to go see their primary care provider and get their testosterone levels checked. Low testosterone is a big deal! People think hormone imbalances are only a women’s issue, but it’s not true. When men’s testosterone levels are low, they report being more irritable, more prone to depression and, of course, less sexual desire. It’s a BIG issue and there’s an easy solution! I have clients who report that they can immediately tell a difference in their sexual desire and feelings in the days following a “T shot.” Get your hormones tested!

But the other thing that stands out here is the possibility that the husband could be feeling a lot of anxiety. Stress causes a TON of anxiety issues for men. And it sounds like they are already having performance issues, which itself can cause a lot of anxiety and frustration. Add to that the fact that you’re trying to conceive and I wouldn’t at all be surprised if there’s an anxiety aspect as well. It really might be good to see a therapist because, really, there are a LOT of things that a therapist can do, to help people talk through anxieties and issues and deal with the stress they might be feeling in a more positive way.

It’s sad, but often people will go for YEARS with dysfunction in sexual aspects of their relationship before they talk and realize, “Why are we doing this?!” If you go for years and years without talking about the elephant in the room, you fall into cycles that don’t need to last that long!


So you need to find a way to have hard conversations. A researcher named David Schnarch wrote a great book called Secrets of a Passionate Marriage. It’s too much to go into here, but he talks about being “relationally mature” when it comes to sex. Part of that is learning how to create safe spaces in your relationship, where you can talk about personal, difficult things. Many couples manage to find a way to have these hard conversations, to create this safe space to talk about their sexuality. Some people, because of their feelings or issues or anxieties, have a harder time doing this. That is when it can be important to have a counselor, who can help negotiate these topics.

SO, if these were my clients … I’d be sure to point out that, no doubt about it, anxiety and emotions play a much bigger role than people realize. But I’d also try to help them understand this: There are all kinds of physical bodies. Women can be bigger. Men might have erectile dysfunction. But if people can stay laughing and playful during sex, then it can still be a positive, desirable, and happy experience.
This is what I always tell people: sex is the only sacred space that’s just yours. My husband and I have NO space that’s just ours! There’s kids, there’s co-workers, there’s friends and parents! But sexual intimacy is just ours!

2 thoughts on “A Therapist Answers Your Questions About Sex – Part I

  1. “Question: How can you tactfully and lovingly approach the issue of your husband becoming so unhealthy that not only is his sex drive shockingly low, but his ability to have sex is also impaired? How can you bring this up, especially if you are trying to conceive?”

    We have no problem communicating, we simply do not get enough time to have sex/make love so he is not able to go for very long or is unable to stay stiff enough long enough. So he is out of shape sexually, if that makes sense? We love our time together when we get it but it is rough to get so turned on, only to not be able to finish after such a buildup. This goes for both of us. Then we build up again and … very frustrating for us both. When we are able to finish, it’s like the heavenly choir but it is very few and far between. Any direction?

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