Guide Continued and Concluding Comments

Attraction is crucial within a sexual relationship. While mutual love and respect are important factors as well, loss of attraction in a relationship can be an obstacle to healthy sexual functioning. If feelings of attraction have been lost, it is important that the couple take active steps to restore these feelings. Attraction includes both physical and emotional attractiveness. A therapist may provide useful guidelines and suggestions about how to restore attraction and desire for each other in healthy ways.

A restricted sexual repertoire is a risk factor for sexual dysfunction. This term refers to limiting one's thoughts and sexual practices to intercourse alone. We have discussed numerous risk factors for developing sexual dysfunctions, and many are not preventable. For example, the natural aging process is something we cannot escape but does impact sexual functioning. If we restrict our perception of sex to intercourse alone, and our ability to have intercourse becomes impacted, we are more likely to incorrectly believe that physical intimacy is no longer possible.

Expanding what we consider to be fulfilling sexual activity is important. For many people, sexual intercourse is the top goal when it comes to sexual activity. We do not want to discount the importance of sexual intercourse. To lose the ability to have sexual intercourse is devastating. However, if you keep an open mind and include different types of sexual, sex after aging can still be exciting. The concept of non-demand sex is another perspective that can help remove the pressure to "perform." Non-demand sex is simply living in the moment and enjoying sexual activity without the pressure to engage in sexual intercourse, or to achieve an orgasm. While it may lead to sexual intercourse, its purpose is to learn to enjoy a full range of pleasant sensual feelings with your partner.

If you are experiencing sexual difficulties with your partner, remember that partnered sex involves more than one person, so maintain a couples' perspective. Assist your partner by communicating understanding and support, ask questions, and otherwise demonstrate that you view the sexual problem as a shared problem. It is best to try and fully participate in the treatment process with your partner. This may mean:

• attending doctor's appointments
• learning to use assistive devices
• understanding medications and their side-effects
• learning to share natural feelings of loss and disappointment in caring and sensitive ways with your partner

It is important to recognize that partners of people who experience sexual dysfunction are significantly affected by sexual dysfunction. They may need their own support. This often means psychotherapy as these are private topics that should rarely be discussed outside the relationship except with a professional helper, or self-help support group intended for this purpose. However, individual therapy is often not recommended during couples' therapy. If you are currently participating in couples' therapy, and feel you need some additional support of your own, please discuss this with your therapist.

Partners of people with paraphilic disorders or sexual addiction, may need additional support. This support is often hard to find as these are not topics most people would want to disclose to friends or family. There are 12-step support groups that are available for partners such as S-Anon that are patterned after Al-anon, a support group for partners of alcoholics. Many people find that the ability to discuss their anguish with someone who has "been there" to be profoundly healing.

Sexual functioning is complicated, which in turn means that sexual dysfunction is complex as well. If you are dealing with sexual problems in your relationship, remember that sex usually involves more than one person, so maintain a couples' perspective. From a couples' perspective, blame has no place in the relationship or discussions. When viewed as "our problem" the solution becomes a shared experience where both partners receive compassion, empathy, and understanding.

Concluding Comments

Throughout our discussion on gender differences, changes across the lifespan, sexual health from a holistic perspective, sexual dysfunction, paraphilic disorders, and gender dysphoria, it seems quite clear that sexuality is variable and there is no single version that is correct for everyone.