The Pelvic Floor Connection Sex Therapists Wish More People Knew
It is not only about leaking. Tone that is too high is as much of a problem as tone that is too low — and it's far less discussed.
One partner wants sex more often than the other. Therapists say this is the norm, not the diagnosis — but how you handle it matters enormously.
Sex therapists have a phrase for the couple who arrive convinced something is broken: the higher-desire partner and the lower-desire partner. It is the most common configuration they see, and in most cases nothing is wrong with either person.
What tends to be wrong is the story each has built about what the difference means.
The model most people carry — desire arrives unprompted, then you act on it — describes spontaneous desire, which is more common in men and in the early phase of a relationship.
Responsive desire works the other way around: willingness comes first, arousal follows contact, and desire appears somewhere in the middle. It is extremely common in women and in long relationships, and it is not a lesser form of wanting.
Novelty is a powerful driver of spontaneous desire and it necessarily fades. What replaces it — for couples who do well — is deliberate context: time, privacy, physical contact that is not a negotiation about sex.
“The couples who struggle are rarely the ones with the biggest gap,” says Ruta Kaminskas, PsychD. “They're the ones where every touch has become a question, and the lower-desire partner has started avoiding contact altogether to avoid having to answer it.”
“The goal is not matched desire, which isn't achievable. It's a sexual relationship both people feel good about.”Ruta Kaminskas, PsychD
The pattern is predictable. The higher-desire partner initiates and is declined, and reads it as rejection of them rather than of the activity. They initiate more anxiously, or stop entirely and become resentful.
The lower-desire partner feels under permanent audit, which reliably reduces desire further. Both are behaving reasonably and the loop tightens anyway.
Separating affection from initiation, explicitly and out loud, so that touch stops carrying a question. Agreeing a way to decline that includes a counter-offer. Scheduling — which sounds unromantic and is what most successfully partnered people with children actually do.
And the reframe that does the most work: the goal is not matched desire, which is not achievable. It is a sexual relationship both people feel good about.
A distinct, distressing loss of desire — particularly one that arrives suddenly — warrants a clinical conversation. Thyroid disease, iron deficiency, depression, perimenopause, and a long list of medications including SSRIs and some hormonal contraceptives all affect libido.
“Painful sex is the one I most want people to raise,” says Dr Boateng. “Dyspareunia gets described as low desire constantly. It is a treatable physical problem and it should never be managed as a relationship issue.”
This article is general information reviewed for accuracy, not personal medical advice. Speak to a qualified clinician about your own health. WomenWelly is reader-supported and free to read; we buy the products we test.
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It is not only about leaking. Tone that is too high is as much of a problem as tone that is too low — and it's far less discussed.
Not by effectiveness alone — by side effect profile, reversibility, cost and how much you want to think about it.
They overlap heavily and are treated differently. The distinguishing question is about what happens on holiday.