Majority of couples with problems in physical intimacy initially consult a gynecologist or sex specialist rather than a mental health specialist. This is because physical intimacy or sexual intercourse is considered a physical act by many rather than a combination of physical and psychological effects. For some, sex is considered necessary only to produce children and is a responsibility or duty towards the same without psychological considerations. Many consider the problem to be that of a woman and hence initially consult the gynecologist.

When the gynecologist examines the woman, it is possible that they may find medical reasons that can explain the discomfort or lack of physical intimacy. These can be reasons related to the reproductive system or other medical disorders or conditions. Some of these might require medication, some might require surgical interventions. However, it is also possible that the problems with physical intimacy exist even in the absence of any obvious physical problems. These may related to non-physical problems like phobias related to pain or a fear of pain, misconceptions regarding masturbation and the sexual experience, low self esteem, feelings of inadequacy or inferiority, cultural stigma and taboos related to sexual intimacy and possibly childhood sexual abuse/assault/molestation.  The discomfort with physical intimacy can also occur if the partner is considered physically or emotionally unattractive or if the environment is not amenable to relax. Needless to say, stress related to finances, work or other areas is an important factor to consider. Irrespective of the primary cause, it is important to work with the mind as much as with the body to improve comfort levels in persons/couples who face problems in physical intimacy.

Psychosexual counseling starts with the assessment of possible factors that may contribute (currently active factors or factors maintained from the past) to the problem. This stress includes a detailed interview of couple (separate interviews initially) exploring possible factors, both common and rare. Once an understanding of the issues that face the couple and the possible reasons for it are obtained, the next step is to initiate the process of addressing and overcoming these issues.

 The initial step is to clarify thoughts regarding various aspects of intimacy such as the need for emotional bonding with partner, open communication of likes and dislikes regarding each others preferences related to intimacy including sensitization that it is acceptable for the female to have preferences and sorting out issues/stressors related to other significant family members or family or work environment that contributes to stress.

 The fear of pain and the feeling of intrusion may be a factor for discomfort in female partners. In such instances, there is a need to initiate to relaxation exercises through a schedule for a week or 10 days. The relaxation exercises will cover the whole body from the head to toe and training to relax will be provided using Jacobson’s Progressive Muscular Relaxation. The logic of these sessions is that a relaxed body will lead to a relaxed mind and the process of relaxing the body relaxes the mind. The relxaed body and muscles will reduce friction and tension and help to reduce or overcome pain.

 Masturbation has often been considered as a cause for problems especially in males. Masturbation is worngly considered as contributing to erectile dysfunction or premature ejaculation. Specific techniques and training on the mind will be taught to overcome these causes in the males (in the absence of any physical cause) to overcome these dysfunctions.

 Cultural and stigma related causes remain a major cause for discomfort with physical intimacy. Appropriate sex and health education is given to the partners with specific focus on identified issues. When childhood abuse orr incest is a contributing factor, emotional or thought related (cognitive therapy) is recommended to settle deep seated trauma that can very actively interfere in couple  relations- both emotional and intimacy related.

 Where factors related to stress with significant family members such as over involvement or lack of privacy for the couple are involved, the couple has to be helped to find out practical solutions to create healthy boundaries between the couple and the other family members, or the space for the couple and other family members. The couple has to be helped to reduce the impact of other stressors on the quality of the time they spend together.  The couple has to be educated that physical intimacy or sex is an aspect that is more influenced by the couple’s emotional relationship rather than feelings of equality or control or determination of who contributes more to the relationship.

 In summary, problems with sexual intimacy can be physical, psychological or a combination of both. Psychological issues can be worked on and resolved as much as possible if the mind is open and willing to acknowledge the presence and depth of the problem. Willingness to work towards resolution also necessitates a willingness to change one’s view and improving acceptance of the partner.

Almost all of us carry some emotional baggage with us often without bothering or realizing how it affects our life.  We carry our emotional baggage for years and sometimes for many decades.

What are the common emotional baggage we carry around?

Our strict father who believed parenting was about dominating, scaring children and maintaining a distance. Where distance, fear and domination was misconstrued as respect.

Our over emotional or over involved mother who invested so much time and affection on us- the umbilical cord was physically cut but emotionally was bound in tight knots.

Our siblings who grew with a feeling of neglect or secondary in the hierarchy of affection showered by our parents.

Can we outgrow these feelings that we collected, as our baggage, over years? What happens to all these strained and over worked emotions?

Knowingly or unknowingly, we show the effects of these baggage on our partners. Our choice of a partner for the complex and intimate spousal relationship is often a reflection of our emotional baggage and needs. We might look for a soft spoken partner if we had an overbearing parent! We decide on a single child so that we don’t transfer a feel of neglect to our children! Most often, we do this subconsciously without even being aware that we are transferring our baggage to the lives of our family members.

Are we happy carrying these emotional baggage? Maybe not or maybe there is a perceived advantage with the baggage! The so called soft spoken friendly person might over the years be considered unassertive and indecisive.  The over emotional partner might be perceived as being too dependent and a burden. Our single child whom we showered all our affection on might end up feeling lonely, spoilt and uncompromising.

Like the worldly assets we accumulate meaninglessly, we accumulate and transfer our emotional baggage to the next generation leading to the development of more complex personalities over the years.

Is there a solution? Can we be aware of the baggage we carry??

We need to self reflect and analyze ourselves from time to time. What drives our actions and reactions?  Can we see our partner as a person by themselves rather than as a reflection of the strained family relations we had? Can we see our kids as human beings in their own right rather than as a vehicle for our shattered dreams or misguided ambitions?

Often, the partner is able to objectively see the baggage brought into the relationship. Are we able to accept the objectivity of our partner? Or do we become defensive? Can we let go of the baggage? Can we recognize it as a problem and deal with it?

The first step is realizing there is a problem, then accepting it and working towards a solution in collaboration with your partner.  Let us try that and see if we can bring back the magic into our married life.

Often, talking issues out with an independent unbiased third party like a psychologist can bring in new perspectives and new insights.  It may also help to retain objectivity and build trust between partners without getting too much caught in defensive reactions.

As Humans, we are related to many of our fellow human beings. Some of these relations are biological in nature, some through social interactions and peer pressures, some just on a need to know or information basis, as part of an organization or a common theme such as parents of children at the same school or play group.

It is interesting to explore if and how we relate. Do we relate in a relative sense or just for the sake of being related? All our relations with different people seem to be need based or expectation based.

What is a real relation then? Is being a relative the same as being related?

Being Friends, Relatives, Family Members is supposed to make us feel secure, comfortable, fulfilled and happy or contented in the relationship but are we able to really feel that relatedness? Don’t we, sometimes if not often, feel lonely, left behind, ignored, used or manipulated even within these “comfortable” relationships?

How do we related with others? Do we relate to others in the sense of being related or do we expect something or the other from the relationship- whether it is material gains, emotional sustenance, social recognition and interaction, or even an identity. Maybe even to climb the social ladder. or Just to fit in. Do we get upset when the other person is not able to meet our needs or expectations from the relationship? Can we relate to others without any expectations, just for the pleasure of knowing, interacting and relating with each other?

As social beings, humans have to relate to be part of a society. Can these relations be unconditional like that of a baby, like a flower that blooms or a fruit that ripens ((maybe the flowers and fruits have conditions of their own!).

How do we then relate without our expectations and needs from the relationship leading to disappointment or hurt? Is relating to our self comfortably a solution? Yes, I need material and will work myself for the material I need, I don’t need a relationship to get that material. Yes, I need an emotional outlet or sustenance, and shall share my feelings with with you without expecting you to share your feelings with me. Yes, I will keep in touch with people but without expecting that they have to keep in touch with us. Is that possible or feasible? Is this the solution? Does it improve the feeling of relatedness or does it increase the disconnect?

Even within the family, if we rely on ourselves alone, does that make us emotionally connected or do we have to limit our expectations to only those whom we feel are “close” to us. Tempering expectations or flexibility in expectations may be a better option.

Don’t we have expectation even when we relate to God? Is it possible that our expectations may be unrealistic, unreasonable? Do we have to assess and reassess the rationale or logic behind all our expectations. Does that make us feel better related? Is there an individual significance that will change for how we relate to each person?

There are no easy answers for these questions although introspecting over these questions within the context of our relationships maybe useful. Understanding the basis for the relationship, the expectations, the need to be self sufficient, the need to approach a relationship with an open mind and tempered or no expectations might be the way to avoid disappointments and hurt in relationships. Now, the scope and parameters of the relationship is an individual choice…and frankly, easier said than done!