Sexuality & Intimacy

What's Actually Causing Your Sexual Difficulties?

6 minute read

Sexual difficulties can be confusing and hard to figure out.

Most people who come to me have already tried a lot on their own. Cutting out porn, taking breaks from masturbation, doing kegels, trying different positions, taking libido enhancing supplements. And still, nothing shifts.

The Biopsychosocial Model: A Different Way to Understand Sexual Dysfunction

That's usually because sex isn't just one thing. When I work with clients, I use the biopsychosocial model to figure out what's actually going on. It's a clunky term, but the idea is simple: your biology, your psychology, and your social world are all tangled up together, and sexual difficulties usually live at the intersection of more than one.

On the biology side, that could be hormone levels, circulation, medication side effects, a tight pelvic floor, or something neurological.

Psychologically, it might be stress, anxiety, past sexual trauma, or depression.

And socially, it could be relationship conflict, cultural messaging about how sex is "supposed" to go, lack of sex education, or the stigma that keeps people quiet about what they're struggling with.

From Emotional Pressure to Physical Symptoms

These pieces don't stay in their own lanes. They feed each other. Say someone feels pressure to perform a certain way in bed. That pressure creates stress. The stress shows up in the body as tension, and over time, a pelvis that's constantly bracing can become a pelvis that's chronically tight. A chronically tight pelvic floor can lead to things like painful sex or pain with penetration (for vulvas) or premature ejaculation (for penises). Across genders, a tight pelvic floor can also just mean reduced sensation and pleasure overall. When those muscles are locked in a defensive, bracing pattern, it's hard for the body to fully drop into arousal, so sex can start to feel flat or effortful rather than pleasurable. What started as a social expectation ends up as a physical symptom. The symptoms can remain the same, or not change much, if both aren't addressed.

Working With a Sex and Intimacy Coach on Sexual Difficulties

This is where my work as a sex and intimacy coach and surrogate partner comes in. I help clients untangle the psychological and social threads, the stress, the shame, the relationship patterns, the stories they've absorbed about sex. Together we might explore what's happening in your body during intimacy, so you build more awareness of what's actually going on underneath. We might practice new ways of communicating or setting boundaries in real time, and start writing your own narrative around sex and relationships instead of the inherited one that's been causing the pressure. When something looks more biological, I help clients find the right specialist, whether that's a urologist or a pelvic floor therapist, so they're getting support on every front instead of guessing at just one.

If you've been trying everything you can think of and nothing seems to change, the missing piece might not be a single fix. I can help you sort out what's actually driving your sexual difficulties so you're addressing the real cause instead of chasing symptoms.


Over time, many people find that clarity is often the first step back to pleasure.