As an openly gay therapist who specializes at the intersection of couples and sex therapy, a large number of the clients I see are also gay. And one of the dynamics I often bump up against with these clients in particular is the gap between sexual and relational compatibility. Meaning that while a person may be an ideal dating partner, this does not necessarily translate into them being an ideal sexual partner, and vice versa.

This can make things complicated, as there is often so much riding on sex with gay men. While sex is an important component to any relationship, gay men often experience sex as the top priority, and so sex comes first: it’s the doorway to a relationship. If the sex is good, then these men become interested in dating the other person. Or in some cases in which the sex isn’t so great, they enjoy the relationship and each other’s company so much they develop an investment in the sex becoming great.

Despite media portrayal that gays are overtly promiscuous, a recent study by OKCupid found that homosexual men are only 1% more promsicous than heterosexuals. Ninety-eight percent of gays have had 20 or fewer sexual partners, compared to 99% of heterosexuals. This data, of course, is primarily based on North Americans who use the OKCupid dating app (which is a relationship based app and not a hookup app like Grindr), however, it goes to show that homosexual intimacy can be just as mundane as it is for straight people even if gays are having sex before entering a relationship.

Of course, there’s nothing inherently bad or wrong about any of this. But whether we want to chalk these dynamics up to hormones and behavior and/or the urban cultural milieu of gay dating in a big city, it can put intense pressure on partners to have sex that is mind-blowingly awesome. This pressure alone can cause problems inside the bedroom and out. And this is where I come in.

I help my clients unpack the love-lust split that so often occurs and, together, we make sense of what’s going on so they can eventually sail toward more fulfilling sexual seas.

Then, once a relationship really gets rolling, I often help couples navigate the sexual shift from spontaneous sexual desire to a more relational, responsive desire. During the first six to 18 months of a relationship—when the relationship chemicals are doing their thing and two partners’ brains are high on this neuro-chemical cocktail—sexual desire is usually spontaneous. Think of it as nature’s way of ensuring we stay interested in and focused on our partner. Slowly, however, these chemicals stop being secreted, and this is when the sexual dynamic usually shifts.

Some couples move through this period organically and find their way toward responsively-attuned sex. But other couples hit that point where there ceases to be a free-flowing, spontaneous sexual charge, freak out, and land in my office.

This is a problem that both gay and straight couples experience, but I find that gay men in particular can get stuck at these crossroads because satisfying, erotically-charged sex is such an essential ingredient to maintaining the integrity of the relationship.

How Do I Approach These Problems with My Own Clients?

I like to tell my gay male couples that I can help them connect their hearts with their genitals. I look at the whole picture—the whole relationship—and work from there. And that means looking at both members of a sexual partnership. For this reason, I ask men—especially men in committed relationships who nevertheless come to see me on their own—if they would be willing to make their partner a part of the therapeutic process. Sometimes, clients are reluctant to do this. Why this hesitance? In some cases, they don’t want to be seen by their partner as anxious. Or they don’t want to let their partner in on what’s really going on for them beneath the surface.

In short, they don’t want their partner to see the parts of themselves that they are most insecure about.

Men, gay or straight, are often under the myth that they have to be sex machines. They feel they must always be able to instantly produce a rock-hard erection and have mind-blowing sex for hours and hours and hours; the last thing they want is to be seen as vulnerable. I help them debunk these myths and let their partner get to know them as people who have feelings and vulnerabilities just like everyone else. This fosters intimacy, which is so much more fulfilling than having to adhere to rigid stereotypes that ultimately let down everyone involved. I help them see this work as an opportunity to deepen intimacy and connection with their partner. I help illumine that, through these seeming “challenges,” they have an opportunity to let their partner in on who they really are.

As for my single clients who have sexual concerns but who are not dating anyone regularly, we explore what’s occurring from the context of their individual experience—although usually it has a relational component.

Either way, this is where we get to work. No matter the issue—premature ejaculation, erectile dysfunction, arousal nonconcordance, or loss of attraction—we get down to the business of exploring what’s really going on within them and between them. This means really analyzing what’s happening for them individually, as well as their collective sexual script (the blueprint for how they approach their sexual roles within the relationship and how they impact each other). We take a closer look at what it means to be sexual with someone they love.

Additionally, we look at the relationship through the lens of the dual-control model: what are their turn-ons? What really gets them going? And what really turns them off? Where is the gas pedal and where are the brakes? As we delve deeper, we explore the entire continuum of a couple’s sexual response, starting at the initial stirrings of desire and moving forward through arousal, the plateau period, orgasm, and finally the resolution phase.

Sometimes, especially with gay men, I find that we can pigeonhole our long-term partners and see them in decidedly non-sexual ways, which of course impacts desire.

Eros gets thwarted, and sometimes it has to do with the anxiety generated from truly committing to someone. When people become more emotionally connected and reliant on each other, they’ve got more skin in the game, which can throw a wrench into the sex.

I normalize and validate all of this and we learn what dots they are connecting that contribute to this anxiety. I help them appreciate that most of us struggle with these dynamics to some extent, and that this certainly need not be the death knell to fulfilling relational and sexual connection. Anxiety can hijack our sexual response and we have to deconstruct that together. As I tell my clients all the time, when we’re in any degree of fight-or-flight, the body is not interested in having awesome sex. It’s more about survival than connection.

What If Someone Is Not Sure Whether or Not Therapy Is the Answer?

The first thing I’d say—if you’re in a relationship—is to talk to your partner about your concerns. If you’re not in a committed relationship, find a friend to talk to. Chances are you’ve already scoured the internet for information, but connecting with other people will help you see that this stuff is more common than you think.

On the other hand, I work with gay men all the time who aren’t comfortable doing that, so they see a professional instead. If you’ve done your research and things aren’t improving, sometimes it takes someone who’s truly trained in deconstructing what’s happening to help you understand what’s going on.

There are so many factors at play that can derail satisfying sexual desire and arousal, including how we view ourselves and our partners, in addition to all the behavioral, relational, and environmental factors. Sex therapists are trained to look at the whole picture. Either way, the key lies in understanding what’s occurring beneath the surface. Sexual problems in relationships and their resolution are usually rooted in relational dynamics that are best tackled together.