Without effective verbal and nonverbal communication, couples must base their sexual encounters on assumptions, past experiences, and wishful thinking—all of which can make a sexual experience feel routine and unsatisfying. Research has found that sexual satisfaction is correlated with the use of sexual terms and a greater degree of self­disclosure about sexual preferences (Hess & Coffelt, 2011; MacNeil & Byers, 2009). A frequent source of communication problems is stereotyped gender roles—in particu­lar, the myth that sex is primarily the man’s responsibility and that sexual assertiveness in a woman is “unfeminine.” For example, women who do not experience orgasm have more difficulty communicating their desire for direct clitoral stimulation to a partner than women who do experience orgasm (Kelly et al., 1990).

Fears About Pregnancy or Sexually Transmitted Infections

The fear of an unwanted pregnancy can interfere with coital enjoyment in a hetero­sexual relationship, especially when couples do not use an effective method of contra­ception (Sanders et al., 2003). On the other hand, many couples who want to conceive and have difficulties doing so often find that their sexual relationship becomes anxiety ridden, especially if they have to modify and regulate the timing and pattern of sexual interaction to enhance the possibility of conception.

Anxiety about contracting a sexually transmitted infection, particularly HIV, can interfere with sexual arousal in both homosexual and heterosexual relationships. For people who are not in a monogamous, infection-free relationship, some risk exists. Guidelines for safer sex are outlined in Chapter 15.