Besides personal feelings and attitudes, relationship factors strongly influence the sat­isfaction and quality of a sexual relationship. One research study indicated that famil­iarity and security support men’s sexual function because men reported fewer problems with erectile function during sex with an ongoing partner than with a nonrelationship partner (Herbenick et al., 2010). Other studies have shown that greater satisfaction with the overall relationship was related to higher sexual satisfaction and fewer sexual problems (Witting et al., 2008). People in satisfying relationships may even experi­ence benefits from sex that individuals in unsatisfying relationships do not. A study that explored the link between stress and sexual activity found that sexual intercourse relieved stress for men and women in satisfying relationships, but did not relieve stress for those in unsatisfying relationships (Ein-Dor & Hirschberger, 2012).

Unresolved resentments, lack of trust or respect, or dislike of a partner can easily lead to sexual disinterest and problems with arousal and orgasm. One partner can even use his or her lack of sexual interest, consciously or subconsciously, to hurt or punish the other. A person who is frequently pressured to engage in sex or who feels guilty about saying no can feel less and less desire. In addition, someone who experiences a lack of power and control in the relationship can lose her or his sexual desire or responsive­ness (Hall, 2008; LoPiccolo, 2000). Sexual difficulties can also occur when partners are too dependent on each other; partners need a balance of togetherness and separateness (DeVita-Raeburn, 2006; Perel, 2006). Even without specific relationship conflicts, lack of emotional intimacy can interfere with sexual interest and response (S. Levine, 2007).

Lack of sexual desire may reflect unresolved relationship problems and negative inter­action patterns (Dennerstein et al., 2009; Hayes et al., 2008). One study found that women with HSDD reported more dissatisfaction with relationship issues than did women with other sexual problems, such as difficulty reaching orgasm (Stuart et al., 1998). In this study, diminished desire was associated with a few specific relationship characteristics:

■ The woman’s partner did not behave affectionately except before intercourse.

■ Communication and conflict resolution were unsatisfactory.

■ The couple did not maintain love, romance, and emotional closeness.