Physical Intimacy and Desire | Couples Therapy | Regina Abayev, JD, LMFT
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Physical Intimacy and Desire

When the physical
connection has
changed

Desire loss in long-term relationships is common and rarely caused by a single factor. It is an intersection of biological, psychological, and relational forces. Together we work to understand what is driving it.

Let's Work Together
Physical intimacy couples therapy Hermosa Beach
A Specialized Area

Not a problem
to fix. A system
to understand.

Most couples who come here with concerns about physical intimacy have been treating it as a problem with a missing part. One person has low desire, or the frequency has dropped, or the connection that used to feel natural now feels effortful. The instinct is to identify what is broken and fix it.

Desire does not work that way. It is a system, responsive to biology, to the relationship's emotional climate, to stress, to body image, to whether the conditions for desire exist at all. Understanding what is actually driving the change is where sessions begin.

My doctoral training in clinical sexology means I can work with the full range of what physical intimacy involves. This is not a topic that gets handled carefully around the edges here. It gets addressed head-on.

Love seeks safety. Desire seeks aliveness. Both are possible in a long-term relationship, but they require different conditions.

What Couples Say

"We love each other but we have not been physically close in months."

"One of us wants more physical connection and the other does not know why they have pulled away."

"We have never been able to talk about sex directly without it becoming awkward or turning into a fight."

"Something changed after we had children and we cannot find our way back."

"I feel like my partner has lost interest in me specifically."

What Actually Drives Desire Loss

The forces that
shape physical intimacy

Desire loss is almost never about one thing. These are the most common drivers, and most couples are navigating more than one of them at once.

Biological
Hormones, health, and medication
Hormonal shifts including postpartum, perimenopause, and low testosterone, as well as chronic illness and the side effects of medications including SSRIs, can significantly affect desire. Before drawing conclusions about the relationship, it is worth ruling out physiological factors. This is maintenance, not failure, and it deserves to be named directly.
Psychological
Body image and spectatoring
When a person is constantly evaluating their own body during sex, watching themselves perform rather than feeling sensation, desire and pleasure both collapse. This is called spectatoring, and it is more common than most people realize. It is exhausting to be both the performer and the audience. The clinical focus is on turning off the internal camera so each person can actually be present in their own skin.
Relational
Resentment and the emotional climate
Desire is rarely found in a state of exhaustion. When one partner carries the mental load of the household — managing the schedules, the logistics, the emotional labor — while the other executes tasks, the power imbalance acts as a biological brake on intimacy. Resentment that builds around domestic labor, unresolved conflict, or the accumulated weight of feeling unseen shuts desire down. The kitchen and the bedroom are not separate.
Relational
Life transitions
New parenthood, career transitions, grief, illness, aging. Each of these reorganizes the conditions of daily life and, with them, the conditions for physical intimacy. Couples who do not actively tend to their physical connection during major life transitions often emerge from them with significant distance they do not know how to close.
Understanding Desire

The spontaneous
vs. responsive gap

One of the most common sources of mismatched desire in long-term relationships is a difference in desire type, not desire level. Most people assume desire should arrive like a lightning bolt, present before any physical connection begins. For many people, particularly in long-term relationships, desire only emerges after physical connection has already started.

Neither type is abnormal. When partners have different desire styles and do not understand the difference, the one with responsive desire often concludes something is wrong with them, and the one with spontaneous desire concludes they are no longer wanted. Both conclusions are wrong, and both cause real damage.

Understanding which type of desire each partner has, and what conditions support each, is one of the most clarifying conversations couples can have. It is also one of the most rarely had.

Type One
Spontaneous Desire
Desire that arises without much external trigger. The classic experience of wanting sex before any physical contact begins. More common in the early stages of a relationship and in men, though not exclusive to either. Often described as the "honeymoon phase" experience that couples expect to sustain indefinitely and are confused when it fades.
Type Two
Responsive Desire
Desire that emerges in response to physical connection that has already begun — after touch, closeness, or intimacy is initiated. Not a lower level of desire, a different pathway. Extremely common in long-term relationships and in women, though again not exclusive. The problem arises when the responsive-desire partner waits for spontaneous desire that never comes, and both partners interpret that as loss of attraction.
The Model
Accelerators and Brakes
Desire researcher Emily Nagoski describes a dual control model: everyone has accelerators (things that move toward desire) and brakes (things that inhibit it). Most people focus on finding the accelerators. What matters more in long-term relationships is identifying and removing the brakes: stress, resentment, body image concerns, disconnection, and the absence of conditions that make desire feel possible.
Clinical Sexology Training

A scope that covers
the full picture

Most therapists approach sexual intimacy carefully around the edges. Doctoral training in clinical sexology means I approach it directly. Desire, sexual compatibility, the impact of biology on sexuality, the psychology of pleasure and avoidance, the conversations couples have never had. All of it is within clinical scope here.

Most couples have never had a direct, informed conversation about their physical relationship. The absence of that conversation is frequently where the distance started.

Sessions are active and specific. Both people are held. Nothing is assumed to be too uncomfortable to address directly.

Training includes

Doctoral candidacy in clinical sexology
Advanced clinical training in human sexuality, desire, sexual function, and the psychology of intimacy.
Gottman Method and Emotionally Focused Therapy
Evidence-based frameworks for the relational conditions that support physical intimacy.
Relational Life Therapy
Direct, accountable clinical approach to the relational dynamics that affect desire and connection.

"Real intimacy is the ability to be who you are, in the presence of someone you love, without losing yourself."

— Terry Real

The most important conversation about your physical relationship may be the one you have never had.

Begin the Conversation

This is a space
for the full picture

This practice serves couples in Hermosa Beach, Manhattan Beach, the South Bay, and across California via telehealth.

Let's Work Together

Other areas of couples work

Communication and Conflict Lack of Intimacy Betrayal and Infidelity Discernment Counseling Pre-Marital Counseling High-Conflict Couples Co-Parenting and Divorce Separation