Many people experience low sexual satisfaction and other sexual concerns for many different reasons, and there are usually multiple factors involved for each person or couple.
On the flip side, a very promising flipside, there are also factors known to increase the likelihood of experiencing sexual fulfilment and pleasure.
We can think of the factors involved as The Four P’s: Predisposing, Precipitating, Perpetuating and Protective factors.
Predisposing factors are things that make it more likely that a sexual problem will develop. This can include biological or genetic factors, such as particular medical conditions. This can also include psychological factors such as low self-esteem and difficulties with body-image, and past experiences such as sexual abuse (any form of unwanted sexual touch) or negative early sexual experiences (perhaps as a teenager or as a young adult). Poor sex education as you grew up, and negative messages about sex and genitals, also fit into this category.
These are the factors that trigger a certain sexual problem to start occurring as an individual or in a relationship. Some examples include: life stage changes (e.g., pregnancy, parenthood, menopause, aging), increased stress or anxiety, conflict with your partner, infidelity, changes in energy levels and fatigue, illness or injury (or medications), diagnosis of a sexually transmitted infection, or a partner developing a sexual problem.
These are things that keep the problem in place and are often called maintaining factors. Perpetuating factors might be the same as the triggering factors (above) – for example, ongoing conflict, ongoing stress – or they may be different.
Here is an example to demonstrate this: Molly and James found that their sex life dramatically changed when they began to struggle with infertility. All the pressure to have perfectly times sex, and all the focus on reproduction meant that sex soon became routine, mechanical and passionless. Then they began IVF and could relax their ovulation-timed-sex routine. Although it was the ovulation-timed-sex that initially triggered their sexual problems to emerge, the perpetuating factor for Molly and James’ sexual issues actually became the side-effects of all the fertility drugs that Molly was on, for over 2 years, and the emotional rollercoaster as they worked their way through multiple IVF cycles.
Lastly, protective factors are the factors that promote healthy and enjoyable sex lives. These protective factors include good physical and mental health, positive attitudes about sex and masturbation, positive feelings about your body, good stress management, realistic expectations about life stage changes and sex, a flexible definition of sex and intimacy, good communication skills, attraction to your partner, and positive role-models in loving relationships.
Getting professional help for sexual concerns is also a big protective factor because this helps people to work on the factors that are maintaining the problem.
When I work with couples or individuals struggling in their sex life, the aim of exploring The Four P’s is to help people understand how the problem/s began, and then to identify which factors are out of one’s control, which factors can be worked on, and which protective factors can be enhanced over time.
The Four P’s are also a good way to look at prevention of sexual difficulties: Identifying any factors that are dampening your sex life, and building up your protective factors, are two important ways we can all keep an eye on the health of our intimate relationships.
Dr. Alice Hucker