We have to bear in mind that men tend to share activities to establish intimacy, and most gay couples had high sexual activity at the beginning of the relationship, and that was one of the core strategies to strengthen their bond. In a situation of hypoactive sexual desire (HSDD), the male couple 'loses intimacy', which can quickly lead them to therapy.

For most women, intimacy is established by sharing information, feelings, secrets, solutions, and - in a couple situation - its foundation will be primarily built on nonsexual bases. Therefore, when there is HSDD, they are still able to maintain a very harmonious relationship, except for the sexual domain, and that makes them postpone looking for therapy.

Retarded ejaculation and secondary orgasmic dysfunction have numerous causes, but we should not forget that the absence of orgasm might indicate 'failure to yield to oneself and to the other'. Reasons might involve low self-esteem, excessive willingness to please the other during sexual relationship, insecurity, unfaithfulness, changes in power relations within the couple, or even the use of medication.

Discrepancies in terms of sexual desire might emerge as a result of: 1 - inexperience, lack of creativity by one of the partners; 2 - aversion to some sexual practice; 3 - power differences between partners; 3.1 - the less influent partner might deny sex in order to have some 'control' over the relationship or demand sex all the time to reassert oneself of the other's commitment to her/himself; 4 - the degree of dependence on the partner. About items 3 and 4: Partners in homosexual unions are often economically active. Male couples are much more independent than female ones. Among women, equality is more related to satisfaction than personal independence, which is the opposite in male couples. Income only influences power in male couples, for which fear of becoming dependent on the partner is common.

Common problems in homosexual couples, which may cause conflicts and lead to sexual dysfunctions, include: 1 - partners having distinct levels of openness to homosexuality as well as to assuming their relationship socially; 2 - one of the women in a couple wishing to differentiate herself from the other, with whom she was 'fused'; 3 - among female couples, reluctance to express different opinions and thus threaten the 'fusion', in an attempt to avoid any conflict. They often report they 'never fight'.

The systemic line associated to the behavioural cognitive one might be useful with homosexual couples. The therapist is often the only person to provide support in a crisis, in which the existence of a sexual problem does not mean the end of the relationship, and a significant degree of affection is the only ingredient needed to start sexual therapy.