WHAT’S WORRYING YOU?

Experiencing sexual problems at some point during your life can be perfectly normal. While everyone’s problems and sexual experiences can be different, it’s important to remember that we can also face similar issues. If you are experiencing problems with sex, you may feel alone and helpless, or even embarrassed, ashamed, or afraid. These are common things felt by people living with sexual dysfunctions. Feeling this way can lead to people waiting months or even years to seek help and support, as they are too afraid to discuss their worries and experiences with others. 

Sex problems are common and can occur for any number of different reasons. In most cases, sexual problems can be linked to other challenges or difficulties you are facing within your life. For example, if you are feeling stressed and have a lot on your mind, you may not feel like having sex or being intimate. This is typically a mild, short-term sexual problem that goes away as your stress levels change. More complex or severe problems can have a deeper, long-term effect that could impact different areas of your life, relationships, and even sexuality.

If you are worried you may be experiencing sex and intimacy problems, it’s important to speak up and seek help. The longer you wait, the more time your problems have to get worse or develop consequences. Reaching out and seeking help can be scary, but it’s the first step towards finding out what is causing you problems and in helping you to fix or manage them. There are many options out there that can help, such as sex therapy, which is considered to be a highly effective way of addressing sexual dysfunctions. Sex therapy can help you to develop a healthier attitude towards sex and sexual intimacy, as well as to explore any underlying issues that may be impacting your ability to relax and enjoy sex.

What are sex problems?

Sex problems, or sexual dysfunction, refers to a wide range of difficulties that may happen at any point before, during or after sex. The sexual response cycle (a sequence of emotional and physical changes that happen when you become aroused and engage in sexually stimulating activity, such as masturbation or intercourse) – has four stages. Excitement, plateau, orgasm, and resolution. If your body doesn’t respond during one or more of these states, it can be a sign that there may be a problem. 

What can cause sex problems and sexual dysfunctions?

A number of different things can cause you to develop sexual problems. Generally, problems develop due to a combination of physical, emotional, psychological and situational reasons. These can include:

Physical factors: disabilities, illnesses or long-term conditions such as diabetes, heart disease, drug or alcohol addiction. 

Psychological: many different mental health issues can negatively impact your sexual desire and responses. These can include anxiety, depression, stress, and more. 

Emotional: feelings of betrayal, unhappiness in your relationship, or unresolved grief can all take their toll. If you have low self-esteem, this may also be having a negative impact on your levels of sexual desire and desirability. Past traumatic experiences with sexual abuse can also have a greater effect than you may realize, and may leave you feeling unable to fully enjoy or participate in sexual intimacy. 

Situational: changes in your day-to-day life, circumstances, or living situation can all contribute to the development of sex problems. For example, if you have recently moved, are having financial problems, or have had a child, this could have a significant impact.   

What are the common sex problems?

Our problems with sex can feel very personal, however many of us face similar issues and struggles due to our experiences, situations, worries, or gender. Many common sex problems for men and women can be addressed, improved, and even overcome with the help and support of counselling.

Sex problems anyone might experience

Peer pressure

Along with a number of physical health risks that are worth keeping in mind when exploring different sexual activities, there can be an emotional impact if one partner is more keen to experiment, or if another feels pressured to try something they may not be ready for. This can cause undue stress and anxiety, or may even lead to feelings of upset and resentment. Creating an open, honest dialogue about why anal sex is so important to incorporate within your relationship can be a positive first step towards avoiding any related issues or upset.  

Problems during or after sex

This may include pain, feelings of guilt, anxiety or loneliness. Ensuring there are no physical issues such as vaginitis (tight muscles that make sex painful or impossible), an STD or STI, an infection like thrush, tight or torn foreskin, swollen testicles, inflamed prostate, or vaginal dryness should be the first step. Getting advice from your GP or a healthcare professional at a GUM clinic is simple, confidential, and free. If you are embarrassed to nervous about speaking with your GP, check your local area for a walk-in clinic. You are not required to give your real name (though you may need to provide contact details if you are seeking any tests).   

Age-related sex problems and concerns

As you age, sexual issues may develop. These can cause additional worry and anxiety around your body image, self-confidence, or even your identity as someone sexual. For men, arousal from visual stimulation may not be as easy, your erection may not be as firm, or you may have a longer period between when you are able to climax. For women, gradual changes (often menopause-related) can include a loss of libido, decrease or lack of lubrication, trouble sleeping or night sweats. While men may typically find age-related changes to be a concern, many women report an improvement in their sex lives, finding changes to be a liberating experience when they feel able to talk about their changing needs. As one counselor explains, talking can make a real difference.

Saying things out loud to another person can feel like a tremendous relief, and feels completely different from the thoughts going around in your head. There is something about the process of speaking about issues that feels very different.

Sex addiction

Also known as hyper-sexuality, sex addiction generally refers to a feeling that you can’t stop or resist a particular sexual activity or related action, such as masturbation, accessing pornography, paying for sex, or having cybersex. As with other forms of addiction, this can lead to feelings of isolation, regret, powerlessness, anxiety, remorse, and shame. Inpatient treatment, 12-step recovery program, one-to-one counselling, group therapy, and cognitive behavioral therapy (CBT) are just a few of the ways you can address any worries around sexual addictions. If you’re unsure if you may have a problem, Noel Bell MA, PG Dip Psych, UKCP shares a few short questions you can ask yourself to know if you have a problem. 

Loss of intimacy and relationship problems

Many worry about the loss of intimacy, asking: can a relationship survive without intimacy? How we talk about intimacy can be the first step towards addressing any concerns. Relate, the relationships charity, have created a sex and intimacy quiz to help you identify where any problems may be coming from, what your emotional triggers may be, and how you can boost your intimacy to increase feelings of satisfaction and connection. Speaking together with a relationship therapist or couples counselor can help you to explore any conflicts or underlying issues, creating a safe space where communication can be addressed at put at the forefront.

Differing sex drives

Experiencing different levels of desire during the course of your relationship can be common. While many find a way to compromise, for some, a sudden increase or decrease can lead to communication difficulties or feelings of rejection. Improving communication through relationship counselling, therapist Geoff Boutle MBACP (Snr Accred), explains:

In order to bring about change, something different needs to happen between the couple. That change may relate to behavior, approach or thinking process. For there to be a shift in the relationship, it may be helpful to introduce a new behavior pattern or approach to dealing with a troublesome issue. One such change can be to recognize the importance of listening rather than talking or responding.

Medical-related sex problems

If you have a chronic illness, are diagnosed with diabetes or cancer, there may be an impact on your sex life. While being diagnosed with any of these conditions doesn’t necessarily mean you will experience sexual problems, the added stress and worry may impact your health and well-being. Diabetes UK has put together a guide on some of the key problems you may experience if you are diagnosed as diabetic. If you are currently or have been previously treated for cancer, Cancer Research UK and Macmillan cancer support have put together some common questions, experiences, and things you can try to overcome any sex and relationship issues. 

Sexual therapist Isabel White discusses common sexual problems experienced by young and old people affected by cancer.

Female sex problems

Pain during sex

Also known as dyspareunia, pain during sex can be very common for women who have gone through, or are going through the menopause. There are various medical conditions that can contribute to this pain, including endometriosis, and ovarian cysts, but other issues such as poor lubrication during sexual intimacy may be psychologically linked. Other causes include scar tissue from surgery and sexually transmitted diseases. 

In some cases, women experiencing pain during sex may have vaginitis – a distressing condition characterized by an involuntary spasm of the muscles that surround the entrance of the vagina. Vaginitis is common in women who fear penetration, and this may stem from a long-term sexual phobia, or a previous traumatic or painful experience, such as sexual abuse or childbirth. Vaginitis symptoms may also be linked to relationship problems or fear of pregnancy. Vaginal trainers are usually provided to help women overcome this sex problem, but counselling is considered an effective treatment in addition to medical intervention.

Orgasmic disorder

According to Relate, around one in four women will have problems reaching orgasm at some stage during their life, while 25-35% may have never experienced an orgasm. Although many women do not need to have an orgasm to enjoy sex, being unable to orgasm may be troubling for some women and their partners. 

Reasons why women can’t orgasm from any form of sexual stimulation will vary, from medical causes to deep-rooted psychological issues that may be impacting their ability to ‘let go’. Typical medical causes of orgasmic disorder include neurological, vascular or hormonal problems, while some medications may also have an effect. Alternatively, some women may just have a very strong fear of sex and feeling aroused (often out of fear of losing control) while others may be dissatisfied in their relationship and with the sexual stimulation their partner is/isn’t providing. Mental health issues such as depression or previous traumatic experiences can also contribute to orgasmic disorder.

Loss of desire

It is common for women to experience lack of sex drive at certain periods in her life – particularly during pregnancy and times of stress – but some women may have it more persistently. Again, there are several psychological and physical factors that can cause this, including diabetes, relationship problems, hormone disorders, depression, excessive tiredness, traumatic sexual experiences and drug and alcohol addiction. Lack of sex drive is also linked to a reduction in a woman’s natural testosterone levels. 

In rare cases, women may have what is called ‘sexual anorexia’ – a condition that is not in itself a diagnosis, but refers to a complete lack of desire for sex. Women with sexual anorexia will constantly avoid sex and may go for years without engaging in sexual intimacy with their partners. Like the eating disorder, sexual anorexia is predominantly psychologically linked, and counselling is considered essential for helping sufferers to perceive sex and sexual intimacy as something natural and healthy rather than bad and shameful.

Male sex problems 

Ejaculation problems 

Ejaculation problems are very common and men will typically experience one of three types of disorder:

• Premature ejaculation: when you ejaculate too quickly during sexual intercourse. The average time of ejaculation is considered five minutes so regularly ejaculating before or within one minute of penetration is regarded as premature.
• Retarded/delayed ejaculation: a delay in achieving ejaculation, or where a man is completely unable to ejaculate during sexual activity. Also known as male orgasmic disorder.
• Retrograde ejaculation: the least common of the three, this condition is where the sperm travels backwards and enters the bladder instead of passing through the urethra and head of the penis. Orgasm is still experienced but there will be no, or little semen. 

As with the female sex problems, male sexual dysfunction such as premature ejaculation is linked to psychological and/or physical factors. These include stress and previous sexual trauma as well as medical conditions such as diabetes. 

Erectile dysfunction 

Also known as impotence, erectile dysfunction refers to the inability to get and maintain an erection that is satisfactory for sexual intercourse. This is quite common and is linked to hormonal problems and the narrowing of blood vessels inside of the penis due to high blood pressure. Stress, anxiety and mental health issues are further causes of erectile dysfunction, along with sexual boredom and constant worrying about pleasing a partner. Unfortunately, for many men, even when the initial cause of an erection problem has passed, the anxiety of repeated failure may block future erections.

When should I seek help for sex problems?

Talking about sex problems is understandably difficult and embarrassing for many, and as a result, some people may refrain from seeking help. Suffering in silence however can make the problem worse, and it could lead to a lot of stress and unhappiness in your life and for those around you – particularly your partner. Although sex problems can stem from deeper issues within a relationship, sexual dysfunction can also cause relationships to suffer. Sex and sexual intimacy is an important part of bonding between two people in a relationship and without it, a couple can become disconnected. When this happens it is a good indication that you need to start thinking about getting help.

Some of the signs that sex problems are affecting your relationship include: 

• Sex causes disappointment.
• Sex is the cause of rows.
• One or both partners are feeling dissatisfied or stuck in a rut.
• Couples start drifting apart and losing touch.
• One or both partners feels taken for granted or neglected.

What treatment is available for sex problems?

The first step in seeking help for sex problems is to make an appointment with your GP to have your condition diagnosed and appropriate treatment methods explored. To establish the cause of sexual dysfunction, your doctor will ask questions about your sexual, social and medical history. Medical tests will also be carried out to identify any physical causes, for which medication can be provided. Sex therapy (also known as psychosexual therapy) is often the next course of action for individuals and couples experiencing sex problems, and although it may seem daunting opening up about intimate and somewhat embarrassing details, talking to a counselor can help.

Psycho-sexual therapy 

There are many professionals in the UK specially trained to talk about sex and help people to explore and overcome sexual dysfunction. Psycho sexual therapists, in particular, are very knowledgeable about a wide range of sex problems and have proven successful in helping individuals and couples of all ages, health and sexuality to realize their sexual needs and desires and work through any negative thoughts that may be affecting their ability to enjoy sex and sexual intimacy. 

Psycho-sexual therapy may involve exploring family myths and cultural taboos that have impacted on the way someone associates with sex and sexual intimacy. Questions that may be asked include: “If sex was once enjoyable, what happened to change that?” and “What feels good and what feels disappointing?”. These encourage the re-examination of deep-set sexual assumptions and beliefs, and in a good therapeutic relationship between client and therapist, there will be the opportunity to find answers and develop a healthier relationship with sex and sexual intimacy. 

For more information on this form of treatment, please see our psychosexual therapy page.

Relationship counselling

Relationship counselling, also commonly called couples counselling, is effective for helping couples to explore their physical communication and their understanding of what sex means to them. Sex may have become mechanical and a way to maintain a safe distance for one person. In such cases, the partner may mourn the lack of intimacy and trust which would allow them to feel safe and enjoy sex. Withdrawal of sex can happen when a person has no alternative way to express their anger and disappointment – so the forbidden feelings are acted out in the bedroom. These are just some of the issues that may be addressed in relationship counselling to help couples become more aware of each other’s needs and desires and thus be able to reach a solution that works best for both of them.

What should I be looking for in a counselor or psychotherapist?

Currently, there are no official rules or regulations stipulating what level of training a counselor dealing with sexual issues needs. There are however several accredited courses, qualifications and workshops available to counselors to improve their knowledge of a particular area, so for peace of mind, you may wish to check to see if they have had further training in psycho-sexual issues. 

If you’re unsure if the therapist you have found is the right person for you, know that it’s OK to ‘play the field’ and try working with another therapist to help find one that fits.