Sexual Difficulties

Sexual problems are among the most common things people never mention. In Britain's largest sexual survey, 42% of men and roughly half of women reported a problem with sexual response. About one in ten were distressed about their sex life.

If you are in that one in ten, start with a GP. Many sexual difficulties have a physical cause, and the NHS treats those first. A talking professional comes after that check, not instead of it.

Once the physical side is ruled out or under treatment, the rest is very workable.

Source: Mitchell & Mercer 2013

Why the GP comes first

Persistent erection problems can signal a treatable health condition. The NHS names high blood pressure, high cholesterol, diabetes and hormone problems among the causes. It advises seeing a GP or a sexual health clinic when the problem persists.

The same applies to low desire. Lower hormone levels with age, especially around the menopause, and some medicines can reduce sex drive. The NHS says to see a GP if you are worried about it.

Sexual health clinics are free and open to everyone, whatever your age, gender or sexuality. You do not need a GP referral to walk in.

Sources: NHS: erectile dysfunction, NHS: low sex drive, NHS: sexual health clinics

Where a talking professional helps

Once a physical cause is treated or ruled out, what remains is usually in the head or the relationship. Both respond to talking.

The NHS itself points there. For ejaculation problems it says psychosexual counselling can help you, and a partner if you have one. For vaginismus it says a GP may refer you to a sex therapist.

For low sex drive caused by relationship problems, it suggests relationship counselling.

Many people find the difficulty started with something physical and stayed for a psychological reason. One lost erection becomes fear of the next one. Pain once becomes bracing for pain every time.

Sources: NHS: ejaculation problems, NHS: vaginismus, NHS: low sex drive

You might find support helpful when

• Desire has faded and the physical checks came back clear
• Sex hurts and you have started avoiding it, or your partner has
• Erections or orgasm have become unreliable and the worry is now the main problem
• You and a partner want different things, or different amounts, and it has turned into a fight
• Sex stopped after a birth, an illness, a bereavement or an affair and has not restarted
• You have never enjoyed sex and have started to wonder whether that could change

None of these needs to be dramatic to count. Wanting it to be better is enough.

What psychosexual therapy looks like

Psychosexual therapy involves no physical contact in the room. Relate describes sessions as weekly to fortnightly, with all the work in the room based on talking. You are given exercises to do in private at home, alone or with a partner.

Those exercises are the method, not an add-on. They usually start by taking sex off the table entirely, so touch can stop being a test. Then they build back up at a pace you set.

You can come alone or as a couple. If the difficulty lives between two people, our couples page covers that side.

Source: Relate: sex therapy

Who to look for

The UK professional body for this work is the College of Sexual and Relationship Therapists, COSRT. It holds registers of psychosexual and relationship therapists and a public search. A professional who names COSRT membership has trained specifically in this.

Ask how they work with your particular difficulty, and whether they see people alone, as a couple or both. If you would prefer a professional of a particular gender, say so at the start.

Source: COSRT: professional body

Kink, fetish and nothing to fix

Wanting something specific in bed is not a difficulty. A kink or a fetish is not a presenting problem, and a good professional will not treat it as one.

It becomes something to talk about only when it causes distress, partners want different things or shame does damage. Then the work is on the distress, the mismatch or the shame. Not on the wanting.

Look for a professional who states that they work with kink and non-monogamy. The ones who do tend to say so.

Services you can contact today

If you would rather walk in somewhere than book anything, these are the places to start.

NHS sexual health clinics

Everyone England

Free clinics open to everyone that check the physical side of erection, pain and desire problems, with no GP referral needed.

Find a clinic

Most sexual difficulties get better once someone is allowed to talk about them. Tell us what has changed, and we will find the right person.