Values, feelings, intimacy; all too often, these things get swept under the carpet, dismissed too quickly and put down to busy lives, heavy workloads or stress levels. Even in a relationship, the tendency to avoid discussing or dealing with certain topics can leave people feeling lonely or misunderstood.
Sex is very often one of them, observes Dr Angela Wright, a GP, menopause specialist, clinical sexologist and one half of Spiced Pear Health. “Research suggests that although problems with sex are very common, very few people come for help, which is a huge shame as changes in intimacy can be a source of conflict or relationship breakdown,” she says. “There is a lot that can be done with the help of doctors and therapists who specialise in sexual issues – but even just talking to your partner can help.”
We ask some of the UK’s top sexologists and psychosexual therapists for the most common sex-related relationship issues that come up time and time again – and their best advice for navigating them.
Painful sex
“Women are particularly vulnerable to pain or dryness when their hormones change – things like menopause, the pill, and breastfeeding can disrupt the way we lubricate and lower arousal and sensation too,” Wright says. “Many women continue to have sex despite the pain – whether to feel ‘normal,’ to protect a relationship or avoid conflict. It’s something I don’t usually recommend, as it can really damage our relationship with sex and our ability to be in connection with our bodies. But the right local hormonal treatments or moisturisers, and using lube, can make a big difference.”
Perhaps lesser-talked about is painful anal sex, notes Dr Ben Davis, a GP, clinical sexologist, and sex and relationship therapist. “As a gay man, both men and women come to see me to discuss painful anal sex. It’s something that is very rarely talked about, and people find it difficult to find safe clinicians they can seek help from,” he says.
“Common causes include anal fissure, haemorrhoids, pelvic floor dysfunction and infections – often a combination comes together to cause pain. Sometimes people anticipate pain or worry that something is wrong, which can cause tension in the pelvic floor and make sex more difficult. A thorough examination by someone trained in anorectal examination and sexology can help diagnose any underlying conditions and advise on treatment from creams to ointments. Often, though, reconnecting with your pelvic floor, with the help of a pelvic physio or some exercises on your own, can make a big difference.”
Mismatched desire and loss of libido
“This is still one of the most common issues I see,” says psychosexual and relationship therapist Lucy Frank. “One person wants sex more often, thinks about it more, or initiates more, while the other feels pressured, avoidant, guilty, or like they’re somehow ‘the problem’. This then creates shame and anxiety for both parties. It’s not about one person being ‘too sexual’ or the other being ‘not sexual enough’, it’s about context, different desire styles, stress, resentment, poor communication, body image, burnout, parenting, routine, or simply not creating the conditions where desire can actually emerge any more. Usually, the most useful question is not, ‘Why don’t you want sex?’ but ‘What helps you feel available for intimacy in the first place?’”
It’s perfectly normal for the balance of desire in a relationship to evolve over time, says Wright. “Early in a relationship, we often have lots of spontaneous interest in sex with a new partner, as they are novel and exciting,” she explains. “After that fades, we fall back to patterns that are more rooted in behaviour and reward, than always down to appetite alone.”
Loss of libido is common in both women and men due to change in hormones, she notes. “But also due to loss of reward from sex – in other words, loss of novelty, pleasure or connection. It can also be because we begin to associate negative outcomes with sex too – pain, urine infection, argument, shame, disappointment, or embarrassment.”
Many women are used to placing others’ needs above their own and disconnecting from what their bodies may want or need, she adds. “This can form the basis of the disconnect from sex that I see so often in women, particularly in the intense parenting years or at midlife.”
Davis says he often sees men seeking advice for low desire when in a relationship, too. “They’ll complain of not wanting sex any more. Sometimes they’ve been sent by their partner. They come wondering if they have a testosterone deficiency. Some of them do. But a lot of the men I see have low desire as part of being in a long-term monogamous relationship. Through exploring the issue, it often becomes apparent they do have a sexual self, but it’s being kept quiet.”
So, how to get the sexual spark back? “Get to know your erotic world and let go of shame around it,” advises Davis. “What turns you on? The erotic isn’t usually a cosy Thursday night in bed with your partner of 10 years. Some people manage that, but for an awful lot of people, their erotic world has more of an edge. Think of your three best sexual experiences in your life: what were the things that made these experiences good? How different is your sex life now?”
Are you allowing space in your relationship for desire? Too little independence in a relationship is known as enmeshment. “Doing everything together and living in each other’s pockets is rarely a recipe for excitement,” Davis says. “Erotic energy needs space for desire. Carve out time in the week to have separate lives, whether it’s a hobby, separate friends, or time to explore sexually on your own. Getting comfortable with separateness as well as togetherness is often the key to a healthy relationship.”
Erectile dysfunction
Despite erectile dysfunction being very common – around one in two men will suffer in their lifetime – it’s still not talked about enough. “I see huge numbers of men buying medications from online pharmacies, without them ever knowing the cause of their erection problems,” says Davis. “In my work as a GP, I see men having heart attacks, strokes, or major cardiac surgery 10 years after going to see their GP for erection problems and being given a few Viagra each month.
“Erection problems, particularly over the age of 50, are a warning sign of a heart attack or stroke five to 10 years down the line. Most men don’t know this. Most doctors don’t know this. Dealing with your erection problems properly will save not only your sex life, but your overall health.”
When to seek help for erection problems, according to Dr Ben Davis
You don’t get morning or night-time erections any more You have difficulty with erections both on your own and with a partner You have difficulty with erections with multiple partners, not just one Your erections have gradually got worse over the past few years You’re over the age of 50, or you have a significant family history of heart disease You have a history of high blood pressure, cholesterol, diabetes or are a smokerFeeling ashamed of a kink or fantasy
“Lots of people still carry huge amounts of shame around what turns them on,” says Frank. “I see people who are frightened to tell a partner about a fantasy, worried that their desires mean something is wrong with them, or afraid they’ll be judged, rejected or misunderstood. In reality, many fantasies and kinks are much more common than people think.
“The problem usually isn’t the desire itself; it is the restriction on letting it breathe that creates shame, secrecy, or fear around it. People often internalise the idea that if their sexual interests don’t look ‘normal enough’, it’s a red flag. The first step is often learning to talk about desire without an apology. A fantasy doesn’t automatically need to be acted out, but it should be something you can understand and speak about without feeling defective.”
Opening a relationship for the wrong reason
“This is something I’m seeing more as conversations around modern relationships evolve,” Frank says. “Ethical non-monogamy (ENM) and poly dynamics can absolutely work for some people, but I also see couples opening their relationship as a last-ditch attempt to fix disconnection, dead bedroom dynamics, betrayal or resentment. That usually doesn’t work because opening a relationship tends to amplify what’s already there rather than repair it.”
Opening a relationship should never be used as a shortcut around intimacy problems or honesty. “The question isn’t just ‘are we open-minded enough?’ but ‘are we emotionally equipped enough?”
If you can’t talk openly about jealousy, boundaries, reassurance, sex and insecurity, you’re probably not ready to add more people to the dynamic. “In my experience,” says Frank. “ENM doesn’t fix a broken relationship; it tends to reveal it more clearly.”
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