Sex & Relationships

Everything You Always Wanted to Know About Sex (and Weren't Afraid to Ask)

Psychotherapist Pamela Stephenson Connolly answers some of the most commonly asked questions about sex.

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Where has my sexual desire gone, and how do I get it back?

Sexual desire is normal for most people. The urge itself is a complex combination of intellectual ideas and fantasies. It is usually connected to a physiological response, but one that can theoretically be separated – for instance, one’s body may become aroused in the presence of someone with whom it would be inappropriate to have sex. The mental wish for sex – either a specific enthusiasm to be erotically connected with another being, a desire to masturbate or a more general longing without a particular object – can precede, follow or be simultaneous with actual physiological arousal.

Sometimes a person who is able to become physiologically aroused in the normal way develops an inability to feel comfortable with the idea of having sex. Anxiety, stress, depression, overwork, bereavement and anger can curb one’s interest, and a traumatic event may lead to an aversion to sex. The treatment for a problem with desire is related to the cause. In simple cases, a couple can work to reduce their stress or anxiety, improve their connection – which often requires solving specific problems that may be causing underlying resentment – or find “quality time” to be intimate. More complex cases usually require professional guidance to help a person heal from a specific trauma, treat sexual aversion or tackle phobias that may not be specific to sex, but may strongly influence sexual desire, such as a fear of germs. They can also help when people have what they believe to be an excess of desire that is causing significant life problems.

Why am I having problems getting aroused? I want to have sex!

Arousal is the initial bodily response to sexual desire and the physical events that prepare it for sex. In men, the most obvious sign is erection, while women normally experience vaginal opening and lubrication, but both can also experience flushed skin, changes in breathing patterns and hardening of the nipples. Both men and women can have difficulty becoming physically aroused, even when they desire it. Men can have difficulties achieving or maintaining an erection that is sufficient for their preferred type of sexual activity, and women can experience a lack of vaginal preparedness. The reasons can be largely physiological or largely psychological, but are most often a combination of the two.

Arousal failures can occur naturally and normally and are nothing to be concerned about. However, when they become frequent – and cause distress and relationship problems – they can usually be treated. Indeed, multimillion-dollar pharmaceutical industries are dedicated to treating arousal problems. However, they have mainly helped men with erectile dysfunction – treating female arousal problems pharmacologically is still a work in progress.

Erectile dysfunction can be caused by a number of medical conditions, such as vascular problems and diabetes. Psychologically, the same life and relationship events that lead to desire problems – stress, anxiety, work and money problems, emotional hurt and trauma – can also cause arousal difficulties, as can various strong fears – pregnancy, disease, punishment, being discarded. Shame, religious orthodoxy, illness and/or body image can also play a part. Finding the causes will lead to the correct treatment.

Why is it over too quickly – or does it go on too long?

Orgasm can be elusive for some, while others may experience it more quickly than they, or their partners, wish. Anorgasmic people are often those who did not explore their bodies as children and teenagers and haven’t yet discovered how they work. They can usually be guided to catch up on this important process, although sometimes they are hampered by religious beliefs or early messages that sex, and touching one’s genitals, is dirty.

Some women who reach adulthood without ever experiencing orgasm may decide they are missing out on the When Harry Met Sally experience and seek help to achieve it, while others may consider it a defect and hide their difficulty through sexual avoidance or faking. Women’s orgasmic struggles are often based on their, or their partners’, lack of understanding that many – probably most – women do not achieve orgasm through vaginal penetration alone, but require direct clitoral stimulation.

Men who find it difficult to orgasm with a partner – or take too long – are often misunderstood, too. Since “lasting a long time” is typically prized, they can be characterized as sexual athletes instead of being recognized as people who never become sufficiently excited to climax. In many cases, they require more vigorous stimulation than can be provided during most forms of bodily penetration. Men who ejaculate “too quickly” usually seek treatment because of shame – or complaints from their partner. Professional help can teach them to recognize their point of ejaculatory inevitability and to control it.

Sex is painful. What should I do?

People experience painful sex for all kinds of reasons, from the simple matter of trapped hair causing irritation to more serious conditions that require professional treatment. The common name for a sexual pain condition, usually referring to sexual pain during penetration, is dyspareunia. The most important thing to remember is that sex should never be painful; if it becomes so, it is not a good idea to continue.

Painful sexual conditions can sometimes be caused by other, medically significant problems that require professional diagnosis and treatment. These include lichen sclerosis (a skin condition that affects mainly the genital area) and problems related to circumcision. Another condition, Peyronies’s disease, is caused by the formation of plaque (scar tissue) in the penile arteries and leads to painful erections and, in some cases, curvature of the penis. Dyspareunia can also be caused by a natural reduction in vaginal lubrication – a consequence of certain hormonal changes – that means the friction of penetration becomes unpleasant or painful. If a woman experiences this, she should stop immediately and ask for (or provide) additional clitoral stimulation that may increase her readiness for penetration, or change to non-penetrative erotic activity. If a woman continues to allow painful sex to occur, she may develop vaginismus, a spasming of the vaginal muscles that makes penetration impossible. This is a fine example of the body protecting itself.

How will my partner’s medical condition affect our sex life?

Since sexual arousal and orgasm involve physical processes such as blood flow, hormonal interaction and muscular tension, it stands to reason that any conditions affecting such processes – or any other relevant physiological systems – may affect a person’s sexual responses. Certain medications, too – either prescribed or over-the-counter – can affect sexual responses. But where there is willingness or desire to continue sexual activity despite a temporary or permanent medical condition or disability, there is usually a way. Despite common misconceptions – even among medical professionals – people often remain sexually interested in the face of severe illness or disability.

However, psychological issues can arise between partners when one, say, becomes a caretaker to the other. Without help and understanding, this can affect their sexual connection. Sometimes there is a simple solution to changes in one partner’s physical status – such as being open to changing their usual pattern and trying new positions or new styles of lovemaking. In many cases, adaption is vital – for example, being sexual at times when pain medication is providing optimum relief or using heat pads in appropriate places. It is most important that the person struggling with illness or disability feels their wishes regarding sexuality are being heard, and that those around them try to be accommodating – even if they believe there are more important priorities. Sexuality – or the lack of it – can truly affect a person’s quality of life, and the right to give and receive sexual pleasure should be upheld.

Am I too old for sex?

Common mythology suggests that sexual failure of one kind or another is a natural consequence of ageing. This is untrue. Commonly, though, hormonal changes – and some illnesses or disabilities that can accompany ageing – affect or disrupt the sexual patterns enjoyed in one’s youth. Our society’s prejudice against sexuality among older people doesn’t help, and some people mistakenly accept one erectile failure, for example, as a sure sign of an age-related, downward spiral. As people begin to age, they tend to begin to prefer more direct genital stimulation, so this is a time to request more direct care and attention from a partner, or to provide it for one’s self. Men’s erections in older age may not be as upright as those of a 20-year-old, but this does not make them less proficient lovers; in fact, their experience, knowledge and better communication skills should make them far better. The arousal mechanism of vaginal lubrication may start to take a little longer, too, so women should ask for more oral sex time, longer caresses or whatever arouses them best. If penetration becomes painful due to insufficient lubrication, this is a sign that more arousal is necessary – and perhaps a tube of lubricant.

Some people become less self-conscious about their bodies as they age, but others become even more acutely aware of their looks. This can affect a person’s enjoyment of sex at any age. Hopefully, by the time someone reaches the point where they may need to adapt their style to accommodate medical or physical difficulties, their repertoire of sexual pleasures will be considerable. In old age, the unavailability of partners – and, indeed, negative societal views about seeking new partners – may make it difficult for a person to continue sexual activity in the way to which they are accustomed; however, many people find masturbation comforting and satisfying until the end of their days.

How often should we have sex?

The question of sexual frequency is a tricky one. Take a couple who have different requirements – James wants sex twice a day, while Joe wants it once a week. Joe is likely to label James “a sex addict”, while James may criticize Joe for what he considers “a low sex drive”. Such differences can be worked out, if not between themselves then with a little expert help. However, when a person is unable to resist the urge to have sex multiple times a day – even in inappropriate situations that can cause work, relationship or legal problems – or their genitals have become raw and damaged from masturbating twice an hour, or they are getting into trouble because of an uncontrollable fixation on internet porn, then they have a significant problem that requires treatment.

The brain architecture of people who struggle with such problems is usually generally compulsive or obsessive-compulsive, and not necessarily restricted to sexual behaviour, although eroticism may be the focus of expression for their disorder. Treatment by a professional is recommended; in fact, this is usually vital in order to protect the person from collateral life problems. Certain medication can help reduce compulsivity, as can certain forms of psychotherapy and targeted behavioral programs. The seriousness of this particular sexually focused disorder must not be underestimated – it can have particularly grave consequences.

Pamela Stephenson Connolly is a psychotherapist who specialises in treating sexual disorders.