Many of us would agree that we live in a sexualised society. We think nothing of seeing an explicit sex scene on the TV or sexualised images in magazines and in music videos, but we are surprisingly coy when it comes to talking about sex when there are difficulties. Sexual problems are actually very common but as a society we rarely talk about them and if we do, it will often be in a way that makes light of them because addressing them seriously can be uncomfortable.
The National Surveys of Sexual Attitudes and Lifestyles 3 (Natsal-3) (1) is one of the largest and most detailed global studies of sexual behaviour. Three of these studies have been done in the UK, and all of these studies have provided us with valuable information about individual experiences, views and behaviours. The most recent was carried out between September 2010 and August 2012, and it interviewed 15,162 men and women, aged between 16 and 74.
Almost one in six people said they had a health condition that had affected their sex life in the past year, but few had sought any type of professional help. Twenty-five percent of men and women who were in a relationship said they do not share the same level of interest in sex as their partner and twenty percent of men and women in a relationship said that their partner had experienced sexual difficulties in the past year.
Breast Cancer Care says that 1 in 8 women will be diagnosed with breast cancer at some point in their lives and Prostate Cancer UK says that 1 in 8 men diagnosed with prostate cancer at some point in their lives. We know that the prognosis for these cancers is usually very good but the treatments for both these cancers will often cause sexual problems. Low desire and dyspareunia (painful sex) for women and erectile dysfunction, ejaculatory disorders and low desire for men. As well as the physical changes, there is also the emotional heartache of having a cancer diagnosis and the impact that this can have on body image and on the partner of the person diagnosed if they have one.
A large study of nearly seven thousand sexually active women aged 16 to 74 suggests that one in ten women experience pain during sex and sexual pain affects women of all ages. Women in their late fifties and early sixties are most likely to be affected (due to associated menopausal symptoms) followed by a younger group of women aged 16 to 24.2
Erectile dysfunction affects more than 152 million men worldwide and that figure is predicted to rise to 300 million by the year 2025.3
As well as illness and sexual problems, there are many things that can affect the way we feel about sex and our desire to want to be sexual and this will constantly change as we move through life. Redundancy, bereavement, raising children, infertility, financial worries to name just a few. And there are the more specific relationship problems. Perhaps one spouse has had an affair or is struggling with mental health issues.
For many years I ran a clinic specifically treating male cardiac patients with erectile dysfunction. We found that for most men seeking help, they had lived with the problem for many years in the hope that it would “just sort itself out” and of course it usually doesn’t and the couple drift away from each other, unsure what is happening and unsure where to seek help.
This is half the battle. If we find ourselves struggling with a change in our sexual relationship and we don’t know how to broach this with our partner or where to turn, we are much more likely to bury our heads in the sand in the hope the problem will just magically disappear – but it rarely does.
If a couple are able to talk regularly about their sex life – the bits they enjoy, the bits they struggle with, differences, desires, etc – then if they hit a bump in the road, they have developed a language and a way of talking about this very intimate subject. This means they are much better placed to tackle the problems together as a team should they arise.
The really good news is that help is available and there are also lots of things that a couple can do to help themselves. To begin with, I would strongly advise that you see your GP so that you can rule out any easily treated underlying physical cause. It is frustrating for couples if they have invested time and money in seeking help with a sex therapist for something like painful sex only to discover a year later that the woman is experiencing recurrent thrush and once this is treated with medication, the pain subsides.
Going to see your GP is particularly important when a man has erectile dysfunction (ED) because we know that this can be an early warning sign of more serious diseases such as cardiovascular disease or diabetes. When you see your GP, they are likely to check your blood pressure, weight and take a blood test to look for diabetes and high cholesterol. All these things can be treated to prevent more serious health issues down the line. The GP can also treat the ED – usually with tablets. This might be a short-term course of treatment if it is suspected that the ED is as a result of performance anxiety or longer term if it considered ‘organic’ this means the ED has an underlying physical cause.
Sex therapy can help the couple find effective ways to communicate and to strengthen the relationship, but there are some conditions that benefit from more medical intervention, certainly to begin with. Some couples benefit from a dual approach so they address the medical issue at the same time as having therapy, and this can be very effective too.
- R. Mitchell, R. Geary, C.A. Graham et al., “Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey”, BJOG: An International Journal of Obstetrics and Gynaecology (2017) 1689-1697
- A. Aytac, J.B. Mckindlay, R.J. Krane, “The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences”, British Journal of Urology International (1999), 84:50–6.