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Further Information : Sexual Problems

You will find plenty of information online.

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This guide is to give you a basic understanding. Some problems can be solved quickly, others need a sex therapist.

With everybody seeking quick-fix remedies in a pill, sex therapists have gone out of the limelight, but they are a reliable body of health professionals who handle sexual problems with great skill. It's important to be clear about who they are and what they do, and don't do.

Sex therapists are health professionals who have been trained in specialist, and reputable establishments (e.g. the Porterbrook Clinic, Relate, NHS). They do not touch their clients, nor offer sex themselves. They just talk: educating, discussing, offering choices and providing tools which clients can use to overcome their problems, e.g. Sensate Focus.

Sex therapists help clients, particularly couples, by opening up and supporting constructive communication between them. They help them sort through their problems and see a way out of them. Usually, only between 4 to 6 one-hour sessions are required. The couple may be advised to avoid intercourse, and are given homework. Single people can also be seen, occassionally using a surrogate partner. People who have been sexually abused may be better off with a therapist who specialises in that, at least to begin with.

Four hours of sex therapy is, I hope you will agree, better than a lifetime of pill taking.

Sex therapists are usually not particularly expensive and some can be referred to via the NHS. Others can be found from the College of Sexual and Relationship Therapists (COSRT) For gay people, if specialist help is requested, there is Pink Therapy

Here are the most common problems:-

Erectile Dysfunction
Most men experience not being able to get an erect penis at some time during their lives, especially with new partners, or when they feel nervous. Some may find it very disturbing. It is important that they see their GP before anything else, as erectile dysfunction can be an early indicator of conditions such as heart disease and diabetes, and different types of medication can cause it. Low testosterone can affect erections. Depression, anxiety, substance misuse, smoking & alcohol can all affect erections. It is natural for erectile function to change with age. Relationship problems, ineffective stimulation or life events can also trigger erection loss.
If drinking and physical problems have been dismissed, the problem is probably with the relationship. Many men suffer from performance anxiety when their partner expects them to “do all the work” and initiate all the sex. This is the most common cause. If you can explain this, and point them towards a sex therapist (which you will have written on your Hand-Out (LINK), the problem is usually easily and quickly solved.
While it is mostly bad practice, and unnecessary to rely on drugs such as Viagra when treatment avoiding drugs can be used, some men find their old age can make erections weak, and men with spinal injury and other conditions may want to use them. But there are a number of alternatives to tablets, e.g. vacuum pumps, injections, intraeurthral device, penoscrotal rings, Testosterone replacement etc.

Lack of Desire
It is normally the woman who experiences reduced desire, often after a long period of unsatisfying sex, when they just give up. But men also suffer, and are usually more disturbed by it, and eager to change.
Lack of desire can be caused by many things: it can be hormonal, psychological, the result of early abuse, due to excessive drink and cocaine, or caused by the onset of a debilitating condition such as a stroke or stress. Relationship issues contribute to lack of desire. Levels of desire change with life events and age.
A sex therapist is trained to help. They really need to see both of the couple, but quite often the person with lack of desire refuses to go, which leaves the other partner in limbo. One way around this is for the person with lack of desire to be given a choice: see the sex therapist or the relationship will end — quite a tall order, but it usually works. The sex therapist can teach them to negotiate so that both partners get what they want. Sometimes therapy with one person, not both, does work.

They both have desire, but one wants sex more than the other
This causes constant relationship difficulties. Chasing and pestering for sex makes the other person run away, close up, and become defensive, so they even avoid all physical affection. The couple have to reach a compromise that is satisfactory for both of them, and each adheres to. A sex therapist can navigate them through the process.

Premature Ejaculation
Premature ejaculation occurs when a man is unable to control the timing of his ejaculation. It can be so extreme that he never manages to penetrate a partner because he ejaculates before entry.

There are two kinds: when the man has never learned to recognise the 'point of no return' so is unable to control his timing, and may even have trained himself to ejaculate quickly in order to avoid being discovered masturbating when young. A sex therapist can instruct the man to learn how to learn and control the situation.

Acquired premature ejaculation is when the man only experiences premature ejaculation with a partner. It often occurs when men do not masturbate. It can be caused by medical condition or be psychological. There are all kinds of relationship difficulties that can cause it. Medications can sometimes help, if sex therapy has not.

Cannot reach a climax
This is more common with women. Orgasm is the triumph of stimulation over inhibition. The woman needs enough stimulation of her clitoris in the form of a vibrator, or fingers or tongue that know what to do, and to feel relaxed. The book The Ultimate Guide to Orgasm for Women by Mikaya Heart covers the subject comprehensively.
Men and women whose impairments affect their genitals, and everybody else in fact, should remember that the whole body is an erogenous zone, including the brain. Orgasm can be reached in many ways. Stimulation of the prostate, nipples, nape of neck and lips can bring on an orgasm.
People with spinal injury find the area just above the level of paralysis becomes more sensitive. Using sensory amplification, they can stroke it (or have it stroked) to produce orgasms.

Vaginismus occurs when the vagina tightens up when entry is attempted, so the woman is unable to have sexual intercourse. This is curable with the use of trainers (of various sizes, slowly introduced inside), and sex therapists know how.

Fear their genitals are not normal
Watching mainstream porn leads and the fashion for cosmetic surgery, people can become dissatisfied with their genitalia. Some say they want labia reduction or penis enlargement. It is easy for doctors to take a peek and reassure them that everyone is a little bit different, but the are within the norm, and many people like smaller penises or longer labia (or whatever it is they complain of).
Men who have a micro-penis can be helped in sex therapy to ensure they become satisfying lovers. They can also be encouraged to look for partners who will not reject them.
Women who have been genitally mutilated as children sometimes want to have their genitals restored. The FGM National Clinical Group has produced an educational DVD which clearly instructs and shows doctors, midwives and nurses how to undertake deinfibulation. This can be ordered from the group’s website:

A sex therapist can help men and women make the most of their bodies.

Body Discontentment
Thanks to celebrity culture, people are becoming more and more worried about their bodies and looks. Sometimes it's just a phase they go through, but cosmetic surgery is both dangerous and also can be addictive and unsatisfying. It is important for all health professionals to take concerns seriously, and spend time reassuring their patient / client that they look lovely, and help them focus on getting on with life.

Troubled by unwanted desires
Many men are terrified of any desires they may have for other men, and people are conditioned into thinking that life must not change. It is not a big deal to be gay, bisexual, transvestite, or whatever. The best way to prove that to yourself is to try it. Second best is to keep the desires safe as healthy fantasies without shame.

Frightened of sex
The fear can be overcome. Fear might be caused by many things: pain, early abuse, vaginismus, fear of success, and many more things. Ask what they think causes it, to see if they can be reassured. Otherwise, refer to a sex therapist.

Sexual Problems related to disability
Problems such as spasms, inability to open legs, to masturbate, to feel genitals etc., are dealt with on Sex therapists are encouraged to keep abreast of current knowledge.
Sex and relationship peer support for disabled people is being pioneered by Alex Cowan (who appears in our video demonstrating how well it works). Alex can be contacted at via

Can't find a partner
Even though there are many dating websites with plenty of people on them, it's still mostly the young and good-looking ones who succeed, with the rest may be struggling on for years, perhaps never finding anybody.

Here are some tips to pass on:

Get busy doing things that “your kind of person” is involved in. Get into the habit of talking to everyone, finding out more about them. Then you won't be so shy when you see someone you really fancy. Stay fit and look after (and love) your body Ask your friends to help you write your profile on dating sites, if you're going to use them, to help you write about all the things people like about you (they may be different to what you think). Stop looking sometimes. That's when people come your way.

The Sex and Disability Helpline is on 0707 499 3527 11am to 7pm weekdays.