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Sexual health Condition

Sexual difficulties

Sexual difficulties encompass a wide range of concerns relating to sexual function, desire, pain and satisfaction that cause personal distress or relationship difficulty. They are extremely common across genders and life stages, yet rarely discussed. Psychosexual therapy provides effective, confidential specialist support for the full range of sexual concerns.

See therapies that may help

What is Sexual difficulties?

Sexual difficulties include: desire disorders (low libido, absent desire); arousal disorders (difficulty with physical arousal, erection, lubrication); orgasm disorders (difficulty reaching or reaching too quickly); pain disorders (dyspareunia, vaginismus); and concerns relating to sexual identity, behaviour or relationships.

Sexual difficulties are common — studies suggest that a significant proportion of adults experience some form of sexual difficulty at any given time. They cause significant personal distress and relationship impact and are significantly underreported and undertreated. The near-universal silence around sexual difficulties creates a false impression of rarity and prevents people from seeking the support that is widely available.

Signs and symptoms

Sexual difficulties may include any of the following causing distress or relationship concern:

  • Persistent low or absent sexual desire
  • Difficulty with physical arousal — erection, lubrication or engorgement
  • Difficulty reaching orgasm or ejaculating too quickly
  • Pain during or after sexual activity
  • Avoidance of sexual activity due to anxiety, fear or past experience
  • Significant distress about sexual identity, behaviour or relationship
  • Impact of health conditions, medications or life events on sexual function

How therapy can help

Psychosexual therapy is the specialist approach for sexual difficulties:

  • Psychosexual therapy (COSRT-accredited) — combining psychological exploration with structured behavioural approaches tailored to the specific difficulty; includes sensate focus and graduated exposure techniques; may be individual or couples-based
  • CBT — for sexual difficulties with significant anxiety, negative beliefs or avoidance
  • Mindfulness-based approaches — building present-moment sensory awareness and reducing spectatoring
  • Medical assessment — important for difficulties with potential physical contributors (hormonal, medication-related, vascular, neurological)
  • Couples therapy — for difficulties embedded in relationship dynamics and communication

Seeking help

COSRT (College of Sexual and Relationship Therapists) can help find accredited psychosexual therapists. Your GP can provide medical assessment and referral to NHS psychosexual services where available. Brook (for under 25s), sexual health clinics and Relate all offer sexual health and wellbeing support. You do not need a specific diagnosis to seek psychosexual therapy — any sexual concern causing you distress is a valid reason to seek support.

Therapies that may help with Sexual difficulties

Showing 12 therapies linked to Sexual difficulties.

Therapy Evidence Notes
Cognitive Behavioural Therapist
strong

CBT helps identify and challenge the anxious thoughts and performance worries that maintain many sexual difficulties.

Counsellor
strong

Counselling offers a confidential space to explore the feelings, shame or relationship strains that often surround sexual difficulties.

EMDR Practitioner
strong

EMDR can help where sexual difficulties are linked to past trauma or distressing sexual experiences.

ISTDP Practitioner
strong

ISTDP works to release the buried emotions and anxiety that can block intimacy and contribute to sexual difficulties.

Mindfulness Practitioner
strong

Mindfulness helps reduce performance anxiety and reconnect with bodily sensations during intimacy.

Psychotherapist
strong

Psychotherapy can uncover deeper emotional or past experiences that may underlie persistent sexual difficulties.

Relationship Therapist
strong

Relationship therapy addresses the communication and intimacy issues between partners that frequently accompany sexual difficulties.

Sex Therapist
strong

Sex therapy uses tailored exercises and education to directly address arousal, desire and performance concerns.

Arts Therapist
moderate

Arts therapy can offer an indirect, less confronting way to explore the emotions and shame tied to sexual difficulties.

EFT Practitioner
moderate

EFT is sometimes used as a supportive way to ease anxiety around intimacy, though evidence for sexual difficulties is limited and it is not a substitute for proper care.

Hypnotherapist
moderate

Hypnotherapy may help some people relax and reduce performance anxiety, but evidence is limited and it should complement appropriate professional care.

NLP Practitioner
moderate

NLP is occasionally used to reframe anxious thinking around intimacy, though supporting evidence is limited and it is not a substitute for proper treatment.

Frequently asked questions

Do I need a diagnosis to see a psychosexual therapist?

No — you do not need a specific diagnosis to seek psychosexual therapy. Any sexual concern that is causing you distress or affecting your relationships is a valid reason to seek support. A psychosexual therapist will assess and formulate your specific situation in the initial sessions.

Is it normal to have sexual difficulties?

Yes — sexual difficulties are extremely common. Studies consistently show that a significant proportion of adults experience some form of sexual difficulty at any given time. The silence around sexual health creates a false impression of rarity. Most sexual difficulties are treatable, and seeking support is entirely appropriate.

Will psychosexual therapy involve physical examination?

No — psychosexual therapy is a talking therapy. It involves psychological assessment, discussion and structured exercises or assignments to complete outside sessions. Physical examination is a medical function performed by GPs or specialists, not by psychosexual therapists.

Can sexual difficulties be caused by mental health conditions?

Yes — depression, anxiety, PTSD, body image difficulties and other mental health conditions frequently affect sexual function and desire. Treating the mental health condition often improves sexual difficulties. In some cases, sexual difficulties are primarily maintained by mental health factors that respond better to general psychological therapy than to psychosexual therapy specifically.

How confidential is psychosexual therapy?

Psychosexual therapy is fully confidential, subject to the same confidentiality standards as all psychological therapy. Therapists accredited with COSRT or BACP work within professional ethical codes that protect client confidentiality. Information is only shared without consent in specific, legally defined safeguarding circumstances.