Psychosexual difficulties
Assessment and treatment — usually a talking therapy, sometimes with medical input — for sexual difficulties such as low desire, pain, erectile problems or difficulties with arousal or orgasm.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Sexual difficulties are common, nothing to be ashamed of, and often treatable.
- Causes are usually a mix of psychological, relationship and physical factors — including stress, mood, past experiences, health conditions and some medicines.
- The main treatment is a talking therapy (psychosexual therapy), sometimes alongside medical treatment where a physical cause or a medicine is contributing.
- If sexual difficulties come with thoughts of suicide or self-harm, or follow abuse or assault and you feel unable to cope, get urgent help: call 999 or go to A&E, call Samaritans free on 116 123, text SHOUT to 85258, or — in England, Scotland or Wales — call NHS 111 and choose the mental-health option. In Northern Ireland, contact your GP out-of-hours service.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Understanding the mix of factors behind the difficulty, without judgement.
A sudden sexual problem with other symptoms (such as new pain, bleeding, numbness, or erectile problems alongside chest symptoms) needs medical assessment...
The contributing factors are explored and a plan is agreed — usually psychosexual therapy, sometimes with medical treatment for a physical cause or...
A plan that addresses physical, psychological and relationship factors together.
The contributing factors are explored and a plan is agreed — usually psychosexual therapy, sometimes with medical...
Therapy focuses on understanding the difficulty and reducing anxiety. Talking about sex may feel awkward at first...
Practical exercises, often done at home and sometimes with a partner, build gradually. Improvement tends to come...
Any physical cause is treated, a contributing medicine is reviewed, or medication for a specific problem is tried...
What are psychosexual difficulties?
Psychosexual difficulties are problems with sex that have a psychological or emotional part to them, often alongside physical or relationship factors. They are common, they are nothing to be ashamed of, and they are frequently treatable.
They include things like low or lost desire, difficulty becoming or staying aroused, erectile difficulties, pain during sex (such as vaginismus), difficulty reaching orgasm, and ejaculating sooner or later than wished. The causes are usually a mix — stress, anxiety, low mood, past experiences, relationship strain, body image, physical health conditions, hormones, and the side effects of some medicines can all play a part.
Assessment looks for this whole picture, because sexual problems often have more than one cause. Treatment is usually a talking therapy — psychosexual (sex) therapy — which helps with the thoughts, feelings, anxiety and patterns involved, and may include practical exercises done at home, sometimes with a partner. Where a physical cause or a medicine is contributing, medical treatment may be used as well.
The aim is to understand what is going on without judgement, and to help you (and a partner, if relevant) towards a more comfortable and satisfying sex life — not to meet any 'normal' standard set by anyone else.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Assessment and finding the causes
A sensitive, confidential conversation about the difficulty, your health, medicines, mood, relationship and history, to understand the mix of factors involved. A physical...
Psychosexual (sex) therapy
A talking therapy, individually or as a couple, that works on anxiety, thoughts, communication and patterns around sex, often including practical exercises to do at home...
Cognitive behavioural approaches
CBT-based techniques to address unhelpful thoughts, performance anxiety and avoidance that can keep sexual difficulties going.
Relationship-focused work
Where relationship strain or communication is part of the picture, therapy may involve both partners and overlap with relationship counselling.
Preparing for your treatment
- Try to note when the difficulty started, whether it is in all situations or only some, and how it affects you and any partner.
- Bring a list of all medicines and supplements, as some affect desire, arousal or orgasm.
- Note any physical health conditions, and for women, anything relevant about periods, menopause or childbirth.
- Think about stress, mood, anxiety, sleep and alcohol or drug use, which all influence sex.
- Consider whether you would like to be seen alone or with a partner; both can be appropriate.
- Reflect on what you would like to be different — there is no standard you have to meet.
- Remember the conversation is confidential and non-judgemental; honesty helps the assessment.
- If a service sends a questionnaire beforehand, completing it helps them understand your situation.
What happens
Assessment is a confidential, non-judgemental conversation. The clinician or therapist asks about the difficulty — when it started, whether it happens always or only in certain situations — and about your physical health, medicines, mood, stress, relationship and any relevant past experiences. They may ask about abuse or trauma, sensitively, because these can be relevant. A physical examination or tests are sometimes arranged if a medical cause is possible.
From this, they explain what seems to be contributing and what could help. For most psychosexual difficulties, this means psychosexual therapy — a course of talking-therapy sessions, individually or as a couple, often with practical exercises to try at home between sessions. Where a physical cause or a medicine is involved, medical treatment may be used as well.
Treatment is collaborative and goes at your pace. You should feel in control of what you discuss and what you try, and able to raise anything that feels difficult.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A sudden sexual problem with other symptoms (such as new pain, bleeding, numbness, or erectile problems alongside chest symptoms) needs medical assessment first, as it may signal a physical condition.
- You are in mental-health crisis or at immediate risk — that needs urgent help before routine therapy.
- Significant untreated depression, anxiety or trauma may need addressing alongside, or before, focused psychosexual work.
- A provider treats the problem as purely physical or purely psychological without proper assessment of both.
Delay or rearrange if…
- You feel unsafe or are having thoughts of suicide or self-harm — seek urgent help first.
- A possible physical cause has not yet been assessed and could be the main driver.
- You are in acute distress relating to recent abuse or assault, where specialist trauma support should come first.
- A medicine you take may be contributing and should be reviewed with your prescriber before assuming a psychological cause.
Alternatives to discuss
- A GP or sexual-health-clinic assessment to look for and treat a physical cause.
- A medication review where a medicine may be contributing.
- Free NHS/HSC psychological-therapy services for associated anxiety, low mood or stress — in England this is often called NHS Talking Therapies and may be open to self-referral; the service name, eligibility and referral route differ in Scotland, Wales and Northern Ireland.
- Relationship counselling where relationship factors are central.
- Self-help resources and lifestyle measures for milder, recent difficulties.
- Choosing not to pursue treatment if the difficulty is not troubling you.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Understanding the mix of factors behind the difficulty, without judgement.
- Practical, evidence-based help that improves sexual difficulties for many people.
- Less anxiety and avoidance around sex, and better communication with a partner.
- Identification and treatment of any physical cause or contributing medicine.
- Improvement in confidence, intimacy and relationship satisfaction for many.
- A confidential space to discuss something many people find hard to raise.
Risks & complications
- Finding it embarrassing or emotionally uncomfortable to talk about sex, especially at first.
- Difficult feelings or memories surfacing during assessment or therapy.
- Therapy taking effort and several weeks before improvement is noticeable.
- Practical home exercises feeling awkward, or being hard to fit around life.
- Tension or disagreement surfacing within a relationship as issues are discussed.
- Discovering an underlying physical or hormonal cause that needs its own treatment.
- A medicine being found to contribute, requiring a review with your prescriber.
- Limited local availability of NHS psychosexual services, meaning a wait.
- Distress severe enough to need additional mental-health support, particularly where trauma or abuse is involved.
- Sexual difficulty being a sign of a significant undiagnosed physical condition that needs medical attention.
The biggest barriers are embarrassment and not knowing where to turn — yet these problems are common and often treatable. A good assessment looks for physical, psychological and relationship causes together, and does not assume it is 'all in the mind' or 'just physical'. If a problem started suddenly, is linked to other symptoms, or could relate to a medicine, raise that, as it may point to a physical cause. Where abuse, assault or trauma is part of the story, you deserve sensitive, specialist support.
Published figures to discuss
Meaningful, single numbers are hard to give for psychosexual difficulties, because they cover many different problems with many causes, and outcomes depend on the cause, the person and the relationship. Many people improve with therapy, particularly when a physical contributor is also treated, but results vary and are not guaranteed. Rather than quoting unreliable success or complication percentages, a responsible service explains the likely contributing factors, realistic expectations and how progress will be judged for your specific difficulty.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Medical cause missed | Recognised | Hormones, diabetes, vascular disease, pelvic pain, menopause, medicines and substance use can contribute to sexual difficulties. | Guide sourcesClinical context |
| Relationship or trauma factors | Common enough to assess sensitively | Assessment should consider consent, coercion, trauma, communication and relationship safety. | Guide sourcesClinical context |
| Therapy response | Variable | Psychosexual therapy often needs both practical exercises and emotional/relationship work over time. | Guide sourcesClinical context |
| Overpromising quick fixes | Common marketing risk | Medication can help some erectile or arousal problems, but it does not address every cause. | NHS — Erectile dysfunction (impotence)nhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. What matters afterwards is engaging with therapy and any practical exercises, addressing any physical cause, and feeling able to discuss what is and isn't working.
- Feeling self-conscious or emotional in early sessions, easing as trust builds.
- Gradual, step-by-step improvement rather than a sudden 'fix'.
- Some home exercises feeling awkward before they feel more natural.
- Ups and downs along the way, influenced by stress, mood and relationship factors.
- Needing to keep practising new approaches for the benefits to hold.
Aftercare
- Engage with the agreed therapy and any home exercises, as much of the benefit comes from doing them.
- Keep communicating openly with a partner, if relevant, about what helps and what feels difficult.
- Treat any physical cause and review any contributing medicine with your prescriber — never stop a prescribed medicine on your own.
- Be patient and kind to yourself; improvement is usually gradual, and setbacks are normal.
- Manage stress, sleep, alcohol and general health, all of which affect sex.
- Raise anything that feels uncomfortable or isn't working with your therapist, so the plan can be adjusted.
- Seek further support if difficult feelings, memories or low mood become hard to cope with.
- Know where to get urgent help if you ever feel unsafe.
- Notes on when the difficulty started and how it affects you and any partner
- A list of all medicines and supplements
- Notes on relevant physical health, and for women, periods, menopause or childbirth
- A decision on whether to attend alone or with a partner
- Questions or concerns written down
- Details of how to access NHS sexual-health or psychosexual services if relevant
- Crisis numbers saved: 999/A&E, Samaritans 116 123, text SHOUT to 85258, and NHS 111 mental-health option (England, Scotland, Wales; in Northern Ireland use your GP out-of-hours service)
⚠ Get urgent help if…
- Thoughts of suicide, or feeling you cannot keep yourself safe — get urgent help now.
- If life is at immediate risk, call 999 or go to your nearest A&E.
- For urgent out-of-hours mental-health support in England, Scotland or Wales, call NHS 111 and choose the mental-health option. In Northern Ireland, contact your GP out-of-hours service.
- Samaritans are free, day or night, on 116 123; or text SHOUT to 85258.
- Distress, flashbacks or low mood relating to past abuse or assault that you are struggling to cope with — specialist support is available.
- A sexual problem that started suddenly, or comes with other symptoms (such as new pain, bleeding, numbness or erectile problems with chest symptoms) — see a doctor, as this may point to a physical cause.
- Persistent low mood, hopelessness or loss of interest in everything alongside the difficulty — this may be depression and is treatable.
- Any thoughts of self-harm — seek medical advice urgently.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A good outcome is a more comfortable, satisfying sex life for you (and a partner, if relevant), with less anxiety and avoidance — measured against what you want, not any external standard. Many people improve with psychosexual therapy, particularly when any physical cause is also addressed.
Not every difficulty resolves completely, and some take time or recur with stress or life changes. The aim is meaningful improvement and the skills and understanding to manage setbacks, rather than a guaranteed 'cure'. Where a physical condition is involved, the result also depends on how that responds to treatment.
Improvements from psychosexual therapy can last well, especially once you have understood the difficulty and built new patterns and communication. Sexual difficulties can return at times of stress, relationship change, illness or with new medicines, and that is not a failure — the same approaches, and a return to therapy if needed, usually help again. Where a physical or hormonal cause is involved, keeping that managed supports lasting improvement.
Related tests, treatments or support
Sexual difficulties rarely sit in isolation. Stress, anxiety, depression and relationship strain commonly contribute and may be addressed alongside psychosexual therapy. Physical health conditions (such as diabetes or cardiovascular disease), hormonal changes including the menopause, and the side effects of some medicines can all play a part, so medical assessment and a medication review may go hand in hand with therapy. Where a relationship is central, couple-based work can be combined with individual therapy.
Follow-up & long-term care
Follow-up checks how therapy and any home exercises are going, whether the plan needs adjusting, and how any medical treatment is working. If a physical cause was found, follow-up includes managing that and reviewing any contributing medicine with your prescriber. Many courses of therapy include a review towards the end to consolidate progress and plan how to maintain it, and you can usually return for further support if difficulties recur.
- Keep practising the approaches and communication that helped.
- Manage stress, sleep, alcohol and general health, which all affect sex.
- Keep any physical or hormonal cause well managed, and review medicines that may contribute.
- Seek support again early if difficulties return, rather than waiting.
- Never stop a prescribed medicine on your own to address a side effect — discuss it with your prescriber.
Repeat, follow-on and what comes next
- Treatment is often adjusted as the picture becomes clearer — for example adding medical treatment for a physical cause, or shifting between individual and couple work.
- If one approach does not help, the contributing factors are usually reviewed rather than simply repeated.
- Difficulties can recur with stress, illness or new medicines, and further therapy can help again.
- Where a medicine is contributing, a medication review may change the plan.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A plan that addresses physical, psychological and relationship factors together.
- Clear, realistic goals agreed with you, and a way to judge progress.
- Review of any contributing medicine with your prescriber, and treatment of any physical cause.
- Sensitive, specialist support available if trauma or abuse is relevant.
- A named contact and crisis information if distressing feelings or low mood arise.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you use NHS services or pay privately for assessment and therapy.
- The training and accreditation of the therapist (for example COSRT registration).
- Whether treatment is individual or couple-based, and the number of sessions.
- Whether medical assessment, tests or a medication review are needed for a physical cause.
- Any medication prescribed for a specific problem, and review appointments.
- Whether follow-up is included.
- In-person versus online sessions, and the provider's location.
- Who provides the therapy and their professional accreditation and registration.
- Whether free NHS sexual-health or psychosexual services could help first.
- What the assessment and each therapy session includes, and the likely number of sessions.
- Any costs for medical assessment, tests or a medication review.
- If medication is prescribed, its cost and review arrangements.
- Whether follow-up is included.
- How concerns or difficult feelings between sessions are handled.
- The cancellation and rescheduling policy.
On the NHS? Some psychosexual and sexual-health services are available on the NHS, usually via GP or sexual-health-clinic referral, though availability and waits vary; private therapy is used by some for speed, choice or privacy.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Treating the problem as purely physical or purely psychological without assessing both.
- Not reviewing medicines that may be contributing to the difficulty.
- Not asking, sensitively, about abuse or trauma where it may be relevant.
- No discussion of what therapy involves, including that it never involves sexual contact with the therapist.
- No plan for additional support if distressing feelings or memories arise.
Marketing red flags
- Promising a guaranteed 'cure' for a sexual problem.
- Selling pills, devices or supplements as proven fixes without assessing the cause.
- Treating every difficulty as purely physical (or purely psychological) to sell a single product.
- Any service that blurs professional boundaries or suggests sexual contact as 'treatment' — this is never appropriate.
- No mention of looking for physical causes or reviewing contributing medicines.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- What do you think is contributing to my difficulty — physical, psychological, relationship factors, or a mix?
- Could any of my medicines or health conditions be involved, and how is that checked?
- What does the recommended therapy involve, and how many sessions might I need?
- Should I be seen alone or with my partner, and can that change over time?
- Is any medical treatment appropriate alongside therapy, and what are its pros and cons?
- What improvement is realistic, and how will we know it is working?
- What support is there if difficult feelings or memories come up?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Are sexual problems common?
Is it 'all in my head'?
Can I get help on the NHS?
Do I have to bring my partner?
Could my medication be causing the problem?
What does psychosexual therapy actually involve?
What if my difficulty relates to past abuse or trauma?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Erectile dysfunction (impotence) NHS — Low sex drive (loss of libido) NHS — Talking therapies on the NHS (England; self-referral in England) COSRT — College of Sexual and Relationship Therapists (find a therapist) Royal College of Psychiatrists — Information for patients and carers Samaritans — free 24/7 support, 116 123 nidirect — urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI) NHS Talking Therapies for anxiety and depression (England) NHS inform — psychological therapies (Scotland) NHS 111 Wales — counselling nidirect — mental-health care professionals (NI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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