Erectile difficulties (difficulties getting or maintain penile erections)

Difficulties with erections are common and can be normal. If they recur frequently or persist it can be distressing (sometimes referred to as erectile dysfunction or ED). All erection difficulties that persist should be assessed by a health care professional as it may represent an underlying health condition. Psychological causes or consequences of ED are very common and often coexist with physical causes.

We will ask questions and undertake some simple investigations to try and exclude or identify physical causes. We will also explore for psychological or relationship issues that may be contributing or occurring as a consequence of ED.

Ejaculatory problems

Problems with ejaculation can include ejaculating too quickly (for the patient or partner), delayed ejaculation or sometimes never ejaculating. This can be life-long, gradual, or sudden onset. Sometimes there are physical causes for this that require further investigation or referral to urologists. For the majority where there is no obvious physical cause, we offer education, training exercises, psychological interventions, and medical treatments where appropriate.

Low sexual desire

Impaired desire, ‘low sex drive’ or ‘loss of libido’ can all be used to describe reduced or absent sexual desire. It is normal to have variations in levels of  sexual desire over time and between people. Desire can be affected by external factors such as stage of relationship, life stressors, relationship difficulties, medication or intrinsic factors such as anxiety/depression, health issues eg. menopause. It becomes a problem only if it causes personal distress, interpersonal difficulty, or both.

There is often a misconception that everyone should experience spontaneous sexual desire all the time. The truth is that many people experience sexual desire in response to external stimuli that can be consciously or subconsciously ignored.

We will ask questions to assess for physical causes and undertake investigations where necessary. Physical causes can include any major health condition including heart disease, diabetes, anaemia, peri/menopause, low testosterone, and some medications.

We will also explore for psychological or relationship issues that may be contributing.

High sexual desire

Some people may experience high levels of sexual desire that is normal for them but may affect sexual relationships. Some people feel they have too much spontaneous sexual desire such it has become distressing for themselves. This may be life-long or new and may rarely be linked to a physical cause such as medication or trauma.

Painful sex

Some people experience painful penetrative sex. There are many causes for this that may be physical including menopause, genital infections eg. thrush, genital skin problems and vaginismus. Sometimes it can be psychological or linked to reduced sexual arousal or a mix of both physical and psychological. It is important to have a proper medical and psychological assessment for this problem to help understand and resolve it.

Vaginismus

Vaginismus is a problem that affects women (or people with vaginas) and can cause difficulties with penetrative sex which sometimes extends to difficulty with tampons, cervical smears, or examination. It is caused by involuntary tightening of the muscles at the entrance to the vagina and is often associated with feelings of fear, isolation, and shame. Vaginismus does not necessarily affect sexual arousal and other types of non-penetrative sex can be enjoyed. This can be lifelong or develop later having experienced pain free sex. It is possible to improve sexual experience with the right help and support.