CThis is the most often presented relationship issue. Mismatched sexual desires can hide relational discord. Adding sexual frustration to a relationship creates “a chaser and a chasee” dynamic which is hard to shake off.

As common and distressing for couples as mismatched libido can be, it is hardly a clinical issue. Just like any other parameter of our existence can have a natural variation to it, so does sexual desire. Pathologising it is as meaningless as pathologising differences in shoe size, an appetite, or an eye colour.

To address discrepancy in sexual desire we need to make sure that:

• It is not a relational concern
• It is not a lifestyle concern
• Neither partners have physiological or psychological concerns in relation to sex
• Both partners derive enough enjoyment out of their intimacy to be motivated to do it
• Communicating your needs is effective and not demanding
• You understand the difference between “initiative” sexual desire and “responsive” sexual desire

Treatment can be a rewarding experience if you approach it as a learning opportunity and an experiment.

Erectile dysfunction is the inability to gain and maintain an erection. It is normal for erectile capacity to reduce with age. Be realistic and be gentle – if you are in your fifties or older, expect occasional misfiring to occur without being panicked.

However, if you are under 50, or if you cannot gain erection most of the time, it might indicate potential health concerns. Inability to gain erection can often be early indicator of cardio-vascular issues, so please see your doctor for a comprehensive check-up.

If you have a clean bill of health from your doctor yet have difficulties with erection, the issue may be a psychological one and a thorough sexual history taking will be required. It is not possible to say what efficacy of treatment will be before we have a good chat.

There is nothing physiologically wrong with your body if you ejaculate immediately after penetration. Your body is simply doing what it was made to do: inseminate and procreate. Elongated intercourse for the purpose of pleasure is a much newer concept, we need to train their bodies to fit this new social paradigm. Premature ejaculation a socially constructed condition and as such there is no medication for it. Rarely spoken about, it effects one in five males. The good news is it can be treated with great efficacy.

Delayed ejaculation is the inability to ejaculate. At first it may sound like a gift for your partner. However, this can be a frustrating experience. It becomes particularly problematic for couples trying to conceive.

Delayed ejaculation can develop into a complex psychological condition. Although the causes of it are rarely physiological, it can sometimes be caused by an undiagnosed medical condition like diabetes or a neurological disease. A common cause can be porn addiction and less common causes can include medications side effects, medical history, sexual history, anxiety, idiosyncratic masturbation style, relational distress, or combination of some of those factors. The diagnosis and treatment of this condition can be complex and lengthy. In some cases we will need to work on adjusting to life without ejaculation. However, this does not need to mean living without sexual fulfillment.

There is nothing wrong with occasional use of porn. However, if your sexual response is depending entirely on use of pornography, it causes numerous long-reaching problems. Compulsive viewing of porn can cause premature or delayed ejaculation, erectile dysfunction (inability to gain and maintain an erection without porn), loss of intimate connection with your partner and relationship difficulties.

The good news is it is possible to control your porn consumption and to regain your natural sexual response and a fulfilling interpersonal experience of sexual intimacy.

Low sexual desire is not a medical condition or indeed a problem. It is a socially constructed condition that manifests only in comparison to someone else. Different levels of sexual desire need be no more distressing than different shoe sizes.

Yet, if your sexual desire is lower than that of all your previous partners, and if it created relational distress in your previous relationships, an attempt to “fix it” is understandable. There is no medication to increase the actual desire in either men nor women (Viagra and Cialis are not that), although increasing level of testosterone might make a difference.

First thing I would ask you if you are on anti-depressants. It is a quite common side-effects of many antidepressants to lower sexual desire. Please do not take yourself off the meds, change your meds under your doctor’s supervision only.

Sometimes in men, what presents as a low sexual desire is in fact a manifestation of erectile dysfunction, which in turn can be a symptom of developing cardiovascular disease.

It is also important to take a realistic look at your lifestyle. Sometimes we have so much on that we have no energy left for physical intimacy, especially when young children are involved. Intentional and realistic changes to your lifestyle can make a big difference to your desire.

It is important to explore what makes a fulfilling intimacy for you, the difference between initiating sexual contact and responding to someone’s initiation. It is also important to take into account messaging about sex and what is normal and expected that you grew up with. In other words, sexual desire is multifaceted and complex phenomena, and getting to know and be comfortable with yours can be enriching and exciting journey.

Vaginismus is an anxiety associated with the pain of penetration that prevents women from having vaginal intercourse. Although distressing to experience, it is easily treated.