Sexuality

Our sexuality and gender can form a big part of our identity and those who don’t fit society’s heteronormative ideal can come up against more challenges. Those who identify as LGBTQ+ may be gay, lesbian, bisexual, transexual, pansexual, asexual, queer, non-binary or questioning (or, may define their gender and sexuality in different ways). They can be seen as ‘different’, facing discrimination, bullying and a lack of understanding.

While things in society are slowly moving forward in terms of acceptance, we still have a long way to go. Incredibly, the World Health Organisation only removed ‘homosexuality’ as a formal psychiatric diagnosis in 1992.

The fact is, being LGBTQ+ does not lead to mental health problems - dealing with other people’s adverse reactions does. Because of this those who don’t identify as heterosexual are more likely to experience mental health problems. Here we’ll explore sexuality and mental health in more detail, where to find support and coming out concerns.

Sexuality and mental health

LGBTQ+ people can be at a greater risk of developing a mental health condition than those in the wider population. The reasons for this are complex and not entirely understood, however, most mental health problems experienced can be linked to discrimination, bullying, homophobia, biphobia or transphobia.

If you identify as LGBTQ+ and you’re struggling with your mental health, know that you’re not alone. You may be particularly prone to:

Depression - when you experience a low mood for a long period of time.

Anxiety - when you feel especially anxious or worried for long periods of time or at a high intensity.

Self-harm - when you hurt yourself on purpose to cope with difficult emotions.

Suicidal thoughts - when you feel very low and as if there is no way out.

You may experience rejection from those around you, including friends, family and work colleagues. Understandably, this can have a big impact on your sense of self-worth and your confidence. You may feel the need to hide this part of yourself from others, and this can be damaging in itself.

Some LGBTQ+ people may find they turn to alcohol and drugs to help them cope with difficult emotions. If you’re worried about the way you’re using alcohol or drugs, your doctor, a counsellor or an addiction helpline can offer support.

There are hidden covert messages in the media about what it means to be 'normal' which in some way reinforces the message that being different is not acceptable. The notion of 'fitting in' not just in the wider community but within LGBT communities can and does come with its own pressures.

Other factors may also complicate things, for example where you live, your ethnicity and religious background.

While, of course, not everyone in the LGBTQ+ community will experience poor mental health, it’s important to know that if you do experience challenges, support is available.

LGBTQ+ counselling

Speaking to a counsellor can help with some of the difficulties you’re facing, such as:

finding it hard to accept your sexuality
coping with other people’s reactions
low self-esteem and low self-confidence
fear of violence or abuse in public places
effects of bullying and discrimination
feeling as if your body does not reflect your true gender (gender dysphoria)
transitioning

If you develop a mental health condition, talking therapies can help you find new ways of coping and either overcome or manage your condition.

What’s important is for you to find a counsellor who you trust and feel able to talk to openly about your experiences. For this reason, it can be helpful to check your counsellor has experience working with LGBTQ+ people and/or has had appropriate training.

If at any point you feel uncomfortable with your counsellor, remember you have every right to stop your sessions and find a more suitable counsellor for you.

Discrimination - what’s the law?

Attitudes in the UK towards the LGBTQ+ community do slowly seem to be improving, however, there are still some people who discriminate against others based on their gender and/or sexuality. There is a law against this at work and in wider society - The Equality Act 2010.

This protects gay, lesbian, bi and trans people and anyone who experiences discrimination because they associate with LGBTQ+ people. You can find out more about what the Equality Act 2010 covers and includes on the gov.uk website.

Coming out

The term ‘coming out’ is often used to describe when you tell people about your sexual orientation and/or your gender identity. For some, it can take a long time to feel comfortable to do this. It’s important to know that you don’t need to come out at a certain time, you simply need to do what feels good and right for you.

Having these conversations can be difficult. You may experience unpleasant reactions and even rejection in some cases. This can make coming out an emotionally trying time. And sadly for many, coming out isn’t a one-time thing. Every time you meet someone new or start a new job, for example, you may need to consider when or how much of your identity as an LGBTQ+ person you want to share.

Despite what may sound like negative repercussions of coming out - this doesn’t happen to everyone. Many people are supported and understood by those they’re coming out too.

Hiding who you are however can be an incredibly difficult thing to do and can be damaging for your mental health and well-being.

I had a realisation that I was gay and that it wasn’t a good thing to be. I began a nine-year battle with hiding the deepest part of who I was. This was one of the heaviest masks I wore.

Everyone will ‘come out’ in different ways. For many, it’s a series of conversations that take place between the LGBTQ+ person and the people in their life they want to tell. It’s important for you to come out in a way that feels right for you and your circumstances.

Telling someone you trust and believe will be supportive first can be a good idea. They can then provide you with some support as you tell others in your life. Picking a time when you can talk through any concerns and worries is also recommended.

Try to keep in mind that while this is likely something you will have known about yourself for a long time, for others it may be a surprise. Initial reactions may be laced with shock, and they may change over time.

Creating a support network, whether that includes friends, family members, online communities or professional support (or all of these!) can be incredibly helpful when taking this step.

Above all, please remember you are not alone. With greater understanding, kindness and representation hopefully making its way through society - we can only push for progress.

Sex problems

If you are experiencing sex problems, you will probably be feeling very alone and helpless. Shame, fear and embarrassment are other common emotions felt by people living with sexual dysfunction, and many will suffer for months, even years in silence - too afraid to discuss their concerns with anyone.

Sex problems are very common, and can occur for a number of reasons. In the majority of cases they are linked to other challenges and difficulties. For example, when you are feeling stressed and have a lot on your mind, you don't often feel like having sex or being intimate. This knock-on effect is usually mild and temporary and will soon dissipate, but if a sexual problem is more severe and complex, it can have stronger and longer-term effects on your sexuality, your relationships and way of life.

Seeking help as soon as possible is vital for ensuring your sex problems do not have far reaching consequences. Sex therapy is considered highly effective for addressing the causes of sexual dysfunction, and for helping people to develop healthier attitudes towards sex and sexual intimacy. This page will explore this treatment in more detail, while also highlighting causes and symptoms of some of the most common sex problems.

What are sex problems?

A sex problem, or sexual dysfunction refers to a difficulty that occurs during any phase of the sexual response cycle. The sexual response cycle is the sequence of emotional and physical changes that take place when a person becomes sexually aroused and engages in a sexually stimulating activity, such as intercourse or masturbation. There are four stages to this cycle - excitement, plateau, orgasm and resolution - and if the body fails to respond during one or all of these, it may signify a sex problem.

What causes sex problems?

There are many different reasons why someone may develop sex problems, but generally it tends to be due to a combination of physical, emotional, psychological and situational factors.

Physical factors - Disabilities and illnesses such as diabetes, heart disease, alcoholism and drug abuse can contribute to sexual dysfunction. Individuals who have experienced major surgery, pregnancy and the menopause are also more likely to develop sex problems.
Psychological - Anxiety, depression and other mental health issues can have a negative impact on sexual responses.
Emotional - Unresolved grief, betrayal, unhappiness in a relationship, and low self-esteem can take a toll on how people feel sexually. For example, if someone has experienced trauma such as sexual abuse, they may feel unable to fully participate during sexual intimacy.
Situational - A change in circumstances or living in a stressful situation (i.e. moving in with the in-laws, having a baby, or financial problems) can contribute to the development of sex problems.

Common sex problems

Although there is a wide range of sex problems, which may affect each individual differently, generally we are all likely to face similar issues within our gender. Below is a list of some of the most common sex problems in men and women to provide insight into some of the conditions that can be treated with counselling.

Female sex problems

Pain during sex

Also known as dyspareunia, pain during sex can be very common - particularly in women who have gone through, or are going through the menopause. There are various medical conditions that can contribute to this pain, including endometriosis, and ovarian cysts, but it can also be due to poor lubrication during sexual intimacy which may be psychologically linked. Other causes include scar tissue from surgery and sexually transmitted diseases.

In some cases women experiencing pain during sex may have vaginismus - a distressing condition characterised by an involuntary spasm of the muscles that surround the entrance of the vagina. Vaginismus is common in women who fear penetration, and this may stem from a long-term sexual phobia or a previous traumatic or painful experience such as sexual abuse or childbirth. Vaginismus symptoms may also be linked to relationship problems or fear of pregnancy. Vaginal trainers are usually provided to help women overcome this sex problem, but counselling is considered an effective treatment in addition to medical intervention.

Orgasmic disorder

According to Relate, around one in four women will have problems reaching an orgasm at some stage during their life, while 25-35% may have never experienced an orgasm. Although many women do not need to have an orgasm to enjoy sex, being unable to orgasm may be troubling for some women and their partners.

Reasons why women can't orgasm during any form of sexual stimulation vary - from medical causes to deep-rooted psychological issues that may be impacting their ability to 'let go'. Typical medical causes of orgasmic disorder include neurological, vascular or hormonal problems, while some medications may also have an effect. Alternatively some women may just have a very strong fear of sex and feeling aroused (often out of fear of losing control) while others may be dissatisfied in their relationship and with the sexual stimulation their partner is/isn't providing. Mental health issues such as depression or previous traumatic experiences can also contribute to orgasmic disorder.

Loss of desire

It is common for women to experience lack of sex drive at certain periods in her life - particularly during pregnancy and times of stress - but some women may have it more persistently. Again, there are several psychological and physical factors that can cause this, including diabetes, relationship problems, hormone disorders, depression, excessive tiredness, traumatic sexual experiences and drug and alcohol abuse. Lack of sex drive is also linked to a reduction in a woman's natural testosterone levels.

In rare cases, women may have what is called 'sexual anorexia' - a condition that is not in itself a diagnosis, but refers to a complete lack of desire for sex. Women with sexual anorexia will constantly avoid sex and may go for years without engaging in sexual intimacy with their partners. Like the eating disorder, sexual anorexia is predominantly psychologically linked, and counselling is considered essential for helping sufferers to perceive sex and sexual intimacy as something natural and healthy rather than bad and shameful.

Male sex problems

Ejaculation problems

Ejaculation problems are very common and men will typically experience one of three types of disorder:

Premature ejaculation - Where a man ejaculates too quickly during sexual intercourse. The average time of ejaculation is considered five minutes so regularly ejaculating before or within one minute of penetration is regarded as premature.
Retarded/delayed ejaculation - A delay in achieving ejaculation, or where a man is completely unable to ejaculate during sexual activity. Also known as male orgasmic disorder.
Retrograde ejaculation - The least common of the three, this condition is where the sperm travels backwards and enters the bladder instead of passing through the urethra and head of the penis. Orgasm is still experienced but there will be no, or little semen.

As with the female sex problems, male sexual dysfunction such as premature ejaculation is linked to psychological and/or physical factors. These include stress and previous sexual trauma as well as medical conditions such as diabetes.

Erectile dysfunction

Also known as impotence, erectile dysfunction refers to the inability to get and maintain an erection that is satisfactory for sexual intercourse. This is quite common and is linked to hormonal problems and the narrowing of blood vessels inside of the penis due to high blood pressure. Stress, anxiety and mental health issues are further causes of erectile dysfunction, along with sexual boredom and constant worrying about pleasing a partner. Unfortunately, for many men, even when the initial cause of an erection problem has passed, the anxiety of repeated failure may block future erections.

When is the right time to seek help for sex problems?

Talking about sex problems is understandably difficult and embarrassing for many, and as a result some people may refrain from seeking help. Suffering in silence however can make the problem worse, and it could lead to a lot of stress and unhappiness in your life and for those around you - particularly your partner. Although sex problems can stem from deeper issues within a relationship, sexual dysfunction can also cause relationships to suffer. Sex and sexual intimacy is an important part of bonding between two people in a relationship and without it a couple can become disconnected. When this happens it is a good indication that you need to start thinking about getting help.

Some of the signs that sex problems are affecting your relationship include:

Sex causes disappointment.
Sex is the cause of rows.
One or both partners are feeling dissatisfied or stuck in a rut.
Couples start drifting apart and losing touch.
One or both partners feels taken for granted or neglected.

Treatment for sex problems

The first step in seeking help for sex problems is to make an appointment with your GP to have your condition diagnosed and appropriate treatment methods explored. To establish the cause of a sexual dysfunction, your doctor will ask questions about your sexual, social and medical history. Medical tests will also be carried out to identify any physical causes, for which medication can be provided. Sex therapy is often the next course of action for individuals and couples experiencing sex problems, and although it may seem daunting opening up about intimate and somewhat embarrassing details, talking to a counsellor can be an enlightening experience.

Relationship counselling

Relationship counselling, or couples counselling is effective for helping couples to explore their physical communication and their understanding of what sex means to them. Sex may have become mechanical and a way to maintain a safe distance for one person. In such cases, the partner may mourn the lack of intimacy and trust which would allow them to feel safe and enjoy sex. Withdrawal of sex can happen when a person has no alternative way to express their anger and disappointment – so the forbidden feelings are acted out in the bedroom. These are just some of the issues that may be addressed in relationship counselling to help couples become more aware of each other's needs and desires and thus be able to reach a solution that works best for both of them.