Sexual health counselling onlineIntimacy without pressure or shame.

It can be helpful to think of sexual health as something wider than function. The WHO's working definition describes it as a state of physical, emotional, mental and social well-being in relation to sexuality, which requires a respectful approach to sexuality and relationships and the possibility of pleasurable and safe experiences free from coercion, discrimination and violence (WHO). In other words, how we feel about sex, about our bodies and about our partners matters as much as what our bodies do.

This view also means there is no single "correct" level of desire or frequency. What matters is whether something is causing you distress, affecting your relationship or getting in the way of the life you want.

Sexual response involves hormones, blood flow, nerves and muscles, and also attention, emotion, safety and connection. Physical factors such as medicines, hormonal change, pain conditions and chronic illness can all play a part, so we encourage a medical check, particularly when a difficulty is new, painful or getting worse. Psychological factors often enter the picture too, either as the main cause or as a response to a physical problem. Research on women's sexual problems, for example, found that distressing sexual problems were associated with depression and anxiety as well as with physical health factors (Shifren et al., 2008).

This is why counselling and medical care work best side by side. A doctor addresses what is happening in the body; counselling helps with the worry, avoidance, relationship strain and beliefs that can keep a difficulty going.

A systematic review and meta-analysis of 20 randomised controlled studies found that psychological interventions improved symptom severity and sexual satisfaction compared with waiting lists, with the clearest evidence for low sexual desire and orgasm difficulties in women (Frühauf et al., 2013). The authors noted that evidence varies considerably across different difficulties, and that more research is needed on others and on long-term effects. That is a fair summary of the field: psychological help is a valid option for many sexual concerns, and the right combination of support depends on the individual.

Consider seeking support if a sexual concern:

• is causing you distress or affecting your relationship;
• has led you to avoid intimacy;
• comes with low mood, anxiety or feelings of shame;
• appeared after a life event, illness or new medicine.

See a doctor promptly for pain, bleeding, new physical symptoms or concerns about sexually transmitted infections. If you have experienced sexual violence, specialist support services can help, and your safety comes first. Online counselling is not an emergency service.