The seven mid-life sex questions you don't dare ask... answered by a top therapist

As a psycho-sexual therapist, I've helped hundreds of couples to improve their sex lives — most often through better communication in and out of the bedroom.

The truth is that most of us just don't know how to talk about sexual problems without becoming upset. 

Unlike the rest of our lives, where we accept ups and downs as normal, when it comes to sex we often assume difficulties are symptoms of relationship problems — and not knowing how to ask for help makes things so much worse.

But almost every difficulty can be overcome if you know how to approach it. Here are the seven sex questions I'm asked most often, and my tried and tested solutions...

Psycho-sexual therapist Kate Moyle, has helped hundreds of couples to improve their sex lives - most often through better communication (Stock Image)

WHAT IS 'GOOD SEX' — AND HOW CAN WE HAVE IT?

So many of us worry about whether we're doing it 'right', particularly with a new partner. 

Performance anxiety is real for both men and women, and it's not like the movies where everything happens seamlessly. 

Real sex means bumped teeth, awkward positions, odd noises and worrying about how you look/smell/taste/feel to your partner.

But none of that means sex isn't good.

The best sex happens when we communicate our feelings and needs, and are open to our partner's. 

Great sex can mean earth-shattering orgasms, of course, but often, the best kind involves true connection and fun.

Men often wrongly believe it's about how long they can last, or penis size, but that's far less important than how attuned they are to their partner.

I encourage my clients to understand that good sex is about discovery, learning by ourselves and together, treating partners with respect, communicating openly and understanding our bodies. 

A common misconception is that a new partner will enjoy the same things as the previous one, but it's essential to check how partners feel, and be confident enough to ask questions without judgment.

When sexual experiences are positive, confidence grows and a loop of good communication and satisfying sex leads to the repeated release of feel-good neurochemicals, such as oxytocin and endorphins.

• Trying something new can be challenging. If you're not used to talking about sex, make separate lists of potential sexual experiences you could try together. Separately, write 'yes/no/maybe' for each one, then share your lists. This can be a way to open up a dialogue and see where you might be similarly curious — or not!

• Understand what's behind your desire. Psychologists David Buss and Cindy Meston questioned more than 450 men and women on their motivations for having sex.

The results uncovered 237 distinct reasons, ranging from emotional connection to the desire to feel wanted, to experiencing orgasmic release and to relieving stress.

Knowing what's prompted your desire can help you to create the sex you really want, whether that's affectionate, passionate or experimental.

ARE WE HAVING ENOUGH SEX?

For many couples. especially those with busy lives, children and careers. regular sex is more of a hope than a reality. 

It can also be difficult if you have health challenges, live apart or are coping with any other difficulties, physical or emotional.

Performance anxiety is real for both men and women, and it's not like the movies where everything happens seamlessly (Stock Image)

Yet how often we have sex has mistakenly become the dominant measure for how successful we consider our sex lives. This makes no allowance for the quality of the sex we're having, which is far more important than quantity.

Generally, regularity is a very sterile way to assess sex and raises the question of what we're actually measuring. 

If it's regularity of full intercourse, does this mean that couples who don't have penetrative sex aren't having meaningful sex? Well no, of course not.

Frequency genuinely isn't important — and the irony in worrying about quantity over quality is that the more enjoyable sex is, the more likely it is to lead to more sex. When we do have great sex, we often want to do it again and again!

• My advice is not to worry about frequency: 'compare and despair' applies to sex just as much as it applies to other people's amazing holidays. Focus on your own sex life, not the 'average' you read about.

• If you do feel you're stuck in a sexless scenario, it's time to talk. The most important thing? Avoid blame. Try, 'I feel so much closer to you when we've had sex recently', or neutral statements like, 'We've been so busy, shall we spend time together this weekend?' This way, you can avoid triggering defensiveness ('Well, if you weren't always so busy …') and brings you closer.

HOW DO WE AVOID BOREDOM CREEPING IN?

When you've been together for a long time, sex can become not boring, exactly, but certainly formulaic. 

You know what works, so why waste time going round the houses? The downside is that novelty falls by the wayside and you end up in a rut.

So if boredom is creeping in, and those fantasies are becoming ever-more vivid, it's time to shake things up a bit — beginning with curiosity.

Lack of curiosity limits ability to learn; and one of the biggest routes to same-y sex is assuming we know exactly what a partner likes. This leads to 'habitual behaviour'.

Habitual behaviour starts when our brain is motivated to chase the feel-good high we get from dopamine during sex, building a connection between a previous action and pleasure. 

But as we get used to something, we fail to respond as much — a process known as habituation.

This is helpful when it stops us reacting unnecessarily to familiar stimuli, such as background noise, but very unhelpful for sex. 

Lack of curiosity limits ability to learn; and one of the biggest routes to same-y sex is assuming we know exactly what a partner likes. This leads to 'habitual behaviour' (Stock Image)

People aren't machines, and just because something worked well the first 20 times, by the 2,000th it's so familiar it is far less likely to turn us on.

• Identify patterns and beliefs that you want to address. Focus on your sexual relationship and feelings — and, again, avoid assigning blame.

Try 'I love what we do so much, and I was thinking we could try faster movements and see what that feels like for us both?'; or, 'You're so good at massage, could we try it on different parts of the body to usual? I'd love to try that …' and so on.

• If you're met by resistance, ask your partner what they think could work for you both. It's important you feel heard and understood, but also that you both have a chance to say 'no'. 'I think that probably won't work for me because it makes me feel …' is better than 'No! What do you take me for?' Whatever they share, avoid shaming them for their fantasies.

• Remember that fantasies are a normal and healthy part of a good sex life. Popular themes involve romance and intimacy, along with non-monogamy and partner-sharing.

In a study by U.S. psychologist Dr Justin Lehmiller, group sex was the top fantasy, with 89 per cent of respondents found to fantasise about threesomes. 

It didn't mean they really wanted to do it — purely that it's enjoyable to imagine.

CAN ERECTION PROBLEMS BE FIXED?

This is one of the greatest worries for my clients, but they often don't realise that such problems are very common. 

A U.S. study in 2020 found that three in five men have had erectile dysfunction at some point.

Increased age was a slight risk factor, with 63 per cent of over 55s affected, and there are many causes, both mental and physical. 

Triggers can include low testosterone, high blood pressure, cardiovascular issues and diabetes.

If everything is fine physically, though, trouble getting or maintaining an erection can also be due to anxiety, depression, stress and relationship problems.

Men often see any difficulty as 'failure', and develop real worry around 'performance', which piles on the pressure and makes the situation worse, so they'll end up avoiding sex altogether. Yet erection problems may improve by themselves once the stress has faded. 

The key is to show desire in other ways, such as kissing and touching, and take the focus off 'performance'.

For some, however, particularly older men, oral medications like Viagra can boost an erection by enhancing the effects of nitric oxide, the naturally occurring chemical that relaxes the blood vessels in the penis so more blood can flow into it and help erections happen in response to sexual stimulation and arousal.

If erectile disfunction is a problem, the key is to show desire in other ways, such as kissing and touching, and take the focus off 'performance' (Stock Image)

• A vasodilator medication, usually Alprostadil, can be given to help blood flow. This is administered via self-injection into the base or side of the penis shortly before sex, but must be prescribed by a GP.

• Psychosexual therapy or counselling, sometimes combined with medications or other methods, can help navigate the emotions and thoughts that can affect erections.

Men may not realise what's at the root of their worries, or be unable to overcome deep-seated issues such as guilt, shame or past abuse, and a trained therapist can help them safely explore what's happening emotionally.

WHAT IF OUR DESIRE IS OUT OF SYNC?

Very few couples always want sex at exactly the same time, but for some a desire imbalance becomes a problem. Maybe your partner wants morning sex and you'd prefer evening passion. 

Or perhaps he'd be happy with once a week and you're more a once a month woman.

In fact, up to 40 per cent of women aged 16 to 44 reported a lack of motivation to have sex.

What most people don't realise, however, is that a 'desire discrepancy' — not being motivated for sex at the same time as a partner — is far more common than being perfectly aligned sexually. 

Having been raised on Hollywood movies, many couples assume there's something wrong if just looking at each other isn't an instant turn-on.

That, however, is rare past the first flush of passion. And what I'd like everyone to know is that 'responsive' desire is far more common than the 'spontaneous' kind.

Spontaneous desire can happen with little sexual stimulation or encouragement; usually, though, something has initiated the response, whether it's the feel of a sensual texture or catching the eye of an attractive stranger.

Responsive desire, by contrast, is triggered in response to direct stimulation, so isn't always there at the start of a sexual experience.

This explains why you might not feel in the mood for sex, but then really enjoy it once you get going. The feelings of desire come second to arousal, creating the desire to continue.

Luckily, understanding responsive desire offers us a huge amount of power and influence over our sex lives. 

It means that being receptive to the idea of a sexual experience, even if we don't feel turned on in that moment, can be fulfilling. This can be helpful if a couple feels out of sync or someone is worried about low libido.

• Be open to seeing where things go rather than focusing on an end goal. Maybe just kissing will be enough, or as desire builds, it might become a more sexual encounter. Either is fine, so don't feel that it has to end with orgasm.

• Change the mood by setting the scene and using cues such as music and lighting to build sensuality for you both.

• Use your 'Sexual Currency' outside the bedroom. Sexual currency is made up of non-sexual acts — long hugs, prolonged eye contact, affirming compliments, playful touch, flirting and suggestive messages — things that we only do with a partner and which help keep a sexual connection alive.

By such means couples can maintain a level of closeness outside of sex, nurturing erotic connections and fuelling desire.

SHOULD I AIM FOR 'MINDFUL SEX?'

A common sexual concern is experiencing a sense of detachment — focusing on what you're doing rather than on how you're feeling.

You may be thinking, 'I hope I look okay from this angle' or, 'I really want to change position but I don't want to look like I'm not enjoying this,' and those thoughts get in the way of being 'in the moment'.

Understanding responsive desire, which is triggered in response to direct stimulation, can offer us a huge amount of power and influence over our sex lives (Stock Image)

Mindful sex involves consciously bringing your attention to your sexual experience, without judgment. Mindfulness exercises can also help where there are added barriers — if desire is low or if painful sex distracts from pleasure.

Any pain can negatively reinforce sex as something we don't want to do, impacting desire and relationships, and it's often connected to menopause. 

Using lubricant and vaginal moisturisers as we age can be key to allowing you to continue enjoying sex and penetration.

But doing the following every day, too, can also help you integrate mindfulness into your sex life and enable you to enjoy the whole experience more fully.

• Note simple things that give pleasure, whether it's the first sip of coffee, the sun on your face, the feel of a soft jumper, or a friend's hug. Noticing pleasure outside of sex helps us to be more aware of it during sex.

• When you notice intrusive thoughts, allow them to be there. Saying to yourself, 'It's a thought, not a fact' reminds you that you play a role in shaping your reality.

• Slow, deep breaths in and out send a signal to your nervous system to calm your body. Honing the ability to focus on your breath outside of sex can help you practice this during sex, so you can focus on the sensations you're experiencing.

AFTER A BREAK-UP, HOW DO I BUILD CONFIDENCE?

Nothing destroys sexual self-esteem like a bad break-up. And if you've been sleeping with the same person for years, the prospect of getting naked with someone new can be terrifying.

The fear of trying something new springs from the awareness that the outcome is unknown; so how willing we are to take a risk can depend on our psychological makeup and willingness to step out of comfort zones. You may also not be over your ex.

Research shows that heartbreak increases levels of cortisol, the stress hormone. 

There's also a link between social rejection and physical pain, though we often hide loneliness for fear of judgment, feeding the belief that we should get over an ex quickly. 

But feeling ready to have sex with someone new is completely individual.

• After a break-up, we need to learn how to take risks again, and it can be helpful to recognise that anxiety and excitement can manifest in a similar way. Physiologically, both increase the heart rate and trigger an adrenaline rush, or 'butterflies'. Anticipation also offers us a hit of the reward neurochemical dopamine.

• Spending time with family and friends after a break-up can boost confidence, too. These interactions feed us socially and emotionally, and feeling confident enough to have sex with a new partner can come from an improved sense of self. Don't rush in.

• Adapted from The Science Of Sex, Every Question About Your Sex Life Answered by Kate Moyle (£16.99, Dorling Kindersley).