Rebuilding a sexual connection

Most couples start by breaking the silence, and then go slowly. Couples who talk about a desire gap, or do something together during it, tend to report being happier with their relationship than couples who let it sit¹. That's a link, not proof that talking causes the happiness, but it's a friendly place to begin.

It helps to aim for the right target. Experts suggest building a shared sexual script that satisfies you both, rather than trying to raise how often you have sex². In practice, that means each of you saying what you'd like, then agreeing compromises on when and how².

Some things to try:

• Write a list of things you might each enjoy, then talk it through together².
• Try a gradual touch exercise such as sensate focus. It reintroduces touch step by step, helps you learn what each of you likes, and takes the pressure off².
• Expect real life to get in the way. Busy schedules, tiredness and parenting often stop couples finishing these exercises, even when they want change³. That's common, and it doesn't mean it won't work for you.

One caution: some people who have sex anyway during a low-desire patch do it to protect their partner's feelings or out of obligation¹. If either of you feels pressured or obliged, say so and slow down.

See a doctor if low desire is ongoing or getting worse, causes distress, or affects your relationship⁴. It's also worth a visit if it has lasted six months or more, or comes with pain during sex, difficulty reaching orgasm, erection problems, or signs of anxiety or depression^4,5.

In plain terms: pain during sex, or changes in desire, arousal or erections that worry you, are worth raising with a doctor. They often have a physical cause, and many can be treated.

A check matters because plenty of everyday things can lower desire:

• Medicines. Some blood pressure medication and many antidepressants can reduce libido⁶. Some hormonal contraceptives can too⁷. If you suspect a medicine, talk to a doctor about changing it before you change anything yourself.
• Hormones, alcohol and long-term conditions. Lower hormone levels with age, particularly during menopause, can lower sex drive, as can drinking too much alcohol. Heart disease, diabetes, an underactive thyroid and cancer can affect it too⁸.

To make the appointment useful, note how long the change has lasted and whether there's pain, erection problems or low mood. Bring a list of your medicines, and mention any recent pregnancy, menopause, long-term conditions and alcohol use.

As for sex therapists, talking therapies for sexual difficulties tend to help, with moderate effects on average, though results vary a lot from person to person⁹. There's no firm rule yet for when to move on to one, so it's your call. Many people start with a doctor to rule out physical causes.