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  1. Sex after hysterectomy

    How a hysterectomy might affect your sex life, how long you should wait before having sex again and how to cope with issues such as vaginal dryness.

    It takes time to get back to normal after an operation, but having a hysterectomy can have a strong emotional impact too, which can affect how you feel about sex.

    If you experience problems with sex after your operation, don't suffer in silence. There is help available – you can talk to your GP, a counsellor or an organisation such as the Hysterectomy Association.

    How long should you wait before having sex after a hysterectomy?

    You will be advised not to have sex for around four to six weeks after having a hysterectomy. This should allow time for scars to heal and any vaginal discharge or bleeding to stop.

    If you don't feel ready for sex after six weeks, don't worry – different women feel ready at different times.

    There are many different types of hysterectomy, which will affect how it is performed and what is removed.

    A total hysterectomy is the removal of the uterus (womb) and cervix. If the cervix remains intact, this is a subtotal hysterectomy. Sometimes the ovaries or fallopian tubes are removed as well.

    Which organs are removed will depend on your own personal circumstances and the reasons you're having a hysterectomy.

    Bleeding after sex after a hysterectomy

    Any woman who notices bleeding after sex should see a doctor to find out why it is happening. This includes women who have had a hysterectomy. Your doctor may be able to offer treatment, and can check that everything is healing well.  

    Feeling sexually attractive

    Having the uterus removed can cause women to worry about feeling less womanly, or losing their sexual attractiveness. Many women also talk about feelings of loss or sadness after a hysterectomy. However, these feelings should pass.

    You may find it helps to focus on your recovery – eating healthily, getting some exercise (your doctor will tell you how much activity you should aim for) and talking to your partner or friends about how you're feeling.

    If you're finding it hard to cope with these emotions, talk to your GP or consultant. You may be able to have counselling to help you work through your feelings. Find a counsellor near you.

    It can also help to read about how other women have coped with similar experiences. You can read about women's experiences of hysterectomy at healthtalk.org.

    Sex and menopause

    If you have your ovaries removed as well as your uterus, this will trigger the menopause whatever your age. The change in hormone levels that occur during the menopause can affect your sex life. Read more about sex after menopause and how to deal with any problems.

    Sex drive

    Some women have less interest in sex after having a hysterectomy. If this happens to you, your interest in sex may return as your recovery progresses.

    If you and your partner feel it's a problem, talk about it together so that it doesn't become an unspoken issue between you. You can also talk to your GP or find a counsellor who can offer help with sexual problems.

    Our talking about sex page has tips from a psychosexual therapist, which you might find useful.

    Lack of sex drive can be made worse by depression, menopausal symptoms, relationship problems and stress. These problems are often temporary, but if symptoms of the menopause or depression persist, see a doctor. Treating menopausal symptoms may boost your sex drive indirectly by improving your general wellbeing and energy levels.

    Read more about keeping the lust alive.

    Vaginal dryness, sensation and orgasm

    Having a hysterectomy doesn't mean you can't have an orgasm. You still have your clitoris and labia, which are highly sensitive.

    It's not known what role the cervix plays in orgasm. Some experts have argued that removing the cervix can have an adverse effect, but others have found that it doesn't.

    A review of the evidence comparing subtotal with total hysterectomy in premenopausal women found both types offered similar results for sexual function.

    In a study comparing different surgical methods of hysterectomy, a number of women noticed reduced sexual sensation. This included reduced feeling when their partner penetrated their vagina, a dry vagina and less intense orgasms. If, before hysterectomy, you had noticeable uterine contractions during orgasm you may find you don't experience these anymore.

    If your hysterectomy has made your vagina feel drier than it used to be, try using a sexual lubricant. You can buy these over the counter at a pharmacy.

    Your surgeon will have advised you to do pelvic floor exercises to help your recovery. These exercises can also tone up the muscles of your vagina and help improve sexual sensation. Read more about pelvic floor exercises.

    Other women in the study mentioned above said their hysterectomy had removed their pre-surgery symptoms (such as pain), and they had a greater sense of wellbeing and happiness.

    The Royal College of Obstetricians and Gynaecologists has leaflets about recovering after hysterectomy:

    Recovering well after abdominal hysterectomy

    Recovering well after vaginal hysterectomy

    Recovering well after a laparoscopic hysterectomy

     

  2. Sex advice for people with chronic pain

    Sexual intercourse can cause discomfort for people living with long-term pain.

    But living with chronic pain should not mean that the pleasures of sexual activity are beyond your reach.

    Sexual activity, when comfortable, can provide a certain amount of temporary pain relief. The key is to return to some form of sex as soon as possible.

    The longer you avoid it, the bigger the fear of resuming sex becomes, and a downward spiral can set in.

    Also, a loss of intimacy can drive couples apart and harm their relationship in the long-term.

    Plan ahead for sex

    If you live with chronic pain, spontaneous sex is never going to be easy.

    Planning and preparing for sex may not sound as romantic, but is a better way of achieving a satisfying sex life.

    People often experience more pain at certain times of day. So it may help to have sex when your body is at its best, when your muscles are the least painful and your joints not so stiff and when you're least tired.

    Many people are most intimate just before going to sleep at night, but for people with chronic pain this can be the worst time.

    Instead, plan to spend time with your partner in the afternoon, or whichever time of day you feel the least pain.

    Tips for more comfortable sex

    If you take medication to control your pain, try to time sex for when your medicine's therapeutic effect is at its peak.

    Experiment with different positions that lessen physical strain, such as lying side by side. Here are some suggestions from Arthritis Research UK.

    It can help to warm the bed in advance with an electric blanket to ease muscle and joint discomfort.

    Also, do some gentle stretches and use polyester or silk sheets to make it easier to turn and move in bed.

    Alternatives to intercourse

    If intercourse is not an option, there are alternatives such as:

    • masturbating each other
    • oral sex
    • sex toys

    Don't underestimate the pleasure and the feeling of intimacy you can get from:

    • touching and being touched
    • cuddling
    • massaging
    • kissing 

    For example, you could take a shower together or massage each other in turn if one of you has a bath.

    Talk openly to your partner

    Talk openly and honestly to your partner about how pain affects your enjoyment of sex and what you want from your relationship.

    Pick the right moment to have this conversation. It may be better to talk about it over dinner or while out walking, for example, rather than while in bed or in an intimate situation.

    When to get help

    If your pain is so severe that it is affecting your ability to have a satisfying sex life, talk to your doctor.

    You may need a different or stronger pain control plan.

    Some types of medication have side effects which can affect your sex drive and your ability to have sex. Your doctor may be able to recommend an alternative or adjust your current medication.

    If necessary, your doctor can refer you for professional sexual counselling.

    Read 10 self-help tips to beat pain.

     

  3. Benefits of love and sex

    Besides a heart full of love and a big smile, romance can bring some positive health benefits.

    Video: maintaining a healthy sexual relationship

    Some scientific studies suggest that a loving relationship, physical touch and sex can bring health benefits.

    Sex is good for your heart

    Anything that exercises your heart is good for you, including sex. Sexual arousal sends the heart rate higher, and the number of beats per minute reaches its peak during orgasm.  

    But, as with most exercise, it depends how vigorously you do it. Some studies show the average peak heart rate at orgasm is the same as during light exercise, such as walking upstairs. That's not enough to keep most people fit and healthy.

    Adults should do at least 150 minutes (2.5 hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

    Unless you're having 150 minutes of orgasms a week, try cycling, brisk walking or dancing.

    Having heart disease doesn't have to hold you back in the bedroom. Experts advise that you can usually have sex as long as you can do the everyday activities that have the same impact on your heart without causing chest pain, such as walking up two flights of stairs.

    Source: Rerkpattanapipat P, Stanek MS, MN Kotler. Sex and the heart: What is the role of the cardiologist? European Heart Journal 2001;22: 201-208.

    A hug keeps tension away

    Embracing someone special can lower blood pressure, according to researchers.

    In one experiment, couples who held each other's hands for 10 minutes followed by a 20-second hug had healthier reactions to subsequent stress, such as public speaking.

    Compared with couples who rested quietly without touching, the huggers had: 

    • lower heart rate 
    • lower blood pressure
    • smaller heart rate increases

    So give your partner a hug – it may help to keep your blood pressure healthy.

    Similar effects have been found for non-sexual stroking, although this appears to only reduce blood pressure in women who are stroked, not men.

    Source: Grewen KM, Anderson BJ, Girdler SS, Light KC. Warm partner contact is related to lower cardiovascular reactivity. Behavioural Medicine, 2003;29:123-30.

    Sex can be a stress buster

    Sex could help you beat the stresses of 21st century living, according to a small study of 46 men and women.

    Participants kept a diary of sexual activity, recording penetrative sex, non-penetrative sex and masturbation.

    In stress tests, including public speaking and doing mental arithmetic out loud, the people who had no sex at all had the highest stress levels.

    People who only had penetrative sex had the smallest rise in blood pressure. This shows that they coped better with stress. 

    Plenty of people find that intimacy or orgasm without penetration helps them feel relaxed, as do exercise or meditation. It doesn't have to be penetrative sex  it's whatever works for you.

    Try these 10 stress busters.

    Source: Brody S. Blood pressure reactivity to stress is better for people who recently had penile-vaginal intercourse than for people who had other or no sexual activity. Biological Psychology, 2006;71:214-22.

    Weekly sex might help fend off illness

    There's a link between how often you have sex and how strong your immune system is, researchers say.

    A study in Pennsylvania found students who had sex once or twice a week had higher levels of an important illness-fighting substance in their bodies.

    Immunoglobulin A (IgA) was 30% higher in those who had sex once or twice a week than in those who had no sex at all. The lowest levels were in people who had sex more than twice a week.

    But don't devise a sex calendar just yet. More research is needed before it can be proved that weekly sex helps your immune system.

    Another study found stroking a dog resulted in raised IgA levels in students. Resting quietly or stroking a stuffed dog didn't.

    Sources: Charnetski CJ, Brennan FX. Sexual frequency and salivary immunoglobulin A (IgA). Psychology Report, 2004;94:839-44.

    Charnetski CJ, Riggers S, Brennan FX. Effect of petting a dog on immune system function. Psychology Report, 2004;95:1087-91.

    People who have sex feel healthier

    It could be that people who feel healthier have more sex, but there seems to be a link between sexual activity and your sense of wellbeing.

    A study of 3,000 Americans aged 57-85 showed that those who were having sex rated their general health higher than those who weren't.

    And it's not just sex  it's love, too. People who were in a close relationship or married were more likely to say they felt in "very good" or "excellent" health than just "good" or "poor".

    It seems that emotional and social support can boost our sense of wellbeing.

    Find out about five steps to mental wellbeing

    Source: Lindau ST, Schumm LP, Laumann EO, et al. A Study of Sexuality and Health among Older Adults in the United States. New England Journal of Medicine. 2007;357:762-74.

    Loving support reduces risk of angina and ulcer

    A happy marriage can help fend off angina and stomach ulcers – at least, it can if you're a man.

    One study of 10,000 men found those who felt "loved and supported" by their spouse had a reduced risk of angina.

    This was the case even if they had other risk factors, such as being older or having raised blood pressure.

    Similarly, a study of 8,000 men found there was more chance of them getting a duodenal ulcer if they:

    • had family problems 
    • didn't feel loved and supported by their wife
    • didn't retaliate when hurt by colleagues – in other words, they repressed their anger (researchers called this their "coping style")

    Researchers suggest that stress, lack of social support and coping style can all affect a man's likelihood of developing an ulcer.

    Sources: Medalie JH, Goldbourt U. Angina pectoris among 10,000 men. II. Psychosocial and other risk factors as evidenced by a multivariate analysis of a five-year incidence study. American Journal of Medicine, 1976;60:910-21.

    Medalie JH, Stange KC, Zyzanski SJ, Goldbourt U. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged men. American Journal of Epidemiology, 1992;136:1280-7.

    And if you're single…

    Spending an evening with friends is good for your health, too. One 10-year study of 1,500 people over 70 years old found those with stronger friendship networks lived longer than those with fewer friends.

    Researchers thought this could be because friends may have a positive influence on lifestyle choices, such as smoking or exercise, and offer emotional support.

    Source: Giles LC, Glonek GF, Luszcz MA, Andrews GR. Effect of social networks on 10-year survival in very old Australians: the Australian longitudinal study of aging. Journal of Epidemiology and Community Health, 2005;59:574-9.

    Or celibate…

    A life without sex is no bar to excellent health. A long-term study into the health and ageing of a group of nearly 700 older nuns found many kept active and lived well into their 90s and past 100.

    Since 1986, participants in The Nun Study had yearly checks on their physical and mental abilities. Researchers used convent records to obtain their social, family and educational background.

    While they found some links between lifestyle and dementia – for example, higher education or positive emotions in early life might cut the risk of dementia – this isn't linked to sexual activity.

    If you do have sex, using a condom will help protect you and your partner against sexually transmitted infections (STIs) and unplanned pregnancy. 

    Find sexual health services near you.

  4. Sexual arousal in men

    When a man gets an erection, his body goes through four stages of sexual response: arousal, plateau, orgasm and resolution.

    Stage 1: sexual excitement or arousal

    A man gets an erection with physical or psychological stimulation, or both. This causes more blood to flow into three spongy areas called corpora that run along the length of his penis.

    The skin is loose and mobile, allowing his penis to grow. His scrotum – the bag of skin holding the testicles – becomes tighter, so his testicles are drawn up towards the body.

    Stage 2: sexual plateau

    The head (glans) of his penis gets wider, and the blood vessels in and around the penis fill with blood. This causes the colour to deepen and his testicles to grow up to 50% larger.

    His testicles continue to rise, and a warm feeling around the area between the testicles and anus (perineum) develops.

    His heart rate increases, blood pressure rises, breathing becomes quicker, and his thighs and buttocks tighten. He's getting close to orgasm.

    Stage 3: orgasm and ejaculation

    A series of contractions force semen into the urethra, the tube along which urine and semen come out of the penis.

    These contractions occur in the pelvic floor muscles, in the tube that carries sperm from the testicles to the penis (vas deferens).

    They also occur in the seminal vesicles and the prostate gland, which both add fluid to the sperm. This mix of sperm (5%) and fluid (95%) is called semen.  

    These contractions are part of orgasm, and the man reaches a point where he can't stop ejaculation happening.

    Contractions of the prostate gland and the pelvic floor muscles then lead to ejaculation, when semen is forced out of the penis.

    Stage 4: resolution phase of sex

    The man now has a recovery phase, when the penis and testicles shrink back to their normal size. He is breathing heavily and fast, his heart is beating rapidly, and he might be sweating.

    There's a period of time after ejaculation when another orgasm isn't possible. This varies between men, from a few minutes to a few hours, or even days. The time generally gets longer as men get older.

    If a man gets aroused but doesn't ejaculate, this resolution stage can take longer, and his testicles and pelvis might ache.

    Find out more about penis health, including how to wash a penis and penis size.

    If you have problems getting an erection or keeping an erection, find information at the Sexual Advice Association.

    Find out more about male sexual problems.  

    Find sexual health services near you.

  5. Sexual arousal in women

    During arousal and sex, there are various stages of physical response. Researchers have identified four stages of sexual response in women and men: arousal, plateau, orgasm and resolution. This article describes what happens in a woman's body when she is sexually aroused.

    Stage 1: sexual excitement or arousal

    When a woman becomes aroused (turned on), the blood vessels in her genitals dilate. There is increased blood flow in the vaginal walls, which causes fluid to pass through them. This is the main source of lubrication, which makes the vagina wet.

    The external genitalia or vulva (including the clitoris, vaginal opening, and inner and outer lips or labia) become engorged (swollen) due to the increased blood supply. Inside the body, the top of the vagina expands.

    The pulse and breathing quicken, and blood pressure rises. A woman may become flushed, especially on the chest and neck, due to the blood vessels dilating.

    Stage 2: sexual plateau

    Blood flow to the lower third of the vagina reaches its limit, and causes the lower area of the vagina to become swollen and firm. This is called the introitus, sometimes known as the orgasmic platform, and undergoes rhythmic contractions during orgasm. 

    A woman’s breasts may increase in size by up to 25%, and blood flow to the area around the nipple (the areola) increases, making the nipples look less erect.

    As a woman gets closer to orgasm, her clitoris pulls back against the pubic bone and seems to disappear. Continuous stimulation is needed in this phase to build up enough sexual excitement for orgasm. 

    Stage 3: orgasm

    Orgasm is the intense and pleasurable release of sexual tension that has built up in the earlier stages, characterised by contractions (0.8 seconds apart) of the genital muscles, including the introitus. Read more here: what is an orgasm? 

    Most women don’t experience the recovery period that men do after an orgasm. A woman may have another orgasm if she's stimulated again.

    Not all women have an orgasm every time they have sex. For most women, foreplay is an important role in an orgasm occurring. This can include stroking erogenous zones and stimulating the clitoris.  

    Find out what can cause orgasm problems in women.

    Stage 4: sexual resolution

    This is when the woman's body slowly returns to its normal state. Swelling reduces, and breathing and heart rate slow down. 

    Find out more

    FPA: sexual health information

    Relate: relationship counselling

  6. Male sexual problems

    It's estimated 1 in 10 men has a problem related to having sex, such as premature ejaculation or erectile dysfunction. Find out more through the links below.  

    Sexual problems can affect any man, whether he is straight, gay, bisexual or transgender.

    Erectile dysfunction (impotence)

    This is when a man can't get, or keep, an erection. Most men experience it at some time in their life, and the causes can be physical or psychological.

    Physical causes include heart disease, diabetes and raised blood pressure. Alcohol, smoking and illegal drugs, as well as some prescription medicines, can also cause erectile problems.

    Worries about work, money, your relationship, family, and even worrying about not getting an erection can all be factors

    Find out more about erectile dysfunction.

    Premature ejaculation

    This is when a man ejaculates (comes) sooner than he wants to during sex. It's only a problem if it bothers him or his partner.

    Causes can include anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.

    You can see your GP or a psychosexual therapist for help.

    Find out more about premature ejaculation.

    Loss of sex drive

    Losing your sex drive, or libido, is common. It can be linked to a number of factors, including relationship issues, stress, anxiety and side effects of medication.

    There is help available. Talk to your GP, or get in touch with the Sexual Advice Association.

    Find out more about loss of libido.

    Talking about your problems can help. Find out more about relationship counselling at Relate.

    Support options

    For help with cutting down on drinking, drug use or smoking, contact:

  7. Let's talk about sex

    If your sex life isn't fulfilling, there are steps you can take to make it better. A good start is talking to your partner about how you feel about sex.

    Video: a healthy sex life

    Denise Knowles is a psychosexual therapist with Relate, a charity providing non-judgemental support around sex and relationships. 

    Here, Denise gives advice on talking about sex, whether it's bringing up a problem or simply telling your partner your likes and dislikes.

    Why talking about sex is good

    Communication is important in any healthy relationship because it lets you share your feelings and tackle problems together. This is also true of your sex life, especially if something is worrying you.

    "If you can talk about things that are going on in your sex life, then you don't have to bury your problems," says Denise.

    "It's often when a problem goes underground that people start to worry about what might be wrong. That's when a distance arises in the day-to-day relationship."

    For example, if you want sex less often than your partner but you don't talk about it, your partner may worry that you don't love them any more or are having an affair.

    If you talk about it – perhaps you're feeling stressed about work, or you're coming to terms with changes to your body as you get older – then your partner will know the truth and both of you can work on managing the problem.

    Find out more about loss of libido.

    How and when to say something about sex

    Denise agrees that many people find it hard to talk openly about sex, especially if they've never spoken about it with their partner.

    "You have to pick the right moment," says Denise. If you're concerned about your sex life, don't discuss it when you've just tried to make love and it hasn't worked.

    "Sex is an emotive subject, and you're in an emotional situation at that time," she says. "Be reassuring and say, 'OK, but I think we need to talk about this another time'. Don't tell them that everything is fine, because it isn't."

    'If you're not happy with your sex life, it’s OK for you to be honest about how it’s affecting you'

    Psychosexual therapist Denise Knowles

    Choose a time when you can be alone together and won't be interrupted by phones ringing or children returning from school.

    Think about the words you'll use. "Many couples don't say anything for fear of hurting their partner's feelings," says Denise.

    "But if you're not happy with your sex life, it's OK to be honest about how it's affecting you."

    In a loving partnership, the two of you can work together to find a solution that works for you both.

    Be sensitive about your partner's feelings

    You can bring up suggestions or concerns without hurting your partner's feelings. Be sensitive and reassuring, and ask your partner to share their thoughts with you.

    Denise suggests saying something like, 'I've noticed we're not making love as often as we used to, and that kind of bothers me. What do you think about it?'

    If your partner asks why you haven't brought it up before, be honest – perhaps it's because you weren't sure how to say it, or you were hoping that things might improve.

    Once you've raised the subject, you'll need to give your partner some time. "It can be a shock for your partner. Once the subject is out in the open, you both might need to go away and think about how you're feeling, and what you could do differently," says Denise.

    "But do come back to it. There's no point raising the subject, then not following it through with another action, even if that action is to have another discussion."

    Together you can work out how to manage the situation. If you're both honest about your feelings, you've got a better chance of finding a solution that works for both of you. If you don't feel you can work it out together, then sexual therapy might help.

    A sexual therapist can help you address issues that you might find difficult to tackle. They can also suggest ways to improve your intimacy and sex life to suit both of you.

    Find out more about what sex therapists do.

    Dealing with infidelity

    If one partner in the relationship has had an affair, trust is broken. You may feel you no longer trust them at all.

    "If I ask a couple in this situation whether they trust each other to pick up the kids from school or drive each other's car, they say yes," says Denise.

    "So trust hasn't completely gone. What we're really talking about is, 'I can't trust him/her not to go off again'. This can help us to focus on things that perhaps were or weren't happening in the relationship."

    A couple can recover from an affair if they both want to, but they need to recognise that their relationship will never be the same again. "They have to let go of the old relationship and renegotiate a new one," says Denise.

    If a partner has cheated on you in the past, it can be hard to trust anyone new. "You need to recognise that this new person is not the person who cheated on you," says Denise.

    "Recognise the effect that the cheating had on you, and tell your new partner. If they want to be in a relationship with you, they'll help you."

    Find sexual health services near you.

  8. Keep the passion alive

    Like other parts of your relationship, your sex life needs care and attention if you want to keep it in good condition. Relate sex therapist Denise Knowles offers some tips on keeping the passion and lust alive in your sexual relationship.

    In the early days of a relationship, sex is full of discovery, intimacy and fun. But as your relationship develops and you perhaps move in together or have children, other demands of life can mean that your sex life is neglected.

    "This doesn't mean you can't still have a fulfilling and desirable sex life," says Denise. "It just means you need to recognise that this is natural, and that your relationship is changing."

    Talk and listen to each other

    If you don't talk about it, the silence can create a distance between you. "You have to talk to each other about how you're feeling," says Denise.

    "You probably talk about other important parts of your life, such as career choices and your child's school, but sex is equally important."

    If you find it difficult to talk about sex, Denise suggests saying how you feel and asking how your partner feels.

    For example, say: "I get the feeling you don't want to make love to me any more, and I wondered how you feel about that." 

    Then listen to what they say. If they're upset, give them space to think and come back to the discussion another time.

    Reassure your partner that you love them and enjoy being close to them. "Your desire for sex might not be as frequent, but that doesn't mean your desire to be with that person has dwindled," says Denise.

    There's more to sex than penetration

    "If I ask people what makes a satisfying sex life, they usually say it's about penetrative sex and orgasms," says Denise. "But this isn't necessarily what sex and intimacy is all about."

    Enjoy all the feelings of arousal with your partner, not just the orgasm. Take time to be more sensual:

    • Explore each other's bodies.
    • Stroke and caress each other's skin.
    • Take a bath or shower together.
    • Kiss with passion.
    • Take time to undress each other.
    • Don't be afraid to tell each other what you like and how you like to be touched.
    • Listen to your partner's breathing and the sounds they make.
    • Don't place too much focus on orgasm – enjoy all the feelings and sensations with your partner.

    Many people give each other oral sex or masturbate together as a healthy and enjoyable part of their sex life.

    If you're not sure about how to suggest something new, try saying: "I enjoy it when we make love, and I wondered how you might feel about trying …".

    Find out what you like and reignite the passion

    Even if you think you know what you like when it comes to sex, it's worth exploring a bit more.

    "Sometimes I'm struck by how little people know about their own body and their partner's body, and their likes and dislikes," says Denise.

    Ask yourself what you might like more – or less – of, and what you can give to your partner. 

    Get to know your body and what feels good. Lie in a warm bath and explore your body. Think about how the water feels on your skin, and relax while enjoying the sensation.

    Find out what you like through masturbation, then share this with your partner.

    "Sexual preferences are such a unique and individual thing that when you start talking about it and exploring it, you might surprise one another, which is exciting," says Denise.

    If you both want different amounts of sex

    This happens in many relationships. Losing desire can happen for a number of reasons, such as getting older, illness, having children, or worries about work, money, or the relationship itself.

    Be open about how you're feeling. Explore why you want less sex and how it makes you both feel.

    "If one partner has a higher sex drive than the other, we work out how to manage it within the relationship," says Denise.

    "Masturbation might be an option, or sex toys. Or perhaps cuddling and kissing may be enough.

    "A lot of people want to be close to their partner and share pleasure with them, but don't feel like having full intercourse. They may be happy to give other things a try though, which can increase intimacy."

    Don't be afraid of hugs and kisses. People often worry that their partner might assume a hug means "I want sex". But if you agree that a hug is just a hug, you can enjoy non-sexual physical contact simply for what it is.

    Relate has information on common sex problems and where you can get help and support. The charity also offers sex therapy to help if you're experiencing difficulties in your love life.

    The College of Sexual and Relationship Therapists has information for the public on several topics, including sex and disability, sex after a diagnosis of cancer, and finding a therapist.

    If you want to see a health professional, you can use NHS Choices to find sexual health services near you.

  9. Good sex tips

    If you want to make the most of your sex life, these sex tips are a good way to start.

    Talking and listening to each other about your feelings, preferences and desires can bring you closer together and make sex more enjoyable.

    But even the most contented lovers can have fun trying new things. Here are a few ideas.

    1. Build anticipation

    Agree on a period of time – say one week, or whatever works for you – when you won't have orgasms or penetrative sex. At first, allow only kissing and holding each other. Gradually move on to touching and stroking each other, masturbationoral sex, or whatever feels right for you. Avoid orgasm.

    At the end of the agreed waiting period, allow yourselves the pleasure of orgasm through any kind of sex you like. This week may help heighten your senses to all the other wonderful feelings you can share when you're making love.

    2. Massage

    Massage can help you have very sensual sex. As part of foreplay, it's a great way to start things off slowly and relax into the feel of each other's skin as your arousal intensifies.

    But a simple massage that doesn't lead to sex can also work wonders for your sex life. A non-sexual massage will familiarise (or refamiliarise) you with your partner's body, reduce stress, and reaffirm the intimacy between you.

    If you don't want a massage to lead to sex, discuss this with your partner so you can avoid any misunderstanding.

    Read more about why it's good to talk about sex

    3. The senses

    Good sex can embrace all the senses, not just touch. Scented oil for a massage, music and candles for soft lighting can all be erotic, as well as listening to your partner's breathing and the sounds they make. But remember not to get oil on a latex condom, as this can damage it.

    Taste each other as you kiss. If you both want to, you could mix food and sex – feed each other something delicious and juicy, such as strawberries.  

    4. Whisper

    Whether it's sweet nothings or your sexy intentions, whispering things to each other can add an extra thrill. It doesn't have to be during foreplay or sex. Foreplay can start during the day with a sexy phone call or text – this could leave both of you looking forward to the event for hours or days.

    This works with texts and emails, too – but make sure you send them to the right person, and remember that your employer has the right to access your work email.

    5. Masturbation

    Masturbation, by yourself or with your partner, can be a bonus for your sex life. Exploring your own body and sexual responses means you can share this knowledge with your partner.

    Masturbating your partner can help you learn more about what turns them on. It can also be an option if one of you doesn't feel like full sex. Talk about this with your partner.

    6. Sex toys

    If you and your partner both feel comfortable, using sex toys can be an arousing thing to do together. Some people use vibrators (and more) as an enjoyable part of their sex life. If you've never thought about using sex toys before, how do you feel about trying them?

    You can buy them online or in sex shops. You don't have to spend a fortune on toys – you can get creative. Soft hair brushes can feel great against the skin, and making your own games up can be fun.

    Find out more in Are sex toys safe?

    7. Read a book

    There are many books that have exercises and ideas to help you achieve a fulfilling sex life, whatever your age, gender, sexual orientation or taste.

    If you've never thought about buying a book about sex, why not do it now? You might wish you'd done it years ago.     

    8. Share fantasies and desires

    Everyone has unique fantasies, tastes and preferences when it comes to sex. From earlobes to ankles, hairline to hips, pirates to picnics, don't be afraid to talk about them.

    If you and your partner know about each other's turn-ons, you can make the most of them.  

    9. Keep it clean

    We're talking about your general hygiene. You don't have to keep yourself super-scrubbed: a certain amount of sweat is fine, as long as it isn't overwhelming.

    But be respectful towards your partner, and wash every day to prevent nasty smells and tastes. For specifics, read more about keeping your vagina clean and how to wash your penis.

    10. Relax

    Sex with a loving partner can be one of the most beautiful and intense experiences in life.

    Sometimes the best sex happens when you're not worrying about making it exciting or orgasmic. Relax with your partner and great sex may find you.  

    Try some relaxation tips to relieve stress.

    Video: a healthy sex life

  10. Sex as you get older

    Things inevitably change as you get older, but that doesn’t mean you have to stop having sex.

    Many people enjoy an active sex life well into old age, with some couples reporting that sex gets better with age.

    Your sexual desires and appetite for sex can change over the years for many reasons. This is normal, and there's no right or wrong level of sexual activity at any age. It's a personal thing and everyone is different.

    Here's some advice to help you enjoy a healthy sex life:  

    Changes in sexual desire

    Ageing causes many normal changes in the body, some of which may affect your sexual desire.

    But there are plenty of ways to enjoy sex. Some couples find new enjoyment of sex without having penetrative sex.

    Enjoy all the feelings of arousal with your partner, not just the orgasm. Take time to be more sensual:

    • Stroke and caress each other's skin.
    • Have a bath or shower together.
    • Kiss with passion.
    • Take time to undress each other.
    • Tell each other what you like and how you like to be touched.

    Many people give each other oral sex or masturbate together as a healthy and enjoyable part of their sex life.

    You may find talking to your partner about your feelings and sexual desires helpful, although it's not always easy to do.

    For more advice read Keeping the passion alive.

    Sex after the menopause

    Some women say they feel more relaxed about sex after the menopause because they no longer have to worry about contraception.

    However, some women can experience vaginal dryness and a lower sex drive after going through the menopause.

    Tips to relieve vaginal dryness:

    • Soap, bath oils and shower gels can aggravate dryness. Instead, use lukewarm water alone or with a soap-free cleanser.
    • Try using a lubricant such as Astroglide, KY Jelly, Replens, Senselle or Sylk. These are available from pharmacies.

    A lower sex drive is often temporary, and being able to talk things through with an understanding partner may be all that's needed.

    However, if symptoms of the menopause persist or if you have low mood, then it may be best to see your GP.

    Find out more about Sex after the menopause.

    New relationships

    Starting a new relationship later in life can be daunting, but it can also be exciting.

    If you've lost a long-term partner, you may feel guilty about getting close to someone else and starting a sexual relationship.

    If you've recently been divorced, you may feel angry. Avoid jumping into a new relationship before you've dealt with your feelings around ending the old one.

    Take it slow and start with whatever feels comfortable for you, like hugs, closed-mouth kisses and caresses.

    Talking about your feelings may help, whether it's with your new partner, a GP, a relationship counsellor or a sexual therapist.

    Erection problems

    Most men have erection problems at some time in their life, and the causes can be physical or psychological.

    You should see your GP if you have erection problems for more than a few weeks, as it could be a sign of a more serious health condition.

    Erection problems can often be improved by making changes to your lifestyle, such as losing weight if you are overweight or giving up smoking.

    In some cases, your GP may recommend tablets, called PDE-5 inhibitors, that can help with erection problems.

    If these drugs don't work or are not suitable, other treatments include:

    • vacuum pumps
    • penis injections
    • counselling

    Find out more about Erectile dysfunction.

    Be wary of buying medication over the internet, as it may not be safe.

    Reduced sensitivity in men

    A lack of sensitivity in the penis is a normal part of ageing. It can make it more difficult for some men to get an erection and reach orgasm.

    To help, you could:

    • exercise your penis by having daily erections (even if it's not for sex)
    • try more direct stimulation of your penis during sex to improve your erection

    Stopping smoking, losing weight and exercising more often can help by improving blood flow to the penis.

    See your GP if you have reduced sensitivity, as this can sometimes be caused by another health condition.

    Sex and arthritis

    Arthritis can affect sexual intimacy. Here are some ways of overcoming common difficulties.

    To help relieve joint pain:

    • Experiment with different positions to take pressure off your joints.
    • Use pillows or adaptive equipment for support. 
    • Take painkillers before sex.
    • Have a bath before sex.
    • Experiment with other forms of stimulation, such as masturbating each other.

    To help with fatigue:

    • Think of ways to reduce your daily workload.
    • Make sure to rest during the day.
    • Share household chores with your partner.

    If you've lost self-confidence:

    • Talk to your partner – they may not realise how you feel.
    • Let your partner know you need some reassurance.

    Sex won't make your arthritis worse, so if sex is a regular part of your relationship then you can try to keep it that way.

    For more advice, including images of helpful sexual positions, read Sex and Arthritis from Arthritis Research UK.

    Sexually transmitted infections

    Rates of some sexually transmitted infections (STIs) among older people are on the rise and don't always have symptoms.

    Condoms are the only form of contraception that will help to protect you from STIs.

    If you've just started a new relationship or are beginning to date again, consider carrying condoms with you.

    If things get sexual, don't wait for your partner to suggest using a condom, because they might not. Don't be afraid to bring up the subject of condoms yourself.

    An STI can be passed from one person to another through sexual contact, including vaginal, anal and oral sex.

    You can get or pass on an STI no matter who you're having sex with – they can pass between men and women, women and women, and men and men.

    For more information on safer sex for same-sex partners, see Lesbian sexual health and Sexual health for gay and bisexual men.

    If you're worried you might have an infection, talk to your GP. You can get tested at a sexual health clinic

    Find out about STI symptoms and where to go for help if you're worried.

    Where to get more help

    These organisations can help with issues with sex and relationships as you get older:

    Video: sex over 60

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