Caroline Lovett, a psychosexual and relationship therapist, gives some practical tips for getting sex back on the agenda.

People having medical treatment can sometimes feel as though their identity can change. Sometimes it feels like you've handed your body over to the medics. You're so used to having things done to you by other people that you kind of lose a connection with yourself to an extent. The thought of reconnecting with that sense of self can feel quite strange as a result. It can be a source of great anxiety: are things going to work the way that you want them to? 

That anxiety is totally normal. When we’re worried about our health, our cortisol levels can be raised. When we’re in this hypervigilant state, it can be difficult to shake it off. That anxiety can seep into other aspects of our lives, including reconnecting with our sexual selves. 

The starting point for dealing with any kind of sexual worries is talking openly about what's going on and, ultimately, what you want. We're all programmed differently, so give yourself time and permission to think about what you would like. If you're in a relationship, set aside some time to talk to your partner. 

Try not to choose a time when you're both tired or stressed. Think about how you can have those conversations in a way that doesn’t feel critical. You want some space to talk about how things are. Car journeys can be excellent for this: you've got a captive audience. Ultimately, you need a space where you can get time and privacy.

Time to fantasise

Sexual identity can change. Some of the treatments that we experience can also affect our arousal pathways, and we need to remember that everyone gets aroused in slightly different ways. 

Give yourself permission to daydream about sex. Give into your fantasies a little bit; take time to explore what really arouses you. 

If you're in a relationship, your partner's arousal journey might be very different to yours. This is a great topic to start a conversation about sex. Ask each other: what are the things that get you aroused, compared to what gets your partner aroused? They might be different on different days. Sometimes our body can be more responsive, particularly around touch. Sometimes our body can be quite spontaneous; we can suddenly find that we're feeling aroused. Embrace those differences day-to-day. 

Getting over the intimacy barriers

Our body image and self esteem can become a barrier. Most people that I work with, whether illness is present or not, worry about things sexually. We can be pre-programmed to have this image of who we should be sexually and how we should behave sexually. 

Making your own connection to yourself sexually is a journey that you need to set aside some time to explore. If you're in a relationship, I recommend that you spend some time being with yourself sexually. 

People say to me: why do sex therapists always go on about masturbation? It's a really good opportunity for you to explore your body for yourself and to see what feels comfortable and what feels pleasurable. The more that you learn about you, the more you can then take that into a relationship. 

Easing discomfort

If you’re experiencing any pain or discomfort, you need to think about some planning around sex. Maybe think about how you can set up the room more comfortably and where you feel most comfortable having sex. Adding in extra cushions and pillows may feel more supportive. 

If you're experiencing any vaginal dryness, it might be that we want to get into the habit of using a vaginal moisturizer. Remember to use a vaginal moisturiser that is designed for the vagina, not any old moisturiser. And likewise with lubricants, there are lubricants specifically designed for vaginal and anal sex. This is a very normal thing to use and might just help with your comfort level.

If we've ever experienced sexual pain or trauma, that can get stored in our brains, bodies and emotional centers, and these can resurface at unexpected times. It might be helpful to talk about these things with a therapist.

It might be helpful to explore that, talk through any past traumas and deal with any physical or psychological pain you might be experiencing, in order to lay a new foundation for sexual exploration.  

If there’s a physical barrier, consider asking your medical team if you can see a physiotherapist who particularly works with the pelvic floor. Both women and men have a pelvic floor; it's a really important part of the structure of support around our genitals. A pelvic floor physio can really help you focus on the muscles, ligaments and the blood supply to your genitals. That might be something your health team can refer you to.

Dealing with anxiety

Men can worry about erection difficulties, or difficulty ejaculating. Things might not work the way they did before treatment. It’s really important that you talk about your concerns. The starting point is to be able to voice what's happening. Because the worry alone is enough to stop things from happening. Who do you feel comfortable talking to? Don’t forget your medical team will be used to these conversations.

I often talk to patients who experience changes in orgasm, or arousal or desire. The treatment can cause some of these changes, but worry can also influence your desire. If we're stuck in this worry loop, it's going to affect our experience. It's really important to find the space to be able to talk about these things. These changes might be temporary, or it might not. Learning to adjust and experience your body in a slightly different way might be an important step if you want to move forward. 

There are various techniques you can use to help ease anxiety. Think about your breathing: take some deep breaths in and some slow breaths out. This will help you bring down anxiety levels. Take time to figure out your coping mechanisms. This is not just thinking about ourselves sexually; these are the things that you do every day that help you cope with different things. Think about using them when you start to feel anxious. It can be helpful to explore some self soothing techniques. There are some really good apps out there giving good ideas, such as the Calm app, for example.

When to get further advice and information

I'm often asked when people should seek further professional help from either a psychosexual therapist or another therapist. My response is that it very much depends on the individual. If you're feeling stuck or frightened, and you feel as though you've got no one else to talk to, then seeing a therapist might help. It might be that just one or two sessions could really help you.

If you think that you are depressed, then please talk to someone. If you feel it's something that you can talk to your medical team about, maybe try talking to them. 

Sometimes things are really easily resolved. Medical teams are quite used to dealing with routine issues. But if you're feeling as though you need a bit more support, don't worry about coming forward.

If you’re looking for some support, I would definitely recommend going to the College of Sex and Relationship Therapists (COSRAT) website. Everyone on that site is trained and regulated, unlike some of the advice you can find on the internet. Make sure you get support from a trained  professional. 

More articles and videos from Caroline

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Further support and advice

• COSRT - College of Sex and Relationship Therapists. Psychosexual Therapists are listed here.
• mojoupgrade.com/ - For over 18's. Aimed at couples who are wanting to connect more sexually
• Omgyes.com - Based on research into women's sexual pleasure. Explores sexual techniques.
• Ergoerotics.com - A website selling products that can support sex (over 18's)