Is it normal to struggle with sex and intimacy?

Yes. Many people experience changes in desire, confidence, comfort, or connection at different life stages and under stress. Therapy can help you work with what’s maintaining the difficulty.

Do we have to come as a couple?

Not necessarily. Some people prefer individual work, others prefer couples work, and sometimes a combination is helpful. We can discuss what fits your situation.

What if sex has become painful?

Pain should be taken seriously and assessed medically where appropriate. Therapy can help with the fear–tension–avoidance cycle and support confidence and boundaries, alongside medical input.

Can therapy help with performance anxiety?

Yes. Performance anxiety is common and often maintained by monitoring and fear of judgement. Therapy helps reduce threat responses and rebuild confidence and presence.

What if we have different levels of desire?

Desire differences are common and can be worked with. Therapy helps you understand the pattern, reduce pressure and resentment, and build more honest and supportive communication.

Do you offer psychosexual therapy in London and online?

Yes. We offer therapy in London and online across the UK.

Psychosexual Therapy

Sex and intimacy difficulties are far more common than people realise, yet many people feel alone with them. You might be in a relationship and struggling to talk about it, or you might be single and worried something is “wrong” with you. Often the hardest part is the shame, the avoidance, and the sense that this area of life has become tense rather than connecting.

Psychosexual issues can involve desire, arousal, comfort, confidence, pain, anxiety, avoidance, past experiences, relationship dynamics, or the pressure to “perform.” Sometimes there is a clear trigger such as stress, menopause, childbirth, illness, medication, or a relationship rupture. Other times it’s a gradual shift over time.

At Hampstead Psychology, we offer psychosexual therapy in London and online across the UK. Our approach is discreet, evidence-based, and emotionally attuned. We help you understand what’s maintaining the difficulty and build a calmer, safer, more satisfying relationship with intimacy.

This page is for information and does not replace a clinical assessment, diagnosis, or medical advice.

When psychosexual difficulties start to take over

You might recognise some of these experiences:

Sex feels tense, pressured, or anxiety-provoking rather than enjoyable or connecting.
You avoid intimacy because you’re worried about what will happen, or how you’ll feel.
You notice a gap between desire in your head and what your body seems able to do.
You feel stuck in performance anxiety, monitoring yourself instead of being present.
You and your partner are mismatched in desire and it’s creating distance or resentment.
You feel shame, self-criticism, or embarrassment that makes it hard to talk.
You’ve had painful experiences and feel anxious about comfort or safety.
You’ve lost confidence in your body or in your ability to relax during intimacy.
Your relationship feels strained because sex has become a difficult topic.
You’ve tried to “fix it” through willpower, but the pressure makes it worse.

If this fits, it doesn’t mean you’re broken. Psychosexual difficulties often reflect a nervous system that has learned to associate intimacy with threat, pressure, shame, or pain. Therapy helps you reduce that threat response and rebuild safety, choice, and connection.

How psychosexual issues can show up

Anxiety, pressure, and “spectatoring”

When intimacy becomes associated with performance, people often start monitoring themselves: “Am I doing it right?” “Is it working?” “What does my partner think?” This turns attention outward and increases threat physiology, which makes relaxation harder. Therapy helps you shift from monitoring to presence, and from pressure to safety.

Desire differences and relationship dynamics

Differences in desire are common. They can become painful when they lead to rejection, resentment, or avoidance. Therapy helps couples understand the pattern: how pressure, pursuit, withdrawal, stress, resentment, and disconnection interact, and how to rebuild closeness and communication.

Pain, fear, and avoidance

danger. Fear and tension can then increase pain and avoidance, creating a self-reinforcing cycle. Therapy supports safe, paced work with anxiety, boundaries, and confidence, alongside appropriate medical input where needed.

Trauma, shame, and difficulty feeling safe

For some people, psychosexual difficulties are connected to past experiences, relational ruptures, coercion, or trauma. Others have grown up with messages that created shame and disconnection from the body. Therapy helps you work with safety, consent, boundaries, and self-compassion at a pace that feels contained.

Life stage changes and health factors

Menopause, childbirth, health conditions, medication, fatigue, and chronic stress can all affect sexual functioning and desire. Therapy helps you work with the psychological impact and the relationship dynamics, while recognising the role of the body and life context.

Related difficulties we often see alongside psychosexual issues

Psychosexual difficulties often overlap with anxiety, low mood, stress and burnout, relationship strain, body image concerns, health anxiety, and self-criticism. Sleep disruption and exhaustion can also reduce desire and increase irritability, which then feeds into the relationship pattern.

Therapy takes the whole picture into account while staying focused on what will help most.

Medical input alongside therapy

Sexual difficulties can have physical contributors, and it’s important that pain or persistent physical symptoms are assessed appropriately. Psychosexual therapy works alongside medical care where relevant. If physical factors may be contributing, we recommend appropriate medical input through your GP or treating clinician alongside therapy.

What keeps psychosexual difficulties going?

Psychosexual issues are often maintained by loops that make sense in the moment.

A trigger appears (pressure, fear of pain, fear of judgement, a relationship tension, a body sensation).
The nervous system goes into threat mode: vigilance, monitoring, tension, reduced desire or responsiveness.
You cope by avoiding, pushing through, trying to “perform,” or seeking reassurance.
Short-term relief happens, but the underlying threat association strengthens.
Over time, intimacy becomes linked to anxiety rather than safety, and the cycle continues.

Therapy helps you step out of this loop by reducing threat, building safety and communication, and helping your body and mind relearn intimacy as something calmer and more connected.

How psychosexual therapy helps

At Hampstead Psychology, we use approaches that are widely used in evidence-based psychological practice, tailored to psychosexual concerns. Depending on what you need, therapy may draw on CBT and ACT-informed work for anxiety and avoidance, compassion-focused work for shame and self-criticism, and relationship-focused approaches where dynamics between partners are central.

In practice, psychosexual therapy often involves understanding your pattern, reducing pressure and performance anxiety, strengthening communication and consent, and building a paced pathway back to safety and confidence. Where appropriate, we support couples to move out of cycles of pursuit and withdrawal and into clearer, kinder conversations that reduce resentment and rebuild closeness.

The aim isn’t to force intimacy. The aim is to create the conditions where intimacy can become safer, more choiceful, and more satisfying again.

What to expect from sessions

We begin by understanding the difficulty in context: what has been happening, what changed, what triggers anxiety or avoidance, and what impact it has on you and your relationship. We’ll agree goals and develop a shared map of what’s maintaining the pattern.

Sessions are discreet, paced, and collaborative. Some people come alone, some come as a couple, and we’ll discuss what fits best. You’ll leave with insight that feels usable and practical steps to try between sessions, reviewed and refined over time. We work carefully with boundaries and safety, because that’s the foundation of change in this area.

How long does therapy take?

This varies. Some people want focused work on performance anxiety, confidence, or desire differences. Others need longer, particularly when pain, trauma, relationship repair, or major life transitions are involved.

We review progress together so therapy stays purposeful and aligned with your goals.

Psychosexual therapy in Hampstead and online

We offer psychosexual therapy in person in London and online across the UK. Many people choose online sessions for privacy and convenience. If you are working as a couple online, we’ll help you set up the space so both partners can feel comfortable and heard.

Take the next step

If sex and intimacy have become tense, confusing, or painful, you don’t have to carry it alone or keep trying to solve it through pressure and avoidance. With the right support, it’s possible to rebuild safety, confidence, and connection.

Contact Hampstead Psychology to enquire about OCD therapy in London or online.

Useful links: Couples Counselling, Menopause Therapy, Anxiety Therapy, Stress and Burnout, Therapy for Men, Fees, Meet the Team, Contact.

Urgent Help

If you are worried about immediate risk to your safety, call 999 or go to A&E. If you need urgent support but it isn’t an emergency, contact NHS 111 or your GP. You can also contact Samaritans on 116 123 (24/7).

Meet The Team

At Hampstead Psychology, all of our psychologists have extensive training to doctoral level and decades of experience in their field of expertise. You will be matched with a psychologist that has the knowledge and skill to help you understand and overcome your problem - not just in the short term but for good.