How to start a conversation about sex

Sex and relationships therapist Victoria Lehmann offers her tips on how to start a conversation about sex with your partner and GP.

Image of a heart in the middle of 2 conversation bubbles


A BHF survey reveals that having a heart and circulatory condition can have a negative impact on your sex life, and make you worry about having sex. 

Of the 2,400 people who took the survey in May 2018, nearly half said their condition had affected their sex life. Of those who were worried about having sex following their diagnosis, 63% said they hadn’t talked to anyone about their concerns, mainly because they either felt too embarrassed, couldn’t find the support they needed, or their partner didn’t want to discuss it. 

Research shows that it’s common for people not to talk about sex. A 2017 survey in the US found that while sex is really important to the health and wellbeing of those aged over 65, it's a topic rarely discussed with partners or healthcare professionals. 

Talking openly about sex can be challenging, and not everyone feels comfortable doing so. 

“It can be difficult to approach the subject,” says Victoria Lehmann, a sex and relationships therapist at London Urology Associates and Trustee of the London Urology Associates. 

“It’s not always an easy conversation to have because other issues might be brought up,” she adds. 

“After an illness, there is a sense of sadness and vulnerability. This is understandable because an illness can lead to a change in roles in relationships, with the other partner sometimes becoming the carer for instance. It is then difficult to reassess and think about being sexually intimate again. 

“You have to think of it as a ‘new normal’ - it may be very different than before, but doesn’t mean your sex life has to be any less pleasurable.” 

Communication is important for understanding what is best for you and your partner, and also helps GPs find a solution for any problems, such as impotence or loss of sex drive, that you might be experiencing, says Ms Lehmann. 

Ms Lehmann offers her tips on how to best start a conversation about sex with your partner and GP:

Talking to your partner

Some tips for talking to their partner

  • Set aside a time when you are less likely to be interrupted and neither of you are too tired. 
  • Tell them directly that you need to talk to them about a problem with your sex life.
  • Try and use the word “I” as it helps to highlight that the thoughts and feelings are personal. If you say ‘you’ or ‘we’ it can sound as if we are blaming the other person or making an assumption that they feel the same way as us.
  • When you begin talking, start with a positive.
  • Use a recent article you have read to introduce the subject or show them the Sexual Advice Association app on the Sexual Advice Association website. You could say, for example: “I love spending time with you but I have noticed recently that we haven’t had sex for a while. I have been reading this article about problems with sex and wondered what you think about it?”

Ask for their thoughts and ideas about what might be helpful

You could say: 

  • “Is there something you are really worried about, especially since my recent heart problems?”
  • “Perhaps we could just have a cuddle but not have sex, would that help a little?” 
  • “Maybe we need to think about having some intimate time together in daylight hours when I’m not tired.” 
  • “I thought about making an appointment to see what the doctor advises. What do you think?”

Think about how you approach the subject

Rather than asking “why” you’re not having sex, say something like: “What would have to happen for us to be intimate again?” If your partner says, “I don’t know”, ask them to have a guess, or think about it.

How to talk to your GP about sex 

It’s important to talk to your GP if you are having sexual issues, as he or she will know your full medical history.

  • Try and go together as a couple as it gives you both an opportunity to talk about your concerns.
  • Never take any treatments until you have seen your GP. It is not advisable to buy any medications over the internet.
  • You could start the conversation by saying: “Ever since my recent heart problem I have been worried about having sex” 

If you’re not sure how to explain the problem, here are some words that might be relevant for your situation: “I don’t feel any desire to have sex”. “My erections are not as firm as they used to be.” “I have been finding sex painful.” “ Recently I haven’t been enjoying sex because I’m worried about…”

Many couples are worried that they may have a cardiac event, such as a heart attack, during sex. Often these worries will be unfounded. Your GP will be aware of the medication you’re taking, and your condition. Just ask: “Is it safe to have sex?”

Where to get more information

The Sexual Advice Association (SAA) has downloadable factsheets on a number of symptoms and sexual problems - you can show these to your GP and partner to help start a conversation.

The SMART SAA app, created by the Sexual Advice Association, gives you information and advice on what you can do if you have any type of sexual problem or concerns. You can use the app yourself or with your partner. Download it via the App Store, Google Play or via the Sexual Advice Association website.

If you want to speak to a specialist doctor or therapist you can try:

  • Institute of Psychosexual Medicine – provides both private and NHS doctors specialising in sexual health across the UK – although be aware that for a NHS consultation you will probably need to be referred by your GP.
  • College of Sexual and Relationship Therapists – provides private consultations across the UK. You can search by location for a therapist.
  • If you decide to have a private consultation, be aware that fees can vary. It’s worth ringing around to make sure you find someone you like, and that the timing of the appointment works for you (consultations over Skype and telephone are often available). The outcome is usually better if you go as a couple.