Kate Moyle, a psychosexual and relationship therapist and author of The Science of Sex, says the single most common problem she treats is anxiety — and midlife is when it tends to spike. Changes in how sex feels or works make people worry something is wrong with them, and that worry then becomes the problem. Her core message: sex doesn't need to look like it did at 25, but if it isn't working, that's a prompt to change something, not a personal failure.
The physical side is real. Men in their 60s often see lower libido as testosterone declines, along with slower recovery between encounters and prostate issues that can affect erections — and a sudden change in morning erections is worth a GP visit, since it can signal diabetes or heart disease. For women, the drop in oestrogen around menopause brings dryness, tissue thinning, discomfort and more UTIs. Moyle stresses these aren't just 'part of getting older': lubricants, vaginal moisturisers and prescription vaginal oestrogen all make a genuine difference.
Pain is another area she thinks medicine has failed, especially for women. Vaginismus — involuntary pelvic floor tightening that makes penetration painful or impossible — affects at least two in 1,000 women and can appear suddenly after hormonal shifts, surgery or stressful experiences. Endometriosis, vulvodynia and lichen sclerosus can all make sex painful, and avoidance can spiral into anxiety-driven conditions. Men get pelvic pain too, from prostate problems, stress or cycling. Her rule: pain is common, but it's never something to just put up with.
The anxiety loop is the piece most people recognise. Worry about losing an erection — whether the trigger is diabetes, stress or SSRI antidepressants — makes the erection harder to keep, and that fear can linger even after the physical cause is fixed. Medication corrects the chemistry; therapy unravels the fear. For women, fixating on orgasm makes it harder to reach. Moyle's advice is to slow down, work out what turns you on and what kills the mood (phone alerts, she notes, are a major culprit), and tell your partner what's happening so you can tackle it together.
She also pushes back on metrics. Frequency is a poor measure of a healthy sex life; satisfaction, pleasure and connection are what count. Her most-recommended product is simply lube — safe, cheap and unfairly stigmatised as a sign of insufficient arousal. Sex toys, she argues, are tools to add variety, not replacements for a partner. And above all, don't suffer silently: the phrase she hears most in her therapy room is 'I've never heard anyone describe this before', usually from someone who assumed they were broken. Start with an honest conversation, a book, a podcast or a GP appointment. As she puts it, sex is always a shared dynamic — one person can rarely fix it alone.