Sex counsellors have a unique insight into our shared concerns and insecurities. Where once they focused on physical issues, now they are tackling psychological ones

Denise Knowles, a sex and relationship therapist with the charity Relate, says patients often say to her: “There are so many options, I don’t know where to start.” Thirty years ago, Knowles was mostly approached with physical problems: erectile dysfunction, painful intercourse, issues with ejaculation. Now she describes the scope of her work as “bio-psycho-social”. That is to say, everything has got a lot more complicated.

“I think it has gone from being very much: ‘This is the problem; this is how we resolve it,’ to: ‘How do we approach sex? What does it mean to you? How does it fit into the relationship, and how have you got to this place?’” She laughs. “Then we can start to deal with it.”

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