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Most of us don’t expect intimacy to change as we get older. When it does, it can be unsettling, and it is often hard to know how to bring it up, even with someone we love.

These are not easy things to talk about. If any of this sounds familiar, please know you are not alone, and that there is nothing to be embarrassed about.

When something changes

For some men, it begins with difficulty getting or keeping an erection. For some women, it may be discomfort during sex, bladder leakage or changes that come with the menopause. The concerns are different, but the feelings can be very similar: embarrassment, a loss of confidence and a worry about what it means for the relationship.

Erectile dysfunction is often thought of as a purely physical problem, but its effects reach well beyond the bedroom. A man may begin to worry that it will happen again, lose confidence or avoid intimacy altogether, even in a loving relationship.

Women face their own challenges, which are not always talked about as openly. Stress urinary incontinence can mean worrying about leaks when exercising, laughing or during intimacy. After the menopause, falling oestrogen levels can lead to vaginal dryness and discomfort during sex, sometimes described as genitourinary syndrome of menopause (GSM). Others live with vulvodynia, where persistent vulval pain makes intimacy difficult. These are not small inconveniences. They can affect confidence, body image and the sense of freedom a woman once felt.

In the silence, partners often fill the gaps with their own assumptions. One partner may pull away because they fear letting the other down, while the other wonders whether they are still wanted. A woman may avoid intimacy because she expects discomfort, and her partner may take that as rejection. Changes in intimacy do not necessarily mean that love or attraction has disappeared. Physical symptoms, hormonal changes, health conditions, stress and anxiety can all play a part.

Often, both people are waiting. One worries about causing embarrassment, the other is waiting for the right moment, and each hopes it will simply pass. Over time, this can leave two people who care deeply about one another feeling further apart than they ever intended.

Starting the conversation

There is no perfect way to raise it, but a little openness helps.

• Begin with how you feel, rather than with what is no longer happening.
• Choose a calm moment, away from the bedroom and without any expectation of intimacy.
• Listen before trying to fix it. Patience and reassurance often matter more than answers.

If you are the partner, it may help to know that the person experiencing symptoms is probably already feeling frustrated or self-conscious. A simple “I’ve noticed things have changed, and I’d like us to work it out together” can lift a great deal of pressure. If you are the one with symptoms, you do not need to have all the answers before you speak. Saying it out loud is enough to begin.

Understanding your options

These symptoms often have a cause that can be looked into. Erectile dysfunction can sometimes be linked to conditions such as diabetes or heart disease, and women’s intimate symptoms can have several causes, including hormonal changes. Your GP is a good first step. Asking for help is a sensible thing to do, not a failure.

Depending on the cause, there may be options. For men, these range from medication and lifestyle changes to other approaches, including low-intensity shockwave therapy, which aims to stimulate local blood flow and may help some men, particularly where circulation plays a part. It is not suitable for everyone, and results vary.

For women, options may include pelvic floor treatment, hormonal or non-hormonal therapies and specialist care. Low-intensity shockwave therapy is also an area of interest in women’s intimate health, with its potential to support local blood flow and tissue health being explored for certain concerns. The evidence is less established for women’s conditions, and appropriate treatment depends on the individual and the concern being addressed.

The most important step is to understand what is going on for you as an individual. Different symptoms have different causes, and what helps one person may not help another. A proper assessment is what makes it possible to choose something suitable, and to rule out anything that needs medical attention.

Intimacy is about more than sex

Intimacy is also about feeling comfortable, connected and wanted. When it changes, couples may need time to adjust, to find new ways to show affection and, sometimes, to seek advice. For many, the first step is not a treatment. It is an honest conversation.

Physical intimacy matters, but its value is not measured by frequency or performance. There is no single right way through a change like this, and no timetable. What matters is that neither of you feels ashamed, and that you give each other the time and patience to adjust.

If you would like to talk it through

If you are worried, or simply want to understand your options, Vigore can help you take the next step. You can find out more about the available options and how to enquire about a confidential consultation with one of our clinic doctors, with no pressure to proceed. www.vigore.co.uk