Welcome to my virtual therapy room! I’m Dr Lori Beth and this is Sex Spoken Here. Today we are talking about communication and sex. Many people find talking about sex very difficult. In my experience, heterosexual couples don’t spend much time talking about sex at the beginning of a relationship. Some have the ‘safe sex’ talk  but many others simply use condoms and avoid this talk. 
Heterosexual couples who do talk about sex before having it come in three flavours: People who prefer kinky sex, people who become involved online (and don’t meet in person quickly), and people who have a sexually transmitted disease and are concerned they could pass it on.   
Many gay men also don’t talk a lot about sex before having sex. But more are happy to talk about sex (at least have a safe sex conversation) than heterosexuals. The same is true for lesbian women. 
Lots of people ask me what the problem is – you have sex, you enjoy sex – what is there to talk about? When you first fall for someone, the sexual energy is high – almost anything you do together sexually can feel good. You spend a lot of time thinking of your new partner, fantasizing about what you will do together. By the time you have sex, you are halfway or more to orgasm. What he does to you doesn’t matter so much. Lots of couples ignore when things don’t quite fit. Both women and men will fake orgasm so as not to hurt their partners.   
Once the relationship settles down into a routine, things change.  Part of this is biochemical.  Research has highlighted that it only takes between 1 ½ minutes and 4 minutes to decide if you fancy someone. 55% of attraction is down to body language, 38% tone and speed of voice and only 7% as a result of what is said. When you first fall in love, you are driven by testosterone and oestrogen.  Then adrenaline, dopamine and serotonin play a crucial role in fostering your attraction. It is at this point when all you think of is your lover.
Oxytocin and vasopressin encourage you to attach to your lover. These chemicals are around after you have sex so the more sex you have, the more you attach and bond. Then you enter routine relationship and these chemicals die down. This is the point at which couples report the beginnings of sexual issues. Usually this is between 6 months and 2 years in a relationship.
This is the point at which talking about sex becomes important but if you have not talked about sex much before, it is the point where it becomes extremely hard to bring the subject up. If you tell your lover you aren’t reaching orgasm, you worry that they will be hurt and also that they will ask if you were faking until that point.  If there is something kinky that you really fancy doing, you worry that your partner will be disgusted or reject you. 
Lots of couples settle into a routine of not talking about sex. Sex becomes something that happens in the same way, same day and sometimes even the same time. The longer the routine goes on without talking about things, the harder it is to talk about things.   
Sometimes this means people live unhappily for years and then something happens that provokes them to get some help. Other times, one partner has an affair. Sometimes the couple then gets help and far more often the couple separates. 
In my most memorable case, a couple was referred to me by a fertility doctor because they were arguing a lot and this doctor felt that they needed to learn to communicate. They had been undergoing fertility treatment for 9 months and no pregnancy had yet occurred.  I have always preferred to take a comprehensive history when I start working with people.  As part of this, I ask about sex life.   Margie told me that they don’t have sex. I asked when they stopped having sex and she replied ‘We have never had proper sex’.  I was a bit stumped.  I clarified ‘You haven’t had sexual intercourse’. And both said ‘yes’.  I asked if the doctors working with them knew and they replied ‘No.’ No one had...