Unconsummated relationships, where couples don’t have sex due to difficulties, trauma or sexual dysfunction are not often spoken about.

Usually, the couple feel embarrassed to discuss their sexual difficulties – but they are not alone. According to an AXA PPP survey, a third of Brits are fearful of getting naked, largely due to body image and self-esteem issues. But nerves around body image aren’t the only reason couples aren’t able to consummate their relationships.

Why aren’t couples having sex? Sarah-Jane Otoo, psychosexual therapist at Priory Wellbeing Centre Birmingham, tells Metro.co.uk: ‘Unconsummated relationships including marriages are largely unspoken about and the reasons behind them are often complex.

‘Some of the most common reasons are from a psychological viewpoint and include a general lack of education around sexual intercourse, fear, anxiety, shame and/or past trauma.

 ‘In addition, sexual dysfunction like erectile dysfunction, premature ejaculation, performance anxiety in males and vaginismus in females has been reported in several studies as well as vulvodynia, an often unbearable pain when the genitals are touched’.

Relationships expert Ben Edwards expands on this, telling us: ‘Post-traumatic stress and the psychological damage from past sexual abuse, low self-esteem or unhealthy relationships can be very hard to overcome.

’ We must not overlook the impact of sexual trauma and mental health issues. Aubrey Good has bipolar disorder, which dramatically affects her sex drive.

 ‘I can sometimes see a decreased or lack of libido, due to my bipolar disorder,’ Aubrey tells Metro.co.uk. ‘During periods of depression, my self-esteem tends to plummet.

‘Mixed with decreased energy and an increase in apathy, my body rejects physical intimacy in favour of seeking emotional nourishment. ‘I suffer from frequent bouts of hypersexuality. I am unable to receive any satisfaction from sexual intimacy and am often in pain or discomfort because of this.’

Aubrey takes medication, but like many taking pills for their mental wellbeing, has found that this has an effect on her sex drive, too. ‘A medication increase has caused me to have loss of libido,’ she explains. ‘Gaining weight from medication has contributed to my struggles.’

For Aubrey, the key is being able to communicate with a partner who understands her struggles. ‘Libido changes are a chronic challenge,’ says Aubrey. ‘Maintaining open dialogue with my partner has helped to ease the anxiety. ‘Sex is an emotional act as well as physical; we discuss the struggles and have seen progress.

Therapy has also been a relief. Our strong emotional connection has allowed us to make it through.’ For Emma (name has been changed), anorexia has brought on issues with intimacy. ‘My body image is awful,’ she tells us.

‘I am embarrassed and ashamed of the way I look and it takes me an extremely long time to feel comfortable with men. ‘It’s been the cause of many of relationships endings. Ironically, my eating disorder started at age 19 in large part due to a guy telling me I was overweight so it’s something I’ve never shaken off.

‘I had a lot of negative thoughts about my body during sex so wasn’t able to enjoy the moment, don’t enjoy being touched or looked at, and have difficulty relaxing. ‘If I had eaten too much, was having a bad day or stressed, then the eating disorder symptoms would creep in and I wouldn’t be able to have sex.

‘Counselling has helped me somewhat and taking things very slowly so I build up trust.’ Kate Moyle, a sexual and relationship psychotherapist, explains that anxiety is a common factor for a lack of sex in a relationship.

‘Every couple is unique and will have their own reasons and experiences for not consummating their relationship,’ she tells us. ‘These situations are often linked to some form of anxiety around sex which can in some instances impact sexual functioning. Some people may struggle with intimacy.’

For Sarah, 35, who has borderline personality disorder, that anxiety comes from a lack of self-confidence as well as a lingering shame around sex. ‘My husband and I have been together for 16 years, married for 12,’ Sarah tells us. ‘I always felt very prudish talking about sex due to my family background, before, during or after.

‘I was told not to have sex before marriage, so it always felt dirty and wrong. ‘My mental health issues mean my self-confidence is rock bottom. I’m at my heaviest weight and although occasionally I enjoy sex, I mainly do it so he doesn’t leave me.

‘We had marriage counselling which helped for a while, but nothing really helps. ‘My husband manages to stay with me. He says he misses not having more sex but he says it would never be a cause to leave me.

I wish I could be more confident.’ So what can you do if you need help with psychosexual issues? The main remedies are psychosexual therapy, counselling and working on communication, touch and intimacy.

Sarah Jane Atoo says: ‘It is important to remember that not one person in the relationship has the “problem”; you are both impacted. Psychosexual relationship therapy can be beneficial to help support couples that are experiencing problems with sex.

‘People may choose to enter therapy individually; however, it is often advised for couples to enter therapy together. By giving them a safe and confidential space, they may be able to come to a place of understanding.’

Ben Edwards recommends understanding each other’s reasons for a lack of sexual desire or drive, and to avoid blame or shame. ‘When working with my clients on their relationships, I  encourage them to understand each other’s “why”,’ he states. ‘We all have our reasons for wanting certain things and you must communicate this to your partner.

‘Lack of communication could be detrimental and to your partners own self-esteem. When it comes to abstaining from sex, the last thing you want is for a partner to harbour feelings of rejection because of an emotional barrier.’ It’s crucial to have a safe space where both parties feel comfortable talking about difficult issues.

‘Doing this work with couples is about opening up a safe space and the hopes and fears to do with sex to be discussed,’ explains Kate. ‘It’s important to see what has been tried and not tried and the ways that couples express intimacy.

‘Integrating touch slowly and becoming more comfortable with each other in states of undress is also a gradual process. ‘I aim to help couples understand desire and arousal so that we can try and get them to a place where they can meet sexually.’