DR THOMAS STUTTAFORD

A When a doctor is consulted by a female patient complaining of lack of interest in sex the first question is, does the woman have an indifference to sex, or an aversion to it? When there is total indifference the problem can be a medical one, associated with hormonal or genetic abnormality. Such cases are rare.

However, when a woman complains of a lack of sexual interest after years of a satisfactory sexual response, a psychological rather than a physical cause is a distinct possibility.

Since you are seized by a panic attack, the most important factor in your reluctance to engage in sex is aversion. When I was a junior doctor working in a psychiatric unit I was taught that in nearly every case of a woman claiming that she was indifferent to men there was an element of aversion. Sex may induce feelings of revulsion even disgust, guilt, anxiety or a fear of sexual inadequacy. A surprising number of women have an often mistaken fixation about a particular feature of their bodies.

In your case the aversion is so strong that it induces symptoms of a panic attack. Panic attacks are induced by sudden intense fear or anxiety. The trigger for you is feeling that your lovely man is about to, as my patients would have said, pounce. Panic attack symptoms include a pounding heartbeat, trembling, hyper-ventilation with chest pain, dizziness, numbness or tingling in the feet or hands. Most patients also suffer a hot flush, but a few feel chilled. Not all symptoms occur in every case but even so can be so frightening that someone has a sense of impending doom. One consequence of panic attacks is living in constant fear of having another one. As a result, sufferers adapt their lives to avoid whatever precipitated an attack. The early tentative physical advances you dread may have started when you were in your twenties because you either feared physical exposure or loss of psychological control. Many young women fear that they will appear unsophisticated, naive, sexually unpractised and inadequate. In some, these anxieties may well be exacerbated by a feeling of revulsion; in others by an entrenched sense of guilt.

The sexual attitudes in a family are learnt by example or by picking up subconsciously revealed opinions of those around you.

These prejudices may be enhanced by actual verbal teaching. My father always advised his young patients that they shouldn’t marry someone unless their intended had had a good – neither too close, nor too distant – relationship with their parents. As Freud pointed out, the early relationship with the parent of the opposite sex was the most important, providing a template for future relationships.

More recent research has indicated that aversion to sex is more common in people with no siblings. Brothers and sisters contribute more to sexual education by encouraging familiarity with nakedness and bodily functions, as well as the art of social interaction, than was realised.

The treatment for social and sexual phobias includes supportive psychotherapy, reassurance, support, education and cognitive therapy. Panic attacks are usually dealt with by accustoming the person to the cause of anxiety. This type of panic attack shouldn’t be dealt with by sudden overexposure to the fear.

— Dr Thomas Stuttaford, The Times, is a doctor who spent many years working in a genitourinary clinic

SUZI GODSON

A Your 25 years of self-imposed celibacy suggest something slightly more sinister than an allergy, my love, but I’m sure you know that already. Panic attacks occur when people cannot cope with certain situations and their stress manifests itself as a physical response. The symptoms of panic become fixed associations with a particular episode and sufferers, understandably, do their best to avoid putting themselves in that position again. Research carried out in 2001 at the Federal University of Rio de Janeiro indicated that 50 per cent of women who suffer regular panic attacks also suffer from sexual aversion disorder, a form of panic attack that manifests specifically in relation to sexual contact. People with sexual aversion disorder may be averse to a single aspect of sex such as genital contact. Others are revolted by all sexual stimuli, even touching and kissing. The Rio study suggests that it is not sexual dysfunction, but the fear of having a panic attack that causes sexual aversion disorder.

Nearly all people suffering from it will go to heroic lengths to avoid sexual activity. Certain people have a greater hereditary predisposition to panic attacks and, inevitably, children who have a genetic tendency who also have difficult childhoods are more likely to manifest anxiety in this way in later life. Sexual abuse, rape, death, domestic violence, divorce, bad relationships, poverty or even unsatisfactory employment can bring on panic disorders, but sometimes normal life changes may trigger attacks. Finishing school or college, changing jobs, moving house or having a baby can all have a cumulatively stressful effect. You may or may not be aware of what triggered your panic but your strategy – avoidance – is surely the most common form of self-help. Though recent surveys indicate that panic disorders affect up to 18 per cent of people in the UK, an estimated 75 per cent of sufferers do not get professional help. Avoidance might be viable for someone suffering from selachophobia (fear of sharks), but you shouldn’t spend your life avoiding sex.

Falling in love and establishing a sexual relationship are among the most joyous experiences. It would be tragic if fear denied you this opportunity. If this lovely man cares, he will understand your anxieties, but if the relationship is to blossom he will need to see you making a concerted effort to tackle them. The best way is through a course of cognitive behavioural therapy (CBT). The British Association for Behavioural and Cognitive Psychotherapies (babcp.org.uk) provides an online list of registered therapists. Or try contacting No Panic (no-panic.org.uk), a national charity specialising in helping people who suffer from panic attacks. Its free helpline (0808 8080545) handles about 55,000 calls a year and No Panic also runs 14-week, one-hour telephone conference sessions in CBT through the year. All you pay is your regular phone tarrif. CBT has an estimated 80 per cent success rate, though Colin Hammond, who founded the charity, says: “Success with panic disorders is relative. It doesn’t necessarily mean that an agoraphobic will fly to the moon, but it does mean that people can live comfortably and happily.”

After 25 years on your own, I think you deserve a little of that, don’t you?

— Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

Times recommends

• 12 party beauty tips
• Nutrition: is being big a genetic destiny?
• What it feels like: to pry into other people's lives