I am 46 and my partner is 38. We have a great relationship in every way, with the exception of the bedroom — this has always been a problem. She is prudish and hung up, whereas I am very open. She thinks that foreplay is overrated. I want to spice things up, but she seems to want to get sex over with as quickly as possible. How can a relationship like ours survive?

A lack of foreplay is usually high on the list of female sex gripes so your partner’s stance seems odd. However, men should never underestimate the complexity of the female relationship with orgasm. Without wishing to be too graphic, the difficulties are rooted in the fact that women generally discover climax alone and it is almost always a non-penetrative experience. When they subsequently become sexually active, a combination of shyness and inexperience makes it difficult for them to translate the pleasure they experience by themselves into sex with a partner.

Invariably, most women’s early sexual experiences are pretty disappointing and, for a percentage, things don’t get much better. In the most comprehensive survey of sexual behaviour in the United States — The Social Organization of Sexuality, Edward O. Laumann, 1992 — 75 per cent of men questioned said that they always had an orgasm during sex, compared with only 29 per cent of women. And in The British National Survey of Sexual Attitudes and Lifestyles (Natsal, 2000), 39.6 per cent of women had a form of sexual dysfunction diagnosed, most commonly, inhibited orgasm (18.9 per cent) and lack or loss of sexual desire (16.8 per cent).

Eventually, most women work out ways of getting what they want. Some simply ask for it. In your letter you mention that your partner likes sex only if she is “on top” and this is one of few sexual positions that provides the stimulation that women need. That she is a willing partner contradicts your description of her as “prudish”. However, that she is so resistant to variation and totally goal-oriented suggests that she is not confident about her ability to enjoy sex in other ways. I suspect that she harbours anxieties about her ability to climax and that she views other forms of stimulation as an unwelcome distraction.

It’s not that she wants to get sex over with, it’s that she feels she needs to race to the finish before she loses the sensations that will tip her over the edge. It is pretty classic behaviour but the more she worries about it the less likely she is to be able to break out of the negative sexual spiral that she has created for herself. If you want to help, you need to radically adopt your take on things.

There is nothing physically wrong with your partner but her approach to sex is creating a rift between you. If you want to change the sexual dynamic between you, you need to do exactly the opposite of what you are doing right now.

Forget the fluffy handcuffs — the most important thing that you can give your partner right now is confidence. Instead of putting pressure on her to experiment, what you need to give her is a kind of “back to basics” course that helps her to understand that her whole body could contribute to her sexual pleasure if she would only allow herself to relax enough to enjoy sensuality and intimacy. If you can reassure her that you will meet her needs no matter how long it takes and encourage her to let go of the idea that good sex is defined by orgasm you will give her the confidence to broaden her sexual horizons.

One of the most effective ways of helping her to do this would be to temporarily let go of sex altogether and practise a series of behavioural exercises called sensate focus. This involves abstaining from sex initially and concentrating, instead, on non-sexual touching sessions.

The idea is that couples slowly build up from touch to, eventually, intercourse. By removing the pressure to perform, sensate focus allows couples to become more aware of the pleasure of touch and to challenge their own assumptions about what makes for a rewarding sexual exchange.

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