A conversation about intimacy, belonging and relationships with Dr Yasuni Manikkage

In an age where relationships are shaped as much by emotional awareness as by digital connection, conversations about sexual health are finally stepping out of the shadows.

As Dr. Yasuni Manikkage explains, sexual health is not just a medical issue but a lived experience woven through communication, consent, mental wellbeing and self-respect. Many couples share a home, a bed, even children, yet still feel like “Roommates with responsibilities” rather than lovers, which often signal a lack of emotional safety rather than a lack of physical contact. When desire shifts, they may panic, blame themselves or fear the relationship is dying, instead of recognising that changes in desire are common, understandable, and often transformable with knowledge, honest dialogue, and small daily acts of connection.

Q: Why did you decide to talk about sexual desire and connection now?

A: Because so many couples quietly suffer here. They love each other, share a home, raise children, but feel like “roommates with responsibilities” rather than lovers. They rarely talk about sex openly, so when desire changes, they panic, blame themselves, or assume the relationship is dying. I want people to know shifts in desire are common, understandable, and often treatable with knowledge, communication, and small daily changes.

Q: You say there is an “education gap” in sexual health. What do you mean by that?

A: Most women have never been properly taught about their own sexual anatomy, especially where and how they feel pleasure. Many men, on the other hand, have been left to “figure it out” from pornography, jokes, and guesswork. That’s a terrible training manual for real bodies and real emotions. This gap affects how easily women reach orgasm, how safe they feel in bed, and how satisfied both partners feel in the relationship.

Q: We hear about the “orgasm gap.” Is it really not biological?

A: There are biological factors, yes, but the main gap we see between men’s and women’s orgasm rates in heterosexual relationships comes from communication, knowledge, and what I call “pleasure equity.” In many bedrooms, the script is focused on penetration, speed, and the man’s climax. Women’s pleasure is often treated as optional or “extra.” When couples learn anatomy, slow down, focus on both bodies, and talk about what feels good, that gap narrows dramatically.

Q: Most people think desire should be spontaneous. Is that a myth?

A: It’s one of the biggest myths. Movies show desire as a spark that appears out of nowhere: one glance across the room and suddenly you’re tearing each other’s clothes off. That kind of spontaneous desire does happen, especially early in a relationship. But for many people, especially women, desire is often “responsive”. That means they start feeling desire after some warmth, touch, emotional closeness, or stimulation, not before.

So, if you’re waiting to “feel like it” before you touch or connect, you may wait a very long time. For many, desire comes “after” they start, not before.

Q: How would you scientifically describe sexual desire?

A: Desire is not just a physical urge. It’s a blend of attraction to your partner’s body and personality, emotional connection and feeling cared for, a sense of self-expansion or growth, learning, feeling alive with them, trust and safety, both emotionally and physically. It’s contextual: it changes with stress, health, life stages, and relationship quality. It’s relational: it lives between two nervous systems, not just in one body. And for many, it’s responsive: you get in the mood “after” a hug, a joke, a shower together, not randomly at 3 p.m. on a Tuesday.

Q: You mentioned an “updated sexual response cycle.” What does that look like in real life?

A: Older models suggested a straight line: desire, arousal, orgasm and resolution. That’s tidy, but human beings are messy and complex. Modern understanding is more like a circle or loop. You can enter the cycle at different points: maybe you start with touch, or a feeling of closeness, or even just a decision to connect. Desire doesn’t always come first; sometimes it shows up halfway through.

For example, you may feel tired and not “in the mood,” but you agree to cuddle and share some gentle touch. As you relax and feel appreciated, arousal builds, and then desire appears. That’s normal, not fake.

Q: Are there real gender differences in how desire works?

A: There are common patterns, though individuals vary a lot. Many women tend to enter through emotional intimacy: feeling heard, understood, and safe. Physical touch then wakes up arousal, and desire follows.

Many men more often start with physical attraction or arousal. They may feel desire quickly in response to visual or physical cues, and emotional intimacy can deepen later.

Both patterns are healthy and normal. The problem starts when each partner assumes the other should work exactly like them, and if they don’t, they must be “cold” “needy” or “broken.” Understanding these differences turns conflict into curiosity.

Q: How does desire change as a relationship ages?

A: Think of three broad stages.

stage 1 – Early Attraction (0-6 months): High novelty, strong chemistry, lots of dopamine. You’re discovering each other; desire often feels effortless. stage 2 – Deepening Intimacy (6 months-2 years): You know each other better. The high settles. Desire becomes more linked to emotional closeness. Frequency may drop, and that is “normal”.

stage 3 – Maintenance and Maturity (2-10+ years): Life arrives -work, kids, money, health. Desire usually doesn’t feel automatic. It needs conscious attention, novelty, and emotional safety.

A common mistake is comparing stage 3 desire to Stage 1 and assuming, “we’ve failed.” Actually, you’ve just moved into a different phase that requires new skills.

Q: What are some main things that influence desire?

A:We can think in three layers.

Biological: hormones (testosterone, estrogen), brain chemicals (dopamine, serotonin), medical conditions like diabetes, heart disease, cancer, chronic pain, sleep problems, menopause, and genital issues such as vaginal dryness or pelvic floor pain.

Psychological: negative early sexual experiences, trauma or abuse, body image concerns, low self-esteem, anxiety, depression, and certain mental health conditions.

Relational and social: how safe and respected you feel, attachment style, quality of communication, power imbalances, work and financial stress, caregiving burdens, privacy, and cultural messages that centre on penetration over pleasure. Desire is never “just in your head” or “just in your hormones” – it’s all three interacting.

Q: What tends to kill desire in long-term relationships?

A: Several patterns show up again and again:

Resentment and unresolved conflict – small hurts that never get repaired.

Lack of emotional safety – fear of being judged, rejected, or punished for being vulnerable.

Poor communication – avoiding difficult topics, sarcasm instead of honesty.

Body image shame – feeling unattractive, “too old,” “too fat,” or “not enough.”

Power imbalance -one partner controlling decisions, money, or sex.

Sexual guilt or religious shame messages that sex is dirty, selfish, or only for reproduction.

Stress, burnout, depression -when your nervous system is in survival mode, it doesn’t prioritise pleasure.

You can’t expect desire to flourish in an environment that feels unsafe, unfair, or constantly tense.

Q: And what actually builds desire?

A: Desire thrives in a combination of safety and aliveness.

Emotional intimacy: feeling seen, heard, and valued.

Nervous system calm: your body is relaxed enough to feel pleasure, not just guard against danger.

Open communication: you can talk about wants, limits, and fantasies without mocking or shutting each other down.

Continued growth: doing new things together, seeing new sides of each other, evolving as a team.

I often say: stagnation is desire’s enemy; growth is its ally. Even small adventures -trying a new cafe, dancing in the living room, travelling a different route-can reawaken curiosity.

Q: Can you give couples a simple framework to reconnect?

A: Yes, I often share a six-step framework that’s practical and gentle.

1. Check in: Ask, “How connected do we feel lately?” Not just “How often are we having sex?”

2. Non-sexual touch: Hugs, stroking hair, holding hands – without expecting sex at the end.

3. Novelty: Try something new together: a class, a walk in a different place, a game, a shared hobby.

4. Appreciation: Tell your partner what you notice and value about them, including non-sexual qualities.

5. vulnerability: Share one fear, one hope, or one truth you usually hide.

6. Initiation: Don’t wait for desire to fall from the sky. Gently invite connection; sometimes the mood follows the movement.

You don’t need to do all of this perfectly. Even one or two steps, done consistently, can shift the energy between you.

Q: How can someone tell if their desire problem needs more attention or professional help?

A: some warning signs include:

You feel emotionally distant, even though you still love each other.

Desire has dropped sharply and is tied to stress, shame, or unspoken conflict.

You feel unable to talk about sex without fighting or shutting down.

sex is used to avoid real intimacy, or to keep the peace, rather than to connect.

You feel afraid or ashamed to say what you truly want-or what you don’t want. In these situations, talking to a doctor, a sexual medicine specialist, or a therapist can be very helpful. You are not “broken” for needing support.

Q: Many couples say, “We love each other but there’s no spark.” What do you tell them?

A: I often say, “Let’s first normalise where you are.” If you’ve been together for years, maybe raising children and navigating financial pressures, it’s normal that your desire doesn’t look like the early days. That doesn’t mean your relationship is dying.

usually, you’re in the maintenance phase. Desire is quieter but can be reawakened with intentional effort: scheduling time for each other, bringing in novelty, and rebuilding emotional safety. It’s less about chasing fireworks and more about tending a fire so it doesn’t go out.

Q: what about couples with mismatched desires – one wants sex often, the other rarely?

A: This is extremely common. The mistake is to frame it as “the pursuer is demanding” and “the less-desiring partner is rejecting.” underneath, there are often two different nervous systems trying to feel safe.

one partner might use physical closeness to feel secure and loved. The other might need emotional safety first before their body can relax into physical intimacy. When couples understand this, they stop seeing each other as enemies and start cooperating: “How can we meet ‘both’ our needs, instead of arguing about who is right?”

Q: Many people, especially women, say sex feels like an obligation. What does that signal to you as a doctor?

A: It’s a red flag – not that the person is broken, but that something important is missing. sex should be about connection, pleasure, and mutual choice. when it becomes a duty, I look for:

Emotional disconnection or resentment.

Fear of conflict or abandonment if they say no.

Lack of felt safety or freedom to express preferences.

The solution is not to “force yourself more.” It is to rebuild emotional safety, renegotiate consent and expectations, and often to have very honest conversations about what feels missing or painful.

Q: If you could leave couples with a few key messages about desire and connection, what would they be?

A: I’d highlight four truths:

Desire and emotional intimacy are deeply connected. When you feel safe, loved, and seen, desire has space to grow.

Desire changes across life and relationship stages. That’s normal, not evidence of failure.

Safety is the foundation. without trust and a calm nervous system, no technique or position will fix desire.

You have agency. Through communication, intentional connection, and sometimes professional help, it is possible to revive and reshape your sexual relationship. If you are reading this and thinking, “This sounds like us,” my invitation is simple: start with one honest conversation. Ask your partner, “Where do you naturally enter the cycle -through emotions, touch, or arousal? What helps you feel desire? What do you need from me to feel safe and wanted?”

Those questions, asked with kindness and curiosity, can quietly change the entire trajectory of a relationship.