I’m nearly 37, and have never had a fulfilling sex life. I can’t let go, because of my severe body dysmorphia and some unresolved issues from my childhood. I hate having someone focus on me, my breathing and the lack of sound I make, as well as questioning if I’m enjoying it. It makes me even less likely to relax and let go. If I were more confident in myself, my sex drive would be higher; I’d be more open-minded and experimental – I know exactly what I like. I’m more confident if I’ve been drinking, but still not enough. I need to get over this before it’s too late. I cause damage in my relationships, and it isn’t helped by my inability to communicate. I am very guarded and protective of myself. You know exactly what your issues are, and are wonderfully aware and analytic about your triggers and responses – yet you seem to think you can continue in the same vein and miraculously have a different result. Take action now to seek treatment for all the things you have identified – body dysmorphia and unresolved childhood issues – and possibly generalised anxiety. These things are all treatable. Seek good therapy with someone you respect and trust, and – when appropriate – add sex therapy. Using alcohol to tolerate sex creates its own set of problems. You deserve to feel better, to have better sex and better relationships, not to mention an overall better quality of life. Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders. If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions: see gu.com/letters-terms. Comments on this piece are premoderated to ensure discussion remains on topics raised by the writer. Please be aware there may be a short delay in comments appearing on the site.