I’m a 27-year-old woman. Each of my relationships starts out with a new, exciting honeymoon stage, which eventually gives way to me not caring about sex. Life gets in the way, with the kids and family problems, but why am I never, ever aroused like before? I have a recent disability that causes me pain, which isn’t helping the situation with my current partner. But I’m at the point where I think there’s something wrong internally, such as hormonal issues. I’m only 27, so getting a professional to check this out is nearly impossible. Pain will certainly diminish sexual desire, so at the moment it is not surprising that you do not feel desirous or have difficulty becoming aroused or achieving orgasm. There are some strategies for managing the pain in order to try to enjoy sex, such as using heat pads, or timing sex for those moments when your medication is working most efficiently. If you suspect there is something physiologically wrong, then do have a check-up, as your experience may or may not be related to your disability. And do not underestimate the role of family life – children, ageing parents, financial stress and lack of privacy are all likely culprits, so plan time for sex when you have arranged childcare and take steps to eliminate any other stressors. 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.