Cathy Scott, a 25-year-old hairdresser from Yorkshire, has been struggling with anorexia and bulimia for 11 years. She’s been in recovery for a couple of years now, since becoming a mother. “When I was 14, I had a boyfriend at school. When I ended up in hospital, he broke up with me. Then, when I came out, I had another boyfriend, with whom I had a child. We were together seven years [and just recently split],” she tells us. Since improving her health and restoring part of her weight during pregnancy, Cathy has been feeling more comfortable with her body, which seems to have had a positive impact on intimacy, too. “I would say everything definitely improved, I've definitely got a sex drive now!” she says, laughing. But she remembers struggling in the past. Obsessing over food and weight loss didn’t leave much room for sexual desire, and her restrictive regimen drained her of energy. Despite having quite an understanding partner, as she puts it, she thinks her disorder probably put a strain on the couple, causing more arguments and tension: “The more I felt like I didn’t want to, the more guilt I felt. I think that had a bit of an impact on the relationship.” These kinds of feelings – guilt, anxiety, obligation – are fairly common among her patients, says Coakes: “More often I see that they stopped having sex and they are worried about that, and worried about how long the other person will stay around,” she says. Other times, they may continue to go through the motions of a regular sex life without wanting it, in a bid to please their partner and keep the relationship going. Physiologically, low weight can be to blame for a lack of sex drive, as it affects the production of the hormones thought to be responsible for women’s libido. “Particularly with anorexia, [patients] will stop producing oestrogen and testosterone and the sex drive will dramatically decrease,” says Coakes. However, as Coakes explains, while gaining weight is a necessary step towards becoming healthier, it is no magic fix: “If [patients] restore their weight, they might actually want to have sexual intimacy, but now they are getting bigger, they may have a battle between wanting more sexual intimacy but having perhaps even less confidence in their body.”