How problems begin

THE VICIOUS CYCLE

In almost every case of sexual difficulty, the patient’s distress and fear of failure will aggravate the problem, even if the problem began purely as a physical one.

The newly delivered mother, with the tender vaginal scar, may start to tense up at the very thought of sex, because her first attempt after the delivery was so painful, and brought back to her all the trauma surrounding the delivery. The middle-aged man whose erec­tion has failed twice in a row, per­haps because of overwork or too much alcohol, will treat his next attempt at intercourse as a personal challenge: ‘If I can’t do it next time I don’t know what I’m going to do.’ The pressure to perform be­comes unreasonably high, the fear of failure is foremost in their minds, they fail to relax during intercourse and of course it happens again. The woman finds sex unbearably painful because she is so tense, and the man’s erection fails. They both now really believe that they have a serious problem and a vicious cycle takes hold.

This vicious cycle can be sur­prisingly difficult to break, even if one understands what is hap­pening. It is very easy to become locked in to feelings of self-doubt and low self-esteem, which become reinforced each time one ‘fails’ sexually. An understanding part­ner helps, but often the partner is also experiencing his or her own crisis of self-worth: ‘Why doesn’t he or she want to have sex with me anymore? Am I no longer attractive? Is he or she having an affair?’

An important part of sex ther­apy is therefore aimed at allowing couples to express these negative feelings, to pull themselves out of this downward spiral and to learn to enjoy physical closeness without performance pressure. ‘Sensate focus’ exercises, described later in this book (see pages 36–9) are used commonly by therapists to help couples slowly regain the relaxation, pleasure and confidence they once enjoyed.

IGNORANCE, MYTHS AND STEREOTYPES

Despite the greater availability of information these days, many people are still not very know­ledgeable about many aspects of sex – from anatomy (especially female anatomy) to aspects of fertility, to the proper way to roll on a condom. Most people pick up bits of information along the way from friends or magazines, but this information is not always accurate.

Doctors quite commonly see women whose partners complain that they can feel a ‘lump’ in their vaginas during intercourse. An examination reveals that this lump is actually the cervix – which is a normal part of the body. Women in particular may grow up quite ignorant of their own genital anatomy. If they attempt inter­course and fail to allow penetration, they may think they are deformed, and are unable to believe that their vaginas are able to accommodate the erect penis.

Some people are also naturally shy and inhibited about sex. This may also be a result of their cul­ture, religion or upbringing. Many religions, for instance, have strict rules about when intercourse can take place, what a woman can and cannot do while menstruating, and may forbid the use of contraception. The value placed on modesty may prevent a woman from examining and exploring herself, and make it extremely difficult for her to seek medical information or help. The association of sex with sin and guilt may be deeply ingrained and difficult to rationalise, and lead to various forms of sexual distress.

Another problem is that, despite a more liberal outlook, men and women are still expected to conform, in some way, to sexual stereotypes. Men are supposed to be highly virile, ready for sex at any time, powerful and in control of all aspects of their lives. They are not expected to be sensual, to give way to emotion, or to communicate easily their innermost feelings.

Women, on the other hand, re­ceive the message that somehow sex and female genitalia are ‘dirty’, and that good girls do not seek or enjoy sexual release. Even leaving aside the fear that their signals will be misconstrued and perhaps lead to danger, many women find it difficult to be truly sexually expressive. Although it seems to be acceptable – even expected – for boys and men to masturbate, female masturbation and sexual fantasy are still taboo subjects.

These conflicting roles and expectations may add spice to the courtship stages of a relation­ship, but can be an obstacle to a fulfilling sex life in a longer part­nership. Sex therapy allows in­dividuals and couples to explore their own feelings in relation to these complex cultural expecta­tions. It may also give them ‘per­mission’ to be as sexual or asexual as they really want to be.

SEXUAL TECHNIQUE

Finally a word on technique. It is usually easier for a man to show a woman how he enjoys having his penis stroked than for a wo­man to explain how he should stimulate her clitoris. This requires a great deal more subtlety and unless the woman masturbates or has explored herself she may not know how she likes to be touched, or how to bring herself to orgasm. The clitoris is highly sensitive, and clumsy or heavy movement can be more painful than arousing. Most women find the tip is too sensitive to direct touch, and prefer the sides to be gently stroked.

It takes time in any relationship for two people to ‘gel’ sexually, and this is particularly so if either or both are sexually inexperienced. Good sex is usually a blend of passion, affection, abandonment and technique – none of which is easy to come by after a day at work. There are now plenty of sex manuals on sale in bookshops, and even videos with real couples. These may offer pointers for the less inhibited, but probably the best solution is to take time out with each other.

KEY POINTS

• It is easy to label oneself a ‘sexual failure’

• Performance pressure ruins good sex

• Ignorance, misinformation and sexual stereotyping can cause sexual problems

• As far as sexual technique goes, practice makes perfect