Read the philosophy behind the “B-Sides” series here . See part 2 here .
This is a piece I wrote sometime in 2006. I was very angry and jaded at that time. Not unlike right now, actually:
In a landmark study, researchers Laumann, Paik, and Rosen (1999) found, in people age 18 to 59, sexual dysfunction in 43% of women and 31% of men. This essentially means that sexual disorders are likely more common than anxiety, depression, and substance abuse. These conditions include such difficulties as low libido, erectile dysfunction, and premature ejaculation, as well as some less common problems like Dyspareunia (genital pain before, during, or after intercourse). Pair the above figures with the more benign but common complaints of “I wish I could have sex more often,” and “Why isn’t sex with my husband more passionate, like it used to be?,” and it becomes clear how prominent sexual disorders and sexual frustration are.
With the development of Viagra and similar medications for both men and women, sexual disorders are at least somewhat controlled. However, like every treatment approach, there are limits to its effectiveness. Most important is the fact that these medicines do not work for everyone (studies indicate numbers ranging anywhere from a 16-82% failure rate depending on the gender being studied), and there can be uncomfortable side effects such as headaches. Additionally, an astute psychotherapist would note that Viagra only works on a person’s physiology. Bach, Wincze, and Barlow (2001) sum up this point nicely, stating that firm erections and adequate lubrication do not always lead to a satisfying sexual relationship.
That’s where therapists come in. Given the various disorders and complaints regarding sex, therapy options for sexual difficulties are vast, ranging from a generalist therapist like myself to “sex therapists,” who have learned detailed, specialized techniques to help individuals and couples overcome sexual problems.
I don’t usually handle specific sexual disorders. Like many typical therapists, I see complaints, conquests, issues, and frustrations about everyday sex, like something you’d hear on Taxicab Confessions. Contrary to popular belief, however, clients’ stories don’t tend to arouse. However, to say that what therapists hear in the office isn’t, at least at times, quite interesting, would be an outright lie.
“I used to see mostly couples who were becoming bored with each other and needed help finding creative ways to keep their sex lives alive,” a seasoned colleague told me, “but with personal ads, the internet, and a trend toward being more open about sexual discussion, single and even married people come to me with some of the most amazing stories. I’m talking one-night stands, sex in alleyways and dumpsters…”
“Sex in dumpsters?”
“Dumpsters, those gigantic oil barrels, on top of horses, you name it. I have one male client who meets other men on the net, but will only have sex with them when their partners are on their way home from work. He even makes the guys call their partners on their phones while they’re in the car to find out how much time he has left! He just loves the thrill of the possibility of getting caught in the act. ‘Regular’ sex doesn’t do it for him. Any therapist who says that listening to these clients talk isn’t fascinating is either a Goddamn liar of some sort of asexual fern.”
A few years in private practice will reveal certain trends in sexual discussions. Single, heterosexual men tend to focus on who they are currently having sex with, who they would like to have sex with, why the person they want to have sex with doesn’t want to have sex with them, and the like.
Client: You know Eva Longoria? I really want to have sex with her.
Dr. Dobrenski: (Join the club): Well, from what I understand, she is involved with someone, and since she is a famous television star and model, maybe we could talk about meeting someone who is more accessible.
Client: Yeah, good idea. What about the chick next door from your office?
Dr. Dobrenski: That’s Dr. Davies, and he’s a man.
Client: Oh. I did go out with a woman the other night from the online ads.
Dr. Dobrenski: That’s great! How did it go?
Client: Not so good. She didn’t want to have sex after drinks, so I called her a frigid bitch.
Dr. Dobrenski: Do you remember our conversation about name-calling a few weeks back, and how it relates to problems getting women to go out with you?
Client: Right, but this time I actually succeeded in getting the woman to go out with me. Do you mean to say that those rules apply to the date itself?
Dr. Dobrenski: I do.
Client: Fascinating. I guess we have more work to do on that score then.
This client is a prototypical example of sexual dissatisfaction as a secondary problem; in this case, secondary to poor interpersonal skills. With proper coaching and some outside reading on “How to Talk to Chicks” (as he called it), he was able to keep his vulgarity and insults to a minimum, which ultimately led to meeting more sexual partners.
Single, heterosexual women lean more towards expressing their secret love of sex, how long she should make a potential partner wait before having sex, and why men tend to fall asleep after sex.
Client: Oh God I love, love sex. It’s just that I don’t want to be a slut and put out for every guy I find attractive.
Dr. Dobrenski: I think I understand. There is an unfair double-standard in today’s society. Men who are promiscuous are cheered by their peers, whereas women are vilified. I think it’s important for you to decide what is most important for you, and deciding what balance you want to strike between your own sexual needs and society’s mandates.
Client: You won’t judge me?
Dr. Dobrenski: No, of course not. Unless you are hurting someone, it is not my position to judge your behavior.
Client: Well, I only have sex with submissives; does that count?
Dr. Dobrenski: I suppose we can make an exception to the rule in that case.
Fortunately for this client, the sex ratio for Sexual Masochism is twenty males for every female, so when she decided that satisfaction of her desires was more important than public approval, she had little to no trouble getting her needs met.
Married clients tend to suffer from repeated, common complaints as well. One partner or the other is unhappy with no sex, too little sex, too much sex, sex that is too long or too short, or boring sex. My session with “Pam,” an upper-class socialite, is quite typical:
Pam: We’ve only been married for two years, but it feels like the magic is gone. I’ve counted, and the past eight times we’ve done it have all been entirely in the missionary position. My husband and I don’t even sweat when we do it anymore, which is hardly ever.
Dr. Dobrenski: Have you and he discussed this?
Pam: Yes, but he just tells me that he doesn’t really have the same sex drive anymore. He says it’s “biochemical.” He’s only 44, c’mon!
Dr. Dobrenski: (Could a lifetime of monogamy AND excitement AND sexual satisfaction be basically impossible? Well, it’s possible to have an arousal disorder at any adult age, but I’m hesitant to think that it would be entirely a biochemical problem. Perhaps you two are in a common rut. I’m not a marriage expert, but I would think the both of you need to be in therapy, together, to decide if sex is going to be a part of your relationship. Monogamy is difficult, it takes effort from both parties, and we can’t guarantee a return to your previous sexual life. What are your thoughts about that?
I had initially developed my “Monogamy + Excitement + Sexual Satisfaction = Fantasy Land” theory after both reading the research on sexual dissatisfaction and hearing dozens of stories from distressed partners, spouses, and even other mental health professionals during my training. Most of my colleagues agreed, and the consensus in graduate school was that clients needed to become more creative with sex and understand that while the excitement of sexual novelty might never fully return, partners needed to consider and remember what they do indeed have in their current relationship (e.g., commitment, support, a shared future, etc.).
However, after hearing my somewhat negative prognosis, Pam made a conscious effort to change her situation. Her individual therapy focused on how she felt about herself, her body image, and how to spice up her marriage in areas outside of the bedroom. Additionally, she searched the internet high and low, looking for information on physiological issues related to sexual dysfunction, then headed to the bookstores to buy popular books on long-term sexual satisfaction for her and her husband to read together. He wasn’t interested in couples work, but he was willing to attend the numerous seminars, workshops, and lectures for married couples and sexuality for which she registered on a regular basis. I was impressed. In fact, I was somewhat intimidated by her wealth of knowledge about healthy sexuality. And, over time, things got better: sex began to occur more regularly, with “much better quality than before he pulled that biochemical bullshit on me.” Pam ultimately became a model to me for what can be accomplished in and out therapy with hard work and determination. She even gave me some brochures on sex and marriage classes, just in case I “get it together and settle down.”
Pam demonstrated to me that sexual satisfaction over the long haul with one partner is possible. Unfortunately, she is not the norm. Whether it’s the guilt-ridden husband who has recently strayed, the devastated wife who walks in on her partner and her best friend, or even the prostitute-turned-housewife who is reconsidering “going back into the field,” monogamy is a significant and pervasive problem. The most recent statistics I’ve noted indicate that the infidelity rate is as high as 60% for men and 55% for women. Some therapists suspect the numbers are even higher because most people, even when guaranteed anonymity, are too paranoid about being found out by anyone to reveal their sexual escapades to pollsters.
Authors’ note: I have no idea why I used to write every bit of dialogue as if I were writing a play, but whatever, it’s cutting room floor material now. Hope you enjoyed it.