Fixing Sexual difficulties

Good feelings are what sex is all about. For a full, satisfying and pleasurable sexual relationship you need to feel good about yourself, about your partner and about intimacy between the two of you. You need to feel relaxed about giving pleasure to your partner and about receiving his or her attentions yourself. There are numerous factors which can prevent good feelings and so cause sexual difficulties, but most of these are not directly related to sexual function.

Anxiety and fear are probably the commonest causes of sexual difficulty, although both are an almost universal experience in the early, learning stage. Later both can be exaggerated and heightened by either of two contrasting approaches towards sex. The first approach regards sex as an unspeakable subject. It is rigid, moralistic and Victorian, and seeks to deny the real pleasure which sex can bring. Any notion of sexual gratification is instantly bound with guilt. This attitude fosters anxiety and reinforces groundless sexual fears.

Secondly, since the Kinsey Report told us all what the ‘average’ couple were up to, there has been an increasing trend towards regarding sex as a competitive sport. The game is played with tape measure and stop- watch. Score is kept of the number of partners, number of orgasms achieved and number of positions used. Individuals are coerced into participation by fictional accounts of the exploits of sexual heroes and heroines which appear in certain sections of the press or in films. Such fiction sets new standards, way beyond Kinsey, which challenge the reader to greater efforts. The inevitable failure to reach such goals can cause new anxieties. Technique is only a part of sexual satisfaction. Fear of failure to perform is no less damaging than fear of unwanted pregnancy, fear of VD or fear of failure to keep a sexual partner. This approach emphasises the role of the partner as an orgasm machine and may lead to a depersonalised and hence poorer relationship between a couple.

Temporary sexual difficulty can result from either partner feeling tired, unwell or depressed. Sex can be like a barometer. If the rest of the body is suffering, then sex will suffer too. In caricature, this problem is often presented as ‘business- man’s impotence’, but can affect anyone. A young depressed mother can lose interest in sex just as readily as an overworked executive. As soon as the initial problem has been solved, the sexual difficulty should right itself.

There are certain specific fears or anxieties which patients frequently experience concerning sexual functioning. We will now try to deal with a few of these. The answers are mostly common sense but still need to be restated.

Masturbation. Children masturbate from a very early age. This is part of the normal process by which they discover the range of feelings from their own bodies. Adolescents and adults gain more specific sexual pleasure from masturbation. It is an outlet for sexual energy when there is no opportunity for other sexual practices, although sometimes it is incorporated into a couple’s regular sexual activity. Virtually all men and many women masturbate at times. It still needs to be said: self- stimulation is not a disease and causes no harm to the body whatsoever. It is a normal, healthy and pleasurable activity. Masturbation has never caused blindness, deafness, madness, pimples or sterility. Some patients do become disturbed by guilt over masturbation when they have been led to believe it is harmful. The only problem with masturbation is the needless guilt such patients feel.

Sexual Fantasies. There is no- one past puberty who does not have sexual fantasies. The content of these can be widely variable. Seduction, exploitation, and sadomasochism are common elements, as well as softer and more romantic themes. Often an imaginary sexual partner is involved; this may be the latest film- star or someone glimpsed across a crowded tube- train. If the fantasy contains some unacceptable elements, such as violence or sexual relations with a close relative then there may be some distress concerning the meaning of the fantasy. Sexual fantasies, like masturbation, are a form of release of sexual tensions. They almost never lead to immoral or illegal acts. Imagination is a gift and it is natural that fantasies develop. Avoid guilt about your fantasies and your sexual life will be enhanced. Erotic literature and pornography.

Erotic art and literature have existed in all eras of history. The works of many great artists and writers have included erotic masterpieces, such as those of D. H. Lawrence and John Donne. At the other end of the spectrum modern underground books and films depicting bizarre sexual acts are unlikely to please even the most broad- minded adult. Some couples however do find that sexual awareness and arousal are helped by erotic literature or pornography. Many of the mass- produced ‘girlie’ magazines are potentially helpful, but the more artless the production the less helpful it is likely to be. Pornography has been described as erotic literature which somebody is trying to ban. Make up your own mind and chose for yourself. If it helps you and your partner to feel good then use it and do not let misplaced guilt detract from these good feelings. Virility. There is a myth about this too. Patients often have fears that their sexual activity is too frequent or too infrequent. This stems very often from publication of figures from large surveys relating to average frequency of sexual activity. People are concerned if their own practice varies widely from the average. Relax. It may be eight times a day or eight times a year. The only rule worth remembering is that in a stable relationship, the frequency should be a workable compromise between the desires of the partners.

Sexual equipment. Both men and women worry about their sexual organs and their figures – or some particular detail concerning their figures. Men may feel they have not got enough hair on their chests. Women may think that their legs are too skinny, that they are either too flat- chested or too busty. There is little worthwhile in concerns such as these.

Some individuals are more attractive than others, some may be more sensual than others, although often the two are not related. The breadth of taste runs from the plump figures of Rubens right through to the slender ‘Twiggy’ type. Women may be excited by a man with broad shoulders or a deep voice. We do not know whether this is due to cultural indoctrination or innate differences between individuals, but the point is the same. Someone likes you the way you are.

Usually the sexual equipment is the least important factor in sexual attraction, but this is a constant source of anxiety. Men frequently worry about penis size. In point of fact, despite a fairly marked variation in the size of the penis in the resting state, there is much less difference in the size of the erect penis between different men. Moreover, the vaginal canal, which has to be able to stretch to accommodate the birth of a baby is potentially much larger than the thickest of penises. The size and rigidity of the penis will vary for the same man at different times. Some factors affecting erect penile size are physical, such as the length of time since previous intercourse, and some are psychological. Impotence is rarely due to disease of the genitalia, nerves or blood vessels. No male is equally potent at all times and all males are, on some occasions, impotent. Chronic impotence usually implies chronic anxiety, at least partially compounded by worry over the impotence.

Premature ejaculation. Whilst physically the opposite of impotence, the cause is the same – anxiety. For many this will be a temporary problem which will improve with time and a more relaxed attitude. Sometimes ejaculation may be delayed by a firm pinch applied across the tip of the penis with thumb and forefinger either side, until the erection begins to subside. Practise this several times over on each occasion.

Female orgasm. This is the most written- about sexual phenomenon of recent years. The subject has been linked inseparably to aspects of the women’s movement. It has been pointed out that some women are multi- orgasmic and may climax several times during a single act of intercourse. On the other hand, it is also true that a large number of women only rarely have an orgasm with intercourse. The comparison between these two groups has led to the belief that women who do not have regular orgasms are somehow abnormal. Yet such women frequently experience a deep and satisfactory sexual relationship. They are not abnormal and their partners should not feel needlessly inadequate.

There has also been much discussion of the differences between the ‘vaginal’ orgasm and the ‘clitoral’ orgasm. Some researchers have concluded that no woman really has a vaginal orgasm and that for the best experience in intercourse, clitoral stimulation is essential. The truth is that some women like direct clitoral stimulation during intercourse, and others do not, finding that it distracts from the sensations produced by the penis in the vagina. Behave in whatever way you find best for you at any particular time. If you let others tell you what you should be doing and then allow guilt to develop if you do not match up to the ‘average’, then you are promoting these myths. Of all human activities, the sexual should be directed by the individual, at his or her own pace and style.

A variety of sexual practices have recently been re- emphasised. These include ‘swinging’, sex with the aid of various appliances and sex in an infinite variety of positions. Such practices are recorded in all eras of human literature, but advocates of sexual variety were discouraged by legal and ethical barriers until recently. Medically, there is no reason either to encourage or discourage sexual variety and experimentation. The problems seen at present are a reaction to earlier attitudes. People now feel guilty that their sex life has insufficient variety. For example, the majority of heterosexual activity takes place in the ‘male- superior’ position. This position is often the most satisfactory for both partners, since it allows the deepest penetration and the sensitivity value of being face to face. Recent derogation of this technique as the ‘missionary position’ illustrates ignorance of history and anatomy. The accusatory tone of the phrase suggests an attempt to arouse guilt and anxiety about a normal practice.

Other individuals, for equally good reason, prefer many different positions, or find their greatest satisfaction with a particular alternative technique. Some couples for example regularly use oro- genital stimulation either as a prelude to intercourse or sometimes proceeding to orgasm, but other couples may find they prefer other sexual techniques. There is no right way and no standard pattern for sexual expression. Averages are meaningless in a personal relationship between two individuals. You should obviously avoid any sexual practice which could cause pain or unhappiness to your partner, yourself or others. Ensure that you both feel comfortable with the ways you find to express your relationship, but within these common- sense boundaries you have personal freedom to be either ordinary or exotic – with pleasure and without guilt.

Home Treatment

We hope that the paragraphs above will have given you some help to deal with any specific fears or worries which you may have, but if there is still a problem there are a number of ways in which you can help yourselves. We frequently find that couples with a sexual problem are simply not giving themselves a chance to get it right. The couple must feel perfectly at ease with each other, emotionally and physically. This may take time, indeed the whole sexual experience takes time. You must give yourselves time to get to know each other really well and intimately. Anxieties about sexual performance can often prevent this process from happening, maybe for years on end. Individuals can hold back from truly revealing themselves to their sexual partners and so prevent the development of a completely full relationships

Occasionally physical or mental illness causes problems with sex. The cause is usually obvious and you can look forward to an improvement as soon as the illness improves. Pain on intercourse can easily be treated at home if it is due to insufficient lubrication. Use KY Jelly (from the pharmacist) if natural secretions are not enough. If the woman experiences persistent or deep- seated pain with intercourse she should see her doctor.

External events may cause either partner to feel unhappy, anxious, depressed or bored. A man could be worried by the threat of redundancy, an ex- career girl may be frustrated by being tied to the house by children. Problems such as these can all too easily be reflected by a disinterest in sex. The basic problem will need to be approached jointly and plans made to find a way round it.

However, if there has been sexual difficulty it is still necessary to re- establish good sexual responses to one another. Do not hold endless discussions or arguments trying to apportion blame on one side or the other. This does not help. You need to do something about it. You will find that the body responds to sexual stimuli from your partner, given time and patience. The good feelings this produces will help you to feel more turned- on than before and enable you in turn to play a more active part. Gradually you should both feel more relaxed and happy with each other and find that your sexual life is improving.

We suggest you start at the beginning and learn all over again the right way to make each other feel good. Pay particular attention to anything your partner likes, both in behaviour and sexual technique. Set aside half an hour or more about three times a week when you can be together, relaxed and comfortable, and free from interruptions. Give yourselves plenty of time. Most couples find that sex is best without clothes on, so get undressed, completely. Then, as it were, start again at the beginning, as if you had met only a few days before. Kiss, cuddle and stroke each other in places where it feels good, but do not attempt for the first few sessions to have intercourse. Tell each other what feels good. After a few sessions spend some time caressing each other’s genitalia. Each partner should teach the other, all over again, how he or she likes this to be done. Take it slowly.

Eventually, start having intercourse again, but again start with the build- up first. It is true that women usually take longer to reach sexual arousal than men, so the man must wait on each occasion until the woman is aroused sufficiently to want to have intercourse. This simple programme alone is often enough to revive a sexual relationship and to help a couple re- establish a pattern that is mutually satisfying. Home treatment will help many of the common sexual difficulties, but if the problem is more serious, then you may need professional help. As a general guide, you should seek help if the sexual difficulty lasts more than a few months, and is either putting a strain on the relationship or causing marked anxiety in one or other partner.

What the Doctor Will Do

It has been traditional to turn to the doctor for help with a sexual problem, but in the past doctors gave advice in the knowledge that whatever was said would often make little difference. In recent years doctors have realised how sexual problems may be helped more effectively. So far, however, only a minority of GPs are experienced in newer methods of treatment.

If you do have a sexual difficulty see your GP first. He should be able to help with any trouble with contraception or with pain on intercourse and may be able to give some advice about the sexual problem. He may refer you to a local hospital clinic which deals with psycho- sexual problems. At present, however, such clinics are very few and far between, so there may not be one in your area.

If your GP is unable to help, you can go for further advice either to a Family Planning Clinic or to the local office of the Marriage Guidance Council. Such organisations may themselves have counsellors who can help with the problem, otherwise they will be able to tell you where else you may get help. If you are unable to< find help and the problem remains you may have to return to home treatment. For more advanced home treatment we recommend you read either Understanding human (Coronet) or Treat yourself to sex by Brown sexual inadequacy by Belliveau and Richter and Faulder (Dent).