Interviews by Anna Moore
Dr Meg Barker, sex and relationship therapist and author of Rewriting the Rules
People are very scared of not being normal. By far the most common question I've heard as a therapist is "Am I normal?" And people come to sex therapy with the hope that it will make them "normal". Generally what they mean by that is the ability to have sex that involves penetration and orgasm, lasts a certain amount of time and takes place an average number of times a week – whatever all that is!
We still have lots of taboos. A "sexless relationship" is one. It's seen as the worst thing in the world that would definitely lead to break-up. In truth, lots of relationships are not sexual and totally fine. There are also taboos about people being "too sexual" or having the "wrong" kinds of desires. A common situation now is people – most often men – feeling disturbed by the kinds of porn they are looking at. They're terrified to think too much about it and get into a pattern of trying not to look at all, then going back to it and feeling deeply ashamed. Fantasies worry us too. We aren't open about the fact that it's normal to have a range of sexual fantasies – including things we would never act out.
Men tend to present with problems about erections, struggling to get and keep them or feeling they orgasm too quickly. There's a lot of pressure on men about performance, and a feeling that you're less of a man if you don't perform as expected. Women present because they don't feel aroused enough or they find penetration painful. Often, they keep having sex because they feel that's what their partner wants and they might lose the relationship otherwise. There's often a deeper discomfort about their body too. They're so worried that they are unattractive that they can't relax. They've never really learned to enjoy their fantasies and their bodies so that sex can be pleasurable.
After Fifty Shades of Grey there is definitely more kink and BDSM – though without much good information about how to engage in it. The novels don't help here. The kink relationship takes place in a very unequal power dynamic. Ana has no experience at all, and Christian has loads, and is also hugely rich and powerful. Ana is given very little opportunity to say what she might like to try – just a list of what Christian is into. He follows her, interferes with her life, tells her she can't talk about the relationship to her friends – big danger signs for abusive relationships.AdvertisementI recently did an analysis of the anxieties people were writing about to the main sex problem pages. The top two were whether they or their partner might be bisexual or gay or whether they or their partner is having an affair. I think we definitely need to open up more conversations, in sex ed in school, in the media, and in sex advice, about the diversity of sexual orientations, and about how people manage the rules of their relationships around monogamy.
Online porn, flirting on Facebook, friends with benefits – we all have different ideas about what is and isn't acceptable. Couples don't have open conversations about it early on; they assume their partner will have the same rules as them. Down the line, they find that one thought it was fine to stay friends with their ex and the other didn't; one thought it was OK to look at online porn and the other is horrified. We go into relationships assuming we will share sexual desires, but there are bound to be differences. Assuming difference from the start and talking about it could be much less painful.
If I could give one piece of advice when it comes to sex it would be stop trying to be normal! Once we stop trying so hard to fit a certain box, we can start exploring what our own desires actually are.
Sarah Fletcher, psychosexual therapist at Coupleworks
Couples often come to see me when they're in that "transitional stage". At the start of the relationship, everything is exciting, new and unknown, sex is triggered by different areas of the brain. A few years later, the couple have moved in together, life is more mundane, there's a loss of desire, they don't have as much sex as they used to. For some people, that's scary.
In my work, I tend to see the negative aspects of porn. Young men, viewing it from an early age often before they've even had sex, expect sex to be like that – but it's on a screen, under their control, they choose the images. Real sex is relational, about you and me, what I want, what you want, how that has to be negotiated. So it can seem much easier and more instant to wank in front of a screen than have sex with a partner.
Men and women have different ways of becoming aroused. However much we like to say we're equal, we're different. I see men who have found porn addictive, starting with quite soft images and escalating to hardcore. Women don't tend to use it in the same way. For women, it's more likely to be chatrooms, online relationships, flirting, "Skype sex". It's not so much about "images", more about "connecting".
There's more sexual experimentation going on. Oral and anal sex are much more common than when I started as a therapist 18 years ago. There's more S&M too. I think it's a response to online porn, Fifty Shades of Grey, the fact that sex is talked about more than ever. Are we enjoying all of this? Has sex got "better"? I don't think so. Some of it leaves people feeling very confused. "It's painful. Am I supposed to like doing this – and what does it say about me if I don't? Am I normal?" We're more open-minded and experimental – and at the same time more pressured, anxious and insecure.
I am a fully qualified, experienced and accredited counsellor and psychotherapist, specialised in psychosexual therapy, relationship therapy, couples therapy and sex addiction treatment, with experience working with a diversity of clients.
A lot of people think that having sex should be easy and should happen without even thinking about it. Therefore, when sex doesn’t work, it leaves people feeling ashamed and broken: ‘why can’t I do this normal and natural thing that everyone else seems to be able to do?’
Our sexuality lies at the core of our being. We are born with it and we develop it from the moment we are born. This means that sexuality is complex and, therefore, having sex is a complicated act.
When one has sex, it is not merely the exploration and union of two bodies. We bring in bed with us our morals, our judgements, our core beliefs about ourselves, our beliefs about being a man or a woman, what it means to us to be sexual in some particular contexts, our fears and hopes, and what we believe about the partner(s) we are having sex with.
Growing up, we constantly receive messages about sex, and, as children, we have to make sense of those messages.
Consider the following scenario: a boy grows up in a home where sex is never talked about. When there is a sex scene in a movie on television, he witnesses his parents hurrying to the remote control to change the channel. The message that the boy will understand from this is ‘sex is wrong’, ‘sex is shameful’, ‘parents do not approve of sex’. Then this boy ends up in a changing room at the end of PE and is teased by his peers because he has a ‘small penis’. This increases his shame and a feeling of inadequacy towards his peers. In time, the boy develops and goes through puberty. He finds himself with a sexual partner for the first time. He feels extremely anxious because it is his first sexual encounter, and his partner is likely to also feel extremely anxious. Because of the anxiety, he doesn’t manage to get an erection. This event is especially devastating for a man, because it makes him question his sense of masculinity and results in tremendous shame. The second time he attempts to have sex, he will feel twice as anxious as the first time and the likelihood is that he will not have or maintain an erection then either because of the compounded anxiety and shame.
Now, let’s look at this scenario: a girl grows up in a family with parents shouting at each other all the time. She learns the message ‘relationships are bad or painful’. Then, at school, she is teased by her peers for being overweight. This is deeply shameful. The girl grows up and becomes a teenager. Her body changes massively in a short space of time. Her parents are too busy arguing with each other to notice the changes, and nobody talks to her about becoming a woman. Going through this process of change with no support or information can be very shameful and painful for a young teenage girl. She will ask herself some questions about her body: ‘Am I fat?’ ‘are my breasts too big?’ ‘how do I manage my periods?’, and so on. When she finds herself with her first sexual partner, she is full of anxiety. Because of the anxiety she finds penetration very painful. She dissociates and tells herself that the first time is always painful but she feels a lot of pain the second time and the third time too. This results in tremendous shame because she feels she has let her sexual partner down. She feels she might be ‘frigid’ or ‘less than a woman’. This increases the likelihood that each time she is in a sexual situation she will fear the anticipation of pain so much that anxiety and shame will continue to increase.
These, of course, are only simple examples; there are very many other experiences that may contribute to sexual difficulties. The main issue I would like to stress is that when sex doesn’t work it is because most people find it difficult to talk about it. In turn, the less it is talked about, the more there will be shame around the issue.
It is often not possible to talk about sex with parents, teachers, peers and even some therapists.
If you experience a sexual problem, it is important to consider the following:
Firstly, is my sexual problem due to physical factors? It is very common that sexual dysfunction is linked to a physical cause. For example, erectile functions can be affected by a heart condition, diabetes, some medications, low levels of testosterone, and so on.
Painful vaginal intercourse (dyspareunia or vulvodynia) can be caused by hormonal contraception, an allergic reaction, some medications, yeast infection, pelvic floor dysfunction, and so on.
I would recommend that if you suffer from any sexual problems that you ask your GP to carry out the necessary tests to find out if there is a physical problem.
If there are no physical causes found, you can safely assume that your sexual dysfunction is of psychosexual cause.
Your second step is to look for a therapist. As mentioned above, some therapists are not comfortable talking about sex. It is therefore important that you look for a therapist that is specifically trained in psychosexual issues.
Psychosexual therapy (also called sex therapy) combines a behavioural approach (learning new tools and habits for better sexual functioning, through specific exercises assigned to do at home on your own or with your partner) and a psychodynamic approach (the exploration of the childhood messages, the experiences of sexual development and your core beliefs about yourself).
If you are in a relationship, couples therapy may be appropriate, because sexual problems impact on a relationship and vice-versa.
The most common psychosexual problems are:
For men: erectile dysfunction, premature ejaculation, retarded ejaculation.
For women: vaginismus (women who cannot have penetrative sex), dyspareunia and vulvodynia (painful intercourse).
For both: Difficulties with orgasms, loss of libido, differences in sexual desire within the relationship, sexless relationships, lack of intimacy.
Psychosexual therapy is the best therapy to treat sexual problems of psychological causes. Over the decades, psychosexual therapy has proved to be successful in obtaining long-lasting positive outcomes.
Making the first appointment for psychosexual therapy is very scary because it involves such an intimate subject, which touches the very core of our being. However, it is a necessary step towards satisfying and fulfilling sex lives and, ultimately, happier intimate relationships.
Published by Silva Neves on 14th April 2014.