DEALING WITH SPECIFIC SEXUAL PROBLEMS

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Women's sexual problems

 By far the most common female concern is "I find it hard to have a climax." This may mean many different things: never having an orgasm in any way, never or seldom having a climax during intercourse but other ways work fine, being able to masturbate one's self but not able to climax when stimulated by a partner, being able to climax only after continuous extensive (45 minutes or more) stimulation or being unable to predict or understand one's orgasms, i.e. it is easy sometimes but elusive at other times. It is not known how many women have had some experiences like these--probably a high percentage--but it only becomes a "problem" if someone is dissatisfied. About 10% of sexually experienced women have never had an orgasm during intercourse, another 10% climax infrequently with intercourse, another 10% are inconsistent. Actually, only 30% or 40% of women orgasm through intercourse alone, which our puritanical culture would consider "normal." About half of all women have trouble having an orgasm. Almost 60% privately say they are dissatisfied with their husband's sexual performance. To what extent are males being held responsible for the female's sexual response?

 Note: if you aren't interested and don't become sexually aroused, then you almost certainly are not going to have a climax. In that case, please refer to the "lack of interest" in the last section.

 Of course, it isn't necessary to climax during intercourse in order to be sexually satisfied. There are other ways to achieve an orgasm; in fact, many (33%) women prefer these "noncoital" orgasms (Hite, 1977). However, if one wants an orgasm during intercourse, most women need more stimulation than just intercourse, for instance extensive foreplay or stroking the clitoris during intercourse. There are two major points: (1) Women should not feel inadequate if they don't climax every time. For many women (70%), orgasms are not always necessary (Sarrel & Sarrel, 1980). Sex can be satisfying and comforting if the woman is "aroused" and experiences the man climax inside of her (Collier, 1982). Yet, it is a safe bet that sex is better with an orgasm than without one. Indeed, over 65% of women sometimes fake orgasms (Butler, 1976), presumably to make the male feel better. (2) Most women can, with practice, learn to have an orgasm either during or without intercourse. Becoming orgasmic may take a little time every day for several days and you may have to deal with some of your childhood inhibitions, but it can be done and it is worth it! Fortunately for women, climaxing improves with age (well, up to a point). There is a lot of interest in female orgasms (Fisher, 1973; Meshorer & Meshorer, 1986).

 Several successful treatment programs have been developed for women who have difficulty climaxing (Hutchins, 2000; Fenwick & Yaffee, 1992; Barbach, 1975, 1980, 1982; Dodson, 1987; Masters, Johnson & Kolodny, 1985; Heiman, LoPiccolo & LoPiccolo, 1976, 1987). Barbach has written the most. Heiman and LoPiccolo have a good book and an instructional video (1-800-955-0888). Hutchins has perhaps the most straight-forward technique. (Remember, these references are for women who are having trouble orgasming, not for those wanting multiple orgasms and/or more novelty.) Most how-to-orgasm books/programs use similar methods: First, the pressure to perform is removed and attitudes about self-stimulation are explored. Certain facts are explained: 42% of women masturbated during the last year, that masturbation more frequently (95%) produces a climax than intercourse (60%), and that masturbation usually produces a more intense orgasm. Sexual taboos cause 40% of college-age women to avoid masturbation, so this is a scary concept for many women and, if so, has to be dealt with.

 Secondly, the woman slowly becomes comfortable examining and touching herself, especially her genitals. Through something like sensate focusing (see above) by herself, she learns what feels the best and she overcomes any distaste with touching herself. After several hours (spread over 10-15 days) of this "pleasuring," including the use of a gentle vibrator, she should be able to overcome her inhibitions about touching herself and her fear of climaxing. (Don't use anything electrical near water.) When she feels safe and able to enjoy self-stimulation, if an orgasm has not already occurred, she is encouraged to masturbate until "something happens." This may take 30-45 minutes; if the orgasm takes a long time, she probably needs to use a vibrator and erotic fantasies. Vibrators are wonderful aids for most women (Blank, 1996 and 2000).

 Third, after she has learned to orgasm easily, the woman then shows her lover how she masturbates and teaches him in detail. Fourth, the male masturbates her in the same way until she can have orgasms regularly. Lastly, if she wants to orgasm during intercourse, they have to modify and integrate the masturbation techniques into intercourse. This four or five step process is reported by Masters and Johnson as being 70-80% successful. Note: two people should not try to have climaxes at the same time; I know that is some people's idea of how it should be, but for most couples it is much too hard to get the timing just right. Simultaneous orgasms are for the compulsive, perfectionistic I've-got-to-do-this-right-crowd, who foolishly miss fully appreciating the awesomeness of both orgasms.

 It may be necessary, in more difficult cases, to understand the causes underlying the inability to orgasm. For instance, having a bad sexual experience or history can, of course, inhibit a sexual response (see Heart, 1998, who was sexually abused and discusses the physical, psychological, emotional, and spiritual aspects of this problem). Likewise, if a woman had been consistently responding sexually and then stopped having orgasms, obviously she should explore what was going on at the time to cause the change. The specific causes will determine what kind of self-help or treatment is needed. Knox (1984) says these causes, beyond those mentioned above, underlie a lack of sexual satisfaction: focusing too much attention on pleasing the partner and not enough on her own feelings, negative feelings about the partner, not enough stimulation (if the clitoris is stimulated 20 minutes or more, 60% have a climax almost every time), fearing letting go (try desensitization), drinking too much, and just not knowing what kind of touching feels good. Albert Ellis (1974) says the pressure to perform prevents orgasms. Lillian Rubin (1976) believes men are at fault because they make two impossibly conflicting demands--(a) be a responsive, orgasmic woman and (b) act like a naive, passive, innocent "good girl." As a result, according to her, women turn off to sex but yearn for more love. The love vs. sex conflict can also become a power struggle. These are the kinds of psychological problems that may need to be solved before a woman is free to climax.

 Other female problems include painful intercourse, vaginismus (closing up of the vagina causing intercourse to be impossible or uncomfortable), and rapid orgasm (like premature ejaculation). Pain is usually due to a lack of lubrication or an infection. Vaginismus can usually be dealt with by gradually inserting one well lubricated finger and leaving it there while relaxing for a few minutes. Later, two fingers can be inserted, then let the partner insert one finger, then two, then his penis. This procedure may take a few minutes a day for 3 or 4 weeks. Stay relaxed (like in vivo desensitization) and use plenty of KY jelly. Rapid orgasm can just be enjoyed.

 Data mentioned earlier in this chapter and in chapter 7 document that many women have been traumatized by many different kinds of sexual abuse and harassment. The mean, hostile, indifferent aspects of sexual abuse are covered in chapter 7. Books for overcoming the long-term emotional scars of incest and sexual abuse include Blume (1990), Jarvis-Kirkendall & Kirkendall (1989), and Poston & Lison (1990). In many cases, psychotherapy and group work will be necessary too.

Causes of sexual problems

 Physical factors, like infections, may cause intercourse to be painful (both for men and women) and this condition may lead to a protective reaction in the woman of vaginismus and a lack of an erection in a man. In addition, hundreds of prescribed drugs, illegal drugs, alcohol, nicotine, and hormones affect our sexual reactions. Hormones may be especially important after menopause. Some physicians claim that 80% of sexual problems are physical in origin, but many psychologists believe psychological causes are just as common as physical causes (Masters, Johnson & Kolodny, 1985). Unfortunately, few therapists are experts at treating both the physical and the psychological factors. So, you may need to see two experts. There is a Male Sexual Dysfunction Hotline (1-312-725-7722).

 Premature ejaculation and difficulty having an orgasm may be "natural" or caused by psychological or interpersonal-emotional factors. What are some of the psychological causes? There are many and every life is unique. As mentioned previously, the family of origin may have had a negative attitude towards sexual body parts or acts, e.g. "sex is crude--something women have to put up with" or "it's a sin to touch down there" or "we don't talk about these parts" (out of 1400 parents interviewed by Elizabeth Roberts none had ever discussed the clitoris with a daughter). Unreasonable guilt and embarrassment may stay with us forever. Conflicts with a parent or parents getting a divorce may result in anger and distrust towards the opposite sex or in confusion about sexual identity. Early sexual experiences may have been traumatic--painful, forced, or guilt-producing (see abuse in chapters 7 and 9). Early experiences can also become an obsession, e.g. being attracted to a certain type of person or activity, such as being tickled or spanked. Many fears interfere with "letting go" and enjoying sex: fear of failing to perform, pregnancy, disease, being used, being swept away (Cassell, 1984), making noise, losing control, urinating, looking ugly or absurd, being caught, and so on. These fears have to be unlearned or reduced.

 The quality of sex usually depends on how positive the two people feel about each other. You might say, "I can imagine having great sex with a total stranger." That's true. But it becomes much more complex when the relationship is intimate. Examples: If one is in love, able to talk freely, feels secure and trusting, enjoys the lover as a friend and a sex partner, then sex is greatly enriched. If we are angry, distrustful, having a disagreement, feeling critical of the partner's appearance, or losing interest in the partner, our involvement in sex is reduced, perhaps to zero. This is especially true if one partner becomes hypercritical of the other: "You are a lousy lover," "You're getting so fat it's disgusting," "You can't get into sex because you are emotionally hung up on your dad" or "You are so uninterested, I think you are gay." Obviously, sex in these cases probably won't improve until the relationship improves.

Talking about sex

 Bach and Deutsch (1970) illustrate the deception that occurs early in a relationship, using "Will" and "Carol." These two people have had a couple of dates, like each other, and are trying hard to please and impress the other. After a fun day at the beach and a romantic dinner, Will asks Carol to stay over night at his place. She agrees. But after a long drive home, both are very tired, have sun burns, and need to go to work early in the morning. Actually, both would rather go home tonight and set aside a special night for making love the first time. However, they are pushed by their own needs to please, to impress, and to deceive the other. Each assumes (without asking) the other is horny. Each wants to give the impression that he/she is highly sexual too. The truth is that both are concerned about their sexual adequacy.

 Since neither can say "let's wait," Will and Carol stay together and have intercourse. They utter the right words to each other: "I love you," "You are fantastic," "Yes, I came," "You are a real man," "You have a great body," and so on. But during sex they were thinking: "I'm too tired to come," "I feel miserable," "He will think I'm frigid," "I can't keep this up, I hope she comes soon," "My God, she wants more!" and so on. Will has a climax and Carol fakes one. After telling each other how wonderful it was (while hoping the other is ready to sleep), they struggle to be affectionate and provide a little afterplay. This leads to more intercourse which neither wants and both fake a climax this time. They weren't honest. The experience was much less satisfying than it could have been. By pretending, they set a high sexual standard to live up to in the future, and they increased their own feelings of sexual inadequacy. If Will and Carol do not become secure enough to be frank with each other, they will become stressed and irritated. Their relationship may be headed for trouble.

 Later in marriage a common complaint is "I ain't gettin' enough." But Masters, Johnson and Kolodny (1985) say frequency is almost never the issue. What is the problem then? The complainer may feel neglected or lonely or that something is wrong with the relationship. The partner being complained about may be anxious at work, upset about adding weight, disgusted with his/her lover, or depressed. The tasks of a couple who "ain't gettin' enough" are to recognize what the real underlying problems are, talk about solving those problems, and express loving concern for each other. The freer one can talk to his/her lover about sex and other concerns, the better the sex will be (Levin, 1975). Many books discuss intimacy and communication in marriage (Gottman, Notarius, Gonso, & Markman, 1976; Rubinstein & Shaver, 1982b; Rubin, 1983). Below are guidelines for communicating about sex:

  1. Be honest, open, and direct. Don't pretend, be genuine. If you don't know what your partner is thinking, wanting, or feeling (and you probably don't), please ask, don't assume. Don't be overly eager to impress, like Will and Carol.

  2. Forget the nonsense that men know or are supposed to know all about making love. No man knows how a woman feels or what she needs to climax; each woman is different. Talk to each other, DON'T AVOID DISCUSSING PROBLEMS. Both the male and the female have to let the partner know what feels good and what doesn't, what acts are appealing and unappealing. If there is a problem, just say "I'd like to talk about our love-making," then find out when is the best time to talk, i.e. after making love, before, or at an entirely separate time.

  3. Forget the notions that men should take the initiative, that the man is responsible for making sex good, and that the woman just lies there, letting the man do things to make her feel good. These are outdated Victorian ideas. So are ideas like: "a man never gets enough" or "most women want to be loved but aren't really interested in sex." The best sexual adjustment (80% satisfied) is achieved when each spouse takes the lead equally often. When the initiative is one-sided, only 66% are satisfied (Blumstein & Schwartz, 1983). A wonderful aphrodisiac is an excited, active partner.

  4. Try your best to avoid thinking negatively about the partner, especially watch out for blaming the other person for your problems. Examples: "I might have a climax if he were a better lover." "If he loved me, he'd take more time, whisper sweet nothings in my ear, and massage my back." "If she loved me and wasn't such a prude, she'd play with my penis a lot." "He/she never wants sex, he/she must have a problem (gay/lesbian, feels inadequate, ashamed of his/her body)." The stereotypes and negative thinking frequently hide our own feelings of inadequacy: "It's not my fault, he/she is the one to blame." You need to understand what is really going on.

  5. Use "I" statements when expressing a concern (see chapter 13). This shows you accept responsibility for your own feelings. It shows that you are hoping to work cooperatively to solve the problems.

  6. Use empathy responses when the partner talks about problems (see chapter 13). This helps get the true underlying problems out on the table. Remember nothing kills sexual urges as fast as resentment and depression.

  7. Use books as a stimulus for discussing sex. They may help you see the problem from another angle, suggest factors you had not thought of, and offer you a variety of solutions to consider with your partner.

  8. Often it is much more effective to show your partner how to do something, rather than trying to tell him/her. If the woman will guide the man's hand as he touches her clitoris, he will more quickly understand what she wants. Likewise, the man can show the woman how he masturbates and then guide her hands so she knows she is doing it just right.

  9. Don't expect things to stay the same; how a couple makes love tends to change from time to time. Don't expect perfection--but you do have the right to a good sex life. Talk about trying new things. And don't forget to laugh too.


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