It happened again. I was in a second session with a young couple who have been struggling with uncomfortable and dissatisfying sex together. They were confused by what was happening in their shared sexuality, as many couples are, and frustrated because they didn’t know how to fix it themselves. Then they told me that their last couple’s therapist had advised them that if they built enough intimacy and emotional closeness their sexual issues would “take care of themselves”. AHHHH!!! Let me explain why this makes my head explode.
First, you should know that many (most?) psychotherapists out there have very limited understanding of the amazing vastness of human sexuality. Also psychotherapists and the field of psychology have been victim and perpetrators of sexual discriminations and basic close-mindedness and puritanical values for years. This is horrible and I am striving to do my part to change this for the field. But the point is, it is not an uncommon stance in psychology to say attachment and intimacy = happy sexual compatibility. As a sex therapist who has helped many people navigate their own complicated sexual desire, I know this is simply not true. As a human being who has had my own journey with love and sex and human closeness, I know this is not true. So why are therapists still saying it?
To claim that intimacy automatically leads to sexual compatibility disregards several key aspects of sex – one, it presumes that everyone is generally turned on by anyone they form a close relationship to; an argument that I think can only be made in a blatantly heteronormative mainframe that disregards what we have learned and should understand about sexual orientation and the limits of our desire. We simply cannot force desire where there isn’t one and attempts to shift desire to an “appropriate” partner are often disastrous. Two, this argument conflates all variations of human closeness into romantic sexual partnership, something that may be entertaining on soap operas but is quite limiting in real life. I am close to many people, in many different ways, and I do not have sexual desire for many of them. In fact with many people I develop a closeness that negates any sexual feelings, when someone begins to feel like family or a sibling for example.
Third, saying that intimacy and emotional closeness leads to sexual satisfaction ignores the variations of desire and how important they can be to our happiness. Most therapists who encourage couples to ignore clear sexual incompatibilities expect their clients to eventually adhere to a basic vanilla sex life – great for some, but deeply dissatisfying for others. This model privileges loving, eye-gazing, comfortable sex over other forms of sexual expression and connection. Loving and trusting your partner doesn’t mean that you both are going to be into restraints or submission play. Loving and trusting your partner also doesn’t mean you can easily give those things up. And being able to deep conversations and feel intimate doesn’t necessarily mean you do a great job talking about the subtleties and emotional vulnerabilities of sex and what you want. Not to mention that the therapist in question may have their own squeamishness and resistances to talking about sexual details and would just like to lump it all into one vanilla blur.
The reason psychotherapists who equate intimacy with sex irritate me so much is that I can see how clients get shamed by this. They feel ashamed that their love is not enough to naturally give them satisfying sex. They feel ashamed because they have desires that their partner can’t fulfill and they are being told that is unimportant in the bigger picture of emotional closeness. They feel ashamed because they are made to doubt their own desires yet again. This is not fair. The bad news is not all people who love each other are going to be great sexual matches. There is still plenty to explore in how to be and stay in relationship within that reality, but you need a support person who will go into those intricacies with you. The good news is your desire for something different than someone else is not something you have to ignore. At least not with me.
I had another client this month coming to see me ashamed and frightened because someone told them they were a “sex addict”. I am happy to support these clients, who often tell me about sexual behaviors that have become overwhelming or out of control. I believe that healthy sexuality should feel full of choice, not compulsion. We work together to re-create a sense of their sexuality that is safe and satisfying, and unique to them.
What bothers me is the way the label “sex addict” is being used. First of all, sex addiction is not an accepted psychological diagnosis. It was considered and rejected for the most recent DSM (Diagnostic Manual). So it is a label being used in a non-scientific context, often by people not trained to assess for psychological or sexual issues anyway.
What I have seen is “sex addict” being used as a new form of moralizing. In the past someone might have felt the righteousness of being able to openly accuse someone of being immoral or perverse in general conversation. Nowadays openly making that type of judgment is not as acceptable, but we can call someone an addict. Because we can claim that is not a moral judgment, it is a condition. But defining what is healthy or unhealthy sexual behavior condition is often a judgment call, especially when done by a non-professional.
The current popularity of ascribing all kinds of diagnoses to one another is probably troublesome to most therapists out there, at least those that take assessment seriously. I wish people would simply say, “I am worried about the sexual behaviors you are describing to me. Maybe you could talk to a sex therapist.” This feels honest and cleaner that using a label to scare or shame someone into seeking help.
I want to be clear - there are many people who suffer greatly from damaging sexual patterns and a loss of control over their behavior and choices. And I want those people to be encouraged to seek help. Because there is help for this. I just want us to be careful and responsible about the way we talk about other people’s sexual behaviors. Let’s not turn “sex addict” into the new scarlet letter, applied whenever we feel affronted or offended by someone else’s sexual history. Sexual compulsivity is complex and contains all the subtleties of the human heart and mind. Let’s respect that.
Are you a health professional who wants to know more and support people in healing sexuality that has become harmful? Attend Melissa’s training in January 2015.https://www.eventbrite.com/e/building-sexual-integrity-a-sex-positive-approach-to-treating-compulsive-sexual-behaviors-6ce-hours-tickets-14098371609
Karen started having a deep burning sensation with intercourse a few months into her first long-term relationship. Sex had never been comfortable for her but she had a few times when it felt easy and fun. But over years the burning gradually got worse and her fear of it increased until sex and pain became linked in her mind. Sometimes now her boyfriend Jon is unable to penetrate her because her vagina is so tight it feels like it is cramping. Even oral sex and touch have become intolerably painful, although sometimes Karen tries to push through it. Sometimes Jon is understanding, sometimes he is frustrated, but mostly both Jon and Karen are confused. Why is this happening? Why can’t sex be easy like it is for other people? Karen’s gynecologist says there is nothing wrong with her, but the pain is very real.
Sexual pain is rarely talked about but it is not uncommon. The type of pain I described here, called Vestibulodynia, affects some 17% of women in their lives. It can last for many years, even decades, and sadly often goes untreated. Factors such as genetics, hormones, infections, allergies, inflammation, and tiny tears in the tissue can contribute. And there are several other common diseases that can cause sexual pain, adding to the numbers of people suffering a major loss to their sex lives. And there are conditions that cause sexual pain for men as well, equally unspoken.
One incredibly challenging aspect of any chronic pain is the isolation involved. There is no way to measure pain objectively, no one else can truly understand or monitor your pain except for you. This can cause people to question themselves. For sexual pain, every woman I have worked with had been told by a doctor that there was nothing physically wrong, leading to years of self-doubt and distrust that anyone could help. In fact, the people that we generally go to for sexual health questions – our gynecologists – are simply not well informed or trained in sexual functioning issues. Sexual pain is a specialty and practitioners can be hard to find but when you do they can often diagnose and treat disorders that a majority of doctors will miss.
And treating sexual pain includes sex therapy. Not because it is all in your head, as it may have been treated in the past, but because ongoing pain, particularly pain that affects such a valued part of your life as sex, is traumatizing. It can lead you to feel alienated from your body, from pleasure, from your partner, from the universe or god or anyone who didn’t help. It may have reinforced past sexual abuse memories or negative beliefs about sex. You may have stopped seeing yourself as a sexual person. There is grief over what you have lost and about the ongoing worry about if the pain will return. Recovery requires new relaxation skills, new attention to sensation and lots of communication with future partners. Reflexive tightening and anxiety about sex can make things worse so it is important to get support as you prepare to reengage with sex.
Do you feel changed by another person’s sexual energy or by interactions with past partners? Sometimes I hear people use language about their sexual experiences like, “I gave it up” or “I feel dirty from having sex with him/her”. What would this mean to you? What are you giving the other person when you are sexual with them? What part of yourself are you sharing? Do you believe something changes in you or about you after being sexual with someone? What about when you are sexual with yourself, masturbating and/or fantasizing?
How can you find your own baseline or ground after being sexual with someone else? If people are attracted to you or have sexual thoughts about you, can you stand your ground and feel confident in your own ability to choose to engage or not? Or do you feel swayed by others sexual desire to a point where it is hard to keep track of yourself? If someone else wants you, do you feel obligated or infringed upon? On the other hand, do you feel that you are only desirable when you are being desired by someone else? Is your sexuality based on reacting or responding to your partners? Truly claiming your body and your sexuality can mean separating what is your energy and desire from what is someone else’s. It can be filling yourself with your own vibrant energy so that you can actively meet someone else’s energy without being overwhelmed by it. It is knowing what you want. Think of a time when your sexuality felt truly self motivated; what was that like for you?
I invite you to journal about these questions. There is no right or wrong answer to come to, but it is valuable to see clearly how you feel about these things. These are great topics to explore in therapy too. If you are a Northern Californian local, you can come see me in my private practice in Capitola, CA. If you are in another area, you can reach out to me for referrals.