It is a brave man or woman who will even admit to having a sex problem, let alone seek help for it. More than in any other field of human endeavor we tend to speak only of our successes; failures are swept under the bedroom carpet.
Yet sexual misery is widespread and profound. Relate Marriage Guidance has waiting lists for its sexual therapy clinics as well as its marriage counselling. Currently those seeking sex therapy will have to wait an average of three months, in one or two areas the delay could be as long as a year. Research in America has suggested that between 60 and 70 percent of relationships encounter “significant” sexual problems at some time or other. Dr Elizabeth Stanley, chairman of the Association of Sexual and Marital Therapists in Britain, believes the figure may be appropriate here as well.
Moreover, the legacy of the permissive society may have made matters worse. “Everyone now gets the impression that everyone else is having a better time than they are,” she says.
The association has around 200 members drawn from a variety of disciplines, including medicine, psychology and nursing. Most base their approach on a combination of behavioral and psycho-dynamic therapies. The former involves unlearning “faulty” behavior and relearning it in a healthy way; the latter is concerned with resolving unconscious conflicts stemming from childhood. Wherever possible a therapist sees both partners.
“We treat the relationship,” says Stanley, senior lecturer in human sexuality at St George’s Hospital Medical School, London. “Sexual problems involve the intra-personal, the baggage you bring from childhood into adulthood, and the inter-personal which are unique to that relationship.” Fees for treatment range from Pounds 15 to Pounds 50 an hour.
Not everyone has the courage to present their problem to a sex therapist. Dr Prue Tunnadine, the scientific director of The Institute of Psycho-Sexual Medicine, which is having a conference in Leicester next week, believes many more people are likely to appear at their GPs with contraceptive problems, infertility, even backaches, when there may be an underlying sexual difficulty. With this in mind, the institute trains doctors to address sexual problems in the course of their work, to pick up signals during physical examination. Between 200 and 300 people, including psychiatrists, GPs, gyneacologists and venereal disease specialists are in training at any one time.
Dr Judy Gilley is a north London GP and senior lecturer in General Practice at the Royal Free Hospital. She believes that working the “front line” enables her to spot problems that patients might be afraid to mention or even recognize.
“You may, for instance, get persistent difficulties with contraception, which suggest an underlying sexual unhappiness. Or there may be a request for a termination from a woman who has not been using any contraception because she has doubts about her femininity and wants to test it. Or you may have a very young woman wanting sterilization when she is trying to obliterate that part of herself.”
A patient’s attitude to a physical examination can be particularly revealing. “If a woman says as she hops up on the couch for an internal `Oh, this must be awful for you,’ she may be talking about her own feelings about her body. It’s a question of picking up on things.”
The most common difficulties for women are non-arousal, loss of desire, failure to reach orgasm, pain on intercourse and vaginismus where an involuntary spasm closes the vagina. For men they include inability to achieve, maintain or control erection, premature ejaculation and failure to ejaculate at all.
Stanley says she may occasionally, if couples wish, give a practical anatomy lesson. Or recommend some natural male enhancement products like ProSolution Plus. Otherwise, she stresses, therapists’ help is strictly verbal. The use of trained surrogate partners is now, in the wake of Aids, almost unknown. “Certainly no reputable therapist would ever suggest sex with a client. If you meet anyone like that, run a thousand miles,” she advises.
“People often have very unrealistic expectations and they are also very ignorant, especially about female anatomy and female sexual response. The trouble with failure is that it steps up a vicious circle, more anxiety, more likelihood of failure and so on.
“And there are some very destructive myths around: the idea that men are born knowing what to do to arouse a woman and that having to ask makes them less of a man; the idea that good sex just happens, it doesn’t have to be talked about; the idea that lovers can read each others’ minds.
Resentment corrodes the sexual response. You’ve heard of the expression `impotent with rage’.”
The association’s therapists, therefore, look for the cause and its possible remedy, usually setting homework tasks such as touching exercises to increase sensuality and ways of improving communication skills.
Recently, more therapists have been prescribing reading the popular relationship guide The Magic of Making Up, which helps patients get along with their partners more.
“You cannot treat sex in isolation,” Stanley says. “You can’t give an antibiotic like you can for tonsillitis. Men in particular tend to say sex is the only problem, everything else is perfect. In fact it’s often the other way round and when you get the rest right sex sorts itself out.”
So far only 160 consultants (10per cent of its therapists) have been trained by Marriage Guidance to help couples where sex is the primary problem. Not everyone who seeks therapy is offered it, however. Sometimes an initial consultation puts it secondary to other concerns. Once on a program couples can expect to attend 12 or 14 hourly sessions.
“You may be undoing a problem that’s been around for years,” says Alison Clegg, Relate’s marital and sexual therapy training officer. “Some couples are lying at the very edges of a double bed, terrified of the slightest touch.”
Their approach is mainly behavioral, with the counsellor helping a couple to establish realistic goals and then tailoring a series of exercises to be done at home. “Here we are very precise and open about everything and we use whatever language a client is comfortable with. I generally use a mixture of the scientific and the vernacular.”
Progress is monitored before, during and after therapy: for instance, the couple and their therapist mark on a nought to eight scale their feelings and attitudes at various stages. A follow-up consultation comes three months after the last session and fees vary according to the client’s means.
Tunnadine thinks that sexual problems can be marriage wreckers. “They make people dreadfully unhappy. They can break up homes, lose people their jobs. Some people muddle along, sex is not very important, but where it does matter it matters enormously. It can make or mar a relationship.
“So much of sex is a matter of confidence, of trusting your instinct. But as a society, we have always tended to be prohibitive. Perhaps we should be more positive about sex.”
Overall, success rates have never been independently assessed, but all practitioners seem optimistic and speak of the actual physical changes that take place when sufferers find help. Stanley says people “positively glow. The women seem prettier, the men smarter. They look 10 years younger.”
Clegg points out that Relate’s success rates are high because the couples set their own goals. She adds: “It is lovely to see how different people look often very quickly and how their body language changes. Sometimes we look out of the window and see them actually arm in arm again.”