Treat your sex life to an NCT

It used to take nerve and ingenuity to accumulate a stash of pornographic materials; now porn is everywhere, only a click away on many mobile phones, tablets and laptop computers.

The fallout from this easy availability is one of the significant trends that sex therapists are dealing with today. But it is not the only societal change that is reflected in problems in the bedroom.

Financial and workplace stress have also taken a toll on relationships in the past five years, sometimes eroding intimacy to the point where partners are hanging out of opposite sides of the bed for fear there might be any physical contact. In such circumstances, their whole relationship is in danger of breakdown.

One positive change is that as counselling has become more widely used and talked about, there are signs that couples are becoming slightly more inclined to seek help for this most private side of their lives. But for most it is a last resort.

The professionals in whom they finally confide cannot talk about individual cases but their observations on issues being presented give some insight into the most common problems people encounter in their sexual lives.

A psycho-sexual therapist with Relationships Ireland, Eithne Bacuzzi, is seeing an increase in men attending with erectile dysfunction. Describing it as "like an epidemic", she says it is "catastrophic" for men.

“I can’t tell you how devastated males can be about this. They invest their whole maleness in this and, if it goes wrong, nothing else matters.”

Porn problem
Bacuzzi believes that one factor behind this problem is increased watching of porn, "with its perfect sex, perfect erections, perfect bodies", giving young men, in particular, the expectation that this is the way it should be.

Her comments are echoed by sex therapist Teresa Bergin, who has two private practices in Dublin, where she is seeing more men with body image issues.

Some men are what she calls “wise consumers” of porn, in that they may enjoy what they are watching but are aware that it bears no resemblance to real sexual experience.

“For other young men what they watch becomes a sexual script and their idea of how they and the other person should interact sexually.

“They are comparing their bodies to what they are watching and they have an expectation that they should look like these guys and perform in the same way.” That can lead to erectile difficulties.

“Their brain is hardwired to the stimulation of pornography, rather than the stimulation of a real sexual experience,” Bergin explains.

“When they go back to having a sexual experience, that feels somewhat less – they run into difficulties with erections and that causes a huge amount of anxiety.”

Perception of cheating
Another side effect of porn and accompanying masturbation is that men may be less inclined to engage in sexual behaviour with their partner, says sex therapist Tony Duffy, who runs his own practice in Johnstown, Co Kildare.

“Some partners will see internet porn as a form of cheating,” he points out. Because porn is often used in secret, there is a sense of double betrayal – that not only has the man been engaging in it, but he has also been keeping something important from his partner.

Other couples may be able to engage in porn together. “There is an understanding,” he says, “that it’s just what it is and nothing other than that.”

However, Bergin makes the point that generally women prefer watching or reading erotica – which is on a softer level and more likely to have a story which they will respond to.

“A sex therapist will often ask women to read some erotic literature to help them around their own arousal and how to achieve orgasm,” she adds.

Bacuzzi describes the nub of the sex therapist’s job as “removing performance anxiety” that may have ruined an individual or couple’s sex life – or prevented it from developing in the first place.

No time for sex
The majority of her clients are couples in their 30s and 40s and, for some, the root of the problem is their lifestyle. With people getting married later, having children when they are older and increased stress in the workplace, it is quite normal, she says, not to be able to find the time to have sex.

“I am very adamant that what happens outside the bedroom is reflected in the bedroom,” says Bacuzzi. Sex needs time, and so do relationships, and without that investment couples can’t expect to flick a switch when they go to bed – yet it causes a lot of upset when it doesn’t work.

Just finding time for each other, perhaps by deciding on a weekly date night, may be enough to rectify the situation. While people may argue that they don’t have enough money to go out once a week, Bacuzzi doesn’t accept that as an excuse.

“You can go for a walk in the park, go for a cup of coffee, and remember why you got together in the first place,” she advises.

Having a shower together, or going to bed early and having a nice massage without any pressure to follow it with intercourse, can also help.

Lack of desire
While lack of desire is one of the most common reported problems, Bacuzzi says this often veils something else. For instance, the man may be terrified that he is not going to be able to sustain an erection, or the woman may be afraid of penetration. In both cases it is easier to say "I don't really feel like it" – end of conversation.

Vaginismus (see case study) is a very common problem for women and one that causes huge distress, yet very little is spoken or written about it, says Bergin.

As a result, when women do seek help, they think they are the only one like this.

“That’s a shame because it is actually a problem that responds quite well to therapy,” she says.

The reasons for this involuntary tightening of the muscles around the entrance to the vagina, which makes penetration almost impossible and painful, are varied but it’s a condition that Bergin sees “daily”.

Relationships Ireland think it is a pity that more people do not avail of sex therapy and that those who do seek help, leave it so late.

“By the time they get to us, they are entrenched in their difficultly,” says Bacuzzi. They have often stopped all sexual activity and have probably stopped talking about it too. They have tried everything and they are often trapped in a cycle of anticipating failure. It is a self-fulfilling prophesy that feeds on itself and they become emotionally alienated.”

In a first consultation, Bacuzzi will try to clarify that the relationship is reasonably sound. “We don’t take people into sex therapy until we are happy enough that they are motivated to want to change, that their relationship is in an okay place in terms of communication and resolving conflict,” she explains.

“It would be very hard to work on sex therapy if, outside the bedroom, things were not going well.”

Sex therapists will also work with individuals, says Duffy. For instance, a man with erectile problems who does not have a partner might wonder what’s the point in going along until he has a partner.

“But with the problem, he probably won’t find a partner because he won’t be going out looking for a partner,” says Duffy. “People can work on these issues by themselves.”

Because of the publicity around drugs such as Viagra, there is a belief that medication can be a “quick fix” for all erectile dysfunction.

“The tablets might help you get an erection but it hasn’t helped you deal with the reason why you weren’t getting one in the first place,” Duffy points out.

“When you stop taking medication, it just goes back to what it was. And some guys have such anxiety related to performance that they don’t get an erection [even with medication] and can’t perform. It just goes to show how strong anxiety is.”

Once medical conditions have been ruled out, sex therapy is about looking at the psychological issues.

He acknowledges that it takes courage for people to make an appointment with a sex therapist but, once they get into the counselling room, they are usually hugely relieved and have very little problem talking. “There are so many people out there with problems that we never see – they are the people we want to get to. They are suffering in silence.”

Better understanding
Even if a sexual difficulty isn't resolved completely through therapy, the couple will at least reach a better understanding of how to deal with it in a more positive way, he says.

“If you have a problem like premature ejaculation, rather than doing the same thing every time and ending up with the same result, they change their behaviour, so their sex is more enjoyable even if the problem is still there.”

He would also encourage all couples to discuss and review their sex lives, even if they don’t go to a therapist. But sitting down with a specialist for what he calls a “sex and relationship NCT” can help to re-energise a vital part of their lives.

“People might say therapy is so expensive,” adds Duffy, “but it is a lot cheaper than a divorce.”

For more information, see: relationshipsireland.com; sextherapy.ie; tonyduffy.com.
Sex therapists working in Ireland are accredited by the UK-based College of Sexual and Relationship Therapists: see cosrt.org.uk

swayman@irishtimes.com

HOW SEX THERAPY WORKS: a case study

Kate and Luke, now in their mid-30s, have been together since their teens. Kate contacted Relationships Ireland because of distress and frustration due to a long-term difficulty with sexual intercourse.

She was experiencing the common problem of vaginismus – an involuntary contraction of the muscles surrounding the entrance of the vagina, which makes it virtually impossible to have intercourse. It is a condition which affects almost one in four women who attend the agency seeking help with psychosexual issues.

'Less of a woman'
Kate described herself as feeling "less of a woman" and it was something she and Luke had not discussed with anybody else before, not even their GP.
They had developed mutual masturbation as an alternative to sexual intercourse, which helped them to maintain an intimate relationship despite the ongoing difficulty.

But the idea of penetrative sex became an “elephant in the room” and was not discussed anymore. However, when they wanted to start a family, it could no longer be ignored.

During their first session with the therapist, emotions built up over the years came tumbling out. Acknowledgement of the issue and its impact on them helped both to talk openly about a very difficult subject.

They were reassured that the issue is quite common and that, with an appropriate sex therapy programme, there is very often a very positive outcome.

For Kate and Luke, their big strength was that they had a relationship in which there was open communication and trust, and they were motivated enough to want to change.

The therapist spent some time getting an insight into their lifestyle – home life and work demands, their recreational preferences and their sexual patterns.

She also asked about habits such as smoking and drinking, use of recreational drugs and the use of pornography and if these activities formed part of their sexual intimacy or were solitary habits.

Therapists also always check that medical assessments have been completed to check for physical factors that may influence the problem.

Sexual history
The next step was taking a history of their relationship from both Kate and Luke, separately, for 90 minutes. Here the therapist was trying to discover any predisposing factors that might have precipitated the problem and, most importantly, maintained it.

Any past trauma, including medical procedures, were looked at, along with possible fear of childbirth, worries about the size of vagina, use of tampons, overprotected background, messages around sex, religious influence, and so on.

Luke came across as shy, with a non-assertive attitude, and the therapist encouraged him to be more pro-active in the sexual relationship. He had a fear of hurting his partner but he was encouraged to be more loving and caring.

The approach of Relationships Ireland to sex therapy is that sexual problems are “couple issues” and best addressed through collaboration.

Therefore, Luke’s role in the outcome of sex therapy was extremely important.

Kate and Luke were asked to park the “goal-focused” encounter of always reaching orgasm and instead concentrate on the sensual aspect, in terms of focusing and experiencing the sensation of touch.

Removing “performance” anxiety reduced the strain and allowed Kate and Luke to enjoy new feelings. This touching was gradually increased to light sexual touching.

Problem resolved
Kate also had exercises to do to discover her own body. Illustrations of the changes in the vagina when aroused can be most effective as this is about cognitive restructuring.

It’s about allowing positive beliefs in.

Dildos and vibrators are often helpful, giving women such as Kate an opportunity to take time alone to discover possibilities.

Over a few weeks the therapist saw that a shift was occurring. Luke was advised to be encouraging and positive without being pushy.

When penetration was achieved, the couple were exhilarated and their relaxation and closeness with each other in the following session was very different from the tension and frustration that was evident when they first attended.

Kate and Luke say sex therapy gave them the opportunity to start all over again and breathed new life into their sexual relationship.

Names have been changed to protect the couple’s privacy.

Most common sexual problems

Erectile dysfunction: inability of the man to achieve or sustain enough of an erection for sexual activity. It can affect all age groups and, as well as factors such as alcohol and stress, a significant cause can be "performance anxiety".

Lack or loss of desire: this can be on the part of the man or the woman but more usually the latter. Hormone levels can be a physical cause of a low sex drive and should be checked with a GP; a sex therapist can help with emotional/relationship issues that may be behind it.

Vaginismus: involuntary contraction of the muscles surrounding the entrance of the vagina, making penetration painful and often impossible. It is usually seen as a psychological issue, which responds well to sex therapy.

Premature ejaculation: affects up to 40 per cent of men. Many men will have a problem with it from time to time, but if it is an ongoing issue, sex therapy can help a couple manage it better.