SEXUAL DIFFICULTIES: UNDERLYING CAUSES

Although an increasing number of sexual difficulties are known to be the result of physical illness, the majority are probably of psychological origin. It is always possible that discoveries such as the fact that high prolactin or oestrogen production in some men can produce impotence will explain some sexual difficulties but they are unlikely to be the explanation in most cases.

It is not only an absence of hard biological evidence that leads us to say that most sex problems originate in the mind; there are other reasons too. First, when investigated, most people’s sex problems show sufficient evidence of a psychosexual origin-to make it worth considering this as a serious possibility. Second, psychotherapeutic techniques (talk therapy) perhaps combined with other techniques that do not involve drugs or surgery, often relieve the problem. Clearly most sexual problems have little or nothing to do with the body’s basic plumbing. Evidence for this is seen in many cases. For example, the man who cannot erect for intercourse but wakes with an erection in the morning and, judged by the stains on his sheets, has night emissions too. Many people with problems are reluctant to consult a doctor, sometimes because they feel that he or she will think badly of them or does not have the time to treat them, whilst others put off seeking help because they do not believe help is available or effective.

At the heart of the psychological factors that prevent sexual success and produce sexual casualties is the anti-sexual nature of our culture. As we have mentioned elsewhere, conservatism on the subject of sex in child rearing leads to the unconscious transmission of sexual suppression from one generation to the next and sex education, at least as it is practised at present, does little to redress the balance.

Normal religious beliefs affect the situation very little except that children brought up in religiously extreme homes have more than their fair share of sexual problems as adults. As we have already explained, in the chapter on childhood sexuality, problems arising from the Oedipal complex can also disrupt sexuality in later life and result in sex difficulties. A false perception of the partner, as in the case of, for example, a man who unconsciously identifies his partner too much with his mother, may result in rare or unenjoyable intercourse.

Avoidance of intercourse, making it brief as in premature ejaculation or reducing the full pleasure by not reaching orgasm, since, unconsciously, he perceives the woman as his mother, also leads to anxiety. Along the same lines, a woman having a baby can change in her husband’s eyes from a lover to a mother and he may well then see her as relatively (or totally) undesirable. He may even become impotent if they do try to have intercourse.

A loss of sex drive, or even completely going off sex, after the birth of a baby is common in women too, for reasons which include pain from an episiotomy, a birth injury, hormonal disturbances, postnatal depression, fear of a further pregnancy, tiredness, over-preoccupation with the new baby, or an unconscious identification with the woman’s own mother, now that she has become a mother. Many, if not most, women perceive mothers in general as sexless.

Increasingly today, drugs, pharmaceutical preparations and chemicals also interfere with sexual performance. More subtly, unconsciously perceived chemical messengers called pheromones may also be involved. Psychological ‘messages’ can also be transmitted by one partner and picked up unconsciously and yet still influence sexual behaviour. Body language is one example. It is quite possible that such psychological and pheromonal messages, if negative and transmitted over a long period of time, might adversely affect the sexual capacity of one’s partner.

The emotional relationship between a couple can express itself as a sexual problem – indeed most so-called sexual problems are probably the result of emotional and relationship problems. A failure to erect or lubricate, premature ejaculation, or failure to have an orgasm can be expressions of resentment, anger and many other emotions, as can the rejection of advances.

There are men and women who see themselves as sexual enthusiasts but who, when the subject is examined more deeply in therapy, are found continuously to be putting sex last on their list of priorities in life. It is not, they say, that they don’t want to have intercourse but there is ‘just no time for it’ and in any case they are ‘always too tired’. Also, they often add, ’sex isn’t everything’. Where both of the partners want to avoid sex such a situation is satisfactory. If a woman places a low priority on sex, or at least continuously finds other things she would rather do, her man sees this as rejection and loses interest or performs badly when she does agree. Many women too measure their attractiveness, and therefore their value, by the ardour shown by their partner. If he puts everything else first she may respond by getting angry, becoming sexually uninterested or performing badly. Believing herself to be unwanted she may even fall out of love with him. A sign that this is occurring is a sudden loss of her ability to have orgasms.

Stereotyped, habit-ridden copulation and insensitivity to the needs of the other partner both sow the seeds of sexual difficulties, as do relatively minor problems such as bad breath and, for many women, the man being unshaven. Sometimes just even loving the partner can produce problems. As mentioned already, some men perceive the woman they love as sexless and put her on a pedestal. They are impotent with her but not with others. Some women are inhibited with the man they love, having been reared in childhood to believe that sexual activity leads to a loss of love (in that case from their parents) but can perform with efficiency and abandon with a stranger. Other women may overcome this by fantasising about other men when having intercourse with their partner. In any case, for reasons which are largely unknown, everyone finds certain members of the opposite sex infinitely more desirable, arousing and exciting than others. Some men and women can perform perfectly well with certain members of the opposite sex but not with others.

Many people who talk continually about how much they want intercourse are unconsciously trying to avoid it. Such people may fix on a physical event such as having a baby, a sterilisation operation or the onset of some disability as an excuse to avoid intercourse, sometimes permanently. For women who see sex as being mainly for reproduction, sterilisation can disturb them anyway. Disturbances of body-image also affect sexual performance. Women who have not accepted their vagina as part of their body psychologically do not to all intents and purposes have a vagina. Attempts at intercourse are experienced as being like a knife being pushed through an intact body surface, and they suffer from a condition known as vaginismus. These are the virgin wives mentioned earlier. A man who has fear-inspiring images of the female body can, unconsciously, think of the vagina as a whirlpool or a mouth with biting teeth. Placing his penis inside it is like putting his head in a lion’s mouth, so it is avoided by failing to erect or by ejaculating before entry or soon afterwards.

So the background to sexual problems is very varied and is often time-consuming to sort out, if only because basic causes are often overlaid with conscious excuses and explanations that first have to be stripped away. Some problems are the direct result of upbringing and the potential problem existed long before that person met his or her partner. It was lying dormant but ready to bloom. In some cases an apparently normal sex life may be sustained for months or even years before a ’sexual breakdown’ occurs. This happens because at the time the person’s sexual desires exceed his underlying fears and he can function fairly well. Once desire wanes even a little all the inhibitory forces take over and the person develops a frank sexual problem. An unhappy example is seen in those women who have been brought up with the ’sex is naughty’ view of sexuality. They function well before marriage and enjoy sex but lose orgasmic capacity and interest in sex afterwards, when it is legitimate. In other cases the problem reflects a difficulty within the relationship. Sex itself may be the primary cause of the problem or it may, so to speak, simply be knocked down as an innocent bystander.

Psychological illness, personality factors and problems with religious beliefs may or may not contribute to sexual problems. For example, a person who is prone to excessive anxiety about life generally may or may not be anxious about intercourse: sex can provide a refuge for such people. Conversely, someone who displays low levels of anxiety in the rest of his life can show signs of alarm, muscle tension and sweating as sexual contact becomes imminent. Men and women with personality disorders run the risk of retaliation through a sex problem in their partner. For example, a critical, domineering or excessively maternal woman may come to be seen by her partner as an unpleasant mother figure.

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