How We Cause Some of Our Sexual Struggles

Some people would rather be right than enjoy sex.

They demand that sex be a certain way, no matter how narrow or unrealistic—or pointless—that is.

Or they insist that bodies—whether their own or their partners’—can only be eligible for desire or pleasure if they’re nearly perfect (however they define that).

Or they refuse to acknowledge that their partner has changed—even if it’s a change they’ve been asking for.

Yes, if you want to see human stubbornness and irrationality on display, be a sex therapist. Here are some common problems I deal with over and over every year. In each instance, the person’s struggle is of their own making. I’m sympathetic, of course, but these people could improve their sexual relationships without their partners doing anything different. What else could you ask for?

1. A woman who insists that she’s unattractive, no matter what her partner says.

While there are men with poor body image, the most extreme cases are women. There’s no reasoning with such women—neither numbers, photos, nor a mirror affect their ability to see themselves more accurately.

I’ve worked with couples in which the husband had literally never seen his wife completely nude. For such couples, sex is frustrating and off-putting for him, terrifying and shameful for her. Pleasure? Intimacy? Simply impossible under these circumstances.

My approach with people who can’t see their bodies accurately is not to convince them they’re actually attractive or “normal,” which never works. First, I send them to a physician they trust. The doctor’s authority can sometimes break through the distortions.

Mostly, I talk about how physical attractiveness is probably not as important for your partner’s sexual satisfaction as you think. And that if your mate likes looking at you, he (or she) is not asking you for your opinion. “I enjoy how you look” is not an invitation for a referendum.

By the way, calling this condition “body dysmorphia” often isn’t helpful, as that’s usually taken to mean “you have no responsibility for your bizarre beliefs.” Most people do. Of course, if someone has another mental health issue—an anxiety disorder, borderline personality problem, etc.—focusing on this is usually necessary and often helpful.

2. A man who says that he “needs” sex so frequently that he has a right to sex with his wife even if she’s not in the mood.

Sometimes I want to gesture toward a male patient, “Hello, it’s 1953–they want their sexual attitudes back.”

Every year, I must say to at least a dozen different men, “no, you don’t need sex every day. You want sex every day.” I then follow with, “every adult wants things they don’t get, and apparently, this is one of yours.” Only a person in a lot of pain would reject this simple, obvious observation.

I understand that enjoyable sex every day or two can be a glorious part of life. And the truth is, very few people with jobs and children have that. I do think that, as a society, we should spend more time grieving the loss of our young adult sex lives. But grieving is different than whining. And it is most certainly different than pressuring and criticizing a partner, which is what I see far more often.

It puts a woman in such a difficult position when her mate says, “I desire you so much, and it’s so painful not to have you–how can you deny me?” It can be surprisingly difficult to break through a man’s narcissism and insecurity to help him find a kernel of empathy for his partner. These guys tend to frame their desire as a compliment to their partner, but they’re really not seeing their partner’s humanity–only an opportunity for their own gratification and validation.

Eventually, a lot of these men insist that they’re married to someone who doesn’t like sex. This misinterpretation makes things worse, of course. Sooner or later, unfortunately, these guys will be right.

3. A woman (or man) who insists that their male partner orgasm every time—and inside them.

I’ve known a few gay men who really enjoyed a partner coming inside them, but the people who are really, really upset if their partner doesn’t do so are almost all women. Why the upset? Usually, “because it means you aren’t really excited with me, or don’t find me sexy enough.”

Like women unable to see their bodies accurately, maintaining this fantasy—if you don’t come inside me, you’re unhappy with me—requires a lack of trust in one’s partner. I’ve seen men beg their girlfriends to believe that they’re satisfied without orgasm, or with coming in her or his hand. When women refuse to believe this, I ask if they think he’s lying to her or to himself.

I’ve seen women destroy otherwise enjoyable sex lives with this one sorrow/belief/demand.

4. A man who can only get excited with a woman who looks like his ultimate fantasy.

Everyone’s entitled to their fantasies, of course. These certainly don’t need to be politically correct; in fact, the most common sexual fantasies are of inappropriate partners and/or activities.

But every grown-up needs to know that real life rarely looks like fantasy, whether the subject is our careers, children, health, or recreation—or our sex lives. And exhibit number one regarding that is our partners. The people we actually want to be with—as opposed to the people we want to pick up in a bar or on an airplane—will have personalities, histories, and emotional needs. What they generally won’t have is excellent lighting, hair and makeup stylists on 24-hour calls, and a winning ticket in the genetic beauty lottery. And while they may be 25 years old when we meet them, in just a matter of months, they won’t be 25.

And yet I work with men who are chronically dissatisfied with their wife's weight or their refusal to wear high heels while washing dishes. A guy who has trouble getting erect with a woman with a few stretch marks or whose breasts are slightly different sizes has a serious problem. Sometimes the real problem is a power struggle in the relationship. More frequently, it’s a guy who refuses to grow up.

I always wonder who these guys think they’re going to partner with when they’re 50 or 60. There just aren’t enough 25-year-old supermodels to go around.