Sexual health: An interview with a Mayo Clinic specialist
Sexual health: An interview with a Mayo Clinic specialist
A fulfilling sexual relationship isn't dependent on frequency or specific sexual behaviors. A Mayo Clinic psychologist explains.
Although sex usually is a source of great pleasure, it can also be the cause of significant stress between partners. Even if you feel fulfilled in your sex life, you may worry about your performance when you hear about what others do behind closed doors — and how often.
But a fulfilling sexual relationship isn't dependent on frequency or specific sexual behaviors. Instead it's reliant on whether the sexual experience makes both you and your partner feel good without compromising either person's health.
David Osborne, Ph.D., a psychologist at Mayo Clinic, Scottsdale, Ariz., addresses these and other issues regarding sexual health in monogamous relationships.
Many people wonder whether their sex life is "normal." Can you help us understand the full range of what constitutes "normal" sex?
It's common for people to wonder whether their frequency and variety of sexual activity are similar to those of other people. Statistics on sexual behavior can be quite misleading. For example, a couple might read that the average married couple has intercourse three times a week. They may not be aware, however, that this average includes a wide range. The frequency of intercourse might range from zero for some to 15 or 20 times a week for others. Therefore, even if their frequency of intercourse is more or less than three times a week, their behavior is within the range of normal human experience. The most important consideration isn't whether their frequency and pattern of sexual activity matches some average, but whether each partner is satisfied and comfortable with the sexual relationship.
It's difficult to arrive at a definition of normal sexual behavior. Cultural attitudes, religious beliefs and the law may all play a role in defining what is considered normal. Within these cultural, religious and legal contexts, a couple's own beliefs are crucial in determining what's "normal" for them.
Human beings may respond to a wide variety of arousing stimuli. As long as a sexual fantasy or behavior doesn't lead to emotional or physical discomfort, conflict in the relationship, or problems in other aspects of their lives, it shouldn't be a source of concern.
What questions can partners ask each other to help determine whether their needs are being met?
The best way is to observe and discuss each other's feelings. For example, does the anticipation of sexual activity produce feelings of pleasure, excitement and arousal? Or does it produce a feeling of pressure, guilt or a sense of obligation? Each partner can also consider how he or she feels after sexual activity. Is there a feeling of satisfaction, relaxation and enjoyment? Or are there feelings of guilt, resentment or anger? If the anticipation and completion of sexual activity usually produces positive feelings in both partners, then their sexual relationship is working for them. If one or both are left with negative feelings, then there's a problem.
What suggestions do you have for couples who have significantly different levels of sexual desire?
There are wide differences in the level of sexual interest and desire among people. Desire also fluctuates for each person as his or her life circumstances change. If the difference between levels of sexual desire is small, couples are generally able to negotiate their activity so that they both feel satisfied.
However, if the disparity in sexual desire is quite large, it can have a negative impact on the relationship. In these situations, the partner who has the lower level of desire often feels pressured to do something that he or she doesn't feel like doing. In the long run, this can lead to resentment, anger and a further decline in sexual desire. The partner with the higher level of desire often begins to feel unloved, deprived and desperate. Because of the increasing feeling of deprivation, the person with greater sexual desire might press for sexual activity even more frequently and more vigorously. This creates a cycle in which one partner's desire increases while the other loses all interest.
Strategies for dealing with a large disparity in sexual desire can be complex and may require the help of a therapist, especially if the problem has existed for a long time. A therapist might address the issue by suggesting that the person who has low interest in sexual intercourse shouldn't be pressured to participate. The therapist might also say that it's good for the relationship when the person with the higher level of desire feels his or her sexual needs are being met adequately. One strategy for accomplishing both of these conditions involves the partner with the lower level of desire being willing to provide sexual satisfaction for the partner in ways that don't involve sexual intercourse. The use of other techniques can avoid forcing the partner with the lower interest to experience sexual arousal when he or she doesn't feel like becoming aroused.
When this approach is used, the partner with the lower level of desire may get pleasure from pleasing the partner. The person with the higher level of desire regains the feeling that the partner does care about his or her sexual satisfaction. In some couples this leads to an increase in desire in the partner with the lower level of interest and a reduction in the pressure for more frequent sexual activity from the partner with the higher level of desire.
Some couples aren't able to accept such an approach. They might feel that they shouldn't engage in any sexual activity unless they're both aroused, or they might feel that sexual satisfaction from an activity other than intercourse is wrong.
What would you suggest to couples who experience tension because one partner requests sexual activities that don't interest or may even repulse the other person?
When a partner's preference for a specific sexual behavior is a source of conflict, the partners need to use negotiation skills to arrive at a pattern of behavior that is acceptable to both. This requires being willing to listen and avoiding blame and ridicule. It's important to consider whether the behaviors being requested are harmful.
Although people shouldn't engage in behavior they consider repulsive, if they're simply uninterested, they might want to try experimenting with the partner's fantasy or behavior to further explore their own feelings about it. If a person decides that they don't want to participate in the behavior requested by his or her partner, it's best for the partner to stop requesting that behavior. If the couple is unable to come to an agreement on this issue, it might be worthwhile to consult a psychologist, physician or marriage counselor to obtain another perspective.
What are the conditions that make it possible for a person to engage in satisfying sexual behavior?
For a person to become sexually aroused and to function normally, he or she needs to have a feeling of self-confidence, freedom from anxiety, the presence of arousing mental and physical stimulation, and the ability to focus attention on sexually arousing thoughts or behavior. Anything that interferes with these conditions can disrupt a sexual encounter. If one or more of these conditions is routinely absent, an inability to perform can become a lasting problem.
Self-confidence includes a belief that you'll be able to perform sexually, a belief that the partner finds you attractive, and a feeling that the partner has good intentions. If one of the partners routinely belittles or threatens the other, such confidence can be undermined.
Any type of anxiety can lead to an episode of sexual failure. The most common type of anxiety is performance anxiety, in which the person is afraid that he or she won't be able to become aroused and function normally. This fear of failure is self-perpetuating because the anxiety interferes with arousal. The inability to become aroused then increases the anxiety.
In order to become aroused, people generally need the mental stimulation of a partner they love or find attractive, combined with appropriate physical stimulation. The need for direct physical stimulation increases with age.
In order for stimulation to be arousing, it is necessary for a person to be able to pay attention to it. If someone is distracted by thoughts of possible failure or a lack of self-confidence or has concerns about how the partner is reacting, this will distract from the arousing sexual activity.
How can people identify whether their sexual activities or attitudes about sex might be unhealthy?
Unhealthy sexual behaviors generally involve recurrent intense fantasies, urges, or behaviors involving nonhuman objects, children or nonconsenting partners, or lead to suffering or humiliation. Some people can't become aroused unless they imagine or act out such fantasies. In these situations, consulting a health care professional is strongly advised.
Infidelity also may lead to very difficult psychological stresses and, often, a shattering of valued relationships. And sexual activities that result in a sexually transmitted disease have a direct impact on physical health.
When should people seek help for a sex-related problem?
A couple should consider seeking help if they're experiencing repeated failures in sexual performance or when there's strong disagreement about sexual practices that they can't resolve. Performance problems include difficulty getting an erection, lack of sexual desire, difficulty reaching orgasm, premature ejaculation or a lack of satisfaction from sexual activity. Since medical problems can cause sexual dysfunction, the family physician is a good starting point for discussion of these problems. A therapist might be needed to explore marital and psychological issues that could be contributing to the problem.
Last Updated: 12/02/2004
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