Thursday 20 September 2018

I've always enjoyed talking about sex and solving people's problems

Masters and Johnson did sensational pioneering work on the diagnosis and treatment of sexual disorders from the 1950s right through to the 1990s, and identified eight sexual dysfunctions, and they still remain the same today, writes Mary O'Conor

Mary O'Conor looked forward to going into work every day
Mary O'Conor looked forward to going into work every day

For all the years I worked as a sex therapist I looked forward to going into work every day. I found the work more rewarding than anything else I had ever done, and I often pondered why this was. I came to the conclusion that it was because it had a beginning, a middle and an end, unlike counselling where it is much more difficult to quantify results.

Also, if my clients were a couple, their emotional connection was good, and the success rate was very high.

It was always wonderful when a client finished treatment to watch their obvious joy in what they had achieved, to note the spring in their step and their head held high, and sometimes many months later to be rewarded with a photograph of a brand new baby.

What causes somebody to seek the help of a psychosexual therapist? It is because they are either experiencing problems in their sex life with a partner, or because they had a problem in a previous relationship and they don't want it to happen again. They can be referred by a GP or by a gynaecologist or urologist and, in some cases, people self- refer, and that is quite acceptable.

The very first thing the therapist will do, after hearing about the actual problem, is to check out the state of the relationship because it has to be good enough if therapy is to work.

A man once came to the clinic where I worked and told me that his wife had sent him to get his erectile problems sorted out. When I asked him how he got on with his wife he told me that he couldn't stand her! He actually found it difficult to understand that this might be part of the problem and I had to tell him that I couldn't work with him and suggested he may seek relationship counselling.

The problems that are most commonly brought to therapy are the same ones that were classified by Masters and Johnson who did so much pioneering work on the diagnosis and treatment of sexual disorders from the 1950s right through to the 1990s. They identified eight sexual dysfunctions and they still remain the same today.

There are four dysfunctions related to the male and four related to the female.

* Males suffer with erectile dysfunction (ED) where he has difficulty either getting or maintain an erection sufficient for penetration. Along with psychosexual therapy there is now a range of medications that is available to help this condition, so it is wise to consult the GP or urologist in the first instance. They can then refer on when appropriate.

* Premature Ejaculation (PE) is another very common problem and one which responds to therapy. While no drug has been specifically approved for the treatment of PE some antidepressants have been successful. Desensitising creams can also be useful in some cases, and the book Coping with Premature Ejaculation by Barry W McCarthy and Michael E Metz is a good resource.

* The opposite end of the scale is Delayed Ejaculation, where the man finds it very difficult to ejaculate, and whereas this may be longed for in somebody suffering with PE it is quite a difficult problem, particularly when the couple want to try for a baby.

* The last classified dysfunction is Inhibited Disorder of Desire - very little interest in being sexual. There is a perception out there that men are ready willing and able at all times to have sex with any like-minded partner, but this is not the case.

* The female problems are Vaginismus where a woman is unable to allow penetration of any kind, cannot use tampons and in a lot of cases cannot tolerate a medical examination of the genital area. This is a very common problem and responds very well to treatment, although it may take a long time to overcome all the anxiety that the woman experiences.

* The problem of Dyspareunia is where a woman can allow penetration and have intercourse but it hurts a lot. In all cases she needs to be checked for a possible medical cause and if none is found then therapy is appropriate.

* Orgasmic problems, either when she is on her own or 'in company', as a very polite medical colleague used to say, are also fairly common.

* Disorders of desire - gone off it or indeed never on it - is perhaps the most multi-layered of all the problems and if the mailbag to Dear Mary is anything to go by is extremely common.

Things like work pressure, body issues, tiredness, children, menopause and no longer being attracted to the partner can all contribute to the woman saying 'I don't care if I never had it again'.

The initial meeting with a therapist is a getting to know you session, where the problem is presented and the therapist explains how they can help and what treatment entails. This is followed by a history taking of each person individually and the therapist explores their background with them and tries to ascertain predisposing, precipitating and maintaining factors that are contributing to their problem. When they meet again the therapist gives them feedback as to what she - I will refer to the therapist as 'she' even though there are also male therapists working in this area - has found and she then outlines what the programme she has devised for them entails. The couple then undertake to devote a few sessions a week at home where they can be undisturbed and not be too tired and they initially give and receive massage.To begin with this is a non-sexual massage, some underwear may be worn, and all of the erogenous zones are skipped. In the meantime the specific dysfunction is worked on with exercises given to the person to be done alone. The purpose in all of this is to start to build the couple's enjoyment of being alone together and to remove all the anxiety that has been built up over the months, or sometimes years, of living with the dysfunction.

Every couple is different and because of this the therapist will make adjustments accordingly. Gradually more steps are added to the sessions at home, depending on the presenting problem, until eventually they are back to a much more enjoyable and hopefully problem free sexual life together.

I remember a particular client who was very sceptical of both giving and receiving massage from his wife. He just wanted to have sex and didn't see the need for massage. His wife meanwhile was all for it and so he agreed to give it a go. He always referred to massage as 'the rub'. When they were back to full functioning and all was well he said to me "you know Mary, I've been thinking, and I'd prefer the rub to the ride any day!" His wife was delighted and so was I.

Of course people also consult a therapist with problems that are not actual dysfunctions.

In more recent years sexual addiction has become quite a problem, cross-dressing and the whole area of gender dysphoria are much more spoken of and people therefore feel able to seek help.

If you are going to seek help from a psychosexual therapist the most important thing is to ensure that she is properly accredited. For people in Dublin the biggest group of therapists is to be found in Mind and Body Works at mindandbodyworks.com, and for outside of Dublin the best route to finding an accredited therapist is to go to the College of Sexual and Relationship Therapists (COSRT) website at cosrt.org.uk. Under Therapist Listings insert Ireland and get a full list of therapists.

For other countries you will have to do some research as to what is available but it will be well worth the effort.

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