The New Male Sexuality (72 page)

2. Before making any appointments, ask about safe-sex practices and proof that the surrogate has had a recent negative HIV antibody test
. If the surrogate and therapist don’t seem concerned about safe sex, if she won’t provide the proof, or if she doesn’t require similar proof from you, stay away.

3
.
Work only with a surrogate who respects who you are
. Good surrogate work, like any good therapy, requires an understanding of and respect for you and your problem. It should begin where you are and gradually take you to where you want to go. It should not ask you to do what you
can’t do, and it should not humiliate or terrify you. I have heard a number of horror stories over the years about surrogates working alone. One of them asked a very anxious man with erection problems to undress and masturbate in front of her—after he had known her only half an hour! If he could have done that, he wouldn’t have needed her help. The only effects were to further embarrass and humiliate him and to convince him that he would never get better.

4. Feel free to bring up any complaints or problems with the surrogate and the therapist
. Years ago a man was telling me about a difficult session he had just had with the surrogate. In trying to determine what went wrong, we finally hit upon the temperature at her place. He said it was as hot as a sauna and he felt totally depleted. When I asked why he didn’t ask her to turn down the heat or open a window, he answered, “I thought the heat was part of the program.” Don’t make the same mistake. Anything that bothers you or that makes you uncomfortable should be expressed as soon as possible. This is also good training for what you need to be able to do with your own partners: Express what’s on your mind.

Since surrogate therapy is so expensive (you should figure on at least two thousand to three thousand dollars, unless your problem is quite specific and you don’t need work on overcoming shyness or the development of social skills), you may want to try other treatment options first—for example, the exercises in this book relevant to your problem. If you make some progress but not as much as you want, you can still see a surrogate later; the work you’ve done on your own will probably decrease the number of sessions you’ll need with her.

CHAPTER TWENTY-FOUR

Resolving Problems of Sexual
Desire and Frequency

I don’t know what to do about my girlfriend. I love her and we get along fine, but her idea of good sex is once, maybe twice, a week. I can’t survive on such a meager quota.—
Man, 27

I feel like shit. I just don’t want to make love to my wife. She feels ugly and thinks I’m having an affair, which I’m not, and I feel guilty and awful. Why can’t I get turned on to her anymore?—
Man, 44

Despite all the news on the media about erection and orgasm problems, the complaint that has brought the largest number of individuals and couples to sex therapy in the last fifteen years has to do with desire and frequency. Michael, for instance, is upset with his lover because “she rarely wants sex. I go around angry at her and horny all the time.” Barney, on the other hand, is upset with his wife because “she’s always hounding me for sex. It’s gotten so I’m almost afraid to come home.” Edward and Janet are upset because they rarely have sex even though they both miss and want it: “It’s just that we’re too busy and too tired; when one of us is in the mood the other either isn’t or is already asleep.”

When you first hear about such complaints, they sound easy to resolve. Surely Michael could just make do with less sex than he’s used to and Barney could interest himself a little more often in order to make his wife happier. And certainly Edward and Janet could set aside a time each week when they’d both be awake and interested in making love. Of course, some people do come up with these solutions on their own and make them work. Yet many other couples cannot resolve these problems on their own. Their egos are involved, their feelings are hurt, and they find it difficult
even to discuss the issues constructively with their partners, let alone make any changes. Yet assuming goodwill on both sides and a reasonably functional relationship, most of these complaints can be worked out.

DESIRE PROBLEMS

Problems of sexual appetite and activity usually come up as a discrepancy in a relationship: One partner wants more or less sex than the other, and they are unable to work out a compromise. It may always have been this way—A wanted more sex than B from the first days of their relationship—or it may be a more recent development. The problem may be or at least seem absolute; that is, A “always” wants sex or B “never” wants it.

A woman I saw in therapy complained that absolutely nothing dented her husband’s sex drive. When she was angry with him, he still wanted sex, as he did when he was angry with her. One night, she recalled, she was suffering from the flu, had a temperature of 103 degrees, “was coughing and sneezing every minute and, as I noticed later, even had snot running down my face,” but was awakened to find her husband rubbing her breasts, trying to turn her on.

On the other side of the continuum, a male client complained that ever since they had moved to California four years earlier, his wife has never, “not once,” wanted sex. She did not initiate nor did she respond positively to any of his initiations.

The problem may also be less extreme, with B being interested some of the time but not nearly enough to satisfy A. A man in his early forties complained, “It’s not that Marge never wants sex. Occasionally she does, but that requires that the kids be out of the house or sound asleep, that we’ve been lovey-dovey for at least a week, and that she isn’t engaged in an important project at work. What this comes down to is sex once or twice a month, and I just can’t deal with that.”

WHAT ARE WE TALKING ABOUT, ANYWAY?

Since much more is often entailed in desire problems than that term implies, let’s try to define exactly what is involved. There are three key concepts: desire itself, the object or purpose of the desire, and the willingness to act on the feeling of desire.

I take the first concept,
erotic desire
, to mean a physical/emotional interest
in engaging in sexual activity. While desire often has cognitive elements (thoughts or images of sex), it is more than a vague intellectual itch. For example, the idea “I should want to make it with such a beautiful woman,” if unaccompanied by any feeling or physical sensation, is not desire as I define it. Neither is the idea “Gee, we haven’t made love in several weeks, so I guess it’s time.” As I use the term
desire
, it is similar to the messages we get from our bodies signifying a desire for food. But just as we don’t always eat when we get a message saying, “
Beep, beep
, hungry,” so too we don’t always engage in sex when we get a “
Beep, beep
, horny” message. And just as we sometimes eat without having received a “
Beep, beep
, hungry,” message, so too we sometimes have sex without a “
Beep, beep
, horny” message.

In some people interest itself is low; that is, they don’t have many sexual thoughts, feelings, or fantasies. Seeing or talking to an attractive person doesn’t evoke any surges of sexual energy or any thoughts or images of what they might want to do sexually with these people. This total or relative lack of interest in sex can be either long-term—and for a few men it’s always been like this—or of recent origin.

Although there are some women who want more sex than the average man and some men who want less sex than the average woman, in general men seem to have a greater libido than women. The observation of sex therapists and researchers Sandra Leiblum and Raymond Rosen fits my own impressions:

Overall, it does appear that men have a more insistent and constant sexual appetite, which is readily accessed through a large variety of internal and environmental prompts. Women, on the other hand, have less intense and more sporadic sexual desires, which they are more likely to suppress or to ignore if a host of conditions are not met.

An example of men’s more constant appetite is that they think about and want sex regardless of whether they are in a relationship, while many women seem to automatically turn off their erotic interest when they’re not connected to someone. As one woman reported: “When I don’t have a partner, I don’t think about sex. And to tell the truth, I don’t miss it much. As soon as I’m in a new relationship, though, and sexually active again, I think about it all the time!”

Women’s desire also fluctuates with their menstrual cycles. Very few women, for instance, have much sexual interest just before and during the first two or three days of their periods. And most women do not have
much sexual appetite in the last trimester of pregnancy or for a while after giving birth.

Despite what I’ve said about men generally being more interested in sex than women, there are many exceptions. In my own practice, in the vast majority of couples consulting me about desire complaints it’s the woman who wants more and the man who always has a headache.

For both men and women, sexual desire does decrease gradually with age. The height of sexual interest for both males and females comes fairly early—in adolescence and the twenties. It’s like everything reminds you of sex and everything makes you feel sexy. This feeling tends to diminish over the years, although there can be resurgences at various times.

There is no physical reason for sexual desire to entirely disappear with age. The production of testosterone, which largely controls sexual appetite in men and women, does decline over time, but it never ceases altogether in healthy individuals. There are many men in their sixties, seventies, eighties, and beyond who remain interested in sex and have it when they can, although factors like lack of a partner or medical problems may get in the way. But interest remains, and not only for men. A friend of mine is a doctor who routinely asks her patients about safe sex. One day, without thinking, she asked a ninety-year-old single woman patient if she was practicing safe sex. The woman smiled sweetly and said, “No, but I’d like to.”

Despite what I’ve said about the constancy of male libido, it can ebb and flow, depending on a number of variables. Some men, for instance, can lose interest when they’re deeply involved in their education, work, or athletics. This can be for days, weeks, or longer. Various stresses can also deflate desire. One man with a usually ravenous sexual appetite reported that he didn’t think about sex or engage in any form of it for four months—the period beginning when he was first contacted by the IRS until the day after the audit was completed.

The same things affect different men in different ways. Although some men forget about sex when involved in their work, other men get turned on while working and use sex as a relief from work and as a way of recharging their batteries. Certainly the stressful job of being president of the United States didn’t dampen John F. Kennedy’s enormous sexual appetite.

Many men’s desire, or willingness to act on desire, is heavily dependent on the physical characteristics of their partners. These men report that their sexual appetites decreased after their partners gained weight or developed stretch marks as a result of pregnancy. Some men’s sexual desire is
severely affected by relationship problems. If they feel angry at or rejected by their partners, their libido disappears. Other men barely seem to notice. It’s as if their sexual urges are in a separate compartment and are unaffected by other considerations. And for a great many men, almost regardless of their age and situation, the appearance of a new partner, especially if she’s young and attractive, can greatly increase erotic desire, at least for a short time.

The second crucial concept is the
object of desire
, which really comes down to the question of, desire for what? There are men who desire and engage in sex frequently, but only with themselves. While this can be the result of a block to sex with the partner—for instance, feeling that sex with her isn’t fun or worthwhile—it can also be a preference. There are men who get all their erotic needs met in masturbation and, left to their own devices, would almost never have sex with a partner. It’s as if they believe intercourse is a poor substitute for masturbation. While there is nothing specifically wrong with such an attitude, it can wreak havoc in relationships where the partner wants more sex with the man and realizes that although he’s unwilling to have sex with her, he’s doing it regularly with himself.