Yesterday The Observer published its special issue on sex. Based on their survey of British sexual attitudes and practices, the issue contains several interesting articles about current understandings and expectations around sex. They interviewed me and a couple of other sex therapists about what we thought was going on in this area, from our work with clients. You can real those interviews here, and I’ve included the full version of mine below. I addressed a few points in greater depth than they could cover in the article.
Overall I was pleased with the interview they published, especially with the fact that they used my quote ‘stop trying to be “normal”‘ as the headline. However, in retrospect I think I might have added a caveat: ‘stop trying to be “normal”. But that is really really difficult to do in a culture that puts so much pressure on people to conform to a certain idea of “normality”, so go gently on yourself.’
What are the most common issues raised in sex therapy by men?
Definitely problems with erections: either struggling to get and keep erections, or ‘premature ejaculations’ which mean that they feel they orgasm too quickly. There’s a lot of pressure on men around performance, so men’s sexual problems tend to relate to not feeling able to ‘perform’ as expected, and anxiety that this makes them less of a man.
Could you just tell me about how this has that changed since Viagra?
Viagra and other similar drugs have certainly changed things. Of course they have been very helpful to many many men in helping them to have the kind of sex they want. However it’s important to remember that they only work to keep erections in guys who can already get erections. So they can be disappointing for people who aren’t getting aroused in the first place.
At the same time, I think a lot of people have understood Viagra to mean that all sexual problems can be physiologically fixed and that this must mean that they are physiologically caused. That isn’t the case. A lot of sexual difficulties stem from the huge cultural pressure to ‘perform’ sexually in certain, limited, ways, and the anxiety that causes. Sexual difficulties can also be a really useful message from our bodies that they are not happy with what we’re trying to make them do (e.g. having sex that we don’t really want). The risk with drug therapies is that they encourage us to ignore those messages, and they may discourage us from trying to change the wider culture around sex which is such a big part of the problem.
What are the most common issues raised in sex therapy by women?
Mostly, for all genders, it is worries about anything that gets in the way of having the kind of sex that people feel is expected of them. With women, for example, if they don’t feel aroused enough or if their vagina is too tight or painful for penetration they often feel anxious. For a lot of women there’s a big fear that if they don’t have the ‘right’ kind of sex they might lose the relationship.
What are we most scared of when it comes to sex?
This one is easy! People are very scared of not being normal. By far the most common question I’ve heard as a sex and relationship therapist is ‘am I normal?’ And people come to sex therapy with the hope that it will make them normal. Generally what they mean by ‘normal’ is the ability to have sex that lasts a certain amount of time, that happens an average number of times a week (whatever that is!), and that involves penetration and orgasm.
Do Britons have a healthy attitude to sex?
No! The NATSAL survey of sexual attitudes and lifestyle found that 42% of men and 51% of women reported experiencing sexual difficulties.
Why is that the case? I’m sure it’s because we have this strong cultural ideal of normal sex and how important it is. Everyone is trying to match up to whatever they’ve seen on TV or read about in magazines instead of realising that sex is hugely diverse. There’s massive variety in the amount of sex people want, how long they want it to last, the kinds of things they enjoy most sexually, the people that they find attractive – all of these things. It is perfectly healthy to experience no sexual attraction or to have a high level of sexual desire or anything in between. We need to stop caring so much about normal and start embracing diversity.
Online porn: good or bad influence?
Both! As with most things porn opens up some possibilities and closes down others. In a world where we still have shockingly little decent education about sex, porn does provide a lot of people with a place to find out about how bodies work and different sexual practices. Also it can help people to realise that there are lots of things that they can do sexually and that is okay.
However, if people only view the most available kinds of porn they could easily come away with another set of ideas about ‘normal’ sexually, which could make them feel worse rather than better. For example, it wouldn’t be helpful to measure your body against a porn star’s body (in terms of how it looks and what it can do – they are like the Olympic athletes of sex!). Plus it is important for people to find their own sexual scripts of what they enjoy rather than feeling that they have to copy any standard script (whether it is porn or Hollywood movies).
Finally there is very little discussion of sexual consent in either porn or mainstream media sex scenes. Given the high rates of sexual abuse and violence that is probably the most vital thing – to get people negotiating sexual consent. It’s shocking that this is absent from most media representations of sex, and from most sex advice too.
Could you tell me what you mean by negotiation?
Negotiation really means having some kind of conversation about sex before having sex. This would cover things like what each person likes and doesn’t like, as well as how they will communicate to each other during sex if they aren’t enjoying it any more. This is very important as research suggests that – currently – couples who have been together for a decade still only know about 60% of what their partner likes sexually, and only about 20% of what they don’t like!
Kink communities have a lot of good ideas about how people might negotiate – given that it can be so difficult to communicate about sex. For example, with a ‘yes, no, maybe’ list you list all of the sexual activities you can think of (either together or on your own) and then go through the list writing ‘yes’, ‘no’ or ‘maybe’ beside each one, to get a sense of what your shared areas of interest are, and also what each person’s hard limits are. This can be a pretty exciting and fun way of opening up a conversation. It’s also good to revisit it every year or so as, of course, these things often change over time. Kinksters also have ‘safe words’ that people can say if the sex they’re having starts to feel uncomfortable in any way (e.g. the traffic lights of green = go, red = stop, and amber = slow down a bit or check in, I’m not sure about this).
One of the positive sides of online technology for sex is that people can also negotiate online prior to having sex in person. Email and online messaging can be great places to talk about sex, to share fantasies, or to try things out in role play (although, of course, it’s important to remember that none of that communication is completely private because online messages go through so many places in their way from A to B).
Have the anxieties you hear in therapy changed in the last five years? (And how?)
I did an analysis recently of the kinds of anxieties that people were writing about to the main newspaper sex problem pages in the UK. That gives a pretty good sense of what people are most worried about at the moment. The top two problems were worries about sexual orientation, and worries about infidelity. So people are most concerned about whether they, or their partner, might be bisexual or gay, and about whether they, or their partner, is having an affair. The next most common fear was around not being sexually normal (the kinds of thing I’ve already mentioned).
So I think we definitely need to open up more conversations, in sex ed in school, in the media, and in sex advice, about the diversity of sexual orientations, and about how people manage the rules of their relationships around monogamy. From the research it seems that over a third of people have attractions to more than one gender, and over half people have sex outside of a monogamous relationship.Clearly people are very anxious about these things, but many don’t have the information and awareness to navigate their ways through it.
What sexual practices are you seeing more of?
After 50 Shade of Grey there is definitely more awareness around kink and BDSM, again without much good information for people about how they might engage in those kinds of sex. The novels definitely don’t give a great sense of how people might do this! There are some very useful books out there by people like Tristan Taormino, Mollena Williams, and Dossie Easton if people are looking to explore those areas.
What’s missing from the novel? In what ways is it not helpful as a sexual education?
In the novel, the kink relationship takes place in a very unequal power dynamic. Ana has no experience at all, and Christian has loads, and he is also a hugely rich and powerful man. It’s really important, in real life, to think about power dynamics when it comes to sex because they can easily make one person feel that they can’t really say ‘no’ to something they dislike, or open up about what they’d like to do sexually. Ana is given very little opportunity to say what she might like to try – just a list of what Christian is into.
Also, Christian does not respect Ana’s boundaries in their wider relationship. He follows her when she’s asked for some space, and interferes with her work life. He also tells her that she can’t talk about the relationship to any of her friends, which is a big danger sign for abusive relationships. Both characters are trying to change each other into something they’re not. It is hard to have consensual sex under such unequal conditions.
Do you think we’re having better sex than previous generations?
Nope, sadly not. I’m always dismayed when I go and talk to students about these topics because their sex ed is generally no better than what I had thirty years ago. Also the current popular sex advice books (which I’ve just been analysing for a research project) just perpetuate the idea that there is one kind of ‘normal’ sex that everyone should be having. They emphasise penis-in-vagina sex and orgasm, and really don’t give any sense of diverse bodies and sexual practices, or much guidance around the issues of sexual orientation and monogamy that people are actually most worried about. Many are mostly a list of different positions in which to have penis-in-vagina sex, which really isn’t much help!
You could definitely say that many of the places that people are going to get help with sex are actually part of the problem, given that they still buy in to the idea of normal sex that everyone should be having, instead of emphasising diversity and helping people to tune in to what they want and to communicate that consensually to others.
What counts as cheating these days? Are we less monogamous – are there more shades of grey?
The evidence suggests that people do not have open conversations, early on in relationships, about monogamy. They generally just assume that the other person will have the same rules as they do. Many relationships then break down because they realise that they have different rules when something goes wrong. One person thought it was fine to stay friends with their ex and the other didn’t. One person thought it was okay to look at online porn and the other didn’t. The lines around monogamy and non-monogamy are blurred, and there are lots of different ways of doing relationships (think about friends-with-benefits, hook-ups, monogamish relationships, and polyamory, for example).
Again I think people just need more awareness about these things and guidance about how they might navigate differences in how much emotional and/or sexual openness they might like. We go into relationships assuming that we will share our monogamy rules and our sexual desires, but actually there are bound to be some differences. Assuming difference from the start, and talking about it it, could be a lot less painful than finding this out down the line.
Is that like the conversation about whether or not you want to have children – important to have early?
I think that’s another conversation that is worth having. In Rewriting the Rules, I suggest that it’s worth thinking about all the things that we often take for granted when committing to relationships (e.g. living together, sharing finances, having kids, going on holiday together, etc.) as well as monogamy, and having conversations about it. There are different ways of doing all these things, and it’s important to respect that each person can be coming from a different place and that is okay.
Is there a difference between how older and younger couples are negotiating or interpreting the new rules?
I’m not sure that there is much of an age difference here. Some older couples have found, through experience, that they want to do something differently to the perceived norm (e.g. living apart together, or having separate holidays, or swinging), whereas some younger couples follow what they think is expected of them. And, of course, there are older couples who feel that they can’t shift after a lifetime of following the perceived rules, and younger ones who do things differently from the start because of their politics, for example.
Do you think we’ve become more open minded and experimental, or more anxious and insecure?
Again I’d say the answer is both! There is both more openness and more anxiety.
What is still taboo?
We still have a lot of cultural bogeymen in relation to sex. The sex advice books that I read talk about a ‘sexless relationship’ like it is the worst thing in the world and would definitely lead to break up. They encourage people to have sex even when they don’t want it in order to avoid this. I think that is really problematic as it encourages non-consensual sex, and also lots of relationships are not sexual and are totally fine.
There are also taboos about people being ‘too sexual’ or having the ‘wrong’ kinds of sexual desires. People get so scared of being labelled a sex addict, or a freak, that they often try to hide from their sexual desires, rather than exploring them in a safe space, and figuring out which can be acted on consensually, and which they want to keep to fantasy only.
Are fantasies quite taboo in general?
Yep, people are often worried by their fantasies, again because we aren’t open about the reality that it is – in fact – normal to have a range of sexual fantasies, including about things we’d never act out. Like dreams, sexual fantasies can be a place where we work out all kinds of things. Emily Dubberley’s recent collection of British women’s sexual fantasies is a great place to look to realise just what a range of things people fantasies about.
What’s the most common advice you give out in therapy?
The most common thing I do is to try to help people to gently explore their ideas about what is normal and what everyone else is doing sexually. Those NATSAL statistics – that half of people see themselves as having sexual difficulties – definitely help with that.
Once we can stop trying so hard to fit a certain box of ‘normal’, then we can start to explore what our own desires actually are, which is a much better starting point.
What issues seem to be most upsetting and pertinent in therapy?
I think those I’ve already mentioned. People feeling that there are certain kinds of sex and relationships that they should have, and that they are an unacceptable human being if that isn’t what feels right to them.
This feeds into many mental health problems, particularly anxiety and depression, and also many relationship problems and conflicts. We really could help people a great deal if we could put out a different message of sexual and relationship diversity.
Do you think have any examples of the most common situations that you see in sex therapy?
One kind of situation I’ve seen a lot of is young people – often, but not always, women – who find penetration sex painful, but keep having it because they feel like this is what their partner will want, and they fear they might lose the relationship if they don’t. Often this is wrapped up in wider discomfort about their body. They’ve learnt to worry greatly that they are unattractive, so they can’t relax during sex. They’ve also never really learnt to enjoy their fantasies and their bodies so that sex might be a pleasurable thing.
Of course what we really need to do about this is to change the messages that young people are getting about their bodies, and about sex and relationships. But until that happens, therapy with clients like this is often about improving confidence, helping them tune into their desires, and challenging assumptions about sex. For example, it might be that they are assuming what kinds of sex their partner wants, and actually both of them would be very happy to take the pressure off penetration sex, by doing other stuff as well, or instead (e.g. mutual masturbation, oral sex, watching erotica together, role-play games, massage).
Another common situation at the moment is people – often, but not always, men – who are disturbed by the kinds of online porn they’re looking at or how much they’re looking at it. Again, the ideas around ‘normal’ sex often mean that they are terrified to think too much about it in case they discover that they are abnormal or ‘deviant’ in some way. Often they then get into a pattern of just trying not to do it at all, and then going back to it and feeling deeply ashamed afterwards.
Again, the best answer here would be to change our cultural ideas about sex, so that we were much more open about the diverse range of sexual practice that are absolutely fine, as well as being much clearer about the lines between consensual sex and non-consensual sex. If sex education throughout school explored those kinds of things then young people would have a much better idea about how to navigate their sexual fantasies and online sexual spaces.
However, in the absence of that cultural shift, therapy can provide a safe space for people to be open about what turns them on, and to start to gently understand what it means to them (rather than just trying to avoid it completely, or get sucked into it totally). Exploring ideas of consent and ethical treatment of ourselves, and other people, can help clients consider their own ethics around watching porn, and engaging in sex, and the lines that they want to draw between fantasy and reality.
When was the last time you were shocked in the therapy room?
In a way every time that I hear another person in so much pain because they are trying to match up to this impossible ideal of normal sex, instead of exploring what they might actually enjoy. That is pretty shocking when you think about it.
If you could give one piece of advice to the nation when it comes to sex, what would it be?
Stop trying to be ‘normal’!