Fighting Fear

Confronting phobias and other fears

Sex: How Much Is Just Right? Part 1

Sexual behavior is varied in a number of different ways.

As usual, I disguise the patients I write about.

When I started my psychiatric practice, I saw a 24 year old woman who came to me for treatment of her agoraphobia and panic disorder. It is my practice to ask about sexual matters as part of a routine psychiatric examination; and I asked her. She spoke comfortably about her sexual life with her husband, who was the same age. Neither of them had any complaints, but they were making love infrequently, about once every two weeks, and in a desultory and disinterested manner. It seemed to me that a newly married young couple would ordinarily be having sex more frequently and with more enthusiasm. I read up on the matter.

Kinsey and then Masters and Johnson had written books that were, in part, a survey of sexual behavior in the United States. Up until then no one really knew what people were doing sexually to each other and how often. There was considerable variation. And they talked about other matters. A certain number of men and women were homosexual, a certain number of men and women were unfaithful to their spouses, and so on.  All of that was interesting in a clinical, non-prurient sort of way; but I am not sure their reports were entirely accurate. People tend to become embarrassed about sex and lie. I don’t think what patients tell me is any more likely to be reliable. If patients come to me for treatment with one sort of problem, they may not choose to speak to me openly about other matters, particularly sexual matters.

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Some of what these experts reported seemed to me at first glance not to be credible. For instance, some men had intercourse an average of five or six times a day over the course of their lives!  I immediately began to calculate that if they were injured or sick, disabled, as it were, for a month, they would have to have sex seven or eight times a day for the rest of the year to keep up their average! But these men, who were at one extreme of sexual behavior, were not much more actively sexually than very many others who were having sex four times a day.

Later on in my practice I came across a man in his forties, a contractor, who was regularly having intercourse with his wife three times a day. That meant he would come home during the day; and he and his wife would go into the bedroom while the children were having lunch in the kitchen. I remember him because he became enraged one day when his wife begged off, feeling ill. When I explained to him that sex wasn’t like turning on a faucet for women, he did not believe me. He never heard of such a thing. He had trouble forgiving her.

People can have a lot of sex in other ways. Another patient of mine, another contractor, (what is it with contractors?) had developed a drug problem, particularly with cocaine, which he said he started using because it delayed his orgasm.

“You had premature ejaculation?” I asked.

“No. But I can go much longer with cocaine. A long time.”

“Really?  Why?” That seemed to me like chewing a long time without ever swallowing.

“It feels good, Doc.”

“Well, how long can you go with cocaine?”

“Usually, about three days!”

“THREE DAYS? You can…three days?” I said, sputtering. “What… you don’t eat or sleep for THREE DAYS?”

“Well, we stop to eat from time to time; but usually we don’t sleep.”

I stopped to think about that for a few moments. “Well… how long can you go without cocaine?” I asked.

“Not more than three or four hours.”

 People can be eccentric in different ways; but there is more room for eccentricity in sexual behavior, I think.

After I treated the young agoraphobic woman I mentioned above for about a year and a half, her panic disorder and the phobia had gone; but she and her husband were still having intercourse every two weeks in a desultory manner. Their sexual life had not really come up in treatment; but now, at the end of treatment, I wondered if I should bring it up. Being new to the business, I asked other psychiatrists what they thought. Their opinions divided as follows:

“You have an obligation to point out to them that an important part of their lives together has gone missing to some extent.  Perhaps, then, they will be able to address the problem.”

and, on the other hand,

“You should mind your own business. If they are content with the sex they have, that is all that matters.”

I was trying to collect as many professional opinions one way or the other when a young couple, a psychiatrist and his wife, came over for dinner. I asked them what they thought.

They stared at me solemnly. “What is the matter with once every two weeks?” they both said at the same time.

I decided, finally, that I should leave well enough alone. I congratulated my patient on her recovery from her phobia and said goodbye. (c) Fredric Neuman 2012   Follow Dr. Neuman's blog at fredricneumanmd.com/blog

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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