Sexual Intelligence

Sex—and culture, politics, psychology—and sex

Talking My Patient Out of a Boob Job

Once she realized why she wanted to do it, it was a whole different conversation

Since last fall I’ve been seeing this very nice couple, Mario & Trisha.

She brought them into therapy because Mario wasn’t interested in sex with her. Periodically she would get so angry or depressed that she’d get blind drunk and behave very, very badly—humiliate him in public, black out at a party, and spend the next few days in bed eating donuts, hating her life.

“I wouldn’t do this if you’d have sex with me,” she’d say. “You can’t expect me to have sex with you when you act so crazy every month or two,” he’d say. She was in tremendous pain about two things: she wasn't getting laid, and she felt rejected by the man she loved. He was in a different kind of pain: the woman he loved was miserable, he knew it was partly his fault, and he couldn’t figure out how to fix it.

This has been their routine for almost three years: promises, anger, tears, dismay, rejection. And almost no sex.

Find a Therapist

Search for a mental health professional near you.

But after six months of couples therapy (and a year of individual therapy), Trisha gradually changed: she stopped drinking. She became more responsible, and started treating him respectfully. Although she got angry periodically, there are no more rages, no more blackouts, no more days in bed with Krispy Kreme.

Mario changed, too: he became more relaxed and even playful sometimes. He notices her and is more involved in her life, and not just for solving problems. He’s even started discussing their future together, which Trisha really craves. But one thing hasn’t changed: he’s still not interested in sex with her.

Trisha is still feeling sexually deprived and rejected. After a particularly profound couples session, Mario started individual therapy. For the first month he neglected to tell his therapist he wasn’t having sex with Trisha.

Recently, Trisha’s therapist called me for our monthly check-in. “Another thing,” she said mid-way through the call, “Trisha’s planning to get a boob job.” What a perfect example of how every couple really is a system, its elements interconnected. And so couples therapy can be like whack-a-mole—you take care of one thing here, another issue pops up there.

When Trisha & Mario next came in, they were attentive, thoughtful, and we did some good work. About half-way through the hour, I said “So, I guess we need to talk about Trisha’s breasts?” “You talked to my therapist,” she said, rolling her eyes, “Right?” Right.

First we talked about why she or Mario hadn’t mentioned it to me. After a few de rigueur excuses (“well, you’re a man,” “well, we didn’t want to get off track,” “well, I didn’t want you to talk me out of it,” “well, she told me not to”), we had one of our periodic talks about our relationship.

That done, Trisha wanted to tell me why getting a boob job was a good idea: wanting her clothes to fit differently (“and I get to buy new stuff, too!”), wanting to look like some of the other women in her gym, and then, half-intimately, half-accusingly, “Besides, he’s always been a big boob man.”

I asked Mario what he thought of her surgery idea. He started with “Well, whatever makes her happy,” but he was clearly uneasy about it. I asked why he hadn’t expressed that more clearly to her, possibly even trying to discourage her. “It’s her body,” he said weakly. And although it is, of course, I told Mario that as Trisha’s partner, he had an obligation to engage her in a serious conversation about every important decision, especially if he disagreed with her idea. “I know you’re still learning about relationships,” I smiled. “You know, Trisha sometimes feels lonely because you don’t talk about things.”

Turning to Trisha, I gently said, “Many women get their breasts surgically changed because they assume it will increase their mate’s sexual desire. Is that why you want to do this?” She protested weakly, but turned to him for justification. “You told me you’ve always loved busty women.” “Yes, I generally have,” said Mario. “But your breasts are fine, more than fine. I like them, really.”

“Trisha,” I said, “When you were drinking and being mean, Mario could blame his low desire on that. And you did something about it. Now that you don’t drink or get enraged, how can we explain his lack of sexual interest in you? If his low desire turns out to be about him, and not you, there won’t be anything you can do about it. That must be very scary. Is that perhaps what this breast surgery might be about—you trying to do something, anything, rather than just sit there and maybe nothing changes?”

Tears, meaningful looks, awkward silence.

“Mario, if Trisha has a bigger chest do you think you’ll be more interested in sex with her?”

“No.”

“Why not?”

“She’s already beautiful. Don’t you think so, Doc?”

Indeed, she actually is very attractive, but of course that wasn’t the point.

“Trisha, what do you hear Mario saying?”

“OK, supposedly it isn’t me,” she said through tears. “So what is it? What should I do, just wait around for some magic? Did I quit drinking and partying for nothing? Are we ever going to have sex at least every week or two? Do you know how helpless I feel?”

We were already over time, and this was a good place to stop. They had a lot to talk about. The next part of the therapy—and more importantly, of their relationship—had just started.

Marty Klein is a certified sex therapist and licensed psychotherapist. He has written five books and 200 articles about sex; his TV appearances include 20/20 andNightline. more...

Subscribe to Sexual Intelligence

Current Issue

Let It Go!

It can take a radical reboot to get past old hurts and injustices.