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I glanced at a blog recently that made the case that first sexual experiences are always memorable and indicative of a future sexual adjustment. That would be interesting if it were so. A sexual history, like every other aspect of a personal history, is taken from every patient at the beginning of treatment precisely because early experiences prefigure subsequent behavior. Indeed, I ask every patient about sex as part of an overall history. However, I have not been struck by a connection between the first sexual experience and that person’s later sexual adjustment. And it is certainly not true that people always remember the first time they had sexual intercourse—although they usually remember the relationship they were in at the time. I ask about these matters routinely when I talk with patients about their high school academic and social experience-- because sex usually begins around that time.
I ask, “When did you first start to date?” After they tell me, I ask, “How did it go?”
The experiences reported to me vary, in part because “dating” means different things to different people, sometimes referring to a group of girls and boys going out together, but more usually referring to going out with a particular person as a couple. Any dating experience that departs significantly from what other kids do—at a particular time and place—can have meaning. In our culture, for instance, a boy or girl having no dating experiences until college, or later, might be inhibited. Something similar can be said for any behavior very different than the norm. One cannot reliably say what such extreme behaviors mean, but it can reasonably be assumed that they mean something.
Next, I ask about sex. “When was your first sexual experience?” There is an intentional ambiguity in that question. Most people assume I am talking about sexual intercourse; some ask if that is what I mean, or they volunteer stories about other sexual experiences. Any response is reflective of a point of view. The circumstances in which sexual intercourse first happens are, as anyone might surmise, very different. The ages vary from very young, eleven or twelve, to not at all—or to not at all until marriage.
I think having sex at a very young age often reflects a somewhat disorganized and unsupervised family life. At the other extreme, those who do not have sex into their twenties sometimes give religious reasons as an explanation. Since there are some who are just as religious—brought up in religions that forbid premarital sex—who nevertheless engage in sexual behaviors to the same extent as others in our society-- I assume that those who adhere rigorously to such a prohibition are responding to emotional influences also. I know some people reading this will be annoyed. They, themselves, are now, or were, virgins when they married; and they think that their religious views—a matter of right and wrong-- are sufficient to account for their abstinence. Maybe so. There are plainly others who are simply afraid of sex and who use religious rationales as excuses for avoidance. It might be anticipated that these individuals will have trouble adjusting to a sexual life even after marriage. On the other hand, there are certainly some who marry late, as virgins, and have a perfectly normal sexual life throughout their marriage.
My impression, though, based solely on my clinical experience, is that there are fewer abstinent individuals now than there were forty years ago. Consequently, it is reasonable to surmise that those few who do remain virgins because of religious beliefs are more likely than they would have in a previous time to be affected also by emotional influences. I should mention in this connection that sexual behavior does not always turn on like a light bulb after marriage. I have treated sexually inexperienced couples that were married for as long as a year or two without being able to consummate their marriage.
First sexual experiences can grow out of early loving relationships, but, also, out of rape, out of drunken encounters and out of myriad other specific circumstances. Most typically they occur in the context of relationships that continue for extended periods, even in adolescence.
I ask: “How did these early experiences go?” The responses I get are varied. Most people say, “It was okay.” “Or “fine.” Some people say something on the order of, ”not so good” or “it was a big let-down.” Sometimes those first exposures to sex are a result of giving in to social pressures. Sometimes the sex was painful. Sometimes it was traumatic. Those encounters may, or may not, color the individual’s subsequent attitudes towards sex. If they do, it is not in such a consistent way that I can predict their effect later on in life. Surprisingly. It seems that violent or aggressive sexual encounters—or incest-- are more likely to lead to changes in self-image rather than to disturbances of a subsequent sexual adjustment.
Having brought up the subject of sex, I always ask, “Have you ever had sexual problems?” Most people have not. Some people ask me what I mean, and then give an ambiguous response. If they give any indication of dissatisfaction, I ask them what sort of problems.
In men, there are two sorts of sexual dysfunction: first, trouble maintaining an erection (impotence, currently called euphemistically “ erectile dysfunction” or, as they say in the commercials, “E.D.” ) second, disturbances of orgasm: premature ejaculation, or retarded ejaculation. Both, when they occur early in life, are thought to be caused psychologically, The use of anti-depressant drugs in high doses, particularly the serotinergic drugs, also causes delayed orgasm--in women also. The effect is such that these drugs can be used to treat premature ejaculation. ( I remember one gentleman whose reached a climax too soon, or went on too long, depending on just how much medicine he took. Like goldilocks, he soon found the exactly right amount,)
Women seem less likely when giving an initial history to complain about sexual problems. When they do, they speak of difficulties reaching a climax—to a varying degree. No one, either male or female, always functions smoothly sexually; but some individuals always have difficulties and are dissatisfied with their sexual life.
In any case, extremes of sexual behavior during adolescence can be used sensibly to draw the clinician’s attention to possible disorders of subsequent sexual behavior and, more expansively, sometimes to other disturbances of social adjustment. BUT GENERALIZATIONS BASED ON THESE LIMITED EARLY EXPERIENCES OF SEX SHOULD BE VERY TENTATIVE. In this connection I should say that any explanation of human behavior—or of any other scientific conjecture-- that is made retrospectively should always be regarded as speculative-- interesting, perhaps—but likely to be wrong. Real scientific explanations should be able to PREDICT what will happen. Ideally, we should be able to say that this sort of sexual encounter, whatever it is—childhood abuse, for instance—should be able to predict what sorts of disturbance that person will develop later in life, AND IT DOES NOT! Every sort of psychological difficulty in adulthood has been attributed in retrospect to early childhood sexual abuse. These “explanations” are a result of misguided psychotherapies which encourage inaccurate memories. False accusations of childhood sexual abuse have devastated some families. Some men and women are languishing in jail because these reports were believed by credulous prosecutors and juries.
Since psychological explanations tend to be retrospective, they should always be taken with a grain of salt. Memories are always interesting, but they report events that may never have happened. Freud wrestled with determining whether or not the incestuous encounters his patients reported to him were real or imagined. It is not always easy to say. What, then, is the purpose of taking a psychiatric history? It is not just to discover the explanation of who that person has become and why; it is to better understand that person’s reaction to his/her current experiences. Everyone has a story of his/her life; and the therapist needs to understand that story in order to help that patient deal with those problems that appear in the present.
During that initial period of taking a patient’s history, the range of responses given to a question about early sexual experiences is not wide. Some experiences were good; and others were not so good, even bad; but women report a much greater variety of reactions when speaking about another universal physical change—menarche—the first menstrual period. Despite the caveats I report above about attributing too much significance to certain memories, I do think a woman’s experience with menarche does suggest attitudes she had then—and may continue to have—about growing up and about sexual behavior, in particular.
These are some of the experiences adult women spoke about when remembering their first period:
Pleasure: “I was really looking forward to my period. I was the last person In my class to get it.” Or, “I went around boasting to my sister.”
Fear: “No one told me what to expect. I thought I hurt myself.”
Embarrassment: “I didn’t tell anybody for months. I used a rag.” Or, “Everyone in the family made fun of me.” Or “I was embarrassed with everything that was going on, like developing breasts.”
Guilt: “I didn’t know what it was. I thought I did something wrong.”
Excitement: “I told everyone. I asked my mother if I could buy a new dress.”
Anger: “I didn’t want it to happen. I was younger than everybody.”
No reaction: “It was no big deal.” Or. “I don’t remember.” Not remembering is so uncommon, I sometimes suspect that the woman I am speaking to is not being frank.
I leave it to the reader to guess—as I have to do—what these different responses suggest about the reaction those women have to growing up as a woman and how they feel—or felt—about their subsequent sexual lives.
Unfortunately, there is no similar physical change that symbolizes and encapsulates a boy growing into manhood.(c) Fredric Neuman 2013 Follow Dr. Neuman's blog at fredricneumanmd,com/blog
