EDITOR’S NOTE: When a woman has female sexual dysfunction (FSD) her sexuality can be affected. This, in turn, affects her husband or partner. They both struggle with the physical and emotional problems that are created. This leads to blaming and fault-finding. In this posting, licensed psychologist and certified sex therapist David Yarian, Ph.D. answers questions about common frustrations couples face when a woman has (FSD).
Rhonda Borman (RB): Men have a difficult time understanding that their partner’s sexual dysfunction has nothing to do with them - it is not their fault. In addition to having the health care provider talk with the couple, what advice can you give to men who need to understand the intricacies of their partner’s problem(s)?
David Yarian (DY): It’s important for couples to work together to navigate the difficult challenges of a pain syndrome. Men often worry they are hurting their partner, and as a result may be tentative in approaching them. They may develop performance anxiety and erectile dysfunction, or choose to avoid sex entirely. I suggest that couples agree to stop what they are doing immediately if there is even the hint of pain. They can then change positions or alter the activity in some way so that there is no pain.
It is vital that the woman commit to speaking up when there is pain. This allows her partner to stop guessing and relax and enjoy intimacy until he is notified that there is pain. There is never any benefit for the woman to "tough it out" or try to endure through the pain. It doesn’t help with the pain, often makes it worse, and leads her to want to avoid sexual activity.
RB: Women with female sexual dysfunction (FSD) often are in a lot of pain. Many times, the woman also has a diagnosis of fibromyalgia or another autoimmune disease. How can relationships grow and deepen when touch is painful?
DY: Communication about the pain is very important. Fibromyalgia sufferers often have better days and worse days. When the woman is willing to keep her partner informed as to her pain status, they can then make informed choices about when to enjoy sexual contact. It is also important that the sufferer be able to differentiate between the kinds of touch that are painful and those that are not. This requires flexibility and creativity on the part of both partners to explore together how to meaningfully connect and not exacerbate the pain.
RD: Men whose partners have FSD resent not having intercourse. How would you advise the man? How would you advise the couple?
DY: There are many, many ways to make mutually satisfying love that do not involve placing a penis within a vagina. In our culture we tend to equate "sex" with "intercourse". Willing partners who love each other and desire to give and receive pleasure can use their ingenuity and creativity to express their love to each other. I recommend Marty Klein’s excellent book Let Me Count the Ways: Discovering Great Sex Without Intercourse, available through Amazon.com.
RB: Many men whose partners have FSD say they feel rejected and disappointed? They become emotionally unavailable. Sometimes this is through anger and lashing out. Other times it is through withdrawal, internet porn, not coming or staying home, focusing all their attention on their children and ignoring their wives, workaholism or substance abuse. What can they do instead?
DY: They can begin to talk openly and honestly together about their problems. If they are unable to do so at home, it may help to consult a certified sex therapist who can help them express their feelings and work together to find meaningful solutions. Many times the things we do to avoid painful situations only makes them worse. It is a given that one partner’s struggle with pain or sexual dysfunction has an effect on the other partner. The challenge is to learn how to work together as a team.
RB: Women with FSD who find intercourse painful resent having to perform oral sex so much. Are their other ideas that will entice their partners?
DY:If the woman feels she "has to" perform oral sex more than she would like, perhaps it’s time to initiate some discussion about the ground rules of the relationship. Many couples are stuck in a kind of mutual isolation, with each partner trying to manipulate the other to obtain what they want or need.
A more egalitarian relationship, where both partners’ needs and wishes are respected, offers an optimal situation for mutual satisfaction. This approach requires communication and mutual respect. It also requires that each partner learn the tools of maturity that help them listen carefully, talk calmly and manage their anxiety.
Marriage offers an amazing crucible for developing maturity and growing up! And, yes, partners can easily find a number of ways to give and receive pleasure that is mutually satisfying and that does not require intercourse. Sex shouldn’t be another household chore!
RB: When a group of men are together touting their sexual prowess, what advice can you give to the man whose partner has FSD?
DY: Find better friends? Change the subject? Realize that these guys are full of it? This is essentially middle-school locker room behavior, and most men have better things to do. It is painful to believe that "everyone else" is having great sex all the time. This is very likely fiction - the truth is we do not know what goes on in other people’s bedrooms. If someone has to brag about their sexual exploits, it probably only reveals their deep insecurity.
RB: Single women with STD’s - especially herpes - have a difficult time dating and finding lasting relationships. How would you advise them?
DY: It’s easy to feel that you are damaged goods, and to worry that you can never find a good relationship. There are several approaches to dealing with this.
First, educate yourself about safer sex, so that you are confident that you know how to protect yourself and your partner. This includes learning how to recognize when you are symptomatic. Then you can resume dating with the confidence that you can be safe. Also, know that many people have STDs and, whatever your worries about the stigma of having an STD, you are not alone. True, some people may not understand and may choose not to continue a relationship. But there are many for whom an STD is not a deal breaker, particularly when you know how to manage your symptoms and protect your partner.
You may wonder how and when to talk about the STD: be sure to talk about it before you are in a sexual situation. As the relationship moves toward exploring sex, make an opportunity to have "the talk." Lay out the facts, including what you know about how to be safe. There’s no need to be overly dramatic or ashamed. Ask for your partner’s understanding and let them know that you are confident about protection.
Finally, there are a number of online dating services that allow persons with herpes to meet each other, thus removing this as a stumbling block. See for example:
David Yarian, Ph.D. is a licensed Psychologist and a certified Sex Therapist in private practice in Nashville, TN. His professional website is www.DavidYarian.com. He recommends books and videos on sexuality and eroticism at www.JoyOfMakingLove.com.