SEXUAL DISFUNCTION AND THE COUPLE: IMPORTANT CONSIDERATIONS
Author: Dr. Jaqueline Brendler
When sexual dysfunction is present, the marital bond is weakened and that weakness becomes a real rupture threat. Facing that possibility, couples create unconscious defence mechanisms, tending to grow apart and see only the partner's flaws, and qualities disappear. That happens because suffering implied in case of loss of a partner who is no longer admired is lower. There is preparation for a possible separation. Couples present several distinct degrees of hostility, from subtle to rough. The dyadic relationship must be improved. Even if only one of them is dysfunctional, the 'other' is always an accomplice to the sexual dysfunction. That happens because it is in 'his' or 'her' presence that the dysfunction takes place. He or she is 'the mirror for the failure of the dysfunctional person'. The regular partner reminds me, even far from the possibility of coitus, that I am not 'whole', that I do not 'work'. As time passes, all other 'likely' partners become a (false) promise for sexual success. The dysfunctional partner starts associating the other partner to bad feelings from fruitless attempts.
To a higher or lower degree, in most cases the other is contaminated, at least in what concerns low self-esteem. The sexually healthy partner starts to question his "virility", since he measures it by the ability to provide pleasure to his partner. Many men feel unduly responsible for their partners' sexuality, which reduces their self-esteem. Affection also starts to be questioned as they conceive that women link sex to affection and all their approaches are answered with the woman's avoidance. An important reason for such refusal is that it is interpreted as sexual approach. The dysfunctional woman is not available for sex, and often not available for affection either. The dysfunctional man also starts developing phobia regarding any attempt to sensual approach that is seen as sexual. His sex partner starts doubting his affection and faithfulness.
If there is a reasonable degree of affection in the relationship, sexuality can be changed as to become more 'satisfactory' for the couple. One of the therapist's first tasks is to 'listen' and 'observe' the couple. How do they interact? Which is the dynamics of their relationship?
Solving the sexual conflict is essential, and acting at specific stages presented by the dysfunctional person is not less important. If a young man presents erectile dysfunction and organic aetiology is ruled out, it might be suggested that he 'stays erotically' with his partner. Focusing on sensations I and II, which are a sensual touch with no association to coitus or any other performance, might be beneficial to bring erection back. There should be no direct pressure for coitus.
In case of vaginismus, the patient must be sure that any attempt at coitus will only occur when she feels confident. Her anatomic normality should be confirmed. The male partner may be present during gynaecological examination. The couple should receive information on anatomy and physiology of human sexual response in order to clarify existing doubts. She can be instructed, individually at first, and then with his help, to reserve some time at home to conduct "in vivo desensitisation" under relaxation. One of the techniques of that procedure recommends placing fingers inside the vagina - only one at first. Kegel's exercises are important, since they introject in her the possibility of voluntary command of muscles surrounding the vagina. Erectile dysfunction e vaginismus were two examples mentioned in terms of suggestions included in the sexual therapist's therapeutic arsenal. The most important thing is that the couple understands, during therapy, what is going on in their relationship and that they have a good motivation to proceed in therapy.
Annals of the 3rd Rio Grande do Sul State Meeting on Human Sexuality and the 3rd Southern Brazilian Seminar on Sexual Education, May 25-27, 2000, Porto Alegre , Brazil, page 27.