Dr Meg Barker, sex and relationship therapist and author of Rewriting the Rules
People are very scared of not being normal. By far the most common question I've heard as a therapist is "Am I normal?" And people come to sex therapy with the hope that it will make them "normal". Generally what they mean by that is the ability to have sex that involves penetration and orgasm, lasts a certain amount of time and takes place an average number of times a week – whatever all that is!
We still have lots of taboos. A "sexless relationship" is one. It's seen as the worst thing in the world that would definitely lead to break-up. In truth, lots of relationships are not sexual and totally fine. There are also taboos about people being "too sexual" or having the "wrong" kinds of desires. A common situation now is people – most often men – feeling disturbed by the kinds of porn they are looking at. They're terrified to think too much about it and get into a pattern of trying not to look at all, then going back to it and feeling deeply ashamed. Fantasies worry us too. We aren't open about the fact that it's normal to have a range of sexual fantasies – including things we would never act out.
Men tend to present with problems about erections, struggling to get and keep them or feeling they orgasm too quickly. There's a lot of pressure on men about performance, and a feeling that you're less of a man if you don't perform as expected. Women present because they don't feel aroused enough or they find penetration painful. Often, they keep having sex because they feel that's what their partner wants and they might lose the relationship otherwise. There's often a deeper discomfort about their body too. They're so worried that they are unattractive that they can't relax. They've never really learned to enjoy their fantasies and their bodies so that sex can be pleasurable.
After Fifty Shades of Grey there is definitely more kink and BDSM – though without much good information about how to engage in it. The novels don't help here. The kink relationship takes place in a very unequal power dynamic. Ana has no experience at all, and Christian has loads, and is also hugely rich and powerful. Ana is given very little opportunity to say what she might like to try – just a list of what Christian is into. He follows her, interferes with her life, tells her she can't talk about the relationship to her friends – big danger signs for abusive relationships.
I recently did an analysis of the anxieties people were writing about to the main sex problem pages. The top two were whether they or their partner might be bisexual or gay or whether they or their partner is having an affair. I think we definitely need to open up more conversations, in sex ed in school, in the media, and in sex advice, about the diversity of sexual orientations, and about how people manage the rules of their relationships around monogamy.
Online porn, flirting on Facebook, friends with benefits – we all have different ideas about what is and isn't acceptable. Couples don't have open conversations about it early on; they assume their partner will have the same rules as them. Down the line, they find that one thought it was fine to stay friends with their ex and the other didn't; one thought it was OK to look at online porn and the other is horrified. We go into relationships assuming we will share sexual desires, but there are bound to be differences. Assuming difference from the start and talking about it could be much less painful.
If I could give one piece of advice when it comes to sex it would be stop trying to be normal! Once we stop trying so hard to fit a certain box, we can start exploring what our own desires actually are.
Sarah Fletcher, psychosexual therapist at Coupleworks
Couples often come to see me when they're in that "transitional stage". At the start of the relationship, everything is exciting, new and unknown, sex is triggered by different areas of the brain. A few years later, the couple have moved in together, life is more mundane, there's a loss of desire, they don't have as much sex as they used to. For some people, that's scary.
In my work, I tend to see the negative aspects of porn. Young men, viewing it from an early age often before they've even had sex, expect sex to be like that – but it's on a screen, under their control, they choose the images. Real sex is relational, about you and me, what I want, what you want, how that has to be negotiated. So it can seem much easier and more instant to wank in front of a screen than have sex with a partner.
Men and women have different ways of becoming aroused. However much we like to say we're equal, we're different. I see men who have found porn addictive, starting with quite soft images and escalating to hardcore. Women don't tend to use it in the same way. For women, it's more likely to be chatrooms, online relationships, flirting, "Skype sex". It's not so much about "images", more about "connecting".
There's more sexual experimentation going on. Oral and anal sex are much more common than when I started as a therapist 18 years ago. There's more S&M too. I think it's a response to online porn, Fifty Shades of Grey, the fact that sex is talked about more than ever. Are we enjoying all of this? Has sex got "better"? I don't think so. Some of it leaves people feeling very confused. "It's painful. Am I supposed to like doing this – and what does it say about me if I don't? Am I normal?" We're more open-minded and experimental – and at the same time more pressured, anxious and insecure.
In couple relationships, masturbation is still taboo, especially female masturbation. Starting in the teenage years, we're very aware of boys masturbating – not so much girls. It isn't something women tend to speak about to one another, and in relationships couples can be very coy about how much they masturbate. That's OK. It's fine for some things to be kept private. We don't have to lose ourselves in relationships.
The impact of drugs and alcohol on sex comes up in therapy more than it used to. I think people are more insecure, they find relationships a bit more difficult and use drugs and alcohol to help them. Then they find they can't have sex without them.
For all our "openness", many problems are still down to lack of communication. Couples often don't talk truthfully about sex to one another. They're so worried about how they "should" be, they're too frightened to be truly themselves.
Our core anxieties about sex don't change. It may present as performance anxiety or low libido, but the underlying issues are about intimacy and closeness. When you have sex, you're making yourself very vulnerable. How close can I let myself be to a person? Can I trust them? Am I good enough? Will I be loved for who I am?
Dr Dmitri Popelyuk, consultant psychiatrist in psychosexual medicine at the Sexuality and Gender Clinic, Nightingale hospital, London
Technology could be making us less sexually adaptable. In our service, we're seeing an increasing number of men with delayed ejaculation or the inability to ejaculate. Very commonly, it's that they can't ejaculate during penetrative sex. Why would that be? I guess it's exposure to different sexual practices. We're seeing a kind of "sexual super-specialisation". Twenty years ago, if I had a shoe fetish, it would be quite hard to find someone else with a similar interest, quite an effort to "super-specialise" in that one area. Today, technology would "indulge" me. There's online pornography, video rooms with everything to choose from, chatrooms, apps which can lead someone to narrow down to one thing at the expense of everything else. He might seek help because he's unable to form or sustain relationships – or maybe he can't get his partner pregnant as he can't ejaculate inside the vagina.
A lot of our sexual difficulties are about the discrepancy between what our sex life is and what we imagine it should be. What our sex life "should be" is dictated by what we hear through the media, what we see online and hear from our friends. Often my job is to close the gap – by improving sexual functioning but also bringing down expectations.
This generation of men feel they bear the full responsibility for their partner's pleasure. In the past, men were probably far less concerned about what their partner was experiencing. On the one hand, it's a good thing, a positive change. On the other, it's a lot of responsibility to take on – and when you feel pressured by sex, you realise you are not enjoying it and sexual functioning begins to show cracks. Then you're in a vicious circle.
Sometimes a spike in referrals will reflect what's in the media, what's very current. Recently there have been the revelations and prosecutions around paedophilia and our service has seen more people coming forward because of unwanted sexual experiences in childhood. Similarly, FGM has been in the press and we've had more referrals of women who have experienced it.
The evidence shows we have more sexual partners in a lifetime and are experimenting with more sexual practices. Yet the amount of sexual activity overall is decreasing. It's interesting. With apps such as Tinder, if you have a sexual thought and can't find a partner within three metres, there'll be someone within 3km or 30km. Sex is more available, there should be more opportunities to connect, yet we're living more and more insular lives when it comes to sexuality. People live alone, marry later or not at all. I see people who know how to be with their own body, their own fantasy, but when they enter into a real exchange with another person, they find it's not the same.
People still find it very difficult to admit to having a sexual difficulty. If you think about depression or ADHD, there has been quite a shift in how society perceives people with these conditions so it's now easier to come forward. We haven't seen that in this field, and I'm not sure we ever will. Sexual problems are incredibly common – the evidence suggests that 42% of men and 51% of women report having had a recent sexual problem – but so few seek help.
I often try to shift patients from goal-driven sex to pleasure-driven. Instead of focusing on how long you want this to last, how many orgasms she will have, and aims like, "I'll make this woman have the best time of her life," focus on pleasurable activities and make the pleasure derived from them the only end goal.
