What I Learned Listening to My Patients Talk About Their Sex Lives

Photo by Chiara Cremaschi via Flickr

This article originally appeared on VICE France.

I'm a clinical psychologist and have been working in a medical center for a number of years. My patients suffer from a wide variety of anxieties, but it's striking to me how many of those anxieties are in some way related to my patients' sexuality.

Some of them would never dare to talk to me about it, but for many the subject is too crucial and closely connected to them to avoid. I am always surprised by the sheer number of different sexual problems people face today, and the psychological effect those problems can have. Between porn, the hyper-sexualization of the body, and the pressure to perform, a large number of young people find themselves lost in their own libidos.

Like G*, a 26-year-old patient of mine. "I had a relatively boring sex life until I met M," she told me. "I was 23, and he was 35. I was crazy about him, and we had an incredible time in bed at first. But then, little by little, he grew rather demanding, sexually. For example, he would push for anal and insisted I wear certain underwear that I would never choose myself. I did it because I was insanely in love with him and didn't want him to leave. I didn't realize I was letting him construct and define our sexual relationship based on his desires alone."

Now that she has been broken up with this man for six months, she's going through an identity crisis. When you're just trying to fulfill the desires of a partner, when you're not creating any boundaries for yourself, you lose sight of what you want and don't want. We had discussed G's sexual experiences during a few sessions, when she said: "At first I thought I was fine, that I was just trying new things. But the longer it went on for, the more I realized this wasn't good for me. I left because I finally accepted that I was just doing it all to make sure he wouldn't leave me for another girl, someone who would be willing to do the things that I didn't like to do."

The societal pressure to perform in bed can turn sex into a race for success. If all you focus on is satisfying your partner at all costs and making yourself irreplaceable, you can easily lose sight of who you are.

As you can imagine, the men at my practice aren't doing much better. F, 24, seemed very fragile when he confided in me that his sex life is, according to him, a catastrophe. "I've had a few sexual experiences, and each time it was awful. I can't help imagining that the girl isn't going to come, that I'm boring her, that I'm not touching her right or in all the wrong places." He's been unable to stop this incessant barrage of thoughts during intercourse ever since his first time, five years ago.

And so here we are, at the heart of performance anxiety. Performance anxiety can eat away at young people trying to establish their place in their work and social lives, but also in bed. In the cases of G. and F., I prescribed some old fashioned refocusing on one's self. Although being attentive to the expectations of others is a good thing in itself, there's no need to take it too far. Our sexuality is not something we can give away. It's more like a garden that needs two or more people to look after it. If you want to give something to someone in the hope that he or she will like you, bake this person a cake.

Another problem I see a lot in my practice isn't about the performance itself, but rather the absence of it. H, a 29-year-old, has been in a relationship with his boyfriend for four years and hasn't felt like having sex with him for a few months now. It's the main reason for him to come to his first consultation. "I love my boyfriend," he told me. "We live very happily together, we provide for each other, and we love spending time together. I basically think we're happy. I don't feel like cheating on him with someone."

Sexual rejection can give off a psychologically very violent message—like, "Your body doesn't deserve to be reproduced with."

When I listen to him talk, I feel that the problem here is mainly external. "I'm afraid to tell my friends that we haven't had sex in a few weeks and that we're just not that interested in it. I've tried to tell them once or twice, and their response is always the same: They suggest we have a threesome, use toys, role play—as though not fucking were an illness."

H isn't alienated from his own partner, but he's socially alienated. From what I understand, his boyfriend is understanding or might see it as a phase in their relationship. In that context, his problem isn't that serious—a relationship isn't based solely on the frequency of sex. But H feels guilty and feels the need to hide the reality of his sex life from his friends. He quickly overcame his anxieties, however, by focusing on the quality of his relationship.

The absence of desire is one thing, and the absence of opportunity is another. A good third of my clientele are people forgotten by sex. Like R, who at 26 finds herself in a pretty closed social and professional environment, with a reduced social circle, and who, after having had too many disappointments with online dating, is tired and fed up. "During the rare evenings I do go out, if there is a guy I like, he's either gay or taken." Worse than that is her feeling of never being chosen or noticed, which makes her feel like a failure. Apart from the occasional one night stand at college, it's been four years since she slept with someone.

"I was never stressed about the future of my love life," she told me. "But every time I really felt like having sex, I realized there was no one I could sleep with. I felt so worthless." Romantic rejection is always difficult, but structural sexual rejection and the ensuing loneliness can also touch us deeply. That rejection could give off a psychologically very violent message—like, "Your body doesn't deserve to be reproduced with."

This pain is universal, which my male patient A can attest to. At 28, growing up in a very male environment, he told me about what he considers his utter failure with women. "My colleagues have girlfriends or one night stands, but at least they have something. I just know that every time I get rejected I don't become stronger—I get a little more scared of the next attempt." Sexual solitude isn't just frustrating for the individual going through it; it changes how we're perceived by friends, family, and other people who can add to the already pretty sufficient personal shame.

What do you say to that? Sometimes, not much. Sexual pressure and sexual competition are part of being young. I'll always advise a patient dealing with this kind of shame and fear to focus on themselves and their personal development. The opinion of the outside world won't change, so what should change is how the person struggling with it is looking at the situation. We need to arm people with the weapons to deal with public opinion. During our sessions, I try to undo the damage and create new dynamics to find a little place inside the patient where he or she can be at peace.

When these young people come to see me, I can see how strong of a hold certain cultural and social phenomena have over them, and it makes me sad. Sexuality, a natural and glorious thing in itself, is being stripped of its spontaneity and subjected to contradictory rules. Those rules paradoxically suggest that we're relaxed and open and "listen to ourselves" while tending to a minimum of three sexual partners a month and/or four positions a night.

The people I speak to have lost their footing in their own sexuality or relationship, and when that happens, I can only conclude what I'd conclude in many other situations: You have to constantly assess what it is you want, what your desires are. That's the beginning and the end of being comfortable with your own sex life—and consequently, life in general. Knowing what you want and don't want is possibly the sexiest thing there is.

*Names have been changed.