How's Your Marriage, Doctor?

Sexual difficulties are not thatcommon in young couples.However, they do exist andthey can be very complex andpainful in their etiology and impact.Here's a story from my practice.

Dr. Paul and May Graceland made astriking couple. They came to see mewith a chief complaint of not makinglove in over 6 months. They had beenmarried for only 2 years and hadenjoyed a rich and frequent sexual lifetogether for 2 years before getting married,after which time bedroom activitygradually ground to a halt. I wonderedwhy, and asked them to tell me theirthoughts about this.

Both Sides Now

May began, "I can't tell you why thisis happening. That's why we've comehere. But what I can tell you is that Ican't bear to be touched by Paul, in anysort of sexual or intimate way. I loveholding hands, cuddling on the couch,and even waking up in the morningsnuggled together in bed. But if Pauleven looks at me with a sexy glint in hiseye, mentions lovemaking, or touchesme in an erotic way, I go cold and rigid.And if he pushes, I go ballistic. It's weird.My body is screaming some sort of message, a message that I don't fully understand."She turned to Paul and said, "Ido love you, I'm sorry."

Paul replied, his eyes moist andexpressive, "I'm so sad, hurt, puzzled,and angry. You treat me like a pariah,like I have syphilis, like I'm despicable.I'm only 29 years old. I work out at thegym. People tell me I'm not bad looking.I'm a sexual being; I want to makelove to you. I love you. I'm your husband.What's wrong with you? What'swrong with me? What's wrong with us?And you say you want a family? So doI, I'm ready, but you can't make babieswithout sexual intercourse."

Strained Root

I had great empathy for their situation.I was curious about May's statementabout her body screaming a messagethat she didn't fully understand."Tell me about the part of the messagethat you do understand,"I said to her.She replied, "Well, I think I'm angry atPaul. No, I know I'm angry at Paul, andI've told him this. A year ago, we decidedto start a family, so I stopped mybirth control. A month later, Paul toldme he wanted to move here for a positionat a teaching hospital and askedme what I thought about it. Eventhough I expressed great reservationsthat I didn't want to leave my very goodjob, my widowed mom, and my childhoodfriends, he paid me lip service. Irealized his mind was made up and hedidn't care about my feelings."At thispoint, Paul interrupted with a defensive,sarcastic, and patronizing statement:"Sweetheart, you're rewritinghistory. Don't lie to Dr. Myers. Yes, youdid raise those issues and I said, ‘Fine,we'll just stay here and I'll continue atthis dead-end job.'Don't you rememberhow accommodating I was to yourvery understandable concerns?"Mayreplied, "Fine, you're right, Paul, I amrewriting history, why do I keep thinkingthat I capitulated to your wishes?Hmm, silly me, I guess it was my decisionto move to Vancouver."

I told Paul and May that I thoughttheir sexual shutdown was psychologicaland related to their relationship. Isaid, "You both seem to be sitting onanger and resentment, and we need totalk about that, here in this office, in asafe place. I think that your decision tocome here is a good one. I welcome thechance to help. I want to get detailedpersonal and family histories from eachof you in the next couple of visits, andthen we'll address some of these toughsubjects. My goal is for the two of youto become intimate again and return toyour plan to start a family together.

And that's what we did. Therapywent very well and ended when theybecame pregnant with their first child.

a clinical

professor in the Department of

Psychiatry at the University of

British Columbia in Vancouver,

Canada, is the author of Doctors'

Marriages: A Look at the Problems

and Their Solutions (Plenum Pub Corp;

1994) and How's Your Marriage?: A Book for

Men and Women (American Psychiatric Press;

1998). He is the past president of the Canadian

Psychiatric Association and welcomes questions

or comments at myers@telus.net.

Michael F. Myers,