Sexuality is central to being human but is not always a topic we are ready to discuss indepth over a cup of coffee or raise with our patients. Nursing Review asked Mary Hodson, a therapist specialising in emotional and sexual intimacy, to share some thoughts on maintaining your sexual wellbeing.
Google “what is a normal sex life?” and you get 126 million results in 30 seconds –article after article asking and answering “what is a healthy sexy life?” or “how much sex is normal?” Also ‘listicles’ like “11 wacky signs your sex life is totally normal” and “Four myths about healthy sex”.
Probably the most obvious thing all these Google hits tell us is that it is fairly normal to wonder what’s “normal”.
But what a normal sex life actually is is very hard to define, says Mary Hodson, as there aren’t any norms when it comes to sexuality.
And how people express or experience their sexuality is as diverse as any other human characteristic (see sidebar for definitions and research) but by the virtue of being human we are all sexual beings.
Hodson’s work focuses on helping couple and individuals work through issues – either emotional or sexual or both – affecting their intimate relationships.
She says probably the most common reasons that people seek help in the age group the majority of nurses fall into – 35 years to 55 years – is low libido and most often female low libido. Also cases of one partner feeling pressured to have sex and, of course, unresolved relationship issues including sexual issues.
The common myth about female libido
While it is more often low female libido than low male libido that prompts couples to seek her help, Hodson says it is a myth that women are less interested in having sex then men.
“Recent research indicates that variation in sexual desire is much more related to relationship issues than gender traits. Women are more likely to leave an issue unresolved to keep the peace than men, and unresolved issues are usually love and passion killers.”
“If I am feeling hurt, resentful, unappreciated, taken for granted, neglected or in any way unfairly treated for a sustained period, it is going to affect my feelings for, and my willingness to engage sexually with, my partner.”
Women’s lives are also so often jam-packed that Hodson believes the major issue for many woman is managing that ‘busyness’ – and the distraction of electronic devices – in order to have time to devote to the emotional and sexual sides of their relationships. “With mothers having children later and staying in employment while they do so, life is really frantically busy and there isn’t much time or energy left over for our partners.”
How do you keep your sexual side alive in a busy life?
“In order to keep the sexual side alive we have to focus on it a little,” believes Hodson. “And I don’t mean become obsessed to the point of being driven by a desire for sexual fulfilment.”
Hodson says the key ingredients in establishing and maintaining a long-lasting, stable relationship is to nurture the love and the sexual desire that the couple both have.
“If you don’t have it, then work very hard to grow it and do everything you can to take care of your partner’s emotional wellbeing.”
She advises couples to be totally honest and clear with their partner about how they can show love, nurture their sexual desire and take care of their emotional wellbeing. And also to:
- Speak respectfully to each other at all times; even when feeling angry.
- Be kind to each other at all times.
- Consider your partner’s needs and what is good for the relationship before making any decision and then make the decision together based on what is good for the relationship.
- Communicate carefully and thoroughly and make time on a daily or almost daily basis to talk about things that will encourage emotional closeness.
- Say clearly but gently what they think, feel and want to happen while not ignoring the other’s rights in the situation.
- Always be prepared to negotiate and compromise – a compromise can always be found even if it is only, “Well we cannot agree, so you make this decision and I’ll make the next curly one that comes up”.
- Treat your partner as an equal at all times.
Her experience is that it mostly attitudes, reactions and responses (or lack of responses) that cause the intimacy problems between couples, whereas couples who are emotionally and sexually in sync will cope better when faced with a major physical or psychological problem.
“I am frequently amazed at the awful experiences, enormous stress and major problems that couples in loving, caring, cooperative and respectful relationships manage to get through, triumph over and come out the other end relatively unscathed.”
“So, for example, a person who is recovering from a prostatectomy and having major sexual difficulties will generally cope better with the sense of loss and feelings of inadequacy when they are able to trust that their partner is there for them, will not judge them adversely and will continue to love and respect them.
“On the other hand, I am sometimes sad and frustrated when couples aren’t coping with difficulties because one or both of them have stopped cooperating with the other or stopped caring and being kind, loving and respectful.”
Sexuality and the single woman
Hodson says she also worries a lot about single woman making the same mistakes with sex that older woman now regret.
She advises people not to rush into any relationships – especially not a sexual relationship.
“Take time to find out if the person can be trusted with your emotional wellbeing before you commit.” Which means looking back over your relationship history and working out at what point in a relationship you usually feel committed and holding back from taking that ‘commitment’ step until sure the person is right for them.
“For many, many women, the point of commitment is when they engage sexually so, if that is your ‘point of commitment’, don’t go there until your prospective partner has proved to be trustworthy,” says Hodson. “Don’t accept second best; commit to someone that you really feel the love for and feel the love from and also feel the sexual desire for and from.”
“A relationship needs all of these components – a feeling of love that goes both ways, a feeling of sexual desire that goes both ways and it also needs a mutual will to work at making the relationship work including a mutual will to take care of each other’s emotional wellbeing.” :
**Mary Hodson is a therapist specialising in emotional and sexual intimacy work for Sex Therapy New Zealand – a nationwide counselling service for help with intimacy and sexuality concerns.
Some sexuality research findings
- The highest proportion of married men (according to a 2010 US study) have sex 2-3 times a week in their early 20s (45%) and this drops to weekly or a few times per month by their late 20s (47.7%)
- A similar trend is reported by married women with 35% reporting having sex 2-3 times per week in their early 20s and the trend shifting to sex weekly or a few times per month in their late 20s to 60, and after 60 the majority were having sex monthly or less.
- Many women express that their most satisfying sexual experiences entail being connected to someone, rather than solely basing satisfaction on orgasm.
- Men are more likely to orgasm when sex includes vaginal intercourse; women are more likely to orgasm when they engage in a variety of sex acts and when oral sex or vaginal intercourse is included.
- Among ages 18-59, older age for men is associated with lower likelihood of his own orgasm; for women it is associated with a higher likelihood of her own orgasm.
- 10% of men and 18% of women reported a preference for oral sex to achieve orgasm.
- 5% of men and 11% of women have never masturbated (1993 study).
- A study of married couples found age and marital satisfaction to be the two variables most associated with amount of sex. As couples age, they engage in sex less frequently, with half of couples age 65-75 still engaging in sex, but less than a quarter of couples over 75 still sexually active. Across all ages couples who reported higher levels of marital satisfaction also reported higher frequencies of sex.
- A 1993 study found 14% of men and 11% of women had some sexual experience with sadomasochism.
Full research references can be found at the www.kinseyinstitute.org/resources/FAQ.html
Sexual dysfunction findings from major cross-nation study
Sexual dysfunction findings from major cross-nation study
The Pfizer Global Study of Sexual Attitudes and Behaviour* was a major survey of 13,882 women and 13,618 men aged 40 to 80 years in 29 countries across most world regions. It found that:
- More than 80% of the men and 65% of the women had sexual intercourse during the past year.
- The vast majority of people did not report any sexual dysfunction but the prevalence increased with age and overall 28% of men and 39% of women said they were affected by some sexual dysfunction.
- The most common sexual dysfunctions for men were early ejaculation (14%) and erectile difficulties (10%).
- For women the most common dysfunctions reported were lack of sexual interest (21%), inability to reach orgasm (16%) and lubrication difficulties (16%).
*Nicolosi, Laumann et al Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 2004 Nov 64(5):991-7. Research sponsored by the manufacturer of Viagra.
Lubricants and the older woman
For the older woman engaging sexually a good quality lubricant is vital in every single sexual engagement, says Mary Hodson.
She advises women to buy a good quality lube made to European or North American health standards. “Then you will know that it has no glycerine, menthol, alum, parabens and DEA; all of these have been shown to cause significant health issues. In New Zealand lubes are not classed as a food or a medicine so there is very little control of what manufacturers put in them.”
More about sexuality
A definition of sexuality
Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical and religious and spiritual factors.
A definition of sexual health
Sexual health is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.
*Working definitions developed after World Health Organisation technical consultation on sexual health with the World Association for Sexual Health (updated 2010).
Further reading and information:
HealthySex.com: a website led by American author and sex therapist Wendy Maltz. A website dedicated to promoting “love-based, healthy sexuality”.
Maltz has also written widely on sexuality, including books on exploring women’s sexual fantasies, recovering from sexual abuse and help with pornography-related problems. www.healthysex.com
A Woman’s Touch: a sexuality resource centre run by two women – a doctor and a sex educator/counsellor. https://sexualityresources.com World Association for Sexual Health: www.worldsexology.org Includes professional ethics for those working in the area of sexuality.
World Health Organisation: sexual and reproductive health www.who.int/entity/reproductivehealth/topics/sexual_health/en/index.html
Work underway developing sexuality counselling guidelines for health care workers
The Kinsey Institute: Indiana University’s Kinsey Institute focuses on advancing sexual health and knowledge and has been researching sexual behaviour for more than 60 years. www.kinseyinstitute.org
Foundation Course for Health Professionals: For nurses interested in further education in the area of sexuality the University of Auckland’s Social and Community Health division is planning to reactivate and offer a two-day foundation course in sexuality and intimacy this year. For more information email firstname.lastname@example.org