7TH INTERNATIONAL CONFERENCE ON SEXOLOGY

ON 15^TH AND 16^TH OF FEBRUARY 2014 AT CHENNAI

D.RETNAMONY

Paper presentation

MARITAL AND PREMARITAL COUNSELING

MARITAL COUNSELING

Definition

Marital counseling also called, couples therapy is a type of psychotherapy. Through marital counseling one can make thoughtful decisions about rebuilding relationship. Couples seek marital counseling to strengthen their bonds, better understand each other, improve troubled relationship etc. Marital counseling can help couples in all types of intimate relationship.

History

Marital counseling, originated in Germany in the 1920s, as part of the eugenics movement.. The first institutes for marital counseling in the USA began in the 1930s, partly in response to Germany’s medically directed, radical purification marriage counseling centers. It was promoted in the USA by both eugenicists such as Popenoe and Robert Latou Dickinson and by birth control advocates such as Abraham and Hannah Stone who wrote ‘A marriage manual’ in 1935 were involved with planned-parenthood.

It was not until the 1950s that therapists began treating psychological problems in the context of the family. Relationship counseling as a discrete, professional service is thus a recent phenomenon. Until the late 20^th century, the work of relationship counseling was informally fulfilled by close friends, family members, or local religious leaders. Psychiatrists, psychologists, counselors and social workers have historically dealt primarily with individual psychological problems in a medical and psychoanalytic framework. In many less technologically advanced cultures around the world today, the institution of family, the village or group elders fulfill the work of relationship counseling. Today marriage mentoring mirrors these cultures.

Basic principles of marital counseling

Before a relationship between individuals can begin to be understood, it is important to recognize and acknowledge that each person, including the counselor, has a unique personality, perception, set of values and history. Individuals in the relationship may adhere to different unexamined value systems. Institutional and societal variables (like social, religious, group, and other collective factors) which a person’s nature, and behavior are considered in the process of counseling and therapy. A tenet of relationship counseling is that it is intrinsically beneficial for all the participants to interact with each other and society at large with optimal amounts of conflict. A couple’s conflict resolution skills, seems to predict divorce rates.

Most relationships will get strained at some time, resulting in their not functioning optimally and producing self-reinforcing, maladaptive patterns. These patterns may be called negative interaction cycles. There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication / understanding or problem solving, ill health, third parties and so on. Changes in situation like financial state, physical health, and the influence of other family members can have a profound influence on the conduct, responses and actions of the individuals in a relationship. Often it is an interaction between two or more factors, and frequently it is not just one of the people who are involved that exhibit such traits. Relationship influences are reciprocal- it takes each person involved to make and manage problems.

Some basic principles for a marital counselor / therapist.

• Provide a confidential dialogue, which normalizes feelings.
• To enable each partner to be heard and hear themselves.
• Provide a mirror with expertise to reflect the relationship’s difficulties and the potential and direction for change.
• Empower the relationship to take control of their own destiny and make vital decisions.
• Deliver relevant and appropriate information.
• Changes the view of the relationship.
• Improve communication.

As well as the above, the basic principles for a marital / couple therapist also include

• To identify the repetitive, negative interactions cycle as a pattern

• To understand the source of reactive emotions that drives the pattern.
• To expand and reorganize the key emotional responses in the relationship.
• To facilitate a shift in partners’ interaction to new patterns of interaction.
• To create new and positively bonding emotional events in the relationship.
• To foster a secure attachment between partners.
• To help maintain a sense of intimacy.

Specific couples therapy techniques.

• Ability to use techniques that engage the couple – to form and develop a collaborative alliance with each partner to enlist their support for relationship focused therapy.
• Ability to use techniques that focus on rational aspects of depression— to focus on and reduce negative cycles of influence between depression and couple interaction.
• An ability to take account of sexual functioning in the couple’s relationship.
• .Ability to use techniques that reduce stress up on and increase support with in the couple.
• Improving communication—teach listening skill, disclosing skills, aid to communicate- using open ended questions etc.
• Coping with stress– to help partners cope with their own and each others stress.
• Managing feelings—encourage the expression and reformulation of depressive affect.
• Changing behavior—hold collaborative discussions to establish and assist in achieving agreed upon and specific goals.
• Solving problems—create and nurture shared systems of meaning with in the couple as a prelude to addressing problems—help couples find a solution to identified specific problems through sequentially.
• Promoting acceptance—help partners empathetically connect with each other around their concerns.
• Revising perceptions—to observe and reflect back on observations of seemingly distorted cognitive processing—to apply developing formulations to achieve changes in perception.

Common core principles of couple’s therapy.

• Respect
• Empathy
• Tact
• Consent
• Confidentiality
• Accountability
• Expertise
• Evidence based

The couple’s therapy practitioner evaluates the couple’s personal and relationship story as it is narrated, interrupts wisely, facilitate both de-escalation of unhelpful conflict and the development of realistic, practical solutions. The therapist may meet each person individually at first but only if this is beneficial to both, is consensual and is unlikely to cause harm. Individualistic approaches to couple problems can cause harm.  The counselor or therapist encourages the participants to give their best efforts to reorienting their relationship with each other. One of the challenges here is for each person to change their own responses to their partner’s behavior. Other challenges to the process are disclosing controversial or shameful events and revealing closely guarded secrets. Not all couples put all their cards on the table first. This can take time. Short term counseling may be between 1 to 3 sessions, where as long term couple therapy may be between 12 to 24 sessions. An exception is brief or solution focused couples therapy.

A viable solution to the problem

A viable solution to the problem and setting relationships back on track may be to reorient the individual’s perceptions and emotions – how one looks at or responds to situations and feels about them. Perceptions and emotional responses to a relationship are contained with in an often unexamined mental map of the relationship, also called a love map. These can be explored collaboratively and discussed openly. The core values they comprise can then be understood and respected or changed when no longer appropriate. This implies that each partner takes equal responsibility for awareness of the

Problem, as it arises, awareness of their own contribution to the problem and need for making some fundamental changes in thought and feeling.

The next step is to adopt conscious, structural changes in the interpersonal relationships and evaluate the effectiveness of those changes overtime. Indeed, typically for these close personal relations there is a certain degree in ‘interdependence‘– which means that the partners are alternatively mutually dependant on each other. As a special aspect of such relations some thing contradictory is put out side: the need for intimacy and for autonomy. The common counterbalancing satisfaction these both, needs intimacy and autonomy, leads to alternatively satisfaction in the relationship and stability. But it depends on the specific developing duties of each partner in every life phase and maturity.

Means to improve conversation / communication in relationships.

We have all had difficult conversations often with difficult people. How to improve the process and outcome of challenging discussions? .Every difficult conversation is really three conversations. There is the conversation about what happened, the substance, the facts. Each of us has a story about what happened. There is also what they call the feeling conversation, the emotional level. And there is also the identity conversation, which asks “ what does this say about me?”. Is some thing in my self-image implicated in what is going on here?. What is making the conversation difficult for me?. Expanding your view of the conversations in this way lets you understand that just battling back and forth to prove that you are right and the other side is wrong is not likely to get you from a breakdown to a breakthrough.

People have this difficulty trying to deal with the three conversations—they get the concept but in real time they found very difficult to use this concept. Even if they practiced in a workshop and got the words to come out of their

mouth, their real time experience was that they were not doing the best practices that they cognitively know they should do. This is a gap called the performance gap, between people’s potential to negotiate effectively, which might be very high, and their ability to practice it. In looking at this gap and trying to figure out how to help people in real time bring forward their skillful means and higher nature, one should ask the question: what if I am the problem? What do I need to do to be more effective to get better results, or develop stronger relationships, or reap deeper rewards of life in general?.

I can stop looking out there. I can stop wishing my spouse would change. I can stop blaming or judging my family members. I can look inside and ask how am I contributing, how is my relationship with myself leading me to get in my own way?. Asking your-self if I am the problem is not the same as self-blame. If you think about your levers of change, where you can influence – it is not easy to change other people, particularly when you are talking about long-standing habits and mindsets. But you actually do have the quality of autonomy that enables you to grow as a human being. You set the intention, you learn skills, and you shift your mindset. It is extremely empowering to notice that one of the ways to improve your interaction in the marital relationship is to get better at how you interact with yourself.

Some ways to communicate respect to your husband.

• Choose joy—It is true: A happy wife makes a happy life. Please do not use moodiness as an attempt to manipulate your man, but in all things rejoice, because that is the right thing to do.
• Honor his wishes—Give weight to what your husband thinks is important. Make those things a priority that matter most to him.
• Give him your undivided attention—women are masters of multi-tasking, but when your husband is speaking to you, make a point to lay other tasks aside, look in to his eyes and listen to what he is saying with the goal of understanding and remembering his words.
• Don’t interrupt—have you ever been around a person who won’t let you finish a sentence? That gets old fast. Even if you think you already know what your husband is going to say, allow him to say it without cutting him off mid-sentence shows both respect and common courtesy.
• Emphasize his good points—sure, he has his faults (as do you), but dwelling on them will only make you (both) miserable. Choose instead to focus on those qualities in your husband that you most admire.
• Pray for him–Wives to tell their mates the positive and tell God the negative. Take your concerns to God. Faithfully lift up your husband in prayer everyday, and you will likely notice a transformation not only in him, but in yourself, as well.
• Don’t nag—your husband is a grown man, so don’t treat him like a two year old. Leave room for God to work. You are not the God’s Spirit , so do not try to do His job.

• Be thankful—cultivate an attitude of gratitude. Don’t take your husband for granted. Be appreciative for every thing he does for you, whether big or small. Always say thank you.
• Smile at him—smiles spread happiness. Smiles have even been shown to create happiness. Smiles are contagious. And a smile makes any woman more beautiful.
• Respond physically—do you know that the way you respond (or don’t respond) to your husband’s romantic overtures has a profound effect on his self-confidence? Don’t slap him away when he tries to hug you or make excuses when he is in the mood. Your enthusiastic cooperation and reciprocation will not only assure him of your love, but will make him feel well-respected, too.
• Eyes only for him—don’t compare your husband unfavorably to other men, real or imaginary. It is neither fair nor respectful and will only breed trouble and discontent. Avoid watching movies or reading books that might cause you to stumble in this area, as well.
• Kiss him goodbye—a study done in Germany which found men whose wives kissed them goodbye every morning were more successful than those who were not kissed. Success and respect often go hand-in-hand, so send him off right, and don’t forget to greet him with a kiss when he return home, for good measure.
• Prepare his favorite foods—although the rest of the family is not overly fond of a particular food, your husband loves it, try to make it at least two or three times a month as a way to honor him. Next time you are planning meals, give special consideration to your husbands preferences
• Cherish togetherness—whether at home or away love to sit near to your husband so that you can listen to the conversation. At home, take your handwork or book to what ever room he is working in, just to be close to him, because you can enjoy his company, even when neither of you  is talking.
• Don’t complain—nobody wants to be around a whiner or complainer. It is grating on the nerves. Remember the serenity prayer, accept the things you can’t change, courageously change the things you can, seek wisdom to know the difference.
• Dress to please him—take care of your appearance. Choose clothes your husband finds flattering, both in public and at home.

• Keep the house tidy—to the best of your abilities, try to maintain a clean and orderly home. Seek to make it a heaven of rest for your entire family.
• Be content—do not pressure your husband, take satisfaction in the lifestyle he is able to provide for you.
• Take his advice—do not dismiss his opinion lightly, especially when you have asked for his counsel in the first place. Make every effort to follow your husband’s advice.
• Admire him—voiced compliments and heartfelt praise are always welcome, but you should also make it your habit to just look at your husband in a respectful, appreciative way. Think kind thoughts toward him. He will be able to see the admiration in your eyes.
• Protect his name—honor your husband in the way you speak of him to family and friends. Guard his reputation and do not let minor disagreements at home cause you to speak ill of him in public. Live in such a way that it will be obvious to others why your husband married you in the first place.
• Forgive his shortcomings—“A happy marriage is the union of two good forgivers “. Please do not hold grudges against your husband. Do not allow a root of bitterness or resentment find a home in your heart.
• Don’t argue—you are not always right, and you do not always have to have the last word. Be the first to say, “I am sorry”. Be willing to accept the blame. It takes two to argue, so abandon a quarrel before it breaks out.
• Follow his lead—if you want your husband to lead, you must be willing to follow. Neither a body nor a family can function well with two heads. Learn to defer to your husband’s wishes and let final decisions rest with him.

Some ways to show your wife you love her

• Listen—to be truly heard is the longing of every human heart and your wife is no exemption. It sounds simple, but listening can be harder than it seems with so many distractions around us and with in us. Set aside some time each and everyday to look in to your wife’s eyes and really listen to what she has to say. You may be surprised at what you hear.
• Communicate—don’t make her guess what you are thinking or feeling.

• Sing her praises—shamelessly brag about her good qualities, and then quietly pray about her bad ones. Her reputation is your reputation.
• Intimacy is a two way street—unfortunately, men are notoriously selfish in the bedroom, yet are dumbfounded when their wives are less than enthusiastic in this arena. Make this area of your relationship as pleasurable for her as it is for you and it will pay huge dividends. It may mean washing the dishes or helping with the kids, so that she has energy left at the end of the day. It may mean cuddling and candlelight, so that she can relax and let the worries on her mind drift away. If you are not sure where to begin, just ask her, and then listen.
• Pray with her and for her—praying on her behalf, not only enlists the help of Almighty, but also puts her and her needs at the forefront of your heart and mind, right where they belong. Furthermore, couples who regularly pray together, stay together.   .
• Value her for who she is—do not compare her to your mom, or your old girlfriend. Your mom may make the best chocolate chip cookies in the world, but unfavorable comparisons won’t win you brownie points.
• Throw your dirty clothes in the hamper—it is likely just a few steps from where you are dropping them any way and it lets her know you don’t think she is your personal maid.
• Turn off the TV—and the video games and the computer. It is staggering how many hours we waste gazing at some kind of screen instead of interacting with the real people in our lives. Consciously, set limits on your tube time, whatever form it takes. Go for a walk together or play a board game instead.
• Loosen the purse strings—we all have to keep an eye on our budget, but the occasional splurge can be well worth it. Seemingly frivolous things like flowers, jewelry, and overpriced restaurants let her know that she is more valuable to you than a number in your bank account.
• Give her regular time to herself—every one needs to rest and recharge. This is especially important if she is home all day with young children. It is very easy to neglect this legitimate need unless you intentionally schedule time for it.
• Set aside time together—Soak in the tub together each evening or go on a date night once a week, whatever gets the two of you alone on a regular basis.
• Be careful with female friendships—we all have friends and colleagues of the opposite sex, but tread cautiously, not all affairs are physical ones
• Practice good hygiene—it is amazing how meticulous guys can be prior to marriage trying to impress the girls, but once they walk down the aisle, all bets are off.
• Be patient—in whatever way this applies, apply it.
• Cherish children—it is a guarantee she does. When you invest time or energy in them, you are investing in her as well. Kindness to them counts as kindness to her.
• Choose her over hobbies—invariably there will come times in your relationships when you will be forced to choose between her and something else that you enjoy. Always choose her.
• Actively seek her insights—then value her input and give it a preferential place in your decision making process.
• Learn to forgive—the past, the present, even the future. Forgiveness is at the heart of every meaningful relationship. It is only when we love people after they have failed us or hurt us that we truly know how deeply we love them.
• Provide—this is so much more than just putting food on the table, it is all encompassing, whether it is physical needs, emotional needs, spiritual needs, or you name it do your best to provide. Sometimes life’s circumstances hinder us in one area, but we can compensate in another area. Often the effort is as important as the outcome.
• Dial down the anger—your caveman instincts are handy on the battlefield, but horrible for a happy home life. Every outburst or flare up is a relationship setback. To go forward, the first step is to stop going backward. Learn to control temper or it will control you, your marriage, and every other aspects of your life. Just because your wife puts up it and your co-workers tolerate it doesn’t make your short fuse an asset.
• Cut out the condescension—if you have been blessed with a quick wit, you can either be the life of the party or a pain in the neck depending on the circumstances. Condescension is anger’s younger brother. It is not as loud or as dramatic, but it can be equally hurtful and all the more so for the subtlety. Lay off the snide remarks, the sarcasm, and the belittling. Speak to your wife the way you would be a respected colleague. She is, after all, your life partner in the most valuable investment of your life, your family.
• Verbally express your love—there are lots of ways to show your love, but women still like to hear it spoken.

The benefits of friendship on a marital relationship.

“It is not the lack of love, but the lack of friendship that makes unhappy marriages”—Friedrich Nietysche.

The key to a healthy relationship is the purposeful development of a healthy friendship. Couples, who have achieved the merits of friendship, have strived to develop their relationship beyond the confines the marriage.

“Excluding some very good family relationships the only other close adult relationships we have beside marriage are with our long term friendships. What is extremely interesting about these two affiliations is that marriage is the least successful adult relationship, where as long term friendships are by far the most successful”—(Glasser & Glasser).

What is a friendship?

“Friendship is born in that moment when one person says another, what! you too? I thought I was the only one”—C.S.Lewis.

Friendship is a purposeful act that occurs through an emotional and psychological connection, linking two persons together. As individuals we are responsible for initiating and commencing friendship, how we intend engaging those friends, and the levels with which we intend on developing the friendship. “This is the reason that long term friendships are the longest and strongest of all human relationships” –(Glasser & Glasser) whereas, marriages do not have the same level of cohesiveness. Sadly, not all marriages or intimate relationships have friendship as their core foundation. You may have encountered a relationship that has been established merely on infatuation; while infatuation is most commonly inspired by an intense passion or admiration for another, such relationships are most commonly fleeting, therefore lasting a very short amount of time.

Intimate relationships founded on the principle of friendship have a greater chance of survival. The benefits are numerous when friendship is employed. Friendships can have a major (positive) impact on your health and wellbeing. Friendship increases your sense of belonging and purpose. If you are fortunate enough to be married to your best friend, then you have the best of both worlds.

Making the decision to go to a marital counselor/ therapist can be tough. In troubled relationship, however, seeking help is more effective than ignoring the problem or hoping they get better on their own.

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                                PREMARITAL COUNSELING

Definition

Premarital counseling is a type of therapy that helps couples prepare for marriage. It can help ensure that partners have a strong, healthy relationship, giving a better chance for a stable and satisfying marriage. Premarital counseling can also help identify weakness that could become bigger problems during marriage.

Necessity for premarital counseling

The Beatle sang “All you need is love “. Your friends might tell you “good communication is all you really need “. Your parent advice “the key is to marry some one with the same values”. Every one has advice these days for people considering marriage. The problem is neither one of this advice is totally correct, nor is it totally incorrect.

Getting married without pre-marriage preparation is like starting a business or any important venture without preparing. Most couples just do not realize that good, skill based premarital counseling can reduce the risk of divorce by up to thirty percent and lead to a significantly happier marriage, according to marriage research. It can also reduce the stress of the pre-marriage period. Premarital counseling is based on the reality that it’s important to strengthen the relationship and prepare constructively for future challenges and conflicts that every one will inevitably face at some point in their marriage. Research shows that there is a window of opportunity during the year before the marriage, that the couples get the optimum benefit from marriage preparation.

Premarital counseling functions as an immunization that boosts the capacity to handle potential difficulties. Couples need every advantage to succeed in today’s marriages. In the global scenario that high quality premarital counseling can save thousands of people from the emotional and financial toll couples, their children, families, friends, co-workers,

government agencies etc are faced with, as a result of the alarmingly high rates of divorce, separation, infidelity, domestic and child abuse, substance abuse, mental health issues, child custody and property disputes etc. Premarital counseling can help people make the right decision about whether or not they should marry each other and / or learn enough skills to face the troubles and celebrate the joys of marriage and family life.

Different modes of premarital counseling

Premarital counseling comes in many different forms. Some couples attend required premarital counseling in their religious set up, some others seek out secular options, while others do not undergo any specified counseling other than their elders advice based on their past experiences. No matter how in love a couple may be, marriage can be difficult and over whelming at times. It comes with amazing benefits, but it also asks a lot in return, such as honesty, commitment, openness, and communication. These are some of the skills that take time and effort to hone and this is preciously where premarital counseling can be invaluable.

What can be expected in premarital counseling?

Premarital counseling typically includes five to seven meetings with a counselor. Often in premarital counseling each partner is asked separately answer a written questionnaire known as premarital assessment questionnaire. These questionnaires encourage partners to assess their perspectives of one another and their relationship. They can also help identify a couple’s strength, weaknesses and potential problem areas. Once both have finished their answers, share their answers with one another. They can note:

• Questions which one partner answered differ from other partner.
• Any patterns that they observe.
• Any time one partner’s answer surprised the other partner.
• Any concerns partners have about each others answers.

Partners will be encouraged to talk about these issues during premarital counseling sessions. The aim is to foster awareness and discussion and encourage couples to address concerns proactively. Counselors can also help to interpret their results together, encourage the partners to discuss

areas of common unhappiness or disagreement and set goals to help overcome challenges.

Main contents of the premarital counseling questionnaire

• Family of origin and family information.
• Personal information.
• Education level
• Health information
• Religious orientation
• Faith / belief information
• Work information
• Money matters
• Parents and in-laws
• Life long goals
• Communication and resolving conflicts
• Meaning of marriage and commitment
• Gender role expectations
• Agreement on issues around erotic moments together.
• Compatibility
• Emotional / counseling –related information.
• Counseling background and experience.
• Social / emotional / relational background and struggles.
• Attitudes and expectations regarding your new family.

Under the above main heads there are sub-heads to elicit more relevant information to understand much better about the bride and groom.

Still some other essential questions to help couples prepare for the gifts and challenges that come with married life.

How do you envision married life?

Your answer to this question is partly based on your hopes and dreams, and largely based on the relationship expectations you learned throughout your life. Identifying and understanding how your relationship expectations impact you (your spouse/ partner) is an important step in preparing for marriage. Relationships are more fulfilling when our expectations are met, and frustrations mount when our expectations are not realized.

Why are expectations so prevalent?

Expectations are beliefs which help you anticipate what will happen in your life. They give a sense of control (or the illusion of control) and predictability to our lives, at times helping us prepare for what is likely to unfold. For instance, expecting that your husband will react defensively about a particular issue can help you approach the subject in a sensitive way.

Where do your relationship expectations come from?

We all have expectations about what love and married life will be like—your expectations about how life is and how ought to be will have a  powerful impact on your marital experience. Your relationship expectations are shaped by the influential relationships you experienced and observed throughout your life (e. g; how your parents interacted with each other; how they dealt with you; the messages you received about love and married life, as well as your early dating experiences all go into forming your relationship expectations.

Is it bad to have relationship expectations?

Expectations are not inherently good or bad. Marriage/ relationship problems can arise, however, when your expectations are unrealistic, rigid, or set you up for failure. Couples find themselves in a bind when their expectations are not consistent with one another’s. This is especially troublesome when you didn’t realize that your partner holds an expectation significantly different from an expectation that you value highly.

Why do you want to get married?

Give yourself time to reflect on this one. You’d be surprised at how many people get married simply because they feel pressured by family, friends or society. If you are getting hitched because you’re the only one of your friends who is still single or your parents want grandchildren, you might want to rethink things before it is too late.

Why do you want to marry this person?

“Because I love him/ her” is not an adequate answer, since love is not enough to make your marriage work. So take a few moments and go deeper. Be very specific (saying “she/ he is great” does not give you useful information, but saying, “she/ he is generous and compassionate”- can).

What is it about this person in particular that makes him/ her different from

everyone else you might have married?

What core values do you share with your future spouse?

This is one of those areas of a relationship where compatibility matters. Sure, opposites might attract ( you are quiet and she is verbose), but your marriage will be on shaky ground when you don’t see eye to eye on issues that matter most to you. While it might be premature to ask some one on the first date about his/ her core values, you definitely should be having these conversations well before saying “ I do “.

What are the main differences between the two of you?

There is a side effect of love that you should know about. The excitement and euphoria of new love can blur your vision. Love-myopia will narrow your visual field until you only see how well you and your partner get along. All your similarities will be highlighted. It is important to refocus your vision and think about the ways in which you and your partner also differ. You don’t want to be blind-sided down the road by a difference you can not live with.

These topics are very important factors in how healthy the marriage will be. This is to lay the foundation for the healthiest marriage possible. Premarital counseling will arm the partners with the tools they need to survive troubled waters in the future. No relationship is perfect and no marriage will ever be problem-free, but with premarital counseling partners can learn how to survive difficulties with their love and their happiness intact. Ultimately they get from their marriage what they put in to it,                                        and premarital counseling can teach them how to put their best self forward and allow them to reap the amazing benefits of a happy, supportive marriage.

D.RETNAMONY,B.COM; M.Sc (C&P)

Psychological Counselor& Psychotherapist

& Flower medicine practitioner

11, Avvai street, 1^st cross, Selaiyur,

Chennai-600 073. Cell: 9884796102

http://issuu.com/chordiels/docs/chordiels_magazine_2_3_2013

 

ANORGASMIA IN WOMEN

Definition

Anorgasmia is a type of sexual dysfunction in which a person can not achieve orgasm, even with adequate stimulation, causing personal distress.

Awareness and awakening

Anorgasmia, or the failure / inability of a woman to achieve orgasm, was never seen as a problem in the male-focused of the past. The ideal woman of the 1900’s was seen as pure, asexual, and she was expected to engage in sex only to please her husband and / or bear him children. Fortunately, forces of social change such as WW II, and the sexual revolution allowed attention to be redirected from the woman being seen as the sexually positive wife who does her “duty“ as the acceptor of the gift of life; to seeing the woman as a fully sexual being who can share in the experience of pleasure which accompanies a mature sexual relationship.

Researchers such as Alfred Kinsey and Masters and Johnson both reflected the changing sexual attitudes of the time, and acted as catalysts for the change. Thanks to the pioneering work of sex researchers such as these, women who are not able to achieve orgasm no longer must resign themselves to frustration, depression and sexual un-fulfillment.

Incidence

Anorgasmia is actually a very common occurrence, affecting at-least I in 5 women world wide. Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulations necessary to trigger an orgasm. In fact, less than a third of women consistently have orgasms with sexual activity plus, orgasms often change with age, medical issues or medications. If one is happy with the climax of sexual activities, there is no need for concern. How ever, if a person is bothered by lack of orgasm or the intensity of orgasm, consult a doctor about anorgasmia.

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Symptoms

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of pelvic floor muscles. Some women actually feel pelvic contraction or a quivering of the uterus during orgasm, but some don’t. Some women describe fireworks all over the body, while others describe the feeling as a tingle.

Types of anorgasmia

Anorgasmia is usually characterized or specified in one of the following three ways.

1. Primary: Primary anorgasmia means that the diagnosed woman has never been able to achieve orgasm at any point in her life.
2. Secondary: A diagnosis of secondary anorgasmia means that the woman was consistently able to have orgasms at one time, but is no longer able to achieve them.
3. Situational: Situational anorgasmia refers to woman who can achieve orgasm in certain sexual situation, bur never orgasm in other specific situation. For example, a woman who can orgasm through masturbation but never during sex in the man on top position.

Causes

Orgasm is no simple, surefire thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If a person is experiencing trouble in any of these areas, it can affect the ability to orgasm.

Physical causes

A wide range of illness, physical changes and medications can interfere with orgasm.

Medical diseases: Any illness can affect this part of one’s sexuality, including diabetes and neurological diseases, such as multiple sclerosis. Orgasm may also be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual problems, such as painful intercourse.

Medications: Many prescription and over-the counter medications can interfere with orgasm. This includes blood pressure medications,

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antihistamines, and antidepressants – particularly selective serotonin reuptake inhibitors (SSRIS).

Alcohol and drugs: A glass of wine may make a person feel amorous, but too much alcohol can cramp one’s ability to climax, the same is true of street drugs.

The aging process: As a person age, normal changes in anatomy, hormones, neurological system and circulatory system can affect sexuality. The drop in estrogen that occurs during the transition to menopause can be a particularly notable foe of orgasm. Lower levels of this female hormone can decrease sensation in the clitoris, nipples and skin and impede blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Still anorgasmia is not limited to older women. And many women say sex becomes more satisfying with age.

Emotional factors

Like many sexual dysfunctions, diagnosis of anorgasmia is some what subjective and depends a great deal up on the thoughts, emotions, and desires of the individual experiencing it. Some women may never achieve orgasm through intercourse with their partner and live active, fully satisfying sex lives by achieving in other ways such as partner’s stimulation of her clitoris manually. Other women may be able to achieve orgasm through manual stimulation, yet still feel depressed, inadequate and unfulfilled because they can not reach orgasm during intercourse. Studies show that women who identify with the latter group are not alone. It is estimated that between 10 % and 40 % of adult American women have problems achieving orgasms.

Psychological causes

Many psychological factors play a role in a person’s ability to orgasm including-

• Mental health problems such as anxiety or depression.
• Performance anxiety.
• Stress and financial pressures.
• Social, cultural and religious beliefs.
• Fear of pregnancy or sexually transmitted diseases.
• Embarrassment.
• Guilt about enjoying sexual experiences.

Relationship Issues

Many couples who are experiencing problems out side the bed room will continue to experience in the bed room. These issues may include-

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• Lack of connection with the partner.
• Unresolved conflicts or fights.
• Poor communication of sexual needs and preferences.
• Infidelity or breach of trust.

Treatment

Women suffering from any sexual dysfunction, including anorgasmia, should be evaluated by a gynecologist before delving too far in to sex therapy. For most women treatment means more than medications.

Counseling for anorgasmic women will most likely focus on three areas. First, women are usually encouraged to attend sex therapy with their primary sexual partner. There are several reasons for this, but the primary one is that anorgasmia, like many sexual dysfunctions, can not be seen solely as the woman’s problem. There are many relationship variables which affect the symptom and, therefore, need to be treated in couple’s therapy. Counseling often begins with an element of sexual education for the couple. The couple is taught the mechanisms of sexual arousal in women and, most importantly, they are taught the differences in the male and female sexual response cycles

Female inhibited orgasm is often treated with specific therapeutic techniques Couple will often be taught to use sensate focus exercises at home, and females will often be taught and encouraged to use systematic desensitization, and directed masturbation to treat their orgasm problem. Directed masturbation is a technique whereby the woman is educated as to how she can bring herself to orgasm. The hope is that through her increased body awareness and comfort with orgasm, the woman transfer this knowledge and take charge in directing her partner during intercourse,  thereby, achieving orgasm with her partner. Beyond education and techniques, counseling will likely focus on the emotional or situational factors, of both the individual, and the couple, that are, contributing to the lack of orgasm in the woman. How these sensitive and all important issues are dealt with in therapy will depend a great deal on the theoretical orientation of each individual counselor.

Prognosis

If the problem of anorgasmia is treated by a qualified sex therapist who takes time to consider the many variables which can contribute to the problem,

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then the couple can expect a positive outcome. And although successful treatment of this condition depends a great deal on the specific nature of the diagnosis (primary vs secondary, age of woman effected, willingness of partner to attend counseling, depth of emotional cause, level of anxiety associated with becoming orgasmic etc.), research has shown a success rate of 80- 90 % for treatment of primary anorgasmia; and between 10-75 % success rate for treatment of secondary anorgasmia. These successful treatment rates are encouraging for the millions of women who live with the frustration of not being able to reach orgasm in their sexual lives. It appears that our society has finally come to the realization that women too are sexual beings, beings who desire, need, and deserve similar pleasure from the act of sex as men have enjoyed for centuries. Fortunately, sex therapists have evolved along with society in their ability to help women live fully satisfying sex lives if they so desire.

ANORGASMIA IN MEN

Definition

Male orgasm is defined as a subjective, perceptual cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. Anorgasmia is defined as a failure to experience an orgasm.

Delayed ejaculation is a medical condition in which a male can not ejaculate, either during intercourse or by manual stimulation with a partner. Ejaculation is when semen is released from the penis.

Incidence

Most men ejaculate with in a few minutes of starting to thrust during intercourse. Men with delayed ejaculation may be unable to ejaculate (for example, during intercourse) or may only be able to ejaculate with great effort after having intercourse for a long time (for example 30 to 45 minutes)

The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder. In other words, if the absence of orgasm follows a decreased desire for sexual activity, an aversion to genital sexual contact, or a decreased lubrication swelling response, diagnoses such as hypoactive sexual desire disorder, sexual aversion disorder, or male erectile disorder might be more appropriate even if they all have a final common outcome

( ie anorgasmia )

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Patients with male orgasmic disorder can achieve firm erections and have normal sexual intercourse with penetrations. Some patients reporting male orgasmic disorder with intercourse can achieve orgasm through manual or oral stimulation or at least report orgasm through nocturnal emission (ie wet dreams). A report of generalized life long male orgasmic disorder with no orgasm at all (across an array of stimulative technique) suggests an organic etiology.

Diagnoses

According to the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Test Revision (DSM IV-TR), the diagnostic criteria for male orgasmic disorder (MOD) is as follows-

• Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that, taking in to account the person’s age, is thought to be adequate in focus, intensity, and duration.
• The disturbance causes marked distress or interpersonal difficulty.

DSM IV –TR male orgasmic disorder specifiers include the following types

• Life long or acquired.
• Generalized or situational.
• Due to psychological or combined factors.

DSM IV –TR does not distinguish between disorders of orgasm and disorders of ejaculation (with the notable exception of premature ejaculation), which suggests an implicit assumption that orgasm and ejaculation are overlapping events (not only from a temporal perspective but also from a physiological perspective). Yet, some researchers distinguish between disorders of orgasm and disorders of ejaculation the latter including deficient and delayed ejaculation, retrograde ejaculation, and ejaculatory insufficiency. Such distinctions might have merit because not only can ejaculation occur with out concomitant orgasm, but orgasm can also occur with out ejaculation (as seen in both pre-pubertal children and adults practicing coitus reservatus).

Delayed ejaculation can have psychological or physical causes.

Common psychological causes include-

• A strict religious background that makes the person view sex as sinful.
• Lack of attraction for a partner.

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*   Conditioning caused by a habit of unusual masturbation.

*   Traumatic events (such as being discovered masturbating or having   illicit sex or learning one’s partner is having an affair)

Some factors, such as anger toward the partner, may be involved.

Physical causes may include-

• Use of certain drugs ( such as prozac, mellaril, and guanethidine)
• Nervous system disease, such as a stroke or nerve damage in the spinal cord or back.

Complications

If the problem is not addressed and treated the following may occur.

• Avoidance of sexual contact.
• Inhibited sexual desire.
• Marital stress,
• Sexual dissatisfaction.

If the person and his partner are trying to get pregnant, sperm may have to be collected using other methods because of lack of ejaculation.

Prevention

Having a healthy attitude about sexuality and genitals helps prevent delayed ejaculation. Realize that one can not be forced to have a sexual response, just as one can not be forced to go to sleep or to perspire. The harder you try to have a certain sexual response, the harder it becomes to respond. To reduce pressure, one should absorb in the pleasure of the moment. The person should not worry about whether or when the ejaculation will take place. The person’s partner should create a relaxed atmosphere and should not pressurize about whether or not ejaculated. Openly discuss any fears or anxieties, such as fear of pregnancy or disease, with the partner.

Signs and Tests

Stimulating the penis with a vibrator or other device may determine whether the person have a physical (often nervous system) problem. A nervous system (neurological) examination may reveal other nervous problems that are associated with delayed ejaculation.

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Treatment

• If the person has never ejaculated through any form of stimulation (such as wet dreams, masturbation or intercourse) may see an urologist to determine if the problem has a physical cause.
• If the person is able to ejaculate in a reasonable period of time by some form of stimulation, may see a therapist who specializes in ejaculation problems. Sex therapy usually includes both partners. The therapist will usually teach them about the sex response, and how to communicate and guide the partner to provide the right stimulation.
• Therapy often involves a series of “home work” assignments. In the privacy of their home the partners engage in sexual activities that reduce performance pressure and focus on pleasure.
• Typically, the person will not have sexual intercourse for a certain period of time, while he gradually study to enjoy ejaculation through other types of stimulation.
• In cases where there is a problem with the relationship or a lack of sexual desire, the person may need therapy to improve his relationship and emotional intimacy.
• Some times hypnosis may be a helpful addition to therapy, especially if one partner is not willing to participate in the therapy. Trying to self-treat this problem is often not successful.
• If a medication is believed to be the cause of the problem, discuss other medication options with the health care provider. Never stop taking any medicine with out first talking to the health provider.

Prognosis

Treatment commonly requires about 12 to 18 sessions. The average success rate is 70 to 80 %.

The person will have a better out come if-

• The person has a past history of satisfying sexual experiences.
• The problem has not been occurring for a long time.
• The person has feelings of sexual desire.
• The person feels love toward his sexual partner.
• The person is motivated to get treated.
• The individual does not have serious psychological problems.

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If medications are causing the problem, the health care provider may recommend switching or stopping the medicine (if possible). A full recovery is possible if this can be done.

D.RETNAMONY, B.COM; M.SC (C & P);

Psychological counselor and psychotherapist

and flower medicine practitioner.

One of my presentations which I did regarding Prevention of Crime, please click link to view presentation: