Sex & Relationships: Good Research On Sexuality

Research That Helps Therapy

I’m slowly digesting the results of the third National Survey of Sexual Attitudes and Lifestyles (“Natsal 3”) conducted in Britain. I note below two written passages from Natsal 3, and one bar chart that stood out for me. These findings connect to views of sexuality that I believe can support good therapy.

Executive Summary

Just to familiarize you a bit with the study, here’s the Executive Summary (from The Lancet Britain’s leading medical journal):

Results published across six papers in The Lancet give the most detailed picture yet of the British population’s sex lives over the last 10 years, as part of the third National Survey of Sexual Attitudes and Lifestyles survey (Natsal). Over 15,000 {emphasis added} adults aged 16-74 participated in interviews between September 2010 and August 2012. Studying this large representative sample of people living in Britain enabled the researchers to produce key estimates on patterns of sexual behaviour, attitudes, health, and wellbeing across the population. Two previous Natsal surveys have taken place, in 1990 and 2000, making it one of the biggest and most comprehensive studies of sexual behaviour undertaken in a single country.

Some Early Impressions

In my first and admittedly fast read of the report, two written passages and one table stood out for me. The two passages are excerpted interpretations of the study by its authors [my italics added].

  1. “We show that sexual response problems lasting at least 3 months in the preceding year are common, even in young people. More than 40% of men and 50% of women report one or more problems, but the proportion of sexually active individuals reporting distress about their sex life is much lower (about 10%). Our estimates of individual problems include infrequent and frequent symptoms as well as mild and bothersome problems and should be interpreted accordingly.”
  2. “We aimed to explore the distribution of sexual function using a definition of function that is relevant to everyday life. We showed a wide variability in sexual function across the life course….This finding confirms our strategy of treatment of sexual function as a continuum of experience. We reported that low sexual function was associated with other indicators of poor sexual health, and call for greater attention to be paid to low sexual function within broader sexual health policies, interventions, and services.

Is “Dysfunction” Normal?

The figures quoted in #1 seem clear: what some in society call “sexual dysfunction” is statistically much better defined as “normal”. In the most basic sense, normal means reflecting actual norms. Normal symptoms can be both temporary and chronic, occurring at all ages and at high levels. By understanding how common these problems are, we can reduce some of the social and personal anxieties that surround them.

The idea that dysfunctions should be seen as more common is not easily acceptable. “Common” can imply a passive acceptance of low levels of sexual health and functioning (or mediocre sex). Therapists could be seen as giving themselves an “out” for not being able to treat these complaints successfully.

A Positive Therapeutic Approach

I work with an idea that the problems are uncomfortable enough to motivate therapy pretty well. It may not be comfortable when therapy looks at the ways that sexual “symptoms” have multiple impacts. Yet this is not a clinical stance that labels people or relationships as “defective.” Rather it’s the struggle to know the widest possible ecology – an “appreciative inquiry” into each relationship I work with. It also comes with an awareness that desire can be expressed and received “ruthlessly”, parallel to existing committed relationships.

Differences In Desire

Excerpt #2 describes the “real world” of therapy, where the primary problem is differences in desire. The basic criteria for sexual health and functioning level is not simply behavioral and medical. It’s relational, developmental and existential. Natsal 3 seems to grasp these perspectives, using ideas like the “continuum of experience” and “relevant to everyday life”

Bar Chart

Here’s the bar chart (among many others) that visually clarified the importance of difference in desire:

sexual functioning

This chart visually shows that “Partner does not share same interest level in sex” is the biggest complaint (other than the peak among women 65-74 who said “Partner had sexual difficulty in the past year”). It’s also the most consistent one across genders and age groups. The largest group of people tend to define sexual problems relationally.

A Driver Of Relationship Change

I have long worked from the principle that differences in desire are a prime driver of relational change. By defining sexual difficulties relationally, rather than just medically. we can readily integrated developmental (lifespan) perspectives. Common sense tells us that these differences are unavoidable, and therefore not “abnormal”.

The most powerful ‘layer’ of all is the existential, where one’s life meanings, motives, functions and impacts can be more deeply explored and understood through eros and sexuality, and how love has been given and received.

We know of course that diagnosable medical problems may be playing a role in the difference of desire, but they are only one part of a larger whole. But differences in desire is still the more comprehensive clinical perspective, easily integrating medical information.

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