Lack of fulfilling sexual connection is making us anxious and depressed. As a family physician, I see this up close and personal
A couple in their late 50’s — a man and a woman — is in my examining room to review a recent visit to the ER for shortness of breath.
Trevor has a chronic lung disease that causes him difficulty in walking more than a few blocks. We talk about Trevor’s recent episode of distressed breathing which required antibiotics and steroids over a 3-day hospital admission. Celine, his wife, recounts with frenzied gesticulation the terrifying wait for the ambulance as her husband struggled for breath. Now that Trevor is stable, we take time to review the treatment plan for his lung disease. As I’m summarizing the medication changes, Trevor says, “Doc, there’s one more thing…”
Sexual Health – an oxymoron in the digital age
Sex – or the illusion thereof – surrounds us. Sex-themed documentaries on Netflix provide light entertainment, VR/AR experiences in sex are blowing up and hook-up dating apps have re-defined the way we meet.
On our crowded subway commute, multiple pairs of feet peek coyly from under 480 thread count sheets and ED pills are touted as the must-have product alongside beard balm. We are a captive audience for marketing that makes us believe that everyone is having terrific, frequent sex. Is it true? No, in fact, evidence suggests the opposite. But when immersed in an illusory landscape of copious sex and not getting this mythical goodness, we experience FOMO and anxiety. As a family physician, I will tell you that, when it comes to sex, we may be more lacking – and lonely – than ever before.
The Hand-on-the-Doorknob Question
“My wife has a problem with me spending time on the internet”, Trevor admits in a low tone. Celine is quiet now, eyes downcast, fiddling with her coat zipper. I am also Celine’s doctor, and I ponder silently on our prior encounters where she has talked about her panic attacks and difficulty sleeping.
I ask Trevor for more details and he grudgingly explains that his wife has been getting angry with him over his late-night sessions on his computer. He says he’s “blowing off steam with some websites”, which, he says, helps him deal with his chronic lung disease.
He doesn’t feel this should concern Celine, however, stating that everyone is online, and pornography is what “everyone’s doing” these days.
Silence has become commonplace in their household. With the kids grown and gone, the couple eats dinner separately, Celine at the dining table with a book and Trevor in his den over the computer. They can’t say when they stopped sharing a bed, but Trevor spends nights on the couch downstairs as it’s easier for him to avoid the walk upstairs and, anyway, “I would bother Celine if I came to bed late”.
In her own clinic visits, Celine has described a choking sensation of panic that usually grips her in the evening hours, the relentless tossing and turning until 3am. She has difficulty concentrating in her job as a human resources manager, and she feels restless and frustrated. On prior visits, I had worked with Celine on medication options and referrals to therapy. Yet it’s only now, as I sit with Trevor and Celine, sensing the palpable wall of hurt and resentment between them, that I understand what has been keeping Celine anxious and sleepless: Lack of intimacy. It has been over 4 year since the couple has had sex.
A plethora of sex in the modern age is a double-edged sword
Choice is wonderful. Choice in sex validates our individuality. Choice invites us to confront our small-mindedness and try new things, and it offers convenient access to sex when competing priorities vie for space on our schedule. However, the now limitless opportunity to consume sex, particularly in the digital space, can put a chokehold on real sex between people, and starves our fundamental human need for intimacy and connection.
Especially as we remain, for the most part, hardwired in our desire for the idealized monogamous relationship and family. If you doubt this, keep an eye out for ads promoting this season’s perfectly curated wedding registry or other paraphernalia commodifying marriage and child-rearing – Ad fonts may be minimalist but our mindset on relationship remains remarkably traditional.
The seduction of virtual sexual experiences can distract us from putting much-needed work into intimacy in our relationship, because it’s easy. Communication about sex, on the other hand, is messy, imperfect, emotionally charged… in other words, real. Discordant desire, which is when one person in a relationship has a different level of libido/desire than the other person, may be caused by a lot of different factors, and each situation is unique. However, relationships affected by discordant desire all share a deep sense of shame, rejection and devastated self-esteem.
Unfulfilled sexual expectation is just as much a concern for single folks. Despite the apparent availability of sex and casual hook-ups, millennials are having less sex than generations prior. Millennials face staggering rates of anxiety and are outpacing prior generations in their use of both prescription and nonprescription drugs to combat poor mental health. Is lack of sexual connection in some way contributing? As digital options for sexual experiences become exponentially more sophisticated and accessible, we need to start talking about how to preserve true human connection, or perhaps redefine them to fit the brave new world.
Acknowledge the deep sense of rejection in discordant desire, then move forward together to build a new paradigm
As a family physician, I recognize how anxiety, panic and insomnia may all be symptoms, at least in part, of feelings of isolation and abandonment in an intimate relationship. Realizing that Trevor and Celine are suffering, I put aside my worries about the full waiting room and commit to spending time with this couple in order to dig under the surface of this issue that, though mentioned tentatively, has profound influence on their wellbeing.
In this clinic encounter we acknowledge the shame and loneliness that Trevor and Celine have suffered as a result of discordant desire, and we bring awareness to the various factors that have resulted in their rift in intimacy. We address Celine’s experience with postmenopausal physical changes that affect her enjoyment of sex and talk about some options that she can try. We highlight Celine’s devastating sense of rejection that has kept her anxious and sleepless. Trevor hears, for the first time, the hurt that Celine has quietly suffered, and commits to working together on improving their intimacy.
Options such as relationship coaching and sex therapy are proposed as means to address sexual detachment and rebuild loving communication. Over the next six months of regular visits with Trevor and Celine, I witness their steady progress toward rediscovering common ground as a couple. Through tremendous hard work and, in spite of ongoing medical issues, they rekindle their desire of years prior. Celine reports that she is finally able to sleep through the night.
Where pharmaceuticals cannot tread: Healing by harnessing one’s own inner wisdom
As a family physician and relationship coach, I am uniquely positioned to help individuals and couples harness infinite inner resources to build healthy connection between physical, mental and sexual wellbeing.
In coaching, I help people reclaim their sense of worth, get clarity on their values and purpose, find their power in their relationship and take decisive action in transforming the dynamics of their intimate life. Through a powerful coaching experience, we are able to see the challenge of sex in the digital age as an opportunity for self-growth and discovery of a transcendent intimate relationship.