I begin all of my intake sessions the same way: "So what brings you in today?" When an individual or couple's chief complaint is related to sexual health, they will often go into a description of why sex is not working. Perhaps there is low desire, low arousal, difficulty with orgasm, or mismatched desire. They will often explain that these difficulties they are experiencing make sex impossible or unenjoyable. When I inquire further, these individuals and couples will often describe how difficulty with specific sexual acts results in all forms of sexual contact becoming derailed. But does sex actually get derailed if there's sexual dysfunction? Are we defining these terms correctly? Let's take a few moments to identify both the definitions and functions of some commonly used terms to describe sexual health and sexual function.
Intercourse
Intercourse, most classically defined, is a specific sexual act that involves the penetration of a penis and vagina. And what are the primary functions of intercourse? One of the central functions of intercourse is that this is how procreation takes place. In fact, all animals that have internal fertilization will generally have some form of intercourse process through which genetic material is transferred from one individual to another. While there are certainly those who would say that intercourse is a source of pleasure or a way for couples to connect, one of the primary functions it's still rooted in procreation. If someone were to say that the primary function of intercourse is pleasure, and I were to ask, "Are there other ways to experience pleasure other than intercourse?", the answer is almost inevitably, "Yes". But, is natural procreation possible without intercourse? Not so much.
So we now have a fairly clear definition, and some primary, secondary, and tertiary functions of intercourse. So, what would be necessary for intercourse to take place? Well, there would need to be a male with an erection, and a female who is receptive to intercourse. So what would happen if you had a male with erectile dysfunction, or a female with vaginismus? Well now intercourse is not possible. But does that mean that sex is not possible? Let's take a closer look at that.
Sex
Sex becomes a little bit more challenging to define. Some people would define sex as being synonymous with intercourse. Others would say sex also includes other forms of sexual stimulation, like oral sex, manual stimulation, or anal sex. Some would say sex begins at foreplay. Others might even say that sex begins long before any physical contact begins, but when one starts communicating about sex, like sending flirtatious text messages, or playful banter before foreplay. One of the ways that I define sex is as a form of communication that involves sexual or erotic stimulation that could potentially result in an orgasm. Intercourse? Sex. Manual stimulation? Sex. An erotic massage? Sex. Sex, therefore, is not as much just a physical act, but a mindset that plays into a physical encounter.
And what exactly is the function of sex? There are many values people identify as reasons why they have sex. They may describe having sex because it's a way to feel close, to feel connected, to feel warmth, to feel pleasure, to express love, to deal with boredom, to make up after a fight, to be exploratory, to be adventurous, the list goes on and on. In fact, Cindy Meston and David Buss, two researchers from the University of Texas, identified 237 reasons why humans have sex. What's the function of sex? Depends entirely on the values of the individual and couple. But, if the definition of sex is much broader and the function of sex more diverse, is specific sexual function linked to the ability to have sex? If the purpose of sex was to experience pleasure, connection, or closeness, is an erection necessary? Is penetration necessary? Is orgasm necessary? One could quite easily make the argument that a meaningful and rewarding sexual encounter need not have any specific sexual function, orgasm, or ejaculation. That's not what the function is. When sex is defined this way couples can actually free themselves from the pressure associated with a particular outcome and instead lean more heavily into enjoying the process.
Intimacy
Intimacy is it concept that's even broader in definition than sex. Intimacy refers to a close emotional or physical connection between individuals. It involves feelings of closeness, trust, and vulnerability shared between partners. Intimacy can be emotional, intellectual, or even spiritual, and it goes beyond physical attraction or sexual activity. It includes sharing thoughts, feelings, and experiences with someone in a trusting and supportive way. So, intercourse, can be a way that couples have sex, and can be a form of intimacy. There are certain kinds of sexual activity that may not be considered intercourse but are also intimate. And there are certain kinds of intimacy that are neither sex nor intercourse.
So what exactly is the function of intimacy? Intimacy serves the essential function of creating bonding between two partners. Without intimacy, individuals and couples might feel detached, alone, or isolated. Intimacy speaks to the deep human desire for connection with others. If we were to adopt this function of intimacy, even in the absence of specific sexual function, couples could quite easily engage in meaningful intimate contact. Things like holding one another, snuggling on the couch, or engaging in a warm embrace, while not necessarily sexual, can be deeply intimate. An intimacy that is not predicated on any specific sexual function.
Conclusion
When an individual or couple presents for treatment of a sexual dysfunction it becomes important to help them define what they are actually struggling with. Is there an issue with intercourse? An issue with sex? Or an issue with intimacy? Unless we can sufficiently define what the challenge is, we could potentially end up treating the wrong issue. How we talk about sex impacts how we think about sex. In our everlasting journey as sexual beings, it becomes incumbent on each individual to continue understanding and leaning into what their values are and moving towards what creates their sense of sexual and relational fulfillment.
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