19861980s TV SHOWS
"DOCTORS REVEAL THE LATEST IN SEX THERAPIES"
WITH HELEN SINGER KAPLAN, M.D., HAROLD LIEF, M.D., CLIFFORD SAGER, M.D., MAJ-BRITT ROSENBAUM, M.D.
WITH HELEN SINGER KAPLAN, M.D., HAROLD LIEF, M.D., CLIFFORD SAGER, M.D., MAJ-BRITT ROSENBAUM, M.D.
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| 00:58:24 6.9 |
PROGRAM HOST DAVID SUSSKIND INTRODUCES SHOW " DOCTORS REVEAL THE LATEST IN SEX THERAPIES " - DIFFERENT SEX PSYCHIATRISTS ARE INTRODUCED - HELEN SINGER KAPLAN, HAROLD LIEF, CLIFFORD SAGER, MAJ-BRITT ROSENBAUM
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| 00:58:25 8.88 |
SUSSKIND INTRODUCES TOPIC AND GUESTS:
David Susskind Good evening. I'm David Susskind. Many people talk a good game when it comes to sex but there are still a lot of hang ups out there. impotency, frigidity, lack of desire and so on. My guest tonight are sex therapists and they will discuss the latest breakthroughs in the treatment of sexual disorders will begin after this brief pause. |
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CUT TO SHORT BREAK
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INTERVIEW BEGINS:
David Susskind My guests are all psychiatrists who have private practices, and they specialize in sexual problems. Please meet them now. First, Dr. Helen singer Kaplan is director of the human sexuality program at New York Hospital Cornell Medical Center. Her many books include the new sex therapy and the evaluation of sexual disorders. Dr. Harold Lief is Professor of Psychiatry at the University of Pennsylvania School of Medicine is also psychiatrists to the Pennsylvania Hospital. Dr. Clifford Sager is Clinical Professor of Psychiatry at New York Hospital Cornell Medical Center. He is also Director of Family Psychiatry at the Jewish board of Family and Children's Services. Dr. Maj Britt Rosenbaum is director of the Human Sexuality Center at Long Island Jewish Medical Center. She is associate clinical professor of psychiatry at the Albert Einstein College of Medicine. What do you say to sex doctors, experts, saying that 20% of all Americans is suffering some kind of sexual dysfunction. Helen Singer Kaplan Actually, Harold didn't mast just save as 50%. Harold Lief Well, one time or another, all couples will have some kind of sexual dysfunction or disorder. So but that may be fleeting and temporary, but the figure is high. There's no doubt about it. Maj-Britt Rosenbaum There's this one study of 100 Married couples that we all quote done in the 70's. Ellen Frank's study that showed that if I remember right, 40% of the men at the time, and about 60 or so percent of the women had complained of what we would define as a sexual dysfunction. Clifford Sager It's difficult to put an exact number on it, but it is high. David Susskind Why is it so high? Helen Singer Kaplan Well, sexual problems are among the most prevalent medical problems, they're more common than the common cold. But fortunately, for most of these problems, the prognosis is now just wonderful. Most people can get help. And that's a drastic change from the way it was when I graduated from medical school 25 years ago, and maybe some of us even earlier or later. At that time, we didn't understand the human sexual response, especially the female response. We didn't know what caused problems and there was no treatment that was any good. David Susskind Can we define what the word problem means sexual dysfunction, does that mean the inability of the man to have an erection? Harold Lief May I respond to that, David, because problems more than than dysfunctions dysfunctions are such things as inability to have an erection or erectile difficulties, premature ejaculation, inability to have sexual excitement or orgasm and the female in inhibited sexual desire. Those are all dysfunctions. But more than that, there are concerns and difficulties. Concerns are those problems that people have with themselves, body image problems, issues about normalcy, and difficulties a whole repertoire of things that go on between couples that cannot be labeled disfunctions, they may relate to the repertoire of sex, what's included in the repertoire of sex, the timing of sex, difficulties with the initiation of sex, the setting David Susskind I went way past some of those primitive problems of the timing of sexual is the time of sex is when you both wanted? Harold Lief Not at all those create problems between partners? David Susskind Well what would be wrong Clifford Sager See perhaps David to go back to your original question. I think we're too civilized. And we have so much culture in us, which begins at our birth, and so many ideas about sex, and so many do's and don'ts and so on. That sex which should be a natural function has become very unnatural for most people in our civilized so called civilized country David Susskind Dr Sager I don't know what that means. Clifford Sager What that means is that we have built in inhibitions. Also that sex for most people depends upon a relationship with another person. Then given a long standing relationship, a very short brief relationship, but it takes two generally speaking, they have sex at least the sex we're talking about. Takes two, and that means as a relationship one person affects the other people are very sensitive to how the other person affects them, sometimes insensitive as to how they're affecting the other person. So, this all contributes to the the problems plus the self image other things that had been been mentioned, David Susskind when a man cannot have an erection. And therefore, ejaculation. What causes that? Helen Singer Kaplan You can have an ejactulation without an erection, those are two separate a reflex. It's more fun when you have an erection. But it's possible people have diabetes people have other organic problems can ejaculated very well. On the other hand, some people have perfectly normal erections for psychological reasons or because you're taking certain drugs can't ejaculate. So those two parts, that's one of the things we've learned in the last 10 years or so David Susskind Well, if you're taking drugs that prevent Erection and ejaculation, should you stop the drugs? Well. First of all, it's Helen Singer Kaplan Well. First of all, it'smore important to live than to have sex for most people. So many of the drugs that do an enormous amount of good that have prevented heart attacks and strokes have sexual side effects, but by working by doing certain tests and working together with the internist, you can usually change the medication and reduce it so that you don't need to have a problem David Susskind You're talking about high blood pressure Helen Singer Kaplan Well different drugs, hurt ejaculation impair ejaculation, ejaculation. There's certain antidepressants which impair the MAO inhibitors, certain very few of the antihypertensive agents, some hormone problem, stop ejaculation or orgasm and women, a different group of drugs and illnesses, cause impotence Maj-Britt Rosenbaum Diabetes being one of the main culprits in this regard men, most men after a few years of diabetes will have some effect on their sexuality. Helen Singer Kaplan The erection Maj-Britt Rosenbaum Not necessarily ejactulation David Susskind What would you advise the wife of a man with diabetes? Who is having trouble erection? Maj-Britt Rosenbaum I guess part of the problem is that it's very important to see their sexual interaction and their sexual function as part of their total life and their relationship. And I think increasingly so we are trying to see the larger picture. But I think if anything has changed over the years, it's trying to first see how to sex fit into this particular man's in this particular woman's life, and then go from there. David Susskind Well make the assumption that they would like to have a sexual experience with each other twice a week would you do but at Maj-Britt Rosenbaum first evaluate how much of their sexual problem is what we say organically caused caused either by their illness or aging or medication? See what question of either or David Susskind Let's say he's aging, and let's say he's got diabetes. And let's say he can't erect, Maj-Britt Rosenbaum right? It's a fairly common problem. Helen Singer Kaplan What Maj-Britt was trying to say is it it's almost never that he can't erect entirely. When he comes into our office, we he doesn't get any psychological treatment and into your center and to your center without having a sleep test, for example, and a penal circulation test and hormone tests. And then we can sit down and say, Look, you can have you've had maybe a 20% loss, but you and your wife don't know how to handle that. It's just a little loss. It's not as firm not as quick as it used to be. Let's talk about the maximize rehabilitation. David Susskind Okay talk. I'm your patient. Helen Singer Kaplan All right. Well, sometimes a woman will insist on having her orgasm only after lengthy intercourse, or once or twice a night. And man loves or feels responsible tries to comply to that demand. And that just won't work anymore. It might have worked when he was 20. So we tried to change the expectations and to have the woman more supportive. As the man ages he is more dependent on his partner for good sexual response Maj-Britt Rosenbaum And is more dependent on direct physical stimulation. Clifford Sager there's generally a need for more stimulation for a woman or a man. As you get more more loving, more skillful in terms of physical manipulation, if you like, and also the employment of fantasy of the couple playing into one another's fantasy of things that might be sexually exciting sites David Susskind such as? Clifford Sager such as talking about whatever the fantasy is that a person may have. In the middle of a very well, they are in the middle of the act, they know one another. And in therapy if they haven't talked about their fantasies previously with one another, we encourage them to do so. Harold Lief They were all saying is that we want to get away from the all or none kind of thinking about erectile difficulties or impotence. Because there may be some organic or biogenic factor that creates a certain percentage of the difficulty. And there are psychological factors that overlay those difficulties and they have to be dealt with, they have to be cleared away, as well. Helen Singer Kaplan If a wife's been angry at her husband, for the last 20 years, he's been a chauvinist, he's been mean. And all of a sudden, he is more vulnerable sexually. I mean, she's mad at him, she's not gonna be very nice to him. And then she's going to just suddenly let him know she's doing him a big favor, and it's taking too long, what's the heck's the matter with him that he can't get an erection that can take that 20% disability and completely, you know, completely make him impotent Maj-Britt Rosenbaum or even welcome the fact that he doesn't have an erection anymore Helen Singer Kaplan very happy about it, and she just sabotage it. Or on the other hand, if a man is very insecure, very performance oriented, and he is used to walking into that bedroom with that direction. And now, as everyone has said, he needs both the physical and the psychological. He's just gonna avoid sex, he'll freak out. And she will think I'm getting older, he really wants a 22 year old, so she won't be able to come forth and help them. But you can't do any of that till you have that record and say, Look, you had an erection at 5am It lasted 25 minutes. You didn't have erections at at one o'clock. So you want to wait. And David Susskind let's tell the audience that you're talking about a test in which the patient the male patient puts a recording device of some kind around his penis. And it records his erections during the evening, during the theory that a man erects 3,4,8 times a night in his dreams and his fantasies. Helen Singer Kaplan Well, it has nothing to do with fantasies. David Susskind How do you know we do that four six or eight times Maj-Britt Rosenbaum You get some of the watch you all night and I promise you, you will Harold Lief That was that was found by Fisher of Sinai and Kerri Zen of down in Houston, those men did some pioneering studies of that. And they discovered that during this phase of sleep, REM sleep, rapid eye movement sleep, the male has erections, often six times a night David Susskind dreaming, dirty dreams. Harold Lief Some of them are connected with dreams because dreams occurred generally in the same phase of sleep as do erections. But that doesn't mean that they're causally connected. As a matter of fact, we still don't know well enough, the connections between dreams during REM sleep and erections. What whether they're causally related David Susskind why should we erect Maj-Britt Rosenbaum we know that children and women, certainly lubrication and swelling in the same phase like nature. So this is something that's part of our physiology, Helen Singer Kaplan it's not important why the marvelous has to differentiate between psychological impotence and organic impotence because most psychological impotence is caused by performance anxiety, by fear, you can't have an erection why you're scared because the blood drains out of the penis. When you're fast asleep, you're not performing David Susskind You're scared because you failed the time before. times before, Helen Singer Kaplan right? But that could be because he was tired or had too much to drink or she was mean doesn't necessarily mean a physical problem when he's asleep. He's not performing. He's not. He doesn't need a caring partner. So it's a reflex. David Susskind Do we have erections in the night? Because we're having pornographic dreams? Harold Lief No. David it's really, if you look at this, perhaps teleologically It's nature's built in way to make sure that the species is maintained. Because the male fetus erects during fetal life we now have, we now have pictures, X rays of that male fetus showing erections so that this is an internal process David Susskind wonderful man could wake up self help. See now, well, Helen Singer Kaplan that doesn't work. Clifford Sager But also you find when people are awakened at the time that they are having these erections and the rapid eye movements, they can remember their dreams very well at that time, and good part of the time, but most of the time, they are not necessarily sexual dreams at all. They'll tell you what the dreams are, they may forget them when they wake up later on, which is what we often do, usually is the dream is closer to the waking state that we do remember, Helen Singer Kaplan if a man wakes up and says there was had men having problems, he says, Uh huh. And he breaks up his wife and tries to use it here. And she's all sleepy. That's not gonna work. He's going to get very scared as soon as he tries to enter and he'll lose it anyway, so that it's not usually the best way to overcome Clifford Sager Sometimes it works. Sometimes. Many men will say I have it now. Yeah, let me use it before it goes away. But that's coming out of a position of fear that he's going to lose it. And frequently Well, David Susskind that's pretty hard on the lady being woken up in the middle of night, Helen Singer Kaplan I have been more and more interested in prevention David and prevention of impotence, we David Susskind will come right back to that. After pausing for one minute |
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INTERVIEW RESUMES:
David Susskind Alright Dr Kaplan, you wanted to talk about prevention? Helen Singer Kaplan Well, I want to say one word about prevention of impotence. Because I mean, organic impotence of middle age and beyond. Two of the most prevalent causes are diabetes, the complications of diabetes and vascular problems, poor circulation of the penis, that's probably the two most common causes, especially poor circulation. And that can be prevented or at least retarded by the same measures we use to prevent heart disease, cardiovascular disease, there's been a decrease of 60% in the last six or seven years in heart attacks, because of people keeping their diet and their blood pressure down. So that a patient of mine who has vascular beginning problems, I make them all go on a diet to take their lipids, I treat them like a coronary patient, and patients with diabetes, and use Maj-Britt Rosenbaum and to quit smoking. Absolutely. I think I mean, which is one of the really major, quite striking slowly, many men that Clifford Sager And some men would rather continue smoking and have good sex. Helen Singer Kaplan But it's easier to get a man to give up cigarettes, if you say he's going to have a heart attack, a certain percentage give it up. But if you tell him he's, he's making his impotence worse, he's more likely to give it up also, the tight control of diabetes where people take their blood sugar couple of times a day and really keep it tight, not just the you know, in a gross way, watching the urine a very tight control, probably, you get less complications, and you can prevent a lot of that. So those are the two things I insist on regulation of hypertension diet, David Susskind By regulating hypertension, you are bringing into play chemotherapy drugs, Helen Singer Kaplan not necessarily you have a guy lose weight exercise, change around the drugs by working with his internist, often they need much less medication. David Susskind But isn't it true that all hypertension drugs in one way or another cause a loss of sexual appetite? Helen Singer Kaplan Yes, they all can Maj-Britt Rosenbaum at one time, in one way or another individually became a switch around drugs that may in one man cause erectile problems, another not Harold Lief one day, we have to see a level of changing drugs is that even though you switch drugs, the there may be a psychogenic reaction to the old pharmacological effect. And so the man doesn't always get better. Once the drug is switched, hasn't been taken into account, Helen Singer Kaplan you're completely right. And what I've been doing is when patients and working with the internist, with a cardiologist, we don't know if a certain drug is making them impotent, or if it's a placebo, what I now do is test all my give my patients that sleep test with the drugs and without the drugs. And unless there's a definite improvement, it wasn't the drug. You don't have to guess because people get so obsessed about their drugs. That's been one of the nicest use, I suppose we Maj-Britt Rosenbaum say the sleep test, I think maybe we should mention that it's a rather cumbersome test, and it's not at home David Susskind Explain that. What do you do? Helen Singer Kaplan Patient comes to the office and a male technician or a male doctor in my group I had a group of people do this work shows him how to put on little strain gauges. And then he gets something that looks like a bowling bag. And it's got a machine in it and he takes it home and attaches it for two nights or three nights, depending if I'm testing with it with that drug. And he comes back and I read that record like an EKG. Harold Lief Are you satisfied with that? Because I have great doubts about that. Because first of all, there are so many artifacts associated with it. Then there are medical legal questions, I don't think to get get in. Because I'm this panel, but they are important. Clifford Sager Well it becomes important to for the attendant to observe the read through Helen Singer Kaplan No, it isn't really not the way it's used. Because most people are positive. They say they don't think they have a reaction. Then you sit with them, but said look, that is so therapeutic. I don't use it as a fine David Susskind Wait a minute, I'm lost. You sit with the patient and put the thing on Helen Singer Kaplan after the record comes back. David Susskind Yes, after he comes back. Helen Singer Kaplan you and your wife come to me and he says I can't possibly haveerections anymore. And like I said, Look, you had this big erection at four o'clock this morning. You had enough that has such a good psychological effect, that that's how it is used or he comes in obsessing about his medicines is finished. And you show him that the medicine didn't stop the erection that faces them with reality. It's it's not the same as an absolute experimental use. Harold Lief Well, I'm not sure, but that we may have some disagreement. I'm inclined to agree with Cliff that direct observation is necessary to make sure that the record is correct. Maj-Britt Rosenbaum I often find myself recommending a very simple and cheap way of doing it. I mean, asking the why for a partner to observe them instead of going through the cumbersome Yeah. This is a real concern to them, they can spend it doesn't take that long. I mean, if you had few hours, or especially early morning observation, Clifford Sager actually, Fisher efficient way of Charles Fisher Sinai, who was a pioneer in these, this type of study, also devised a very simple method of folding over a few postage stamps. As a gross test Helen Singer Kaplan Too gross because you turn around and bed Clifford Sager that's another simplification process, David Susskind How do you test women? Helen Singer Kaplan well, that's a different issue. You were starting to mention it if if you start if you have the patient, do a masturbation with the device on and then compare. If it's better than masturbation, that is good, we'll get Harold Lief There are, there's the woman lubricates during sleep. The trouble is that our technology hasn't caught up with this yet. I mean, there are a plethora demographic devices, and thermocouples things that will measure the increase in temperature, the increase in blood flow during sleep, but they are not only special laboratories have that it's not in wide use. And I think maybe one day it will be so we can have the same kind of measure of the female that we have of a male Clifford Sager Or if sufficient studies were done on this at Sinai again, to indicate that the same thing precisely happened with women's happens with men with REM sleep is an increase in blood flow. It's lubrication, which is similar to the erection and a male, which takes place same number of times during the night. Maj-Britt Rosenbaum But I think it's also important to keep in mind that male and female sexual problems are very different. Yeah, erection is a much more specialized the physiological function then the lubrication, swelling in women, and we much more rarely will see that face interfered with and women women's problems are different David Susskind what would be the female equivalent of failure to have an erection? Maj-Britt Rosenbaum there is no clear cut equivalent clinically, I mean, it would be a woman who has good sexual desire, but then does not have the swelling and the lubrication. You may have sort of the organic equivalency after menopause in some women when the hormones drop and there is less lubrication because of organic causes, but it's not quite the same and more easily corrected with hormone therapy or creams or vaginal lubrication Harold Lief Isn't it true that a woman will come in complaining of lack of orgasm rather than a train. Rather than saying I don't get turned on during sexual stimulation. So the chief complaint may be different. Although her physiologically she may be going through a similar process to the male. Helen Singer Kaplan for women, the most important medical test other hormones, because many women come in after hysterectomy after menopause, and they say I've lost my sex drive. And we've always assumed this was completely psychological. But we've been doing some hormone studies and we now find that some women don't have enough testosterone, which is a hormone they need in very tiny amounts to feel sexy. And we've been giving some of that hormone and little amounts so it doesn't masculinized woman with excellent results. David Susskind And when a woman comes in and complains of lack of satisfaction, orgasm. How do you deal with that? Why isn't she having orgasm? Maj-Britt Rosenbaum For many reasons, if there was one David Susskind premature withdrawal. Maj-Britt Rosenbaum Women can usually be divided roughly into groups women who have never had the experience of orgasm, which has a lot to do with biological experiential learning she may never David Susskind How large of a group is that? Maj-Britt Rosenbaum It depends on the age group. I mean, most young men will have the experience of orgasm during their adolescent years, many young women will not Helen Singer Kaplan About 10% Maj-Britt Rosenbaum women but even higher in the 20s 18 years 20 or 20, before they've had enough experience with their own bodies, again, it takes longer for women to have their bodies respond sexually, at this sort of label all the sensations because it's vaguer and just takes a longer time for her body to start forming the experience Clifford Sager with cultural their culture cultural variations are very important. When I first started practice, and having read Kinsey Kinsey 1938 39, in their published the fact that women are most orgastic at the age of 38, after having had two children and young women at the time were relatively non orgastic compared to where they are today. Evidently, a sex education change and cultural social mores, has made a big difference women had been liberated, so that now a much higher percentage of women are able to enjoy orgasm then did their counterparts a generation or two ago, David Susskind enjoy it and at an earlier age Clifford Sager and at an erlier age Harold Lief they expect to their expectations are important Clifford Sager Expect it and they want it David Susskind Oh, that's the murder spot. We'll go back the moment we come back |
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INTERVIEW CONTINUES:
David Susskind Dr. Kaplan, Helen Singer Kaplan I want to go back to that very important question. You asked David about what causes How come women don't have orgasms. And it ranges from just not getting enough stimulation from the partner to being furious with the partner to having deep problems and to just being too guilty about really letting go. And I'm sure there many other causes. The important thing when when when a woman's consults a doctor is that they don't assume well, it's always the same thing. It's always daddy or mother or whatever. You have to really talk to each woman herself and find out what it is, before you can have a cure. And most women can learn to have orgasms. It's very rare. That is a very rare thing isn't David Susskind Is it any longer true that the majority of men fail to prepare their women with a pre love. foreplay Clifford Sager But today we can avoid vice versa. David Susskind And also that they failed men. I think this is an old wives tale today that they fail to know the parts within her that will respond most excitedly. Helen Singer Kaplan Well, I would put it that the young woman it is her responsibility to let the partner know what she needs. Men have this nice erection so we can always tell if they're responding. Women don't. It's up to the young woman and say young woman because it's easier to to, I should say all women I shouldn't say young woman that was wrong. A woman's responsibility is to let her partner gently not like a traffic cop, but gently know what she needs to feel good. It's not the man's sole responsibility. Maj-Britt Rosenbaum But it's also not an old wives tale or a myth that women as well as men had their David Susskind Do you find that most men today know about the clitoris and vaginal orgasm Maj-Britt Rosenbaum It's so hard to say most men but there is an enormous amount of ignorance in terms of anatomy and where, they may know that there is a clitoris but where is Clifford Sager And where to find it David Susskind Well It's very hard to find the thing Harold Lief Well we see that in our offices. And we don't know what percentage of the general population This is. What we certainly see clinically is a tremendous amount of ignorance. So the sex illogical examination is one way of getting around that that's a logical Yes. Well, there are a lot of clinics that do that. And that is to have an examination. Let's say we're talking about the woman with a husband present, and the doctor's physical examination and the doctor will point out the various parts of the anatomy and and the woman looks at herself holding a hand mirror so she can identify the parts of her own anatomy. David Susskind You got much action for this kind of test. Clifford Sager Oh, it's not a great many people who do this. Some of us though prefer to give them a book or a diagram. Give them a reference and have them go home and do it together and make their discoveries together. Maj-Britt Rosenbaum And especially women and to young women, but also older women who don't know their own adult anatomy will ask them to just take a little mirror and show them Want to diagram and go home and check? Helen Singer Kaplan physical examinations on women Maj-Britt Rosenbaum We encourage women as well as men to go home and David Susskind on a scale of one to 100. What percent of women are there? Because they fail to have orgasm, ones that are in trouble, is it? I don't have orgasm and something's wrong. I missed it. I needed Helen Singer Kaplan what percentage of our patients come in with your female? I would say 30% Come in with that problem is that your experience, I would say 30 Maj-Britt Rosenbaum female patients Harold Lief little bit higher. Maj-Britt Rosenbaum I would say 50, 50 desire and orgasm because they often go together. It's very hard to Harold Lief actually I would put desire a little higher than orgasm. Overlap. David Susskind It's hard when they come to you about desire. You mean the absence of desire, Helen Singer Kaplan I don't want to on a version, I don't want him to touch me. I love him. He's a good person that I can't stand it when he touches me. And so David Susskind How far out in the marriage, he's telling you this Helen Singer Kaplan sometimes right at the honeymoon and sometimes 20 years later, David Susskind Right at the honeymoon? Clifford Sager or before the honeymoon today.I love her, I want to get married but Harold Lief And one of the most startling things that all of us have seen as a change in the passion before marriage and after marriage. And sometimes it's like you just cut off a switch, you turn to force it, the passion is going either from the man or the woman. And that's a very startling phenomenon. David Susskind Why? Harold Lief Well, number of different reasons. The man often has what we call the Madonna prostitute complex. He unconsciously divides women in the two classes, the angels in the whores. And as soon as he's married, symbolically, his wife turns into the angel, and he cannot have sex with her anymore. That's him. As a matter of fact, Freud call that the most prevalent form of degradation of erotic life. That was his phrase, and the title of one of his early papers. It was extraordinarily prevalent. Clifford Sager One of my studies that I found very interesting finding in the study of remarriage, people who were remarried, that had been married previously to somebody else. In their first marriage, very often, sex went down very fast after marriage. In their second marriage, though, at a stood up very well, both for the man and a woman appreciably better there is some going down. But whether it has to do with the fact these people are older, they know better what they want, they have more experience. They're trying harder in their second marriage, perhaps than they had before. Maybe they made better choices, is 5% do make better choices. David Susskind In terms of what Dr. Leif told us. Is it possible that before marriage, he's got her. So Madonna? Because she's an angel, she's just heavenly. And so he's going to marry her and commit this glorious person forever to himself. And then afterwards, she isn't sufficiently whorish for his bedroom for his hopes Harold Lief Well there are a lot of variations on this whole plan. But most of the time, there's no inhibition of passion before marriage, and that occurs after marriage. So the marriage has some metaphoric meanings. Clifford Sager How am I and I find that the Madonna complex begins more often after the first child, that she has a child then it really comes into this Maj-Britt Rosenbaum mother, and then it's very hard to have sex with mothers and sisters Harold Lief But I have seen it occur on the night when their engagement was announced, was an anticipatory kind of Clifford Sager that's an anxiety. Helen Singer Kaplan I think at various points of intimacy, the inhibition and commitment the inhibition or start setting in different people have different commitment comfort zones. Some people if the fella asked him for the woman once a weekend with them start becoming turned off and avoid sex. For other people. The commitment comfort zone is exceeded on the engagement as the honeymoon or living together. So it's a real terror. It's an emotional claustrophobia Harold Lief This can happen to the female too. I remember a case that the psychoanalytic clinic at Columbia years ago is not my case, but it was a fascinating one, this young woman was completely non orgasmic and lost all desire for sex right after marriage. So after about 10 or 11 months of this, they decided to separate but they still will fond of each other so they went to bed that night, and for the first time she has she got turned on was orgasmic. That wasn't an indication of what we've been talking about. David Susskind Talking about both subjects, dysfunction and the lack of desire on the part of the woman. She's in other words frigid. He doesn't Helen Singer Kaplan Yeah, we don't use that term more because it's not accurate. Well, these women can be warm and capable of love, but they have a an aversion or a phobia. Like it's like an elevator. frigidity means that a woman doesn't like man hostile to men is cold men, some of these a warm women David Susskind Do you advise such women to find stimulation by themselves? Masturbation? Helen Singer Kaplan It depends on each particular case. These are very sad women sometimes because they go from man to man. They're always lonely. They're either infatuated with someone or turned off to the underlying problem, they are doomed to a life of never being happy. So I think just the idea of a quick solution. These are the cases we can't find such very big, quick, we can help these patients but not by any quick mechanics, which is Maj-Britt Rosenbaum the really, really relationship problem. But you're asking do we ever encourage women to stimulate themselves? Very sure. So because I think one of the the main ingredients in having a good sexual relationship is being able to experience pleasure in your own body. And it's often a first step with women who are not in touch with their sexual self, would you bet you we will encourage self pleasuring and self stimulatory David Susskind Would you recommend vibrators? Maj-Britt Rosenbaum occasionally, if all else fails, but we tend to have them use their hands, their their bodies, their partner's bodies before them, because vibrators will guarantee an orgasm in most women, and it may bypass some of the subtler forms of stimulation that are really necessary for a partner relationship. But we certainly will use them and they Harold Lief may ask you a question, what's your experience in doing in suggesting and recommending this with women with women who have a previous history of masturbation but have never achieved orgasm? versus those who have never masturbated? Before? What difference does that make? Maj-Britt Rosenbaum I guess my tendency is to always recommend it in one form or another for women who've never had an orgasm. women who've achieved orgasm. Harold Lief No, I mean, those who have not masturbated versus those who have but neither group had achieved orgasm. Maj-Britt Rosenbaum I would use it for both of them with us, you seem to have a I'm just curious. You I just find it a very kind of soothing and experientially powerful way of getting in touch with one's body and sexuality loss which which is the way masturbating to orgasm feeling comfortable with your hand with your hand preferably Clifford Sager with a hand or sometimes with a shower or shower five, pulsating shower. showerhead, Maj-Britt Rosenbaum showerhead, mainly the hand is specially useful mainly be thoughts that always have you always have it with with you. And also, it makes it easier for you to be able to then communicate to your partner, what kind of stimulation how where, to what degree, because it's very hard to ask women, why don't you tell your partner what she wants, if she has no idea? Helen Singer Kaplan Well, many, many women to underscore what Maj-Britt is saying many women with sexual problem had mothers who didn't discourage them who were competitive for daddy's attention who were not encouraging in the area of sexuality, especially with a female therapist telling a woman therapist, I want you to have pleasure. It's okay. I like it to have a man it makes me happy. If you do well sexually. That's very powerful. You will love the phrase you use the experiential experience and that can be so moving. That is almost more important than the actual physical response, the encouragement from a caring person know when to stamp. Clifford Sager It has a real it has a releasing effect upon the woman and her inhibition. David Susskind We'll come right back after this pause |
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David Susskind we're on the subject to women and you're recommending masturbation when other methods seem to be Maj-Britt Rosenbaum even when other methods but as one very significant and powerful way of getting in touch with your sexuality. Clifford Sager Let me say something. I think the masturbation is very important. But there were groups of women who would meet with another woman and who would learn to masturbate and so on. But they found When their husbands were not involved in that, a high percentage of these women later on, were not able to translate this over to their relationship with their husband. So that now today very early on, if not from the beginning, that it's becomes important to involve the spouse, with with a woman in this procedure. So that the woman then can help her husband and vice versa to translate this over into their relationship. But it's very important for the woman to be able to know that she can masturbate, give herself pleasure. As the man has learned a long time ago, David Susskind I was wondering if in place of masturbation, oral sex on the part of the husband could be used to do the role of masturbation, Helen Singer Kaplan oral sex, and women who are very open sexually is a very desired method of stimulation. But if a woman is so inhibited, she doesn't know what it takes to have an orgasm, it's probably pretty unlikely that the first orgasm she'll have will be with oral sex, it's pretty unlikely. It's also pretty unlikely that the first orgasm she'll have would be with intercourse. So there's a certain sexual development and many people feel that self stimulation is part of that what? Harold Lief Yeah, I would see where the concept of the sexual body I think is important that we grow up. And if there's a reasonable amount of affection from the people who take care of us as infants, somatosensory experience, if there is a lot of that, then people become comfortable with their bodies. They don't have all these hangups, they'll experience masturbation and sex play. And in those societies where this is been is done, not only are they less inhibited sexually, but there's far less violence in those sites that may be a topic for another paneDavid David Susskind Volume 2. Next year Helen Singer Kaplan When you touch and kiss a baby is likely to have be less angry and have more sex. David Susskind Don't you think that men are far less tolerant of a woman's sexual difficulties, then the women are tied to them? Helen Singer Kaplan That's a good question. Can we I need to say one thing about masturbation, oral sex, some of the things that have been mentioned, because when treating a couple you have to be very sensitive to their values. For some couples, masturbation is a religious is forbidden. So you don't use masturbation with those couples, there are other techniques, you don't have to use self stimulation, all sex, as I said, it's a wonderful sexual experience for men and for women. And it becomes more important for the man as a man ages, it's an easier to easier way to be stimulated than the vagina for a man. So it's a very useful, wonderful thing. But if it's against the people's feelings, you don't use that there are many ways to have good sex. And there isn't any cookbook. Wait, do sex therapy? Yeah, we treat many orthodox religious Jews and devout Christians. We can't use masturbation or we're spilling seed oral sex with those couples, and you can still help them a great deal. I know, Maj-Britt Rosenbaum you. I'm sorry, sitting here, when we listening to our conversation a little bit then feeling a bit uneasy. Yeah, our focus on the genitals? Yeah, sure. Because I think most of us increasingly so um, you spend a few years in this business and realize that most of the difficulties and the problems are very much embedded in the relationship in the relationship between a couple and in the relationship the woman or man has with their own bodies and previous sense of self. And we're talking about free body. So I think we should maybe mention some of that, really talking about that and Harold Lief It's crucial to emphasize that Maj-Britt. We have to say that Masters and Johnson that was one of their contributions, because they focused on the couple and took it away from the individual where their primary focus in therapy previously had been on the individual. Now the focus was on the couple. And the relationship is a key element in the treatment of all sexual dysfunction. Clifford Sager Also, it's a no fault situation. It's not his fault. It's not how they have Helen Singer Kaplan before they did that when we were all practicing analysis. I don't know if you're an analyst and you've studied individual psychiatry. It was a no no, to have the partner and you could have a man lying on your couch telling You had an impotence problem. And you didn't know if he was married to Marilyn Monroe, or to a 900 pound gorilla, you are not allowed to see the other partner. So you were just treating in isolation and Masters and Johnson defined the couple as the patient, you can go a little too far with that, because there are some people who are so damaged, they would have sexual difficulties with even the most caring the most sensitive partner and I don't want people listening to get a guilt trip and to always think it must be the fault of the relationship. Some people would have troubles with anyone. But the majority of people could function under some conditions and we try to help a couple structure those conditions. David Susskind Why is it I asked you experts, why is it the the marriage relationship, the physical sexual aspect is, in fact that downhill experience as the years go by? Maj-Britt Rosenbaum You may say that, for frequency, genital sexuality, maybe intercourse, sexuality goes down and I think statistics, Helen Singer Kaplan Frequency may go down but not quality necessary. Quality often goes up David Susskind but wait a minute. Now. The very factor of predictability, a couple will make love a particular kind of way. And for the fact of its predictability, as the years go by, it must by definition. Helen Singer Kaplan Now, David, if the opposite may sometimes happen, because she knows so well, what he needs the him to have that erection enjoyed. She knows his fantasy, she's so familiar with his needs, and he with hers, it can work a lot better. David Susskind Helen can work Harold Lief There is some data to support the importance of novelty and sexual excitement, and it goes through all species, not only human, animal, but all animals. The whole animal kingdom novelty is extraordinarily important. And we studied couples who have been married for 25 years or longer, and compare them with couples who had been married for two years or less. There's no question that the recently remarried couples had far more frequent sex. It doesn't mean that what Helen says is inaccurate. Sometimes the quality remains great, maybe improve over the years. But there is there is something to be said about novelty and human experience, then I also Clifford Sager doubt that there is something to be said for it does make a difference. However, for those people who want to keep their relationship together and not involve anybody else, then we have to develop this type of help them develop this type of novelty in relation, David Susskind I want to come to novelty. Helen Singer Kaplan I've been studying couples who have been married for 25 years or more, very few, unfortunately, because of Crusher, right? Very frequently, it becomes boring. But there are a few couples who still are each other sexual fantasy. They're 80 years old and 75 years old, they still are romantic. It's very rare. And by studying these couples, we can develop techniques. David Susskind They are blessed. We'll be right back. |
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David Susskind Doctor you were saying that There's something to the theory that different mates stimulate better than one mate Harold Lief Yes, I think David Susskind monkeys Harold Lief A lot of I don't want to go into all the animal experimentation. But the monkey one, monkey one. Yeah. Well, it's true that, that there's no question about the difference in potency, when they bring in a strange potential mate into a monkey colony. And so that the novelty is important, but there must be it must be dozens of experiments of this sort with a variety of species to show the ones Yeah. Yeah, show the show the influence of novelty. David Susskind Is there truth to the assertion and I wish I could cite chapter and verse I can that a man could make enthusiastic love for three people in the space of 24 hours, and he would have difficulty doing that with one person. Same person, Harold Lief Except if His name is Victor Hugo, three from you remember his famous clip when he was being given the honor by the French Senate at the age of 83. He said that almost as difficult to address this August assembly as it is to have sex three times and then he corrected himself no four times in the same day. Helen Singer Kaplan I, this has been such a constructive. It's such a constructive program, but I it not everyone can make love to three different women within 24 hours unless they're under the age of maybe 35. David Susskind We're on the issue of novelty. Yes. Yeah. Okay. Helen Singer Kaplan This novelty and there is a Clifford Sager Might want to raise that to 50 55. However women on the other hand, unlimited unlimited. Say that's now now refracted is one of the things that we men have to be envious. David Susskind I want to ask you about a thing that has puzzled men for generations. How can you tell if a woman has had an orgasm? She may, she may. She may suggest that she she may even say it. But how can we mere males tell Helen Singer Kaplan there is no man who can tell and good fake there is just no man. But there is a little trick I will give to your listeners. Pulse goes up over 120 If you have a real orgasm, but then the other. Clifford Sager The other hand, we might ask the question, why do we have to know if the woman tells us that she's satisfied? And we see other evidence of it. And she corroborate David Susskind I think males suspected for a long time that there was certain amount of fakery going on. Maj-Britt Rosenbaum That's also very important. Harold Lief you know that story about the man who the husband says to his wife is why don't you ever tell me when you have an orgasm? She says you never Helen Singer Kaplan most women, fake I don't want people listening to be guilty because most women fake because they feel a man needs that they're doing it for their partner or they're insecure and feel well, everyone else thinks so he thinks everyone has an orgasm on intercourse and I better do it or the man will feel anxious. A very insecure man becomes very obsessive about his wife's response, and it can drive a woman can ruin the beautiful ambience of loving, did you have an orgasm? Was it good? Am I okay? And some sensitive woman say it's kind of easy to make, make him think he satisfied me. That's a very bad practice over the long run. Because then the man never knows how to stimulate his wife and really gives her an orgasm Harold Lief she inhibits her own responsivity by that sim simulator, David Susskind I'll tell the men I know to take the pulse. Harold Lief Although there might there is recent evidence that there is that there is vaginal sensitivity and that percentage of women so it isn't only the clitoris, and even the uterus may be involved in an orgasm. Helen Singer Kaplan Oh, you can only have organ. What do you tell a husband and a wife they come in. And he's all distressed because she doesn't have orgasms. And, of course, it's such a common thing. Harold Lief I see that I see that. I see that among physicians and young physicians come in, they bring their wives in because they're not having a coal orgasm. And so you have to instruct them that this may be a perfectly natural and normal response on the part of their wives and they're not bad lovers. And you have to treat them machismo rather than the the wife. Maj-Britt Rosenbaum On the other hand, I think we are women who in midlife and later are so used to sexual intercourse and vaginal penetration is their only form of, of sexual satisfaction that they get the quite unhappy or dissatisfied if their partner loses erections or is not able to present Helen Singer Kaplan that to them in the age and to get back just just wanted to have a sense of completion. There are some women who don't have vaginal, so called vaginal orgasms, there are techniques for helping a certain percentage of those. So it isn't that you tell every couple it's impossible. We just say it may be a normal response. But we do have techniques to help people learn that in some cases, right. I mean, you do David Susskind well after clitoral orgasm. Maj-Britt Rosenbaum Stimulated as an orgasm David Susskind There's one type of after the clitoral experience Yeah. Is it then most likely that there'll be a vaginal orgasms? Helen Singer Kaplan Actually, it's interesting Some women do find it easier to have an orgasm on intercourse after they've had one before and clitoral stimulation. But not always. Every woman is different. It's sort of fun to find out what your partner's David Susskind Is every woman capable of vaginal orgasm Maj-Britt Rosenbaum no, no, no. Harold Lief I believe the majority and not Helen Singer Kaplan not every woman is capable of a clitoral induced orgasm But not all women are capable, Maj-Britt Rosenbaum since a clitoris really is the most sensitive part of the female genital anatomy to keep it in mind, it's not me it's not as if it's a sign Harold Lief to increase the complexity of this there by 15% of women who actually have orgasm without knowing it without being able to label it, because they, somehow the connections between the physiology and the brain are cut, they have learned not to deal with erotic sensations in the body, you hook them up to machines that can demonstrate the peri vaginal, pelvic contractions they are and the pulse rate and blood pressure, they are having orgasm, and yet they cannot label it as long as we did. So that is, just to show you how complex this whole process is. Clifford Sager I also raised one other question, if I may. And that is I'm seeing an increasing number of people. Now couples who come usually on a complaint of one or the other, that we have good sex. He knows how to push my buttons. I know how to push this, but we have orgasms almost all the time. But something is missing. There's something emotional between us that we don't have now. And this is beginning to emerge as a growing syndrome David Susskind is called Emotional deterioration in the relationship. Maj-Britt Rosenbaum Well, or it may never happen. Sometimes, sexual problems get blamed and sort of pinpointed as the problem in a couple or in an individual. But if we cure this, everything will be fine. And it might just be the tip of an iceberg. And it might not be the whole whole issue. And I think what we often are up against I mean, just as in your comment, our expectations. You know, what is orgasm supposed to feel like? What is a sexual relationship supposed to be like? And that's where most of our unhappiness is our David Susskind I want to thank my guests for being particularly interesting. And on the subject of great concern. We'll be right back. |
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SUSSKIND CLOSES SHOW:
David Susskind That's it for tonight. Thank you for being with us and join us again |
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