Fishing for the right answers.

I recently met a woman complaining of a long history of painful intercourse. Several years ago she finally had the courage to tell her doctor about it. The doctor responded by recommending that she go see a therapist.

The woman met with a therapist and was asked all the typical intake questions. When the therapist asked her about any abuse in her history, the woman said that she was never abused. The therapist asked if she was certain. “I’m certain”, she replied. But the therapist kept bringing it up, and they spent the next few months on a fishing expedition, trying to find a repressed memory of sexual abuse that the therapist assumed was behind the painful intercourse.

 Unfortunately I have heard this storyline many times, and it is troubling on many levels:

  1. The therapist operated on the premise that painful intercourse always has a root in sexual abuse. This is an inaccurate assumption and there are many women who have painful intercourse who haven’t had sexual trauma. Conversely, there are plenty of women who have had sexual trauma and have no sexual dysfunction.
  2.  The story reinforces the disturbing misconception that no matter how certain you are that you were never abused, there may be a repressed memory and we need to find it to “cure” you. For many women, being asked over and over if they are sure they were never abused or being told that there must be a repressed memory, can put a woman in a position where she might start suspecting innocent men from her childhood — despite no memory or any prior reason to suspect so.
  3. The ongoing mental fishing expedition implies that sexual issues are just a manifestation of emotional issues. That basically it’s all in your head.

Sometimes people will say that sexual dysfunction is just a function of stress in your life. People also say that about migraine sufferers, but would we ever tell a migraine sufferer that their headache isn’t “real” and that they shouldn’t go to a doctor? Yes, there are migraine sufferers who may find therapy helpful, but it doesn’t change the fact that it’s a physical condition that needs to be treated.  Hopefully with increased discussion around sexual dysfunction, sexual issues—and their medical components—will be better understood and “caught” in time.

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