Toward Sexual Wisdom After the Sexual Revolution

Another book about sex? Is there any other subject so overworked, so beaten into the ground? Does anyone need another book about sex?

"Yes," I say emphatically, and I am writing this book because I believe I have solutions for some of the most serious current problems caused by human sexuality. These solutions are relatively simple if we can get at the physical and emotional truth about sex and sexual relationships. Obviously, the problems with sexuality are nothing new. Sexual misuse and abuse have existed for centuries. However, since the onset of the "sexual revolution" in the late sixties, an ever wider variety of sexual problems has confronted us: these problems are more numerous and severe than ever before in human history.

Now, at the end of the last decade of our century, we are appalled to find that our problems are not being solved but are multiplying. In the United States today, the number of illegitimate births is increasing dramatically; sexually transmitted diseases are infecting adults, teenagers, and newborns at record levels; new diseases and new manifestations of old diseases are surfacing at an unprecedented rate; debate over abortion is more impassioned than ever; censorship by those offended by sexually graphic works is bitterly opposed by the artists; hate-filled confrontations escalate in the battle over homosexual rights; women express outrage over sexual harassment and date rape; and the divorce rate has skyrocketed.

Throughout the country, family physicians like myself are seeing, among their regular patients, ever-increasing numbers of people with sexually related problems problems not solved, but aggravated or even caused, by this sexual revolution. And beyond my office, I see deeply worrisome, frustrating cases reported in newspapers and medical journals. Even more painfully, I see them among my family and friends.

Let us consider two recent examples from my own practice. One, a young man who was concerned about a sore on his genitals, stated that he had been depressed during the few weeks prior and had sought consolation through sex. He had sexual intercourse with several women in one week, and now he was facing two of the consequences an incurable herpes infection and deepening depression.

Another patient, a thirty-five-year-old woman, complained of lower abdominal pain. Her initial evaluation was normal. We discussed the likelihood that she simply had a bladder infection that would be cured with antibiotics. Because some sexually transmitted diseases can also cause abdominal pain, we also discussed her recent history of sexual activity. She and her boyfriend had lived together for a year and were soon to be married, a circumstance which seems quite ordinary today. But then, after further discussion, she asked to be tested for sexually transmitted diseases that are usually found among those with multiple sexual partners. I was struck by her apparent distrust of this man to whom she would soon be committing herself "until death do us part."

The remarkable thing about both of these people-one an entertainer, the other an administrator is that they exemplify an extraordinary number of likable, intelligent people whom I regularly see as patients. Such people could just as well be your next door neighbors, the nice couple you met at a wedding reception, or people with whom you work. What is so disturbing is that painful consequences of sexual behaviors can and do affect such a large proportion of the population.

Recently an affable young man, who was experiencing his first outbreak of herpes, came in to confirm his diagnosis and obtain medical advice. He was noticeably distressed, and as he departed he said that while discussing his infection with his mother she had commented that it was "just a consequence of growing up in the 1990s." She is wrong in the sense that one does not "just get herpes" from breathing the air or drinking the water in this decade. No, it is specific, identifiable misconceptions or mistaken attitudes about sexuality which are so prevalent today that lead inevitably to widespread suffering. Today, these harmful consequences of sexual behavior are increasing at an alarming rate among the young, the old, the single, and the married. Most people are rightly ambivalent about what our nation has just lived through. They are afraid for their children, their relatives, and their friends in this time of sexual crisis. But through all this some of us still believe that sex can and should be the source of great pleasure and human joy.

Some of us believe that sex can bring inordinate good into people's lives. For example, as physicians we witness the tears of joy that often follow the diagnosis of pregnancy to a hopeful couple. The potential positive results of sex include the gift of new life, tender affirmation, passionate encounters, and more. To achieve these positive results, however, requires some forethought, which is what this book has been written to encourage.

The best and ultimately most healthy attitudes about sex may not come spontaneously to most of us. My own attitudes have changed dramatically since my days as an inquiring teenager and single adult. Now, as a husband, father, physician, and sex educator, I feel that I have come a long way, and I now most earnestly wish to share with others what I have learned.

In the early decades of this century, many people were dismayed with what they saw as repressive, "Victorian" attitudes toward sex. They were hoping and working for a sexual revolution that would liberate and free them from outmoded moral and social constraints. They were right that we needed a revolution, but what we now have is the wrong revolution. Mistaken ideas of the past have, in large measure, been replaced with worse ideas. Our society desperately needs a fresh approach, and that is what this book has to offer. This book is an invitation to experience sexuality on a level different from the one we have witnessed becoming the norm in our society. This book reviews the ways in which society went wrong, examines the consequences we are facing today, and explores the best means of encouraging positive, healthy attitudes about sexual relationships.

In my practice, when I encounter patients with conditions that are the result of unhealthy attitudes about sex, I can sometimes interest them a different approach. A case in point is the twenty-seven-year-old man who came in to my office for evaluation of a sexually transmitted disease. He was a handsome, seemingly rough and ready sort, who had been dating his current girlfriend for a few months. He said, "When I told my friend about my problem he told me to go to the doctor and have him fix me up"a quick cure and back out to cruise the scene. My initial impression was that it would be imprudent to attempt a serious discussion about sexuality with this apparent womanizer.

After offering my usual medical advice we wound ourselves around to a discussion of condoms, abstinence, and other issues. Somewhat to my surprise, he did not dismiss my introductory comments on these issues and the conversation rapidly advanced to some highly controversial, difficult areas. Fearing that I had overstepped a bit I became somewhat hesitant but he urged me to continue: "Just get on with it" he told me, "I want to hear what you have to say." He was more sensitive, insightful, and open-minded than I had at first assumed and was anxious to hear more. He was also aware that I hadn't much time to offer him in a busy office setting. Later, he called me from home with a few more questions, one of which was how to get a copy of the book I was writing.

In another case, as I concluded an office visit with a married couple they asked me if I could recommend a urologist to the husband for a vasectomy (sterilization procedure). I asked about their feelings toward future children and the husband eventually explained that they were having a serious conflict-he desired more children but she did not. This admission led to a discussion about a range of trouble spots they were having related to sexual intimacy. As the discussion progressed it became apparent that a vasectomy would not resolve their underlying conflict but in fact would more likely act to increase barriers between the two. The discussion left the couple with some food for thought about what constitutes a healthy sex life. Their difficulties were perhaps more basic than they had thought and would find resolution not through a procedure but by increased communication and intimacy.

A woman came into the office complaining of painful intercourse. During the course of the interview she described a rather stormy career with men. She was raising her young daughter as a single parent and had been sexually involved with her current boyfriend for the past eight months. Her initial glowing portrayal of him diminished greatly as we discussed specifics about his attitudes about sex. He had risk factors for sexually transmitted diseases (a potential cause of her current symptoms) and had demonstrated, in some circumstances, that he took more interest in his own sexual gratification than in providing her with basic levels of affection and affirmation.

We discussed what attitudes she might reasonably expect from men about sex and why she was willing to put herself at risk for once again being controlled or deserted by a man. We also discussed the risks she was taking for contracting diseases and the impact of her own attitudes toward men on her daughter. She mentioned how difficult it was for her to think through these issues, and how grateful she was for the opportunity to discuss them with a physician.

These are the kinds of conversations I believe the public needs to hear to allow individuals to choose the best course of action for themselves. But they are only one means, not the end, for which I am writing this guide for parents, young adults, educators and physicians. That end is to positively integrate the gift of sexuality into relationships so to make us most fully human, alive, and whole.