WAlthough there is often a common belief that the world is hypersexual and everyone has a lot of sex, the reality is quite different. Some international studies found that rates of sexual activity are generally falling. One of the reasons proposed to explain this decline was reliance on pornography and Internet-based sex exploration without a partner instead of partnered activities.
Ben* came to therapy because of problems in his relationship with his girlfriend. He was 25 and his girlfriend was his first partner. They had been together for a year and had just moved into a shared house together. Ben said they struggled to communicate about sex and found it difficult to agree on sexual frequency. He admitted with some sheepishness that his girlfriend wanted sex more often than he did; he said he would be happy with sex once every two weeks.
Although there is no specific frequency that is “normal”, it was on the lower end of typical for his age. We talked in more detail about his sexual functioning and he said he preferred masturbation to sex. He found sex “boring” and often struggled to get an erection or ejaculate, and felt like he was letting his girlfriend down and “wasn’t a man”. He was very anxious about sex and began to avoid intimacy and touch altogether.
Ben said that he had been looking at pornography since the age of 11. He first came across it with an older friend and found it exciting. He started looking for pornography when he was alone and soon used pornography to masturbate. His parents were going through a divorce and were distracted with their problems; there was little supervision of his Internet use, and he began to escape to the Internet as a way to avoid the conflict at home.
By 13, he was spending a lot of time watching pornography and continued doing so until he moved in with his girlfriend. Over time, Ben started accessing more and more extreme material, such as pornography with strong violent themes. He found that he could no longer get excited with “weaker stuff”. He also got used to a very specific masturbation pattern and found it difficult to break this sexual template and enjoy the different pace of sex with a partner. Ben said he had never learned to communicate with women about sex and accepted the sexual acts he saw in pornography (eg strangulation) was desired by women. He felt uncomfortable with the idea of engaging in these acts himself, but didn’t have the vocabulary or confidence to talk to his partner about what they both wanted.
Once we identified the primary factors contributing to Ben’s sexual problems, we were able to formulate a treatment approach. Ben and I decided to use a cognitive behavioral therapy approach in our work together, with some additional techniques derived from acceptance and commitment therapy.
Our initial focus was on providing basic psychoeducation around sex, including the differences between arousal patterns in men and women, and the importance of temporarily stopping using pornography to allow oneself to build broader sexual templates. Ben found it very difficult to stop using pornography, and we explored the reasons why he used this material – identifying that it served a self-soothing function was a way for him to disengage from the stressors of the day and a way for him to feel empowered, as well as providing his primary means of sexual pleasure.
We worked to help Ben understand the triggers for pornography use (eg, feeling lonely or withdrawn), build a range of skills to help him “use the urge” to use pornography and identified it as a thought that could be tolerated and ignored instead of acted upon immediately. He had to build a series of other emotional management techniques, and he realized he was very socially anxious and hid in pornography use instead of seeking and finding other forms of sexual or non-sexual connection.
Ben and his partner began seeing a sex therapist who could work with them on sensation-focused therapy to help him break the masturbation patterns he had formed so he could find pleasure in other forms of intimate contact. They also worked on building communication skills so they could talk about sex.
Ben had to work very hard to rewire and change his sexual patterns and it took effort, time and commitment. It also meant that he had to confront the reasons why he started using pornography (mainly a difficult family life and a need for comfort) and the other problems that overuse of pornography and masturbation masked – such as his social anxiety and poor communication skills.
*All clients discussed are fictitious amalgams
Dr Ahona Guha is a clinical and forensic psychologist, trauma expert and author from Melbourne. She is the author of Reclaim: Understanding Complex Trauma and Those Who Abuse, and Life Skills for a Broken World
