Dear Dr. Milrod:

My relationship with my spouse of 18 years hasn’t been very good for the past several years. One of our major issues, at least for me, is the nearly complete lack of sexual desire and/or ability on her part. We had intercourse one time last year and other activities occur once every 4 – 6 weeks. She hasn’t allowed me to perform oral on her for essentially 17 years, after our first child was born, although she enjoyed it prior to then. She doesn’t like to give oral, either, but will on occasion.  She had a complete hystorectamy and HRT hasn’t worked, but the frequency started decreasing well before then. I’ll admit, I finally got tired of the refusals, so I saw escorts on business trips. She doesn’t know about these activities and I have had no other encounters besides the ones with the call girls. We are considering sex therapy, but I am scared to death that the therapist is going to ask about extramarital affairs. If I mention it, the session and the marriage will end immediately. If sex therapy can help us improve our relationship, including hotter sex, that would be great. However, I am also mentally prepared to ultimately leave if it is the right thing for everyone in the family.

Mr. Skittish

Dear Mr. Skittish:

If your idea of “hotter sex” is what you’ve had with the call girls, then that will most likely be a very remote possibility with someone who has had a hysterectomy and ineffective HRT. Complete hysterectomies frequently sever innervated tissue and areas around the uterus as well – areas necessary for sufficient sexual excitation. It is possible that a different type of HRT could be administered, but somehow I don’t think that would solve the entire dilemma. In addition, your relationship with your spouse is not only compromised from a sexual standpoint. The outcome of the therapy really depends if you can work out all the other long-standing issues.

As to my own treatment modality, I usually meet with the couple jointly the first session, then once with each party separately to find out more information. At that time, I would most likely ask the client if there was someone else in his/her life, and if there was anything that this “relationship” may have done to affect the marriage in any way. There are differing schools of thought on this one: some therapists flat-out state to the client not to “tell anything to the therapist that s/he wishes to keep confidential.” This approach does not work for me, as I find it a very unempathic and punitive way to deal with a client who already is suffering from possible guilt and shame. My attitude is to be as empathic and “holding” as I possibly can. Sometimes that means “holding” a client’s confidence as well. When the client is ready and the therapeutic process has progressed sufficiently, such information usually comes from the client himself/herself, with no prompting from me. I am first and foremost a facilitator and not a judge. I don’t tell clients in therapy what to do – even if I liberally dispense advice on my blog. But in therapy, we have the luxury of delving profoundly into intrapsychic issues, face to face; most clients in my practice go very deep and can eventually come to some understanding of what has happened, without blow-by-blow accounts from either party. Finally, I wish you a good and productive therapy outcome, even though this may mean a dissolution of your long-term marriage. So many couples just stick their heads in the sand, for fear of rocking the already sinking boat. You and your wife are to be commended for trying to resolve this in an adult and responsible fashion – I hope things will go well for you, whatever the result may be.

Christine Milrod, Ph.D.