"Sex and the City" Shrink Talk

HBO presents

June 21, 2000

"Sex and the City" presents Dr. Michael Perelman who discusses, in an online interview, issues concerning sex, relationships, and dating.

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HBO: Welcome to the Sex and the City Online Group Therapy chat! Did this week's episode bring up some familiar "issues" for you? Dr. Michael Perelman is live, ready to field your questions about relationships, sex and dating. First, we do have to remind everyone that this Web cast is NOT therapy, and is broadcast only for purposes of education and entertainment.

Fluffy: I believe that my boyfriend is falling out of love with me. Should I leave him?

Dr. Perelman: Why do you think he's falling out of love?

Ms Massochist: A guy says he has low self-esteem, and that sometimes he is a workaholic to avoid dealing with his feeling of inadequacy. What message should I be receiving?

Dr. Perelman: Well, he may be telling you the truth about himself, but there are other messages as well. There may be some truth in what he's telling you directly. But both being a workaholic as a way of avoiding other issues, and entanglements in life, may be a way of distancing himself from this particular relationship, or it might be a coping style in general. The best advice one could give in a situation like this is to ask him about it. Ask him if it's something that he'd like some assistance with, and ask him more specifically to do things that you would like to do together with him, as a way of spending time together. See if he is willing to put aside his work for you. Anyone in a situation like this, most importantly, first needs to think of their own needs. Are you getting what you want from the relationship? If you ask for what you want directly, are you more inclined to get it, or is he too busy to even talk?

Blueshound: Why do men crave oral stimulation? Is it about power?

Dr. Perelman: It's not just men who enjoy oral stimulation, both the giving and receiving. The statistics on that type of preference are fairly equivalent between men and women. Certainly for some men oral sex fulfills a type of fantasy, which may be related to power issues. But mostly, of the men and women who are comfortable with oral sex, which, while many people, is by no means everyone, they like it because it feels good. Certainly for many women, direct stimulation to the clitoris is the most reliable way of reaching orgasm. Oral sex is merely one of a number of ways of doing just that. It's worth reminding everyone that oral sex still needs to be practiced safely, as the risk of STD or disease transmission remains there as well.

Erocative: Is it normal for a woman to lose interest in sex in a long-term relationship?

Dr. Perelman: I don't think it's any more normal for women than it is for men from a statistical point of view. But there are a number of reasons why people experience reduced desire over time. Some of them have nothing to do with the relationship itself. While other causes can definitely be related to both emotional issues within the relationship, as well as problems with technique. In terms of people in long-term relationships, men and women fight at a very high frequency about sex, in-laws, kids, money and religion, not necessarily in that order. However, conflict over any of these issues can result in avoidance of sexual activity. However, as I said before, it's not always something specific to the particular relationship. For instance, depression is one of the most common causes of diminished desire in both men and women. 70 percent of individuals suffering from depression report some kind of sexual difficulty. In addition, the very medications that treat depression can also cause sexual difficulty. SSRIs, the most commonly prescribed anti-depressant, are notorious for causing delay and diminishment in orgasmic response. And who wants to do what we don't feel we're doing well? There are solutions for these problems, which should be brought to the attention of a physician who's prescribing the medication. Along these lines, other pharmaceuticals such as high blood pressure medication can also cause sexual difficulty. Again, this is something that should be discussed with your doctor. Finally, a more common situation from many peoples' point of view, are changes that take place as you get to know your partner physically over a period of years. For some people, the disparity between the reality of these changes and an idealized image of a sexual partner can be very distressing, and cause sexual avoidance. Yet, we can all be optimistic because our movies, books, and medical texts are filled with stories where love helps maintain sex by transcending these physical problems. And, very last, probably the most common cause of sexual dysfunction in the United States is fatigue. Sometimes we really are just too tired, and we all have to learn, within the framework of a relationship, how to make time for fun, how to make time for pleasure, how to make time to make love. If you feel that's not something you want to do, or your partner is not in the mood at a highly different rate than you are, then it's a good idea to seek some professional help.

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