LiveWorld Transcripts

HBO presents

Dr. Perelman
Sex and the City-Shrink Talk

September 13, 2000

Dr. Perelman answers your questions about HBO's hit show "Sex and the City" as well as sex, relationships, and dating.

Page 1 of 2

HBO: Welcome to Shrink Talk! Did this week's episode bring up some familiar issues for you? Dr. Perelman is live, ready to field your questions about relationships, sex and dating.

Dr. Perelman: Welcome everyone. I just want to remind our audience that this Web cast is for purposes of education and information and entertainment only.

PrinceOfCharms: Would it be a good idea for a couple that been together for a long time to sort of date, to bring the passion back? If not why?

Dr. Perelman: I'm not exactly sure. I'm not exactly sure what is meant by the question but let me use it as an opportunity to make the point that the more we treat our spouses or significant others as valued companions and not take them for granted, the better the relationship would be. There is a tendency, when dating, to put your best foot forward. While often people mistakenly feel that they can behave any way they feel with their long-term partner. This invariably leads to disappointment, hurt and frustration. While it is, of course, important to feel comfortable in being yourself with your partner, this does not translate into doing whatever you want, whenever you want or saying the first thing that comes into your mind without a thought as to its impact on the other person. There's no doubt that for any of you in long term relationships if you would treat your lover as a very desirable, hot date for next Saturday night, you are much more likely to have a terrific evening.

Elshya: Do you think it is possible that Trey is gay, and that's why he isn't particularly interested in sex with Charlotte?

Dr. Perelman: It's a very interesting question and while I think it is unlikely that he is gay, it would, of course, make for interesting television. To assess someone's sexual orientation, we would need to be aware of Trey's current and past sexual fantasies as well as his behavior sexually. What we do know, is that he currently has been unable to obtain and maintain an erection with Charlotte adequate for intercourse so they may consummate their marriage. This in no way is an indication that his sexual orientation is homosexual. However, it is one of the most common fears of female partners in my office when their husbands manifest such difficulty with erection. We will have to stay tuned to see what happens next.

Joan: Charlotte says she didn't have sex with Trey on their honeymoon. Is that unusual?

Dr. Perelman: It's typical for most couples to have some sort of sexual experience on their honeymoon, while the quality of sex experiences varies considerably. Of course, they did attempt sexual experiences--twice, we are told. But he was unable to consummate the act. At this point, Charlotte is understandably concerned but I remain quite optimistic that Trey can be restored to sexual health.

Joan: Charlotte figured out that Trey's erectile problem isn't physical. Was her technique valid? And if so, what is Trey's problem?

Dr. Perelman: It's an excellent question and in part, reflects my optimism for Trey's eventual sexual success. Like many questions asked of a psychologist, the answer is not necessarily so black and white. First, was the technique valid? The answer is yes and no. What we learned from this "stamp test" is that he was able to break the ring of stamps. This indeed does rule out certain kinds of potential medical/physical problems but others still remain unexplored. There are more sophisticated means to measure nocturnal penile tumescence (NPT), which is the technical name for the multiple erections a "normal man" experiences during sleep. Sleep research has shown that men have multiple erectile episodes of many minutes duration while they sleep and that it is highly associated with REM or dream states. By the way, studies have shown that this is the case regardless of the dream content. In other words, very frequently the dreams are not sexual in nature. So over 20 years ago, this information became available and was used with a variety of different tests to try and help distinguish organic from psychogenic impotence under the theory that if you could get it up while you were sleeping and couldn't when you needed to, then the problem was probably psychogenic. This is frequently true, but other causes can result in a similar affect and also need to be ruled out. So many years ago, a "stamp test" was developed and used first in Denver, I believe, to establish causation. Just like Charlotte did. However, what we learn is Trey probably had an erection but we don't know how rigid it was or how long the erectile episode lasted. Rigidity and duration would be important information to have in evaluating whether or not an organic cause is present. Now, of course, none of this tells us, getting back to the question, why he isn't particularly interested in sex with Charlotte. I think for the first reason he is not interested in sex with Charlotte is a very simple one. Who wants to do what they don't do well and he is certainly having a problem here. As we discussed previously, there could be many reasons, both superficial and deep psychologically for him having difficulty having a successful intercourse experience with Charlotte. Sex therapists are like sex detectives. We'd want to get a lot more details. I would want to know in some way that is pleasing to him. Many men and women erroneously presume that erections should be automatic and available on demand. Often, they are not. Now, he is young enough that it would not be the least bit surprising if he was to have a spontaneous erection, if not more than one in his lovemaking with Charlotte. Yet it is equally common to need direct stimulation or friction if you will, to produce the desired response. We also need to know what he is thinking about if we are to evaluate him. I would want to know if he were in my office (and I'd probably want to see him alone initially for a consultation) whether or not he was worried about failure and focused upon that rather than her beauty and desirability. Remember, on her wedding night, he acknowledged that this problem had happened before. Under such circumstances, men tend to worry very much as to whether they will have the problem again. Next, it would be very important to find out some information about his current and past masturbation history. Idiosyncratic and hidden masturbation is a common under acknowledged cause of sexual problems. Having said all this, I do remain optimistic for them as at this point in time a combination of sex therapy and pharmaceutical approaches is able to help most men to restored sexual function and health, if not passion. If I haven't bored all of you with the details of this area of profound interest to me clinically, let's take another question.

Page 1 of 2