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Fifteen jaw-dropping questions for two sexologists!

The topic is often avoided and the tough questions are skimmed over. Intimacy4Us asked two of our country’s top sexologists, Elmari Mulder-Craig (also a co-worker at Intimacy4Us) and Dr Etienne Kok, to answer 15 tough questions honestly. This is what they had to say:

Question 1: What does a sexologist do?

Etienne: Even the term or title is off-putting. Literally it means a person who specializes in the knowledge of sex, or somebody who studies sex. There are people who call themselves sexologists, clinical sex therapists, sexual health physicians, sex counsellors, sexuality educators, marriage counsellors or relationship therapists.

Elmari: A sexologist is someone who has specialized in sexology or sex therapy. The aim of sex therapy is to focus on the sexual side of a relationship. Sexual problems are one of the most common sources of conflict in a relationship and are often also the reason for divorce. This is a specialized field and can help to solve problems within the marriage. I believe in a holistic, multi-professional team approach. These things work on body, soul and a spiritual level. Sex therapy and marriage counselling can’t be successfully done with only one person, and you can seldom focus only on the physiological dysfunction, seeing as there is an overflow effect. Sexual problems must be solved within a relationship context. Sex therapy combines sex education, relationship counselling and sexual exercises.

Question 2: So tell us something about yourself. Where did you study, how many years are you practising now and why did you decide to become a sexologist?

Etienne: I qualified as a medical doctor at the University of Pretoria and then decided to study psychology after-hours during my internship and conscription at 1 Military Hospital – because I knew about sicknesses, but I understood very little about the people who got sick. During my conscription I worked at the urology department. Everyone thought I was the ideal person to work with patients who have sexual problems because I studied psychology. I started to read about sexual dysfunction out of desperation and decided to specialize in urology. After a few years in the urology department at the University of Pretoria, I realized that an urologist was mostly a surgeon and that was not where my heart lay. I worked in the andrology department – where the focus is on male infertility problems and sexual dysfunction. Later I went to the Loyola Sexual Dysfunction Clinic in Chicago, USA, to get further training. I also did a course in marriage education and counselling at Unisa. I got training in hypnotherapy and am a registered psychometrist, and also a member of the International Society for Sexual Medicine (ISSM), European Society for Sexual Medicine (ESSM), International Society for the Study of Women’s Sexual Health (ISSWSH) and a peer reviewer for the Journal of Sexual Medicine (JSM). I am a lecturer in urology at the Department of Urology and for the past 23 years I’ve been a sexual health physician.

Elmari: I originally qualified as a social worker. The dynamics of relationships have always fascinated me and as I did more marriage and relationship counselling, I realized that people tended to avoid discussing sexual problems in their marriages. Research has shown that couples argue the most about money, but it is sex that creates the most problems in a marriage. Interesting, hey? Therefore I decided to specialize in sexology. I went to the Loyola Sexual Dysfunction Clinic in Chicago, USA, for further training. I then got my master’s degree with the focus on sexology and sexual problems, and specialized in psychometristry. I am also a certified, advanced, clinical hypnotherapist at The Wellness Institute in Washington, USA. I am a well-known speaker and have given input into 15 books. My professor, Hannie Stander, and I wrote a book, “The A-Z of Sex”, which is a best-seller. I also give regular contributions to magazines and daily newspapers and appear on radio and television.

Question 3: There are so many people who call themselves “sexologists”. How do you know that your sexologist is the real deal?

Etienne: Find out what their qualifications are and where they achieved it. Not everyone who calls themselves “doctor”, is medically qualified. Many sexual dysfunctions have a medical reason, and in some cases a registered nurse and physiotherapist can diagnose your body. Psychologists, social workers, theologists, counsellors and educators can, according to their training, only give information, counselling and therapy, but not diagnose or give prescriptions. Ensure that the sexologist is registered with the Health Professions Council of South Africa (HPCSA), who is there to protect the public.

Elmari: This is a very difficult question because there isn’t a society in South Africa where you can register as a sexologist, and there isn’t going to be one any time soon. A minister, doctor, gynaecologist, social worker, nurse or psychologist can study further and call themselves a sex therapist, but they do not necessarily know about all the therapeutic skills. It is also important that all the medical reasons of sexual dysfunction first get diagnosed by a medical doctor, like a gynaecologist or urologist. The best is to follow your gut. Does this therapist resonate with you and do you feel comfortable and safe there? Integrity also matters and make sure that the person is registered with a professional board. Don’t just accept and believe what the person tells you. The best is to choose someone that you can trust on the grounds of word of mouth.

Question 4: There is lately a lot of controversy in the media regarding sex, and Gretha Wiid has claimed to be the expert on where sex begins. Where does sex begin according to you? (At mutual masturbation, making out, penetration?)

Etienne: People may differ from me, but my definition of sex is the physical activity where the end aim is for one or both parties to reach an orgasm. To experience an orgasm, is to say to your partner: “I am prepared to lose control over my body for a few seconds in your presence and with your physical help.” It’s something very private and personal that is in ideal situations shared with only one other person. To say that mutual masturbation and oral sex that leads to an orgasm isn’t sex, but only foreplay, carries no logic. If only penetration sex was true sex, then more than half of women in relationships have never had real sex, because it’s impossible for them to reach an orgasm with penetration only!

Elmari: I have a problem with the word “sex” because everyone’s definition of sex is different. For me it matters where a relationship begins. When you have an emotional relationship with somebody where you feel safe and comfortable, must your physical relationship also grow as your emotional relationship grows? I see daily how people have buried their sexuality. A couple must decide for themselves what sex is for them and what they are comfortable with. I completely agree with Etienne’s opinion!

Question 5: Many young Christians struggle with sex before marriage. Sexologists often say that a relationship must develop naturally, but where does this leave a young Christian couple?

Etienne: This is where a relationship must develop naturally, also the physical. Unfortunately people get too physical in the “in love” stage, and even have sex. There is nothing as bad as when you are looking for love and acceptance and then instead get sex that is not equal to love. It is often said that couples must ensure that they are sexually compatible before they get married. A penis and a vagina are made to be compatible. A person must ensure that you are emotionally, intellectually and spiritually compatible and that doesn’t happen easily if you are already on the physical road.

Elmari: Nine out of ten couples that I see had sex before marriage and feel guilty about it. Or they suppressed it and the wedding night was a disaster. A young couple must decide for themselves where their last step on the ladder is before they step over the line. Naturally things depend on how long they have been together and how old they are. There are many Christian couples who are divorced and had sexual relationships before. Where does the “no sex before marriage” promise leave them? The respect that a couple has for each other and their commitment to each other is more important for me. There are two approaches: The rule-bound approach that says: “For me as a Christian there are rules – you may for example touch my breasts, but no further.” And there is another consequentiality approach that looks at the intentions and results of a couple’s activities. I am more inclined to agree with the second approach, but then a couple must know that they must be mature enough to follow it through.

Question 6: What do you do if only one partner is willing to go for counselling?

Etienne: Couples with sexual problems normally have relationship problems too, but also the other way around – relationship problems can also create sexual problems. It’s almost impossible to try to solve a problem like this if both parties are not willing to work on it. Even if sexual dysfunction is the result of a medical problem and should be solved with medication, a person should still make the partner part of the solution.

Elmari: Then only one person goes for counselling. Relationships force you to confront your own issues, problems and hurts. Certain things come to the surface and then counselling is necessary. You can start with yourself and then change the energy of the relationship. If you change how you handle the dynamics of the relationship, you also force your partner to change, and often it is a case of “I want what you have”.

Question 7: Some people are afraid of what to expect when they visit a sexologist. Tell us what a couple can expect and how much it will cost.

Etienne: Sex therapy doesn’t require that you get rid of your clothing, or that you have to partake in sexual activities with yourself or with each other in the presence of the sexologist, or with the sexologist! A detailed sexual history will be taken (sometimes together and sometimes apart) and it may include that very personal sexual questions can be asked. This is so that the sexologist can get to the root of the problem. All information is confidential and stays between you and the sexologist. It’s always important that the medical reason for the sexual dysfunction gets diagnosed and treated – for this reason a medical and genital investigation will be conducted in most cases. If the sexologist is not qualified to do that, the couple must be referred to a qualified person. The sexologist shall then talk to the couple and expect of them to do some homework. I work in a state hospital. A person pays a specialist consultation fee. Depending on your income and medical aid, the consultations are normally covered.

Elmari: Because I believe in a holistic approach, the first session is a complete assessment and sexual history. Couples prefer sometimes to come apart, because they feel they can talk more freely and then we decide on the follow-up sessions and what the plan of action will be. Sometimes individual therapy is better in the beginning before we can begin with marriage counselling or sex therapy. Often it’s necessary to begin with post-traumatic stress or sexual trauma therapy to heal the past hurts before the process can move forward. Therapy fees in private practises differ. My current fee is R450,00 per hour, of which medical aids usually pay a part.

Question 8: What types of questions do you come across the most often?

Etienne: People’s ignorance regarding their own sexual functioning and their partners, and the differences in how people view, approach and experience their needs and sexual drive, result in the most sexual problems. Specific sexual dysfunctions like libido with men and women, sexual pain disturbances and orgasm problems with women, premature ejaculation and erectile dysfunction with men can have medical or psychological reasons, and lead to personal and relationship problems. These I see often.

Elmari: Normal relationship problems. People can’t communicate or handle conflict effectively. Many people have unrealistic expectations of marriage and sexuality. Many people have unnecessary guilt feelings over their sexuality. There are also people who have hurts that they experienced in their childhood and they are not necessarily dramatic events. Then there are also physical problems, like women who can’t reach an orgasm and women who don’t have a sex drive (I just don’t feel like having sex), premature ejaculation, and men and women who experience pain during penetration.

Question 9: What do you believe is the one sex aid that a married couple can’t do without?

Etienne: There is no such thing! What I seriously recommend, is never to have dry sex. This makes a lubricant sometimes very necessary or a wonderful aid. A simple vibrator is also sometimes a wonderful aid for couples in cases where the woman has never before experienced an orgasm or struggles to have one.

Elmari: To allow your partner to be the best that they can be, in other words to accept them unconditionally for the person they are.

Question 10: Many people wonder and differ about sex toys. For once and for all – is it ok? What sex aids are not acceptable?

Etienne: “Normal” when it comes to sexual intimacy, is what both feel a desire for, what both enjoy and what doesn’t lead to any physical, emotional or spiritual disadvantages. Sex toys must be seen or judged in this light. Anything that causes pain or potential damage (for example infections) is not acceptable! There are many people who have a satisfying sex life and relationship without ever using toys.

Elmari: The answer lies with the intentions of the relationship. If you use a vibrator and brag to your friends that you now have a “lover”, it’s not acceptable. If you use a vibrator to spice up your sex life, then it can be wonderful. A lubricant is a compulsory aid, a feather is optional. Also a scarf, book, film, the whipped cream in the fridge . . . What is not acceptable, depends on the framework within which the sex aids are used. If both give permission and it does not lead to physical or emotional damage, it’s acceptable. It also depends on what you view as sex aid. If a man brings in a third party and claims it’s a sex aid, it’s definitely not acceptable! If it’s something that affects your integrity, the integrity of your relationship, your commitment and trust, then it’s a problem. Men often communicate their love to their wives through the sexual and women want to be touched, cherished and have a spiritual connection that you can’t get from any toys.

Question 11: What should a married Christian couple avoid?

Etienne: Things that lead to pain, being uncomfortable, irritation, frustration, unfaithfulness and feelings of being forced, misused and belittling. A third party (affair), more than one sexual partner at the same time (threesome) and the swopping of sexual partners (swinging) are red-light activities for a married couple.

Elmari: A third party, or anything that sacrifices the sacredness of your relationship.

Question 12: How do you know when it is necessary to see a sexologist? And what results can you expect?

Etienne: Don’t wait until the problem is too big or unsolvable. Sometimes giving permission, getting information, advice and medical treatment can cause a dramatic improvement in a sexual relationship. Poor communication and conflict that gets worse and is not resolved must also be addressed by a professional person.

Elmari: Hopefully you realize early enough that there is a problem. Naturally also when there is a sexual dysfunction, when you argue about sex, when your needs differ or when sex becomes boring for you. Results depend on how open you are to change and how prepared you are to work. It’s sometimes necessary for a therapist to look into the relationship from the outside.

Question 13: What is the most important thing that men and women should know about oral sex?

Etienne: It’s not for everyone, and there’s not necessarily something wrong with you if you don’t like to give or receive it. Don’t try to think about it or react to it on behalf of your partner. Men and women often have different views and needs regarding this and we’re not going to change each other. Hygiene is important and don’t forget that sexually transmitted diseases are also spread in this manner.

Elmari: Relax and enjoy!

Question 14: What’s normal in a marriage? Should everyone have sex twice a month on the kitchen table?

Etienne: Normal is not what people see in films, DVDs and on television. It’s even less than what you see in pornography. Sex is a small, but important part of what two people share in a marriage. Today there is too much emphasis on making sex, where you need places, areas, techniques, positions and sex toys or aids and too little emphasis on making love, where you need only two people that are still breathing!

Elmari: To open the door and say: “Cake or tart?” No. Dance around a broomstick? No. Many people read advice and tips and wonder if they are normal, but you must ask yourself: Is it necessary that I climb out of my own comfort shoes and widen my horizons? Is there something that is making me feel uncomfortable? What is normal? Normal is what is normal for you! If you are both happy to have sex once a month, that’s normal. If one wants sex once a month and the other once a day, then you have a problem (and it doesn’t mean that one or both of you is normal!). Gather information if you need inspiration, but don’t think that everything is supposed to work for everyone.

Question 15: Please give five small changes that a married couple can do to bring a huge positive change.

Etienne: 1. Communicate more and better. Make sure that your partner hears and understands what you are saying. Make time to talk to each other about your sex life. Talk about your needs, preferences and things you don’t like.

2. Don’t try to change each other, it’s not possible. You will just start to resent your partner, get frustrated, ruin them, wound them and in the end destroy them.

3. Handle conflict that is necessary, natural and unavoidable in a mature way. Learn to make compromises.

4. Don’t make sex a weapon, negotiating tool, glue, problem solver, comforter or stress releaser. This is not the aim of sex in a relationship.

5. Have less sex and love each other more!

Elmari: 1. Know yourself and be comfortable with your body and your God-given sexuality. Be a healthy person inside, emotionally and physically.

2. Do something small that’s special for each other every day. Make quality time for each other where you give attention only to each other, without children or cell phones.

3. Learn to communicate effectively, to listen and to handle conflict. Get to know each other’s needs and make your spouse your top priority, without sacrificing yourself in the process.

4. Go away alone at least twice a year, just the two of you, because the energy between the two of you is different to when the children are with you or even when you are with other people.

5. Forget sometimes of the aim of sex and focus more on the sexuality.