I remember a female patient who came to our clinic because she was having difficulty achieving orgasm. She was an attractive 32-year-old who worked as a health care professional. Early in our initial interview, the patient reported that she routinely had unprotected sex with men she met on the Internet. Her behavior was similar each time: she would meet the potential partner at a restaurant, have dinner and consume large quantities of alcohol, and then return with the man to his apartment where she would usually have unprotected sex. Her lifestyle was not the problem, she said. She actually enjoyed these isolated liaisons. What distressed her was that she only rarely achieved an orgasm.
She broke down in tears when confronted with the dangerous and self-demeaning nature of her lifestyle, along with evidence that she was becoming an alcoholic. She revealed that she often had periods of depression and self-hate because she felt overweight and unattractive, and that no one could love her. She enjoyed rough sex with her lovers because she felt she deserved to be punished. It was during these episodes that she felt most free from her depression and feelings of self-loathing. This case is a clear cry for help from a health care professional who is well aware of the risks of this lifestyle.
Although she refused to admit there was anything wrong or self-destructive about her sexual behavior (she also would not commit to work with a psychotherapist) the patient was still grateful to the clinic staff. She told us she felt cared about by our staff and hopeful for the future. In theory, consenting adults are free to have sex when and with whom they choose. As she acted out her freedom, however, this young woman had exposed herself to sexually transmitted disease, unwanted pregnancy, and personal danger, as well as an alcohol addiction.
Fortunately for her, her inability to orgasm gave her an opportunity to seek help from mental health professionals. She eventually accepted a referral for psychotherapy and, while her orgasmic problem may not have been resolved, she has adopted a much healthier and safer lifestyle.