DR. RUTH'S GUIDE FOR MARRIED LOVERS
--By Dr. Ruth Westheimer

OPENNESS
         The openness under consideration here is between the wife & the husband. Ideally these two can turn to each other with great frankness, knowing that this partnership is where the most personal support is to be found. If you have a full heart, you can pour it out to your spouse & get love & counsel. You don't have to be on your guard with your spouse, no matter how close to the vest you must play it with the rest of the World. Isn't that what marriage is for?
         I say it is, but that you have to judge your spouse's strength when you load your troubles on his or her back. Perhaps you should keep some of your troubles to yourself when you think your spouse is carrying enough. That involves holding something back, or less than total openness. I suggest this kind of restricted or selective openness, even though I know the suggestion will horrify some readers!
         During the entire relationship, whether it lasts a week or 50 years, you don't have to reveal things that are buried for keeps unless you want to dig them up. And if you are part of a well-publicised story, you don't have to be the one who keeps retelling it. Say you are the girl who let a certain senior boy pressure you into having sex, believing he loved you & would fall ill if you were so cruel as not to go all the way, & then found out that he had bragged all over the school about it. Now a story like that may live forever, & if you think it will reach your permanent man someday, you don't want to live in fear of that day coming. But I don't think that you have to challenge your fianc with it before you marry him. What you have to do is decide what you will say & do if he ever confronts you with the story.
         A wife in that position has every right to say, "You're talking about something that happened before I met you. You had plenty of time to interrogate me about my past if you wanted to, before we got married. What happened was the most cruel thing anyone has ever done to me. It was partly my fault, but I was very young."
         Marriages take place in the real World; there has to be talk about difficult things, & disagreement occurs between any two people. So it is best to start working out disagreements from the beginning, establishing a way for doing it. Letting your feelings be known & hearing the other partner's feelings. By all means, let yourselves be known to each other. But it is wrong to make a fetish of brutal frankness, to overdo "kidding".
         Openness means above all openness to the flow of warmth & tenderness between husband & wife. While you're being open, say something sweet!
         Finding the right mixture of frank intimacy & careful tact in marital conversation takes time. The do's & don't's are different with each couple, & they change from year to year within each marriage. But be prepared for surprises. Be ready to learn that your loving spouse can flare up when you dig into a nerve, just as if you were a stranger.
         A weekly Sex Talk. I think a couple might be well advised to institute a weekly sex discussion. At each one, let each partner bring up a topic close to home in the spirit of helpfulness. This doesn't have to be the soberest business in the World; there is room for a little frivolity, playfulness, & digression. But once a week let the couple talk about factual sex between them. Establish the easy habit of bringing out special pleasures &, if any, grievances. This would go a long way toward preventing a great silence developing.

ERECTION DIFFICULTY
         Depression & erections. A man who is going through a bad time, who feels depressed, can lose his ability to have erections for awhile. That can increase his depression & make him even less likely to become erect. Then his life can change for the better, he cheers up, suddenly he notes that his sexual potency has come back to him. This can happen to him even at an advanced age.
         I am not saying, "Don't worry, my dear man, just wait around & your erections will come back like the swallows--if not this spring, perhaps when your beard has turned white." But if your erections have become undependable, you should know that they can make a comeback. And there are ways to help them.
         Of course there are males who have never had any trouble with their erections, except sometimes finding someone to share them with.
         The class of males who have the least trouble having erections are males under twenty. Erections plague them! At all hours & often in public places. But later, when they begin to replace fantasy girls with real women, they often come to know what erectile difficulties are. A rudely assertive penis can be a shrinking violet when you take it out in company.
         As for older males--between 20 & 100, say--there are very few who do not know what it is to have a suddenly uninterested penis. This can cause the beginning of panic.
         A very typical case. Here is the case of erectile problem that was so typical because more than one thing was going wrong with this couple. And the other things contributed to the man's erectile problem. They were a very conventional couple in their 30's. With all their troubles, they weren't thinking seriously of divorce. This was to the good as far as sex therapy was concerned--I can't do sex therapy as a last-ditch stand against divorce. The couple have to be agreed about wanting to stay together & be willing to try to help each other to a happier sex life. They don't have to be madly in love, but they have to be friendly enough to be mutually helpful.
         He worked too hard. His kind of business required it, & it was his ingrained habit. There was no question of his changing his line of work. They had two children, lived in a good neighbourhood & had a summer home. He was away at work up to 12 hours a day, sometimes 7 days a week. They had pretty good sex in the early years of marriage, but less of it as time passed. Resentments built up between them about various aspects of their life.
         First Things First. After I had listened for one & a half sessions to their story, I told him, in her presence, "The first thing I want you to do is to go buy yourself a basketball." That startled him! This was sex therapy? Was I going to tell him to have sex with a basketball?
         I said, "Look. Six days a week you work late. Once a week you have dinner with your family or your wife's family. You go to PTA, you serve on committees, you help with the scout troop. All that is great. You're a good husband & father, even though your job is exhausting. But what time is there for yourself? You used to play basketball. Go buy yourself a basketball & one morning or afternoon a week I absolutely want you to go shoot baskets."
         If I had told him to find himself a hobby he would have put it off. But this assignment was definite. If a ball was in his hands he would go use it. He needed something entirely his own, not for the job or the family or the community, just for him, or he would go on thinking he himself did not exist. Now, I don't tell every man with an erectile difficulty to buy a basketball!
         One problem at a time. Then I discussed their sexual problems, which were first that she had no orgasms & then that he'd had no erection for six months. "One thing at a time," I said. "First we deal with his erections. Then if you still aren't having orgasms, we'll work on that."
         The exercises. For the first week they were to have no intercourse & he was not to be made to ejaculate by any means. He was to lie back & let her pet & caress & nuzzle him from top to toe except for the genitals. And he was just to lie there & feel whatever sensations he felt & take note of them. Then he could do the same for her.
         "When you met, you wanted to touch each other," I said. "That came before sex. You have to remember those feelings, & how exciting touching was." It was also to let him react to sensuous touching with no challenge to produce an erection. This usually allows the man to have erections, the burden of producing them being gone.
         During that week they found the exercises embarrassing & they were awkward about doing them, but they stuck diligently to the task, making little jokes about it being time for homework, her turn or his to be the playground etc. The awkwardness disappeared a little at a time, & by week's end it was forgotten & he was having pretty good erections. But he feared he would not if he were ever challenged to produce them.
         The next week they did the same thing, with an interesting addition. Now, the tour of the body finished, they could--must, in fact--play gently, teasingly with each other's genitals. She was not to bring him to orgasm.
         During this period he was instructed to think only of his own pleasure when it was his turn to lie back & play the pasha, the fancier of erotic pleasure. At another time he might play the attentive lover to her, but when she was pleasuring him he was to think only of himself.
         His erections were strong & reliable during this part of the exercises, except for one night when he was exceptionally tired & fell asleep. That was not important. I took them on to the next step. I had to use my little jointed wooden dolls to explain the female-superior position to her. When he was erect she was to get into this position, straddling his loins, & guide his penis into her vagina. She was to move gently but to disengage before he ejaculated. Then she was to repeat the action & disengage again. This teasing behaviour, very arousing to the man, was to be repeated on several occasions until the time came when he wanted very much to thrust & ejaculate. Then she would permit him to do so. In this way his erectile ability & his confidence that he could enter her & continue intercourse would be restored.

PREMATURE EJACULATION
         If you are a man you have probably experienced it at some time. Premature ejaculation is coming before you want to--before you have enjoyed the encounter, leaving you frustrated.
         The Exercises. For two weeks the couple will abstain from intercourse. The husband is to take it easy for awhile. Flat on his back, letting her play with his penis, thinking of nothing but the sensations in his groin.
         First he has to have an erection, which they can obtain by any means they prefer. Then he is to lie back with eyes closed & let her stimulate him manually. Now, she may know how to do that or not. If not, he can give her directions. He must not worry about her feelings at the moment. He is the pasha; she is the harem girl. He's the samurai & she the geisha.
         If he doesn't know what to tell her to do, I shall be surprised. She is to masturbate him slowly, gently, & he is to wait for that moment just before it's too late. For a feeling that tells him, "One more stroke & there is no turning back--you're going to come." He has to learn to recognise that premonitory sensation. Then he must ask her to stop. When he has that feeling, let him say, "Stop, please." Very soon the feeling that he is going to come will go away. Then let him say nicely, "Start, please." We call this the stop-start exercise.
         At this point he may have lost part of his erection, but a little attention will bring it back. He may think it wise to advise, "Faster, please" or "Slower, please". When he feels the premonitory sensation again, once again he says, "Stop, please."
         Once, twice, three times, let her bring him to the brink of orgasm & stop. The fourth time she will keep going for the big one. This time he can ejaculate.
         The next night he can pleasure her & give her as many orgasms as she wants. He can hug her, kiss her, massage her--whatever she wants. But no intercourse. He can use his fingers, tongue, nose, toes--anything to show how appreciative he is of her efforts. This should keep her from feeling she has to do all the work.
         The couple continues this for a couple of weeks, or until he has been able to last until the fourth premonitory sensation on at least four occasions. After that she is to use petroleum jelly or some such lubricant on her hand. This simulates the feeling of the lubricated vagina & is much more exciting than the dry hand--which is why we don't use it from the beginning.
         Let them continue with the slithery hand until he has lasted to the fourth premonitory sensation on four occasions.
         During all this the man learns to control ejaculation almost indefinitely. He gains confidence, & in the following months he learns to stop & start so smoothly, at just the right point, that his performance seems one long uninterrupted entity.
         A man can adapt these exercises to a life in which there is no helpful regular partner; following the very same exercises, starting with a dry hand & going on in time to a lubricated one, he can do for himself what the woman is described as doing. This is not ideal, but a man can learn good control this way & then put it to use in intercourse.

VAGINISMUS
         What about a wife in bed with her husband, & she wants to have sex with him very badly, but her vagina won't let him in? Seems to have a mind of its own, & truly a penis-hating one. The muscles at the entrance are clamped tight as a vise. And she has no idea on earth what is going on down there.
         Vaginismus shows up the first time a couple try to have intercourse, & sometimes it goes on for weeks after the wedding. Months. Years. The married pair tell nobody about it because--well, how would you feel? All the hoopla on the wedding day, then you ride off in the Just Married car, tin cans banging &, comes the wedding night--nothing. Just shame & embarrassment & discomfort to remember.
         I have had clients who have struggled with vaginismus a long, long time. Very seldom do they come to someone for help in the beginning. I have helped people whose marriages have been unconsummated for 3 years. The first thing I tell them is that we are going to get the marriage consummated very soon, without the slightest doubt. Definitely. I have no reason to believe otherwise, & at this point they need a big dose of optimism.
         What else about vaginismus? There are a number of interesting facts. Sexual response: You might think the woman with vaginismus would be so much afraid of sex that she could not lubricate, but very often she can. And many women with vaginismus know what it is to have an orgasm. They have masturbated & had orgasms that way, or they have had them during heavy petting. Sometimes she can insert a tampon to absorb menstrual fluid. Either the opening is large enough for the tampon but not a penis, or the emotional situations are different & she is not tense when inserting the tampon. I would suppose the latter.
         Not every woman with vaginismus is a virgin. The condition can develop after she has had intercourse many times. Some painful condition in the vagina can bring it on. Women sometimes have it after childbirth, fearing that they are not healed entirely & that lovemaking will be painful.
         Like many other sexual problems, this has been blamed on misdirected religious teaching, & sometimes the histories of the women involved seem to bear this out. But the condition exists in very modern, broad-minded women too. Getting rid of your religion will not cure your vaginismus.
         Vaginismus can be relieved by a very simple procedure to be carried out by husband & wife together, patiently & lovingly, over a short period of time.
         During this period it will be wonderful if the couple have a little repertoire of sexual activities for bringing each other to orgasm. Manual stimulation & oral sex are available to this couple & will take the tension out of overcoming vaginismus.
         Little by little we are going to persuade that muscle to accept the presence of harmless objects in the vagina. Not by stretching the muscle, only by getting it to relax.
         This is what I tell them to do. Lying side by side, or in any position they find comfortable, with no idea of having sex just now, she is to take his little finger & put the tip against the entrance to the vagina.
         The man is to let her do that, she being in control of the finger. Let the finger stay there at the lips a little while, then let her push it in a very little bit until she feels just a little discomfort. Let the finger stay like that & let her become accustomed to the feeling. While she is allowing this the discomfort may go away. If not, after a while let her remove his finger & put her own there awhile. This continues (not so long at any one session as to let really strong feelings of boredom or annoyance build up) until the feeling of discomfort disappears. Little by little, fingers go farther into the vagina. The feeling of discomfort eases at each stage of insertion. The nerves & muscles in there must be shown, very patiently, that this thing the couple want to do doesn't hurt. After a period of a week or so, usually, the couple can insert the whole pinkie & move it in & out easily. Then larger fingers are tried, patiently, & then two fingers. When two fingers go in easily, can be moved in & out & then rotated, it is time for the next big step.
         Although the muscle is unresponsive in the beginning, the vagina is usually lubricating in response to the attention it is getting. She should not put a finger to those lips until she has some sensation that means getting wet down there, & he should not push in until he is aware of some wetness. Not gushing out, just enough to feel. I might, in some cases, suggest using a lubricant on the fingers.
         During this period I like the couple to be relaxed & chatting easily while they conduct these gentle instructions. Couples report giggling a good deal, which is natural enough. Some soft music during this deconditioning may be soothing. I shouldn't think hard rock or disco would set the right mood.
         Now they're ready to try--guess what? To try putting the penis in there little by little, at the woman's pace. I suggest the female-superior position, with him on his back & her straddling him. When he is good & hard, let her lower herself onto the penis a little. No thrusting or attempt to have anything like intercourse. Getting the whole penis into the vagina easily may take a few sessions, but the end is clearly in view at this point.
         It takes a while before they can effect intercourse & totally uninhibited thrusting. But that day does come. While he is supplying patient erections the couple may sometimes have to pay attention to his penis & pet it hard again. And he should be given orgasms manually or orally throughout the deconditioning period.
         I think that a couple could work this problem through on their own, using good sense & mutual kindness. Actually, many couples relieve mild vaginismus without ever going near a sex manual or a therapist--just by being gentle & unhurried in their early lovemaking.