Anal Pleasure and Health: A Guide for Men, Women and Couples (7 page)

Of equal importance, physicians could become much more effective in helping all of their patients to resolve anal medical problems. This is because the majority of common ailments-especially chronic or recurring ones-are exacerbated and perpetuated, if not caused, by negative attitudes toward the anus, lack of anal awareness, and chronic muscle tension-the exact same conditions that limit anal pleasure. Nothing can help a person develop and maintain anal health more than a comfortable, relaxed sensitivity to the anal area, including a willingness to explore it. There's no question about it: The anal taboo is dangerous to your health!

It's not my intention to indict the entire medical profession. Almost as amazing as the pervasiveness of the anal taboo is the ability of some doctors to look beyond it and listen respectfully to their patients. These are the gifted healers who continue to believe-in spite of a doctor-knows-best ethos and the limited time in today's medical system-that they have as much to learn from their patients as they have to offer. They know that the path toward optimal health is a collaborative effort. It has been my pleasure to work closely with a terrific group of doctors who encourage their patients to cultivate self-awareness and relaxation before resorting to surgery for some anal problems.*

THE ANAL TABOO IN PSYCHOLOGY. Just as the anal taboo has inhibited the medical community from offering any more than incidental information and support to those who want to explore anal pleasure, similar pressures have blocked many potential positive contributions from within the field of psychology. Freud at least discussed the erogenous qualities of the anus. In fact he saw it as the strongest focus of pleasure throughout one period of each person's life. He called this period the "anal phase" and to it he ascribed enormous power to shape our personalities. Although his ideas brought phrases such as "anal retentive" and "anal fixation" into popular parlance, the overall impact of his theories has been to legitimize anal pleasure as a developmental necessity for small children, while labeling it infantile for adults. So while Freud introduced anal eroticism into psychology, his theories ended up, ironically, bolstering the anal taboo.

Psychology has evolved in literally hundreds of directions since Freud. Most, but by no means all, of today's psychotherapists take a far less dogmatic view of sexual behavior and accept a wider range of activities as potentially healthy and mature. However, the anal taboo still thrives among therapists and researchers, in spite of a general open-mindedness. I've had countless people write or tell me about their frustration that anal sexuality seems like a forbidden subject in their psychotherapy, regardless of its duration or how helpful it is in other ways. When they've followed my suggestion to bring up the topic-or at least mention their discomfort in doing so-some have reported positive results. But in most cases, brief discussions have quickly fizzled, never to be raised again.

My hunch about the dynamics at work here is that the lingering effects of the anal taboo, in both therapist and client, join forces to create an unspoken, semi-conscious consensus to avoid anxiety and embarrassment, especially on the part of the therapist. Clients don't want their therapists to be anxious while discussing difficult material. How paradoxical, that in a setting specifically designed to promote honesty and deepening levels of self-disclosure, a deafening silence infuses the anal taboo with even more power than it may have had before.

There's reason for optimism, however. In recent years I've noticed an unmistakable opening among a significant group of therapists. Nowadays, thoughtful questions about how to work with clients' anal concerns commonly arise at seminars. I'm particularly impressed when a therapist acknowledges his or her discomfort about a topic, and then forges ahead in spite of it. One of the first signs that a taboo is loosening its grip is an increasing ability to admit its existence.

SEX THERAPY AND ANAL CONCERNS. Sparked by the publication of Masters and Johnson's pioneering book on sexual problems in 1970, the field of sex therapy has grown rapidly, along with a greater awareness that sexual difficulties, far from being rare, actually affect large numbers of people. Men seeking sex therapy are usually concerned about getting or maintaining erections under various conditions, or else they are concerned that they ejaculate too fast or take too long. Women are often concerned about lack of arousal or not being able to experience orgasm. Both men and women who have little or no interest in sex are increasingly likely to consider this a problem.

For those who are willing to listen and inquire without judgment, clients will start to reveal a host of even more complex sexual conflicts and dilemmas, such as their compelling, yet problematic, attractions and erotic interests. Terms like "sex addiction" or "porn addiction" have entered the popular lexicon. While there's no doubt that many people feel a distinct and disturbing lack of choice in their sexual lives, thinking of these challenges as addictions only encourages people to fight with them, which invariably makes things worse. Theories and techniques for dealing with a vast array of sexual concerns vary widely. Yet all sex therapists view sexual behaviors, whether positive or problematic, as complex phenomena in which psychosocial learning plays a major role along with biology. Appreciating the lifelong process of sexual development opens up the possibility of further growth, and the discovery of more fulfilling avenues for expressing oneself sexually. But just how much sexual change is possible and how it can be facilitated is still, and probably always will be, a subject of intense debate.

Aspects of a person's sexuality that are established before or during adolescence, and which generate high arousal, are strongly resistant to change. More often than not, long-established turn-ons become so thoroughly interwoven into a person's entire psyche that changing them is virtually impossible. Sexual orientation is like this. Although humans are noted for sexual experimentation, trying to fight against something as deep as one's orientation is doomed to failure. Those who claim to have done so are deluding themselves.

Sex therapists are most successful at helping clients create conditions for learning new sexual behaviors, overcoming performance anxieties, improving communication, and expanding their preferences somewhat, but usually not dramatically. If new discoveries turn out to be more pleasurable and fulfilling or less anxiety-provoking, then they'll gradually supplement or supplant older behavior patterns-unless the old ones produce stronger rewards of their own, which is often the case, even with problematic behaviors. Sex therapists are least successful at helping clients get rid of behavior or alter preferences that bring them high excitement, regardless of whether the client expresses a desire to do so. In these cases, the most effective approach by far is self-acceptance, which is less about changing one's turn-ons than it is about using them in more self-affirming ways.

Today's sex therapists are initially concerned with: (1) providing accurate information and confronting destructive beliefs, (2) working with clients to design targeted experiential exercises free of pressure to perform, (3) teaching practical techniques for coping with and reducing anxiety and tension and (4) improving interpersonal skills, especially the ability to discuss sex openly and to be more assertive in asking for what one wants. Usually, the development of new behaviors-or avoidance of them-evokes emotional reactions and sometimes insights into how past experiences are still getting in the way. Further experimentation provides additional opportunities for learning, deepening self-awareness, and compassionate self-acceptance.

Sex therapists base their work on the assumption that sensual and sexual pleasure is a positive and healthful human experience as long as it is accompanied by a sensitivity to the rights of others. Sex is seen as having the potential to enhance a person's self-esteem as well as his or her relationships. Cognizant of the tremendous range and variety of sexual behavior among humans, sex therapists usually feel less compelled than traditional psychotherapists to formulate universal ideals of how people should behave. These basic shifts in attitudes are undoubtedly responsible for the successes of sex therapy, much more so than any specific technique.

Notwithstanding the overall atmosphere of openness that permeates much of sex therapy today, practitioners have not fully escaped the effects of the anal taboo, and therefore are not always as open about anal sexuality as they are about other sexual activities. Luckily, many are quite willing to discuss anal pleasure with their clients, but don't know how to help with their concerns. To this day, most therapists have few, if any, opportunities to learn about or discuss anal pleasure with their colleagues.

One reason why so few sex therapists have made any systematic attempts to apply their skills and techniques to the problems of blocked anal pleasure is the fact that such problems haven't traditionally been defined as concerns worthy of serious therapeutic intervention. In reality, for a person who desires anal pleasure, especially intercourse, the inability to relax the anal muscles is as much a problem as a man's concerns about his erections or ejaculations or a woman's concerns about her arousal or orgasms. Wanted, but inhibited, anal enjoyment can have the same negative effects on a person's self-esteem and vitality as any other sexual concern.

If we must name it, I've suggested that we call this problem anal spasm, because involuntary contractions of the anal sphincter muscles-and, to some degree, rectal muscles as well-is the primary physiological mechanism blocking anal enjoyment, especially the pleasure that can be derived from internal stimulation of the anus and rectum. Anal spasm is similar to vaginismus, which involves involuntary spasms of the muscles surrounding the outer vagina, making insertion of a penis, gynecologist's speculum, or sometimes even a finger painful, difficult, or impossible. Like anal spasm, vaginismus not only prevents insertion, but over time it also tends to reduce all pleasurable sensations and desires.

I began working clients with anal spasm in the mid-1970s. Working in collaboration with these clients, we developed an approach that seemed most helpful. Then I began testing our discoveries through formal research in which 143 people (114 men and 29 women) participated in an eightweek group therapy process developed and refined during my earlier work. Participants ranged in age from 21 to 62. Represented among the participants were men and women of all sexual orientations and a variety of backgrounds and lifestyles. All wanted to experience less pain and more pleasure from anal erotic stimulation. Eighty percent wished specifically to be able to enjoy anal intercourse. This work lead to my doctoral dissertation, and then to the first edition of this book in 1981. My work in this area has continued to expand and evolve ever since.

For the reader desiring to enhance the capacity for anal pleasure, it's important to know that this is not an impossible or even difficult goal. Among the 143 participants in the original research, 71% learned to enjoy anal stimulation in the ways they desired by the time the eight weeks of therapy had ended. An additional 12% were able to do this within four months after therapy. For the total of 83% who reached their goals, many factors contributed to their success. Most important was the willingness to devote regular time and attention to anal exploration, and to carry it out with calm persistence.

Virtually anyone, regardless of gender or sexual orientation, can become more aware of the anal area, learn to relax anal-rectal muscles and expand their capacity to enjoy whichever types of anal stimulation may be desired. Required, however, is sufficient motivation, a little patience, and a clear idea of how to proceed. It is also necessary to become aware of and to challenge the effects of anal taboo. Almost everyone with whom I have worked has found that the rewards-anal pleasure and health-are well worth the effort.