PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – FURTHER TREATMENT OR REFERRAL? (PSYCHOSEXUAL THERAPY)
Although doctor had a special interest in psychosexual therapy and some skill in this field, his personal feelings made therapy with this woman, or her husband, a potential minefield. The professional pride of this doctor nearly led him to embark on a dangerous offer of therapy. He could recognize that, because of his training, he had been able to stick with the real problem – that the woman wanted to change her method of contraception without the existence of a logical acceptable reason. He knew from his previous experience with similar encounters that an emotional reason was likely. He had several bright ideas: she might feel she was too old to be continuing on the combined oral contraceptive, or that she might want a less reliable method in order to risk pregnancy without taking a definite decision to start a family. The failure of these ideas to strike a chord with the patient reminded the doctor that each patient is unique and that experience gained from other patients is of no help in understanding what is happening with this particular patient. Only when he waited, in ignorance, for her to tell him what the problem was for her, did he discover the underlying difficulty. He knew, too, that if the husband had come to him with the problem of premature ejaculation, he might have been able to help him discover why it happened. Perhaps his first wife had taken too much from him and he wanted subconsciously to retain the sexual pleasure for himself; perhaps he had always had this pattern and could not see any difficulty, or any of the myriad other reasons why it occurs. Then he could perhaps help him to make the necessary changes to ovecome the precipitate ejaculation. The doctor’s difficulty was his nonprofessional partisan feelings, which made referral elsewhere a preferable option. He would have to propose this to Mrs S. without making her feel rejected.
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