"Sex therapist" was a very, very new job description when by chance I found myself studying to be one in the early 1970s.
The clinical psychology program I was enrolled in featured the work of the famous sex researchers William Masters and Virginia Johnson, who believed that most significant causes of sexual problems were conservative Victorian attitudes to sex, and ignorance about basic sexual functioning. They had therefore developed a new treatment program, which dominated the field of sex therapy for decades, and was all about detailed, explicit education about the human body and its sexual function.
It is true that in the first part of the 1900s there was considerable sexual ignorance in western society -– many women didn't know men got erections so were rather surprised on their wedding night, and the clitoris was an unknown to a lot of men and women -– but was there really the widespread sexual dissatisfaction that is commonly assumed to have blighted most relationships at that time?
In my early years of practice, I had the opportunity to talk with people who were born into that Victorian era, and I learnt some surprising things. I found out that many couples, unrestricted by a heavy media idealisation of "great sex", discovered sexual pleasure through their own gentle and considerate exploration of each other's bodies. One woman told me she didn't know what all this modern fuss was about, she and her husband had had sex most nights –- what else were they going to do once it got dark?
But I also learnt that what sex meant to the person or couple played a large part of their sense of sexual satisfaction: one woman expressed great pride in never saying no to her husband every Friday night, no matter how tired she was.
As I talked to more elderly people over the years, I gained a greater respect for these past generations that we sometimes have a tendency to feel sorry for. But think about it: could we really be the first and only generation to discover sexual desire and sexual pleasure?
And is this current generation really that much better off? I remember thinking, when I was doing the sex therapy training in the 1970s, that I would be out of a job by 2000. After all, by then, I reasoned, we would have educated the masses so everyone would know all there was to know, and sex therapists wouldn't be needed any more.
How wrong I was: the demand for sex therapy continues, but expectation has replaced ignorance as the major source of distress. Now sexual success seems to focus more on behaviours than emotions; tender vanilla sex is derided, prolonged erotic activity has become the gold standard. Judgement of self or the partner sits at the core of sexual unhappiness:
What's wrong with me that I don't feel hot for sex? Why won't my partner try new things? Why can't I last longer? What's wrong with me that I wish he wouldn't last so long? Why won't my partner give me sex every day? If she doesn't initiate sex, does this mean she doesn't find me attractive? If we don't have passionate sex, does this mean we don't really love each other?
The proliferation of sexual imagery in the media since the 1960s, and now particularly the easy access to erotic material on the Internet, has fuelled some of this dissatisfaction. However, Sex Therapy itself has played a part, promising the secrets to great sex, accompanied by admonitions such as "always make time for sex" (even though sometimes life has other competing demands) and "never let your sex life get routine" (read: "boring", but for many routine is reassuring, soothing, pleasurable).
Of course, wanting more from sex isn't a bad thing. Some people are keen to develop their sexual interest and explore new activities, but this is best done from a position of curiosity and delight, not shame or guilt. Does this justify judging those who don't share this curiosity?
Without accurate statistics, we can never know whether we are better off now than 100 years ago, but as I have travelled through several decades of ever changing sexual rules and expectations, I suspect that the satisfied/dissatisfied ratio would be about the same.
What I now understand is that there are winners and losers in every cultural shift in attitudes and values: those who are closest to the prevailing good sex stereotype are more likely to feel that right is on their side and everyone else is deviant; those who differ from the accepted standards are more likely to be worry about what is wrong with them, or rebel regardless of the consequences. Previously it was the sexually adventurous person who was demonised, now it is the sexually quiet person who is regarded as dysfunctional.
A truly inclusive society is not just one which accepts diversity in sexual orientation and gender identity, but also respects the range of sexual interest and expression, from not that interested to super keen, from routine vanilla to wanting to push the boundaries - and teaches people how to respect and negotiate these differences. We have made progress, but we aren't there yet.