Back Pain, Freud, & Low Desire

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She hated her nipples. His back hurt most of the time.

But we’re getting ahead of ourselves.

Jalen and Maria were a couple in their thirties, together almost four years. The sex had started out just fine: they each found the other attractive, enjoyed kissing and touching each other, and desired sex about the same amount.

Soon, though, they found themselves wrangling about which position to use for intercourse. It started as teasing, but eventually became more like negotiating that quickly turned into quarrelling.

Maria wanted variety in intercourse—including on her hands and knees with Jalen behind her, or standing up, or side-to-side. Most of all, she wanted to be on her back, with Jalen on top of her. “I like it when he does me that way,” she said more than once.

Jalen, on the other hand, wanted Maria on top of him. “I like looking at you during sex,” he said, “And I love playing with your breasts while we do it.”

And that was the problem—the way Jalen wanted sex the most was the way Maria wanted it the least. And the ways Maria wanted it were of little interest to Jalen. And yet they both liked sex, and wanted it with each other. What was going on?


As I often do, I asked each of them two questions: What is it that you like about what you like? And what is it that you dislike about what you dislike?

As often happens, the answers were both surprising and helpful.

“I love feeling you on top of me,” Maria said, “all manly and strong, just like when you take me from behind. Or when you hold me up when we do it in the shower.”

“Well,” replied Jalen, “I’m not always in the mood to be manly—maybe I’m tired, or I have a lot on my mind, so having to be all manly can seem like a lot of work,” he said. “But I always love you sitting up on top of me,” he continued, “acting like you really want it, and making sure you enjoy it. Not so much pressure for me!”

Where could they go from there?

Acknowledging their honesty—and desire for each other—I pushed a little more. What might each of them be trying to avoid with this recurring conflict?

They both continued hiding crucial information, claiming that various factors were more important than they really were.


Maria didn’t want to be on top during intercourse, but didn’t want to admit why. Instead, she critiqued Jalen wanting to be on his back: “I read two articles online saying that a man who doesn’t want to be on top during sex is rejecting his masculinity. It’s like a Freudian thing.”

That approach was so unhelpful—while Maria kept demanding he get on top of her during sex—that Jalen began withdrawing from sex altogether. She thought he was rejecting her sexually, which made her more self-conscious. She demanded he “climb aboard and pound me” to prove he was attracted to her, which made him withdraw from sex even more.

At the same time, Jalen insisted more and more that he had a “right” to be on his back during sex, as he increasingly “rejected” any request for any other lovemaking position.

When their sex life collapsed over this, they came to me for therapy. They were each hurt, angry, and baffled: why was the other one making sex so complicated?

In my professional experience, when people make sex complicated, there’s always reasons. My job is finding out what those reasons are. That, of course, meant getting Jalen and Maria to talk honestly to each other.

One day I looked at the two of them and said, “Either you don’t really want to have sex and won’t admit it, or you have reasons for blocking sex and you won’t admit those. Which is it?”

Of course they each had a reason. “OK, I hate my nipples,” Maria started sadly. “If I sit on you during sex, they stare you in the face, which is just too embarrassing. And then you want to touch them—you know how you love playing with my boobs—which makes me even more uncomfortable.”


“I had no idea,” said Jalen, shaking his head sadly. “But what’s the problem here—you have great nipples!” “Great BIG nipples, you mean,” replied Maria. “They’re huge and dark and ugly. They’re such a turn-off! Any kind of sex where you don’t see them is a plus for me.”

Jalen was amazed—so much anguish over something that wasn’t a problem for him—in fact, it was a bonus. All her work to manipulate their lovemaking positions had been all about hiding her nipples—nipples that he loved to touch and kiss and look at.

I was hoping the foible was more or less symmetrical, and it was. When they had unpacked “nipplegate” together (without yet resolving it), Maria asked if Jalen had anything new to say. “Well,” he drawled, “my back hurts from that old skiing accident, and it’s been getting worse. Getting on top of you and thrusting for a while is just too uncomfortable.”

“Why didn’t you tell me?” Maria said in disbelief. Jalen looked at the floor as he answered. “C’mon, it’s not very sexy,” Jalen said. “Plus I didn’t want to worry you. I can move around OK for oral sex and other stuff, but these days the only way I can really enjoy intercourse is on my back. I can move my hips and arms, but the days of pounding you just may be over.”

At that they both had tears in their eyes. Actually, I did too—watching these two nice people realize they’d been trying to get close by being dishonest, and seeing how poorly that works. And dealing with the sexual limitations that life had handed this otherwise vigorous man—and, therefore, this woman.

Indeed, watching Jalen struggle with his limitations certainly put Maria’s dislike of her nipples in perspective: “You really like those big ol’ dark things? They don’t turn you off? I can maybe relax about it a bit?” The mutual secrecy unveiled, they were friends again. And lovers again. They could find compromises that workd.

I won’t say a little communication went a long way. I’ll say a LOT of communication went a long way. They’re back to having sex on a regular basis, enjoying it more than they ever have, and learning to face life’s ups and downs together.

And Maria has promised not to diagnose Jalen by reading articles online anymore.

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