Talking Mary Out of a Boob Job

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I’m seeing this couple, John & Mary. Very nice people.

They came in last summer because he’d hardly ever have sex with her. Periodically she would get so depressed or angry that she’d get blind drunk and behave poorly—humiliate him in public, black out at parties, spend a few days in bed eating donuts.

“I wouldn’t do this if you’d have sex with me,” she’d say. “You can’t expect me to have sex with you when you periodically behave so badly,” he’d say.

They’d been doing this for over two years. Lots of anger, almost no sex.

But after six months of therapy, Mary changed: she stopped drinking. She treated him respectfully. No more blackouts, no more rages, no more days in bed with Krispy Kreme.

John changed, too: he became more relaxed, more complimentary, and he started discussing their future together. But one thing didn’t change: he still wasn’t interested in sex.

Mary didn’t know what to do. Neither did John, although she was in far more pain about this than he. John started individual therapy. For the first month he neglected to tell his therapist he wasn’t having sex with Mary. They’re finally talking about it.

Recently, Mary’s therapist called me for our monthly check-in. At the end of the call, she said “By the way, Mary’s planning to get a boob job.” It was the common couples therapy whack-a-mole—you take care of one thing here, another issue pops up there. Every couple really is a system, its elements all connected.

A few days later Mary & John came in, and we had a friendly, productive session. When we came to a natural stopping place about 10 minutes before the end, I said “So, I guess we need to talk about Mary’s breasts?” “You talked to my therapist,” she said, “Right?” Right.

Mary gave the usual reasons—wanting her clothes to fit differently (“and I get to buy new stuff, too!”), wanting to look like some of the other women in her gym, and then what she thought was the clincher: “Besides, he’s always been a big boob man.”

I asked him what he thought of her surgery idea. He was lukewarm. I asked why he hadn’t expressed that more clearly by trying to discourage her. “It’s her body,” he said weakly. And it is, of course. But I told John that as part of her decision-making process, Mary needed a clearer picture of how he feels. Even at age 40, John was still getting the hang of this relationship thing.

Turning to Mary, I gently said, “Many women get their breasts surgically changed because they assume it will increase their mate’s sexual desire. Is that a reason you want to do this?” She protested weakly, but reminded him, “You told me you’ve always loved busty women.” “Yes, I generally have,” he said. “But your breasts are fine, more than fine. Really,” he said.

“Mary,” I said, “When you were drinking and being mean, John could blame his low desire on that. And you did something about it. Now that you don’t drink or act out, how can we explain his lack of sexual interest in you? If his low desire turns out to be about him, and not you, there won’t be anything you can do about it. That must very scary. Is that perhaps what this breast surgery might be about—you trying to do something, anything, rather than just sit there and maybe nothing changes?”

Tears, meaningful looks, awkward silence.

“John, do you think if Mary has a bigger chest you’ll be more interested in sex with her?”


“Why not?”

“She’s already beautiful. Don’t you think so, Doc?”

Indeed, she actually is very attractive.

“Mary, what do you hear John saying?”

“I hear him,” she sniffled. “It isn’t me…OK, then what is it? What should I do? Did I change for nothing? Are we ever going to have sex?”

We were already over time, and this was a good place to stop. They had a lot to talk about. The next part of the therapy—and more importantly, of their relationship—had just started.

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