How can the therapist deal with a couple with male demands for anal sex

Abstract

We report a case that was referred to us as sexual reluctance in a wife and conflict over anal sex. The wife was a survivor of child sexual abuse. Subsequently, it was felt that the presenting problems were a reflection of difficulties in their general marital relationship. In addition to traditional behavioural sex therapy, structural interventions within sessions and strategic interventions including the use of paradox were used to help the couple. Some ethical problems were presented to the therapist.