In one of her many costumes, the singer Madonna, for a certain period, wore T-Shirts with the writing: "ITALIANS DO IT BETTER", but what do they do better? Sex of course. This might be true, but what is also true is that they do it less.

Newspapers often publish the statistics on the frequency of sexual relations, and this data puts Italy back to European average which is pretty low, especially when compared to less industrialized and "civilized" countries.

We are not interested in looking at this problem from a historical or social point of view; we are going to limit ourselves to accepting this as a matter of fact, from which we can take a look at the individual, setting aside sociologic or anthropologic considerations.

All of this happens, or rather, doesn't happen, in the private lives of Italians; while in the public dimension of the media (television, newspapers, shows, advertising...) and costume, sex and sexual references, are constantly present and exhibited in an increasingly explicit manner.

"We do it, but we don't say it", this was the chorus of a cheeky song from the 40s; maybe nowadays the opposite is true "We say it lots, but we never do it".

The difficulties which impede a serene and regular sex life are many and of various natures: I would however like to exclude from this discussion all physical and organic problems, which the medical community is facing both on the surgical front (plastic surgery, reconstructive surgery) as well as the pharmaceutical front (products that by improving blood circulation favor sexual activity; various other medicines aimed at improving people's overall health).

The most serious obstacle in the sexual field is impotence. But the term "impotence" is generic and in some cases, is not the right term to define certain situations; it is therefore necessary to define what the nature of this impotence is and how it shows up.

In order to exclude physical or organic causes, in front of a person who declares himself impotent, or confesses that he has never had or has had very few and difficult sexual relations with his partner, the therapist, in order to formulate a more precise diagnosis, must ask a certain series of questions to check that:

  1. the person has always been impotent, or that impotence occurs after a certain amount of time;
    • in the first case (the person has always been impotent, even though he has tried) telling him to go to his physician is mandatory
  2. in the second case (onset of impotence) the therapist must check whether sexual activity has been interrupted due to illness (of the patient or his partner), accidents, stressful periods, trauma, or grieving. These situations, excluding the physical consequences of illness or invalidating accidents, can be faced with a psychotherapist, who must use therapeutic strategies based on each individual case
  3. impotence is with a certain partner, while with previous partners a satisfying sexual life was to be had; then it is probable that the impotence is hiding a profound crisis in the relationship, which can be faced with psychotherapy (individual but better as a couple) and, if necessary, with the help of exercises and advice that come from sexology
  4. the person is able to masturbate and have an orgasm in this way.
    • if the answer to this question is yes, it means that the sexual organs function properly, at a physical level, but that there are problems in a relationship with a person of the opposite sex. The fear of intimacy, or rather of an intense, deep and direct relationship with a partner is maybe the most important cause of physical impotence. In this case as well psychotherapy can offer the necessary support.

But the fact that Italians, as the statistics say, have less sex, is not mainly due to impotence; what mostly happens is that healthy couples, who are apparently in perfect harmony, have sex less frequently making it so that there is a daily routine in which there is rarely time for sex.

This mostly happens because of negative elements that can be external or internal to the couple.

Among the various external factors, which can negatively influence sex in a couple are:

  • excessive intromission of both partners' families of origin (and the relative inability of the couple to "cut the umbilical cord")
  • worries about the health issues of a family member or one of the two partners
  • the birth of children, when it turns a couple of lovers into a couple of people who live their lives thinking that they are only parents; and if we add tiredness and isolation which often condition those taking care of children - without any help - it is quite probable that sex is slowly "forgotten"
  • tiredness, stress, worry and lack of time caused by excessive work
  • depression that often accompanies being unemployed or working very little
  • unresolved disagreements on how to economically manage the family, the children and work
  • situations in which different ways of seeing sex, that emerge over time, do not find agreement and are not in harmony
  • excessive independence of the partners who, over time do not share their free time, no longer make projects together, do not have fun together, but each one continues his/her own interests and friends without sharing them with his/her partner
  • a study recently published by a newspaper shows how images of violence and death that are transmitted everyday on the news can inhibit the sexuality of the viewers

Moving on to examining the internal factors that can undermine sexual relations in a couple, we shall indicate a few that seem of particular relevance:

  • the betrayal on behalf of one of the partners and the discovery of that betrayal; the loss of trust in that person; the decision to stay together and the difficulty of rebuilding the relationship
  • the lack of acceptance on the part of the man, of the different role that women have today and of female independence
  • the unresolved need to update the model of the perfect couple where it is the man who is supposed to earn more
  • there are religions that impose severe restrictions on sexual activity and on contraception; those following these rules without criticism, have serious problems reconciling faith with sexual desire. The risk is that of considering anything to do with sex "dirty" and developing a psychological "complex" which can heavily block normal sexual life
  • a series of psychological problems that can be an obstacle to sex, and that can be faced with psychotherapy
  • first of all the inability to get over the Oedipus complex, or rather the childhood link to parents. For those who cannot mature their affection for their parents (from a total, symbiotic and sexual affection typical of children, to an adult affection, where they accept the distance from their parents and the different mentality), independence in personal choices will be influenced for their whole lives because of this lack of detachment. There are situations in which an adult woman will continue to undervalue her partner and see in her father the only true male reference point; and an adult man, who may have many amorous encounters, will always remain a "Mamma's boy". This mentality impedes maturity and an adult way of living freely and responsibly, and risks influencing the sentimental choices towards people who are similar to their parents. In the sexual field, the lack of resolution of this conflict, blocks true communication and intimacy between the partners and makes it difficult to feel the true pleasure of a normal sex life
  • coming from a family in which sex is morbid. This is the case when sex is never talked about, channels are changed if there are love scenes; but this is also the case where children are forced to give up their privacy and live at home with their family in an atmosphere of constant and hidden sexual excitement.
  • monopolar disorder, which, by erasing the desire to live, also erases the joy of sex
  • bipolar disorder or cyclothemia, which alternates depression in which sex is non-existent, with phases of euphoria or mania during which often irresponsible and dangerous sex is practiced
  • anxiety, which in a man can provoke precocious ejaculation, physical difficulty and consequential distancing from sex; while in a woman anxiety often makes it so that she is unable to let herself go enough to have an orgasm
  • fear of intimacy, that is an authentic and deep contact with others; very often this fear derives from negative experiences during childhood with strict and moralistic parents
  • sexual abuse or rape which happened during childhood or adolescence, which heavily conditions a person's life and in some come permanently impede a sex life or in others, favor, as a reaction , homosexuality
  • use of drugs and alcohol which, besides provoking physical damage, falsify the reality of the sexual act and in the long term impede it

In order to face each of these situations, it is necessary to put different therapeutic strategies in action, or personalized combinations and different therapeutic techniques; remembering however that the road to healing starts from acknowledging the problem, admitting the difficulties and not denying them, and the need to be clear and honest with oneself and with one's partner.

As the Chinese wise man Lao Tzu once said: "Even a journey of a thousand miles must begin with a small step".