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Case Vignette – Nadia and Ivan

“Nadia didn’t like sex. Married to her husband, Ivan for nearly 13 years, and mother their two young boys, ages 4 and 5, she felt numb when they made love. Throughout their marriage she had tried to meet Ivan’s needs; however, lately he was becoming increasingly frustrated with her over her lack of desire. Complaining that they did not have sex frequently enough, Ivan didn’t like when Nadia would “just lay there”.

Nadia agreed that she wasn’t interested in lovemaking and that Ivan was right about the frequency issue. Given her responsibilities with the children, she had been more tired lately, and, consequently, she was having more difficulty forcing herself to have sex with her husband. Not having had intercourse in more than 6 months, Nadia said that as far as she was concerned, she could live just fine without sex, she loved her children very much and Ivan was a good husband who treated her well. If anything, she felt sympathy for his plight. However, several weeks earlier, they had had an argument about sex, during which Ivan threatened divorce if Nadia didn’t get “her problem solved”. This was especially upsetting for Nadia because Ivan has never threatened to leave her before. Ivan always went by his word, so Nadia knew that if she didn’t do something, he was likely to leave”. Nadia consulted her gynecologist, who unable to find a medical problem, referred her for psychotherapy” (p. 191).

Green, S. K., & Flemons, D. G. (2004). Quickies: The handbook of brief sex therapy. New York: W.W. Norton.