A conversation with the sex therapist and chairperson for the Middle Eastern Sexual Health Committee at the World Association for Sexual Health.

Question: How does sexuality differ across the globe?

Sara Nasserzadeh: When we're talking about global perspectives on sexuality, I have to say, again, based off my experience when I travel around the world, I can give you some really -- they are not strictly caught, you have to understand that, but on the other hand, there are some specific areas that I can generalize.

The first part is in the Middle East. The whole culture is so sexualized; the literature and the whole talking to each other women to women, men to men, they make lots of jokes and all that. But as soon as it comes to problem, problematizing the sexual life, people go silent. This is not something to be discussed. So they go to the doctor probably, at most.

In Asia and countries, South Asian countries, they are more conservative I would say. There is not a chance for you to joke around sex or use the sexual words. They are not as many sexualized words, if you like, in those cultures, even in the terminology that they have. So that is the difference between those two cultures.

But one of the similarities that you can find among Middle Eastern, South Asian, and Asian cultures is that actually sexuality is a part of the person's life; it comes naturally. So nobody tells them to supress them forever. For example, in some of the more religious Christian based countries or cultures. So they come to know their sexuality after marriage, but it is a part of the social life of a human being. So you are expected to be sexual, but it is after marriage.

But then you come to Western European countries and Northern American countries, it's mostly you can joke about sexuality. As far as you medicalize it, you problematize it, you speak about it scientifically, or on the other hand put it on the Hollywood movies, naked pleasureville and sassy, then it should be okay. But in everyday life, really, you don't sit with your girlfriends or boyfriends and joke about sex or talk about sex all the time.

So this is -- and also sex is a separate phenomenom. It could have nothing to do with your social life. You can just have sex, one night stands, and all that. It's your sexual part. And then you can have a total separate social life for yourself as well. So it's not something that is quite supported by your social network.

Question: What were some problems you saw in your London practice?

Sara Nasserzadeh: The good thing about being a clinician or practitioner in big cities like London or New York is that you don't necessarily see people from that specific city but you get to see people from all around the world. To add another plus, London, because it's close to many, many places like other European countries or Middle East or Southern Asia, I used to get some clients flying from Israel or France, different European countries as well as Middle Eastern countries or Israel. Just for short intense therapy, for specific sexual dysfunction. Most of the cases that I saw were related to vaginismus, which is the involuntary contraction of the vaginal entrance so that the penetration actually is not possible, the intercourse. So at the point that I used to see those couples, most of them would come to me based from very, very religious backgrounds and they just came to me to get pregnant.

For some of them, I would just ask them, "Is it important to you to have a sex life or are you just here to have sex to get pregnant?" If it is the second choice that you're making, no sex life but the baby, don't waste your money on me. Go and do it yourself. Like with the turkey baster or something. Or even go to a gynecologist. Just ask them to do the insemination for you. If was very interesting-- I had three couples who chose to do that, rather than going through the whole sex therapy and getting close to each other and all that. And that's perfectly okay because it really depends on the dynamic of the relationship. And when we are getting trained as therapists, the most important thing for us is the goal that the client wants to achieve because I might go there with lots of perceptions and expectations and want to impose it on my clients; that's not how it works. They come to you with specific agenda. You might give them information and based on that they might change their goals in their minds, but it doesn't happen all the time because they have their own dynamic of their relationship and the whole playing thing going on, give and take between the couple and the whole social circle around them: in-laws and the social capital that they have and all that.

Question: What was it like to host a sex radio program in the Middle East?

Sara Nasserzadeh: I had a radio and online program for BBC World Service. It went on for one year before I moved to New York, and it won an award for innovation of the year 2007, which was really the icing of the cake. And the main questions that I used to get, because it was for the Farsi-speaking audience globally, were very interesting. You could get some questions from military camp in Afghanistan -- I actually had a gentleman call me to buy bread or something. And they called us: “Oh, hi, I'm in the city for two hours; I have this question; could you please ask Dr. Sara?” And it was so touching that they could just have this source to reach out and ask their question. But the neighboring country, Iran, the questions that you would get from them would be quite different. For example, from Afghanistan, even from Kabul, you would get questions that made you realize how closed the culture is, how conservative the culture is, even after Taliban. But then the neighboring country, Iran, you got all these questions about different fetishes, different fantasies, and it could be a really interesting contrast. Or from Tajikistan. Or from the same people, Afghani or Iranian population outside the country. So, for example, “I'm calling from The Netherlands,” and the question could be quite different because of the whole social, cultural aspect of it. But unfortunately the BBC Web site got censored in Iran because of the political reasons, so we couldn't reach to the population that we had, the audience that we had, through written material. So what I came up with was to put them all into the email format, ask people their email, and then e-mail them out as PDF files. And they were actually very kind at BBC to let me do that, because of the copyright issues and all that. But you know, the main purpose of that is to educate people who couldn't be educated otherwise this openly, you know, talking about masturbation, homosexuality -- nothing was off-limits.

Question: What kinds of questions did you field?

Sara Nasserzadeh: Initially, all the people from Afghanistan, Iran and all these countries were men. Ninety-nine percent were men. Over time -- I don't know whether because I was a woman -- what gave them the encouragement, but more and more we saw women calling, writing to us, e-mailing us and all that, which was an interesting achievement. But the questions -- for example, mostly from Afghanistan, from what I can remember -- were mostly about relationships, getting married, the first-timers. So I'm getting married; what should I do? I'm so scared. Or inhibited ejaculation for men, as I can remember. And many, many questions about size -- size of the penis. Am I normal? Am I not normal? Which is really interesting, because if you compare the scientific literature, this is top of the range of the questions that men post to the Web site and all this, you know, about the size and also rapid ejaculation.

Question: Do you believe in sexual chemistry?

Sara Nasserzadeh: With all due respect to my colleagues who are working in this field, especially Dr. Helen Fisher, whom I respect deeply, I personally don't believe in sexual chemistry. I believe in sexual harmony and balance. And I'll tell you what my idea about it is. The way you describe it, if I told somebody that I have sexual chemistry with you, it seems to me, to my visual mind, seems as if oh I have a sexual chemistry with this person, click. And this will be like this forever. That's not going to happen because I'm a person, the other person hopefully is a human being too, so we evolve over time. The emotions evolve over time, even different phases of time but that we have like menopause and all that. We really change and men do as well.

So if I believe in chemistry, then I say oh, we've been unhooked so I'm going to hook with somebody else. But if I think of it as a harmony then it seems as if I send you energy, you send me back the energy. So it's a constant evolving process; that's what I believe in and what I work with my couples with this concept rather than the chemistry. I don't believe in it.

Question: Are women and men looking for different things?

Sara Nasserzadeh: When we talk about sexual interaction, there are huge debates around it. And these days we have two huge debates. So if I can just put it this way for the sake of simplicity. One is the one which says that men are emotionless, so they can have sex with whoever they want with no strings attached and be happy with themselves. The same debate says that women need the emotional attachment and all that. On the other hand, other people say that no, if men are like that, women are like that too. So women don't need emotional bonds either. I personally believe that you have to look at the individual and the social cultural context that they live in. So although there are some certain scientific studies about physiological differences that could happen and the hormones that could be produced based on sexual activity that could differ between men and women; therefore, that could impact the person differently.

But on the clinical side of that, I wouldn't go to see my clients based on that perception, that men and women are quite different. More and more I see in urban areas like I work in London and New York, big cities. More and more men who I see, they come to me to seek advice on how to become more emotional, become emotionally in touch with themselves and their partners.

Question: Does waiting to have sex until marriage complicate things for the woman?

Sara Nasserzadeh: For women who wait until marriage, I personally have conflicting views. The reason is there are many, many people out there that they are virgins based on their culture and they get married, they live happily ever after. So it is not a big deal for them. But for the segment of the society that I see, basically I will have a biased view because they come to me because of the problem, right? When I lecture to parents and schools, I always say that it's quite respectful what you're doing. It's good just tell your children about the values that you have so, for example, you tell your daughter, "Please don't have sex and this is not in our culture until you get married." This is fair enough, but promise them a good sexual life and emphasize on the values: why they are postponing it, rather than just connecting it with guilt, which shame, horror stories, or you're going to bleed to death, it's going to be painful, don't ever let anybody touch you. I actually have clients, when they come to me, I say that, "Look. You have to understand. It's not as if your virginity, your hyman, was your dignity for 20 something years before you get married. Then if they get married by 20 something." And all of the sudden, by signing the marriage contract, "Oh, honey. I'm ready." That's not going to happen. It's really deep inside the subconscious.

So the partner has to really understand in these situations that a girl's dignity, when it’s tied to the hyman, they're not going to just give it away. So it takes trust, letting go and a whole new attitude towards sexuality.

Question: What is love?

Sara Nasserzadeh: If I want to define love, I first of all encourage everybody to go and read the terminology in different languages and different cultures for love. This could actually give very good insight to people as how different people define love. The other thing is, I was reading a book by Stephen Covey. He very nicely put it this way: love is a verb. And I always say love is a verb. When I say I love you, I’m out of love with you, I'm in love with you, such language I use is quite irresponsible. It's as if it can come and go without my knowledge. But if I say I choose to love you, it's a verb. I'm going to make myself to love you. And if we think about arranged marriages in, for example, Indian cultures, because you are supposed to love your spouse, you will eventually end up loving your spouse. So it's really the whole world perspective, rather than what we've been told about love, mostly from Hollywood.

Recorded on October 20, 2009