For most physicians specializing in the treatment of infertility, the subject of sexuality – and especially the “how to’s” of sex – are rarely a subject of concern. Couples arriving for a consultation are generally in their mid-reproductive years and have had long, sometimes diverse sexual experience, often with one or more previous partners. At the very least, they are expected to have been sexually intimate for a year in their current relationship prior to seeking evaluation for infertility. (For women past the age of 35 this time interval is shortened to six months.) But for those specialists whose practices include large numbers of Orthodox couples, frank discussions of sexuality, including instruction on the basics of anatomy, techniques and sexual responsiveness, are de rigueur.
The reasons for this are obvious. Most Torah-observant couples arrive at their chuppah with none or limited sexual experience. Indeed, in some communities they are likely to have had no prior experience socializing with members of the opposite sex save perhaps, for family members. Although in such circles it is common for the prospective bride and groom to have taken instruction – in the form of a “kallah class” or “chosson class” – these sessions focus more on the laws of taharat hamishpacha than on the more delicate, but arguably as important topic, of human sexuality. Thus, the expectation that most couples will be able quickly to “connect” is unrealistic and in fact often unmet. This dearth of both information and preparation often comes to light not in the office of the sex therapist or psychologist but during an evaluation for infertility.
It cannot be overemphasized that, as is the case in the secular world, the vast majority of cases of infertility in Torah-observant couples are the result of straightforward medical issues. However, the religious and social dynamic that brings couples together at a young age, and poorly prepared, is at the heart of a phenomenon that is virtually unique to this community: infertility resulting from sexual naiveté. Having cared for large numbers of Orthodox couples for 25 years, my staff and I have encountered the fallout from this problem in many forms, from transient sexual dysfunction to longstanding unconsummated marriages. Initial counseling for these couples has therefore become part of our everyday practice.
It is with this in mind that we welcome the recent publication of Et Le’Ehov: The Newlywed’s Guide to Physical Intimacy (Gefen Publishing). The authors, Jennie Rosenfeld and David Ribner, present this little treasure (92 pages) to address a topic that heretofore has been taboo in some segments of the Orthodox community, and they do so in a way that is direct but not offensive. The subject matter is compelling in importance. It would not be surprising to see it lead the list of recommended reading materials by those charged with preparing couples for their upcoming marriage.
As the title denotes, the authors’ audience is primarily young Orthodox couples preparing for their sexual life together. At the outset they state that they wrote their book because “[r]egrettably, this area of education has long been neglected in the religious world…” At all times cognizant of the delicate nature of such discourse, the authors are careful to defer to the couples’ halachic advisors on matters that might be considered controversial. Still, they lay out the specific information that is needed to prepare couples for one of the central aspects of their future life together. The authors provide anatomical descriptions of the male and female reproductive systems as well as the common terminology of sex. As an aid to their readers, the book also includes simple and sensitively drawn illustrations. Wisely, those illustrations are attached as a separate package at the end of the book, complete with a peel-open disclaimer. This is meant, it would seem, to deflect any criticism from rabbinical authorities who might be uncomfortable with the graphics and therefore consider the book to be in violation of the spirit of tzini’ut (and hence forbidden to read). This would of course render it unobtainable to those most in need of this information.
The information the authors provide is clear, thoughtful and comprehensive. The book has two sections. In the first, the authors present the basic facts of anatomy and sexual functioning. Following each part they present certain questions that may occur to the reader as the material is digested. These questions are boxed separately with the title We Were Wondering…heading each section. In using this technique, one sees how central it was to the authors’ mission to validate their readers concerns. Their answers are to the point and written in a style that makes the reader comfortable despite the potentially charged nature – halachically speaking – of the subject matter and the vernacular required to discuss it. The second section addresses a myriad of concerns that relate specifically to men or specifically to women, particularly in the area of sexual dysfunction. The authors are clear in stating their indications for couples to seek sex therapy, psychological help and/or medical intervention. Their list of resources is also helpful.
Of course, no book is without shortcomings. The audience for this work is, as stated, newlyweds or those planning for an upcoming marriage. Nevertheless, the authors include a substantial discussion of sexuality during pregnancy and postpartum. On balance, some mention of the fact that not all couples will conceive naturally, or quickly, and some not at all should have been included. There is a section dealing with sex when one partner has a medical illness, but no mention at all of infertility, a much more common affliction that confronts young couples. The treatment of niddah and tahara is good but not comprehensive. Their discussion would have been richer had it dealt these subjects as they pertain to the many women who have long, irregular or no cycles at all and for whom the described interruptions in sexual relations do not apply. Finally, the book does not include a discussion of the problem that cycle irregularities commonly pose to many young women prior to their marriage. Often brought for evaluation by their anxious mothers, the unspoken concern is their eligibility for a future shidduch – their “marriageability,” as it were – as much as it is about the underlying medical disorder. Issues pertaining to prior gynecological exams, future need for medical treatment to conceive and – on occasion – the secrecy and deception that may have been advised in order to “secure” the shidduch can all weigh heavily on a young woman planning for her chuppah. (It should be noted that there is no male equivalent of this problem, as there is no outward sign of potential reproductive problems in otherwise healthy boys.) One gets the sense that this book is the authors’ first step into the churning waters and that they will give us more if their effort is welcomed widely in the Orthodox community.
The community indeed owes Rosenfeld and Ribner a debt of gratitude for taking this bold first step in giving young couples access to proper information about their intimate lives together and for doing it in a way that, readers will agree, sanctifies the Name of Heaven. Rabbis, doctors and others who provide counsel for young couples on such matters would be wise to read and recommend this book.
Richard Grazi, MD is the Founder and Medical Director of Genesis Fertility & Reproductive Medicine and the author of Overcoming Infertility: A Guide for Jewish Couples (Toby Press, 2005).
About the Author: Richard Grazi, MD is the Founder and Medical Director of Genesis Fertility & Reproductive Medicine and the author of Overcoming Infertility: A Guide for Jewish Couples (Toby Press, 2005).
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