Gale Golden: A Life of Sexuality

By Katharine M. Hikel

Making sex anything but clinical–pioneer Gale Golden says “sex really does make the world go round.” Photo: Margaret Michniewicz

Vermont Woman recently enjoyed a delightful visit with Gale Golden, LICSW, BCD, a clinical social worker and clinical sexologist, author, expert witness, consultant, and pioneer in the field of sexuality and mental health. At age 66 she is also Clinical Associate Professor in Psychiatry at the University of Vermont College of Medicine. She maintains a private practice and is currently writing a book, In the Grip of Desire. She is an on-line advisor for SexualHealth.com.

In the Beginning

When I finished graduate school in social work at Bryn Mawr College, I worked for a few years to get my supervision and do my internship and then we moved to a town in upstate New York in the Mohawk Valley. Shortly after I moved there, a family friend knocked on my door and said, “You’ve got to help us start a Planned Parenthood because we need a social worker.” I said, “I’m a clinician, not an administrator,” but finally I agreed to do it. I became the first executive director of Planned Parenthood of the Mohawk Valley.

We recognized the needs of migrant workers and their families – there are a lot of farms in the area; migrant workers came to the Valley in the fall, and none of those women had any health care. So we would take buses out there, pack them up, and bring them to the clinic. I put together a group of volunteer physicians, who came into the clinic at night to provide health care for these women who’d never had any. We also reached out to women and families in the community as well.

We managed to get the first HEW (Health, Education, and Welfare) grant ever given for preventive care. Then I got pregnant, and so did all the other women on the staff; so when patients came to the clinic, there we were, all running around with big bellies. And I went around raising money for Planned Parenthood – as pregnant as could be! Those were exciting times for women: Roe v. Wade, setting up an infertility clinic as well as a reproductive health clinic within one Planned Parenthood, bringing sex education to the community and to the schools. I guess I was an activist and still try to be one today when the opportunity presents itself.

In those days there wasn’t much formal information around what to do about sexual problems. When we had clinics, any time anyone said “sex” in the examination room or wanted to discuss a sexual problem – they called me. My main intervention was that I didn’t faint when someone said “penis.”

I scrambled around to get every bit of knowledge I possibly could. I learned about a couple in New York, Shirley and Leon Zussman; he was an OBGYN and she was a PsyD. They had been among the first couples that Masters and Johnson had trained in St. Louis. Then they went out into the greater world, like Johnny Appleseed, and started the Long Island Jewish Sexuality Program. It was one of the first in the country. They became lifetime mentors and friends.

I also joined some of the earliest professional organizations and became active in helping them grow into the major professional groups in the field: for example, the Society for the Scientific Study of Sexuality, the Society for Sex Therapy and Research, and the American Society for Sex Education and Therapy. It was an exciting time in the field of sexuality. Now the field is well established with clinicians and researchers all over the world.

When I left the Planned Parenthood executive directorship, the same family friend, who was an obstetrician and gynecologist, came to me and said, “I need a therapist in my office, and you need to be in private practice. So I sat behind his great big desk – which I never would do ordinarily – and people began to come to me with reproductive health problems, and the rest is history. I was the first social worker to be in private practice in Utica, New York.

Moving On

I moved to Vermont in 1982, to work full-time in the department of psychiatry at the medical school. They hired me because they wanted someone who had a specialty in sexuality and could see patients with sexual problems as well as teach a course to first-year medical students in Human Sexuality. I had never been to Vermont, but this was my idea of a perfect place to live.

I became full-time faculty as a Clinical Assistant Professor of Psychiatry and Obstetrics-Gynecology. I practiced psychotherapy and taught the Human Sexuality course to the first-year students. I became involved in the infertility clinic and provided preventive mental health for the couples going through infertility work up. After two-and-a-half years, I decided to leave my full-time position and go into practice for myself in Burlington. I now have an appointment as an unsalaried faculty member and Clinical Associate Professor in the department of Psychiatry.

It was hard won to get a promotion when you are not fulltime faculty, but I earned my stripes. I lecture the medical students at various times during the year, and participate in teaching them interviewing skills in sexuality with people who are hired to act as “standardized patients”. In their evaluations, students would always remark that they wanted more about sexuality in their curriculum. So I started a “Brown Bag” lunch series called “Let’s Talk (More) About Sex.” It is an informal, lunchtime session for anyone who wants to come. I love it. I love the students and am happy to just be with them and mentor their interest in working with sexual issues with their patients. Sex is, after all, so central to each and every one of us. Sex really does make the world go ‘round, and when it is not working right it is truly a crisis in a person’s life. Their doctor should be able to help them.

The Essence of Sexuality

Sex has an emotional charge unlike any other type of human behavior. Humans have always been fascinated, perplexed, and repelled by sex. People live for it and die because of it. Even in these enlightened times, sex makes people anxious. In spite of the many years I have worked with people who have concerns about their sexuality, I am not immune to the anxiety either.

People are conflicted about sex. Think about the Victorian era, for example when people covered up the legs of pianos or went to museums in same gender groups because it was immodest to go with a gentleman or lady if there were nude paintings on display. This was also the era when the Marquis de Sade wrote erotica and men frequented the lavish and plentiful houses where prostitutes openly plied their trade.

Today, the expression of sexuality in the media leaves nothing to the imagination. With the advent of the Internet, sexual images and fantasy material can be accessed anywhere any time; you can even make your own fantasy material on your webcam or telephone as you go about your daily business. The questions on the SexualHealth.com website are primarily written by young people. The questions asked now are exactly the same as the ones I used to get on the three by five cards that I distributed when I spoke at high schools years ago. I’d hand the cards out so students could write questions on them privately and not have to stand up to ask about intimate things in front of their peers. The questions about sexual health are still the same; they come from all over the world.

It is important that we teach children that sex is a healthy activity and can bring much joy into a relationship. Too often the sex education programs are based on just the dangers sex can provide. There needs to be an integration of both points of view. When I used to speak at high schools, I talked about having orgasms, and intercourse because that was what students really wanted to know. If I were running the world, even for a couple of days, the first thing I’d mandate is not only that there should be reading literacy, but also sexual literacy! It is so central to a fulfilling life. We all exist because someone had sex with someone else; we owe our existence to sex.

In the beginning of my career, people came to my office wanting greater satisfaction from their sexual relationships: higher frequency; more and better orgasms; longer, stronger erections. Bigger, better, more are the hallmarks of the twentieth and twenty-first century. However, in recent years, the concerns people bring to me are more often about an excess of sex. People may be preoccupied with sexual fantasies for example, or repetitive sexual behaviors, and feel that sex interferes with their lives rather than enhances it. It is strange to try to conceptualize that, for some people, too much of a good thing can seriously interfere with their lives, that too much sex can be painful and harmful – even if it is not criminal or illegal behavior.

If somebody has erectile difficulty, or permanent loss of the capacity to have an erection – that’s a complicated problem. Maybe 90 percent of erectile difficulties are physiological. It used to be thought that they were psychological. And what’s really funny, I think, is that a lot of people come in here, and they WANT it to be psychological – because it’s fixable. Sometimes medication is useful for the performance-anxiety type of erectile difficulty. But most of the time there’s something really going on physiologically. For example, it can be the first sign of diabetes, cardiovascular problems, tumors, endocrine problems etc. So after taking a history I often send people back to a physician.

Two People Own the Same Sex Life

Only about 50 percent of men who take medications for erectile difficulty continue to take it. Often the reason is that the wife is not invested in the sexual relationship. Maybe 15 percent of men over 70 will have profound erectile loss, but most men have some erectile loss on and off throughout their lives – they may have had too much to drink or eat or be overtired. Women, as they age, may experience many physical changes that also cause sexual difficulties, such as vaginal dryness and pain. It is always important to have support to broaden the sexual repertoire as we move along in life. Sex does change but it can be a positive change if both people who own the sex life work together on making the changes. Doctors need to be invested in helping couples make these changes together.

The Stages of Sex

I have my “Epigenetic Theory” of life. Most people seem to think that at 21, they come out of the oven of life and they’re a perfectly-finished, fully-cooked gingerbread cookie. The piping is right; the raisins are in the right places; they’re perfect; and they think that all that happens between then and when they die is that they rot.

But what really happens is that every ten years or so, you morph into a different kind of cookie. In your forties, you’re the cream between the two Oreos – pressed between your children’s needs and your aging parents’ needs. When that stage is over, you morph into the ultimate macadamia chocolate-chip cookie in your fifties – and so on. Anticipating the changes and challenges of each stage of life make them easier to cope with.

When couples start life together, they have to realize they will move through various stages in their relationships as the years go by. Sex will not stay the same as it did when they were dating. Careers take time away from family life to build and become successful, children take time to raise. These happen at roughly the same time and it is a far cry from the idyllic honeymoon time when you first met and had no children.

Each person in the couple goes through these stages, but most likely at a different pace. If they survive that state of intense growth and what seems like they are just ships passing in the night or two people On parallel treadmills, they come back together as two autonomous people, the children leave, the marriage, more mature, more autonomous, survives and they sail off into the sunset. That’s a preventive model: if you know ahead of time what’s going to happen, you’re prepared to deal with it.

Most of the couples I see are heterosexual, but every so often a same-sex couple will come in for help with the same variety of concerns that heterosexual people come in with. There is a wonderful book, The Male Couple, by David McWhirter and Andrew Mattison, published back in the ‘80s, which is the best book on the subject, and highly translatable to heterosexual couples as well. People still idealize marriage. Even today with the divorce rate so high, people think, “It’s not gonna happen to me – we’re gonna live happily ever after.” It takes a great deal of compromise and patience to be in a partnership for many years.

Sex Ed

There’s a lot of controversy about what should be taught in school. Parents have very different ideas about how much is too much information. My feeling has always been: Don’t let the school do all of the job. On the other hand, don’t expect yourself to be the perfect sex educator, because a lot of us were brought up in households where talking about sex was taboo. It is hard to overcome that reticence. It’s really important, when a child asks questions, not to expect yourself to have all the answers, but to let the child that you know where to get them – and then follow through!

When your children are very young, become an askable parent. One way to be askable is to give kids permission to ask you questions. One way they are apt to ask is if you get some age appropriate books and leave them around or read them to the child. There is a good resource as to what to buy for all ages at SEICUS.com; you can also call Planned Parenthood. Parents should realize that they might not be comfortable with it; they shouldn’t expect themselves to know everything. But I wouldn’t leave it up to the schools. Often their programs promote the dangers of sex without a balanced discussion of the positive parts.

Then there’s this whole abstinence program. Back in 1979 I gave my first paper on the definition of intercourse. It fascinated me – the issues around unconsummated marriages, what the law said; how religions define it. In the medical dictionary in the library at Syracuse, if you looked up “intercourse,” the definition was “coitus,” and if you looked up “coitus,” the definition was “intercourse.” There wasn’t a lot of information!

In the past couple of years, ‘intercourse’ has come to mean any kind of genital contact between two people. Abstinence programs have been a big failure. They promote celibacy and abstinence. But teenagers today believe that if they have oral sex, they are not having intercourse. It is just unrealistic; and without good information, it is difficult to make good decisions about when it is okay to become sexually active.

Sex is and can be a healthy and life affirming activity. I am glad to have spent a lifetime learning its mysteries. It is so complex that we will never really be able to capture its essence, but I hope to spend the rest of my life trying.