Josephine had one request when she came to the Sexology Clinic: that I ask her husband to get into an extramarital affair. I reclined back on my seat, not sure of where this was headed.

“If he hears it from you am sure he will oblige,” she said, “My pleas to have him get another woman have fallen into deaf ears.”

The couple had been married for 13 years and had four children. Josephine was 42 while Justus, her husband, was 40. Life had been good for the first 10 years of their marriage then Josephine lost her libido. She was never in the mood, a common occurrence which is sometimes due to hormonal or life circumstances but which can be transient.

Justus, unfortunately, could hear none of it and kept forcing his wife. The action became painful for Josephine as her body and mind failed to respond to Justus’s advances. She dreaded sex. A gush of sweat drowned her and she got a throbbing headache.

The result was that Josephine resented Justus’s touch. She slept in her jeans and sweater at the bed’s edge. Justus got offended in return and fought back, accusing her of not fulfilling her marital obligations. Josephine told him to get another sex partner.

“I feel rejected, she needs to tell me what wrong I have done to deserve this,” Justus said when we met at the clinic, “Could my wife be sleeping out and so persuading me to do the same?”

After a full assessment, I concluded that Josephine had severe sexual performance anxiety and was sliding into sex aversion. Sexual performance anxiety is a situation where the thought of or exposure to a sexual situation causes one to be extremely scared. You get the same feeling you would get if you suddenly met with a lion or an armed robber ready to shoot. Your body releases adrenalin causing your heart to pace, you sweat, and your headaches. You take off and run for your life. Unfortunately, in a sexual situation, you cannot run and so you get the feeling of being in danger and you cannot escape.

Sexual performance anxiety is common. About a quarter of men and 15 percent of women face it at any given time. The severity of the condition may differ from person to person or according to the situation. An affected man loses his erection. If they get some form of erection, it may disappear halfway through. Some men also ejaculate prematurely. Affected women will not lubricate. As a result, they get pain during sex.

Sexual performance anxiety starts with an incidental sexual failure. A man may have lost an erection because of a trivial reason then this goes into his head as a failure. Similarly, a woman may have had an isolated episode of sex pain which complicates into a psychological fear. In some cases, relationship problems are the cause. Where intimacy is failing, sex desire for your partner goes and if the relationship issues are not resolved, your body soon shuts up. If you continue having sex against your will then anxiety crops in.

“All that is a well-understood doctor but then can my request be granted?” Josephine interjected.

“The marriage will continue, I promise, but let Justus look for another sex partner,” she said with finality.

Sexual performance anxiety is traumatising. There are men, for example, who will stay the whole night watching TV to avoid a sexual encounter. Some get into alcohol while others become violent, all because they want to keep the woman at a distance and evade a sex situation. Women are also known to walk out of marriages when the anxiety becomes unbearable.

Marriages do not however have to collapse due to sexual performance anxiety. Whether it is a man or a woman who is inflicted, therapy protocols have been developed in addition to medicines to help resolve the condition. The most important thing is that one gets insight into their condition and accepts help. The treatment takes time and so the commitment of the couple to be helped is key to treatment success.

Josephine and Justus had a record 20 therapy sessions for six months before things were fully resolved.