My girlfriend looks like a different person now. It's a painful reminder of what I did to her.

How to Do It is Slate’s sex advice column. Have a question? Send it to Jessica and Rich here. It’s anonymous!

Dear How to Do It,

My girlfriend lost a lot of weight during a very rough patch, and while things are better now, every time the clothes come off, I see her ribs and hip bones and feel so guilty I can barely get hard.

I have a chronic illness. Last year, a new doctor switched me to a completely new drug combination. It had severe mental health side effects that neither he nor I caught on to. I became paranoid and left my girlfriend out of the blue. I burned professional bridges and hurt people I loved in different, bizarre ways. I was lucky—it only lasted two months. I had a terrifying inpatient hold, got off the medication, and started to rebuild my life. It honestly feels like a movie supervillain took the wheel for two months and tried to destroy everything I care about. It’s painful, and I’m on a waitlist for therapists who take my insurance now that I’m no longer eligible for acute care.

I apologized, and my girlfriend took me back. We’ve mostly gotten on the same page. She knows what happened, and I take responsibility for it, but she doesn’t blame me for the things beyond my control. But while I was sick and right after, she lost a lot of weight from the stress. She used to be curvy with big hips and big breasts, overweight on paper. Now she’s what her doctor says is healthy, but her face looks hollow, and she has visible bones where she never used to. She bruises more easily, and I can’t stop thinking about how I hurt her emotionally, and now it’s visible physically. It’s messing with my head when we do have sex, and she has messy feelings about her very slow weight re-gain, so I don’t want to bring it up. How do I handle this in bed?

—Picking Up the Pieces

Please keep questions short (

Rich Juzwiak: Sometimes I think grief or guilt can be a little bit selfish and tainting. Obviously, our writer affected their girlfriend’s life a lot. But she is also an independent person who responded to this the way that she did.

And so, even though the letter writer’s behavior seemed to lead to her weight loss, it was the girlfriend responding as well. So it’s a little bit egocentric to say, “This is all my fault. I did this and now I’m looking at what I did,” even if it was kind of triggered by this event. The girlfriend is an adult as well, who made her decisions and who responded accordingly. I don’t know that the weight loss was entirely in her control, but objectively speaking, I don’t think that this is completely the letter writer’s fault, and thus, they should not have to carry all this guilt.

Jessica Stoya: It very much seems like the movie supervillain narrative is the dominant one here. And while it could, for a different person, lead them to think, “It’s like some other person took control, and now my life is ruined, and I have no responsibility here,” our writer seems to have gone in the complete opposite direction, which is that they, through a complicated choice—which we can dig into in a minute—allowed a supervillain to control of their brain and body and have caused all this harm.

It’s also possible that the girlfriend has another health issue going on that has nothing to do with the writer, and everything just coincidentally occurred at once. Or that the stress that the girlfriend went through, because of what was happening with the writer, caused a first flare-up of something that was an underlying condition.

So even though it’s the girlfriend’s responsibility to take care of her own health, I would, in case the girlfriend is also reading this, encourage her to get a medical opinion about what’s happening. Don’t let this narrative lock in a set of beliefs that then prevent important medical follow-up.

Rich: Yes.

Jessica: I’m not an expert on bodies, but the bruising more easily feels like a big flag.

Rich: Yes. The letter writer mentions the girlfriend has messy feelings about her very slow weight regain. And the writer mentions, “I don’t want to bring that up.” But what’s that about? What is the actual goal here? How does the girlfriend feel about this stuff? Is she actively trying to gain the weight back? And why? And is it the letter writer’s influence?

Because what happened in the past is in the past, and there has been forgiveness. Please don’t pressure her to gain that weight back now, if you feel some responsibility for her weight loss. In particular, what complicates things here, too, is that she’s been told that this is now a healthy weight by a doctor, which could have its own kind of prejudices. Doctors can be very tough on their patients about weight.

So I don’t want to automatically side with the doctor. But there is a possibility that the writer is so wrapped up in this narrative and their guilt that they’re, again, not seeing the bigger picture. This might be what the girlfriend wants. Maybe this is healthier for her, for whatever reason, because, obviously, people can be healthy at lots of different weights. But weight can have a lot of complicated repercussions.

So I would just, as much as possible, try to take a step back and let her be. Maybe having a conversation to get some clarity on where she is at exactly and what her goals are could be useful.

Jessica: For sure. So let’s talk about guilt and blame in the situation that led up to why our writer wrote in. It is perfectly reasonable when you have any kind of health condition, including a chronic illness, to put a lot of weight on the medical advice of the doctor in question. That’s a totally normal thing humans do, even when we’re talking about chronic reproductive system difficulties in people with ovaries, and uteruses, and all these parts that medical science has not studied as well as we would like.

Still, you go to a doctor, and unless the doctor seems completely unhinged, or is telling you something that is at odds with, for instance, basic anatomy, you’re probably going to say, “OK, we’re going to do this the doctor’s way.” So listening to your doctor at the time is not something to beat yourself up over. And the doctor bears some responsibility for knowing that severe mental health side effects are possible, and for communicating to the patient. Whether we’re talking about RFK Jr. or women who are fed up with super heavy periods being brushed off, there’s only so much doing your own research that a patient, without having a medical degree themselves, can really be expected to do.

So while we, or the writer, might feel that perhaps it would’ve been more ideal for the writer to have noticed, “These thoughts are strange for me. I’m going to check in with my doctor or get into a mental health professional’s office ASAP,” I don’t know that it’s a reasonable expectation for anyone to notice that they’re going off the rails in a way that they aren’t familiar with.

Rich: Right. And the greater point there is that the writer can ease up on themselves about that because that was also beyond their control.

In the meantime, the writer wants to know about reconnecting through sex. But they have so much going on that getting to the sex part feels a little bit less of a priority here. They need to focus on rebuilding the relationship and working through it, because I’m not convinced that part is done. The writer acknowledges that to a certain degree by saying, “I’m waiting for the therapist.”

Jessica Stoya
My Girlfriend Has a Way to “Finish the Job” in Bed. I Hate Every Second of It.
Read More

We’re not sidestepping the sexual question. You just have to get this stuff straight before you can actually approach that element of your relationship. Sure, some people can go through a crisis and remain sexually connected.

But in a lot of cases, that doesn’t happen. This is a case, too, where you have to renovate the house before you can sleep in the bedroom. You can’t just beeline there. So I think, number one, this is a matter of time. This is something that needs to be worked through, and you just have to allow yourself to re-acclimate.

Jessica: I completely agree. And to belabor the renovation metaphor: Let’s say that before the demolition, the writer always slept on the left side of the bed, and the girlfriend always slept on the right side of the bed. That doesn’t have to be how you arrange yourselves in the bed right now or moving forward.

So under all of the guilt, and medical/psychological layers of this question is a really simple one: “I can’t get an erection because X, how do I have sex?” The simple response is, ask yourself what you and your partner get out of physical intimacy. Even though I know it’s difficult, try to set aside the usual scripts for a penis needing to be hard and used for penetration. Come at it from a fresh perspective. Ask yourself: How can I, with my body, give and receive what is important about intimacy as my body is now?

Rich: Don’t be afraid to rely on external help, like a cock ring or a PDE5 inhibitor. Even if you are situationally experiencing erectile dysfunction, there’s a lot of anxiety that comes with that. These pills can help alleviate that anxiety, which can help you get an erection. So rely on the help that’s out there in this period, when you do sort out where you’re at sexually.
It seems to me like couples therapy could help, too.

Jessica: If infinite resources are possible, I would say, go for the individual therapy, couples therapy on top of that, and maybe also see someone who specializes in sexuality. However, given that the writer is waiting for a therapist who is covered by insurance, that indicates to me that the resources might be scarce. In which case, my instincts say that the writer, working through all of the guilt that they have in this situation, and the harm they experienced going through all of the events that led to now, is going to be the keystone of working through all of this.

Rich: So again, just to underscore, be forgiving to yourself. Even if you did things that you regret, you are not those things. Understand that this is a process, and work through it. That’s what you have to do now. You can’t change the past, but you can modify what you do now.

Jessica: It’ll be really useful for the writer and the relationship to understand for themselves and the girlfriend what the point of having sex at this time is. What is the aim, the motivation?

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My girlfriend looks like a different person now. It’s a painful reminder of what I did to her.

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