Sexual dysfunction refers to any difficulty experienced at any phase of the sexual response cycle (excitement, plateau, orgasm and resolution) that prevents the experience of satisfaction as a result of sexual activity. Research suggests that 43% of women and 31% of men report some sexual difficulties, however, many are hesitant to discuss it. Because treatment is available, it is important to share any sexual concerns with your partner and health care provider. Sexual disorders are generally classified into four categories:
- Desire disorders — lack of sexual desire or interest in sex.
- Arousal disorders — inability to become physically aroused or excited during sexual activity.
- Orgasm disorders — delay or absence of orgasm.
- Pain disorders — pain during intercourse.
Sexual dysfunction can affect people of any age, however, it is more common in those over the age of 40 because it can be related to a decline in health associated with aging. It is also more common in females.
Signs of sexual dysfunction
- Unable to achieve or maintain an erection suitable for intercourse (Erectile Disorder).
- Absent or delayed ejaculation despite adequate sexual stimulation (Delayed Ejaculation).
- Unable to control the timing of ejaculation (Premature [Early] Ejaculation).
- Unable to achieve orgasm (Female Orgasmic Disorder).
- Inadequate vaginal lubrication before and during intercourse (No DSM-5 diagnosis)
- Unable to relax vaginal muscles enough to allow intercourse (Genito-Pelvic Pain / Penetration Disorder)
- Unable to become aroused (Female Sexual Interest / Arousal Disorder)
Possible reasons for sexual difficulties
Physical: Diabetes, heart and vascular disease, neurological disorders, hormone imbalances, chronic diseases (e.g. kidney or liver failure) and substance abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual functioning.
How do psychologists treat sexual dysfunction?
Once any underlying physical problems have been addressed or ruled out, seeing a psychologist can be helpful for treatment of a sexual disorder.
Individual psychotherapy: Therapy with a qualified psychologist (usually Cognitive Behavioural Therapy or Acceptance and Commitment Therapy) can assist in addressing sexual trauma from the past; feelings of anxiety, fear, or guilt; and poor body image. These are all factors that may be interfering during the sexual response cycle and thus impacting on current sexual functioning.
Couples therapy: A common underlying cause of sexual disorders can be other relationship problems that manifest subconsciously in the way the body responds during sexual intercourse. Therefore, attending couples therapy in order to identify and address such issues and improve the overall quality of your relationship may also be helpful for improving the quality of your sexual relationship.
Psychoeducation: Psychoeducation about sex, and sexual behaviors and responses, may help individuals to overcome any anxieties they may have about sexual function. Open dialogue with your partner about your needs and concerns also assists in overcoming many barriers to a satisfying sex life.
Sensate focus: This is a mindfulness-based treatment developed specifically for addressing sexual disorders. A trained therapist guides the timing and technique of the sensate focusing. In the first stage, the couple may touch each other in a mindful way (excluding breasts and genitals), becoming increasingly aware of the texture and other qualities of their partner’s skin, focusing particularly on what they enjoy about their partner’s body rather than what their partner may enjoy. The second stage increases the touch options to include breasts. Sensation and gathering information about the partner’s body is still encouraged and intercourse and touching genitals is still off-limits. Participants are encouraged to place their hand over their partner’s hand in order to show what they find pleasurable in terms of pace and pressure. Learning about the partner’s body is still the goal. Further stages include the gradual introduction of genitals and then full intercourse. Orgasm is never the focus.
Can sexual dysfunction be improved?
The success of treatment for sexual dysfunction depends on the underlying explanation for the problem. The prognosis is positive for dysfunction related to a medical or psychological condition that can be treated or reversed. Mild dysfunction that is related to stress, fear, or anxiety can often be successfully treated with psychotherapy, psychoeducation and improved communication within the relationship.
If you are currently experiencing sexual difficulties, speak to your GP or another relevant health professional in order to explore any medical or psychological explanations for this problem. They may refer you to speak to a qualified psychologist, either individually or with your partner, in order to further discuss your difficulties and treatment approaches that may assist you.
Cleveland Clinic. (2015). An Overview of Sexual Dysfunction. Retrieved from: http://my.clevelandclinic.org/health/diseases_conditions/hic_An_Overview_of_Sexual_Dysfunction