The Psychology Service
Sexual Dysfunction

What is Sexual Dysfunction?

Sexual problems that come to our attention tend to involve either disorders of sexual desire, where there is no interest in sex (or more rarely excessive sexual interest) or of sexual arousal i.e. erectile failure, ejaculatory failure or premature ejaculation in males, or orgasmic failure in females. Lastly there is the condition of Vaginismus in women. Sexual problems can be symptoms of other conditions, for example in Depression, PTSD, or a Generalised Anxiety Disorder. They can occur as a side effect of medication and can be symptoms of physical ill health. They can also arise because of difficult experiences such as sexual abuse, rape or trauma.

What are the symptoms?

Symptoms in men include inability to achieve or maintain an erection, early or very delayed ejaculation, and lack or interest in sex. In females, symptoms include inability to achieve orgasm, lack of interest or revulsion for sex, or, in Vaginismus, intense pain on penetration due to involuntary spasm in the lower part of the vagina, sometimes preventing penetration altogether. Sexual problems also tend to have an impact on the person’s life in other ways, for example affecting their relationships, self esteem, confidence, and mood.

How long does it last?

The duration of sexual disorders is extremely variable, with some being very transient during a period of stress or ill health, and others being life long.

What is the treatment?

The first stage of any psychosexual intervention is a full assessment which will assist in identifying those problems that might have a psychological origin, those that might be more physically based or a combination of the two. The therapist will then indicate an appropriate treatment plan. It is often best for a couple to be treated together, even if it is clear that one “has the problem,” as otherwise treatment may be less effective. However, this is not essential and therapy can be orientated toward the single person. One of the commonest approaches is “sensate focus”, which involves a graded approach to sexual contact while eliminating pressure to “perform” in order to reduce anxiety. CBT in combination with this approach has also been found useful. However, where a psychosexual problem arises following trauma, then it is usually the case that the traumatic response would be addressed first.