is Sexual Dysfunction?
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?
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?
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?
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