Psycho-sexual issues

Sexual problems represent a large spectrum of physiological and psychological illnesses that can affect individuals of both sexes along their life. Wether one is involved in a couple relationship or not, sexual disorders may or may not occur. In the same time, nothing guarantees that a person involved in a couple relationship is somehow immune to the development of sexual disorders.

Causes:

The causes of sexual problems are very diverse and can be grouped in:

Physical causes: abnormal functioning of the body and sexual apparatus:
a condition that prevents the realization of any sexual act, a recent surgery (Diemont, Vruggink, Meuleman, Doesburg, Lemens & Berden, 2000), use of certain mediation (antidepressants are known for reducing libido (Mitchell & Popkin, 1983), as is anti-hypertensive medication (Hoggan, Walin & Baer, 1980), use of contraceptives may reduce libido and lubrication with women etc).

Psychological causes: all the feelings, thoughts and attitudes that lead to sexual problems. Such feelings can be motivated by a disfunction of the couple (maybe one of the partners has cheated on the other one, perhaps someone lied or offended the other in a way), bad feelings about self-appearance (due to aging, weight loss or gain etc), recent unpleasant facts (a difficult moment at the job, bad news, stress etc), old trauma (people abused during their childhood meet with difficulties later on in their sexual relationships), personal attitudes about sex (some people can find certain practices enjoyable, while others dismiss them from the start).

Social causes: education, culture, religion and other factors that make an impact both on one’s sexual development as well as on the social limits in which it is allowed to be expressed.

Sexual disorders:

According to DSM-IV, there are 3 main categories of sexual problems: sexual dysfunctions, paraphilias, gender identity disorders and sexual disorders not otherwise specified.

Sexual dysfunctions:

• Hypoactive sexual desire disorder is defined as a deficiency or absence of sexual fantasies and desire for sexual activity in a person without it being caused by drug use or medical conditions. In order to qualify this as a problem it is important for the individual and/or the partner to have been affected by that situation.
• Sexual aversion disorder: fear, disgust and anxiety feelings in relation to sexual organs and sexual activities. Education and a childhood guided by tutors who believed and instilled in the children the belief that sex is dirty and evil may be some of the be possible causes of such feelings.
• Female sexual arousal disorder: difficulties or impossibility of getting aroused before or/and during sexual intercourse. Lack of vagina lubrication is a sign of possible arousal disorder.
• Female orgasmic disorder: difficulties or impossibility to reach orgasm despite the long sexual stimulation. There is also a male orgasmic disorder, although it is much rarer.
• Dyspareunia – a sexual disorder that manifests as pain during sexual intercourse. It can be seen both in men and women, but it is statistically happening more often in women.
• Vaginismus: quite a rare feminine sexual disorder that manifests as strong vaginal contractions that prevent the woman from enjoying the act of sexual intercourse because of severe intense pain. Sometimes the pain may be so great that it renders the penetration impossible.
• Male erectile disorder: difficulties in obtaining or maintaining a satisfactory erection that prevents the man from having sexual intercourse. It happens more often at older ages.
• Premature ejaculation: a sexual dysfunctions that happens quite often at young ages. Ejaculation happens very quickly, as a result of a very brief and superficial stimulation.

Paraphilias: “Paraphilia are the recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other non consenting persons, that occur over a period of at least 6 months.” (DSM-IV, p. 523). It is more than fantasy since people with such disorders cannot be aroused without being stimulated by those unusual factors. Examples of paraphilias: exhibitionism, voyeurism, frotteurism, fetishism, sexual masochism, sexual sadism, pedophilia.

Gender identity disorders: in order to put such a diagnosis, “there must be evidence of a strong and persistent cross-gender identification (and) there must be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex.” (p. 533). Although still classified as medical conditions by DSM-IV, people go to therapy in order to get support and counseling to fight with a hostile, narrow-minded society, not to fix their condition.

Sexual disorders not otherwise specified: refer to distress due to sexual performance, as well as distress about objectifying sex partners and about sexual orientation.

Therapy:

Not all sexual disorders can be healed through psychological therapy (especially if there is a medical condition involved, such as drug use or certain reproductive problems). However, psychotherapy is often times the best solution to deal with sexual and couple problems. People can go to a therapist individually or as a couple. Together with the therapist, they discover the causes of the sexual dysfunctions in their life and often times end up understanding and solving more about their life than the sexual issue. The most widely used therapies for sexual problems are (Sadock & Sadock, 2007):

• Interpersonal therapy: develops communication skills between the partners so that they get to better understand the problem and the possible causes that have lead to it;
• Cognitive behavioural therapy: helps the client get control over his/her thoughts that lead to bad feelings and anxiety in relation to sex (low self-esteem,feelings of shame, fear etc).
• Hypnosis: often used with cognitive behavioural therapy techniques
• Behavioural training and specific techniques to make the client develop sexual experience: notions about masturbation, methods of avoiding premature ejaculation, methods of relaxing and gaining confidence for women predisposed to vaginismus etc.

Whatever the problem is, overcoming the fear and shame and searching for a therapist is always a much better option that silently enduring the frustration and resentment of a sexually incomplete or unsatisfactory life. With the right therapist and with lots of confidence in yourself and your partner a solution can be found to whatever problem.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author
Diemont, W.L., Vruggink, P.A., Meuleman, E.J., Doesburg, W.H., Lemmens, W.A., Berden, J.H. (2000). Sexual dysfunction after renal replacement therapy, American Journal of Kidney Dis., 35(5), p. 845
Hogan, M. J., Wallin, J. D., & Baer, R. M. (1980). Antihypertensive therapy and male sexual dysfunction. Psychosomatics, 21, p. 234-237
Mitchell, J. & Popkin, M. (1983). The pathophysiology of sexual dysfunction associated with antipsychotic drug therapy in males: A review, Arch Sex Behav 12, pp. 173–183.
Sadock BJ, Sadock VA (2007). Abnormal sexuality and sexual dysfunctions. In Kaplan and Sadock’s Synopsis of Psychiatry, 10th ed., pp. 689–705. Philadelphia: Lippincott Williams and Wilkins.