Sexual Issues Page for Bay Area Psychologist - Web Site for Dr. Jennifer Poirier, Ph.D.


		Do you experience any of the following? Pain during intercourse? Decreased interest in sex? Difficulty becoming aroused or staying aroused? Problems with penetration? Difficulty experiencing orgasm? Guilt or shame about sexual activities? Problems in your relationship related to sex? Feeling compulsive about engaging in sexual activities? Other problems having to do with your sexuality? Sexual problems are common Sexual problems among women and men are more widespread than is often suspected. When researchers* asked a random sample of U.S. women to report on "sexual problems experienced in the last year for several months or more," they found: 33.4% reported lack of interest in sexual activity 24.1% indicated lack of orgasm 21.2% reported sex was not pleasurable 18.8% reported difficulty with lubrication 14.4% reported pain during sex Similarly, when researchers asked a random sample of U.S. men to report on sexual problems, they found: 14.7% reported lack of interest in sexual activity 7.8% indicated lack of orgasm 8.3% reported sex was not pleasurable 10.2% reported difficulty with maintaining or achieving an erection 30.7% reported that they climaxed earlier than they wanted Therapy may help Many sexual problems are caused at least in part by psychological factors. By addressing these factors through psychotherapy, you can alleviate the problem, and have a more satisfying and fulfilling sex life. Because sexual problems can be due to physical causes, the first step to addressing a sexual problem is seeing your physician. However, there are often psychological factors as well. For example, any of the following can have an affect on the quality of your sexual life: Past sexual experience Stress Communication patterns in your relationship Activity level What is "sexual dysfunction"? In medical terms, some sexual problems are referred to as "sexual dysfunctions." Because of this, you may have heard of terms used to describe what you are dealing with without knowing exactly what the terms mean. Although not all sexual problems can be easily categorized, there are some problems that have specific names and common symptoms. A list of common sexual dysfunctions and their definitions follows: Sexual dysfunctions specific to women:* Female Sexual Arousal Disorder Female Orgasmic Disorder Vaginismus Sexual dysfunctions specific to men: Male Erectile Disorder Male Orgasmic Disorder Premature Ejaculation Sexual dysfunctions of both sexes: Hypoactive Sexual Desire Disorder Sexual Aversion Disorder Dyspareunia Female Sexual Arousal Disorder Female Sexual Arousal Disorder (FSAD) is indicated by the lack of physical (for example, lubrication of and blood flow to the vagina) and subjective psychological (that is, thoughts and feelings) sexual response. This disorder has unknown prevalence, though it is thought to be most commonly seen in conjunction with other sexual dysfunctions, such as dyspareunia or female orgasmic disorder. Treatment should first examine physical factors. Additionally, psychotherapy, with a focus on issues such as worries about contraception, inadequate stimulation, or lack of attraction to a partner may be useful. Back to list of dysfunctions Female Orgasmic Disorder Female Orgasmic Disorder is defined as a frequent delay in or lack of orgasm. Lack of orgasm during intercourse is not considered to be a dysfunction if the woman can reach orgasm through other means. Psychological and interpersonal factors, such as believing that sex as shameful or having a history of unpleasant sexual experiences, can contribute to lack of orgasm. Physical factors more rarely play a role, although there are a substantial number of women who complain of orgasmic delay due to taking a specific type of antidepressant known as an SSRI as well as other antidepressants. For orgasmic disorders that are not medication-induced, treatment can include bibliotherapy, therapy with a clinician trained in sex therapy, masturbation, or a combination of these treatments. When treatment is performed by a trained professional, success rates are in the 88-90% range for becoming orgasmic during masturbation and around 25-75% for becoming orgasmic with a partner. Back to list of dysfunctions Vaginismus Vaginismus is the recurrent, involuntary spasming of the muscles of the outer third of the vagina. The response is usually triggered by a fear that accompanies the anticipation of penetration of the vagina. Vaginismus is less common than dyspareunia, and is often due to an association between vaginal penetration and a negative or painful experience. Causal factors are primarily psychological, and can include: sexual inhibition, sexual trauma, negative feelings toward sexual partner, and phobia about sexual response or intercourse. Treatment requires both physical and psychological approaches, in which the cycle of anxiety is slowly broken down by pairing relaxation with the use of a series of dilators. Back to list of dysfunctions Male Erectile Disorder Male Erectile Disorder is indicated by the lack of physical sexual response. The difficulty may be in becoming erect or in maintaining an erection. Treatment should first examine physical factors. However, when physical treatment is not indicated, a cognitive-behavioral psychotherapy may be useful. Back to list of dysfunctions Male Orgasmic Disorder Male Orgasmic Disorder is defined as a frequent delay in or lack of orgasm. As in Female Orgasmic Disorder, psychological and interpersonal factors, such as believing that sex as shameful or having a history of unpleasant sexual experiences, can contribute to lack of orgasm. Although physical factors are not usually causal, it appears that antidepressants may cause orgasmic delay. For orgasmic disorders that are not medication-induced, treatment can include bibliotherapy, therapy with a clinician trained in sex therapy, masturbation, or a combination of these modalities. Back to list of dysfunctions Premature Ejaculation Premature, or early, ejaculation is the recurrent experience of ejaculating with minimal sexual stimulation before, on, or shortly after penetration, and sooner than the man wishes to ejaculate. In this disorder, the man is unable to voluntarily control the timing of his ejaculation to the extent he desires. Cognitive-behavioral psychotherapy has been shown to be very effective with this problem, with over 90% of men reporting satisfactory ejaculatory control after 14 weeks of therapy.** Back to list of dysfunctions Hypoactive Sexual Desire Disorder Hypoactive Sexual Desire Disorder (HSD) is defined as a low level of interest in sexual activity that causes the person distress, often indicated by persistent or recurrent lack of sexual fantasies and desire. Factors found to be associated with decreased desire include: medical illness, depression, stress, interpersonal conflict, hormonal imbalance, and the use of certain medications (e.g., many antidepressants) or recreational drugs. Back to list of dysfunctions Sexual Aversion Disorder Sexual Aversion Disorder is an extreme aversion to, and avoidance of, all genital sexual contact with a partner. This diagnosis is rare. The causes are usually negative interpersonal or intrapersonal factors such as extreme negative thoughts about intercourse or a having had painful, phobia-inducing sexual experience. Psychotherapy, either couples or individual, can be useful in resolving the aversion. Most often, therapy includes cognitive-behavioral techniques, desensitization, and, when appropriate, working through issues of past sexual assault. Back to list of dysfunctions Dyspareunia** Dyspareunia is a recurrent genital pain that occurs before, during, or after intercourse. Both physical (e.g., injury, endometriosis, scarring) and psychological (e.g., guilt and shame, relationship difficulties) factors can be causal factors. Lack of lubrication may be a contributing factor to painful intercourse. If physical causes are found, they may or may not be responsive to treatment. In conjunction with any physical treatment, or when physical treatment is not indicated, psychotherapy may help the woman deal with feelings and behavioral interactions associated with the sexual pain. Although tricyclic antidepressants (TCAs) have been shown to help alleviate pain associated with intercourse, their use must be decided upon judiciously, given their potential for causing decreased desire and difficulty with orgasm. Back to list of dysfunctions Laumann, E.O., Gagnon, J.H., Michael, R.T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States.* Chicago: University of Chicago Press. Back Laumann, E.O., Paik, A., Rosen, R.C. (1999). Sexual dysfunction in the United States: prevalence and predictors. in the Journal of the American Medical Association, 281(6), 537-544. Back Adapted from the "Female Sexual Dysfunction" entry in The Corsini Encyclopedia of of Psychology and Behavioral Science, Third Edition, Volume 2, New York: John Wiley & Sons, authors Jennifer Poirier, Ph.D., and Julia Heiman, Ph.D. Back ***Kaplan, H.S. (1989). How to Overcome Premature Ejaculation. Brunner-Mazel. ISBN: 0-87630-542-7. Back
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