Sexual Disorders and Sex Therapy

Sexual Disorders and Sex TherapyBy Gina CiprianoHaving issues with sex can feel like an isolating experience. However, “Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men” (Rosen, 2000). According to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), sexual disorders are diagnosed if the symptoms occur at least 75% of the time during sexual encounters and include the following:

• Female Orgasmic Disorder: Lack of or reduced intensity of an orgasm
• Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder: Lack of desire in relation to sexual stimuli
• Genito-Pelvic Pain/Penetration Disorder: Pelvic or vulvovaginal pain, tensing of muscles, or anxiety concerning vaginal penetration
• Delayed Ejaculation: Difficulties ejaculating or being unable to ejaculate
• Erectile Disorder: Inability to have, maintain, or achieve a rigid erection
• Premature (Early) Ejaculation: Ejaculation that occurs within one minute of vaginal intercourse
• Substance Induced Sexual Dysfunction: Sexual dysfunction that results from the use or withdrawal of a substance

Additionally, the DSM-5 explains the presentation of sexual dysfunction may vary. Depending on the level of distress a person’s symptoms cause them, sexual disorders are characterized as mild, moderate, or severe. Additionally, sexual issues can be:

• Situational: Issues with sex arise within a specific context (i.e., with a certain partner or during a specific situation)
• Generalized: Symptoms of sexual dysfunctions are experienced across all contexts
• Lifelong: Sexual dysfunction has occurred from a person’s first time of intercourse
• Acquired: A person did not experience distress when they first began having sex, but they acquired symptoms of a sexual disorder later in life

What Does Sex Therapy Entail?For many, the thought of attending sex therapy can be nerve-wrecking. However, a qualified therapist will spend time building a relationship with a person and will gently assist them in recognizing what sexual topics they would like to address within therapy. Specific interventions may include mindfulness, directed masturbation, cognitive-behavioral therapy, and psychoeducation (see female orgasmic disorder blog). Also, sex therapy entails taking an integrative approach, so a therapist will determine how a person’s biological, psychological, and social factors contribute to their problem. Below outlines contributing factors to sexual disorders that a therapist can help a client overcome (Weeks, 2005):

• Biological Factors: A therapist can work jointly with a medical professional to determine if a person’s biology is playing a role in their problem.
• Hormones (such as a decrease in estrogen or testosterone) can lead to sexual dysfunction
• Certain medications may lead to sexual issues. For instance, Selective serotonin reuptake inhibitors (SSRI’s), are commonly prescribed for anxiety and depression. However, they can reduce a person’s desire.
• Psychological Factors:
• Mental health issues (i.e. anxiety and depression) can prevent a person from actively engaging in sex or influence their ability to stay present during sex
• A person’s thought process when sex occurs may negatively contribute to the problem (i.e., thinking that they have to orgasm for their partner may lead to stress and prevent orgasm from occurring)
• Traumatic experiences can prevent a person from feeling safe when having sex
• Social and Cultural Factors: Family and/or Couple Therapy may benefit a person experiencing sexual dysfunction. The messages a person receives concerning sex/sexuality can greatly influence them.
• Communication between sexual partners may need to be adjusted in order to create a context that allows for sexual satisfaction to occur
• Cultural factors shape what many people view as a “normal” sex-life. For instance, people often characterize that having a high sex drive is vital for sexual health. However, many people do not experience arousal at the mere anticipation of having sex, and that is okay (Nagoski, 2015)!

References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.Nagoski, E. (2015). Come as you are: The surprising new science that will transform your sex life. Scribe Publications.Rosen, R. C. (2000). Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, 2(3), 189-195. https://doi.org/10.1007/s11920-996-0006-2Weeks, G. R. (2005). The emergence of a new paradigm in sex therapy: Integration. Sexual and Relationship Therapy, 20(1), 89-103. https://doi.org/10.1080/14681990412331333955Sex therapist in Jupiter, FL.