Sexual dysfunctions are conditions that impair sexual satisfaction. This can manifest as reduced desire to initiate or sustain sexual activity, or lack of ability to achieve sexual satisfaction. Epidemiological data suggests that the prevalence rate for all sexual disorders is approximately 31% for men and 43% for women. (Blaney & Millon, 2009, p. 399) That rate is given to fluctuate, however, depending on the definition of what a “dysfunction” actually entails. The reality, for Blaney & Millon, is that any particular label or operational definition is imperfect and subject to alterative interpretations. The key consideration for the therapist is that we must been seen as nonjudgmental.
I am not overly surprised by the suggestion that Americans have never learned to be comfortable talking about things sexual. “Even couples who have been together for many years, and experienced physical intimacy hundreds of times, are still often most reluctant to reveal their sexual desires, fears, and concerns to each other.” (Blaney & Millon, 2009, p. 400) This is the 21st Century; it’s perfectly acceptable (even desirable)… this is foreign to me.
“Rewarding sexual activity requires the adequate functioning of at least three organ systems: cardiovascular, hormonal, and neurological.” (Blaney & Millon, 2009, p. 401) These systems can be adversely affected by medications, particularly SSRI Antidepressants. Virtually any medical condition that affects those systems; including illnesses, treatments, procedures, and changes- could also serve as precipitating factors. Finally, culture and psychosocial variables weigh in as contributing factors, although “many people with sexual dysfunctions report none of these factors and many with one or more of these risk factors report satisfying and functional sexual lives.” (Blaney & Millon, 2009, p. 402)
If a regular partner is a variable, it is preferable to have them present and willing to participate in the process. “The involvement of the partner of the symptomatic client in treatment is widely believed to play an important (even critical) facilitative role in sex therapy.” (Blaney & Millon, 2009, p. 404) Even if the partner is unwilling or unable to be present for the office visits, partner cooperation and participation (along with sensitivity to partner issues on the part of the therapist) are “good enough” to make reasonable progress.
Knowing what is at stake is a key consideration for therapists to measure or ascertain. What if they therapy fails? Will the relationship end or will it continue? “Having more at stake in treatment (i.e., the continuation of the relationship) can sometimes serve as an important motivator for one or both partners.” (Blaney & Millon, 2009, p. 404) However, this presents negative aspects as well… primarily because it is an outward indication that there is serious dissatisfaction with the relationship.
Sexual pain disorders are another dimension of sexual dysfunctions that are often neglected. Recurrent or persistent genital pain in a female, typed dyspareunia, often causes marked distress. Vulvodynia, characterized by chronic vulvar discomfort or pain, is also not uncommon. The third common complaint is involuntary contractions or spasms of the outer third of the vaginal barrel, called vaginismus. This condition makes intercourse painful or impossible.
Treatment of sexual pain disorders always begins with a careful and comprehensive gynecological exam. “Among the many medical treatments that have been used, with at least some success, are the following: topical creams, oral medications, biofeedback, physical therapy, cognitive behavioral sex therapy, pain management, local anesthetic agents, topical estrogen, electrical stimulation of the vestibular area, and surgery.” (Blaney & Millon, 2009, p. 422)
Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.