In therapy for sexual disorders there is no change without work. The sex therapist offers herself as an educator, a person who is prepared to sit down with the individual or couple and work out a solution. The sex therapist devotes much of the therapy time to discussion. Some problems may be solved by a short informative discussion. Despite the advances in sex education, many people still have misconceptions about sex, or their sexual organs, or sexual functioning. No one who believes he/she has a problem goes directly to a sex therapist.

The individual will first try to address the problem herself or talk with her partner about it. From there, they may read a book or article, talk to a friend, go on line or later talk about the problem with a medical doctor. Often times, couples will seek out a Marriage and Family Therapist who also has specialized training in sex therapy. (This is the case with almost all of my clients). Individual concerns like gender confusion, sexual orientation, sexual addiction, or issues around masturbation, or the more serious problems of the sexual predator make up a small percentage of clients seen in private practice. Not unlike communication problems, sexual problems arise within a relationship where two people are trying to communicate effectively (or have a mutually satisfying sex life!).

Sexual problems can be mutifaceted. It is the task of the sex therapist to ask frank questions, take a detailed history, and thoroughly discuss the various aspects of the sexual concern. In a nutshell, sexual problems in a relationship can be broken down to three areas:

Individual Issues. A complete history of each individual must be taken regarding their sex education, early sexual experiences, beliefs about sexuality and their sexual self concept. If there has been sexual trauma, or early signs of sexual difficulties, or negative attitudes about sex or body image, these can affect the current state of the couple's sexual relationship. Also, any current psychological problems such as depression and anxiety must be identified.

Couple Issues. Is the sexual problem a symptom of a relationship problem? Is there hidden anger, dislike, emotional distance, abuse? Is the couple's relationship healthy and free of power struggles and unresolved conflicts?

Sexual Issues Within the Relationship. Is there a long history of sexual incompatibility? How has the problem been handled in the relationship? When did it start, and what efforts have the couple made to fix the problem? Typically, a sexual problem gets worse over time because the couple does not know how to deal with it in a healthy way.

What Kinds of Problems Can be Helped?

SEXUAL DESIRE DISORDERS are problems associated with the desire phase of sexual functioning. This includes Lack of Sexual Desire, and Discrepancies in the Partners' Sex Drive

SEXUAL DISORDERS - WOMEN include the following:
* Painful Sexual Intercourse - Dyspareunia is the name given to this. Women can experience pain in the vagina due to poor lubrication. This can be caused by inadequate excitement or insufficient foreplay. Also, infections of the vagina may inflame the mucous membrane lining. Post menopausal women may experience pain because of the thinning of the vaginal walls or inadequate lubrication. Anything that is unnatural to the vagina like sprays, some douches and lotions must also be considered because they are an irritant to the mucous membranes. Deep pain in the pelvis also can be caused by psychological factors.

* Vaginismus is a spasm of the muscles surrounding the vaginal entrance. The condition may be present to varying degrees; however, in a severe form, penetration is almost impossible. The majority of cases of vaginismus are due to unfortunate experiences during attempts at intercourse, or during rape episodes. In cases of primary vaginismus (where a woman has never been able to have intercourse because of the condition), repressive sexual upbringing is frequent.

* Orgasmic Dysfunction. Many women request sex therapy because they find it difficult, or impossible, to obtain orgasm during sexual intercourse. This may be a problem to the client, but this is not a sexual dysfunction. Less than one-fifth of women do reach orgasm through sexual intercourse alone. Orgasmic dysfunction is represented by the woman who has frequent or severe difficulty coming to orgasm by any method during a sexual encounter. The woman often responds well sexually as far as the plateau phase. Her difficulty may be solely the inability to come to orgasm despite every effort even though she is both excited and lubricated. Education, practice through masturbation, and the resolution of any couple or individual psychological problem may resolve this issue.

SEXUAL DISORDERS - MEN include the following:

* Erectile Dysfunction. Masters and Johnson considered that a failure of erection in twenty-five percent of attempts at sexual intercourse was a "persistent" inability. Usually, the man who has erectile difficulty can get erect before sexual intercourse, but may lose the erection during or shortly after penetration. The man may still ejaculate because erection and ejaculation are two separate functions. There are different degrees of erectile dysfunction and it is common for all men to experience some occurances of erection problems in thier life time. With the advent of medications to treat Erectile Dysfunction, this problem is treated more easily today than in the past.

* Rapid Ejaculation. This is a condition where orgasm and ejaculation occur before or immediately after penetration (within 30 seconds). Many cases are referred at the partner's instigation because it is usually the partner's dissatisfaction which brings the matter to the therapist. It is usually found that the condition has been present during the whole sexual life of the client. Ejaculatory control can be learned through exercises and homework assignments given the couple during sex therapy. There is also a positive influence on rapid ejaculation by certain antidepressant medications. The combination of cognitive/behavior intervention and medication can be effective in treating rapid ejaculation.

* Delayed Ejaculation. This is the persistent inability to ejaculate in the vagina during sexual intercourse, but the same problem can occur during masturbation when a partner is not present. Some medications and diseases such as diabetes, and prostate disease can create this condition, but this is rare. Delayed ejaculation can be due to low sex drive, but the condition also appears in men who have a good sex drive. Either the client is insufficiently excited or aroused or is unable to relax sufficiently to allow orgasm. A sexually repressive upbringing with much guilt and many prohibitions often appears in the history. Psychological problems can also be the cause of this condition.


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