Psychosexual Issues

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Sexual problems affect almost everyone at some stage in their life – sometimes these problems resolve themselves but other times expert help may be needed. Psychosexual therapy (PST) has proven success rates and is often referred to by GPs and other medical professionals. Sex therapists are trained counsellors who've undertaken extra training in psychological and physical issues related to sexual functioning and they are able to deal with almost any sexual problems that are causing distress. Some of the most common psychosexual problems are listed below:

Sexual dysfunctions

The most common sexual dysfunctions in men are erectile impotence and premature ejaculation, and in women, failure to reach orgasm or vaginismus. Sexual dysfunctions are generally problems that make sex difficult and prevent the individual or couple from enjoying sex. These problems can begin early on in a persons sex life, develop suddenly after previously enjoying satisfying sex or develop gradually. Sexual dysfunctions are usually categorised into the following areas:

Inhibited sexual desire (ISD)

Although it is common for sexual desire to fluctuate at different periods in a persons life, ISD is the persistent loss of desire. This is more common in women than men, however both can be affected. Some causes of this condition include depression, anxiety, alcoholism, aging, fatigue, pregnancy, stress, sexual trauma and relationship problems. Decreased libido can also be caused by a decrease in normal estrogen (in women) or testosterone (in men and women).

If testosterone deficiency is the cause of ISD, replacement therapy is usually recommended. Alternatively, a sex therapist or other appropriate specialist is helpful to try and determine the underlying cause.

Sexual pain disorders

Sexual pain disorders affect women and are known as dyspareunia and vaginismus.

Dyspareunia is a condition characterised by recurrent pain with sexual activity (usually during penetration, but can also occur during non-penetrative stimulation too). The pain can be at the vaginal opening or deep inside and can cause a negative cycle by leading to avoidance of sexual activity, ISD and anorgasmia. Some causes of dyspareunia are sexual trauma, vuvlvovaginitis or inadequate lubrication. Deep pain may be due to pelvic flammatory disease, endometriosis, irritable bowel syndrome or ovarian cysts (this list is not exhaustive and does not include psychological causes). If the dyspareunia is of a psychological nature, a sex therapist is again advisable.

Vaginismus is a condition affecting a women's ability to engage in any form of vaginal penetration. Involuntary spasms of the vaginal muscles interfere with intercourse and some women's symptoms are so severe that they avoid any sexual contact. Vaginismus is quite frequently the result of physical or sexual abuse, however other causes include relationship problems, religious beliefs or the fear of pregnancy. Cognitive behavioral therapy is often used to help women control the vaginal muscle spasm through various exercises.

Anorgasmia

Anorgasmia is a condition characterised by an absence or persistent delay of orgasm following a normal sexual excitement phase. Those with the disorder experience strong sexual desire and adequate arousal but are unable to achieve orgasm. Causes include anxiety, a sense of loss of control or hostility towards a partner. A sex therapist is often recommended for those suffering from the disorder, and partners.

Premature ejaculation (PE)

Premature ejaculation is the most common sexual problem in men and affects approximately 25-40% of males. The condition is characterised by a lack of voluntary control over ejaculation. Most men experience this at least once in their lives, especially during their first sexual encounters, but soon learn ejaculatory control. Often the condition is associated with performance anxiety and is rarely caused by any physical factors (although some infections and an overly tight foreskin are possible physical causes). It is more likely to be psychological factors that contribute to this condition – such as anxiety, depression, sexual repression, lack of confidence etc. Sex therapists or psychologists can use a series of exercises to enable men to gain ejaculatory control, most commonly the so-called start-stop technique.

Erectile dysfunction (ED)

Erectile dysfunction, also known as impotence, is a condition characterised by the inability to develop or maintain an erection. Occasional impotence is common and can be caused by stress or performance anxiety, however if the condition is persistent or recurrent a sex therapist may be considered. There are various causes such as diabetes, drugs, alcohol, or decreased testosterone levels, however causes can also commonly be psychological.

Gender Identity Problems

Gender identity is a person's sense of whether he or she is male, female or ambivalent. Gender identity disorder is characterised by an individual identifying as belonging to another gender (not based on their sex), or not conforming to the gender role their society has assigned them. Transexuality, transgenger identity and transvestism are all terms categoriosed under 'gender identity disorder'. However many people often question what a “normal” gender identity or “normal” gender role actually is and most transgender people do not regard their feelings and behaviors as a disorder. The feelings are often reported as “always being there”.

Further Info & Advice

Sexual issues and therapy

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