Psychology of Sexual Dysfunction

Sexual dysfunction is a problem for many. Here's what you can do about it.

You know the cliche: a woman is so uninterested in sex that she makes a shopping list while making love. Jennifer and Laura Berman see such women all the time, and it's frustration -- not boredom -- that brings them to the Bermans' clinic at UCLA.

"I was talking to a woman earlier today about her low libido, which was a result of the fact that she can't reach orgasm," says psychologist Laura Berman, Ph.D., who with her sister, urologist Jennifer Berman, M.D., is a founder and codirector of the Center for Women's Urology and Sexual Medicine clinic. "Because she can't reach orgasm, sex is frustrating. She feels a hopeless, fatalistic complacency about her sex life. When she's having sex, her partner picks up on that and feels rejected and angry, or notices she's withdrawing. Then intimacy starts to break down. Her partner feels less intimate because there's less sex, and she feels less sexual because there's less intimacy. The whole thing starts to break down."

Acknowledgement of sexual dysfunction in America is booming. But with all the attention on Viagra and prostate problems in men, most people would probably never guess that more women than men suffer from sexual dysfunction. According to an article in the Journal of the American Medical Association, as many as 43 percent of women have some form of difficulty in their sexual function, as opposed to 31 percent of men.

And yet female sexuality has taken a back seat to the penis. Before Viagra, medicine was doing everything from penile injections to wire and balloon implants to raise flagging erections, while female sexual dysfunction was almost exclusively treated as a mental problem. "Women were often told it was all in their head, and they just needed to relax," says Laura.

The Bermans want to change that. They are at the forefront of forging a mind-body perspective of female sexuality. The Bermans want the medical community and the public to recognize that female sexual dysfunction (FSD) is a problem that may have physical as well as emotional components. To spread their message, they have appeared twice on Oprah, have made numerous appearances on Good Morning America and have written a book, For Women Only.

"Female sexual dysfunction is a problem that can affect your sense of well-being," explains Jennifer. "And for years people have been working in a vacuum in the sex and psychotherapy realms and the medical community. Now we are putting it all together."

No single problem makes up female sexual dysfunction. An article in the Journal of Urology defined FSD as including such varied troubles as a lack of sexual desire so great that it causes personal distress, an inability of the genitals to become adequately lubricated, difficulty in reaching orgasm even after sufficient stimulation and a persistent genital pain associated with intercourse. "We see women ranging from their early twenties to their mid-seventies with all types of problems," Laura says, "most of which have both medical and emotional bases to them." The physical causes of FSD can range from having too little testosterone or estrogen in the blood to severed nerves as a result of pelvic surgery to taking such medications as antihistamines or serotonin reuptake inhibitors, such as Prozac and Zoloft. The psychological factors, Laura says, can include sexual history issues, relationship problems and depression.

The Bermans codirected the Women's Sexual Health Clinic at Boston University Medical Center for three years before starting the UCLA clinic in 2001. At present, they can see only eight patients a day, but each one receives a full consultation the first day. Laura gives an extensive evaluation to assess the psychological component of each woman's sexuality.

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"Basically, it's a sex history," Laura says. "We talk about the presenting problem, its history, what she's done to address it in her relationship, how she's coped with it, how it has impacted the way she feels about herself. We also address earlier sexual development, unresolved sexual abuse or trauma, values around sexuality, body image, self-stimulation, whether the problem is situational or across the board, whether it's lifelong or acquired." After the evaluation, Laura recommends possible solutions. "There is some psycho-education in there, where I'll work with her around vibrators or videos or things to try, and talk about addressing sex therapy."

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Last updated: 11/05

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