Assessment and Psychological Treatment of Sexual Dysfunctions - Sexual problems

Written by HealthyPlace.com Staff Writer

Few seek help for sexual problems

• 20% of women 10% of men (NHSLS)

Need to identify individual or relationship issues that may cause, maintain, or exacerbate the sexual problem

Individual

• Anxiety
• 36% of men and 50% of women with panic disorder had sexual aversion disorder
• Depression
• Substance abuse
• Low self-esteem

Relationship Issues

• Can be the cause, effect, or both of sexual problems

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• Sexual boredom
• Dislike of partner
• Anger, Fear
• Power differences, control issues
• Fallen out of love
• Lack of sexual attraction
• Infidelity
• Disappointment
• Perceived selfishness
• Money, kids, in-laws
• Different values or interests
• Abuse
• Partner's psychological disturbance

Sensate Focus

• Developed by Masters and Johnson
• Guided couple's exercises
• Both diagnostic and therapeutic
• In vivo systematic desensitization
• Early exercises designed to be more sensual than sexual

Designed to

• Reduce stress, expectations, and spectatoring
• Increase sexual pleasure

Designed to help couples

• Identify what pleases them and their partner by focusing on their own and their partner's bodily sensations
• Improve sexual communication
• Take time for their sensual pleasure
• Go back to a place when sex was fun and satisfying

Sensate Focus

• Done in private
• Includes prescriptions and proscriptions
• Is gradual, beginning with non-genital touching
• Usually precedes more disorder-specific exercises
• Is individualized to the couples
  • Where they are starting from
  • The nature of their problem(s)
  • Their response to each exercise

Desire Disorder

• Difficult to treat
• Prognosis is better when etiology is apparent
• No empirically validated treatments
• Approach usually depends on assumed etiology
  • Primary vs. secondary
  • Generalized or partner specific
  • Individual vs. couples' therapy
  • Medical (e.g., estrogen) vs. psychological
• Often requires lengthy individual and/or couples' therapy