Orgastic Dysfunction.

The most common sexual complaint of women involves the specific inhibition of orgasm. Orgastic dysfunction refers solely to the impairment of the orgastic component of the female sexual response and not arousal in general. Nonorgastic women can become sexually aroused and in fact enjoy most other aspects of sexual arousal. Inhibition and guilt about masturbation, discomfort with one's body, and difficulty giving up control, contribute to orgastic dysfunction. With a combination of education and practice, most women can be taught to achieve orgasm.

Vaginismus.

This relatively rare sexual disorder is characterized by a conditioned spasm of the vaginal entrance. The vagina involuntarily closes down tight whenever entry is attempted, precluding sexual intercourse. Otherwise, vaginismic women are often sexually responsive and orgastic with clitoral stimulation. Similar attitudes to those found in impotent males are often found in these women. Religious taboos, physical assault, repressed or controlled anger, and a history of painful intercourse all contribute to this dysfunction.

Sexual Anesthesia.

Some women complain that they have no feelings on sexual stimulation, although they can enjoy the closeness and comfort of physical contact. Clitoral stimulation does not evoke erotic feelings though they do feel a sensation of being touched. Dr. Kaplan believes that sexual anesthesia is not a true sexual dysfunction, but rather represents a neurotic disturbance and should be treated through psychotherapy rather than sex therapy.

As with sexual dysfunctions in men, the female dysfunctions also have to be understood from a social, familial and psychological perspective. Attitudes, values, childhood experiences, adult trauma, all contribute to the sexual response in women. The attitudes and values of her partners, as well as their sexual technique, play a major role in the sexual response as well. An inept or mysogynistic lover can significantly affect the female response. Since a woman often does not want to "damage the male ego," she will try to accommodate her responsiveness to him often sacrificing her satisfaction in the process. She then builds up a secondary inhibition to sexual arousal in order to avoid the frustration accompanying an unsatisfying sexual experience. This inhibition or accommodation then becomes a habituated conditioned response.

Inhibited sexual desire.

As indicated above, inhibited sexual desire is almost always caused by psychological factors (some medications cause a reduction in sexual desire). Since women in our society are often more concerned with intimately connecting to their partner (as compared to men who are more often phallocentric and more concerned with orgasm), women become more sensitive to the psychological climate. When women feel that they are being used, exploited, misunderstood, rejected, unappreciated, and unattractive, their sexual desire will often be affected. Unexpressed anger and hurt can lead to depression, which affects desire. Sometimes these emotions are expressed in passive-aggressive ways, sexual withdrawal being one manifestation. Sexuality, especially for women, is more than a form of pleasure and release; it is a form of communication.

Sex Therapy

Sex therapy provides information and counseling on all aspects of human sexuality, including enhancing sexual pleasure, improving sexual technique, and learning about contraception and venereal diseases. Sex therapy is used in the treatment of all of the dysfunctions discussed earlier. In many cases treatment is relatively short, requiring specific techniques, homework, and practice. In some cases, the underlying issues are more complicated. They may require an exploration into historical and psychological factors, both conscious and unconscious, that are contributing to the dysfunction. However there is a very high probability of success, even in those cases, if people are motivated, cooperative, and willing to learn.

Unfortunately, most people would rather live with a sexual dysfunction and a less than satisfying sexual life than seek help. The embarrassment they feel in discussing their sex life with a professional is too great. There are others who have adjusted to their sex life and despite the fact that their spouse might be unhappy, they refuse to seek help. When these people hear that their spouse is unhappy about their sex life, they experience it as a criticism, become defensive, and often become either hurt or angry, rather than open themselves up to exploration with a sex therapist.

Four common causes of sexual dysfunction:

1. Stress.
   Often unidentified, stress can produce temporary sexual dysfunction which can become permanent. Unfortunately, people often consider sexuality such a private matter that they are reluctant to discuss it with others. Even those who have had sexual difficulties as a consequence of disease or surgery, have difficulty seeking sex therapy to facilitate adjustment to the dysfunction. Many men prefer to needlessly avoid sex altogether rather than seek professional help. Their pride gets in the way of sexual satisfaction.

2. Attitude.
   One of the most significant contributing factors in sexual dysfunction is your attitude toward the dysfunction. If you view it as a diminishing your self-worth and reflecting negatively on your overall value as a human being, sex therapy will take a little longer since we first have to overcome these initial feelings.

3. Motivation.
   Another contributing factor is your motivation and that of your spouse or partner. Your partner's cooperation, participation, and support can accelerate the process and in many cases is essential for effective treatment. Remember, when one member of the dance team is impaired, the team is impaired. Sex therapy, like sex itself, is a cooperative venture.

4. Performance anxiety.
   This is frequently a prime cause of sexual dysfunction. People become so preoccupied with their sexual performance or the performance of their partner, that they lose sight of the process. Enjoying the pleasure involved in being together, the pleasure of human touch, and the process of love making ought to be the primary focus. Many individuals are more concerned with their "reviews" than they are with whether they are enjoying themselves.

Many sexual problems aren't just about sex. Usually, there are some relationship issues that need to be worked out. That's where relational and sex therapy come together.

By: Dr. Edward A. Dreyfus is a Clinical Psychologist, Marriage, Family, Child Therapist, and Sex Therapist. Dr. Dreyfus has been providing psychological services in the Los Angeles-Santa Monica area for over 30 years. His book, Someone Right For You is available when you click the link.

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