Assessment and Psychological Treatment of Sexual Dysfunctions
Here's a step-by-step guideline of how to diagnose and treat sexual dysfunctions.
Assessment of Sexual Dysfunctions
Often requires medical evaluation
- By competent, sensitive physician
Psychosocial evaluations
- Can be complex
- Multiple etiologies
- Distinguishing cause, effect, & their interaction
- Frequently identify co-morbidities
- Sexual and non-sexual
- Medical and psychological
- Within and between partners
Ideally, both partners get interviewed
- Together and separately
- Not always possible
- Could itself be diagnostic
- Identified patient is sent in to be "fixed"
- Stories often differ
- Even about objective data
- Often about conceptions of the problem
- Or even if there is a problem
"There are no unaffected partners in sexual dysfunctions" (Bill Masters)
- Resentment
- Anger
- Doubts
- Does she still love me?
- Does he still find me attractive, sexy, appealing?
- Diminished Quality of Life
Sexual dysfunctions vary across several dimensions
- Nature of presenting complaint
- Is this really a sexual problem?
- Length of dysfunction
- Primary vs. Secondary
- Has the person always had the dysfunction or was there ever a period of good functioning?
Sexual dysfunctions vary across several dimensions
- Medical vs. Psychological Etiology
- Frequently difficult to determine
- Particularly if the problem is of long duration
- Locus of the problem?
- One partner, the other, or both?
- Do both partners see this the same?
- Single or multiple dysfunction(s)
- In one partner or both?
- Relationship, if any, of multiple dysfunctions?
Important to explore
- How each partner understands the problem
- What has the couple has tried to deal with the problem?
- With what success?
- Anything make it better/worse?
- What is the non-sexual relationship like?
- Non-sexual sources of stress
- Health problems?
- Medications?
- Why are they in treatment now?
- What does each hope to get from treatment?
- How willing is each to participate in treatment?
- Strengths, as well as problems
- What competes with sex?
- Time, work, kids
- A detailed description of what the couple typically does sexually
- Maladaptive attitudes, beliefs, behaviors, and expectations
- Each partner's outside sexual experiences
- Before or during this relationship
- What's at stake if the problem isn't resolved?
- Is the problem also a solution?
- Secrets
- Fantasies
Sexual History
- Critical for understanding the problem
- Always done for symptomatic partner
- Best when done for both partners
- Time and detail are variable
- How far back do you go?
- How much detail do you need?
- Certainly, need a detailed history of the problem
- As far back as it goes
- Precipitating events?
Sexual history includes
- Sexual messages received growing up
- Earliest sexual experience
- How did it go?
- Significant sexual experiences
- Both positive and negative
- Particularly any abuse (psychological, physical, sexual)
- History of sexual relationship with current partner
Treatments
Psychological
- Individual
- Couple
- Combination
Medical
- Rarely includes the partner in assessment or treatment
Combinations
Psychological Treatment
- Primary goals
- Support
- Normalization
- Permission giving
- Sex education
- Stress reduction
- Symptom removal
- Improved communication (sexual & other)
- Attitude change
- Helping to make sex fun
Most common approaches are cognitive-behavioral, also the most researched and supported
Cognitive: Identifying and challenging irrational or unreasonable beliefs, attitudes, expectations
Behavioral: Sensate focus exercises
Most involve sex education
- Learning what's "normal"
Improve communication
- Learn and communicate about each other's desires and fears s
Important to work within the individual's or couple's value system
- Important to be non-judgmental
- You must be comfortable talking about sex
- Any sign of your discomfort will make it more difficult for them to talk
- How comfortable are you?
- How do you know?
It will be difficult for many clients to talk about their sexual problems
- Where were they supposed to learn to be comfortable discussing sex?
- At home, school, with friends or family?
- Where did you learn to be comfortable?
- Admitting to sexual problems is even more difficult
- Especially for men
- Gets more difficult the longer the problem has existed
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
- 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
Sexual Aversion
More common in women
- Prevalence unknown
More serious than desire disorder
- More often associated with significant individual psychopathology
- History of abuse, rape or other trauma
- More often associated with significant relationship problems
- Severe anger, distrust, infidelity
Difficult to treat
- Symptomatic partner may have little motivation
- Almost always requires lengthy individual and/or couples' therapy
Arousal Disorder
- Medication sometimes helpful
- Psychological interventions
- Individual psychotherapy
- Treat historical issues or Axis I disorders that are etiologically significant
- Couples' counseling
- Sensate focus
- Treat communication and other relationship issues believed to cause or maintain the disorder
Female Sexual Dysfunctions
Vaginismus
- Good prognosis
- Dilation
- Relaxation
- Kegel exercises
- Partner involvement
Primary Anorgasmia
- Good prognosis
- Directed Masturbation
- Sensate focus
- Systematic Desensitization (~)
Secondary Anorgasmia
- Guarded prognosis
- Sex education
- Sexual skills training
- Communication training
- Directed masturbation (~)
Treatment:
- Multidisciplinary
- Need a physician who understands and treats these problems
- Cognitive-behavioral therapy:
- Vaginal dilation (Vaginismus)
- systematic desensitization
- couples counseling
- Oral medications
- PDE-5 Inhibitors
- Prostheses
- Rigid, Semi-rigid, Inflatable
- Psychological
- Sensate focus
- Systematic desensitization
- Sex education
- Communication training
Premature Ejaculation
- Medication
- E.g., Clomipramine
- Psychological
- Sex education
- Normalizing PE
- Blueprint alternatives
- Cognitive-behavioral
- Squeeze
- Stop-start
- Do better in short-term than long-term
APA Reference
Staff, H.
(2021, December 27). Assessment and Psychological Treatment of Sexual Dysfunctions, HealthyPlace. Retrieved
on 2024, December 6 from https://www.healthyplace.com/sex/main/assessment-and-psychological-treatment-of-sexual-dysfunctions