What are Sexual Dysfunctions?

How Therapy Works

Goals of Therapy:

• Improve sexual knowledge and communication
• Reduce anxiety or shame
• Address trauma or past experiences
• Improve emotional and relational intimacy

Evidence-Based Therapies:

1. Cognitive Behavioural Therapy (CBT)

• Challenging cognitive distortions related to sex, body image, and performance
• Builds confidence and enhances coping with sexual anxiety

2. Sensate Focus Therapy

• A structured, step-by-step technique to reduce performance pressure
• Enhances physical and emotional intimacy between partners

3. Couples Therapy

• Addresses relational conflicts
• Encourages open communication about needs, desires, and boundaries

4. Mindfulness-Based Therapy

• Aids in reducing distractions and anxiety while improving bodily awareness during intimate moments.

5. Sex Therapy

• A specialized approach by trained professionals focusing solely on sexual concerns
• Involves guided exercises and education to restore satisfying sexual function

6. Psychoeducation

• Assists clients in comprehending anatomy and the sexual response cycle while dispelling common misconceptions.
• Normalizes sexual concerns and promotes healthy attitudes toward sexuality

Treatment

The approach to treatment is determined by the particular type, underlying cause, and severity of the dysfunction. A multimodal approach is typically most effective.

1. Medication

When appropriate, medications may be prescribed:

• PDE5 inhibitors (e.g., Sildenafil, Tadalafil for erectile dysfunction)
• Hormone therapy (e.g., testosterone replacement)
• Topical anesthetics or lubricants for arousal and pain issues
• Adjusting medications contributing to sexual side effects

2. Psychotherapy

Therapy addresses psychological, relational, and emotional aspects.

Assessment and Diagnosis

Clinical Interview and History Taking
Mental health professionals explore medical, psychological, and relational history.
They evaluate the initiation, length, frequency, and circumstances surrounding the dysfunction.

Diagnostic Criteria (DSM-5-TR)
Sexual dysfunctions are diagnosed based on clear criteria, considering distress, duration (typically 6+ months), and consistency.

Psychological Assessments and Tools

• Sexual Health Inventory for Men (SHIM)
• Female Sexual Function Index (FSFI)
• Relationship and Sexual Satisfaction Scales
• Depression, Anxiety, and Stress Scales (DASS)

Medical Evaluation

To rule out physiological causes such as hormonal issues, nerve damage, or medication side effects.
Tests may include blood panels or physical exams by specialists (e.g., urologists, gynecologists).

Causes

Sexual Dysfunction can stem from a complex interplay of biological, psychological, and social factors:

Biological Factors

• Hormonal imbalances (e.g., low testosterone or estrogen)
• Chronic illnesses (e.g., diabetes, cardiovascular disease)
• Neurological disorders
• Medication side effects

Psychological Factors

• Anxiety or performance pressure
• Depression
• Trauma or history of abuse
• Low self-esteem or body image issues

Relational and Social Factors

• Lack of emotional intimacy or trust
• Poor communication with the partner
• Stress, fatigue, or life transitions
• Cultural or religious beliefs causing guilt or shame

Signs & Symptoms

Sexual Dysfunction can manifest in different ways depending on the individual and underlying causes. It has four main types:

1. Disorders of Desire

• Lack of sexual interest or desire
• Absence of sexual thoughts or fantasies
• Avoidance of sexual activity

2. Arousal Disorders

• Difficulty becoming or staying aroused
• Inadequate lubrication or erectile difficulties
• Reduced genital sensations

3. Orgasmic Disorders

• Delayed or absent orgasm despite sufficient stimulation
• Premature ejaculation
• Reduced orgasmic intensity

4. Pain Disorders

• Genital pain during intercourse (e.g., dyspareunia)
• Involuntary tightening of vaginal muscles (vaginismus)

Painful erections or ejaculation

Types

Male Sexual Dysfunction

• Erectile Dysfunction (ED)
• Premature Ejaculation (PE)
• Delayed Ejaculation
• Low Libido (Hypoactive Sexual Desire Disorder)

Female Sexual Dysfunction

• Female Sexual Interest/Arousal Disorder
• Female Orgasmic Disorder
• Genito-Pelvic Pain/Penetration Disorder

Situational vs. Generalized Dysfunction

• Situational: Occurs only in specific contexts (e.g., with one partner or under stress)
• Generalized: Occurs regardless of situation or partner

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