Sexual Dysfunction

Introduction
The term ‘sexual dysfunction’ refers to difficulties in the sphere of sexual activity. Sexual dysfunction is very common; there are many people with varying degrees of difficulties; and only some come for help. This is partly because what one individual or couple may see as a problem, may be quite acceptable to another individual or couple.

Types of problems
There are several major sexual dysfunctions. Those in males are: Erectile dysfunction (inability to get or sustain a strong enough penile erection for sexual intercourse); premature ejaculation (reaching a climax in sex far too soon for satisfactory intercourse); retarded ejaculation (inability to reach climax in sex easily – or at all); loss or reduction of the sex drive and sexual aversion (a very strong dislike for particular aspects of sex, often leading to avoidance of sex altogether).

Among females, the main problems are: Lack of physiological responsiveness (lack of lubrication, and/or lack of the expansion of the vaginal canal when aroused); anorgasmia (inability or difficulty to reach a climax); loss or reduction of the sex drive; vaginismus (tightening of the muscles surrounding the vagina when sexual intercourse is attempted); and dyspareunia (intense pain in sexual intercourse).

Causes
Causes of sexual dysfunction may be physical or psychological, or a combination. Physically, there are hormonal factors, especially around the time of menopause for women. Other physical causes include a history of diabetes in men, and prolonged alcohol abuse, both of which are linked to erectile difficulty. Spinal injuries and neurological disorders also affect sexual functioning. Some types of medication can also cause problems in the sexual sphere. Psychological factors are more commonly implicated than any of the above. These include: Anxiety about sex; fears of pregnancy or sexually transmitted diseases; depression mood: misconceptions, incorrect beliefs and ignorance about sex: and strict moral attitudes. Finally, relationship factors can be a major cause of sexual problems. For example, unhappiness about the infidelity of a partner may well lead to loss of interest in sex.

Even when there is a physical cause for a sexual dysfunction, very often psychological factors play a part in perpetuating it.

Treatment
Sexual dysfunction is usually treatable successfully. There are many services available for those needing help. Sufferers may make use of self-help literature. Some general practitioners undertake treatment for these problems; however, most would refer the client to a specialist service. These services include specialist sex therapy clinics. Some marital/relationship counselling services offer help with these problems. Many general psychiatric and psychological services provide treatment for these problems.

Most clients with sexual dysfunction benefit from psychological treatments. In recent years this treatment has usually taken the form of cognitive behavioural therapy (CBT). Elements of this approach include anxiety reduction, graded retraining, work on faulty beliefs and attitudes, and work on relationship issues. Treatment is usually offered as a package, but the elements differ reflecting the specific problems and the history/circumstances of each client. Treating the couple together is seen as the best option, but individuals who do not have partners are also treated using the same basic principles.

Physical treatments are also used and in cases where an organic cause is identified, such treatment may be the treatment of choice, but even then additional CBT helps. For erectile difficulty various techniques such as injections of smith muscle relaxants (to induce erections), vacuum devices, and penile prostheses are sometimes used. Oral medication is also used and strong claims have been made for the efficacy of some of them. In practice, the treatment depends on a careful evaluation by the therapist, and for most the CBT approach is the best option, sometimes in combination with other methods.

Conclusion
Sexual dysfunctions are not uncommon, and those who need help have many therapy services available to them. The field has grown rapidly in recent years, and there have been many developments which have enhanced the positive outcome of therapy.

What are Behavioural and Cognitive Psychotherapies?

Behaviour Therapy, Cognitive Therapy and Cognitive Behaviour Therapy have some common features. They are based firmly on research findings and derive from specific theories. The focus is mainly on the here-and-now, rather than the past, and the main goal of therapy is to help bring about changes in the person’s life which are measured and evaluated. Goals for change may involve:

• A way of acting eg. being more outgoing
• A way of feeling eg. being less scared or less depressed
• A way a thinking eg. learning to problem solve or get rid of self defeating thoughts
• A way of dealing with physical or medical problems eg. lessening the difficulties associated with back pain.
• A way of coping eg. training developmentally disabled people to care for themselves

Cognitive or Behaviour Therapists may work with individuals, groups or families, and therapy is time limited. The approaches can be used to help any person – irrespective of intelligence, insight or other abilities.