Sexual Problems

There are only 4 sources of sexual problems. These are organic, performance, lack of sexual desire and lack of information.

  1. Organic- problems related to medication, diseases, surgery, pain or fatigue. Problems with this origin require consultation with a physician.
  2. Performance Anxiety- people with performance anxiety often have sexual desire but are not able to perform. Problems in this category include: o Anorgasmia- inability for a woman to have an orgasm. o Vaginismus- psychological sexual condition where the vaginal muscles are so tight that penetration of the penis is not allowed. It can be helpful to gently insert a finger or a small instrument to loosen up the vaginal muscles. o Retarded ejaculation- condition where the man cannot ejaculate. This is linked to anxiety and might require intensive therapy (IT). o Premature ejaculation- anxiety performance problem where the man cannot hold back his ejaculation long enough to satisfy the woman or man. The term has become a little controversial because the length of time from arousal to ejaculation may vary in satisfaction from couple to couple.Generally - premature ejaculation is if the man goes from desire to arousal to ejaculation with no ability to sustain the arousal for any length of time, but he is not able to remain aroused. Another and perhaps even better definition of premature ejaculation is when the man does not have control over when the ejaculation will occur.  Treatment = squeeze technique. The man or his sexual partner squeezes the end of the penis in order to stop the undesired ejaculation. Male is encouraged to masturbate but stop just short of ejaculation. Medication can also help with as a side effect of the selective seratonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, Luvox, Celexa or Lexapro is diminution of desire and inhibition of ejaculation due to elevated levels of Serotonin. Exercises typically given are:
    1. Sensate focus- caressing non-erotic parts of the body. You can tailor this to your comfort such a starting with caressing hands, face and feet with clothes on and then gradually moving to larger parts of the body without clothes on.
    2. Use of lubricants is often helpful, however, it is often best to start without lubricants then move to water-soluble lubricants.
    3. It is a good idea to start without talking and later move to talking.
    4. After this is tolerated well and then enjoyed, there is movement to the erotic parts of the body but still without sexual intercourse. (This is often difficult as people become sexually aroused and want to have intercourse but it is important that there is no intercourse for this treatment to be successful in the long term).
    5. This exercise leads to gradual desensitization so the couple is slowly moved toward having sexual intercourse. Jack Annon’s acronym PLISSIT is applicable to performance problems.
      • P = Permission. Sometimes people have to be told that all sexual activity including masturbation is normal and healthy.
      • LI = limited information. There is then specific suggestions (SS) that can be used to help the woman learn how to relax and masturbate leading to orgasm (done with sexual partner).
      • IT = intensive therapy. Indicated if the problem is more complicated and is due to deep psychological problems either in the couple or in the inner world of the individuals.
      • 3. Erectile dysfunction can be very complicated. It can be caused by a medical condition, performance anxiety or a lack of sexual desire. It is important for the clinician to determine which one or all of these causes are applicable. If it is a medical condition the patient should be referred to a medical doctor. If it were a performance problem, someone who has been trained in classical sex therapy would best treat the patient.
  3. Lack of sexual desire- can be organic, medical, or psychological. For example, when the man is angry with the woman, or related to a problem with closeness.