Hypoactive Sexual Desire Disorder (Sexual Interest/Arousal Disorder):

Deficient sexual fantasies and desire for sexual activity (DSM criterion).

These clients often say that they do not desire sex or care for sexual intimacy. They may enjoy sex when it occurs but notice that it is not something that matters to them or that they initiate outside of initiating for their spouse’s satisfaction. Their spouse may be the one that voices a strong concern and may be the one pushing for therapy, as the low desire partner may see nothing wrong with not having a libido. This is stereotypical a problem that women face, although we have plenty of clients where the man struggles with low sexual desire and the woman has a strong sexual desire. Note that we all need to be accountable for our own sexuality. This doesn’t mean that we shouldn’t try to fulfill our partners sexually or do those things that increase their desire to be sexually intimate. It does mean that we shouldn’t rely on our spouse to get us in the mood or make us have sexual desire.

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Female Sexual Arousal Disorder (Sexual Interest/Arousal Disorder):

Inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement (DSM criterion).

There are a lot of reasons, medically and psychologically, that a woman would have this disorder. Part of good sex therapy is a thorough and evolving assessment for various dimensions of sexuality. In our experience, this is often a problem when either one or both partners are unaware of what the woman needs for sexual functioning. Note that this can easily be a problem when there is not enough foreplay for the woman. This also might lead to a pain disorder.

 

Erectile Disorder:

Inability to attain, or to maintain until completion of the sexual activity, an adequate erection (DSM criterion).

Although believed to be an issue with older men, we meet with more and more younger men who struggle with erectile disorder. Most often, we see that the cause is psychological. If believed to be medical, we will refer the client to a medical doctor that specializes in men’s sexual problems to rule out physical causes. Note that myths concerning men’s sexuality and anxiety are the primary causes we see impacting men having erectile dysfunction. Recent research correlates pornography addiction and erectile disorder.

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Premature Ejaculation:

Ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it (DSM criterion).

This is often an issue for men who have had limited sexual encounters with a partner. Anxiety also plays a fundamental part with premature ejaculation. Note that we have seen an association with men who have a sexual addiction and premature ejaculation. Men who disassociate with their physical experience and do not orchestrate a normative arousal continuum will similarly struggle with these issues.

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Female Orgasmic Disorder:

Delay in, or absence of, orgasm following a normal sexual excitement phase (DSM criterion).

This is one of the main presenting problems that we treat in women. Myths, misinformation, or limited information about sex and sexual performance are among the top reasons that women struggle with this problem. In the sexuality literature this disorder is also known as inorgasmia and anorgasmia. They are all the same thing. Note that this issue can often be resolved with psycho-education and correcting misinformation.

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Male Orgasmic Disorder:

Delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity (DSM criterion).

There is a strong correlation between this disorder and pornography/masturbation addiction. What occurs with an addiction is that the reward center of the brain is telling you subconsciously to repeat that behavior because it alleviated stress and produced positive chemical reactions. This conditioning process gets repeated over and over again. When sexual activity with another person takes place, the man often struggles with having an orgasm because he has conditioned himself to respond (orgasm) to a very narrow stimuli (pornography) thus making it difficult to (respond) orgasm while intercourse occurs.

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Vaginismus/Dyspareunia (Genito-pelvic pain/penetration disorder):

Involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse (DSM criterion).

I have included the old diagnoses for female sexual pain as many still know their disorder as vaginismus or dyspareunia. In the new DSM (manual used for mental health therapists) the diagnoses have been changed to one, genito-pelvic pain/penetration disorder.

There is a plethora of reasons why women experience sexual pain during intercourse. Part of our assessment and treatment is to refer you to a medical professional who works with women who have such sexual pain disorders. We do this to rule out physical causes of sexual pain. Note, not all medical doctors will be aware of the physical causes of sexual pain. The book entitled “When Sex Hurts” is a great resource and place to start for women with this issue. After ruling out physical causes, sex therapy can begin for these couples. Even if you have a medical cause and you have or are being treated, your physical cause could have given rise to psychological components that now need to be addressed in sex therapy. It is a misstep to not factor this into your treatment as you may still experience pain even after medical treatment. Such psychological issues could include anxiety about sex being painful, which itself will now make sex painful.

 

Satisfaction:

Many couples who don’t have any of the above sexual dysfunctions still find that they are struggling in their sexual relationship. There are many reasons as to why this is so. Some find that they have dull experience within their entire sexual response cycle. Others have past experiences with another or their spouse that prevents them from being able to enjoy the sexual experience. There are many other reasons why you may find lack of satisfaction in your sexual relationship. Sex therapy can help to identify, clarify, and address such issues with a highly trained professional and your spouse.

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Sexual Abuse:

Unfortunately sexual abuse in all it’s forms such as molestation and rape is rampant in the world. There are many different measurement and surveys used to examine the statistics of sexual abuse. Some staggering statistics tell us that 1 in 5 girls and 1 in 20 boys will be survivors of childhood sexual abuse and 18% of women in the United States have been raped. Only 30% of sexual assault cases are reported to authorities. This link provides some other statistics about sexual violence. Many that have experienced sexual assault are substantially impacted by their abuse. They may have trouble sleeping, concentrating, enjoying life, forming and maintaining relationships, etc. Our therapists work regularly with those survivors of sexual abuse so that they can regain a fulfilling life and sexual relationship.

 

Sexual Addiction:

Therapists at Covenant Sex Therapy have an extensive history of working with clients with a sexual addiction. These include but are not limited to pornography, masturbation, and sexual involvement. Our therapists bring with them myriad of experiences helping addicts and their spouses heal from the damage of an addiction. We do not work with sex offenders as many of these clients are required to have therapy from a therapist with certain certification specific for sex offenders.

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Problematic Sexual Behavior, Sexual Compulsion & Hyper-sexuality:

Problematic sexual behavior, sexual compulsion, or hyper-sexuality are different from a sexual addiction. In fact much of the sex therapy community posits that there is not enough evidence to support a diagnosis of a sexual addiction. That’s why sexual addiction has been left out of the DSM. Please read AASECT’s position statement on this topic Position on Sex Addiction However, the proponents of sexual addiction diagnosis believe that the future research will illustrate that a sexual addiction does exist. Please read a reaction statement by one leader in the sexual addiction world, Response to AASECT Position Statement Covenant Sex Therapy’s therapeutic feelings on the matter are that there is a wide range of sexual behaviors that couples and individual’s engage in. Many are not problematic, even if they deviate from the perceived “norm”, until certain criterion are met. When the sexual activity is problematic our therapists determine if the behavior is problematic sexual behavior, sexual compulsive, hyper-sexual, or sexual addictive. We then work to treat the behavior, thoughts, feelings, and system that support the problematic behavior.