Hypoactive Sexual Desire Disorder

DSM criterion: Lack of sexual fantasies and desire for sexual activity.

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Clients with deficient sexual fantasies and desire may not actively seek or prioritize sexual intimacy. It is common for the concerned spouse to initiate therapy, especially when the low desire partner sees no issue with their lack of libido. While predominantly associated with women, this issue can also affect men, where the female partner has a higher sexual desire. It's important to acknowledge individual accountability for our own sexuality and not rely solely on our spouse to ignite desire. However, it's still essential to make efforts to fulfill our partner's needs and engage in activities that enhance intimacy.

Female Sexual Arousal Disorder

DSM criterion: Inability to attain or maintain an adequate lubrication-swelling response during sexual activity.

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This disorder can be caused by various medical and psychological factors in women. Comprehensive and ongoing assessment of different aspects of sexuality is crucial in effective sex therapy. In our experience, this issue often arises when one or both partners are unaware of the woman's specific sexual needs. Insufficient foreplay can contribute to this problem, potentially leading to a pain disorder.

Erectile Disorder

DSM criterion: Inability to attain or maintain an adequate erection during sexual activity.

While commonly associated with older men, we are increasingly encountering younger men who experience erectile disorder. Psychological factors are often the root cause of this issue. If there is a suspicion of a medical cause, we will refer the client to a specialist in men's sexual problems to rule out any physical factors. It is important to note that myths surrounding men's sexuality and anxiety are major contributors to erectile dysfunction in men. Recent research suggests a correlation between pornography addiction and erectile disorder.

Premature Ejaculation

DSM criterion: Premature ejaculation - ejaculation with minimal sexual stimulation before, during, or shortly after penetration, and before desired.

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Premature ejaculation is frequently observed in men with limited sexual experience with a partner. Anxiety is a significant contributing factor to this issue. Additionally, we have noticed a correlation between sexual addiction and premature ejaculation. Men who dissociate from their physical experiences and do not establish a normal progression of arousal are likely to face similar challenges.

Female Orgasmic Disorder

DSM criterion: Delay in or absence of orgasm despite normal sexual excitement phase.

This is a common issue we address in women seeking treatment.

Women often experience difficulties reaching orgasm due to myths, misinformation, or a lack of comprehensive knowledge about sex and sexual performance. This disorder is also referred to as inorgasmia or anorgasmia in the literature, all describing the same condition. It's important to note that psycho-education and correcting misconceptions can often lead to resolution of this issue.

Male Orgasmic Disorder

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

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There is a significant correlation between this disorder and pornography/masturbation addiction. Addiction to pornography or excessive masturbation can impact the brain's reward center, creating a subconscious urge to repeat the behavior due to the alleviation of stress and the release of positive chemicals. This repetitive conditioning process can lead to difficulties in experiencing orgasm during sexual activity with another person. The individual may struggle to respond orgasmically because they have conditioned themselves to a narrow range of stimuli (pornography), making it challenging to achieve orgasm during intercourse.

Genito-Pelvic Pain or Penetration Disorder/Vaginismus/Dyspareunia

DSM criterion: Involuntary spasm of the outer third of the vagina that interferes with sexual intercourse.

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Formerly known as vaginismus or dyspareunia, the current DSM combines these diagnoses into genito-pelvic pain/penetration disorder.

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Sexual pain during intercourse in women can have various causes. We assess and refer you to a specialized medical professional to rule out physical factors. Not all doctors may be familiar with the physical causes of sexual pain. "When Sex Hurts" is a helpful resource for women facing this issue. Once physical causes are ruled out, couples can engage in sex therapy. Even if you have received medical treatment, it's crucial to address any psychological components that may contribute to ongoing pain. Psychological factors like anxiety about painful sex can perpetuate the pain experience.

Satisfaction

Many couples who don't experience the specific sexual dysfunctions mentioned above still face challenges in their sexual relationship. The reasons for these struggles can vary. Some couples may feel that their sexual response cycle lacks excitement or intensity. Others may have past experiences with their spouse or previous partners that hinder their ability to enjoy sexual experiences. There are numerous other factors that can contribute to a lack of satisfaction in a sexual relationship. Sex therapy, facilitated by a highly trained professional, can assist in identifying, clarifying, and addressing these issues in collaboration with both partners.

Sexual Abuse

Sexual abuse, including molestation and rape, is unfortunately widespread. Disturbing statistics indicate that 1 in 5 girls and 1 in 20 boys experience childhood sexual abuse, while 18% of women in the United States have been raped. Shockingly, only 30% of sexual assault cases are reported to authorities. Survivors of sexual abuse often face significant impacts, such as sleep issues, difficulties in concentration, and challenges in relationships. Our therapists specialize in supporting survivors to rebuild their lives and foster healthy sexual relationships.

Sexual Addiction

At Covenant Sex Therapy, our therapists have a wealth of experience in working with clients who struggle with sexual addiction, encompassing issues such as pornography, masturbation, and sexual involvement. They bring a wide range of experiences in assisting addicts and their partners in recovering from the detrimental effects of addiction. It's important to note that we do not provide therapy for sex offenders, as specific certification is required for therapists working with this population.

Problematic Sexual Behavior, Sexual Compulsion & Hyper-sexuality

At Covenant Sex Therapy, we recognize that problematic sexual behavior, sexual compulsion, hypersexuality, and sexual addiction are distinct concepts. While sexual addiction is not included as a formal diagnosis in the DSM, the sex therapy community has diverse perspectives on this topic. AASECT's position statement expresses the view that there is currently insufficient evidence to support a diagnosis of sexual addiction. However, some proponents of sexual addiction believe that future research may demonstrate its existence, as mentioned in the reaction statement by a leader in the field.

Our therapeutic approach acknowledges the broad spectrum of sexual behaviors individuals and couples engage in. Many behaviors are not problematic unless certain criteria are met. When sexual activity becomes problematic, our therapists carefully assess whether it falls under the category of problematic sexual behavior, sexual compulsion, hypersexuality, or sexual addiction. We then work to address the behavior itself, as well as the underlying thoughts, emotions, and relational dynamics that contribute to and support the problematic behavior.

For Youth and Family

We are pleased to extend our expertise and specialized knowledge in sexuality to younger clients who are grappling with a range of issues. This includes providing support for concerns such as sexual abuse, identity exploration, compulsivity, addiction, behavioral challenges, developmental milestones, education, and overall sexual health. We offer individual and family sessions to address these specific concerns and work collaboratively with clients and their families to navigate these important areas of their lives.