Specific Sexual Difficulties

What is the most common problem that brings people to sex therapists?

What are the symptoms of sexual aversion?

What is the definition of male erectile disorder?

What percentage of women has never experienced orgasm? How common is the problem of premature ejaculation?

What conditions can cause painful intercourse in men and in

women?

Origins of Sexual Difficulties

What kinds of medical problems and medications can interfere with

■s’-mil liimimii?

What relationship factors can create sexual problems?

Basics of Sexual Enhancement and Sex Therapy

How can individuals increase their sexual self-awareness?

What are the guidelines for sensate focus?

What are the steps for a woman who wants to learn to experience orgasm?

What is the process for resolving vaginismus?

How can a man learn to prolong his arousal before ejaculating?

What is the typical course of therapy for a man having difficulty with erections?

What medications are available for women with hypoactive sexual desire disorder?

How might someone select a sex therapist?

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I wish my first time had been better. I would have had sex with someone I at least liked, instead of just with someone who would do it with me. We were both pretty drunk, but not drunk enough to forget how fast I came. Word got around about it, and I avoided sex for a long time. My first girlfriend after that was cool about it, and after a while I could relax and last longer. (Authors’ files)

Sexual health, "a state of physical, emotional, mental, and sexual well-being related to sexuality," goes beyond identifying and treating sexual problems (Sadovsky & Nus – baum, 2006, p. 3). This definition of sexual health by the World Health Organization is what guides us in this chapter’s discussion about a number of relatively common sexual problems, the factors that frequently contribute to them, and self-help and sex therapy approaches to help resolve sexual difficulties.

As you read this chapter, it is important to remember that sexual satisfaction is a subjective perception (McClelland, 2010). A person or couple could experience a spe­cific sexual problem and yet be satisfied with their sex lives, or they could experience no problem in physical sexual functioning and be very dissatisfied with their sexual expe­riences (Balon, 2008; Basson et al., 2003). I Figure 14.1 shows how men and women around the world rate the pleasure of sexual interaction.

Research indicates that sexual problems as typically identified by medical, clinical, and research literature are quite common. For example, in the National Health and Social Life Survey (NHSLS), 43% of women stated that they experienced some type of sexual dysfunction, according to the study’s criterion of having experienced the sexual problem for 3 or more of the last 12 months. The prevalence of sexual problems in the NHSLS sample is shown in ■ Table 14.1.

Men Women

■ TABLE 14.1 Prevalence of Sexual Problems by Selected Demographic Characteristics

Lack Interest in Sex

Cannot Achieve Orgasm

Erectile

Dysfunction

Pain During Sex

Climax Too Early

Women (%)

Men (%)

Women (%)

Men (%)

Men (%)

Women (%)

Men (%)

Agea

18-29

32

14

26

7

7

21

30-39

32

13

28

7

9

15

40-49

30

15

22

9

11

13

50-59

27

17

23

9

18

8

Education

Less than high school

42

19

34

11

13

18

38

High-school graduate

33

12

29

7

9

17

35

College graduate

24

14

18

7

10

10

27

aSexual problems are most common among younger women and older men. SOURCE: Laumann et al. (1999).

However, individuals who have what researchers or clinicians consider sexual prob­lems may not feel distressed and sexually dissatisfied. A subsequent random phone survey (less rigorous than the NHSLS) by the Kinsey Institute also asked women sub­jects whether they considered their lack of interest, arousal, or orgasm to be a problem. Slightly over 24% of the subjects reported distress about their sexual dysfunction (Ban­croft et al., 2003). A more current study found that of women who had sexual prob­lems, 36.5% reported feeling distress about their sexual functioning. In the same study, 16.5% of women without sexual problems reported feeling distress (Burri et al., 2011). For readers currently in a sexual relationship, the self-assessment inventory in the Your Sexual Health box on page 401 will give you an indication of your level of satisfaction.

Studies have found that women were most likely to report distress about sex in the context of other factors. For example, they were more likely to report distress about sex when also reporting poor personal emotional well-being, feelings of general anxiety, or a negative emotional relationship with their partners (Bancroft et al., 2003; Burri et al., 2011). Research does indicate that sexual problems can be associated with overall well­being. People with sexual problems report lower satisfaction with overall life than do those without sexual difficulties (Hellstrom et al., 2006; Mallis et al., 2006).

To be accurately considered a sexual disorder, the problem happens in spite of the person having adequate physical and psychological sexual stimulation. For example, in one study, "too little foreplay" was reported by 42% of women who reported sexual distress and problems (Witting, Santtila, & Varjonen, 2008). On the other side of the coin, research has found a correlation between greater physical stimulation and increased sexual response: Women who routinely experience orgasm engage in a relatively greater repertoire of sexual techniques than do women who do not reliably experience orgasm (Fugl-Meyer et al., 2006). Further, with a longer duration of stimulation prior to orgasm, women’s orgasms tend to be more intense than after shorter lengths of time of stimulation (Laan, 2009).

Adequate psychological stimulation is also essential. For example, a man who ejacu­lates quickly after his partner demands, "Hurry up and get it over with!" is not receiving adequate physical and psychological stimulation and cannot be considered to have a problem with premature ejaculation from that situation alone. In another example, a diagnosis of lack of sexual desire would be inappropriate for a woman whose partner continually pressures her to be sexual in ways that he likes but that she does not enjoy or find arousing.

Sexual Difficulties and Solutions