Подпись: ReviewQuestion Identify and describe the genital pain disorders, and describe the treatments available. Like vaginismus, dyspareunia should be evaluated medically prior to treatment. Several physical and psychological issues can contribute to painful intercourse. If there is a phys­ical problem, such as an infection, medical treatment will usually result in a lessening or total elimination of the pain. As we discussed earlier in this chapter, women suffering from dyspareunia should also be evaluated for vulvodynia prior to any treatment for their sexual dysfunction. Treatment for vulvar vestibulitis, including psychotherapy, biofeed­back and surgery, have resulted in significant reduction in dyspareunia after treatment and in follow-up studies (Binik et al., 2002). Psychological causes of dyspareunia, such as performance anxieties or a fear of intimacy, must be treated through counseling or psychotherapy.

A controversy arose in 2005 over whether dyspareunia should be classified as a sex­ual pain disorder. Some researchers believe that it should be classified as a pain disorder, rather than a sexual dysfunction (Binik, 2005). This discussion will continue and may affect how dyspareunia is diagnosed and treated in the future.

Question: Why do women fake orgasms rather than honestly telling their partners what they are doing wrong?

Подпись: sex byte Researchers have recently discovered a condition known as sleep sex, which causes people to commit sexual acts in their sleep. Similar to sleepwalking, in which a person walks in his or her sleep, sleep sex involves a person either making sexual sounds, engaging in violent masturbation, or making unwanted violent sexual advances on his or her partner (Guilleminault et al., 2002). Treatment involves medication, combined with psychotherapy. Treating Dyspareunia and VulvodyniaFaking orgasms often occurs as a result of a dysfunction. To a man or woman who experiences orgasmic disorder or retarded ejaculation, faking an orgasm may seem the best way to end the sexual activity or to please the partner. However, such deceptions are not healthy in a committed relationship, and partners are generally advised to discuss any sexual problems they have instead of covering them up. A woman (or a man) may have a difficult time communicating sexual needs and desires. So, instead of talking to her partner about what sexually excites her, she hopes that he knows how to do it. She may feel too embarrassed or vulnerable to tell him what to do. In this society, we expect men to know exactly what turns a woman on. However, what feels best to one woman may not feel good to an­other, and what feels good may change over time. Many variables can also interfere with sexual pleasure, such as stress, fatigue, anxiety, or depression. It is important that couples communicate so that they can make their sex lives satisfying for both partners.

ILLNESS, DISABILITY, AND SEXUAL FUNCTIONING

We all need love, and we all need touching and contact with others. Yet somehow we have grown to think that sexuality is the privilege of the healthy. We tend to exclude ill or disabled people from our visions of the sexual, and so we deny them a basic human right (see the nearby Personal Voices, “I Want Sex—Just Like You”). If you were sud­denly disabled or developed a chronic illness, would you lose your desire to be regarded by another as sexy and desirable?

Healthcare providers often rely on the International Classification of Diseases (ICD), an official system of identifying various illnesses. Several of these illnesses and their treatments can interfere with a person’s sexual desire, physiological functioning, or both. Sexual functioning involves a complex physiological process, which can be im­paired by pain, immobility, changes in bodily functions, or medications (Levay et al., 1981). More often, though, the problems are psychological. Sudden illness causes shock,

Treating Dyspareunia and VulvodyniaSEX in Real Life