The information below may help you define and better understand your sexual problem as well as demystify the process of sex therapy. Below you will find separate sections defining the common female sexual problems, along with their causes and treatments. Knowledge is a good antidote to the shame and discomfort that many people feel about having a sexual concern. Hopefully, the information below will decrease the barriers you have to understanding and working on the problem and increase your comfort as you do so.
Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below. Others won’t. There is usually a hidden part of sexual problems, the emotional part that is unique to each individual and / or the couple. Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.
General factors that contribute to Female Sexual Disorders.
There are also cultural messages from specific cultural backgrounds.
Nice girls don’t, women should be passive, sex is a woman’s duty, and on and on.
Personal history can contribute to female sexual difficulties.
Lack of information about sex
Generalized anxiety disorder and depression
Poor communication regarding sexual needs
Fears of being intimate with a partner
Relationship issues of power, control and conflict (especially hostility and resentment)
Severe cultural, religious and family restrictions on masturbation and premarital sexuality or other negative messages about sex
Aversion to sex
Past sexual trauma – rape or sexual abuse
Painful first attempts at intercourse or history of chronic painful intercourse
Expectation that sex hurts
Fear and distrust of men or partner
Fear of pregnancy
Sexual \ orientation conflict
Relationship conflict (especially hostility)
Unconscious fears and ambivalence
General approaches to Treating Female Sexual Disorders
Psychological treatment will always start with taking a comprehensive sex history and exploring causes.
Psycho-education
Role modeling
Relaxation techniques
Humor
Touching exercises for self and for partner
Body image exercises
Reading and specific sex education videos
Journaling
Assertion training.
Treatment
Addressing relationship, physical and medical factors that contribute to the problem
Challenging Negative Sexual Beliefs
Developing Positive Sexual Attitudes and Motivations
Assertion training
Conditions for Good Sex
Graduated massage, self touch and partner touch exercises
Exploring fantasy and erotica
Medical Treatment
Medications
Surgical interventions
Orgasmic Dysfunction
Definition
Persistent or recurrent delay in, or absence of, orgasm following a normal sexual phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives. The disturbance causes marked distress or interpersonal difficulty.
Prevalence non-orgasmic 24.1% (Laumann et al, 1994).
Causes
Usually there are several influences that contribute to the condition occurring. Please see section above: General Factors that Contribute to Female Sexual Disorders.
Treatment
Body Image & Body Touching to reduce self-consciousness and reawaken senses
Exploring and labeling genital parts
Graduated self touching exercises
Assertion and communication training
Exploration of fantasies, erotica
Partner exercises
Vaginismus or Unconsummated Marriage
Definition
Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina when penetration with penis, finger, tampon, or speculum is attempted. The disturbance causes marked distress or interpersonal difficulty.
There are varying degrees of intensity. There is not a sensation of contraction and the woman is unaware of these muscle spasms. Vaginismus may occur with or without pain. This condition can be absolute or situation specific. Careful history taking by the sex therapist and exam by an OBGYN are helpful in making this diagnosis.
Prevalence of pain during intercourse (includes vaginismus) 14.4% (Laumann et al., 1994).
Causes
The cause of this conditioned muscle contraction is sometimes hard to determine. Usually there are several influences that contribute to the condition occurring. Please see section above: General Factors that Contribute to Female Sexual Disorders.
Treatment
The treatment can include exercises that address the following steps:
Biofeedback – Pelvic floor treatment by trained biofeedback therapist
Watch sexuality education videos and read books
Partner may be requested to attend some or all sessions
Positive sexual mind-set
Discuss negative sex training, expectations, and traumatic experiences that you associate with sex
Relaxation training
Learn and practice deep breathing
Learn progressive muscle relaxation
Develop awareness and voluntary control over the tense muscles
Kegel exercises
Practice penetration with graduated dilators or fingers with lubrication
Biofeedback sessions
Beginning Intercourse
Woman astride position with graduated steps, employing the learning above
Stop, calm yourself and talk about any discomfort
Develop conscious awareness of thoughts before, during and after a practice session
The most important element in this treatment program is that the woman patient has a sense of control.
Vulvar, Vaginal and Pelvic Pain
Definition
Dyspareunia is recurrent or persistent genital pain associated with sexual intercourse in either a male or a female. The disturbance causes marked distress or interpersonal difficulty. The disturbance is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for by another Axis I disorder except another sexual dysfunction and is not due exclusively to the effects of a\ substance (drug or medication) or a general medical condition. The types are lifelong/acquired, generalized / situational, and due to psychological factors/due to combined factors.
Prevalence of pain during intercourse (includes vaginismus) 14.4% (Laumann et al., 1994).
Causes
There are a variety of physical and psychological conditions that can cause vulvar and pelvic pain. Please see section above: General Factors that Contribute to Female Sexual Disorders.
This multidimensional pain problem is influenced by a variety of factors including thoughts, emotions, behaviors, and couple interactions. Women afflicted with this disorder report significantly lower levels of sexual desire and arousal, lower frequencies of intercourse, and lower orgasmic success than women without dyspareunia.
Dyspareunia is often accompanied by a hyper tonicity of the muscles in the outer 1/3 of the vagina and pelvic area that occur as a conditioned response to the pain.
Careful history taking by the sex therapist and exam by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems are essential in making the diagnosis and beginning treatment.
Treatment
The treatment can include exercises that address the following steps:
Watch sexuality education videos and read books or workbooks
Physician assessment and treatment
Careful exam and subsequent medical treatment by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems
Referral to a pain management anesthesiologist for specialized medications when necessary
Partner may be requested to attend some or all sessions
Develop a joint understanding of the multidimensional treatment for this problem and reduce blame and shame
Validate couple strengths and encourage non-intercourse lovemaking to maintain the emotional bond
Positive sexual mind-set
Discuss negative sex training, expectations, and traumatic experiences that you associate with sex
Discuss impact of sexual pain condition on the individual and the sexual and couple relationship
Develop coping statements to help you develop an active rather than a passive attitude toward this pain problem
Relaxation training
Learn and practice deep breathing
Learn progressive muscle relaxation
Develop awareness and pain management techniques
Identify where the pain is located through self-exploration
Keep a Pain Diary
Learn cognitive restructuring to cope with the before, during and after phases of the pain experience. This technique will help you to react differently to your pain
Develop voluntary control over the tense muscles
Kegel exercises
Practice penetration with graduated dilators or fingers with lubrication (pain level permitting)
Biofeedback treatment by a skilled therapist trained in treating vulvar and pelvic floor pain and muscle problems
Beginning Intercourse
Woman astride position with graduated steps, employing the learning above
Stop, calm yourself and talk about any discomfort
Develop conscious awareness of thoughts before, during and after a practice session
The most important element in this treatment program is that there is a multidimensional approach to this treatment.
Sexual Aversion Disorder
Definition
Persistent or recurrent extreme aversion to and avoidance of, all (or almost all) genital sexual contact with a sexual partner.
Prevalence: Sex is not pleasurable 21.2% (Laumann et al., 1994)
Pain during intercourse 14.4% includes vaginismus (Laumann et al., 1994)
Trouble lubricating 18.8% (Laumann et al, 1994)
Causes
There are a variety of physical and psychological conditions that can cause sexual aversion. Please see section above: General Factors that Contribute to Female Sexual Disorders.
Treatment
Gradual, slow pace of treatment
Developing boundaries to protect physical and emotional safety
Challenging Negative Sexual Beliefs
Developing Positive Sexual Attitudes and Motivations
Assertion training
Conditions for Good Sex
Graduated massage, self touch and partner touch exercises
The most important element in this treatment program is that there is a slow pace of treatment based on the client’s sense of safety and comfort with proceeding to the next step.
Sexual Arousal Disorder
Definition
Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement. The disturbance causes marked distress or interpersonal difficulty.
Causes
There are a variety of physical and psychological conditions that can cause sexual aversion. Please see section above: General Factors that Contribute to Female Sexual Disorders.
Treatment
Addressing relationship, physical and medical factors that contribute to the problem
Challenging Negative Sexual Beliefs
Developing Positive Sexual Attitudes and Motivations
Assertion training
Conditions for Good Sex
Graduated massage, self touch and partner touch exercises
Exploring fantasy and erotica
Problems with sexual desire and frequency
Problems with sexual desire and sexual frequency are some of the most common and complicated concerns that cause individuals and couples to seek sex therapy.
Definition
Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.
Prevalence
Studies report Hypoactive Sexual Desire diagnosis ranges from 14 – 63%.
Causes and Barriers
Biological
Hormonal factors, health/major illnesses, street drugs, medications, and age and aging
Emotional
Religious, cultural, and family messages about sex. Self and body image concerns, inhibitions regarding sexual fantasies, sexual trauma history, masked sexual orientation issues, lack of information, unrealistic expectations and fears of intimacy and closeness, and lack of differentiation from family of origin or from partner.
Relationship
Stored anger, resentment and chronic conflict, need for power and control, not attracted to partner, disagreements about conditions and reasons for sex, inability to negotiate differences as a fundamental relationship problem.
Unrealistic Expectations
Initial infatuation stage vs. deeper, calmer stage of attachment (not all consumed with sex). Real love is built on communication and intimacy. Sex becomes a part of the whole relationship, not the centre of it.
Lifestyle / Culture
Life in the fast lane, role overload, fatigue, unrealistic expectations for sex, body image and relationships from media influence.
Treatment
Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below. Others won’t. There is usually a hidden part of female sexual problems, the emotional part that is unique to each individual and /or the couple. Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.
Improving communication about sex
Do sex checks. State what I want in positive respectful terms. Talk about sex more often. Listen carefully and non-defensively to what my partner has to say. Be willing to try what my partner suggests while respecting my own sexual limits. Refrain from blame and criticism. Praise my partner daily. Talk about my resistance and hesitancy to communicate about sex.
Good sex takes effort once you’re past the infatuation stage of the relationship
Sexual excitement is made not born
Cultivate sexual mindfulness
Finding time in your busy life
If you don’t make an effort, forgetting to have sex can become a habit
The key to a good sex life within a busy life is planning
Finding couple time and making sex a priority
Ask for help if needed and also learn to say no. Divide the labor.
Find couple time – overlap shifts, extend day care, meet for lunch, cancel appointments, enforce bedtime, use the media, use baby sitters, relatives and friends or trade with other parents.
Regular date nights, 15 minute face to face talks daily and romantic weekends away.
Conditions for good sex
Turn off the TV, computer, cell phones
Go to bed at the same time, and earlier in the evening
Light meals and little or no alcohol
Feeling rested and connected
Candlelight and flowers?
Restore touch & affection so that touch does NOT equal sex
Eye contact
Touch gently during conversation
Sit close on couch
Spoon
Hold hands
Romantic Love Starter Kit – Cultivate Good Feelings
Say “I love you”
Send a SMS with a sexy message
Send me a card in the mail
Bring me a flower
Do a chore without being asked
Go for a walk and talk with me
My sex treasure box – Be prepared!
Lock on the door
White noise or radio near the door
Special underwear & sleepwear
Favorite sex toys
Romantic music
Massage oil
DVD’s, erotic books & magazines
Contraceptives & lubes
Better sex through chemistry?
Sex is more than just chemistry
Drugs may reduce or enhance libido
Consult with your physician
Where to get Help
Many people often need the boost of professional help to get the many aspects of their sexual concern sorted through and resolved. I offer individual and couple counseling services with a specialization in sex and couple therapy.