These include lack of interest, decreased libido, performance anxiety, difficulty achieving orgasm, problems maintaining arousal, erectile dysfunction (impotence), premature ejaculation, vaginal pain and general sexual dissatisfaction. These problems can be caused by anxiety, stress, fear, lack of sexual knowledge and experience, childhood physical and sexual trauma, relationship difficulties, physical disabilities and medical problems. Family of origin child rearing practices, and childhood sexual experiences, both overt and covert are incredibly significant with regard to the manifestation of sexual problems earlier and later in adulthood!
Most often baby boys become erect and baby girls lubricate in the first six hours of life according to the famous sex researcher William Masters. Unfortunately, our society often falls short in supporting positive attitudes and behaviors associated with the biological potential in our genetic makeup. Albeit, the biological apparatus is present from the beginning for sexual reproduction and activity, however the learning process is highly influential in the enjoyment of that experience. A variety of socio-cultural influences play dominant roles in the ability of an individual to maximize his or her unique human sexual potential throughout the life-span. A child’s healthy sexual curiosity can be easily laden with negative emotional baggage by our often confused, fearful and constricted society. The media, pop-idols, religious icons, political figures and sport stars significantly influence youthful individuals with real and dramatic sexual drama thereby placing a tremendous amount of pressure on sexual performance. Exemplary of this sexual bombardment is the twenty something young man strutting normal physiological genitalia unable to rise to the occasion or the young lady exclaiming shear ecstasy at some point during the sexual encounter but lacking the ability to achieve orgasm. Of course, sexual abuse and trauma at any age will play havoc with the sense of a healthy sexual self!
Emphasis is placed on educating clients about the sexual system. Treatment issues encompass sexual orientation (heterosexual, homosexual, transsexual), transgenderism, gender identity, sexual role behavior, affairs, communication skills, enhancing creativity, coping with non-normative sexual practices, sexual addiction, sexual compulsion, masturbation, pelvic pain disorders, menopause, pregnancy, abortion, infertility, medical illness, sexual desire discrepancy, emotional distress, trauma, depression, anxiety, stress, low self-esteem, and body image.
Sexual behavior is based on an intermingling of psychological, physiological, and sociological influences. Therefore, consultation with physicians to evaluate physical functioning may be included as part of the evaluation process. Generally, sexual disorders may be considered situational or generalized, (i.e. certain activities or specific partner verses all activities); lifelong or acquired; caused by physical or psychological factors, or a combination of both.
“I won’t be able to get it up. One time a girl laughed at me because I couldn’t perform and I have had trouble ever since. I am already taking Viagra and there is nothing physically wrong with me.” (23 year old male medical student)
“I have been faking orgasm forever. I don’t want my husband to feel inadequate, not to mention, I feel as if something is wrong with me.” (51 year old female banker)
“I have never been able to have an orgasm with my husband present. We both want to enjoy that experience together.” (40 year old female engineer)
“I am terrified to come out of the closet and tell my family I am a lesbian.” (35 year old university coach)
“My girlfriend is ready to dump me because I cannot maintain an erection for more than thirty seconds.” (27 year old male construction worker)
“I have painful intercourse and my husband never seemed to care. I went to many doctors and they would tell me to take a drink or a valium or simply relax. Now I can’t have sex at all.” (50 year old woman school teacher)
“I have herpes. I know I am being punished for premarital intercourse. I can have sex, but I have absolutely no sexual desire.” (28 year old female tennis professional)
“I told my parents I was gay and they want to change me to be straight.” (19 year old male business student)
“I am always on the hunt for a new conquest. I feel powerful when I bring a man home with me. In the morning I feel like crap.” (33 year old female corporate attorney)
“I feel bad and out of control because I masturbate to porn three to four times a day, even at work in my office.” (35 year old male certified public accountant)
“My wife divorced me recently. I am dating a terrific woman, but I cannot maintain an erection. I have tried all the ED drugs and they don’t work. My urologist told me I was normal. I can masturbate as long as I want and have an orgasm, no problem.” (48 year old male physician)
For some, this will include increasing sexual knowledge, decreasing performance anxiety, improving sexual communication, and/or enhancing sexual options and creativity. For others, therapy will focus on more effectively dealing with issues of fear, anger, trust and the vulnerability of intimacy, hence becoming more comfortable emotionally and physically with one’s self. Most importantly, one must understand the sexual self in relation to the multitude of psychodynamic forces of past and present that create the sexual self of today and an awareness of the changes necessary for sexual contentment in the future.