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This disorder generally causes serious marital discord. It is be found in both men and women, both single and married. In evaluating lack of sexual desire, the possibility of a medical cause must be considered. In some cases, there may be both medical and psychological issues. The individual's history and the history of the relationship is reviewed. A history of sexual traumas or relationship issues is commonlly found. Most often psychotherapy is required to resolve this disorder. Problems with Erections (Erectile Dysfunction)Erectile Dysfunction (E.D.) is described as the inability to obtain or to maintain an erection long enough to complete intercourse the majority of the time. While erectile problems may occur occasionally with any man, when this becomes a common event, the man and his partner are adversely affected. His partner may feel that it is her fault, that she is not attractive enough or that he no longer loves her. The opposite is generally true. A man may care so much for his partner that he is overly concerned with pleasing her. A cycle of anxiety and fear of failure begins. Sex therapy can be utilized by men with or without partners to break into this cycle. While medication can be useful in some situations, sex therapy, or sex therapy plus medication, is highly recommended in order to bring about a complete resolution of this problem. Premature EjaculationRapid ejaculation, that is ejaculation just before or soon after penetration in intercourse, is among the most common of sexual complaints. Possible causes may be behavioral (i.e. habit), psychological (i.e. anxiety related) or biological. The direction of the therapy is dictated by the probably cause. This is determined by a detailed history. Behavioral techniques, psychodynamic techniques and occcasionally medication are useful in the treatment of this disorder. Retarded Ejaculation (Male Orgasmic Disorder)A less common sexual dysfunction, men with retarded ejaculation require prolonged stimulation in order to reach orgasm and sometimes may not be able to reach orgasm at all. Therapy generally involves a search for underlying psychological issues and/or behavioral techniques to increase response time to sexual triggers. Lack of Orgasm in WomenApproximately ten percent of all women do not experience orgasm under any conditions. Another twenty percent of women do not experience orgasm in intercourse but do by other means. Orgasm can be considered a learned reflex, that is, the triggers for the orgasmic reflex must be learned. Emotions can also block this reflex from happening. Inability to experience orgasm can be caused by lack of appropriate stimulation, history of painful intercourse, guilt, history of sexual abuse, concerns about body image, fear of losing control of one’s self or the situation, trust issues, and relationship conflict. Women who engage in sexual intercourse primarily to please their partners may be among those who do not experience orgasm. All women are capable of experiencing orgasm. A gradual program of learning to focus on sensations is beneficial in developing an orgasmic response. Painful Intercourse/ VaginismusMany women experience painful
intercourse from time to time. Consistent painful intercourse should be
evaluated by a physician. Routine pain upon attempt to enter with no
visible source of the pain may be caused by vaginismus. Vaginismus is a
condition in which the muscle surrounding the outer third of the vagina
involuntarily contracts when attempts are made to enter the vagina.
Continued attempts to enter result in pain. Unconscious anticipation of
pain reenforce the involuntary contraction of this muscle at the next
attempt. This problem can cause serious marital stress. While the OTHER PROBLEMS RELATED TO SEXUALITY:Premenstrual Syndrome (PMS)PMS is a disorder characterized by irritability, anger, mood swings, anxiety or depression, beginning a week to ten days before the onset of menstruation. Women with PMS may also feel overwhelmed, have less interest in daily activities, feel fatigued, have trouble concentrating, experience changes in sleep or appetite, among other physical symptoms. These symptoms usually disappear dramatically with the onset of the menstrual flow. In some women, PMS-like symptoms are associated with an imbalance in hormones produced by the ovaries or produced by the pituitary gland. For other women, underlying depression, anxiety or unresolved issues like marital conflict may become unmanageable during the premenstrual time. The proper treatment for significant problems with PMS begins with appropriate screening for physical problems, for hormonal imbalance, for psychological factors and for significant events within the personal history. Initial charting of symptoms is a must for proper diagnosis. While one single treatment plan is not effective for all who suffer from this multi-factorial disorder, the good news is that PMS is now recognized as a treatable disorder. Sexual AbuseA history of sexual abuse is unfortunately very common. One estimate is that one in three women and one in seven men have been sexually abused as children. The resultant feeling of violation, mistrust, lack of control, and confusion regarding sexuality takes a large toll on an individual’s feelings of self worth, confidence, and their ability to function in healthy relationships. Past sexual abuse generally results in difficulties in functioning sexually in a healthy way. Partners may be unaware of the sexual abuse. If aware, the partner may feel angry and confused because actions that someone else has perpetrated is adversely affecting his or her sexual relationship. The partner may feel powerless to help. Psychotherapy is necessary to develop a healthy self concept, healthy sexuality, and improve intimate and marital relations. Sexual Addiction (Sexual obsessive-compulsive behavior)It is human
nature to enjoy sexuality. Normal sexual interest can encompass a wide
range of frequency of sexual thoughts and sexual behaviors. When does
this interest cross over to an unhealthy obsession? When sexual
thoughts are obtrusive, interfere with work and relationships, drive one
to sexually “act out” in ways the individual can’t stop, a sexual
addiction can be identified. This addiction may be focused on
masturbation, sexually explicit materials, the internet, massage parlors
or prostitutes. The addiction may also be focused on one’s partner.
One causative factor may be childhood emotional abandonment. Other
factors may be an underlying low level of depression or a history of
child sexual abuse. Therapy involves identification of causative
factors, treatment of any depression, behavioral modification and Gender IssuesAn individual with normal biology of one sex may psychologically feel an identity with the opposite sex. This individual is referred to as transgendered. Psychological assessment and proper diagnosis of this condition is necessary before proceeding with hormonal and surgical intervention. Individual and group psychological support is generally necessary through the two to five year transition. The above information is not intended to be a complete description of these disorders and their treatment. It is also not intended as a self-help guide. It is only given to help you decide if your problem is one with which Dr. Sherman specializes. All therapy is individualized and your therapy may not necessarily be carried out exactly as described above.
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