Sex therapy is needed when the sexual difficulty that started out as an occasional problem that occurred infrequently becomes an ongoing source of frustration and disappointment for the couple and/or individual and may be getting worse over time.
The ongoing sexual difficulties may either be psychosexual, psychosocial, medical, or a combination of all three. Psychosexual difficulties are psychological factors that can interfere with sexual functioning such as, unconscious fears, ongoing stress, anxiety, depression, guilt, fear of infidelity, partner conflict, fear of intimacy, dependency, abandonment, and concern over loss of control. Anxiety plays an important role in developing and maintaining sexual difficulties, for example, performance fears, or the fear of not being able to perform during sexual behaviour, and an excessive need to please a partner interfere with sexual functioning.
Psychosocial factors are comprised of difficulty with one’s social environment, which often is conflict and disconnection with one’s significant partner caused by one or more of the following: infidelity, poor interpersonal communication, ‘emotional divorce’, pornography addiction, loss of respect, partner domination and abuse, long-distance relationships, ‘flat mate’ relationship dynamic, and financial and family stress to name just a few.
Medical problems contributing to loss of sexual functioning are many and varied. Sexual difficulty increases with age, which is mainly because of physical factors such as disease, disability, illness, and use of many commonly used drugs. For example, prescription drugs may cause erectile or ejaculatory problems in men, orgasm problems in women, and a loss of sexual desire in both. Psychotropic medications, or medications prescribed for psychological disorders, such as depression and anxiety, can often lead to sexual dysfunction. Non-prescription drugs such as tobacco, alcohol, marijuana, LSD, and cocaine may also contribute to sexual dysfunction.
University qualified and experienced Sex Therapist Darren Radley is The EPICentre specialist in this area and able to assist clients find solutions and answers to occasional and on-going sexual difficulties and dysfunctions.
Sexual difficulty or problems that create a disturbance in the sexual response and that don’t go away by themselves, and in fact may get worse over time are characterised as sexual dysfunctions.
These dysfunctions can be organised into four main areas:
- Primary sexual dysfunction – A sexual dysfunction that has always existed.
- Secondary sexual dysfunction – A sexual dysfunction that occurs after a period of normal sexual functioning.
- Situational sexual dysfunction – A sexual dysfunction that occurs only in specific situations.
- Global or generalised sexual dysfunction – A sexual dysfunction that occurs in every situation.
Sexual Desire Disorders
Hypoactive sexual desire disorder (HSDD) – When someone has HSDD, there are diminished or absent feelings of interest in, or desire for, sexual activity.
Sexual aversion disorder – Unlike HSDD, in which a person might be able to engage in sexual activity even though he or she has little or no desire to do so, a person with a sexual aversion reacts with strong disgust or fear to a sexual interaction.
Sexual Arousal Disorders
Female sexual arousal disorder (FSAD) – Is a persistent or recurrent inability to either obtain or maintain an adequate lubrication response of sexual excitement.
Male erectile disorder (ED) – Erectile disorder is defined as the persistent inability to obtain or maintain an erection sufficient for satisfactory sexual behaviour.
Female orgasmic disorder – Is defined as a delay or absence of orgasm following a normal phase of sexual excitement.
Male orgasmic disorder – Is defined as a delay or absence of orgasm following a normal phase of sexual excitement.
Premature ejaculation (PE) – PE usually refers to a man reaching orgasm just before, or directly following, penetration. Occasional or substance-induced early ejaculation often does not qualify for a diagnosis of PE. However, usually if a couple believes there is a problem, then it is often treated like one.
Delayed or absent ejaculation – Is defined as a male being unable to reach orgasm or requires a prolonged stimulation period (30-45 minutes) to reach orgasm.
Retrograde ejaculation – Involves the backward flow of ejaculate into the bladder instead of its being released through the urethra. Typically men with retrograde ejaculation still experience orgasm but have very little ejaculate (or a “dry” orgasm).
Sexual Pain Disorders
Dyspareunia – May occur before, during, or after sexual behaviour and may involve only slight pain, which does not interfere much with sexual activity. However, when it is extreme, it may make sexual behaviour difficult, if not impossible. Contrary to popular belief, men can also experience dyspareunia, which may cause pain in the testes or penis, either during or after sexual behaviour. Types of dyspareunia for women are Vulvar vestibulitis syndrome and Vaginismus.
Vaginismus – The pubococcygeus muscle surrounds the entrance to the vagina and controls the vaginal opening. Vaginismus involves involuntary contractions of this muscle, which can make penetration during sexual intercourse virtually impossible.
Sexual Dysfunctions due to a General Medical Condition
Presence of sexual dysfunction that is due to the physiological effects of a general medical condition or disability.
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Further Recommended Reading:
Gottman, J., Notarius, C., Gonso, J., & Markman, H. (1979). A couple’s guide to communication. Champaign. IL: Research Press.
Gottman, J. M., & Silver, N. (1999). The Seven Principles for making marriage work.New York: Crown.
Heiman, J. R., & LoPiccolo, J. (1988). Becoming orgasmic: A sexual and personal growth program for women (rev. ed.). New York: Prentice-Hall.
Kaplan, H. S. (1989). How to overcome premature ejaculation. New York: Brunner/Mazel.
Kilmann, P. R., & Mills, K. H. (1983). All about sex therapy. New York: Plenum.
McCarthy, B. (1998). Male sexual awareness: Increasing sexual satisfaction (rev. and updated ed.). New York: Carroll & Graf.
McCarthy, B., & McCarthy, E. (1993). Sexual awareness: Enhancing sexual pleasure.New York: Carroll & Graf.