The history of sexuality has revolutionized the way contemporary theorists perceive sexuality. Let us begin by defining Sexual Dysfunction.
Sexual Dysfunctions can be defined as disorders in which people cannot respond normally to in key areas of sexual functioning, making it impossible to enjoy sexual intercourse. The dysfunctions are usually very upsetting, and they usually lead to sexual frustrations, guilt, loss of self-esteem, and interpersonal problems. Many patients experience more than one dysfunction. Another definition from Jennifer, Laura and Elisabeth (2005) defines female sexual dysfunction as a recurrent or persistent complexity encountered in one or more of these aspects: sexual arousal, orgasm, sexual desire, or pain during sex.
Sexual dysfunction can result from several factors, including rape, vaginal infections, female genital mutilation, infertility, childhood sexual abuse, genito-urinary prolapse, fistula, congenital malformations, and adhesions from inconsiderate partners or injuries. [Progress in Reproductive Health Research]
According to Susan, André, and Norman (2004), “Female Sexual Dysfunction is a problem that restricts a woman from enjoying sex”. This turns out to be a great problem in marriage life. Problems like lack of sexual climax or orgasm, Painful intercourse, inability to be aroused and absence of sexual desire may incorporate physical or psychological causes. “Psychological causes may occur as a result of anxiety and work-related stress” (Susan, André, and Norman (2004). This may also include relationship problems or concerns about marriage or depression.
Physical causes occur following conditions such as heart disease, diabetes, hormone problems, or nerve disorders. Certain drugs can as well affect function and desire. To some women dysfunction results from past sexual trauma. Sporadic problems with sexual function are common. However, should they last more than a few months or cause agony for one of the partners it is advisable to consult the health care provider.
As noted by Jane and Imelda (2004), the human sexual response consists of a cycle with four phases; desire, excitement, orgasm, and resolution. Sexual dysfunctions affect one of the first three phases of the cycle. Resolution consists simply of the relaxation and contraction in arousal that follows orgasm. Some persons struggle with sexual dysfunction throughout their lives. In other cases, the dysfunction is present during all sexual situations, in others, it is tied to particular situations.
Disorders of the Desire Phase
The desire of the phase of the sexual response cycle consists of an urge to have sex, sexual fantasies, and sexual attraction to others. Two dysfunctions-hypoactive sexual desires and sexual aversion- affect the desire phase. An illustration is given of a client named Ms. X who experiences both sex disorders. Mr. and Ms. X have been married for fourteen years and have two children ages eight and twelve. They complain that Ms. X has never enjoyed ‘sex’ since they had been married. Before their marriage, although they had intercourse only twice, Ms. X had been highly aroused by kissing and petting and petting and felt she used her attractiveness to ‘seduce’ her husband, Mr. X into marriage.
- Hypoactive sexual desire- is a lack of interest in sex and resulting in thea ,Many low level of sexual activity. When a person with hypoactive sexual desire does have sex, she often does so normally and may even enjoy the experience, while our culture portrays men as wanting all sex they can get.
- Hypoactive sexual desire may be found in as many as fifteen percent of men (LoPiccolo, 1995; Rosen and Leiblum, 1995). It may also be in twenty percent to thirty five percent of women (LoPiccolo, 1995; Rosen and Leiblum, 1995 qtd. Jane and Imelda, 2004). In one survey ninety-three, happily married couples were asked to report how often they desire to have sexual encounters. Almost all of them said that they desire sex at least once a week. Around eighty-five percent reported a desire rate of several times a week or more. According to LoPicclo and Friedman (1998), sexual desire would be considered hypoactive only when a person desires sex less frequently than once every two weeks
Women with sexual aversion find sex distinctly unpleasant or repulsiveness advances may sicken disgust or frighten them. Some women are repelled by a particular aspect of sex, such as penetration of the vagina; others experience a general aversion to all sexual stimuli, including kissing and touching (Jane and Imelda, 2004). Aversion to sex seems to be quite rare in men and somewhat more in women. Let us see some of these disorders’ causes:
Biological Causes
A woman’s sex drive is affected by a combination of biological, physiological and socio-cultural factors. Any of them may reduce sexual desire (Beck, 1995, Rosen and Leiblum; 1995). A number of hormones are involved in sexual desire and behavior, and abnormalities in their levels can lower the sex drive. In both males and females a high level of the hormone prolactin, a low level of the male sex hormone testosterone and either a high or a low level of the female sex hormone estrogen can lead to low sex drive. Low-level sex drive has them for example, been linked to the high levels of estrogen contained in some birth pills.
Long-term physical illness can also lower the sex drive (sciaviavi, 1995; Kresin, 1993). A low sex drive can be caused directly by the illness or indirectly by the stress pain and depression that result from the illness.
Sex drive can be lowered by some medications for pain, certain psychotropic drugs, and a number of illegal drugs such as; cocaine, marijuana, amphetamines, and heroin (Beck, 1995; Segraves, 1995). “Alcohol may increase the sex drive at a level, by lowering a person’s inhibitions; yet reduce it at a higher level” (Roehrich and Kinder, 1991). Meanwhile, the center of searching has failed to find a true aphrodisiac, a substance that increases the sex drive (Henderson, Boyd and whitmarsh, 1995; Bancroft, 1989).
Psychological Causes Disorders
A general increase in anxiety or anger may reduce sexual desire in most women (Beck and Bozman, 1996; Bozmanand Beck,1991). Frequently as cognitive theorists have noticed women with hypoactive sexual desire and sexual aversions hold particular attitudes, fears, or memories that contribute to this dysfunction such as sex is immoral or dangerous(Lo Piccolo,1995). Other people are also afraid of losing control over their sexual urges that they try to resist them completely and that others fear getting pregnant.
Certain psychological disorders may also lead to hypoactive sexual desire or sexual aversion a mild level of depression can interfere with sexual desire. Lo Piccolo (1995) asserts that some people with obsessive-compulsive symptoms find contact with another person’s body fluids and orders to be highly unpleasant
Socio-cultural Causes
The attitudes, fears, and psychological disorders that contribute to hypoactive sexual desire and sexual aversion occur within a socio context and thus some socio-cultural factors have also been linked to these dysfunctional sufferers are facing situational pressures- divorce, death in the family, job stress, infertility difficulties having a baby (Burns, 1995; Letourneau and O’Donohne, 1993). Others may be having problems in their relationships (LoPiccolo, 1997, Beck1995). Persons, who are in unhappy relationships, have lost affection for their partner, or feel powerless and dominated by their partner can lose sexual interest.
In general happy relationships, if one partner is very unskilled, unenthusiastic lower, the other can begin to lose interest in sex. And sometimes partners differ in their needs for closeness.
Cultural standards can also set the stage for hypoactive sexual desire and sexual aversion. More generally, because our society equates sexual attractiveness with youthfulness, many aging women lose interest in sex as their self-image or their attraction to their partner declines with age (LoPiccolo, 1995). The trauma of sexual molestation or assault is especially likely to produce the fears, attitudes, and memories found in these sexual dysfunctions.
Sexual aversion is very common with victims of sexual abuse and may continue for years, even decades (Jackson, 1990; McCarthy, 1990). In extreme cases, persons may experience vivid flashbacks of the assault during sexual activity.
Disorders of the Excitement Phase
The excitement phase of the sexual response cycle is marked by changes in the pelvic region, general physical arousal, and increases in the heart rate muscle tension, blood pressure, and rate of breathing. In women, this phase produces swelling of the clitoris and labia, as well as lubrication of the vagina. These Dysfunctions are referred to as female sexual arousal disorder or frigidity. To explain further, women with sexual arousal disorder are repeatedly unable to attain or maintain proper lubrication or genital swelling during sexual activity. This disorder is rarely diagnosed alone (Segraves, 1991). Studies vary widely in their estimates of its prevalence, but most agree that more than ten percent of women experience it.
Female Orgasmic Disorder
The orgasm phase is the phase of the sexual response cycle during which an individual’s sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically. A woman with this disorder repeatedly experiences a much-delayed one. More than ten percent of women have this problem-including more than one-third of postmenopausal women (Rosen and Leiblum, 1995; Lauman, 1994). Once again; biological, psychological, and socio-cultural factors are each at work in these disorders.
Biological causes-Diabetes can damage the nervous system in ways that interfere with postmenopausal changes in skin sensitivity and structure of the clitoris and the vaginal walls.
Psychological Causes- the psychological causes of hypoactive sexual desire and sexual aversion may also lead to female arousal and orgasm disorders. To add memories of childhood traumas have also led to these disorders.
Socio-cultural causes-; For years clinicians have believed that female arousal and orgasmic disorders may result from society’s repeated message to women that they should hold back to deny their sexuality.
Sexual Pain Disorders (Vaginismus)
In vaginismus, involuntary contractions of the muscles around the outer third of the vagina prevent the entry of the penis. Severe cases can prevent a couple from ever having intercourse. Perhaps twenty percent of women occasionally experience pain during intercourse, but vaginismus probably occurs in less than one percent of all women. Most clinicians agree with the cognitive-behavioral position that vaginismus is usually a learned fear response; set off by a woman’s expectation that intercourse will be painful and damaging. This may come from anxiety and ignorance about intercourse, exaggerated stories about how painful and bloody the first occasion of intercourse is for women, trauma caused by an unskilled lover who forces his penis into the vagina before the woman is aroused and lubricated, and trauma of childhood sexual abuse or adult rape. (LoPicolo, 1995).In this, most women just fear penetration of the vagina.
Treatment for Sexual Dysfunctions
Sex therapy
Modern sex therapy is short-term and instructive, typically lasting fifteen to twenty sessions. As a sex therapist and researcher Joseph, LoPocco, (1997, 1995) as cited in Jane & Imelda (2004), has explained, it centers on specific sexual problems rather than on broad personality issues. This includes a variety of principles and techniques applied in almost all cases regarding the dysfunction.
- Assessment and conceptualization of the problem- Patients are given a medical examination and are interviewed concerning their ‘sex history’ (Warren and Sampson, 1995). The emphasis during the early interviews is on understanding past life events and in particular, current factors that perhaps are contributing to the dysfunction. Sometimes a team of specialists, perhaps including a psychologist, and neurologist is needed for a proper assessment.
- Mutual responsibility-therapist stresses the principle of mutual responsibility. Both partners in the relationship share the sexual problem, regardless of who has the actual dysfunction, and treatment will be more successful when both are in therapy (Heinman, 1997).
- Education and sexuality- many patients who suffer from sexual dysfunctions know very little about the physiology and technique of sexual activity. Thus sex therapists may offer discussions, educational films, and instructional books, and videotapes.
- Attitude change-Therapist helps patients examine and change the beliefs about sexuality that preventing sexual arousal and pleasure.
- Elimination of performance anxiety and spectator role- Therapists often teach couples sensate focus, or non-demand pleasuring a series of sexual tasks, sometimes called ‘petting’ exercise, in which sexual partners focus on the sexual pleasure that can be achieved by exploring and caressing each other’s bodies at home, without demands to have intercourse or reach orgasm.
- Increasing sexual communication skills – couples are told to use their sensate- focus tensions at home to try sexual positions in which the person being caressed can guide the other’s hand and control the speed, pressure, and location of the caressing are taught to give instructions in a non-threatening, informative manner.
- Change destructive lifestyles and interactions-This involves couples not to distance themselves, from interfering in-laws, or quit jobs that require too many hours.
- Addressing physical and medical factors-When sexual dysfunctions are related to a medical problem, such as a disease, injury, unwanted effect on medications, or alcohol abuse, therapists try to address this problem.
References and Bibliography
- American Medical Association, (1992). Diagnostic treatment guidelines on domestic violence. Washington. DC. Autthor.
- Anderson, D, (1994).Breaking the tradition on college campuses; Reducing drug and alcohol missus, Fairfax, VA; George Mason University.
- Jane Pilcher & Imelda Wheleham, (2004), Key concepts in Gender Studies; Sage publisher’s ltd. London
- Jennifer, B., Laura, B. and Elisabeth B. (2005), For Women Only: A Revolutionary Guide to Reclaiming Your Sex Life, New York, H. Holt
- Progress in Reproductive Health Research No. 57 part 1 2001.
- Ronald J. Comer,(1999), Fundamentals of Abnormal Psychology, Second edition; Worth publishers, Drinceton University, New York.
- Susan, D. André T.; and; Norman A. (2004), Endocrine Aspects of Female Sexual Dysfunction The Journal of Sexual Medicine, Volume 1, Number 1, 2004 , pp. 82-86(5), New York, Blackwell Publishing