You are on page 1of 29

Overview of sexual dysfunction & interventions

Joy Hall Head of Division Womens Health MSc BEd(Hons) RN. BASRT Accredited UKCP Registered Psychosexual & Relationship Therapist Joy.hall@bcu.ac.uk

Sexual dysfunction The persistent impairment of the normal patterns of sexual interest or response [ Hawton,1985] Masters & Johnson (1970)Disorder based on their sexual response cycle DSMIV : Persistent or recurrent,deficient or absent, parital or complete. Kaplan [1979] triphasic model of sexual response : sexual desire, sexual arousal, orgasm

Type of disorder

Male

Female

Desire

Hypoactive sexual desire disorder Sexual aversion disorder Erectile dysfunction

Hypoactive desire disorder Sexual aversion disorder Female sexual arousal disorder Inhibited female orgasm

Arousal

Orgasm

Inhibited male orgasm Premature ejaculation Dyspareunia

Pain

Dyspareunia Vaginismus

DSM IV also categorises


Sexual dysfunction due to : general medical condition. substance misuse Paraphilias Gender identity disorders. Primary/secondary. Generalised/situational. Therapists will also work with : Post rape/sexual assault.CSA, sexual orientation issues. Etc.

Prevalence
WOMEN : 35 60%: Mostly inmpaired sexual interest & arousability. 10 15 % anorgasmia. MEN : Rapid ejaculation : 20 40% Erectile dysfunction : 7 10% [ 25% at 65yrs] Retarded ejaculation : 4%

ASSESSMENT History Examination Investigations Formulation

Physical causes/factors Psychological factors: Predisposing/ Precipitating/perpetuating.

Predisposing factors
Restrictive upbringing Disturbed family relationships Inadequate sexual information Traumatic early sexual experiences Poor self esteem Physical/emotional/ Sexual abuse childhood Psychiatric illness Early insecurity in psychosexual role

Precipitating factors
Childbirth Discord in general relationship Infidelity Unrealistic expectations Dysfunction in partner Random failure Ageing Reaction to organic factors Depression & anxiety Traumatic sexual Experience Work /financial stress Bereavement

Perpetuating factors
Performance anxiety Anticipation of failure Loss of attraction between partners Guilt Poor communication Discord in general relationship Fear of intimacy Impaired self image Inadequate sexual information: sexual myths Restricted foreplay Psychiatric disorder.

Physical examination External for secondary sexual charactristics. Check normality of : endocrine, nervous and vascular systems. Bimanual examination (if appropriate) PR examination & PSA ( as appropriate)

Formulation
Provides a diagnosis An assessment of individual or couples ability to change. Action plan for interventions rationale. Provides individual/couple with further understanding of the problem. & the therapist can check interpretation.

Interventions
An eclectic approach Behavioural Cognitive Relationship

Case Study GP Referral. Mr H aged 27yrs. Mrs H aged 32yrs 2 year history of secondary situational erectile dysfunction. Lifelong generalised mild vaginismus. vaginismus.

History of presenting problem Non consummation of marriage ( 2 years) Erections on masturbation sufficient for penetration, orgasm & ejaculation ( masturbation x 2 per month Morning erections & erotic response present. Balanitis & slight phimosis. Sound general relationship Currently x 2 per week mutual masturbation.

Investigations. Physical : Temp,pulse,BP, chest/heart, abdomen : NAD Scrotum & secondary sexual characteristics: NAD Penis : Balanitis : treated c/o saline bathing & sensilube. Urinalysis: NAD

Investigations continued Serum testosterone: 15.5 mmols FSH : 5.8 IU/l LH : 4.3 IU/l Plasma glucose : 5.2 mmols Thyroid function & FBC/U&Es : NAD

Medical history Mr H : Nil of note Mrs H : Migraines, irregular periods, overweight later diagnosed with polycystic ovary syndrome. Medication,smoking,alcohol, use of recreational drugs : NIL.

Social & school history Mr H :Telecommunications manager. Mrs H : Medical secretary. Both single sex schools, uneventful school histories. Both have strong Christian beliefs & upbringing, help to run church youth club.

Family history: Mr H. Youngest of 2 children ( older married brother c/o children) parent in good health.No sex education at home.Little affection shown .Little open communication ( keep feelings to yourself) Described upbringing as restrictive.

Family history : Mrs H Oldest of 2 children ( younger sister,married c/o children) Parent in good health. Affection more openly between parent & towards Mrs H. Limited sex education - periods discussed.

Sexual History No abuse or homosexual experiences For both, each was first sexual partner.Had decided to wait until married before intercourse. No genital contact/touching prior to marriage. A lot of non genital body touching arousing, erections Ok. Friends prior to partners. courted for 3 yrs prior to marriage. Wedding night erectile failure.

Current sexual relationship Mutual masturbation at best 1-2 x per week 1 No oral or anal sex. No use of visual/audio aids etc. Both orgasmic via masturbation Restrictive Mrs H unhappy about her weight, covers up. Vaginismus when penetration attempted, Mr H looses erection.

Formulation Predisposing Factors: Couples restrictive Factors: upbringing. Inadequate sexual information.Belief that all would be good on wedding night. Mrs Hs perceived unattractiveness. Mr Hs slight phimosis. Precipitating Factors: Unrealsitic goal Factors: focussed expections. Random failure on wedding night PERFORMANCE ANXIETY. Mrs Hs vaginismus.

Perpetuating factors Performance anxiety. Anticipation of failure. Belief of sexual myths. Guilt sex was something to be endured not enjoyed

Interventions Ban on sexual intercourse. Education and permission giving A & P of genitalia & sexual response ( guided tour via video) Exploration of sexual expectations & myths. Showering & body exploration ( individual & together)

Interventions continued Kegal exercises,deep breathing & relaxation exercises ( Mrs H) Sensate focus programme including oral sex ( at which point good firm erections sufficient for penetration) Vaginal digital insertion & relaxation. Enhancement of communication skills.

Outcome of therapy Full penetrative intercourse. Number of sessions seen : 1 assessment 6 follow up 1 3 month review.

Reading & useful contacts Hawton, K (1985) Sex therapy : a handbook for practice. Tomlinson, J (editor) (2005) ABC of Sexual Health.2nd edition. London: BMJ British Association of Sexual & Relationship Therapists.0208 543 2707

You might also like