As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
There is a lot of stigma attached to the area of sex and sexual function. As such, it can be very difficult to talk about sex-related issues with a mental health provider, or even your partner. Mental health providers, such as therapists, social workers, psychologists and psychiatrists are professionals and well equipped to help you cope with any sexual issues you may be having.
There are a range of issues that fall under the umbrella of sexual dysfunction. One of the most commonly treated conditions is Erectile Disorder. However, it is important to note that there is significant controversy in the sexual health fields about the origins of sexual dysfunction and what can be accepted as “normal” sexual function. As such, it may be worth it to consider consulting a therapist who is a Certified Sex Therapist, or someone who has significant specialized experience in sexual health issues. They can help you explore, in-depth, what constitutes functional, normal sex, and thus dysfunction.
Erectile Disorder
Erectile Disorder, or ED, is one of the most commonly treated sexual dysfunctions in the United States. It is estimated that about 1 in 5 men over the age of 20 experience erectile issues. This number increases greatly as men age, reaching about 77% of those who are aged 75 or above. Those living with the condition may experience difficulty achieving and/or maintaining an erection, difficulty reaching orgasm, and a general reduction in rigidity of an erection when present. This can be quite disruptive to some men and it is often the prevalence of this occurrence, or a suggestion by a sexual partner, that prompts men to seek out medical care. Others, who are not distressed by their function, do not meet the criteria for Erectile Disorder.
There is a lot of variability in people’s experiences with the condition, but across all those diagnosed, the difficulty with erections must be present 75% of the time or more in sexual situations. Additionally, the symptoms must be present for 6 or more months. Some may experience ED in all sexual contexts, but some may not. For some, erectile dysfunction may be situational. It can also either be an acutely acquired or lifelong problem.
Delayed Ejaculation
By contrast, Delayed Ejaculation is a condition in which men have difficulty reaching orgasm. The condition is very similar in that symptoms must be present for a period of at least 6 months and occur in the context of partnered sexual activity at least 75% of the time. Additionally, the absence of orgasm must be considered problematic by the individual themself.
Delayed Ejaculation, by definition, manifests by difficulty reaching ejaculation during sex. This can be frequent or not and can mean that there is an absence of ejaculation altogether.
Premature (Early) Ejaculation
As one might imagine, premature ejaculation is a condition in which men feel emotional distress due to reaching orgasm within one minute of vaginal penetration. This, of course, is specific to partners who are of different biological sexes and there has been little research of this condition in men who have sex with men or with men who engage in sexual acts other than vaginal penetration.
What is most unique about Premature Ejaculation is that the severity of the condition is in direct relation to a very specific amount of time, with cases being considered “severe” if a man reaches ejaculation within 15 seconds of vaginal penetration or even before sexual contact.
Female Sexual Interest/Arousal Disorder
Arousal and desire disorders are among the most common sexual dysfunctions for women. This is most often captured by the condition called Female Sexual Interest/Arousal Disorder.
Much like the conditions mentioned previously, the presence of this condition is most often present for at least 6 months and can be a lifelong problem or acquired. It may be specific to certain situations or generalized to all sexual situations; it also varies in the amount of distress it causes in the person’s life.
Female Sexual Interest/Arousal Disorder is characterized by:
- Little to no interest in sex or sexual activity
- Little to no interest or experience of sexual thoughts or fantasies
- Little to no excitement, or arousal while in sexual situations
- Little to no interest, arousal, or excitement to erotic/sexual cues or stimuli
- Little to no interest in initiation of sexual activity or lack of interest or reciprocity when approached by a sexual partner
- Absent or low reaction to both genital and non-genital focused sensations
Female Orgasmic Disorder
Female Orgasmic Disorder is a condition that is marked by a delay, great infrequency, or absence of orgasms. In some, however, this may manifest in dramatically reduced intensity of orgasms experienced during sex as well. This experience can be acutely acquired or can be considered lifelong (originating when a person first became sexually active). Like the other conditions listed previously, Female Orgasmic Disorder exists when these symptoms exists the vast majority of the time during sexual encounters (75% of the time and above).
Other sexual dysfunctions
In addition to the conditions listed above, there are other much less common sexual dysfunctions. They include: Genito-Pelvic Pain/Penetration Disorder, Male Hypoactive Sexual Desire Disorder, Substance/Medication-Induced Sexual Dysfunction, and other specified and unspecified sexual dysfunctions.
A note about Sexual Dysfunction Among Transgender, Genderqueer, and Gender-nonconforming People
Many of the sexual dysfunctions listed in this section are specifically gendered and arguably heavily focused on anatomy. As such, those who identify as transgender, genderqueer, or gender non-conforming are strongly advised to work closely with trans and/or queer affirming medical and mental health providers when addressing issues related to sexual function and desire.
Treatment
Treatment for sexual dysfunction most often includes medication and/or psychotherapy. Most often, when entering treatment, individuals concerned about their sexual functioning may be asked to complete a physical exam. In certain instances, a follow up appointment with an endocrinologist, urologist, or obstetrician/gynecologist may be indicated to screen for physical and structural causes or issues.
Medication
Medical doctors, including psychiatrists, may prescribe medication to help people cope with the symptoms of sexual dysfunction. Currently, there are a variety of options to help men cope with Erectile Disorder as more funding and research has been conducted in this area. Some common medications for ED include: vardenafil (brand name Levitra), tadalafil (brand name Cialis), and sildenafil (Viagra). These medications are designed to help men sustain an erection.
Complaints among women about sexual satisfaction are incredibly common, with about 40% of women expressing dissatisfaction in their sexual lives. Decreased arousal is the most common complaint. As such, most medical treatment centers around hormone replacement such as localized estrogen treatments or testosterone (to increase arousal).
Testosterone replacement therapy is also helpful for men who report decreased sexual desire.
Psychotherapy
Sexual complaints can be an important part of individual or couples counseling (therapy). Due to the sensitive nature of discussing sexual issues, many therapists use the PLISSIT Model in addressing sexual issues. This model provides a framework to help therapists approach these kinds of conversations with ease and comprehensiveness.
Individual therapy
Sexual issues may be worked out during individual therapy with your therapist and many of the same techniques may be discussed in individual or couples therapy sessions. If a person is currently partnered and their partner(s) is willing to engage in couples therapy to work through sexual issues then that is often recommended. However, if the individual him/herself wants to work through the issues on their own and introduce strategies discussed in therapy later with their partner, they may also do so. Therapy will differ greatly depending on the specific dysfunction a person presents with. For women who experience arousal/interest disorder or orgasmic difficulties, the work in therapy may focus learning to accept one’s desires and getting in tune with one’s body and sexual arousal more intimately. This may be achieved by assignments designed to explore different types of arousal and may include recommendations by a therapist to watch pornography or otherwise utilize erotica, as well as include practicing masturbatory stimulation. Therapy may also include skills-based learning to more effectively communicate wants and needs during, and about, sexual experiences. A reconstruction of thought patterns that reinforce female sexuality being limited and solely for the pleasure of a partner only may also be a significant part of individual therapy.
For men, Erectile Disorder is the most common sexual dysfunction. This can be worked through in individual therapy alone or in conjunction with prescribed medication. In individual therapy, a therapist will help you examine what is most often experienced as a frustration and embarrassment cycle in which men encounter sexual situations in which they are not able to sustain erection. In individual therapy, a therapist will provide psychoeducation on arousal, as well as help you identify behavioral patterns that will greatly improve erections and overall sexual satisfaction.
For the other conditions mentioned here, many of the techniques of individual therapy may be molded to address the specific ways in which they manifest in people’s lives. Most often, individual therapy will include a combination of the following interventions: masturbatory retraining, mindfulness, imagery rehearsal, thought reconstruction, and establishing a close relationship with a “sexual friend” (if an individual is not partnered).
Couples Therapy
Couples therapy will often focus on the dynamic between the partners involved and center on better communication about sexual needs and desires. Operating within the safe space of therapy with a professional may better enable partners to speak openly about their concerns and receive guidance and direction from a licensed professional. Couples therapists may approach specific sexual concerns in the context of a coupled dynamic (assisting in imagery rehearsal, asking for partner’s likes and needs during sex, etc.), as addressed above, but may also encourage work on bettering the overall health of the relationship.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- I have trouble reaching orgasm with my partner but not when I’m alone, does that mean I still have a sexual dysfunction?
- My partner doesn’t want to have sex as much as we used to, could they just be depressed?
- I worry that my partner and I are not sexually compatible, can you help us change that?
- Is it normal for me to not reach orgasm through vaginal penetration?
- Sometimes I think that I want sex too much. Is there something wrong with me?
Sources
American Psychiatric Association. "Sexual Dysfunctions." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 201-213.
Erectile Dysfunction. (2015, November 01). Retrieved June 19, 2017
McCarthy, B. (2015). Sex made simple: clinical strategies for sexual issues in therapy. Eau Claire, WI: Pesi Publishing & Media.
Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ, Urologic Diseases in America Project. Predictors and Prevalence of Erectile Dysfunction in a Racially Diverse Population. Arch Intern Med. 2006;166(2):207-212. doi:10.1001/archinte.166.2.207