SEX & PSYCHOSEXUAL THERAPY
WHAT IS A SEXUAL DYSFUNCTION?
There are a number of different conditions that we might refer to as sexual dysfunctions or disorders. Some are unique to males, some to females, and one or two that appear to have no bias whatsoever.
The male sexual dysfunctions are generally focused on erection reliability, the speed or latency of ejaculations, extremes of sexual desire, and sexual arousal.
The female sexual dysfunctions are generally focused on chronic genital or pelvic pain, extremes of sexual desire, orgasm ability, and sexual arousal.
“In psychosexual therapy I explore lifestyle factors, cognitive factors (keeping in mind that the most common distraction affecting penis function is performance anxiety), emotional factors (such as anxiety, depression, trauma, and loss), behavioral factors (such as pornography usage and masturbation style), socioenvironmental factors (family, culture, and religion), and relationship difficulties within ‘the couple’.” –sh
WHAT IS ERECTILE DYSFUNCTION (ED)?
ED can be defined as “the persistent inability to attain and maintain an erection of sufficient rigidity to permit satisfactory sexual performance”.
ED can be further cateogrised according to the duration of the condition, as: Lifelong (the issue has been present for the entire duration of the person’s sexual life); or Acquired (the issue presented itself after a period of normal sexual function).
ED can also be categorised according to the situations in which it presents itself, as: Generalised (the issue is not limited to certain situations or partners; or Situational (the issue only presents with certain situations or partners).
ED is extremely common. Indeed, a UK based population study in 2013 suggested that 12.9% of men under 40 reported an issue with unreliable erections (compared with 18% in the US). Further studies found that the percentage increases with age, where it rises to 20-40% of men in their 60s, and 50-75% of men older than 70.
In the treatment of ED, it is important we consider an integrative approach where both the physical and psychological factors are understood, assessed, and form the agreed treatment plan. For this reason, I will always insist you discuss your condition with your GP so they can directly consider the physiological factors that can contribute to, and have been associated with, ED. Then you and I can work together on any psychological concerns that affect your sexual function. “Anxiety is high on the list of sexual function saboteurs.” –sh
If you want help with any issue related to your erections, please contact me.
WHAT IS PREMATURE EJACULATION (PE)?
PE is as common amongst men as ED, and is sometimes associated with with ED. PE may also be referred to as Rapid Ejaculation and, despite attempts to relable the condition, the acronym RE hasn’t really caught on, possibly due to a misunderstanding of the word ‘rapid’, as it suggests we are measuring the speed that semen leaves the penis. In fact RE and PE both refer to the latency time between penetration and ejaculation.
About one third of men who suffer from ED, also have an issue with PE. This can sometimes happen if erections are experienced as a rarity and one has the temptation to then rush sex whilst the erection lasts.
There is an important PE related acronym worth mentioning. IELT stands for intravaginal ejaculation latency time. This is a fancy phrase for measuring how long a penis can move back and forth inside the vagina before ejaculation occurs. This acronym is clearly problematic because not all penises go inside vaginas. From now on, we shall assume IELT stands for intraanything ejaculation latency time.
The word ‘premature’ when judging the IELT is subjective. If a man is distressed because he has an IELT of five minutes, he is unlikely to get help for PE, but perhaps might find sex coaching or psychoeducation helpful. Nonetheless, it helps if we have some criteria to determine PE, and most definitions include, 1) a short IELT of less than 90 seconds; 2) a percieved lack of competence, adequacy, or control about the IELT; and 3) an obvious distress related to the condition.
As with ED, PE can also be further categorised into subcategories. Lifelong PE means the issue has been present for the entire duration of the person’s sexual life. Acquired PE means the issue presented itself after a period of normal sexual function.
PE can also be categorised according to the situations in which it presents itself, and so we will refer to the condition as being either Generalised, when the issue is not limited to certain situations or partners; or Situational when the condition only presents with certain situations or partners. There is also a further category called “anteportal ejaculation”, which is reserved for ejaculation that occurs prior to penetration, and is considered to be the most severe form of PE.
The current clinical thinking around PE is that it is a psychological or learned condition in the majority of cases. One of several forms of anxiety tend to be the primary etiology, such as a fearful or phobic response, a conflict between contradictory urges, or a crippling performance anxiety where there is a preoccupation with failure and performance.
I also see men in my clinic who have a lack of sexual sensory awareness. These men have failed to learn and develop a sensory feedback loop around their sexual arousal. It is typical for these men to go from almost no arousal to ejaculation very quickly without any awareness of the arousal process that is taking place within their body. Therefore, sensory exercises and masturbation exercises, either alone or with one’s partner, are frequently used to retrain the body in the treatment of PE.
If you have an issue with PE, I would love to help you. Please contact me.
WHAT IS DELAYED EJACULATION (DE)?
Delayed Ejaculation typically refers to men who struggle to ejaculate. We also use the IELT measurement (that we used for PE, in the section above) when discussing DE and typically we would expect to see an IELT of greater than30 minutes and accompanied by personal and/or relationship distress.
Although not as common as ED or PE, millions of men suffer from Delayed Ejaculation. It is usual for men with DE to have reliable and long-lasting erections and they can often ejaculate successfully via masturbation, and will often present for help with a complaint or concern about their relationship.
It is common for men to suffer this condition for some considerable time before seeking help. This is largely due to there being less of a stigma than is associated with ED or PE, plus it being generally less well-known as a condition or dysfunction, and also men tend to seek help once they wish to start a family and intravaginal ejaculation becomes necessary.
There has been a long-standing clinical opinion – albeit much less common now – that DE suggests an unconscious and unexpressed anger and hostility towards women; or that men who suffer from DE are unable to let go of control or receive pleasure. These concepts are still worthwhile exploring, especially when there are obvious relationship concerns around anger and resentment, and also when the couple wish to conceive.
Consistent with ED and PE, anxiety is also common within DE, and may include a fear of pregnancy, a fear of hurting one’s partner, depression, a lack of confidence, religious anxiety, or poor body image or self-esteem.
It is also extremely common for men who were unable to develop sexually through self-exploration and masturbation – perhaps through a lack of teenage privacy, insufficient education, religious and cultural concerns surrounding sex and masturbation – to present in therapy with DE. For young men who were able to masturbate, some developed a style and technique of masturbation that is impossible to be duplicated by a partner. Then, when the time comes to penetrate their partner, the speed, pressure, position, or intense focus on a very specific genital area, that was required to complete masturbation, cannot be found within the partner.
Arousal plays an important role in ejaculation and some men have a disparity between the sexual fantasies they use for masturbation, and real life sex with their partner. In working with DE, it is vital that we explore historic and current masturbation techniques, habits, and fantasies.