It has been found that most sexual dysfunctions, alterations in sexual response, are due to psychological causes. Therefore, it is possible to intervene from psychotherapy and applied sexology in behavior modification and emotional management programs to achieve greater satisfaction.
But to understand what therapeutic strategies and resources healthcare professionals work with to address these issues in their daily lives, it is necessary to know what they are. the most common sexual dysfunctions. In this article we will talk about them.
What are sexual dysfunctions?
By sexual dysfunction we mean the alteration of some of the stages of sexual behavior that affects the functionality and satisfaction of the individual, emphasizing the significant discomfort it causes in the affected subject. Concretely, it is a mismatch in any phase of sexual response (desire, arousal, plateau, orgasm, or resolution) or pain associated with intercourse that make it difficult to have satisfying sex.
Although the latest version of the American Psychiatric Association’s Diagnostic Manual (DSM 5) does not maintain sexual stage classification, it does present the same disorders associated with these stages. Likewise, it adds gender specifications and in order to be able to diagnose sexual dysfunction, the involvement must last at least 6 months.
What are the most common dysfunctions in the population?
Of those who present for dysfunction, the most common in women are orgasmic dysfunction and sexual interest/arousal disorder; men, on the other hand, are more prone to erection problems and premature ejaculation.
Variations such as place of residence also influence the prevalence of the disorder. For example, hypoactive sexual desire in men is 12.5% in the northern European population, rising to 28% in Southeast Asia.
Also, there are disorders whose exact prevalence is not known, such as female sexual interest/arousal disorder. On the other hand, there is an increase in the frequency of the condition in subjects who consume psychotropics or some type of drug. It should also be kept in mind that with age most sexual disorders tend to increase.
We will see here what are the main characteristics of sexual dysfunctions that occur more frequently in the population. We will also briefly explain therapeutic techniques used to help patients who have developed these disorders; Virtually all can be taught and learned in face-to-face and online therapy sessions.
1. Premature (early) ejaculation disorder
The DSM 5 defines premature ejaculation as a repeating or persistent pattern where, during sexual intercourse with the partner, ejaculation occurs approximately one minute after vaginal penetration and sooner than desired by the individual. This pattern must be present for at least 6 months and appear in all or almost all sexual encounters between 75% and 100% of the time.
It is necessary that the subject shows significant discomfort and has no organic cause such as drug or medication use. The diagnosis also makes it possible to specify whether it is for life (has always been presented) or acquired; whether it is generalized or situational (occurs only with your partner) or the severity of the condition: it is considered mild if ejaculation occurs approximately 30-60 seconds after penetration, moderate if it occurs between 15-30 seconds after penetration or severe if it occurs before sexual activity or 15 seconds after penetration.
In terms of prevalence, it is estimated that 20 to 30% of men between the ages of 18 and 70 reported having had an episode of premature ejaculation, although only 1-3% of these men meet the criteria to receive the diagnosis. If we look at the course that usually presents this disorder, we see how it tends to increase its presence with age.
The treatments that have been shown to be effective for this dysfunction are different. For example, the stop and start technique, which involves stimulating the penis to stop just before ejaculation, and the compression and basilar compression techniques, in which cycles of stimulation plus compression of the penis are performed , are often used, they interrupt ejaculation. This strategy aims to delay ejaculation and thus make intercourse more satisfying for the couple.
2. Erectile dysfunction
In order to be able to diagnose an erectile dysfunction disorder, the DSM 5 assesses that most of the following symptoms must be realized during sexual intercourse with the partner (75-100% of the time), one of the following symptoms: difficulty getting an erection during sexual activity, difficulty maintaining an erection until the end of sexual activity, or decreased stiffness of erection.
As with other dysfunctions, it must be shown for at least 6 months and cause discomfort. It is also necessary to specify the severity, whether it is generalized or situational and whether it is lifelong or acquired.
It has also been observed an increase in prevalence with age, especially from the age of 50. The population under 40-50 years old has a frequency of about 2%, while in subjects between 40 and 80 years old the prevalence increases to 13 or 21%.
Currently, the intervention considered to be the most effective and most frequently used are the multimodal packages which they include behavioral, cognitive, systemic and communication techniquesas these are the areas that are affected are those with sexual dysfunction.
One of the most widely used strategies was proposed by Masters and Johnson, and involves stimulating the penis, then stopping and repeating the process; in this way, it allows the subject to verify that the erection can be lost and then regained. Finally, intercourse is performed.
Another technique that gives good results is filling, which consists of encouraging the individual to practice penetration even if the erection does not occur completely, in order to concentrate on the sensation without the pressure of having to end intercourse. It has also been tested with pharmacological interventions, although there are no studies comparing its effectiveness with psychological techniques.
3. Orgasmic dysfunction in women
The DSM 5 lists the presence of any of the following symptoms in most sexual activities as necessary criteria for the diagnosis of female orgasmic disorder: delay, frequency or absence of orgasm; or marked reduction in intensity of orgasm. Similarly, the minimum duration of 6 months and the presence of significant discomfort in the subject must be respected.
As a new specifier, aside from common dysfunctions in other dysfunctions such as gravity, one should assess whether you have ever experienced an orgasm in any situation.
With reference to the prevalence, this is very wide, ranging between 10 and 42% by valuing different factors. Of the women with orgasmic dysfunction, only some report associated discomfort and 10% report never having had an orgasm. The likelihood of having an orgasm increases with age, the onset of which is more variable than in men.
Guided masturbation training is most effective for the treatment of female orgasmic disorder. This technique involves training the pubococcygeal muscle through self-stimulation supplemented by the use of vibrators. The wedging technique or bridge technique has also been tested, which consists of manual stimulation of the clitoris during penetration accompanied by a pushing movement to facilitate reaching orgasm.
4. Female sexual interest/disorder excitement
The DSM 5 predicts that reduced sexual interest or arousal is expressed by at least three of the following symptoms: absence or reduction of interest in sexual activity; absence or reduction of erotic sexual thoughts or fantasies; absence or reduction of sexual initiative, unresponsive; absence or reduction of pleasure in most situations (75-100%); absence or reduction of interest or arousal in internal or external sexual cues; or absence or reduction of genital or non-genital sensations during intercourse most of the time.
It persists for 6 months or more and causes discomfort. According to the DSM 5 description of interest or arousal disorder, the exact prevalence is not known, although sexual desire appears to decrease with age. They can also be influenced by variables such as culture or the presence of stress. It has been reported that most women, with a longer relationship, point out that with high frequency the onset of intercourse is unclear.
One of the most proven and probably the most effective interventions is to orgasm consistency trainingis an intervention with cognitive and behavioral techniques that aims to increase sexual satisfaction, intimacy and knowledge through the application and practice of new strategies and sexual skills of the couple.
- American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Mason: Barcelona.
- Birnbaum, G. (2009) Sexual dysfunctions. Human Relations Encyclopedia
- McCabe, M., Sharlip, I., Atalla, E., Balon, R., Fisher, A., Laumann, E., Won Lee, S., Lewis, R. & Segraves, R. (2015). Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. The Journal of Sexual Medicine.
- Muñoz, JJ (2018) CEDE PIR Preparation Manual: Clinical Psychology Vol.1. CEDE: 5th Edition.