Female Sex Problems

It is estimated that at least 40 - 60% of couples struggle with a sexual problem at some time in the course of their relationship

New clients always welcome.
Please email Mary or
phone 408.371.4847.

 

 

by
Mary M Buxton LCSW, Inc. AASECT Certified Sex Therapist

(Note: Links are to headings on this page which can also be reached by scrolling)

Female Sexual Interest / Arousal Disorder (302.72)

Problems with sexual arousal, desire and frequency are some of the most common and complicated concerns that cause individuals and couples to seek sex therapy.

Definition

Lack  of or significantly reduced sexual interest/arousal, as manifested by at least three of the following:

  1. Absent / reduced interest in sexual activity.
  2. Absent / reduced sexual / erotic thoughts or fantasies.
  3. No / reduced initiation of sexual activity, & typically unreceptive to partner’s attempts to initiate.
  4. Absent / reduced sexual excitement / pleasure during sexual activity in almost all or approximately all (75-100%) sexual encounters.
  5. Absent / reduced sexual interest arousal in response to any internal or external sexual / erotic clues ( eg., written, verbal, visual)
  6. Absent / reduced genital and non-genital sensations during sexual activity in almost all or all (75-100%) sexual encounters.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of Female Sexual Interest / Arousal Disorder ranges from 14 - 63%.

Causes and Barriers

Biological

  • Hormonal factors
  • Health/major illnesses
  • Street drugs
  • Medications
  • Age and aging

Emotional

  • Religious, cultural, and family messages about sex
  • Self and body image concerns
  • Inhibitions regarding sexual fantasies
  • Sexual trauma history
  • Masked sexual orientation issues
  • Lack of information
  • Unrealistic expectations and fears of intimacy and closeness
  • Lack of differentiation from family of origin or from partner

Relationships

  • Stored anger
  • Resentment and chronic conflict
  • Need for power and control
  • Not attracted to partner
  • Disagreements about conditions and reasons for sex
  • Inability to negotiate differences as a fundamental relationship problem

Unrealistic Expectations

  • Initial infatuation stage vs. deeper
  • More calm stage of attachment (not all-consumed with sex)
  • Real love is built on communication and intimacy
  • Sex becomes a part of the whole relationship, not the center of it.

Lifestyle / Culture

  • Life in the fast lane
  • Role overload
  • Fatigue
  • Unrealistic expectations for sex
  • Body image and relationships from media influence.

Treatment

Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below. Others won’t. There is usually a hidden part of sexual problems, the emotional part that is unique to each individual and /or the couple. Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.

Improving Communication About Sex

Do sex checks. State what I want in positive respectful terms. Talk about sex more often. Listen carefully and non-defensively to what my partner has to say. Be willing to try what my partner suggests while respecting my own sexual limits . Refrain from blame and criticism. Praise my partner daily. Talk about my resistance and hesitancy to communicate about sex.

Good Sex Takes Effort Once You’re Past The Infatuation Stage of Relationship

  • Sexual excitement is made not born
  • Cultivate sexual mindfulness!

Finding Time in Your Busy Life

  • If you don’t make an effort, forgetting to have sex can become a habit
  • The key to a good sex life within a busy life is planning!

Finding Couple Time and Making Sex a Priority

  • Ask for help and say no. Divide the labor.
  • Find couple time - overlap shifts, extend day care, meet for lunch, cancel appointments, enforce bedtime, use the media, use baby sitters, relatives and friends or trade with other parents.
  • Regular date nights
  • 15 minute face to face talks daily and romantic weekends away.

Conditions for Good Sex

  • Turn off the TV, computer
  • Go to bed at the same time, and earlier in the evening
  • Light meals and little or no alcohol
  • Feeling rested and connected
  • Candlelight and flowers?

Restore Touch & Affection So That Touch Does Not Equal Sex

  • Eye contact
  • Touch gently during conversation
  • Sit close on couch
  • Spoon
  • Hold hands

Romantic Love Starter Kit - Cultivate Good Feelings

  • Say “I love you”
  • Send me a card in the mail
  • Bring me a flower
  • Do a chore without being asked
  • Go for a walk and talk with me

My Sex Tackle Box - Be prepared!

  • Lock on the door
  • White noise or radio near the door
  • Phone off in bedroom
  • Special underwear & sleepwear
  • Massage oil
  • Videos, erotic books & magazines
  • Birth control & lubes

Better Sex Through Chemistry?

  • Sex is more than just chemistr
  • Drugs may reduce or enhance libido
  • Consult with your physician

Where to Get Help

  • Many people often need the boost of professional help to get the many aspects of their sexual concern sorted through and resolved.
  • I offer individual and couple counseling services with a specialization in sex and couple therapy.
  • For referrals to a sex therapist in your area, contact www.aasect.org

Genito-pelvic Pain / Penetration Disorder (302.76)

Definition

Persistent or recurrent difficulties with one (or more) of the following:

  • Vaginal penetration during intercourse.
  • Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
  • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during or as a result of vaginal penetration.
  • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of pain during intercourse 14.4% (Laumann et al., 1994).

Causes

There are a variety of physical and psychological conditions that can cause conditioned muscle contraction, vulvar and pelvic pain. Usually there are several influences that contribute to the condition occurring. Please see section above: General Factors that Contribute to Female Sexual Disorders.

This is a multidimensional pain problem that is influenced by a variety of factors including thoughts, emotions, behaviors, and couple interactions. Women afflicted with this disorder report significantly lower levels of sexual desire and arousal, lower frequencies of intercourse, and lower orgasmic success than women without dyspareunia. Women sometimes develop aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

Careful history taking by the sex therapist and exam by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems are essential in making the diagnosis and beginning treatment.

Treatment

The treatment can include exercises that address the following steps:

  • Watch sexuality education videos and read books or workbooks
  • Physician assessment and treatment
    • Careful exam and subsequent medical treatment by an OBGYN specializing in the diagnosis and treatment of vulvar and pelvic pain problems
    • Referral to a pain management anesthesiologist for specialized medications when necessary
  • Partner may be requested to attend some or all sessions
    • Develop a joint understanding of the multidimensional treatment for this problem to reduce blame and shame
    • Validate couple strengths and encourage non- intercourse lovemaking to maintain the emotional bond Conditions for Good Sex
    • Graduated massage, self touch and partner touch exercises
  • Positive sexual mind-set
    • Discuss / challenge negative sex training, expectations, and traumatic experiences that you associate with sex
    • Discuss impact of sexual pain condition on the individual and the sexual and couple relationship
    • Develop coping statements to help you develop an active rather than a passive attitude toward this pain problem
    • Developing boundaries to protect physical and emotional safety / Assertion training
    • Developing Positive Sexual Attitudes and Motivations
  • Relaxation training
    • Learn and practice deep breathing
    • Learn progressive muscle relaxation, mindfulness
  • Develop awareness and pain management techniques
    • Identify where the pain is located through self- exploration
    • Keep a Pain Diary
    • Learn cognitive restructuring to cope with the before, during and after phases of the pain experience. This technique will help you to react differently to your pain
    • Develop awareness and voluntary control over the tense muscles
    • Kegels exercises
    • Practice penetration with graduated dilators or fingers with lubrication (pain level permitting)
    • Possible referral to Physical Therapist skilled in treating vulvar and pelvic floor pain and muscle problems
  • Beginning Intercourse
    • Woman astride position with graduated steps, employing the learning above
    • Stop, calm yourself and talk about any discomfort
    • Develop conscious awareness of thoughts before, during and after a practice session

The most important elements in this treatment program is that the woman patient has a sense of control and that that there is a multidimensional approach to treatment. The pace of treatment is based on the client’s sense of safety and comfort with proceeding to the next step.

Female Orgasmic Disorder (302.73)

Definition

Presence of either of the following symptoms and experienced on almost all or all (75-100%) occasions of sexual activity:

  • Marked delay in, marked infrequency of, or absence of orgasm.
  • Markedly reduced intensity of orgasmic sensations.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of Female Orgasmic Disorder 24.1% (Laumann et al, 1994).

Causes

Usually there are several influences that contribute to the condition occurring. Please see section above: General Factors that Contribute to Female Sexual Disorders.

Treatment

  • Body Image & Body Touching to reduce self-consciousness and reawaken senses
  • Exploring and labeling genital parts
  • Graduated self touching exercises
  • Assertion and communication training
  • Exploration of fantasies, erotica
  • Partner exercises

Post Traumatic Stress Disorder(309.81)

Childhood sexual abuse, rape and other sexual trauma may be a factor in painful sex.

_________________________________________________________________

Adapted from:

  • Clinical Update on Sex Therapy, course notes, Linda De Villers, Ph.D.
  • Cognitive-Behavioral Pain Management for Dyspareunia: A multidimensional Perspective, S. Bergeron, PH.D., 2000.
  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, 2014.
  • Great Sex for Moms, Valerie Raskin, M.D., Simon & Schuster, 2002.
  • Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking, Love, et al, Plume, 1999

 

Nov. 20, 2015

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Mary M Buxton LCSW, Inc. - Sex & Couple Therapy - Licensed Clinical Social Worker  #LCS 7780
15951 Los Gatos Blvd., #14, Los Gatos CA 95032 -  Phone: 408. 371.4847 -  Email Mary

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