PSYCHOGENIC SEXUAL DYSFUNCTION:OVERVIEW

Definition

A disturbance of sexual functioning, such as impotence, premature ejaculation, or anorgasmy, that may be caused by one's mental and emotional difficulties concerning sexuality rather than physical disorders.

In psychosexual dysfunction physical problems have been ruled out. Mental or emotional problems are at the center of the dysfunction.

Causes
Psychosexual dysfunction is a sexual dysfunction that is due to psychological causes rather than physical problems, medical illnesses, or the side effects of medication.

Some of the psychological conditions include:

• stress or anxiety from work or family responsibilities
• anxiety about sexual performance
• conflicts in the relationship with your partner
• depression/anxiety
• unresolved sexual orientation issues, guilty feelings
• previous traumatic sexual or physical experience ( abuse, rape)
• Negative body image and self-esteem problems
• worry or fear about sexually transmitted diseases
• Interpersonal relationship causes may include:
• partner performance and technique/lack of a partner
• relationship quality and conflict
• lack of privacy

Socio-cultural influence causes may include:

• inadequate education
• conflict with religious, personal, or family values
• societal taboos

Risk Factors

Reduced sexual desire or activity is very common among men. Often, the condition is treatable, but first it is necessary to determine whether the dysfunction is caused by physical causes (such as diabetes , heart disease , alcoholism , heavy smoking, side effects of medications (a very common cause of decreased libido or desire), or hormonal problems or psychological causes. 

Only sexual dysfunction due to psychological factors is called psychosexual dysfunction.

Symptoms 

Symptoms of psychosexual disorder may differ for men and women.

Symptoms for men include:

• Not able to keep an erection
• Ejaculations are premature
• Ejaculations do not occur
• Not able to become aroused when appropriately stimulated
• Not able to achieve orgasm
• Inhibited sexual desire

Diagnosis 

The doctor will ask about the symptoms, medical history, and sexual history. The doctor will also perform a physical exam. The doctor to ensure asking about all the medications that are currently being  taken. Questions about the partner should also be asked..

Tests may include the following:

• Blood tests to check for problems in your hormones or blood vessels (arteries and veins)
• Test  testosterone level. Testosterone is the hormone that creates sexual desire in both men and women.
• Depression scale to measure depression
• Mini mental state examination (MMSE)
• A test to gauge mental awareness and judgment (also known as cognitive functioning)
• Additional tests for men:
• NPTR test: to find out basically the ause of erectile dysfunction whether it is psychogenic or organic
• Vascular assessment— The doctor needs to make sure the blood flow to the penis is sufficient: It is mostly done by pharmopenile doppler.In our clinic we sometimes prefer to do Pharmacologically Induced Penile Injetion(PIPE test).Some people also conduct sildenafil office test if patient is scary about penile injection.

Treatment 

The most appropriate treatment will depend on the cause of the psychosexual dysfunction.

Some medications can alleviate the symptoms (for example, medications to alleviate erectile dysfunction). However, to successfully manage psychosexual dysfunction, it is important to treat and manage the mental and emotional issues that underlie the problem.

Treatment options for psychosexual dysfunction include the following: 

Medication  

Medications may be prescribed to treat the symptoms:

For premature ejaculation-Medications in the SSRI family, such as paroxetine, depoxetine have been shown effective. They may be used on a daily basis, or several hours prior to intercourse.

Anesthetic creams may be useful and usage of double condoms may reduce sensations thereby prolonging ejaculation. 

Psychotherapy  

Patient  talk and work with a psychiatrist, sexologist,  urologist, psychologist,  to figure out ways to deals with stressful or painful issues. 

Sex Therapy  

Sex therapists assist you by encouraging communications, teaching you about sexual fantasies, and helping you focus on sexual stimuli. 

Behavioral Therapy  

A psychiatrist, psychologist, social worker or licensed counselor works with patients to unlearn automatic behaviors. 

Marriage or Relationship Counseling  

Couples meet with a psychologist, sexologist or other type of mental health professional to discuss issues, including communications problems.

Some Psychological Treatment Techniques of Premature Ejaculation

Premature ejaculation is sometimes a symptom of anxiety. The amelioration of anxiety by such techniques as relaxation, desensitization, and assertive training has therefore proved helpful in certain instances. Some essentially simple tricks may occasionally meet with gratifying success. For instance, some individuals have managed to delay orgasm and ejaculation merely by dwelling on non-erotic thoughts and images while engaged in sexual intercourse. Others have found it more effective to indulge in self-inflicted pain during coitus (e.g., pinching one's leg, biting one's tongue).

Masters and Johnson (1970), however, are not in favor of distraction techniques. The reduction of tactile stimula­tion (e.g., by wearing one or more condoms, or by applying anesthetic ointments to the glans penis) is also often recommended. All of the foregoing procedures are of limited value (Lazarus, 1978).

• Two very effective techniques for the treatment of premature ejaculation are the pause (Semans, 1956) and the squeeze (Masters and Johnson, 1970) procedures. The pause technique consists of the female stimulating the male manu­ally until he feels the physical sensations immediately preceding orgasm. At this point, the wife stops stimulating him until the sensations subside, then begins stimulating the penis again, and stops just before ejaculation. As this procedure is repeated, the male begins to develop ejaculatory control. The next step consists of repeating the procedure with the penis lubricated, so that the intravaginal environment is more closely approximated.
• Masters and Johnson (1970) have developed a modification of this procedure in which the wife manually stimulates the penis until it becomes erect. She then squeezes the penis at the coronal ridge for three to four seconds, which causes the man to lose the urge to ejaculate and to lose 10-30% of his erection. The wife waits fifteen to thirty seconds, then repeats the procedure. After practicing for a few days, the couple repeats the procedure with intravaginal containment of the penis, but no thrusting, to produce stimulation. The next steps are intra­vaginal containment with slow movement, and than fast movement, using the squeeze as before.

Prevention  

There are no known ways to prevent psychosexual dysfunction.

To help reduce the  chances of developing psychosexual dysfunction:

• Stay aware of the psychological or emotional health.
• Talk to the doctor or mental health provider if you feel the problems surfacing again, you are experiencing excessive stress, or you anticipate a stressful situation in the near future.
• Spend time alone with the partner often, especially nonsexual intimate time, to help maintain the relationship. This will most likely lead to increase sexual interest.
• Continue to communicate openly with the partner about intimacy and sexual issues.