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