Sexual dysfunction categorization in women (DSM-IV according to symptom criteria)
I- Sexual Desire Disorders a) Hypoactive sexual desire disorder b) Sexual aversion disorder
II- Stimulation Disorder
III- Orgasm Disorders
IV- Sexual Pain Disorders a) Dyspareunia (pain during sexual intercourse) b) Vaginismus
I- Sexual Desire Disorders
Hypoactive sexual desire disorder (Sexual Reluctance)
It is the state of not having any or very less desire for sexual fantasies or activities constantly or in a recurring manner.
The doctor, taking into consideration the sexual factors such as a person’s age or living conditions, decides whether the sexual desire is decreased or entirely absent. This disorder causes a definitive trouble or adversities in interpersonal relations.
As an important part of the sexual dysfunctions is comprised of “desire disorders”, in the recent years this ratio is on the rise.
It is hard to find a correlation between hormones and sexual desires and behaviors. Sexual hormones of the women alter frequently as a result of many different situations such as menstruation, breast feeding, pregnancy, and menopause. Despite this information, it is shown that there is a correlation between the frequency of the women to establish a sexual relation and in the testosterone hormone level which is in the center of this cycle.
While women who experience sexual reluctance may get very little pleasure or none at all from sexual stimuli, they may not have any genital functioning at the physiological level. Thus, during sexual intercourse, the lubrication, which is caused by the mechanic stimulation of the penis being in the vagina, is also very little. These women also have orgasm difficulties.
About the causes for low sexual desire, regarding the personal factors, scientists LoPiccolo and Friedman point out strict religious beliefs, anhedonic or obsessive compulsive personality, problems in gender identity and choosing a sexual object, sexual phobias and aversions, fear of losing control over sexual urges, masked sexual perversions, fear of pregnancy, depression, loss of a spouse, and anxieties about age.
The confirmed deficiencies in a relation are loss of interest to a spouse, differences about the suitable distance between two people and conflicts in marriage. Moreover, other reasons such as lack of sexual skill in a spouse, fear of intimacy, differences in the spouses, power inequality, passive-aggressive approach, and inability to reconcile sexual desires and love are noted.
Schreiner-Engel has asserted that in people who have sexual desire disorders, the rate of encountering mood disorders is doubled. It is said that the most important reason for this disorder to develop is the deficiency in the quality of the marriage relation.
Sexual Aversion Disorder
Sexual aversion disorder is the state of extremely detesting or totally averting from establishing a genital relation with the sexual spouse. Women, who are in this group, have more serious marriage or emotional problems, more serious intrapsychic conflicts than other dysfunctions, relation adversities and more frequent personality disorders. Traumas such as rape or abuse may cause aversion disorders.
Solving these problems is harder and more time consuming compared to the other sexual problems.
It takes more time to set up the harmony in the couples that is necessary in order to establish the sexual treatment relation.
It is the state, showing itself in a constant or recurring manner, where sexual stimulation fails to facilitate enough lubrication-swelling response or the woman is not to be able to maintain these up until the end of the sexual affair.
The sexual stimulation disorder causes a definitive trouble or adversities in inter-personal relations.
The power and duration of the stimuli are not enough to give pleasure during sexual intercourse. Blood accumulation in the genitalia is not sufficient, so vaginal wetting (lubrication) is very little or none.
The disordering of the vaginal wetting (Lubrication) and the swelling response is parallel to subjective stimulation and pleasure. Most of these women also have orgasm problems.
It is the state of not having an orgasm or to have a delayed one constantly or in a recurring manner after the usual phase of sexual stimulation.
Women show high amounts of variation in the intensity or type of stimulation that triggers an orgasm.
The orgasm disorder diagnosis in a woman resides on a clinician’s judgment that the ability of the woman to achieve an orgasm is lower than expected, which is based on the assessment of the woman’s age, sexual experience and the sufficiency of the sexual stimuli she gets.
Orgasm disorder cause a definitive trouble or adversities in interpersonal relations.
Having a hard time in achieving an orgasm is the most frequently encountered sexual complaint in the Western countries. Orgasm disorder can be divided into groups such as primary and secondary, total or situational.
The division of the orgasm into its components as vaginal or clitoral has been argued by different schools. Masters and Johnson’s view is that there is one kind of orgasm.
According to Kaplan, woman’s orgasm is always situated in the vagina and around it and it is highly experienced in this region.
Derogatis and Meyer have specified that women, who suffer from orgasm disorder, have feelings of insufficiency and negative body images. Compared to the control group, women who suffer from orgasm disorders are less content about their sexual affairs and activities and their spouses know less about their sexual preferences.
(Click for information about anorgasmia (inability to have an orgasm))
IV- Sexual Pain Disorders
Dyspareunia (Painful sex) and Vaginismus
It is the state of having constant or recurring genital pain accompanying sexual intercourse.
Dyspareunia causes a definitive trouble or adversities in interpersonal relations.
The definition of dyspareunia is to feel pain during sexual intercourse. This pain is due to problems in vaginal wetness, abrasions and contractions of the muscles as it is in the case of vaginismus.
As the pain might be the result of causes such as endometriosis, ovary cysts, Bartholin’s cysts and pelvic infections, a gynecological examination is a must. In the psychogenic dyspareunia, the pain entails phobic expectancies.
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Vaginismus is also described among sexual pain disorders.
Treatment in sexual dysfunctions in general
In the recent years, usually, problem focused and short behavioral sexual therapies are conducted more in the treatment of sexual dysfunctions.
Together with this, depending on the level of the intrapsychic conflicts, dynamic and analytic psychotherapies are still valid. However, the effectiveness of hormone and medicine treatments, hypnosis and assisting methods are temporary.
The sexual therapy method of Masters and Johnson has been improved by many doctors, foremost by H.Kaplan. After the assessment of the patient, personal, group, couple and marriage therapies can be conducted.
In sexual treatments, the approach has four fundamental features
► A couple receives treatment together
► The couple is assisted in their sexual and nonsexual relations by changes in their behaviors and language to establish a better communication. The aim is to enter into cooperation with the couple and give them the responsibility to overcome their problem.
► To fix deficient and incorrect knowledge by informing about the anatomy, physiology and psychology of a sexual relation.
► To give series of graded “sexual home works”. With this method that is based on the cognitive behavioral treatment, therapy is completed in four to ten sessions. The existence of a love bond between the couple is the most significant factor that gives the treatment a chance.