At some point in life, most people will experience sexual problems. Such occurrences are considered sexual dysfunctions when they become frequent and distressing for an individual or couple. Below are some of the more common problems:


Performance anxiety

Most of us are familiar with the term “stage fright” - the fear that our performance will be disapproved of or criticized. When such fear occurs in our sexual relations, it can trigger a destructive, self-fulfilling prophecy: heightened self-consciousness and fear of disappointing one’s partner lead to anxiety, which in turn dampens desire, resulting in sexual dysfunction. The ensuing feelings of failure create the setting for the next anxiety-ridden encounter. People with generalized anxiety, fear of rejection, or low self-esteem are particularly vulnerable. Sometimes, a partner’s real or perceived criticism can create or perpetuate this negative cycle.


Sexual desire problems

Low sexual desire can affect both young and old and can result from a wide range of causes, such as depression, anxiety, life crisis, medical conditions and medication side-effects. Desire problems can cause partners to feel guilt, anxiety, rejection and even fear for their relationship’s future. Though we are accustomed to seeing low desire as the issue, elevated desire can also be problematic. Rather than viewing desire in terms of quantity, it is important to consider the quality of desire in the context of the couple’s dynamic. For instance, a woman’s elevated sexual desire may be unconsciously fueled by emotional dependence and fear of abandonment. Her partner, experiencing her desire as suffocating, might in turn feel a decrease in desire and a need to create distance. Whatever the source, a couple experiencing problems with desire should both participate in the therapeutic process.


Sexual arousal problems in women

Physical arousal and feelings of sexual desire are integrally connected, so factors that weaken a woman’s desire - anxiety, depression, stress, and relationship problems - will also diminish arousal. Many physiological and life-cycle events can affect a woman’s sexual response, including childbirth and menopause, and medical conditions such as diabetes, thyroid disorders and cardiovascular conditions. Anti-depressants, anti-hypertensives and birth control pills can also have deleterious effects.


Difficulty reaching orgasm (anorgasmia)

Some men and women have never experienced orgasm. Others can experience orgasm alone, but not with a partner. Both commonly result from underlying emotional issues: shame, guilt, past sexual abuse, fear of intimacy or of relinquishing control. Sometimes, anorgasmia develops from a medical condition or medication side-effects.


Pain during intercourse (dyspareunia)

Dyspareunia can be a particularly distressing experience for a woman and her partner. As sex becomes painful and frustrating, desire generally diminishes and one or both partners may avoid any intimate contact. Frequently, women will feel anxious and guilty over “depriving” their partner of sex. Men may feel guilt at the thought that they are causing their partner pain. Complicating matters, diagnosis is often difficult, because the cause may be psychological or medical, or both. For these reasons, it is crucial that treatment involve both partners in collaboration with physician, physiotherapist and sex therapist. Dyspareunia can be caused by medical problems such as infections, estrogen deficiencies or prior physical trauma to the vaginal area. Emotional factors stemming from past sexual abuse, relationship issues, or anxiety can also play a role.


Vaginismus

This condition is due to contraction of the vaginal muscles which makes penetration painful or impossible. A young woman may only discover she suffers from vaginismus when first attempting intercourse. Often a negative cycle develops in which vaginismus leads to painful sexual experiences further intensifying the problem. These complications may cause low desire in either or both partners, and it is not uncommon for the male partner to develop erectile dysfunction as a result. Common causes of vaginismus are fear of pain during penetration, negative attitudes about sex or past sexual trauma. Sometimes this disorder results from medical conditions such as vaginal infections.


Rapid ejaculation (premature ejaculation)

Premature ejaculation (PE) is one of the most common sexual complaints. However, PE need not be considered a problem unless it causes distress for either partner. Some men experience rapid ejaculation throughout their lives; others may develop PE at a particular time because of emotional factors, such as stress, anxiety, or depression. Frequently, PE stems from relationship issues such as performance anxiety with a new partner, poor communication, hurt feelings, or unresolved conflicts. In some cases, PE may be due to medical conditions such as hormonal problems, prostatitis, or drug side-effects. Whatever its origin, once the cycle has started, sexual encounters may become charged with tension and anxiety that may perpetuate the problem.


Delayed ejaculation

Men who experience this phenomenon may find sex becomes a chore. As a result, their level of desire may gradually decrease. Partners may worry they are unattractive or somehow at fault. Medications such as anti-depressants commonly lead to this occurrence. If medical causes are ruled out, then the emotional root must be identified and treated: feelings of guilt and shame around sex, preoccupation with pleasing one’s partner, and control or intimacy issues are common causes.


Erectile dysfunction

This phenomenon can be caused by numerous factors such as medication side-effects, medical conditions including hypertension and diabetes, or emotional problems such as anxiety, depression, relationship issues, or low sexual desire. Erectile dysfunction (ED) can trigger feelings of uncertainty about a relationship’s future. Expressions of alarm or frustration on either partner’s part may create a vicious circle of anxiety, pressure and more dysfunction. Many who experience ED first turn to medication. However, when the source of the problem is emotional or relational, medical intervention will not address the root of the problem, and may in fact reinforce it.


Sexual aversion

People with this condition typically perceive sex as distasteful or even repulsive. Sexual aversion may be related to specific aspects of sex such as genitalia, bodily odors and secretions, or specific acts like kissing, oral sex or intercourse. Typically this condition leads to avoiding or limiting sexual contact. It may occur with a specific partner due to fear of intimacy, relationship discontent, discovery of marital infidelity, domestic violence or simply because of a partner’s poor personal hygiene. Lifelong sexual aversion may be caused by past trauma, control or intimacy issues.


Compulsive sexual behavior (sexual addiction)

This condition includes obsessive sexual thoughts, urges or behaviors that may range from mildly compulsive to high-risk and addictive in nature. Compulsive sexual behavior, sometimes referred to as sexual addiction, can cause significant distress and harm one’s health, relationships, family and career. Despite such consequences, these individuals find themselves returning to the same behaviors (obsessive viewing of internet porn, soliciting prostitutes, serial extramarital affairs, voyeurism or exhibitionism). Initially, compulsive sexual behavior provides instant gratification and a means of escape, but ultimately becomes a dysfunctional coping mechanism that is destructive to oneself and others.


Sex therapy for sexual dysfunction in the Haifa area, North Israel

Faced with such difficulties, many don’t know where to turn for help. It is common to feel uncomfortable discussing sex with a physician or counselor. And unfortunately, many health professionals have little or no training in treating sexual issues or dysfunction. A therapist specializing in sex therapy can offer a safe, confidential space in which to address and treat such concerns.