It has been proven that the majority of sexual dysfunctions, alterations in sexual response, are due to psychological causes. Therefore, it is possible to intervene through psychotherapy and applied sexology in behavioral modification and emotional management programs to achieve greater satisfaction.
But to understand what therapeutic strategies and resources health professionals work with when addressing these problems in their daily lives, it is necessary to know what they are. the most frequent sexual dysfunctions In this article we will talk about them.
We understand sexual dysfunction to be the alteration in any of the stages of sexual behavior that impacts the functionality and satisfaction of the individual, highlighting the significant discomfort it causes in the affected subject. Specifically, it is an imbalance in any of the phases of sexual response (desire, arousal, plateau, orgasm or resolution) or pain associated with the sexual act that make it difficult to have sex satisfactorily.
Although the latest version of the Diagnostic Manual of the American Psychiatric Association (DSM 5) does not maintain the classification according to sexual stages, it does present the same disorders linked to these phases. Likewise, it adds specifications according to gender and in order to make the diagnosis of sexual dysfunction, it requires that the condition last at least 6 months.
What dysfunctions are most common in the population?
Of the subjects who come to consultation for dysfunction problems, the most common in women are orgasmic dysfunction and sexual interest/arousal disorder; On the other hand, men go more for erection and premature ejaculation problems.
Variables such as place of residence also influence the prevalence of disorders For example, hypoactive sexual desire in men is 12.5% in the population of northern Europe, increasing to 28% in Southeast Asia.
Likewise, there are alterations for which the exact prevalence is not known, such as the case of sexual interest/arousal disorder in women. On the other hand, an increase in the frequency of the affectation is observed in subjects who consume psychotropic drugs or some type of drug. We must also keep in mind that with age, most sexual disorders tend to increase.
Here we will see what are the main characteristics of the sexual dysfunctions that occur most frequently in the population. We will also briefly explain the therapy techniques used to help patients who have developed these disorders ; Almost all of them can be taught and learned both in face-to-face therapy sessions and in online therapy.
1. Premature (premature) ejaculation disorder
The DSM 5 defines premature ejaculation as a recurring or persistent pattern where, during sexual intercourse with a partner, ejaculation occurs approximately one minute following vaginal penetration and before what is desired by the individual This pattern must occur for at least 6 months and appear in all or almost all sexual relations between 75%-100% of the time.
It is necessary that the subject shows significant discomfort and not have any organic cause such as drug or medication consumption. The diagnosis also allows us to specify whether it is lifelong (has always occurred) or acquired; whether it is generalized or situational (it only occurs with your partner) or the severity of the affectation: it is considered mild if ejaculation occurs approximately between 30 to 60 seconds after penetration, moderate if it appears between 15 to 30 seconds after penetration or serious if it occurs before sexual activity or 15 seconds following penetration.
Regarding the prevalence, it is estimated that Between 20 to 30% of men between 18 and 70 years old have reported having had an episode of premature ejaculation, although only 1 to 3% of these men meet the criteria to receive the diagnosis. If we look at the course that this alteration usually presents, we see how it has a tendency to increase its presence with age.
There are different treatments proven to be effective for this dysfunction. For example, the stop-start technique is usually used, which consists of stimulating the penis to stop just before ejaculation, and the compression and basilar squeeze techniques, in which stimulation cycles occur plus compression of the penis than They interrupt ejaculation. With these strategies, an attempt is made to delay ejaculation and thus make sexual intercourse more satisfactory for the couple.
In order to diagnose erection disorder, DSM 5 states that on the majority of occasions when sexual intercourse is performed with a partner (75-100% of the time), one of the following symptoms must occur: difficulty getting an erection during sexual activity, difficulty maintaining an erection until the end of sexual activity, or decreased rigidity of the erection.
As with other dysfunctions, it should appear for at least 6 months and generate discomfort. We must also specify the severity, whether it is generalized or situational and is lifelong or acquired.
It has also been observed an increase in prevalence with age, especially after 50 years of age The population aged less than 40-50 years has a frequency of approximately 2%, while in subjects between 40 and 80 years the prevalence increases to 13 or 21%.
Currently, the intervention that is considered most effective and most frequently used are multimodal packages that include behavioral, cognitive, systemic and communication techniques since these are areas that are affected in individuals with sexual dysfunctions.
One of the most used strategies was proposed by Masters and Johnson, and consists of stimulating the penis and then stopping and repeating the process; In this way, it allows the subject to verify that the erection can be lost and then regained. Finally, intercourse proceeds.
Another technique that is giving good results is filling, which consists of encouraging the individual to perform penetration even if the erection is not completely achieved, in order to focus on the sensation without the pressure of having to end the sexual relationship. It has also been tested with pharmacological interventions, although there are no studies that compare their effectiveness with psychological techniques.
3. Orgasmic dysfunction in women
The DSM 5 points out as a necessary criterion for the diagnosis of female orgasmic disorder the presence, in most sexual activities, of one of the following symptoms: delay, infrequency or absence of orgasm; or marked reduction in orgasm intensity Likewise, the minimum duration of 6 months and the presence of significant discomfort in the subject must be met.
As a new specifier, apart from those common in other dysfunctions such as severity, it should be assessed whether you have never experienced an orgasm in any situation.
In reference to the prevalence, this is very wide, ranging between 10-42%, assessing different factors. Of the women with orgasmic dysfunction, only a portion report associated discomfort and 10% say they have never experienced an orgasm. The probability of having had an orgasm increases with age, with the occurrence of this being more variable than in men.
Guided masturbation training It is the one that shows the greatest effectiveness for the treatment of female orgasmic disorder. This technique consists of training the pubococcygeus muscle through self-stimulation complemented by the use of vibrators. The shoring technique or bridge technique has also been tested, which involves manual stimulation of the clitoris during penetration accompanied by a thrusting movement to make it easier to achieve orgasm.
4. Female sexual interest/arousal disorder
DSM 5 considers that reduced sexual interest or arousal is expressed by three or more of the following symptoms: absence or reduced interest in sexual activity; absence or reduction of erotic sexual thoughts or fantasies; absence or reduction of initiative for sexual intercourse, she is not receptive; absence or reduction of pleasure in most situations (75-100%); absence or reduction of interest or arousal to internal or external sexual cues; or absence or reduction of genital or non-genital sensations during intercourse in most cases.
Persists for 6 or more months and causes discomfort According to the DSM 5 description of interest or arousal disorder, the exact prevalence is not known, although it seems that sexual desire decreases with age. Variables such as culture or the presence of stress can also influence. It has been recorded that the majority of women, with a longer relationship, point out that, with high frequency, the beginning of the sexual act and desire is unclear.
One of the most tested interventions and considered probably effective is orgasm consistency training it is an intervention with cognitive and behavioral techniques that aim to increase sexual satisfaction, intimacy and knowledge through the application and practice of new sexual strategies and skills for the couple.
