Sexual Issues

Sexual Desire

Both men and women suffer from problems with desire and they probably always have. They used to be written off under the heading of “impotence” or “anorgasmia,” which are really response disorders.

More recently, therapists have referred to “lack of sexual arousal” and “inhibited sexual interest.”

Wider interest was stirred in 1979 when Helen Kaplan published her classification of desire problems in Disorders of Sexual Desire.

Kaplan suggested that perhaps 40 percent of people seeking help for a sexual problem have difficulty with sexual desire rather than with sexual response.

It’s a common observation that the strength of the ejaculation declines when men get older or if they are taking medication for the prostate such as Flomax (Tamsulosin). The same may be true for other medications.

Hypoactive sexual desire disorder may show itself as difficulties with either arousal or orgasm. The identification and treatment of sexual desire problems is still far from being fully understood. All we can be sure of at present is that something activates a turn-off mechanism so that the person no longer experiences sexual desire.

The causes of inhibited sexual desire are still the subject of speculation. Anxiety about sex is one possibility; fear of intimacy, anger with a partner and anxieties about relationships are three more.

Any of these may interact and there may be other emotional or psychological factors too. It is possible that organic problems may be wholly or partly responsible as well. Certainly anyone with a sexual desire problem (or a sexual response problem, for that matter) would be well advised to see a doctor and possibly a therapist.

Treatment for inhibited sexual desire is usually multidimensional. Individual and relationship psychosexual therapy is common. Medication to control anxiety or depression may be indicated.

Erotic exercises to be performed at home may be proposed by the therapist – touching, non-demanding pleasuring routines, body image exercises and maybe others too, depending on the person and the relationship. These are indeed the preserve of the Lover archetype within a man – or a woman for that matter. The Lover archetype is the part of the personality which is responsible for holding sensual and sexual energy. It is the part of us which embraces the joy of sensual and sexual connection. Generally speaking, this is a young internal psychic part, sometimes referred to as The Inner Child, the Lover or The Feeling Body.

The treatment approach is flexible and tends to integrate a variety of psychotherapeutic methods as indicated, but success rates in treating inhibited sexual desire are apparently lower than with other sexual problems. Another great way of dealing with such issues is to undertake shadow work. This approach to shadow healing is a means of accessing the root cause of psychological or emotional issues in adulthood. (For a definition of the shadow, see this.)

Sexual Response

Problems of response are generally more easily diagnosed than problems with desire. Some can be treated more successfully too.

The most common response problems are: for men – delayed ejaculation, also known as delayed ejaculation or anorgasmia, and erectile difficulty, also called impotence. For women: orgasmic difficulty, painful intercourse, and vaginismus. They are discussed in that order.

Premature Ejaculation

The definition of premature ejaculation is particularly difficult and experts differ. Everyone agrees that a man who ejaculates before his penis enters the vagina is premature, but thereafter? Two minutes? Three to five? Ten to 15?

The most useful definition provided to date has been Helen Kaplan’s, as elaborated by Michael Perelman and others.

They define a premature ejaculator as a man who is unable to recognize that he is almost ready to ejaculate and is unable to stop or delay his orgasm.

Therapists all agree that premature ejaculation is not only one of the most common male sexual disorders but that it can sometimes lead to other problems – questioning of one’s masculinity, relationship conflicts, erectile difficulty and inhibition of desire.

It is unfortunate that for many young men in our society, speed in sexual experiences seems desirable.

You cannot take your time in the back seat of a car in the same way that you can relax at home. If a young man goes to a prostitute, she is likely to want him to complete the act quickly.

A boy who feels guilty about masturbating is likely to do it as fast as he can. It is thought by some therapists that this kind of early experience may contribute to the inability to delay ejaculation.

The causes of premature ejaculation are not certain, but they are unlikely to be organic. Psychological factors such as fear of failure or relationship factors such as anger at the partner seem more likely.

Therapists conventionally work through individual and relationship problems when they are treating a man for premature ejaculation. The treatment for premature ejaculation which has proved most successful is that evolved by Dr J. Semans in 1956 and subsequently modified by others. The idea is to make a man more aware of the sensations that precede orgasm. As the man learns to recognize the stages he learns to modify his movements to delay the ejaculatory reflex.

Treatments are highly individual and therefore go beyond the scope of this article, but experienced therapists working with willing individuals or couples achieve high success rates in curing premature ejaculation. A cure may be achieved in a few weeks, but is more likely to take a few months of once a week sessions.

Delayed Ejaculation

It is not a common problem, but men with this condition find it extremely frustrating and often humiliating, and their partners frequently experience it as a powerful rejection and as a sign of their own inadequacy.

We don’t really know what causes delayed ejaculation. Over control of, and over-concentration on, ejaculation may be one answer, and this might be the result of multiple emotional/relationship factors.

Ejaculatory control is the result of recognizing the signals of approaching ejaculation and allowing the ejaculation reflex to function only at an appropriate time.

Delayed ejaculation is a common male condition in which the man can’t ejaculate during sex, caused by a variety of factors including both physical and emotional antecedents.

It’s a problem for men because it means they can’t achieve sexual satisfaction through the normal release of orgasm during intercourse, possibly leaving them with a state of sexual arousal which is unrelieved, a state sometimes known as “blue balls”.

For the couple it represents difficulty because women often assume that the reason men can’t ejaculate is that they doesn’t find them attractive or are not turned on by them.

Most men with delayed ejaculation deny this fervently, saying that they are aroused, and that their extended sexual performances and hard erections demonstrates this very clearly.

There is, however, a body of opinion which suggests that the state of arousal a man appears to have when he suffers from delayed ejaculation is in fact an illusion, and that sexually in his mind he’s not really aroused at all.