A recent epidemiological survey done in the United States has reported the overall rates of sexual dysfunction in men and women as 31 percent and 43 percent respectively (Laumann et al 1999). The figures are unlikely to be vastly different elsewhere. Only a miniscule proportion of this population is able to receive treatment.
More than 50% of these disorders are related to anxiety, depression and general life stress. The common psychological elements seen in clients presentations are lack of trust, fear of intimacy, power imbalance in the relationship and an inability to reconcile feelings of love and sexual desire.
Sexual disorders in men
Premature ejaculation is the most commonly reported sexual disorder in men affecting about 20 percent of male population. Erectile problems on the other hand are seen in about 10 percent of the general male population and the prevalence increases with age. About 50 percent of the normal population over 50 and 75 percent over 75 suffer from erectile problems.
Sexual disorders in women
Studies show that between 20 and 30 percent of women in general population report low sexual desire and about 25 percent women experience orgasm difficulty at some time in their lives. About 10 percent suffer from pain during sexual intercourse and about 15 percent of women who present themselves to sex therapy clinics suffer from vaginismus (spasms in vaginal muscles during penetration accompanied by phobia of penetration). Information from workers in the field would anecdotally suggest that vaginismus is seen more in teachers and police women. Strangely, vaginismus is more common among Asians whereas vulvodynia (superficial neurogenic pain during penetration) is seen more often among Caucasian women. Childhood sexual abuse, high levels of anxiety and relationship difficulties are the main causes of sexual difficulties in women
Treatment of sexual dysfunction
These problems can be treated with simple stress management techniques, psycho-educational and personal growth programmes. Sensate focus therapy described first by Masters and Johnson (1970) has been found useful in a variety of sexual problems. It has undergone several modifications in recent years. Sexual problems in men could be related to an imbalance between sympathetic and parasympathetic nervous systems and these can respond to biofeedback treatment.
Anxiety plays a dominant role in the inhibition of desire and arousal, and different anxiety and stress management strategies have been found useful in these disorders. In addition to these, learning new sexual stimulation techniques and fantasy shaping have been found useful along with cognitive behavioural therapy techniques.
• Laumann, EO, Paik, A & Rosen, RC (1999) Sexual dysfunction in the United States: prevalence and predictors, Journal of the American \medical Association, 281, 537-44.
• LoPiccolo, J (2002) Post-modern sex therapy, In F Kaslow, editor in chief, Comprehensive handbook of psychotherapy, Vol 4, New York, John Wiley and sons
• Masters WH and Johnson VE (1970) Human Sexual Inadequacy, Churchill, London.