Sexual dysfunction is a common complaint of many people seeking psychotherapy. In fact, it’s estimated that approximately half of women and a third of men suffer from some degree of sexual dysfunction. What is sexual dysfunction? There are several perspectives among mental health practitioners on the concept and definition of the issue.
However, in general, it’s broadly defined as any problem that occurs during the sexual response cycle-excitement, plateau, orgasm and resolution that causes dissatisfaction for the individual or couple.
The latter is an important point that shouldn’t be overlooked. Indeed, the issue may not be a problem for one partner but causes significant distress for the other. Therefore, in therapy, it’s important to assess potential impact on both parties, especially during couples therapy.
Categories of Dysfunction
There are three categories of sexual dysfunction that make up the majority of problems. These include disorders of desire, arousal and orgasm.
Deficits in desire usually present as a lack of interest in sex to include foreplay. Even though the person may feel emotionally connected to his or her partner, there is no desire to be intimate. On the flip side, a lack of emotional connection may be the culprit associated with the reduced desire.
The most common arousal complaint is an inability to become physically excited during sexual activity. Although it may seem similar to reduced desire, an inability to become physically excited during foreplay and intercourse is generally not because the person doesn’t want to be intimate, but an issue of becoming physically able to be intimate.
Concerns related to orgasm include an inability to have an orgasm or a delay in reaching orgasm that causes distress for the person or couple. Often, this problem is the most embarrassing for the partner (or couple) to discuss. There is a social stigma and shame associated with both men and women who have a difficult time reaching sexual climax.
Causes of Problems
The causes of sexual problems vary. Some are purely biological or medical in nature whereas others have psychological origins. Although service members and veterans are generally not at greater risk of developing sexual problems compared to their civilian counterparts, there’s a common factor that contributes to the sexual dysfunction of many with post traumatic stress disorder.
The connection between PTSD and sexual dysfunction is one that has been studied for the past few decades with increasing interest over the past several years. The increased interest as of late is a direct result of the wars in Iraq and Afghanistan and the hundreds of thousands of veterans who have been diagnosed with the trauma-based disorder.
Any clinician who treats service members or veterans with PTSD is well aware of the co morbidity between these two clinical issues.
A number of theories exist as to why there is an increased rate between PTSD and sexual dysfunction. And there are a number of theories as to why this co morbidity plagues so many who have served.
Individuals suffering from PTSD are often highly anxious. Anxious people produce excessive amounts of hormones and neurochemicals. Some of these substances negatively impact sexual functioning by constricting blood vessels and blood flow, both which are important to sexual health.
Over time, the flux of chemicals and strain on the sexual response cycle lead to a variety of sexual concerns for many service members and veterans.
A core symptom of PTSD is feeling emotionally disconnected from loved ones. For many people, loving feelings for a spouse or partner are few or absent. And, without the emotional connection, it’s difficult to develop and maintain intimacy.
Intimacy is the bedrock of a healthy sexual relationship.
A common treatment for PTSD is the use of medications that regulate the level of the chemical serotonin in the brain. Serotonin plays an important role in sexual functioning. When taking these medications, it’s not uncommon for men and women to report delayed and absent orgasms and reduced interest in sex.
For men, it’s not uncommon to hear complaints of difficulty achieving or maintaining an erection.
However, it’s important to note that in some individuals with PTSD, sexual dysfunction gets better following medication treatment. This outcome is especially true for those individuals who have a strong depressive component to their PTSD. Considering that a common side effect of depression is reduced sex drive, this correlation makes sense.
The relationship between PTSD and sexual dysfunction is a complex one. A number of factors can contribute to sexual problems, which can cause significant distress for the person or couple.
However, the fix is often relatively simple. It may include individual or couples therapy or a switch to a different type of medication.
Regardless of which fix is best for your patient, the first step is to assess the presence, degree and impact of sexual dysfunction. All too often we neglect this important aspect of overall psychological health.
*This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
Distressed man in bed photo available from Shutterstock