Sexual dysfunction considered

Americans are confronted with the problem of sexual dysfunction every time they turn on the television. Seems there’s no end to the ads for products designed to improve sexual performance.

What is your response to this media blitz? Are you thankful that individuals with real problems have access to information and solutions? Or, and this is probably more likely for most, are you feeling harassed by drug company profiteering on our society that makes sexual zenith the end-all-be-all human experience.

Both are true. Despite the over-emphasis in the media, couples really do have struggles with their sex lives. And due to a number of factors (embarrassment, lack of church conversations about good sex, histories of abuse, etc.) many suffer in silence.

What follows are some common questions a good counselor will ask couples in order to uncover the nature of their problems.

Perception:

1. What is your understanding of “good enough” sex? This question explores one’s view of sex. What does it entail? Who leads? Is it planned or spontaneous? How long does it last? Is there a focus only on orgasm or penetration?

2. What shapes your overall view of sex? This question begins to explore prior experiences with sex (and abuse), shaping beliefs about meaning and purpose, and perceptions of each person’s sexual identity and feelings about their own body. The point of these perception oriented questions is to uncover differences in perceptions and meaning regarding sexual intimacy.

Relationship:

1. How are you feeling about your relationship? Sex therapy is not indicated if there are significant ongoing conflicts across the marriage relationship. Counselors need to deal with hurts and conflicts first since good sex is based on a trust relationship. It is hard to be naked with someone you do not trust.

2. How do you two talk about your sex lives and/or sex frustrations? Can you share with each other your fears and dream; what you like or don’t like? Are their affairs, abuse, or other addictions getting in the way?

Desire:

1. How would you rate your level of desire for sexual intimacy with your spouse? (High to low) What do you think accounts for this change? Has there been any changes in your level of desire? These questions begin to get at (a) the amount of desire each partner has for sexual intimacy and, (b) possible reasons for either too much or too little desire. Desire is defined as ongoing thoughts and feelings about wanting to be sexual with one’s spouse. Low desire may signal hurts, fears, and other struggles. High desire may signal addictions and/or demanding attitudes.

2. How do you feel about the differences in desire amounts? What we find is that in every couple, one wants more sex than the other. This is not a problem…unless either the one wanting more is hurt and angry about being turned down or the one wanting less feels guilty for saying no.

Arousal/Pain

1. During sex, are you able to maintain your arousal? Do you lose your erection/interest? We want to discover what if any problems begin during the arousal period. Here we may uncover medical issues (disease states, medicines, etc.) that interfere with sexual intimacy.

2. Do you experience pain during sex? Pain is a major sex killer. This may be the result of ancillary problems (e.g., a bad hip or back) or the result of poor lubrication and/or other nerve-related injuries. Some pain in women is the result of anxiety at the point of penetration. But, sadly, these women are told to push through it. Pain must be dealt with in order for them to be comfortable enough to work on anxiety.

Orgasm:

1. How do you feel about the frequency of and time to orgasm? Does it take too long or happen too quickly for you? These questions begin to uncover the possibility of problems in achieving a satisfying orgasm. Premature and delayed orgasm are real problems but sometimes we discover that the problem is one of perception. Men generally cannot thrust vigorously for more than 5 minutes without orgasming–actually most are in the 2 minute range. Women rarely orgasm from intercourse alone.

There are certainly more things to know and explore in order to help a couple solve sexual problems but these are the beginning questions most therapists will want to start with. You can find a 2009 PowerPoint presentation and accompanying questionnaire on the topic of sex therapy (When Sex in Marriage Doesn’t Work) that was part last year’s CCEF conference.