The assessment phase involves gathering information from the couple concerning current attitudes towards sex, religious influences, first sexual experiences, childhood views on sexuality, and family history.  The next step involves the client(s) giving a detailed description of the current sexual problems for diagnostic purposes and the development of a treatment plan.

         Sexual difficulties are not always psychological in nature which is why it is important to rule out any medical or physical conditions before counseling is started.  It is also important to know what types of medications or substances a person is using before commencing the sex counseling process.  A few things that can cause or exacerbate sexual problems include chronic alcoholism, diabetes, antidepressants, and blood pressure medications.
     I have certain physicians that I refer clients to if they do not have their own physician.  It is important to feel comfortable speaking with a physician about such personal issues.  It also helps to see a medical specialist who is trained to do these types of assessments.

     Once medical issues are ruled out, the relationship between the couple itself will be the next area of focus.  Communication is often at the root of sexual problems and sexual behavior is only one way that partners communicate with each other.  Many couples feel uncomfortable discussing sexual matters.  This can be done in a safe environment where I can coach them through it.  Couples will learn how to improve communication in order to build trust and to learn how to be more assertive to get their needs met.  Working through communication issues oftentimes helps couples to dispel their fears of failure which can be a major contributing factor to sexual difficulties.  Sometimes fixing relationship or communication problems will solve the sexual problems before techniques in sex counseling are even discussed.  This means that the relationship itself was the cause of the sexual problems. 

 

     Once relationship factors are dealt with or ruled out, the physical aspects of the sexual relationship will be looked at.  This is where specialized techniques will be taught to the couple in order to overcome their problems.  There are many techniques that I teach that cover a multitude of different sexual dysfunctions including erectile dysfunction, decreased sexual desire, premature ejaculation, painful intercourse, and female and male orgasmic disorder to name a few.  Many of these techniques have proven extremely helpful in overcoming sexual dysfunctions. 

Sexual Disorders in Females

• Hypoactive Sexual Desire (HSD):  characterized by a lack of desire for sexual activity.  While this disorder is prevalent in men and women it is much more common in women.  Some people that suffer from HSD are still able to become aroused and experience orgasm.  However, they still show no desire for sexual activity.  HSD is only seen as a problem if it causes problems in the relationship.  This is one of the most commonly treated sexual dysfunctions.  Some causes of HSD are known to be history of abuse and difficulties in the current relationship. 

• Female Sexual Arousal Disorder:  persistent inability of a woman to attain or maintain vaginal lubrication/vaginal swelling.  Arousal and lubrication can be diminished by psychological factors such as feelings of anger, fear, or apathy.  Low estrogen level is just one of several biological factors.  Lubrication can also be decreased during breast feeding and during the period following menopause.

• Female Orgasmic Disorder:  prolonged delay of orgasm or inability to achieve orgasm following normal sexual arousal on a persistent or recurrent basis.  Some women are able to engage in sexual activity and obtain satisfaction without achieving orgasm whereas other women may be highly disturbed by the inability to achieve orgasm.  Women are not diagnosed with Female Orgasmic Disorder if the inability to orgasm does not cause personal distress within herself or within the relationship. 

     Female Orgasmic Disorder is diagnosed in two types of women.  The first type of woman has never experienced orgasm in her life by any means of stimulation.  The second type of woman has experienced orgasm in her past but cannot achieve orgasm currently.  Causes of Female Orgasmic Disorder can include medications (antidepressants, anti-anxiety meds), sexual or physical abuse, emotional trauma, inadequate sexual stimulation, and certain types of surgeries and medical conditions.    

• Dyspareunia in Women: experiencing pain during intercourse.  Dyspareunia is prevalent in men and women but is more common among women.  It is important for women to specify where the exact location of the pain is occurring because painful intercourse can stem from several different causes.  Pain in the opening of the vaginal opening or inside of the vaginal walls can be caused by inadequate lubrication, yeast infections, bacterial infections, as well as many other conditions.  Pain that emanates from deep inside of the pelvis can be caused by endometriosis or jarring of the ovaries during intercourse.  This can be especially problematic during the time of ovulation.  Psychological factors can also contribute to painful intercourse.  Feelings of fear or anxiety associated with sex may cause painful intercourse. 

 

• Vaginismus:  strong involuntary contractions of the muscles of the outer portion of the vagina.  The contractions can be severe enough to make intercourse extremely painful or even impossible.  A woman with Vaginismus can learn to control the contractions even though they are involuntarily and unconsciously produced.  Vaginismus can be caused by several factors including chronic painful intercourse, past physical or sexual assault, confusion over sexual orientation and fear or hostility toward a partner.

Sexual Disorders in Males

• Erectile Dysfunction (ED):  persistent ability to attain or maintain an erection.  Occasionally men are unable to attain or maintain an erection due to alcohol or drug use, fatigue, or stress.  This is not considered ED.  ED is persistent inability to achieve or maintain an erection sufficient for intercourse for a period of at least 6 months or longer.  ED is not considered a problem unless it disrupts the relationship or the life of the individual experiencing ED.  Although age itself does not cause ED, the incidence of ED increases with age.  Cardiovascular problems, Diabetes, and high blood pressure can be some of the age-related causes.  ED can also be caused by psychological factors such as performance anxiety, poor communication with a partner, and relationship problems. 

 

• Premature Ejaculation: ejaculating so soon that it impairs the enjoyment of the sexual experience for the man, his partner, or both.  A man can ejaculate quickly and still not be diagnosed with Premature Ejaculation if it does not interfere with the sexual gratification of himself or his partner.  Premature Ejaculation is perhaps the most prevalent sexual disorder in males.  In most cases, Premature Ejaculation is caused by psychological factors or anxiety.  Anxiety can increase muscle tension which in turn can cause Premature Ejaculation.  Performance anxiety or fears of not pleasing one’s partner are two of the major causes.  Sex counseling is highly effective at treating Premature Ejaculation.  

• Male Orgasmic Disorder: prolonged delay of orgasm or inability to orgasm following normal sexual arousal.  Some men with Male Orgasmic Disorder are not able to orgasm during intercourse but may orgasm from the manual or oral stimulation of a partner.  Some males with Male Orgasmic Disorder are able to orgasm during intercourse but only after a prolonged period of time.  Others can only orgasm from masturbation.  Male Orgasmic Disorder is only diagnosed if it causes marked personal distress in the person or couple experiencing it.    

     While Male Orgasmic Disorder can stem from organic causes (related to a condition in the body), most cases appear to be psychological in origin.  Some of the psychological causes can include feelings of depression, stress, anxiety, and low self-esteem.  Resentment, hostility, or general dissatisfaction with the sexual partner may also be a cause.  Finally, past experiences of sexual abuse or traumatic sexual encounters can also cause Male Orgasmic Disorder.