Sexual Dysfunction

Sexual pain disorders include dyspareunia, which males and females can experience, vaginismus and vulvodinia, which are exclusively female complaints.

Dyspareunia is the technical term for recurrent and persistent genital pain in a man or woman before, during, or after sexual intercourse. They may experience the pain as repeated, intense discomfort; momentary sharp sensations of varying intensity; or intermittent twinges and/or aching sensations. Dyspareunia in men, who may experience the pain in the testes and/or the glans after ejaculation, appears to be much less common than painful intercourse in women

In a study by Edward O. Laumann and colleagues (1994), U.S. women reported prevalence rates of almost 15 percent. A large study in France found that 5 percent of the sexually active female respondents indicated that they had often experienced pain during sexual relations (Spira, Bajos, and LeGroupe 1993). The discrepancy between these prevalence rates may result, in part, from different methodologies and/or cultural differences.

A wide variety of disease and disorders of the external and internal sex organs and their surrounding structures can make intercourse painful for men and women. When physical disorders have been ruled out, psychological factors are assumed to be the cause.

Vaginismus refers to the involuntary spasm of the pelvic muscles surrounding the outer third of the vagina. Women who experience these spasms of the pubococcygeus (PC) and related muscles may be quite capable of becoming sexually aroused, lubricating, and experiencing orgasm but cannot have intercourse. The partner of a woman with this dysfunction who tries to have intercourse with her may have the sensation that his penis is hitting a rigid wall about an inch inside her vagina. Vaginismus rates have ranged from 0.5 to 30 percent of the women treated at clinics (Simons and Carey 1990).

Treatment ranges from the medical correction of physical problems to the use of psychotherapy, although it is sometimes difficult to determine the precise source(s) of the vaginismus. Relaxation training and gradual insertion of successively bigger dilators into the vagina appear to be highly effective in curing vaginismus. It is very important, however, that the woman (rather than a therapist or her partner) control the pace of treatment and the size of dilator (Heiman and Metson 1997)

Vulvodinia is characterized by a painful burning sensation in the vulvar and vaginal area. Also called burning vulva syndrome, the presenting complaint of women with this problem is burning and painful intercourse. The syndrome is associated with a history of vulvo/vaginal infection, microorganisms that cause dermatosis, and early contraceptive use (Binik et al. 1999). Current treatments include laser surgery, topical preparations, dietary restrictions, physical therapy, and pain reduction techniques such as self-hypnosis.

From this review of sexual dysfunctions, it should be clear that whatever the original source (biological, psychosocial, or both) of a person's inability to respond as he or she wishes, the problem may be aggravated by the development of fear of failure in future sexual contacts. Such fear can produce self-fulfilling prophecies; in other words, an intense focus on whether a person will respond adequately can reduce the likelihood that healthy sexual feelings and responses will unfold. No matter what particular treatment procedures sex therapists use, they should also identify and attempt to eliminate both clients' fears of sexual inadequacy and their tendency to engage in distracting and maladaptive thoughts during sexual intimacy.