Many of your clients will have sexual issues. Although clients aren’t always comfortable bringing them up, their sexual issues still need to be addressed. Research shows that lack of knowledge is one of the reasons sexual issues aren’t addressed in counseling. Toward that end, in this post I will describe the major sexual dysfunctions, including treatment options and when to refer to a sex therapist.
Sexual issues can affect clients in many ways. Unresolved problems in the bedroom can lead to lowered self-esteem and can strain relationships. Therefore it is paramount that counselors feel comfortable enough to allow the client to talk about sex.
Sex therapists specialize in treating all of these sexual issues. When a sexual issue is the primary complaint, or is more complicated than you are equipped to handle, you should refer your client to a sex therapist, just as you would refer out for anything that you are not knowledgeable about or don’t have experience treating. In addition, sexual issues are commonly caused by relationship issues. Therefore, if the sexual issue needs to be addressed with the couple as opposed to the individual, if you are not a couples therapist you should refer your client to one.
Low Sexual Desire
This type of dysfunction can happen in either sex. For women, causes are more likely to include environmental stress, including finances or relationship issues. For men, it is usually fatigue. For both genders it could be due to low testosterone levels. New research suggests that low sexual desire may not be an issue for women; that in some cases women need to become physically aroused before they feel desire. Treatment includes stress reduction, improving communication skills, and masturbation, particularly for women to get to know their bodies and what they like sexually.
Sexual Arousal Disorders
These include Erectile Dysfunction (ED) or lack of lubrication in women. Causes for ED in men include medications, poor circulation, excessive pornography use, performance anxiety, age (men over 40 have a much higher incidence of ED), and alcohol. Lack of lubrication can be caused by hormonal imbalance, insufficient stimulation, or age. Treatment for ED includes psychological counseling to treat underlying anxiety or relationship issues, medications such as Viagra or Cialis, injections, a vacuum pump, or penile implants. For women, treatment for lack of lubrication include use of synthetic lubricants such as KY, and a visit to your doctor to balance your hormones. Low estrogen levels can cause dryness in the vagina, therefore women undergoing menopause are more likely to have issues with lubrication. Thereofre, lack of lubrication does not necessarily mean lack of sexual excitement.
Orgasmic Disorders
These include rapid orgasm (known as Premature Ejaculation in men, in women it is so rare it doesn’t have a name), and inorgasmia. Both sexes can suffer from inorgasmia. Premature Ejaculation (PE) is defined as ejaculation before it is desired and inorgasmia is defined as inability to have an orgasm. The primary cause for PE in men is anxiety. Inorgasmia can have many causes, including relationship issues, a distracted mind, a partner’s poor sexual skills, and individual psychological issues. Treatment for PE includes SSRI (Selective Seratonin Reuptake Inhibitors such as Zoloft), and psychological counseling for anxiety. Treatment for inorgasmia is mainly psychological, although there may be physiological causes involved.
Dyspareunia (Sexual Pain)
Both sexes can suffer from sexual pain. Females can also have vaginismus, which is the reflexive closing of the vagina, making intercourse impossible. Unfortunately, treatment for dyspareunia is complicated and poorly understood.
With any of these sexual dysfunctions, it is a good idea to recommend a physical checkup for clients.
Yours in the Joy of Knowledge,
Barbara LoFrisco
