Female Sexual Dysfunction
It is estimated that up to 50 percent of women have experienced sexual dysfunction and this is increased by up to 75% when sexual dissatisfaction or problem are included. Female sexual dysfunction can be subdivided into different stages of the sexual response cycle: desire (interest in wanting to engage in sex), arousal (e.g. physical lubrication or genital warmth due to blood flow), organism and sex pain disorders. There may be an overlap as decreased desire may come from an Anorgasmia.
Orgasmic dysfunction/ Anorgasmia (Female Orgasmic Disorder)
Anorgasmia is when a person experiences a persistent difficulty in achieving orgasm which causes significant personal distress or interferes with your relationship with a partner. Sometimes, it can be similar to delayed ejaculation in cisgender males. Unfortunately, there are no pharmacotherapies to assist with experiencing orgasm for females so treatment is primarily psychological. Apart from physical and medical causes, psychological causes can include mental health struggles such as anxiety or depression, poor body image, guilt, shame, relationship issues, past sexual or emotional abuse or cultural or religious beliefs.
Libido (Low desire and low sexual arousal)
Sexual desire is a feeling that includes wanting to have a sexual experience or feeling receptive to a partners initiation or thinking or fantasizing about having sex. It is not unusual for desire to fluctuate over life cycles due to hormonal changes, pregnancy, illness, relationship distress or stress. Sexual arousal incorporates physical aspects such as feelings of warmth tingling in the genitals and lubrication.
Sex therapy counselling is a place to explore and communicate how important an active sex life is to you and look at ways to manage desire discrepancies.
Sexual Pain / Painful Sex
Up to 21% of women have been estimated to experience sexual pain however many women suffer in silence as find discussing this issue with a professional embarrassing. Symptoms can include pain on entry (intromission) which can be burning or cutting sensation or pain can be “deep” pain or pain can be feelings of muscle spasms or muscle tightness. Sexual Pain can be primary pain which has always been there since the first intromission or it can develop after a period of time symptom-free. Sexual Pain can be classified into vaginismus, vulvodynia, dyspareunia, and dysmenorrhea.
Vaginismus is the involuntary contraction of the muscles of the pelvic floor that interferes with penetration, around the lower one-third of the vagina. While it may have originated in an initial painful experience, continued pain may have a psychological component due to Grantley Dick-Read discovery in the 1920sof pain-tension-fear cycle. It can result from an association between fear of pain resulting in muscles becoming tense which increases the pain.
Sexual pain may occur around the opening of the vulva and may or may not be associated with sexual penetration. Pain may be constant or occur every once in a while. Pain may be general in different areas and it can be characterised by a localised burning or stinging sensation. Pain may be provoked by touch or pressure.
Vestibulitis is pain localised to the vulval vestibule which is a part of the vulva between the labia minora and the vaginal opening. A study by the University of Michigan found that about 28% of women have experienced vulvar vestibular pain in the past. Vestibulodynia is a subset of vulvodynia and relates to pain in the vestibule.
Dyspareunia is most commonly experienced during vaginal penetration. It can be primary, occurring since the first attempt at vaginal intercourse or secondary occurring after a period of pain-free intercourse. Pain can be closer to the entrance or it may be deeper in the vaginal canal.
Dysmenorrhea also known as painful periods or menstrual cramps is pain during menstruation. It is caused by uterine muscular contractions. There can be underlying problems such as uterine fibroids, adenomyosis or endometriosis. It may be useful to have a medical exam to rule out pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain. Co-occurring symptoms can include nausea, vomiting, diarrhea or constipation, headache, dizziness, fainting, and fatigue.
Sex Therapy Counselling for Treatment of Sexual Dysfunction
Treatment for sexual dysfunction starts by identifying the cause by doing a thorough assessment which is crucial as this will determine a treatment plan. Whether the underlying cause is medical or psychological, it is still important to talk with a sex therapy professional in addition to your GP. If sex has been painful for a while, there may be a negative emotional response and psychological fear that causes tension which then generates more pain. It may also be difficult to talk about sexual issues with a partner and a therapist trained in sex therapy can help you communicate easily. A professional counsellor can help you use techniques such as Cognitive Behavioural Therapy, Mindfulness, Sensate Focus, Communication exercises, sexual education, control of vaginal muscles using vaginal relaxation exercises, use of a trainer under controlled relaxation, discussing/communicating control of penetration and exploration of any phobias. One particular therapy that is gaining popularity and more and more scientific based evidence is hypnotherapy.
Hypnotherapy as a treatment for sexual pain
There has been a lot of research on the use of hypnosis for general pain and in recent years there has been a lot more research on sexual pain. Pukall, Kandyba, Amsel, Khalifé, & Binik (2007) examined the effectiveness of hypnosis and pain and psychosexual function in women experiencing painful sex (vulvodynia). Participants did an initial 1.5 hour assessment to gather information and create a tailored hypnosis script. This was followed by 6 x 1 hour assessments. Study participants experienced significant decreases in pain and pain on intercourse. In addition, overall sexual functioning and satisfaction increased.
Pukall, C., Kandyba, K., Amsel, R., Khalifé, S., & Binik, Y. (2007). ORIGINAL RESEARCH—SEXUAL PAIN DISORDERS: Effectiveness of Hypnosis for the Treatment of Vulvar Vestibulitis Syndrome: A Preliminary Investigation. The Journal of Sexual Medicine,4(2), 417-425. doi:10.1111/j.1743-6109.2006.00425.x