This is my last article in this series on human sexuality. I trust that over the last 10 months you have gained a deeper insight into what is for many a profound mystery.

This week, I will introduce you to the treatment options you can pursue to overcome sexual dysfunction.

Whether you are suffering from sexual arousal disorders, sexual desire disorders, orgasmic disorders or pain disorders, most sexologists believe that good sexual response is a natural function which will occur under appropriate psychosocial (mental and environmental) or tactile stimuli (sensual touch) unless there are psychological or physical reasons. Some of these factors are:

Performance anxiety.

Absence of fantasies.

Inability to participate actively in a sexual situation (spectating).

Difficulty in seducing or arousing your partner.

Relationship problems.

Early conditioning as a child (parental and religious influences).

Psychological blocks.

Sex referrals

If you have any of the above conditions and your doctor lacks the expertise to treat you, he/she will tailor the appropriate referral to suit your needs.

When depression, anxiety or substance abuse presents symptoms, you will be referred to a psychotherapist. If your primary problem is a weak pelvic floor, a physical therapist is needed. When pain impacts seriously on your sexuality, a pain specialist should be consulted. If the sexual problems stems from a disorder of the genital tract, a gynaecologist or urologist is the preferred provider.

If you have a number of co-morbid problems such as hypertension, diabetes, hypercholesterolaemia, heart disease, respiratory disorders, musculoskeletal disorders, etc, you should be referred to an internist.

But, if the problem is purely sexual or due to relationship issues, you need to see a sex therapist.

Who is a sex therapist?

A sex therapist is a licensed mental-health professional who has obtained specialised training in the evaluation and treatment of sexual disorders.

When do you consult a sex therapist?

When relationship issues are the main cause of sexual disorders.

When lifelong or acquired problems are diagnosed, such as erectile dysfunction (ED), premature ejaculation, anorgasmia (inability to have orgasms), painful sex, problems with penetration, arousal disorders, sexual addiction, etc.

When sexual rehabilitation is recommended such as sensate focus exercises, the use of vaginal dilators, the Eros clitoral therapy device, etc.

When sexual problems develop after an illness or surgery.

How are you evaluated?

The therapist will do a comprehensive psychosexual evaluation which involves:

An intake interview in which the therapist determines to what extent the problem is related to sexual attitudes, performance anxiety or is it related to relationship issues, a medical problem or psychological issues.

He will also want to know if it only occurs with specific partners (situational) or under all circumstances (global).

Assessment of the chief complaint: You will be asked to describe your symptoms.

Sexual status examination: The therapist will try to create a video of your sex life. You will be asked to divulge all the intimate details of your sex life, such as the time of day and location of intercourse, who initiates sex and how your partner responds.

What is your sexual behaviour? (preferred sexual positions, preference for particular types of stimulation). Can you have an orgasm? And what activity facilitates this? What are your fantasies? How does the sexual disorder affect you emotionally?

Medical history: This details illnesses, surgeries, and medication along with assessment of drug use, over-the-counter and prescription medication.

Psychiatric history: This focuses on previous or existing emotional problems and treatment, as well as a brief family history of psychiatric problems.

Family history - this concentrates on relationships in the home during childhood and adolescence and the patient's perception of the intimate relationship of parents.

Sexual histories - this includes a description of sexual learning and modelling as well as accounts of sexual experiences with and without partners. Any unwanted sexual experiences, such as rape, incest and sexual abuse, will be explored.

Relationship histories - How the relationship began, how the partner feels about each other, how is it different from previous experiences, any problems with intimacy, communication and control issues, future plans re: children, marriage, etc.

Treatment techniques

The therapist utilises a variety of techniques that are tailored to the needs of the patient or couple:

Bibliotherapy: Assigned reading of appropriate books and viewing of videotapes.

Education and reframing: The patient is educated about various aspects of sexuality and helped to restructure or reframe his or her concepts of sexuality.

The therapist also helps the couple to become more immersed in a sexual experience, and to become comfortable with a variety of sexual fantasies and experiences, rather than being mere spectators. They are also encouraged to set up dates or times to be together and to take risks in initiating intimate activity, while at the same time giving permission for the other to reject such advances as long as it is supportive.

Sensate focusing: You are taught the art of sensual touching, thus enabling you to explore your spouse's body and discover new aspects of your own sexuality and deepen intimacy.

Tantric sex: You are taught erotic rituals which focus on exchanging pleasures, awakening the senses and allow couples to communicate deeply, physically and emotionally.

Cognitive therapy, psychodynamic the-rapy, play therapy and dream analysis: These can be used for all disorders which have a strong psychological component.

Treatment of specific dysfunction. Typical examples are:

Self-help techniques and couples the-rapy, using the squeeze or the stop-start technique for premature ejaculation.

Dilator and desensitisation therapy for vaginismus (involuntary spasm of the vaginal muscles).

Psychotherapy for ED and vaginismus.

Sex therapy broadens couples' approach so that sexual practices become more varied, creative and exciting. Anxiety about specific practices is reduced and the needs of both lovers are met.

I hope you all had a safe and pleasant Christmas and may all your future sexual endeavours be truly fulfilling.

Source: Sexual Dysfunction - Michael Plaut, Alessandra Graziottin, Jeremy P.W. Heaton; Health Press; Oxford