Why Do People Have Sexual Dysfunctions?

Sexual functioning involves biological, relational, emotional, and psychological factors. For this reason, sexual health is conceptualized using the biopsychosocial model. 

Biological conditions that can lead to a reduction of sexual desire including testosterone deficiencies, thyroid problems, endocrine disorders, or medications.

Medical conditions that may cause arousal or orgasm difficulties may include:

• Fatigue

• Infections that lead to painful sex

• Heart disease

• Diabetes

• MS

• Spinal cord injuries

• Complications from surgeries

• Cancer

• Hormonal problems

Medications for hypertension or psychiatric disorders can also cause problems for arousal or orgasm.

A general rule of thumb is to always see a medical doctor to rule out medical causes of sexual dysfunction prior to pursuing psychological solutions or sex therapy. 

Counseling, psychotherapy, and sex therapy treat the relational, psychological, and emotional causes of sexual dysfunctions. 

Psychological factors play a significant role in sexual functioning. Changes in sexual desire are usually explained by psychological and interpersonal factors. Anxiety is the most reported factor that can lead to low sexual desire, performance anxiety, fear of pleasure, or loss of control. Other factors that impact sexual functioning include:

• Depression

• Cultural influences

• Psychosexual trauma

• Ineffective sexual techniques

• Emotional factors

• Problems in the relationship

• Lack of sexual skills

• Irrational beliefs, including unrealistic expectations

Children who are reared in a sexually repressive culture or home environment may learn to respond to sex with feelings of anxiety and shame rather than anticipation and pleasure. This may begin, for example, when parents instill a sense of shame over touching one’s own genitals. These children then may grow into adults who find it difficult to accept their sex organs as a source of pleasure. 

Women are more likely than men to be taught to suppress sexual desire, as self-control and vigilance are commonly seen as female virtues. For these women, expressing sexual desires may be not only uncommon but psychologically blocked. In general, women who are taught throughout their life to turn off these sexual desires may find it difficult to become aroused or enjoy sex when they are older.

Women and men who are sexually victimized in childhood are also more likely to have trouble becoming sexually aroused. Sexual stimuli can become deeply tied to traumatic experiences such as rape, incest, or molestation, leading to anxiety or complete dissociation when sex is experienced again. Unresolved anger, misplaced guilt, feelings of disgust can also make sexual response difficult for years after the inciting event.

Performance anxiety is perhaps one of the most common aspects of all sexual dysfunctions. Whether it’s the anticipation of loss of functioning as experienced in erectile dysfunction, the loss of control of functioning as experienced in premature ejaculation, or the anticipation of pain such as experienced in vaginismus or painful intercourse for women may lead to a cycle of performance anxiety and subsequent intensification of symptoms.

In general, performance anxiety is the anxiety concerning one’s ability to perform behaviors, especially behaviors evaluated by others. Many times, performance anxiety puts one in a spectator role, where the focus is on negative thoughts and feelings, self-evaluation, and self-doubt, and not on the physical experience and sensations of pleasure.

The Role of Thoughts in Sexual Functioning

One common factor in almost all causes of sexual dysfunction is negative thinking or negative cognitions. Negative cognitions are negative thoughts that a person has after having a negative experience. Such negative cognitions can impact the perception of future experiences and how one relates to themselves, others, and the world around them.

To illustrate the role of thoughts in creating and maintaining sexual dysfunction, the case of Aiden will be presented. (Note: The elements of this case presentation are taken from clinical case presentations but all identifying patient information has been removed.)

Aiden came to sex therapy reporting erectile difficulties from his earliest sexual experiences. He reported that he grew up with a critical father and had a general negative feeling about himself - “I’m not good enough.”

He reported that his parents never talked to him about sex, and he also had limited sexual experiences growing up. He described feeling anxious about getting erections and in general felt like he had negative thoughts and feelings about a lot of things in life. Although he didn’t know why, he reported feeling uncomfortable with masturbation and didn’t like how heavy he was - although he was only slightly above average weight. It was clear he didn’t like his body.

He also had unrealistic expectations about erections and felt like they had to happen on demand and last as long as needed. He avoided sex all together with his partner, despite his partner regularly and enthusiastically initiating, because of feelings of dread and fear of not being able to get or maintain an erection.

He reported that his partner blames herself for the lack of consistent erectile functioning and that they were unable to have any meaningful or productive conversations about their sexual intimacy, or really any emotional intimacy at all. 

From this brief clinical presentation, some negative thoughts may be clear while others may be more subtle. Here are some negative thoughts that Aiden had during sex: 

• “I’m not good enough.”

• “Masturbation is wrong.”

• “I’m too fat.”

• “I won’t get hard.”

• “I have to get an erection.”

Negative thoughts like this can take one out of the present moment, and out of their body. Additionally, negative thoughts tend to fuel negative emotions, creating a negative feedback loop in which the physical body is responding to the negative thoughts and feelings and a symptom of sexual distress and dysfunction is maintained. 

EMDR in Treating Sexual Dysfunctions

Eye Movement Desensitization Reprocessing (EMDR) was developed in the late 1980’s by Francine Shapiro to desensitize traumatic memories and change the way individual’s thought about and experienced those memories. EMDR therapy can only be performed by a trained EMDR therapist and involves utilizing bilateral stimulation or alternating left to right eye movements, sound, or tactile stimulation, while recalling a negative or traumatic memory and associated negative cognition.

During the course of the EMDR therapy, which one session usually takes place in 60-90 minutes, one negative memory and negative cognition can be effectively treated, leaving the patient with fewer negative feelings and more rational thought, e.g. moving from “I’m not good enough” to “I’m fine as I am.”

Working through negative memories then results in the individual being more present in situations that used to remind them of the negative memory. EMDR is a highly effective therapy, producing significant results in a short period of time. 

Individuals with sexual dysfunctions have higher rates of performance anxiety and negative thoughts. Individuals with sexual dysfunctions commonly have a history of negative experiences ranging from significant childhood maltreatment and trauma, including childhood neglect and abuse, to other forms of negative experience throughout the life span that leads to developing negative thoughts about sex. Developing an understanding of what negative thoughts accompany symptoms of sexual dysfunctions is part of a comprehensive treatment plan.

Utilizing EMDR to target negative thoughts can result in individuals with sexual dysfunctions having more adaptive or positive thoughts in sexual situations, which leads to greater levels of sexual functioning and satisfaction. 

Contact us to learn more about how EMDR can be helpful in the treatment of sexual dysfunction.