FAQs About Sexual Addiction and Sexual Dysfunction

By Martin V. Cohen, Ph.D.

Q Do sexual addictions really exist?

Yes, sexual addictions do exist and can create chaos in the lives of an individual and their family. Moreover, sexual addictions can also put the individual in danger of legal action, potential violence or sexually transmitted disease. Whether specific behaviors can be considered sexual addictions may vary from person to person. However, an addiction may exist if an individual is unable to control certain sexual behaviors; the sexual behavior is self-destructive and it interferes with the normal daily functioning of the individual.

Q What type of sexual addictions are seen by psychotherapists?

There is a tremendous range of sexual addictions that people experience and seek treatment for. Over the last several years, addictions to internet pornography are very common. This type of addiction may be accompanied by excessive masturbation lasting long periods of time or by the use of prostitution. Other forms of sexual addiction may involve exhibitionism, public masturbation, uncontrolled sexual contact with strangers and a wide variation of activity designed to elicit sexual pleasure.

Q What types of treatments are available for a person with a sexual addiction?

There is no one form of treatment that has been proven most effective. Often, a combination of treatments are used in working with the person who has a sexual addiction. For example, some of the psychiatric medications can be helpful in reducing sexual drive or in decreasing sexually intrusive thoughts. These medications may also allow an individual to consider consequences before acting on a sexual urge or impulse. In addition to medications, treatment almost always involves therapy or counseling on a regular basis. In the United States there are also self-help programs for people with sexual addictions. These are modeled after the AA 12-step programs and are found in most major cities in the US.

Q What can I do if I think my partner has a sexual addiction?

Clearly, the first step is to speak with your partner and discuss your observations and concerns. Like all addictions, denial is common. In some cases, the individual may not realize that a problem exists or that certain behaviors have become out of control. Encouraging psychological treatment and providing strong emotional support are critical if changes are expected. Expressing emotional support is often difficult at this time because of personal distress and feelings of anger.

Q How can someone I love do this to our relationship?

In trying to grasp a situation such as this, it is important to remember that the sexual behavior is an addiction. Like all addictions, they serve a purpose. Often, the behavior is an attempt to cope with feelings such as depression, stress or other emotionally painful material. In other cases, there may be a void in the individual's life or in their primary relationship. Typically, the reasons behind addictive behavior are complex and multi-faceted. For this reason, marital or couple's counseling may be an adjunct to treatment

Q Can a sexual addiction really be eliminated?

Like any addiction, maintaining control and avoiding future problems is a difficult, life-long process. Maintaining sobriety over sexual addictions requires strong motivation and a constant vigilance over times of potential danger. With good emotional support, however, it is possible to make the necessary changes. For most people, a sense of overconfidence and a premature termination of psychological treatment and support are the biggest mistakes that can lead to future problems.

Psychotherapy for Sexual Dysfunction

Q How do I know if my sexual difficulty is from a psychological or physical problem?

The answer to this question may depend on whom you ask. A mental health professional may believe that your problem comes from a psychological issue and a medical doctor may feel that there are physical concerns. The reality is that most sexual difficulties have both psychological and physical components that can contribute to the problem. Today, because of recent medical advances, physical causes are often discovered in the majority of cases. The psychological or emotional component thus may be a result of the sexual problem rather than causing the sexual difficulty. Also, relationship issues often emerge after any form of sexual difficulty. Because there is no simple answer to this question, a good psychotherapist should refer you to a medical doctor for an evaluation, while a medical doctor may also suggest that you address the emotional issues with a therapist.

Q If my sexual difficulty is because of psychological causes, what can I do?

There are new, effective treatments for people who have sexual problems due to either physical or psychological reasons. Almost everyone who has a sexual difficulty hopes that a physical reason can be discovered. We all want a quick fix and hope that a pill can solve our problem. (This is why Viagra has become so popular.) Psychological causes for a problem are much more vague, difficult to understand and sometimes more difficult to treat. If there are psychological difficulties, we tend to blame ourselves and self-esteem is affected. Unfortunately, even in this age, many people feel a sense of shame and inadequacy about psychological problems. We all believe we should be able to fix the problem ourselves without seeing a professional!

Q Shouldn't I wait to see if a sexual problem goes away on its own before I see a professional?

With sex being such a personal matter, most people do wait considerable time before seeking professional assistance. The embarrassment surrounding sexual difficulties often prevents people from getting early help. Some problems do clear up on their own, especially if they are related to factors such as excessive alcohol consumption or stress. However, if a problem persists over a period of weeks or months, there is a good chance that the situation will not improve without some professional intervention. Once a sexual problem has occurred, even once, we tend to anticipate difficulties every time in the future. This loss of sexual confidence and fear of failure can easily intensify an already existing sexual difficulty.

Q I am unable to ejaculate during intercourse although I have no difficulty during masturbation. What should I do?

This problem is often seen in clinics and can be either from medical or psychological issues. For example, a decrease in the sensitivity of the penis may be caused by a nerve injury thus making ejaculation difficult with the friction of intercourse. On the other hand, anxiety about reaching orgasm may be another factor. A good medical evaluation is an essential first step and would be recommended by most therapists.

Q What causes premature ejaculation?

No one is quite sure how men develop problems with rapid ejaculation. However, many professionals believe that the ability to control one's ejaculation is a skill that is learned during adolescence and early adulthood. Often, masturbation is considered a method in which this response is learned and mastered. Although the problem is more common among young men, it can persist throughout the life span of an individual. Today, in addition to the standard sex therapy treatments available, medications (such as antidepressant medications) are often used to delay ejaculation. Unfortunately, some of these medications can also have a negative effect on sexual interest and the quality of a erection.

Q Is it common for women to lose interest in sex after the birth of a child?

Men and women may lose interest in sex at any time throughout their lives. Often, this lack of interest may extend for years. For women, the loss of sexual desire after the birth of a child is very common and is poorly understood. Newer research is beginning to suggest that a decrease in hormone levels may play a major factor in this condition. In spite of its frequency, good treatment is also difficult to find. Most ob/gyn doctors have little to suggest that will improve sexual desire. Naturally, such a situation can create extreme tension in a marriage and often leads to frustration, anger and marital conflict. Some Urology departments at major medical centers are beginning to take an interest in this condition and offer treatment to the woman and her partner.

Q Is it normal for sexual intercourse to be painful for women?

Female sexual dysfunction is a new area of scientific study and at this time little is known about its causes. It is not normal for women to experience discomfort during sexual activity or intercourse. However, there can be numerous reasons why intercourse may be painful for women and it is a common complaint. Physical reasons may include low androgen levels, lack of arousal and lubrication or internal structures such as cysts on the walls of the vagina. Doctors are just beginning to understand the many variables involved in causing women to experience sexual discomfort. Psychological issues such as anxiety, past sexual trauma, rape, abuse or relationship difficulties may also be factors related to discomfort during sexual intercourse. Like many female sexual problems, evaluation and treatment for these problems may be difficult to find. As more women become vocal about sexual dysfunction, however, doctors are being forced to address their concerns. It is important to be a strong advocate for yourself in seeking treatment.

Q Why do men have such a difficult time facing a sexual difficulty?

Most men will develop some form of sexual dysfunction at various times throughout life. Often, this will be a crisis in the man's life. For many men, these difficulties are temporary and can be attributed to stress, fatigue, medical issues or a preoccupation with work or some other aspect of their lives. Because sex is such a vulnerable area for many men, issues of masculinity often come into question when a sexual difficulty arises. Self-doubt can intensify almost any sexual difficulty and feelings of inadequacy are usually very prevalent. A man's masculinity and his sexual attraction to others are not related to the quality of erections, sexual desire or ability to delay ejaculation. Having a sexual difficulty need not be a serious, anxiety-provoking situation.

Q Isn't it normal to have sexual problems as you get older?

Most men and women do develop some form of sexual dysfunction as they age. Often, this may be a result of some medical issue such as a circulation, hormone or neurological problem. Also life style factors such as alcohol use, smoking, weight and cholesterol levels have been associated with sexual difficulties. Even depression and many medications have sexual side effects. Nevertheless, many people stay sexually active throughout their lives and have a strong sexual desire even into their 70s and 80s. Although it may be common to develop sexual problems as you age, you should expect to be sexually active throughout life. If not, treatments are available at any age.

Q Will Viagra solve my sexual difficulties?

In spite of Viagra being the most popular medication ever developed, it will not solve all sexual problems. It was originally developed for the treatment of erectile difficulties and has been proven to be very effective in many cases. Although not intended for other problems, it is sometimes used to help with low sexual desire and ejaculation problems. Its effectiveness in these types of cases has not been proven and is often used in conjunction with psychotherapy. Currently, Viagra is also being studied in the treatment of women's sexual problems. Viagra has opened the door for research on new medications for the treatment of sexual dysfunction. If you have a sexual problem, it is wise to stay in touch with medical professionals as new oral medications and treatments are constantly being developed. We are in a time of tremendous revolution in the treatment of these problems.

© 2005 Martin V. Cohen, Ph.D.

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