Get your sex problem properly identified. False assumptions frequently mean that sexual problems are identified incorrectly or misunderstood.
And don’t rely on instinct and old wives’ tales. The causes are probably counter-intuitive, so it’s vital to listen to high quality systems of diagnosis rather than make assumptions.
For instance, a man with erection difficulty may convince himself that he has a physical problem; or a woman who suffers pain during intercourse may assume that the reason is purely physiological. In both cases men and women tend to resist an underlying psychological cause and reject a multi-faceted solution.
Part of the role of sexual psychotherapists, like me, is to help people to understand that sex problems may involve more than one sexual domain. Men with erectile dysfunction find it difficult to appreciate the full impact of psychological causes, such as performance anxiety. Even when they do see performance anxiety for what it is, they may find it difficult to move forward and shift it.
Women may discount the advice of a consultant gynaecologist or obstetrician or psychotherapist who suggests that the pain they feel is as much in their head as in their genitals. Of course their physical pain is real and needs to be validated, but psychological factors may also contribute and be crucial to finding solutions.
The psychological components of pain have to be explained in a supportive and understanding manner, without denying what the patient feels physically. Body and emotions are constantly interacting, and this fact is even more powerful in sexual activity.
One problem with pain is that we flinch in anticipation, a psychological side effect. Women may suffer from vaginismus, a muscular spasm caused by a signal from the brain. Such a spasm can be prompted by anticipation.
But, if a woman feels relaxed and in control of a situation, the spasm may be avoided or reduced. Part of the treatment for vaginismus ensures good context so that the sufferer relaxes and, if they experience a spasm, it is less pronounced.
In the next issue SexMatters will discuss how to deal with problems.
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