Sexual problems in adulthood may be related
to feelings of personal inadequacy, conflicting feelings regarding the opposite sex, severe family or religious training regarding sexuality, or experiences of sexual abuse in childhood.
The effects of childhood sexual abuse are particularly damaging. Such experiences are often kept secret by the victim, leaving scars of shame, confusion, guilt and an inability to trust a sexual partner.
It is important to recognize that adult sexual problems are not always due to childhood sexual abuse. Inexperienced or poorly trained therapists may damage their patients by over-enthusiastically and improperly pursuing evidence of “repressed memories” of childhood sexual abuse when in fact no such abuse ever occurred. The page on multiple personality provides some further information about the problem of “recovery of repressed memories of sexual abuse”
The most common sexual problems in men include premature ejaculation,
problems in achieving or maintaining an erection, and diminished or excessive sexual desire. The most common problems in women include diminished sexual desire and problems in achieving a climax. Couples often have problems because their levels of sexual interest are different. The stereotype that it is the man who wants more sexual activity than the woman is not always correct. I see many couples in my practice where the opposite problem exists.
Other symptoms may involve forms of sexual behavior which are problematic,
including an obsessive preoccupation with sexuality. This may take the form of a compulsive preoccupation with pornography, a compulsive seeking of multiple sexual partners or prostitutes, compulsive masturbation, or compulsive involvement with sexual liaisons through chat rooms on the Internet. With the advent of widespread access to the Internet, a new type of compulsive and addictive forms of behavior has become common. As with drug alcohol and gambling addictions, addiction to pornography on the Internet can expand until it interferes with or destroys all other aspects of a person’s life, including personal relationships, leisure and social activities and functioning in the workplace.
Terms to be distinguished from gay or lesbian include transgender, transsexual and transvestite.
Transgender is a general term that has evolved in meaning over the past 30 years. It is an umbrella term referring to people whose gender identification differs from their anatomical gender.
Transsexual is a term that refers to a person who has a powerful identification with the gender incongruent with his or her anatomy. For example, a transsexual man has the physical attributes of a man but identifies with women and behaves like a woman. He is attracted to men, and wants to be treated like “a normal female.” A transsexual may feel so miserable about the incongruity between his or her psychological and physical sexual identity as to sacrifice his career, lose his family and undergo hormonal treatment and multiple, painful surgeries to eliminate the incongruity. Transsexuals generally have a powerful gender identification have no desire to achieve an identity congruent with their anatomy.
The term transvestites is sometimes confused with the term transsexual. Transvestites have a strong compulsion to wear the clothes of the opposite sex (cross-dressing). They are generally males and are generally heterosexual. They derive an intense satisfaction from cross-dressing. Although they typically try to conceal their cross-dressing from others, they are willing to risk the danger of public ridicule and even the survival of their marriage rather than to give up this compulsion.
Treatment of sexual problems always starts with a good psychosocial history
including, but not restricted to the nature and history of the problem. A psychologist is interested in other aspects of a person’s history and present life, because problems in sexual functioning can only be understood in the context of a person’s whole life situation. Pressure or conflict in other areas of your life may play a role in causing the symptoms of sexual dysfunction.
It is often difficult for someone to make that initial appointment to discuss such personal matters. Nevertheless, in the private, confidential and professional atmosphere of a psychologist’s office people are often surprised to discover how quickly they are able to overcome their initial discomfort and discuss their personal problems.
Depending on the nature of the problem, the psychologist may recommend having the spouse or other committed sexual partner involved in treatment.
You can expect an experienced psychologist to approach your problems in a manner
which is sensitive to your feelings and you can expect him or her to behave in a professional, ethical and responsible manner. Most people respond favorably to treatment by a well-qualified and experienced psychologist. I would recommend that you make sure you see someone who identifies himself or herself specifically as a psychologist, and not just as a “counselor,” “therapist,” or “sex therapist.” See my page on selecting a psychologist for more information about the qualifications to look for.
What else can you do to decide who is the right professional person to help you with this kind of problem? You may get information about me at Marvin S. Beitner, Ph.D. You may get information about how to evaluate the credentials of any psychologist at Check Qualifications.