Pain during sexual activity

Premature ejaculation

Inability or delay in reaching orgasm

Diminished sexual desire

Difficulty in obtaining or maintaining physical arousal

Aversion to sexual activity

Cognitive-Behavioral Model of Sexual Dysfunction:
The complex interaction between thoughts, behavior, biology, and interpersonal functioning is central to the cognitive-behavioral model of sexual dysfunction. Negative thoughts that adversely affect sexual function often involve anxiety about performance, which can distract from erotic cues and reduce sexual responding and pleasure. Unrealistic (e.g., "I should be able to last all night ") and maladaptive attitudes about sex (e.g., "If I can’t get it up, I must not really love my partner") can also contribute to sexual dysfunction. As these negative thoughts impact a person's emotional reaction to sexual activity, the sexual experience becomes paired with negative emotions, such as fear and anger, which can lead to avoidance of sexual activity. This can sometimes be misinterpreted by the partner as an indication that he or she is not attractive, causing additional problems.

Sexual dysfunction may be caused by medical problems that affect vascular, neurological, or endocrine systems that underlie sexual response including diabetes, spinal cord injury, hypertension and hormonal insufficiency. Infections, physical trauma, as well as chronic drug use and alcoholism may also be responsible. In addition, medications prescribed for these and other conditions (i.e., depression, high blood pressure) may affect sexual response and performance. Attitudes and beliefs about the impact of these variables on sexual functioning can also play a role in sexual response and satisfaction.

Psychological factors such as depression, low self-esteem, anger, and fear have been associated with sexual dysfunction. Relationships issues such as marital satisfaction, physical attraction, and how one partner approaches sex can also be contributing factors.

Cognitive-Behavioral Treatment of Sexual Dysfunction:
Treatment options vary by patient and may be offered individually or in couple format. Usually several sessions are necessary to identity and treat the underlying problem. Some treatment options include:

Assessment – identify causes of sexual dysfunction (i.e., depression, marital problems)

Psychoeducation - discussing possible misinformation and erroneously held beliefs

Exposure Based Treatment - individual or couple is given "homework" to reduce anxiety and heighten pleasurable situations

Sexual Communication Training

Scheduling and Planning for Intimacy

Cognitive Restructuring - to change negative thoughts about sex

Referrals - as needed for medical assessment