"I can't seem to keep it up like I used to. The drugs my doctor prescribed don't seem to help much. My partner and I have not even tried in months because I am afraid I will fail, and she no longer approaches me because she is afraid to upset me."

What is sexual dysfunction?

• Diminished sexual desire or drive
• Aversion to sexual activity
• Difficulty attaining or maintaining arousal (including erection or lubrication)
• Delayed or absent orgasm
• Premature ejaculation
• Pain during sexual activity

Cognitive-behavioral model of sexual dysfunction
The complex interaction of cognition (thoughts), behavior, biology, and interpersonal functioning is central to the cognitive-behavioral understanding of sexual dysfunction. Negative thoughts that adversely affect sexual function often involve worry about performance, which can distract from erotic cues and reduce sexual responding and pleasure. Unrealistic (e.g., "I should be able to reach orgasm during every sexual encounter") and maladaptive attitudes about sex (e.g., "it is selfish and inappropriate for a woman to enjoy receiving sexual stimulation") can also contribute to sexual dysfunction. As these negative thoughts affect a person's emotional reaction to sexual activity, the sexual experience becomes paired with negative emotions, such as fear and despair, which can lead to avoidance of sexual activity, which is sometimes misinterpreted by the partner as an indicator that he or she is not attractive, causing further problems.

Medical problems can also affect sexual response. Conditions that affect vascular, neurological, or endocrine systems that underlie sexual response are associated with the greatest risk, including diabetes, hypertension, spinal cord injury, and hormonal insufficiency. Sexual pain may be caused by physical trauma or underlying infection. Prescription drugs can also interfere with sexual response. Attitudes and beliefs about the effects of these physical variables on sexual functioning can also play a role in sexual response and satisfaction.

Relationship problems can also play a role in causing sexual dysfunction. Anger, resentment, and lack of emotional intimacy are generally incompatible with healthy sexual function.

Cognitive-behavior therapy for sexual dysfunction

• psychoeducation focusing on common myths and misinformation about sex
• scheduling and planning intimate time
• exposure-based treatments in which the person or couple carries out a series of specific, home-based behavioral homework assignments designed to reduce anxiety in sexual situations and increase focus on pleasurable aspects of intimacy
• sexual communication training
• cognitive restructuring to challenge negative thoughts associated with sex
• discussion of expanding sexual repertoire to minimize boredom and maximize interest
• lifestyle interventions such as exercise and sleep hygiene that may affect sexual response
• marital therapy to resolve interpersonal conflict and enhance intimacy
• individual therapy to address contributing problems, such as depression
• referral for medical evaluation to assess or treat contributing problems

Books:
For links to purchase these books and others, please go to Self-Help Books for Adults

McCarthy, B., & McCarthy, E. (2003). Rekindling desire: A step-by-step program to help low sex and no sex marriages. New York, NY: Taylor & Francis Books.

Wincze, J.P., & Barlow, D.H. (1997). Enhancing sexuality: A problem-solving approach (Client Workbook). New York, NY: Oxford University Press. (Copyright by Graywind Publications).

Zilbergeld, B. (1999). The new male sexuality, revised edition. New York, NY: Bantam Press.