We're closing in on having covered all ASWB exam content outline items on the SWTP blog. Thinking we'll stitch them all together eventually under one cover. But first, let's get to the last of 'em. Next up: The indicators of sexual dysfunction. Let's dig in and then try out a practice question on the topic.
Sexual dysfunction is characterized by persistent difficulties in one or more stages of the sexual response cycle—desire, arousal, orgasm, or resolution. These difficulties can stem from psychological, physiological, relational, or environmental factors and often lead to distress or relationship difficulties. Below is a breakdown of key indicators:
Desire-Related Disorders
Desire issues involve either a lack or excess of sexual interest.
Low Sexual Desire (Hypoactive Sexual Desire Disorder - HSDD)
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Primary indicators:
- Persistent or recurrent absence of sexual thoughts or fantasies.
- Little or no interest in sexual activity, even with a long-term partner.
- Reduced or absent response to sexual cues (e.g., erotic content, partner initiation).
- Avoidance of sexual intimacy or distress over the lack of sexual interest.
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Possible causes:
- Hormonal imbalances (low testosterone, estrogen decline in menopause).
- Psychological factors (depression, anxiety, past trauma, low self-esteem).
- Relationship issues (unresolved conflicts, emotional distance).
- Side effects of medications (e.g., SSRIs, birth control pills).
Excessive Sexual Desire (Hypersexuality)
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Primary indicators:
- Preoccupation with sexual thoughts, urges, or behaviors.
- Engaging in frequent or compulsive sexual activities despite negative consequences.
- Using sexual behavior to cope with stress, boredom, or emotional distress.
- Feeling out of control regarding sexual impulses.
- Interference with daily responsibilities (work, relationships, social life).
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Possible causes:
- Psychological conditions (bipolar disorder, obsessive-compulsive disorder).
- Substance use disorders (alcohol, stimulants).
- Neurological conditions affecting impulse control.
Arousal Disorders
Arousal disorders affect the ability to become physically or mentally aroused.
Female Sexual Interest/Arousal Disorder (FSIAD)
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Primary indicators:
- Lack of genital response (e.g., vaginal dryness, lack of swelling).
- Reduced or absent sexual sensations during sexual activity.
- Difficulty achieving or maintaining arousal, even with adequate stimulation.
- Psychological distress or frustration due to arousal difficulties.
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Possible causes:
- Hormonal imbalances (low estrogen, menopause, birth control effects).
- Psychological factors (stress, anxiety, body image concerns).
- Chronic health conditions (diabetes, cardiovascular disease).
- Medications (antidepressants, antihypertensives).
Erectile Dysfunction (ED)
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Primary indicators:
- Persistent difficulty achieving an erection.
- Difficulty maintaining an erection sufficient for intercourse.
- Reduced penile firmness or rigidity.
- Avoidance of sexual activity due to fear of failure.
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Possible causes:
- Vascular conditions (high blood pressure, atherosclerosis).
- Neurological disorders (Parkinson’s disease, multiple sclerosis).
- Psychological factors (performance anxiety, depression, stress).
- Lifestyle factors (obesity, smoking, excessive alcohol consumption).
Orgasmic Disorders
Orgasmic disorders involve delayed, absent, or premature orgasm.
Delayed or Absent Orgasm (Anorgasmia)
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Primary indicators:
- Marked delay or inability to achieve orgasm despite adequate stimulation.
- Reduced intensity or absence of orgasmic sensation.
- Frustration, distress, or decreased satisfaction with sexual activity.
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Possible causes:
- Psychological factors (anxiety, fear of loss of control, trauma).
- Neurological conditions (spinal cord injuries, nerve damage).
- Medication side effects (SSRIs, blood pressure medications).
- Hormonal imbalances (low testosterone, thyroid dysfunction).
Premature Ejaculation (PE)
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Primary indicators:
- Ejaculation occurring within one minute of penetration or sooner than desired.
- Lack of control over ejaculation timing.
- Distress or frustration for the individual or partner.
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Possible causes:
- Psychological factors (performance anxiety, stress, relationship issues).
- Hypersensitivity of the penile nerves.
- Genetic predisposition.
- Neurochemical imbalances affecting serotonin levels.
Delayed Ejaculation (DE)
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Primary indicators:
- Persistent difficulty or inability to reach orgasm despite sufficient stimulation.
- Need for prolonged stimulation to achieve ejaculation.
- Frustration or distress affecting sexual satisfaction.
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Possible causes:
- Psychological factors (fear of pregnancy, anxiety, trauma).
- Neurological conditions (spinal cord injuries, nerve damage).
- Medication effects (SSRIs, beta-blockers).
- Chronic health conditions (diabetes, multiple sclerosis).
Pain Disorders (Genito-Pelvic Pain/Penetration Disorder)
Pain-related sexual dysfunctions can occur in both men and women.
Dyspareunia (Pain During Intercourse)
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Primary indicators:
- Persistent or recurrent genital pain during penetration.
- Deep pelvic pain or burning sensations post-intercourse.
- Pain unrelated to lubrication or arousal issues.
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Possible causes:
- Vaginal infections (yeast infections, bacterial vaginosis).
- Endometriosis or pelvic inflammatory disease (PID).
- Insufficient lubrication (hormonal changes, menopause).
- Psychological factors (past trauma, anxiety, fear of pain).
Vaginismus (Involuntary Vaginal Muscle Contraction)
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Primary indicators:
- Pain or tightness during attempted penetration.
- Involuntary muscle spasms preventing intercourse or medical exams.
- Anxiety, fear, or avoidance of penetration due to anticipated pain.
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Possible causes:
- Past sexual trauma or assault.
- Negative sexual conditioning (fear-based beliefs about sex).
- Underlying pelvic floor dysfunction.
Penile Pain (Less Common but Possible in Men)
- Primary indicators:
- Painful erections or ejaculation.
- Post-coital discomfort or burning sensations.
- Pain related to Peyronie’s disease (penile curvature due to scar tissue).
Psychological and Behavioral Indicators
Sexual dysfunction often includes emotional and behavioral signs that affect relationships and self-esteem.
- Emotional distress (frustration, guilt, embarrassment, anxiety).
- Avoidance of intimacy due to fear of failure or discomfort.
- Relationship conflicts stemming from sexual dissatisfaction.
- Reduced self-confidence related to sexual performance.
- Depression or anxiety contributing to decreased libido.
- Negative body image leading to self-consciousness during intimacy.
Key Takeaways
- Sexual dysfunction affects different stages of sexual response: desire, arousal, orgasm, and pain.
- It can be caused by medical conditions, psychological issues, medications, or lifestyle factors.
- Symptoms often result in distress, avoidance of intimacy, or relationship difficulties.
- Treatment options vary based on the cause and may include therapy, medical interventions, lifestyle changes, or medication adjustments.
On the Exam
There's lots of info that might show up in an exam question. Here's one to try out your knowledge on:
A 40-year-old female client seeks therapy due to distress over her inability to reach orgasm. She describes a supportive partner but admits feeling anxious during intimacy. She also reports a history of childhood trauma. What is the MOST appropriate intervention?
A. Educate the client about different techniques to increase sexual stimulation
B. Refer the client to a medical provider for hormonal assessment
C. Explore the client’s past trauma and its impact on sexual functioning
D. Encourage the client to engage in mindfulness exercises before sex
Have your answer?
The client’s history of childhood trauma suggests that unresolved psychological factors may be affecting her sexual response, making trauma-informed therapy the most appropriate approach. Sexual education (A) and mindfulness (D) can be helpful later, but first, the root cause (psychological trauma) should be addressed.
Medical causes (B) can sometimes contribute, but the primary concern here appears to be trauma-related anxiety.
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