Factors that Complicate Treating Sexual Disorders

Introduction

In sex therapy practice, couples may request treatment for a specific problem or condition. Often, the problem is stated in the initial contact or during the first session. Once the therapist begins to address the presenting problem, however, other factors can arise that obscure assessment and treatment. Factors that complicate treatment often involve faulty communication or misinformation, thereby intensifying the presenting problem. In this chapter, we review some of the common issues that can interfere with treatment, including sexual ignorance, faulty cognitions, sexual guilt and shame, and underlying problems in intimacy.

Sexual Ignorance

Sexual ignorance is a major contributor to many sexual disorders. Masters and Johnson (1970) were the earliest sexuality researchers to note the striking connection between the lack of sexual information and consequential sexual problems. Zilbergeld (1999) also identified the destructive effects of sexual ignorance and misinformation on sexual enjoyment and functioning. He proposed that a performance-based, goal-oriented model of normalcy is particularly damaging to sexual intimacy. By focusing on performance and the solitary goal of orgasm, men and women subscribe to a myth that fails to recognize the sensual and intimate nature of physical touch, non-demand stimulation, and overall intimacy.

Sexual Mythology

The greatest source of sexual misinformation and ignorance is the mythology associated with sex. Sexual myths are misguided beliefs, misconceptions, and distortions that promote unrealistic standards and rigid expectations about sex. These beliefs originate within culture,

religion, the family-of-origin, and other contextual sources and become woven into the fabric of the individual’s sexual script. In practice, we have noted that mythological beliefs can perpetuate sexual fear, shame, embarrassment, and unrealistic expectations regarding sexual intimacy and can contribute to sexual dysfunction.

Common sexual myths target penis size, erectile capacity, the idea of simultaneous orgasm, and the decline in sexual enjoyment and/or activity with aging. Other sexual myths focus on sexual and gender orientation and other consensual behaviors, such as kink and consensual non-monogamy. Unfortunately, sexual myths form the basis of many prejudices. The list of sexual misinformation is extensive and based on years of hearing clients express many erroneous ideas. An Internet search reveals numerous sites that offer help to individuals troubled by sexual concerns that are maintained by mythological beliefs, misinformation, or simply a lack of factual information. These sites can be both humorous and informative:

• • https://www.guide2getting.com
• • http://afterhours.lifehacker.com/10-stubborn-sex-myths-that-just-wontdie-debunked-by-1522576378
• • http://abcnews.go.com/Health/Wellness/14-sex-myths-busted/story? id=24520345
• • https://www.medicalnewstoday.com/articles/320885.php
• • https://www.plannedparenthood.org/files/4614/0134/0619/Male_ Sexuality_Myths_and_Facts.pdf
• • https://www.splcenter.org/fighting-hate/intelligence-report/2011/10-anti-gay-myths-debunked
• • https://www.webmd.eom/men/features/sex-fact-fiction#l
• • https://www.apa.org/topics/lgbt/orientation.pdf
• • https://www.lelo.com/blog/six-myths-about-bdsm-debunked-by-science/

Faulty Cognitions

Acceptance of sexual mythology can interfere with the cognitive understanding of normal sexuality, sexual enjoyment, and prevention of sexually transmitted infections. It can also interfere with physical health and relationship satisfaction. Furthermore, sexual misinformation that is learned early in life becomes so engrained that it drives automatic cognitions during sexual activity. The activation of these negative cognitions may lead to guilt, anxiety, confusion, and unhealthy or unrewarding sexual behaviors.

Depending on the individual’s culture, religion, and psychological disposition, faulty cognitions can interfere with sexual fantasy and significantly contribute to sexual guilt and shame. Consequently, sexual desire is interrupted, and limitations are placed on a range of sexual behaviors, such as masturbation. Another source of misinformation involves the distortion about the prevalence of sexual dysfunction. For example, we have seen many women who learned as adolescents or young women that sex was intended for procreation, not recreation. Thus, the woman’s role would be to tolerate rather than enjoy sexual intimacy. These introjected beliefs become self-fulfilling prophecies that wreak havoc on sex later in life.

A young, extremely religious Christian couple presented for sex therapy. They never had coitus prior to marriage because it was against religious beliefs. In treatment, they demonstrated sexual ignorance, lack of communication about sex, pelvic pain in the woman, premature ejaculation in the man, and severe relationship discord. They believed that sex was predominantly for the man’s enjoyment. Further, he stated that they had little idea about “normal” sexuality and his wife agreed. One disturbing complaint was the fact that he had been forcing penetration on his wife while she was asleep without realizing why this behavior was causing pain and fear in her. She did not believe it was her right to refuse sex with her husband. It may be difficult to understand how they could be so uninformed in a social climate that opposes nonconsensual sex; yet, they agreed to a narrow, uninformed belief system that resulted from internalized and distorted interpretations of religious doctrine. Therapy is ongoing.