Female Sexual Dysfunction - Case Example

The following case example illustrates the use of some of the treatment strategies discussed above. Techniques of therapy and treatment outcome for a woman with secondary orgasmic disorder are presented.

Presentation and Etiology

Mr. and Mrs. D, aged 51 and 48 years, respectively, were referred by a family planning agency. Mrs. D described difficulties in her sexual functioning that suggested secondary orgasmic dysfunction. The couple had been married for 25 years, having lived together for 12 months prior to marriage. Mr. and Mrs. D were tertiary-educated professional people who had met and become friends while working together. At that time, Mrs. D was just emerging from a broken first marriage and subsequent divorce. Although the sexual relationship in this first marriage had not been good, Mrs. D had had several affairs in which she had enjoyed sex, become sexually aroused, and experienced orgasm most times during intercourse. At the time the couple presented for treatment, it had been 2 years since Mrs. D had achieved orgasm during intercourse, and the frequency with which she experienced orgasm during other sexual activity had fallen to 25%. As a consequence, she claimed that she was beginning to lose interest in sex, and came to therapy looking for more enjoyment for herself. She reported her loss of interest in sex as beginning when the couple's second child left home, which meant that for the first time in 24 years they had no children living at home. Up until then, their sexual relationship had been satisfactory from both their points of view. She also reported no anxiety about sex and a rather neutral attitude toward it in the original family home, with no other repressive influences. There was no evidence that she was starting to experience physiological or psychological changes associated with menopause.

Summary of Treatment Program

The program used to treat Mrs. D focused on dealing with performance anxiety and enhancing communication between the partners. Sensate focus homework exercises, in conjunction with bans on intercourse and orgasm, were explained, with Mrs. D commencing to engage in general body pleasuring with her husband. Mrs. D was seen weekly by the therapist for 6 weeks, and Mr. D was also seen by the therapist on two occasions. To improve communication between the partners, communication homework exercises were developed to parallel the sensate focus assignments.

A major feature of the program also entailed the use of erotic fantasy within therapy sessions by the therapist, and at home by Mrs. D. She was encouraged to use fantasy, either self-generated or from other sources, during sexual interaction with her husband, incorporating whatever stimulation she was giving or receiving into her fantasy. She could share the fantasy with Mr. D or keep it to herself. She was also encouraged to use whatever themes that she might find sexually exciting and was reassured of the normative and nonpathological nature of such fantasizing. Fantasy was being used primarily to distract from performance concerns during sexual interaction and to enhance arousal. Imaginative involvement in the program's fantasies brought to the surface Mrs. D's ambivalence about her own sexuality and her anxiety about being perceived as a sexual person.