13. Psychological factors of sexual dysfunction and methods to provide psychological support to patients.

Psychological factors of sexual dysfunction

The causes of sexual dysfunction can be divided into psychological and physical aspects. Psychological factors generally only play a contributing role; a single factor may not necessarily cause sexual dysfunction, but the interaction of multiple factors can lead to sexual dysfunction. The psychological causes of sexual dysfunction are divided into: predisposing factors, precipitating factors, and maintaining factors. Predisposing factors refer to early life experiences that can make a person more susceptible to sexual dysfunction later in life; precipitating factors are events or experiences related to the initial occurrence of sexual dysfunction; maintaining factors explain why sexual dysfunction persists.

Predisposing factors

1. Parenting style

The accuracy, quantity, and openness (or covertness) of the sex education a person receives from childhood will profoundly influence their attitude towards sexuality later in life. In many Chinese families, sexual issues are never discussed, considered taboo. Some parents, however, openly express their negative attitudes towards sexuality.

2. Family discord

If parents have a disharmonious relationship and lack affection, especially physical affection, it can affect their children's sexual attitudes and relationships in adulthood.

3. Lack of sex education

Lack of sex knowledge is a contributing factor to sexual dysfunction. Sex education is insufficient or completely lacking for many people, especially middle-aged and elderly people. Many people's sex knowledge comes from hearsay or from unhealthy information obtained from conversations with other people who also lack sex knowledge.

4. Early traumatic life

According to reports, 23% of women who were sexually harassed by adults during childhood develop sexual dysfunction, compared to only 10% of boys who experienced the same sexual activity.

Triggering factors

1. Childbirth

Secondary sexual dysfunction in women often begins after childbirth, as fatigue, depression, and the care of an infant often prevent the recovery of libido. Additionally, pain from episiotomy scars or postpartum vaginal dryness can make intercourse uncomfortable, leading to avoidance or decreased libido.

2. Infidelity

Discovering infidelity in one spouse is a common trigger for sexual dysfunction, manifesting as loss of libido or erectile dysfunction.

3. Spouse's sexual dysfunction

Premature ejaculation can be triggered by the other person's sexual dysfunction, and the relationship between the two can influence each other. If a man's wife loses interest in sex, he may experience premature ejaculation; if a woman's husband has erectile dysfunction, she may also lose interest in sex.

4. Accidental failure

The psychological consequences of one or two isolated failures can lead to a vicious cycle of fear of failure, anxiety about performance, and actual failure, resulting in long-term erectile dysfunction.

5. Aging issues

Changes in age, physiological changes, and increased disease incidence can affect libido and sexual function.

6. Depression and anxiety

Depression and anxiety are very important contributing factors to decreased libido.

7. Traumatic sexual experiences

Seen in rape cases, because after a surprise attack, sexual intercourse rarely yields pleasure, and there is a possibility of dysfunction in libido, sexual arousal, and orgasm.

Maintenance factors

1. Sexual anxiety

This is the most common cause of persistent sexual dysfunction, seen in men with erectile dysfunction and premature ejaculation, and in women with orgasmic dysfunction. Sexual anxiety is often associated with neglecting one's own pleasure and satisfaction, and instead simply fulfilling or satisfying excessive sexual demands of one's partner.

2. A premonition of failure

Couples with sexual dysfunction often experience a strong sense of unease about the potential outcome of each sexual encounter, which is closely related to sexual anxiety. One failure after another creates a vicious cycle, leading to the persistence of sexual dysfunction.

3. Guilt

Women who lose their libido after childbirth may feel guilty for refusing their husbands' sexual satisfaction. Even if they do have intercourse, they may feel that it is merely an obligation without any pleasure, thus hindering the recovery of normal libido.

4. Loss of attraction between spouses

This is a common finding among people with sexual dysfunction. This change can occur spontaneously or due to social factors, age, or physiological changes.

5. Lack of sexual communication between spouses

Couples who cannot discuss sexual issues, lack tenderness and caresses before intercourse, experience a decrease in passion for sex.

6. Damage to self-image

Masculinity can gradually disappear due to erectile dysfunction, and a woman's dissatisfaction with her body shape or feelings of inadequacy in certain parts of her body can affect her sexual function.

Methods to provide psychological support to people with sexual dysfunction

Emotional communication

The doctor should first understand the couple's sexual problems based on the causes of male sexual dysfunction, and then have a heart-to-heart talk with him about his concerns. For example, the doctor could say, "I understand your distress. This problem undoubtedly causes great pain for you and your wife, and you must have mustered up the courage to seek help." This simple conversation and emotional connection can provide him with immense psychological comfort, making him more trusting of the doctor and more receptive to treatment.

Enthusiasm and care

The relationship between doctor and patient during treatment should not be distant or cold, but rather warm. The treating physician should not only offer opinions on sexual relationships but also show concern for all aspects of the couple's life with a friendly attitude. For example, asking about their children's exam preparation or other matters not directly related to treatment will make the couple feel close and cared for. Of course, lengthy conversations should be avoided. The doctor should also understand that the patient is concerned about their sexual problems, when they can expect progress and improvement, and when they might encounter difficulties during treatment. When the patient mentions even slight progress, the doctor should express sincere concern and hope with a positive attitude, emphasizing how to use their knowledge and experience to better understand the existing problems and how to overcome them.

trust

It is crucial for men undergoing treatment for sexual dysfunction to fully trust their treating physician, and the physician must also trust that what the man says is entirely confidential. From the beginning of treatment, it should be understood that some men may express concern about the physician keeping their treatment records, worrying about the potential consequences. Therefore, the physician needs to explain to them that these records are necessary to provide information about different stages of treatment, serving as a basis for the physician and couple to develop weekly home therapy plans, and for medical and legal purposes. At the same time, the physician can reassure the patient that these records will be kept absolutely secure. Only when patients completely trust their physician can they confide their sexual weaknesses, fears, and specific concerns.

respect

The treating physician should show respect to the patient, emphasizing that their sexual problems require specific treatment. They should treat the patient with empathy and compassion, demonstrating sound understanding and tailoring the treatment plan to the couple's sexual dynamics. Special care should be given to elderly patients and intellectuals during treatment planning, as some behavioral therapies may be difficult for them to accept.

Encouragement and support

In sex therapy, doctors can use many methods to express encouragement and support. For example, when they hear couples talk about their progress in therapy, they should express their happiness and give appropriate praise. When they talk about problems encountered in therapy, they should explain to them that these are expected and can be overcome with therapy.

Give hope

Through treatment, doctors should maintain an optimistic attitude towards the patient's ability to overcome difficulties, create a good atmosphere for providing treatment plans, and express confidence in the possible effects of treatment. However, this should only be appropriate; excessive expression may give the patient the wrong feeling, and if the final result is not ideal, the patient may lose confidence in future sexual treatment.