Sexual disorders

If you are experiencing sexual complaints and wish to seek treatment, it is recommended that you approach a sexologist who is registered with the Netherlands Scientific Association for Sexology [Nederlandse Wetenschappelijke Vereniging voor Seksuologie, or NVVS]. The NVVS website provides information about sex therapy and registered sexologists in your area. Your Move for Motion therapist is a registered NVVS sexologist. A description of a number of sexual disorders that can be treated at Move for Motion is provided below. If you do not see your particular complaint below, feel free to contact Move for Motion to find out if the practice can offer you treatment.

In cases where sexual dysfunction is affecting a relationship, your therapist will almost always request that your partner becomes involved in the therapy. This often entails evaluating your relationship and the dynamic between you and your partner. Involving your partner in treatment is not mandatory, but is often advisable as it can facilitate the therapeutic process. If your therapist believes it is important for your partner to attend therapy sessions, it will always be discussed with you first.

Sexual dysfunction

A variety of complaints are categorised as ‘sexual dysfunction’. A few examples are discussed briefly below.

  • Dyspareunia

The term used to describe painful intercourse is dyspareunia. Dyspareunia is more common among women, but men can also experience pain during sex. Such complaints often arise when a person has difficulty relaxing and/or becoming sufficiently aroused. Sometimes the pain can have a physical cause, such as inflammation or infection, an STD, Lichen sclerosis, scar tissue after childbirth, uterine prolapse, etc. A frequent physical cause of dyspareunia is vulvar vestibulitis syndrome (VVS). VVS is associated with a burning or stinging sensation around the vaginal opening, and frequently accompanied by visible red or raw patches.

It is important to rule out a physical cause of the pain before beginning sex therapy. Your therapist may recommend that you first see your GP or direct you to a gynaecologist or urologist.

  • Vaginismus

Vaginismus is a condition which makes it difficult or impossible to insert a penis, finger or tampon into the vagina. This is due to excessive tension in the pelvic floor muscles, which causes the vagina to close up, as it were. The pelvic floor muscles can spasm in this way if a person is generally very tense, has negative thoughts about sex (e.g., ‘sex is dirty’, ‘sex is forbidden’) or has had a traumatic sexual experience. Dyspareunia can also be a cause of vaginismus. If you repeatedly experience pain during intercourse, it is likely that in time, you will begin to fear sex. The resulting anxiety can cause the pelvic floor muscles to spasm and lead to vaginismus.

It is important to rule out a physical cause before beginning sex therapy. Sex therapists often work with a so-called pelvic floor physical therapist, a PT who specialises in the pelvic floor muscles and can teach you to relax them.

  • Erectile dysfunction

Erectile dysfunction is the medical term for when a man has difficulty achieving or maintaining an erection during sexual activity. Approximately 15% of all men over the age of 18 will experience erectile problems. The chance of developing erectile dysfunction increases with age. Impotence can result from physical conditions or illness, for example, nerve damage consequent to surgery for the back, abdomen or prostate; neurological illnesses or brain damage; diabetes; cardiovascular disease; high blood pressure and so on. Certain medicines, including anti-depressants or alcohol and drugs, can also cause erectile dysfunction.

Other key causes of erectile dysfunction are psychological and relationship problems. When men are under considerable stress and their minds are somewhere else, it can sometimes be difficult to get or keep an erection. It is often true that men become insecure after an experience of failing to achieve or maintain an erection. During the next sexual encounter, they begin to think negative thoughts, like ‘what will my partner think if I can’t get it up again?’ or ‘please don’t let it happen again!’. Because such thoughts are not in the least erotic, they make it harder to achieve an erection or cause the erection to diminish.

Medication such as Viagra or Cialis can help sometimes. Always consult your physician for advice before using medication.

  • Premature ejaculation and orgasmic dysfunction

If a man ejaculates earlier than he wants to and experiences this as a problem, it is called premature ejaculation, or ‘ejaculatio praecox’. Many men who suffer from premature ejaculation often climax upon or shortly after penetration. In such cases penetration persists for no more than one or two minutes, and the man has little to no control over his orgasm. In some cases, a mild anaesthetic cream or medication can help. Your GP or urologist can advise you about such options.

Orgasmic dysfunction is defined as not being able to achieve orgasm at all or only with severe difficulty, despite adequate stimulation and sufficient sexual arousal. In contrast to the diagnosis of ‘premature ejaculation’, which only presents in men, ‘orgasmic dysfunction’ can affect both men and women. Most women cannot or only rarely achieve orgasm through penetration. They require clitoral stimulation in order to orgasm. If a woman is unable to reach orgasm through penetration alone, but can climax under other conditions of sexual stimulation, a diagnosis of orgasmic dysfunction does not apply.

  • Diminished libido and sex addiction

‘A lot’ and ‘a little’ are relative concepts that mean different things to different people. If you want sex once a week and your partner desires sex once a month, then your partner would say you have a big sexual appetite. A different partner, who wants sex four times a week, would describe you as having little interest in sex. Your therapist will not generally make any statements about what constitutes a normal sex drive. What counts is, if both you and your partner are satisfied.

With a diminished libido, people experience problems from a declining interest in sex or the fact that their sex drive has decreased over time. Some people lose all interest in sex. This can lead to relationship problems, but relationship problems can also be responsible for the diminished libido. Being focused on other things (children, a new job, the illness of a family member, etc.), not finding your sex life exciting enough, medication or physical illness can also lead to loss of libido.

On the other hand, if sexual desire increases and you feel you’ve lost control over it, you could be suffering from sex addiction. This is also called ‘hypersexuality’. While the term sex addiction is frequently used, it is not an official diagnosis. When psychologists need to provide a name for the diagnosis, they use ‘sexual dysfunction NOS (not otherwise specified)’.

In sex addiction, sexual activity in the short term is often experienced as satisfying, but in the long term it frequently has more negative consequences. For example, relationship problems, difficulties at work, and health or legal risks. Self-esteem and self-confidence also tend to decline drastically over time. The most common treatment for sex addiction in the Netherlands is based on the work of G.J. van Zessen and focuses on improving an individual’s self-esteem in order to tackle the addiction.

Sexual orientation problems

Sexual orientation refers to a person’s sexual preference. Commonly, a distinction is made between heterosexuality, homosexuality and bisexuality. We do not see these as dysfunctional sexualities, but people may still struggle with their orientation. Sometimes it can be difficult for a person to accept their sexual orientation, or their friends and family might find it hard. Treatment at Move for Motion can help you to develop a better understanding of your sexual orientation and how you want to lead your (sex) life. Treatment can also help you accept your feelings or learn to deal with lack of acceptance from your friends, family or work environment.

Asexuality entails an absence of sexual orientation, so there is no sexual attraction or desire for others. Asexuality can bring problems with acceptance too. Many people who identify as asexual often still want to have relationships with other people, but are not interested in having sex with them, which can lead to problems in the relationship.

More information about asexuality is available from the Asexual Visibility and Education Network, AVEN.

Gender Dysphoria

Gender dysphoria, previously known as gender identity disorder or GID, is characterised by a sense of discontent regarding your biological sex. This distress can occasionally be strong enough to cause a person to wish to modify the body to match the psychological gender identity, in which case the term transsexuality applies. Modifying the physical body to match the target identity can be achieved through hormone treatments and/or a sex-change operation. In the Netherlands, there are two places that offer such treatments, Kennis en Zorgcentrum voor genderdysforie at VU University Medical Center in Amsterdam and the Groninger Genderteam UMCG. Before proceeding you must undergo extensive diagnostic research.

More information on gender dysphoria and treatment options (hormonal or sex-change) can be found on the Kennis en Zorgcentrum voor Genderdysforie website [in Dutch]. For more information in English, see The Transgender Zone.

Many people affected by gender dysphoria are confused about whether they wish to act on their feelings of discontent, or about how they could go about that in the first place. People with gender dysphoria often struggle to accept their feelings. Friends and family or the work environment may also struggle with your gender dysphoria. These are good reasons to consult a therapist. A treatment at Move for Motion can help focus your thinking and provide insight into what you actually feel and want. Your therapist can help you how to accept your feelings or how to deal with lack of acceptance from the people around you.

The Dutch patient organisation Transvisie can help you get in touch with other people with gender dysphoria. Transvisie Zorg offers guidance to people with gender dysphoria and their children. Both the Transvisie website and the Transvisie Zorg website provide further information and downloadable literature.

Sexual dysfunction with a physical cause

As mentioned a few times above, some sexual problems are caused by physical conditions. Physical complaints or diseases can frequently be treated, diminishing or stopping the sexual problems. If this is the case, it is recommended to first treat the physical cause or disease. However, if a physical cause is difficult to treat or cannot be treated, sex therapy may be able to help you cope or to reshape your sex life despite your physical limitations.

Some examples of physical complaints or diseases that can cause problems with sex include:
STDs, skin diseases like Lichen Sclerosus, Peyronie’s disease (extreme curvature of the penis), incontinence issues, uterine protrusion, physical complaints following pregnancy or childbirth, intestinal complaints due to Crohn’s disease, diabetes, cardiovascular diseases, rheumatic diseases and arthritis, back problems, nerve damage, neurological diseases or brain damage, muscular diseases, chromosomal disorders such as Turner’s syndrome or Klinefelter’s syndrome, etc.