Assignment Task: Orgasmic Disorder
Since this week's chapters were largely focused on men's major sexual disorders, I'll focus on orgasmic disorders, specifically premature ejaculation and delayed ejaculation. I learned that these issues are not necessarily considered erectile dysfunction, because neither issue has this problem: acquiring an erection is not a problem, but reaching orgasm too soon, or not at all are the issues here. Over many decades of research, clinicians came to correlate both premature ejaculation and delayed ejaculation to be on somewhat of a spectrum. Curiously, research has found a higher prevalence of premature than delayed. Either way, men with these issues are erroneously diagnosed with erectile dysfunction, then prescribed medicine with little to no results in sexual function.
Behavioral patterns of premature ejaculation, according to the DSM include a widely agreed upon definition that it is, "the persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it" (Levine et. al., 2016, p. 137). Behavioral patterns of delayed ejaculation do not have clear definitions due to less research but behaviors/symptoms, which can be found in the DSM in order to diagnose delayed ejaculation include; marked delay in ejaculation, marked infrequency or absence of ejaculation persisting for a minimum of approximately six months, and the symptoms cause clinically significant distress in the individual. Lastly, the sexual dysfunction is not better explained by a nonsexual mental health disorder or severe relationship distress or medical condition.
The psychological issues found to be associated with premature ejaculation are two-fold, and are the top two most researched theory's, although there are myriad other psychological issues which may precede the dysfunction. But the two discussed in the text were: Premature-like Ejaculation Dysfunction (or subjective premature ejaculation) and Natural Premature Ejaculation Dysfunction (variable premature ejaculation). Subjective PE is more related to psychological and cultural factors. Men with variable PE only occasionally experience early ejaculation. There may be medical/neurological etiologies to these dysfunctions, but as for psychological, these issues are usually related to premature sex in early adolescence, to self-esteem, and relationship issues or unconscious fears and performance anxieties.
Therapist response based on gender of client is not statistically relevant here, due to these particular orgasmic disorders automatically being a male issue. But a therapist may come across more rare instances of these issues from the more complex aspects of transgender person's coping with sexual satisfaction during transition. I'm now curious as to the research on this.
Yes, if there were a partner to the client, I would ask the client how they felt about including their partner in therapy. I would emphasize the importance of supporting one another both physically and emotionally because the treatments are far and wide, and there are both physical and psychological therapies showing good promise and have been shown to help many couples.
Levine, S.B., Risen, C.B., Althof, S.E., (2016). Handbook of Clinical Sexuality for Mental Health Professionals. 3rd. Ed. Routledg