Question

Susan has come to a therapist's office with a generalized complaint of mild depressed mood associated with distress in her marriage. About a year ago, she was feeling tired and wasn't particularly in the mood for sex. When Duane persisted, she relented, and they began intercourse despite her lack of arousal. Midway through their session, they began arguing. At some point after stopping, Susan angrily admitted that she had never had an orgasm during sex. She also mentioned that she wasn't sure if she'd ever had one.

In the two months that followed, she and Duane tried a variety of techniques to make the experience more pleasant. She reports that he was very attentive to her needs and feelings, both physically and emotionally. Although Susan appreciated this, it didn't bring her any closer to orgasm. She tried to fake it a couple of times, but Duane was able to tell, and more often than not, this put a halt to their intercourse. As time went on, Duane seemed to focus solely on Susan, to the point of neglecting his own enjoyment. Often, there was a mutual feeling afterward that the sex "wasn't worth it" because Susan failed to orgasm. She says that they haven't been fighting about it but just kind of drifting apart, both emotionally and sexually. Lately, they've been having sex less and less frequently.

On the surface, Susan and Duane seem to have a decent marriage, but this is definitely a continuing source of stress. They spend time together and are generally pleasant, but Susan admits that some troubling things are occurring. She knows that Duane frequently views pornography late at night in their spare bedroom, though she hasn't confronted him about this. In fact, she says, "I don't blame him. There's no way that I can compete with those women." This knowledge seems to be further disrupting her ability to enjoy sex, however. She states that the last couple of times they had sex, she was anxious about trying to live up to what Duane was watching. She says that she just wants their sex life to go back to the way it used to be.

When asked about her sexual history, Susan states that it has been largely unsatisfying. She lost her virginity to her boyfriend in high school. About the incident, she says, "He was pressuring me, and I probably wasn't totally ready for it." She reports that he was very rough and that she never enjoyed it. Susan's next boyfriend was similar, and she lost interest in sex until meeting Duane. She says, "With Duane, I wanted to have sex again, and it was nice. It was enjoyable, and we did it regularly, at least until recently." Susan attempted to masturbate once but felt very uncomfortable about it. She says that the genital area just seems dirty and gross. Growing up, her family rarely discussed sex. When they did, it was usually in a disapproving tone. Often, her mother referred to it as "that disgusting act." To this day, they have no knowledge of Susan's sexual history.

A.) Often, a sexual dysfunction will have effects that go beyond the patient and impact his or her partner. What evidence suggests that Duane is beginning to form negative associations with sex?

He repeatedly makes comments about how disgusting sex is.

He openly refuses to have sex with Susan.

He doesn't want to have sex as much these days.

He chastises Susan for wanting to have an orgasm during sex.

B.) How might the attitude of Susan's parents toward sex have influenced the development of her condition?

Susan's negative experiences with sex stemmed from an effort to get back at her parents.

Susan thinks that sex is only for procreation and doesn't view it as pleasurable.

Susan probably has some long-standing negative associations with sex.

C.) Some of the symptoms associated with various sexual dysfunctions are listed in the following table. In the Present column, indicate which symptoms are clearly present in Susan's case. Check all that apply.

Sexual dysfunction is experienced on almost all or all (75%–100%) occasions of sexual activity. Symptoms of sexual dysfunction have persisted for at least six months. Sexual urges and desires produce impairment in social functioning. Sexual dysfunction is not better explained as a consequence of severe relationship distress. Ability to have sexual relations is impeded by lack of desire for sex. According to the full diagnostic criteria listed by the DSM-5 for sexual dysfunctions (not just the symptoms highlighted in the previous question), Susan appears to meet the criteria for a diagnosis of: lifelong female orgasmic disorder, acquired female orgasmic disorder, lifelong female sexual interest/arousal disorder, acquired female sexual interest/arousal disorder or genito-pelvic pain/penetration disorder

Answer 1

A. The evidence that suggests Duane is beginning to have negative associations with sex can be seen by - he doesn't want to have sex often these days.

B. Susan's parents attitude towards sex has influenced Susan's attitude as well as she has some long standing negative associations with sex.

C. All those that apply are as follows-

Sexual dysfunction is experienced on almost all or all (75%–100%) occasions of sexual activity.

Symptoms of sexual dysfunction have persisted for at least six months and Ability to have sexual relations is impeded by lack of desire for sex. According to the full diagnostic criteria listed by the DSM-5 for sexual dysfunctions (not just the symptoms highlighted in the previous question), Susan appears to meet the criteria for a diagnosis of: lifelong female orgasmic disorder, acquired female orgasmic disorder, lifelong female sexual interest/arousal disorder, acquired female sexual interest/arousal disorder or genito-pelvic pain/penetration disorder.