Sexual problems

Sexual problems range from common mild sexual dysfunctions to less common and more serious problematic sexual behaviours which cause significant distress to the person and/or other people.

Sexual problems may occur at all stages of life from adolescence to old age. Individuals often are reluctant to seek help due to embarrassment or shame, although effective treatment interventions are available.

Sexual dysfunctions include erectile dysfunction, premature ejaculation, pain on intercourse, and low or excessive sexual desire or drive. Although many people with sexual dysfunction may function very well in other aspects of their lives, sexual dysfunctions can result from both physical illness and psychiatric disorders, and also as a common, but poorly recognized, side effect of medication. Sexual dysfunctions may also cause mental disorders, particularly anxiety and depression.

More serious sexual problems include paraphilias and other sexual thought patterns and behaviours that may cause significant distress to the individual and/or other people. A paraphilia refers to a condition in which there are sexual interests that are more unusual. Some paraphilic behaviours such as fetishism or transvestism may be considered by many as part of the full range of normal human sexual behaviour if they occur between consensual adults. However, some paraphilias, such as voyeurism, exhibitionism and paedophilia are illegal as they cause hurt, distress, fear, or shame in others. 

Legal paraphilias may also become problematic if they cause the individual significant personal distress, for example if the behaviour becomes compulsive and dominates the person’s life. 

Other problematic sexual behaviors include addiction to pornography (legal or illegal), excessive sexual drive or masturbation, and illegal sexual aggressive behaviours such as rape. Both legal and illegal problematic paraphilias and sexual disorders may be associated with depression, shame and hopelessness.

How the Tavistock and Portman can help

The Trust does not offer psychological interventions specifically for the more common sexual dysfunctions, although these may be present as part of the overall presentation of the patient. However, the Portman Clinic offers specialised long-term psychoanalytic psychotherapeutic help to people who suffer from more disturbing and damaging sexual behaviours or experiences, including paraphilias and other sexual disorders. 

Following an in-depth assessment over several sessions, therapy may be offered, which is usually individual or in groups and may be long-term, requiring motivation from the patient to address their difficulties. 

As well as working with adults with the above issues, the Portman Clinic also works with children and adolescents who act out sexually in ways that are deemed inappropriate. 

They also work with the systems and networks around the child to offer assessment, consultation and support and to help other professionals ascertain how serious the worries are about a child’s behavior or proclivities.