Case Study

Rob and Melissa (not their real names), both 23 years old and university students, were referred because intercourse had not yet occurred in their 3-month-old marriage. With relish, they regularly engaged in other sexual activities. History from both, plus her pelvic exam, revealed a diagnosis of vaginismus uncomplicated by vaginal pathology. Conventional treatment of vaginismus was successful in a technical sense (intercourse took place), but Melissa was chagrined to find that it was not as pleasurable as she anticipated (12). From the time of Rob's initial attempt to insert even part of his penis, he was concerned over her report of intercourse-related pain, and found that his sexual desire had diminished considerably when compared with the pre-treatment level. He found that in general, he was thinking much less about sexual matters, and when he and Melissa were sexual together, his erections were less than full and he was unable to ejaculate in her vagina. Moreover, he reported that his desire to masturbate had plummeted. His sexual desire slowly returned (but not to the pre-treatment level) as he accepted her reassurance that her intercourse pain was progressively diminishing. Her continuing lack of physical pleasure in intercourse (she looked forward to the closeness) seemed to impede the recovery of his own desire.

Child Sexual Abuse (CSA)

The results of investigations on the sex-related impact of CSA on adult men are unclear. One study indicated that did not predict sexual dysfunction in a clinical sample of adult men asking for treatment of this disorder (37). However, in a different study that reviewed the sexual consequences of CSA on adolescents and adults, the authors described a wide variety of effects on adult men (although HSDD was not reported) (38).

Paraphilias (PAs) and Paraphilia-Related Disorders (PRDs)

PAs and their cousins, PRDs, usually manifest with a high level of sexual desire (39). However, from the perspective of a partner, the opposite is usually the case.

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