Andrea Grauvogl Andrea Grauvogl Sacha Ruland

I’m sexually dysfunctional, you’re sexually dysfunctional

In Society
Written by  Femke Kools Wednesday, 12 February 2014 10:44

‘Sexual dysfunction? If I don’t accidentally get pregnant and don’t have an STD, everything’s just fine’, many young people seem to think. Women not reaching orgasm, men ejaculating prematurely – either young people do not see these as problems, or the threshold for seeking help is too high. Yet, 27% of male and 43% of female 15- to 24-year-olds suffer from at least one sexual dysfunction. PhD candidate Andrea Grauvogl studied the extent of young people’s knowledge of these issues and developed a brief, anonymous counselling course. She also examined the relationship between sexual functioning and disgust. Here she discusses her dissertation, ‘Let’s talk about sex!’

The most common sexual dysfunction in young women is not being able to reach orgasm, followed by pain during or after intercourse, vaginismus (not being able to have sex at all) and lack of libido (or a mismatch with the partner’s libido). The most common problem among young men is premature ejaculation, followed by erection problems and the same libido problems as those experienced by women. Grauvogl conducted qualitative interviews with 22 young people about their sex lives. “None of them could identify any sexual dysfunctions and they reported having no sexual problems whatsoever. The same thing can be seen in the literature: many young people with sexual dysfunctions don’t see them as problems or think they’re normal. Pain during sex, premature ejaculation; they don’t realise it doesn’t have to be that way. And if they do realise, they’re wary of psychologists. They’re afraid that their whole lives will be picked over, or that their parents will find out through the insurance company.”


Young people’s ideas about sex are often shaped by what they pick up at home and by sex education in schools. “Sex education mainly focuses on using contraception and preventing STDs. Very little attention is paid to the pleasurable aspects of sex, and what you can do to make it as enjoyable as possible. Nowadays 93% of young people use contraception on first sexual contact, so the message has got through. Now it’s time to take the next step: talking about what makes sex pleasurable and what can go wrong.”

The latter is rarely up for discussion, neither by young people nor among older target groups. “It’s thought that our culture deals with sexuality openly, but this is mainly restricted to topics such as contraception and STDs. Everything else is supposed to stay in the bedroom. When young people talk about their sexual experiences, it’s only about the ‘successes’, not about bad experiences.” The first step in treatment, therefore, is to normalise the problem; to let the person know they’re not alone. “Young people then say it would have helped to be able to talk about the issue with their friends.”

Sex counselling

Specialist care often presents too high a threshold for young people. Together with the Regional Public Health Service (GGD) for Rotterdam–Rijnmond, Grauvogl therefore developed a brief sex counselling course that allows young people to remain anonymous. As the costs were covered through the Exceptional Medical Expenses Act (AWBZ) and the city council, their insurance details were not needed. In three 45-minute sessions spread over three months, participants first underwent psycho-education, receiving information about sexual dysfunctions and their own specific problem. They were then given homework assignments with the aim of finding out what they felt comfortable with sexually. How does my body work, what do I enjoy? “This reminds you to associate sexuality with something pleasurable”, explains Grauvogl. Finally, they received a mild form of cognitive therapy to aid in altering unhelpful thought patterns.


Grauvogl had difficulty finding willing participants for her study. “Maybe people were hesitant because there was a chance they’d be put in the control group and so receive no treatment for six months. Others dropped out because apparently they weren’t too motivated to work on their problems.” Ultimately, she managed to divide 71 participants over three groups: brief sex counselling, waiting list and regular (intensive) therapy. “Because these groups were small, we found no significant effect of either treatment.” For women, however, doing something appeared to be better than doing nothing. “Purely on the basis of costs, which are lower for the brief sex counselling than for the traditional therapy, the short version is more effective.”

Nice or nasty

Finally, Grauvogl conducted a study on the relationship between sexual dysfunctions and disgust. “Various factors are involved in sexual dysfunction, including fear of pain. But research has shown that fear does not play a role in some sexual dysfunctions, such as sexual aversion and vaginismus. Instead, disgust may be a factor here. If you find sex dirty instead of nice, that will hamper your sexual functioning.” Participants performed computer tasks to measure their subconscious associations with sex (nice or nasty?), then watched erotic, explicit films while their level of genital arousal was measured using a sensor. “We hypothesised that if you have a stronger and faster disgust reaction, also outside a sexual context, this will influence your sexual functioning. For women, this indeed appeared to be the case; these women were less sexually aroused by the films. The result for men was surprising: men with a faster disgust reaction were in fact more sexually aroused. We know that negative emotions in men without sexual problems lead to stronger erections, so that may be the mechanism at work here. But that’s a matter of speculation.” It is hoped the study will be repeated at the University of Groningen, which has a large research group in this field, to consolidate these results.

Andrea Grauvogl will defend her PhD dissertation Let’s talk about sex! Sexual health and sexual dysfunction among adolescents’ at 10.00 on Friday 14 February 2014 at Maastricht University. She conducted her research at the Faculty of Psychology and Neuroscience under the supervision of Jacques van Lankveld, professor of Clinical Psychology at the Open University.

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