International Handbook of Clinical Hypnosis - E-Lib FK UWKS

TREATMENT OF SEXUAL DYSFUNCTIONS 243
sexual arousal; increased absorption and ampli®cation of initially small sexual
responses; metaphors of arousal and lubrication such as an analogy with sweating
and a healthy journey of discovery through the sexual organs and ®nding the sites
of sexual pleasure; these may all be used in heightening arousal.
TREATMENT OF DISORDERS OF SEXUAL PENETRATION
DYSPAREUNIA IN THE MALE PATIENT
Male dyspareunia most often has an organic cause. This aetiology ought to be
treated medically where possible, but if dyspareunia continues it may be managed
as with other pain states. Such approaches as hypno-analgesia and glove anaesthesia
being transferred to the erect penis may be successful. It is also necessary to
consider when male dyspareunia may represent a conversion symptom requiring
hypno-exploration rather than symptom management.
DYSPAREUNIA IN THE FEMALE PATIENT
DyspareuniaÐpain during or after sexual intercourseÐis a commonly presenting
clinical problem requiring a careful medical history, physical examination and a
detailed psycho-sexual evaluation. Dyspareunia is diagnosed only if the pain syndrome
is not the result of inadequate arousal and lubrication, or vaginismus. The
treatment of female arousal disorders has already been detailed. A true dyspareunia
due to causes other than arousal dif®culties most often has an organic cause
that requires medical intervention. If the resulting state is a residual dyspareunia
that is not amenable to medical treatment, it may be appropriately treated as a pain
disorder and the hypnotic techniques applicable to pain may be used. Such
approaches as hypno-analgesia and glove anaesthesia being transferred to the
genital area may be used successfully. As with male dyspareunia, it is necessary to
consider when female dyspareunia may represent a conversion symptom requiring
hypno-exploration rather than symptom management.
VAGINISMUS
Vaginismus, involving a recurrent or persistent involuntary contraction of the
perineal muscles surrounding the outer third of the vagina when vaginal penetration
with penis, ®nger, tampon or speculum is attempted, most commonly is of psychological
aetiology, although it may also arise as a disorder secondary to dyspareunia.
Hammond 1990) provides ideas about the appropriate suggestions to use to
enhance sexual arousal and encourage vaginal lubrication. Metaphorical treatment
approaches may also be successful as indicated in the example given earlier in this