Name: Sarah Age: 31 Sex: Female Family: Married, 3 years Occupation: Assistant retail manager Presenting Problem: Mild d

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Name: Sarah Age: 31 Sex: Female Family: Married, 3 yearsOccupation: Assistant retail manager Presenting Problem: Milddepressed mood Case Summary: Sarah has come to a therapist’s officewith a generalized complaint of mild depressed mood associated withdistress in her marriage. About a year ago, she was feeling tiredand wasn’t particularly in the mood for sex. When her husband,Duane, persisted, she relented, and the began intercourse despiteher lack of arousal. Midway through their session, they beganarguing. At some point after stopping, Sarah angrily admitted thatshe had never had an orgasm during sex. She also mentioned that shewasn’t sure if she’d ever had one. In the 2 months that followed,she and Duane tried a variety of techniques to make the experiencemore pleasant. She reports that he was very attentive to her needsand feelings, both physically and emotionally. Although Sarahappreciated this, it didn’t bring her closer to orgasm. She triedto fake it a couple of times, but Duane was able to tell, and moreoften than not, this put a halt to their intercourse. As time wenton, Duane seemed to focus solely on Susan, to the point ofneglecting his own enjoyment. Often, there was mutual feelingafterward that the sex “wasn’t worth it” because Sarah failed toorgasm. She says that they haven’t been fighting about it but justkind of drifting apart, both emotionally and sexually. Lately,they’ve been having sex less and less frequently. On the surface,Sarah and Duane seem to have a decent marriage, but this isdefinitely a continuing source of stress. They spend time togetherand are generally pleasant, but Sarah admits that some troublingthings are occurring. She knows that Duane frequently viewspornography late at night in their spare bedroom, though she hasn’tconfronted him about this. In fact, she says, “I don’t blame him.There’s no way that I can compete with these women.” This knowledgeseems to be further disrupting her ability to enjoy sex, however.She states that the last couple of times they had sex, she wasanxious about trying to live up to what Duane was watching. Shesays that she just wants their sex life to go back to the way itused to be. When asked about her sexual history, Sarah states thatit has been largely unsatisfying. She lost her virginity to herboyfriend in high school. About the incident, she says, “He waspressuring me, and I probably wasn’t totally read for it.” Shereports that he was very rough and that she never enjoyed it.Sarah’s next boyfriend was similar, and she lost interest in sexuntil meeting Duane. She says, “With Duane, I wanted to have sexagain, and it was nice. It was enjoyable, and we did it regularly,at leats until recently.” Sarah attempted to masturbate once butfelt very uncomfortable about it. She says that the genital areajust seems dirty and gross. Growing up, her family rarely discussedsex. When they did, it was usually in a disapproving tone. Oftenher mother referred to it as “that disgusting act.” To this day,they have no knowledge of Sarah’s sexual history.
1.
When Sarah first told Duane about her inability toorgasm, he was highly supportive. Lately though, he changed. Howmight this change have made Sarah’s condition worse?
His refusal to have sex makes Sarah feel bad
Duane is having difficulty maintaining an erection
When he gets angry, Duane doesn’t feel any desire to havesex
They both feel much more pressure to perform during sex
2.
How might the attitude of Susan’s parents toward sex haveinfluenced the development of her condition?
Sarah’s negative experiences with sex stemmed from an effort toget back at her parents
Sarah probably has some long-standing negative associations withsex
It probably didn't impact it at all.
Sarah thinks that sex is only for procreation and doesn’t viewit as pleasurable
3.
Some of the symptoms associated with various sexual dysfunctionsare listed below. Check those that are clearly present in Sarah’scase. Check all that apply
Sexual fantasies are interfering with ability to have sexualintercourse
The disturbance has been present since the individual becamesexually active
Mild symptoms of depression are the cause of disruption innormal sexual relations
Marked fear or anxiety about vaginal or pelvic pain occurs inanticipation of sexual interest
Sexual dysfunction produces distress and interpersonalstress
Based on the full diagnostic criterial listed by the DSM-5 forsexual dysfunctions and not just those listed in the previousquestion, Sarah appears to meet the criteria for a diagnosis of______________
lifelong female orgasmic disorder
lifelong female sexual interest/arousal disorder
genito-pelvic pain/penetration disorder
acquired female sexual interest/arousal disorder
acquired female orgasmic disorder