Sexualtherapie pp 169-208 | Cite as

Störungen des sexuellen Interesses und der sexuellen Erregung bei der Frau

Chapter

Zusammenfassung

Eine verminderte oder fehlende sexuelle Appetenz ist das mit Abstand häufigste sexuelle Problem bei der Frau und gleichzeitig auch der häufigste Anlass für Frauen, professionelle Hilfe zu suchen. Die Luststörungen, wie sie – auch von den Patientinnen – meist genannt werden, genießen einen eher „schlechten Ruf“ und gelten als kompliziert und schwierig zu behandeln. Tatsächlich reichen die Probleme, denen sich der Therapeut bei dem Beschwerdebild des verminderten sexuellen Verlangens gegenüber sieht, von der Frage, was unter welchen Bedingungen eigentlich als „normal“ gelten kann (oder: Wie wenig Sex ist zu wenig Sex?), über Unklarheiten der Begrifflichkeit und Klassifikation bis hin zu den als limitiert geltenden therapeutischen Möglichkeiten. Die vielen Unsicherheiten erzeugen in der Praxis oft ein Gefühl der Hilflosigkeit oder Ohnmacht bei gleichzeitig hohem Problemlösedruck, was typischerweise entweder zu einem eher resignativen und abwehrenden Verhalten gegenüber diesem Problembereich führt oder aber zu einer erhöhten therapeutischen Betriebsamkeit, die auch in zwar gutgemeinten, aber meist eher untauglichen „guten Ratschlägen“ (Entspannen, Sexpause, Wellnesswochenende, Gläschen Sekt vorher u. ä.) oder in immer neuen Vorschlägen für Erfahrungsübungen ihren Ausdruck finden kann. Auch erfahrene Sexualtherapeuten erleben es meist als leichter, eine sexuelle Dysfunktion, wie eine Erektionsstörung oder eine Schmerzstörung, zu „beseitigen“ bzw. zu reduzieren als etwas bei einer Patientin aufzubauen, wieder zu beleben oder „reinzubringen“, was nicht vorhanden ist und oft auch gar nicht vermisst wird, weil die Patientin auf Drängen ihres unzufriedenen Partners kommt und berichtet, für sich selbst gut auf Sexualität verzichten zu können. Der Therapeut steht so häufig in einem komplexen Auftragsgeflecht und fühlt sich mitunter als eine Art „Erfüllungsgehilfe“ des Partners, für den er die Patientin wieder „reparieren“ soll. In der Paartherapie sind Allianzaufbau und Zieldefinition daher oft eine große Herausforderung, zumal diese sexuelle Problematik in einer besonders engen Wechselbeziehung zu partnerschaftlichen Kränkungen, Verletzungen und Enttäuschungen steht und maladaptive Emotionen und fest eingefahrene destruktive Interaktionszyklen jede konstruktive Veränderung anfänglich fast unmöglich erscheinen lassen. Gerade bei diesen komplexen Problemen kann unser neuer Sexualtherapieansatz aber seine Stärken ausspielen und wirkungsvolle Veränderungen erzielen.

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Authors and Affiliations

  1. 1.Leiter des Arbeitsbereichs Klinische Psychologie und SexualmedizinMedizinische Hochschule HannoverHannoverDeutschland

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