1. Sexual difficulties

2. Sexual problems are common Causes? Organic Cultural Individual Relationship

3. Most commonly reported sexual problems By men? Erectile dysfunction By women? Inability to climax Lack of sexual desire

4. What medications and produce sexual problems? High blood pressure medications Depression & antipsychotics Barbiturates and narcotics

5. Emotional difficulties producing negative affects on sexuality Depression Extreme work stress Fear of intimacy

6. Types of sexual disorders (summary) Desire Phase Excitement phase Orgasm phase

7. Desire phase Hypoactive sexual desire Related to: Lack of trust Lack of power and control Imbalance in independence and dependence Never fantasizes, rarely masturbates, never initiates sex Sexual aversion disorder (SAD) Physiological symptoms Nausea Sweating Diarrhea Irrationally fearful Feel disgusted or repulsed by sexual activity

8. Excitement phase Erectile dysfunction Most likely to be physiologically based (have an organic component) Viagra http://www.goaskalice.columbia.edu/1445.html Primary Secondary Situational

9. Erectile dysfunction (ED) cont. As many as 25% of cases are related to medication side effects Tobacco appears to be one causative factor Age - A man is 50’s = twice as likely to experience ED as a man in his 20’s

10. Performance anxiety Can turn a transitory problem into a serious one

11. Sexual self confidence Women who are least self-conscious about their bodies as compared to similarly shaped women were more assertive with their partners

12. Orgasm phase - Men Men Premature ejaculation Squeeze technique Ejaculatory inhibition Merc manual http://www.merck.co m/pubs/mmanual/se ction17/chapter220/ 220a.htm http://www.merck.co m/pubs/mmanual/se ction17/chapter220/ 220a.htm

13. Orgasm phase - Women Orgasmic disorder (preorgasmic) Primary Secondary Situational E.g. Orgasm with masturbation, but not with oral sex Orgasmic with manual stimulation, but not with intercourse is typical, not a sexual dysfunction

14. Dyspareunia (For women) Painful intercourse Vaginismus Hegar dilators Merc Manual http://www.merck.com/pubs/mmanual/section18/chapt er243/243e.htm http://www.merck.com/pubs/mmanual/section18/chapt er243/243e.htm Smegma Smegma collecting under the clitoral hood may cause discomfort when hood is moved during sexual stimulation

15. Dyspareunia (For men) Phimosis - tight foreskin Infected or irritated foreskin Peyronie’s disease - Fibroses in penis Pelvic or genital infections E.g. STD’s

16. Deep pelvic pain in women during intercourse Caused by Jarring of ovaries Stretching of uterine ligaments Endometrioses STD’s

17. Average duration of intercourse for American couples Five to ten minutes