1. Chapter 14 Sexuality Difficulties and Solutions

2. Defining Sexual Difficulties
Sexual satisfaction is subjective
The way people are surveyed can skew results

3. How Physically Pleasurable is Your Relationship?
Caption: Men and women worldwide were asked “How physically pleasurable is your relationship?” The Pfizer Global Study of Sexual Attitudes and Behaviors, the first worldwide study of its kind, surveyed more than 26,000 men and women in 29 countries around the globe.

4. Prevalence of Sexual Problems By Selected Demographic Characteristics
Caption: Prevalence of sexual problems by selected demographic characteristics

5. Desire-Phase Difficulties
Hypoactive sexual desire disorder (HSDD)
Lack of interest in sexual activity
Usually temporary
Often due to relationship problems or internalized negative attitudes about sex
Very common
Desire Discrepancy
Sexual aversion disorder (SAD)
Extreme, irrational fear of sexual activity
Often due to sexual abuse or assault

6. Excitement-Phase Difficulties Women
Female genital sexual arousal disorder
Inhibited lubrication
Female subjective sexual arousal disorder
Physical signs of arousal are present, but feelings of sexual excitement and pleasure are absent or diminished
Combined genital and subjective sexual arousal disorder

7. Excitement-Phase Difficulties Persistent Sexual Arousal Disorder (PSAD)
Spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest
One or more orgasms do not relieve arousal
Arousal can persist for days
Individuals have normal physiological and psychiatric evaluations
Causes and treatment are unknown

8. Excitement-Phase Difficulties Male
Erectile Dysfunction (ED)
Lack of erection for at least 3 months
ED occurs in 1 in 5 men older than 20 years
Most often caused by combination of biological, psychological, and social factors

9. Male Erectile Dysfunction
Caption: The incidence of erectile disorder related to age (Kim & Lipshultz, 1997).

10. Orgasm-Phase Difficulties Female Orgasmic Disorder
Anorgasmia = absence of orgasm
Many cases are situational (situational female orgasmic disorder)
Influenced by cultural factors
Younger, unmarried and uneducated women most likely to experience difficulty with orgasm
For some, experiencing an orgasm is something learned

11. Have You Ever Had an Orgasm?
Caption: College students answer the question “Have you ever had an orgasm?”

12. Orgasm-Phase Difficulties Male Orgasmic Disorder
Male coital anorgasmia
Difficulty with orgasm during intercourse
Partner anorgasmia
Difficulty with orgasm by partner manual and oral stimulation
Premature ejaculation (PE)
Inability to control orgasm to either partners’ satisfaction
% men worldwide (ages ) repeatedly experience PE

13. Faking Orgasm
Common among women and men but usually discussed in reference to women
Reasons
Avoid disappointing or hurting partner
To get sex over with
Poor communication
Limited knowledge of sexual techniques
Attempt to hide deteriorating relationship

14. Have You Ever Faked an Orgasm?
Caption: College students answer the question “Have you ever faked an orgasm?”

15. Dyspareunia Painful Intercourse
Men
Infected or irritated foreskin
Pelvic or genital infections
Peyronie’s disease: fibrosis in penis
Women
Decreased lubrication
Infections in vagina and bladder
Vulvar vestibulitis syndrome
Endometriosis or STI
Gynecologic surgery, childbirth

16. Vaginismus Strong, involuntary contractions of outer third of vagina
Fear or ambivalence due to assault, hostility, pain, or sexual taboos
Vicious cycle can be created

17. Origins of Sexual Difficulties Physiological Factors
Hormonal, vascular, neurological
Good health habits = good sexual functioning
Chronic illnesses and disabilities
Medication effects

18. Origins of Sexual Difficulties Cultural Influences
Negative childhood learning
Sexual double standard
Narrow definition of sexuality
Performance anxiety

19. Origins of Sexual Difficulties Individual Factors
Sexual knowledge and attitudes
Self-concept
Emotional difficulties
Sexual abuse and assault

20. Origins of Sexual Difficulties Relationship Factors
Unresolved problems
Ineffective communication
Fears about pregnancy or STIs
Sexual orientation

21. Basics of Sexual Enhancement and Sex Therapy
Self-awareness
Communication
Sensate focus
Sexual orientation

22. Specific Suggestions for Women Becoming Orgasmic
Through self-stimulation
Vibrator use
Eros Clitoral Therapy Device
Allow time

23. Experiencing Orgasm With a Partner
Sexual assertiveness important
Masturbation in presence of partner
Sensate focus activity
Techniques to increase arousal

24. Specific Suggestions for Men Delaying Ejaculation
More frequent ejaculation
“Come again”
Change positions
Communication
Alternative activities
Stop-start technique
Medical treatment

25. Dealing with Erectile Dysfunction
Psychological: reduce anxiety
Medical: Viagra, Levitra, Cialis, and others
Mechanical: suction pump
Surgical treatment : implants

26. Seeking Professional Assistance What Happens in Therapy?
Identify and clarify problems and goals
Medical, sexual, and relationship history
Often given homework
Never includes sex with therapist

27. Seeking Professional Assistance Selecting a Therapist
Referral from trusted source
Ask about credentials, training and experience
Interview: practicalities & “fit”

28. Chapter 15 Sexually Transmitted Infections

29. Sexually Transmitted Infections
Engaging in risky behavior
Multiple partners
Unprotected (without condom) sex
Highest in adolescence and early adulthood, when incidence of STIs is highest
Oral contraceptives
Lack of public health measures and limited access STI prevention and treatment

30. Bacterial Infections Chlamydia Gonorrhea
Nongonococcal Urethritis (NGU)
Syphilis

31. Bacterial Infections Chlamydia
Most prevalent STI
Few or no presenting symptoms
Consequences: chronic, contagious trachoma; infertility and sterility; preterm birth; infant conjunctivitis or pneumonia
Trachoma (form of conjunctivitis); Leading cause of preventable blindness
Treatment: doxycycline or azithromycin
All sexual partners should be tested for STIs

32. Bacterial Infections Symptoms of Chlamydia
Women: 2 types of genital chlamydia infections
Infection of mucosa of lower reproductive tract
Few or no symptoms; mild irritation or itching, burning; slight discharge
Infection of upper reproductive tract (PID)
Pain, fever, headache, and nausea
Men: Epididymitis; nongonococcal urethritis (NGU)
Heaviness in testis; small, hard, painful swelling in testis; inflamed scrotum

33. Bacterial Infections Gonorrhea
“The Clap”
Consequences
Women: PID; ectopic pregnancy; severe pelvic pain; infant conjunctivitis
Men: Prostate abscesses, painful BMs, difficult urination; possible sterility
Both: Fever, loss of appetite, arthritic pain; can invade heart, liver, CNS, can cause blindness in infants
Treatment
Cephalosporin

34. Bacterial Infections Symptoms of Gonorrhea
Women: Gonococcal Cervicitis
80% no early symptoms
Yellow-green discharge
Vulval irritation
Men: Gonococcal Urethritis
Discharge
Burning
Swelling

35. Bacterial Infections Nongonococcal Urethritis
Symptoms
Women: few symptoms; itching, burning, vaginal discharge of pus
Men: penile discharge, urinary burning
Consequences:
Women: inflamed cervix or PID
Men: can spread to prostate, epididymis, or both
Treatment: Doxycycline or Azithromycin

36. Bacterial Infections Syphilis
Recent increase in rates, primarily among MSM
Pregnant women should be tested
Phases of Development, Symptoms, Consequences
Primary: Red, painless chancre
Secondary: Painless, non-itching skin rash, flu-like symptoms
Latent: No observable symptoms
Tertiary: Severe disorder, death

37. Bacterial Infections Treatment of Syphilis
Early cases (primary, secondary, or latent syphilis of less than 1 year) with benzathine penicillin G or other antibiotic
Later cases (more than 1 year): 1 weekly injection for 3 weeks (benzathine penicillin G or other antibiotic)
All partners tested at 3 month intervals

38. Viral Infections
Herpes
Genital Warts
Viral Hepatitis

39. Viral Infections Herpes
Herpes Symplex Virus (HSV) Types 1 & 2
Transmitted even when no blisters present
20-25% of Americans have HSV-2
May or may not be recurrent
Symptoms
painful, red bumps develop into blisters that rupture and form sores
swollen lymph nodes
headache
fever
muscle aches

40. Viral Infections Consequences of Herpes
Risk for cervical cancer
Newborn infected during delivery may die or suffer severe damage
C-section for women with active disease
Can cause eye infection
Psychological distress

41. Viral Infections Treatment of Herpes
Acyclovir may reduce length and severity of outbreak; Valtrex and Famvir may reduce recurring attacks
Suppressive therapy vs. Episodic treatment
Hygiene and stress reduction
No cure; vaccine in development

42. Viral Infections Genital Warts
Human Papillomavirus (HPV)
Epidemic levels
Transmitted even when no warts are evident
Symptoms:
moist, soft cauliflower-like warts; or dry, yellow- gray, hard warts
majority of people have no symptoms

43. Viral Infections Genital Warts
Consequences
Urinary obstruction and bleeding
Greater risk of genital cancers
Respiratory infection in newborn
Treatment
No cure; removal of warts
Recurrence likely
Vaccine against 4 types - Gardasil

44. Viral Infections Viral Hepatitis
Three types
Hepatitis A (commonly transmitted sexually)
Hepatitis B (more commonly transmitted sexually)
Hepatitis C (commonly transmitted through blood-contaminated needles)
Hepatitis C most health threatening
Symptoms
Few or none
Flu-like initially
Can become incapacitating: fever, vomiting, abdominal pain
Yellowed whites of eyes and skin

45. Viral Infections Viral Hepatitis
Consequences
Liver cancer
20-25% Hepatitis C infected develop severe complications (liver failure)
Death
Treatment
Bed rest and fluids
Vaccines for Hepatitis A and B
Antiviral combination may help Hepatitis C

46. Common Vaginal Infections
Bacterial Vaginosis
Candidiasis
Trichomoniasis

47. Common Vaginal Infections Bacterial Vaginosis (BV)
Symptoms
Foul smelling, thin flour-paste discharge
Genital irritation or urinary burning
Most men have no symptoms
Consequences
Women: Greater risk of PID; premature rupture of amniotic sac, and preterm labor
Men: Mostly asymptomatic; may develop urethritis or cystitis
Treatment
Oral metronidazole
Recent research: intravaginal application of topical gel or cream are as effective as oral

48. Common Vaginal Infections Candidiasis
Second most common vaginal infection in North America
Symptoms
White, cottage-cheese like, discharge
Intense itching, sore tissue
Consequences
Confused with other infections
Treatment
Vaginal suppositories or creams

49. Common Vaginal Infections Trichomoniasis
Symptoms
Copious, odorous, frothy, white or yellow-green vaginal discharge
Inflamed, irritated, itchy, and sore
Consequences
May increase risk of cervical cancer
Treatment
Both partners; oral Flagyl; topical cream

50. Ectoparasitic Infections
Pubic lice
Scabies

51. Ectoparasitic Infections Pubic Lice
Commonly known as “crabs”
Quite common, especially prevalent among young 15- to 25-year old) single people
Associated with presence of other STIs
Symptoms
Little to severe itchiness
Treatment
1% permethrin or pyrethrin lotion or cream
Launder clothes and sheets

52. Ectoparasitic Infections Scabies
Too tiny to be seen by naked eye
Highly contagious condition
Symptoms
Small, pimple-like bumps; red rash around primary lesion
Intense itchiness, especially at night
Treatment
Topical scabicide
Launder clothes and sheets

53. Acquired Immunodeficiency Syndrome (AIDS)
HIV (human immunodeficiency virus)
Retrovirus that targets and destroys helper T-4 cells
HIV becomes AIDS when
HIV is present
and
CD-4 count is < 200

54. Incidence of AIDS Rates rising among teenagers, women, and minorities
MSM transmission had leveled off in 1990s, but is now increasing
U.S. cases increasing among “heterosexual” transmission
Heterosexual contact has always been primary form of HIV transmission worldwide
Women are the fastest growing population with HIV

55. AIDS and Adolescence
Many young people with AIDS were infected as teenagers
Risk factors for teenagers include
Multiple partners
Engaging in sexual activities without condoms
Lack of access to condoms during teenage years
Substance abuse increases risky behavior
Feelings of invulnerability

56. HIV Transmission Transmission occurs in any bodily fluid
Mother-to-child transmission (MTCT)
Depends on viral load
Likelihood greatest when HIV transmitted directly to blood
Low risk: casual contact
High risk: sexual contact, sharing needles

57. HIV Symptoms and Complications
Brief flu-like symptoms that progress depending on immunosuppression
HIV Antibody Tests
Most develop antibodies in a few months, but it can take 3 years to seroconvert
Usual progression (8 to 11 years)
Full-blown AIDS

58. HIV Treatment No cure or vaccine at this time
Combination drug therapy, Highly Active Antiretroviral Therapy (HAART), shows best results for slowing progress
Zidovudine may significantly decrease maternal transmission

59. HIV Treatment Search for a Vaccine
Vaccine remains best long-term hope for controlling HIV/AIDS pandemic
Two categories of vaccines
Prophylactic
Therapeutic
Several vaccines under clinical trials

60. HIV Prevention Prevention is the best solution
Use condoms and avoid multiple partners
Do not share needles
Avoid oral, vaginal, or anal contact with semen
Avoid sexual behaviors involving anus
Avoid oral contact with vaginal fluids
Do not share items that could be contaminated with blood (e.g., razors, toothbrushes)
Avoid sexual contact with sex workers

61. Preventing STIs Prevention Guidelines
Abstinence
Get to know partner(s) before sex
Obtain prior medical examinations
Always use condoms and spermicide
Avoid multiple sexual partners
Inspect and wash genitals
Obtain routine medical evaluations
Disclose your STI status to partner