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Copyright 2008 Allyn & Bacon

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1 Copyright 2008 Allyn & Bacon
Sexual Dysfunctions Chapter 15 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or in part, of any images; any rental, lease, or lending of the program. Copyright 2008 Allyn & Bacon

2 Copyright 2008 Allyn & Bacon
Sexual Dysfunctions Types of Sexual Dysfunctions Origins of Sexual Dysfunctions: A Biopsychosocial Approach Treatment of Sexual Dysfunctions Copyright 2008 Allyn & Bacon

3 Types of Sexual Dysfunctions
Persistent or recurrent difficulties in becoming sexually aroused or reaching orgasm People with dysfunctions often avoid sexual opportunities Feel inadequate or incompetent Find it difficult to talk about No precise figures on occurrence of sexual dysfunctions Copyright 2008 Allyn & Bacon

4 Types of Sexual Dysfunctions
DSM proposes four categories Sexual desire disorders Lack of interest in sex or aversion to sexual contact Sexual arousal disorders Failure to become adequately sexually aroused to engage in or sustain sexual intercourse Orgasmic disorders Difficulty reaching orgasm or reaching orgasms more rapidly than one would like Sexual pain disorders Persistent or recurrent experience of pain during coitus Copyright 2008 Allyn & Bacon

5 Types of Sexual Dysfunctionss
Classified as: Lifelong Acquired Generalized Situational Copyright 2008 Allyn & Bacon

6 Types of Sexual Dysfunctions
Sexual Desire Disorders Hypoactive sexual desire disorder Little or no sexual interest or desire Most commonly diagnosed sexual dysfunction More common in women than men Cause unclear Sexual aversion disorder Sex is considered disgusting or aversive May be due to sexual frustration from failure or to sexual trauma Copyright 2008 Allyn & Bacon

7 Types of Sexual Dysfunctions
Sexual Arousal Disorders Male erectile disorder or erectile dysfunction Persistent difficulty achieving or maintaining an erection sufficient to complete sexual activity Can be situational or generalized May occur due to performance anxiety Anxiety concerning one’s ability to perform behaviors, especially behaviors that may be evaluated by other people May have physical causes Copyright 2008 Allyn & Bacon

8 Types of Sexual Dysfunctions
Female sexual arousal disorder Persistent difficulties becoming sufficiently lubricated in response to sexual stimulation Can be lifelong or situational May have physical causes Usually has psychological causes, such as anger, resentment, or trauma Copyright 2008 Allyn & Bacon

9 Types of Sexual Dysfunctions
Orgasmic Disorders Female orgasmic disorder Anorgasmic Never having reached orgasm Women who try to force an orgasm may assume a spectator role A role in which people observe rather than fully participate in their sexual encounters Male orgasmic disorder This is also termed delayed ejaculation, retarded ejaculation, or ejaculatory incompetence Copyright 2008 Allyn & Bacon

10 Types of Sexual Dysfunctions
Orgasmic Disorders Premature ejaculation Ejaculation occurs with minimal sexual stimulation and before the man desires it Hard to define what is meant by premature Rapid female orgasm: Can women reach orgasm too quickly? It is not classified as a sexual dysfunction. However, it may result in sexual relationship issues. Orgasmic disorders can have physical or psychological causes Copyright 2008 Allyn & Bacon

11 Types of Sexual Dysfunctions
Sexual Pain Disorders Dyspareunia Persistent or recurrent pain during sexual intercourse which is commonly caused by lack of lubrication in women and genital infections in men Psychological factors such as guilt or anxiety could contribute to pain Vaginismus Involuntary contraction of the muscle surrounding the vaginal barrel Prevents penile penetration or makes it painful Caused by psychological fear of penetration Copyright 2008 Allyn & Bacon

12 Origins of Sexual Dysfunctions
Biological Causes Testosterone deficiency Hypogonadism Reductions with age Fatigue Medical conditions: heart disease, diabetes, MS, spinal cord injuries, surgical complications, hormonal problems Medications Copyright 2008 Allyn & Bacon

13 Origins of Sexual Dysfunctions
Medications Hypertension SSRI’s (depression, panic disorder, OCD, anorexia) Impair sexual arousal HIV Therapy changes hormone levels Copyright 2008 Allyn & Bacon

14 Origins of Sexual Dysfunctions
Psychosocial causes Cultural influences More common in sexually repressive cultures Sexual double standard Negative sexual attitudes Psychosexual trauma Sexual victimization can negatively affect sexual arousal Copyright 2008 Allyn & Bacon

15 Origins of Sexual Dysfunctions
Sexual orientation Sexual dysfunctions within a heterosexual relationship can reflect a lack of heteroerotic interests Ineffective sexual techniques Include failure to diversify, brevity, and lack of communication Emotional factors Include fear of losing control, depression, and stress Copyright 2008 Allyn & Bacon

16 Origins of Sexual Dysfunctions
Problems in the relationship Communication problems Resentment Lack of sexual skills Irrational beliefs When one instance of erectile or orgasmic disorder leads to false, catastrophic beliefs Performance anxiety Can create a vicious cycle of failure and increased anxiety Copyright 2008 Allyn & Bacon

17 Treatment of Sexual Dysfunctions
Sex Therapy A collective term for short-term behavioral models for treatment of sexual dysfunctions, which aim to: Change self-defeating beliefs and attitudes Teach sexual skills Enhance sexual knowledge Improve sexual communication Reduce performance anxiety Copyright 2008 Allyn & Bacon

18 Treatment of Sexual Dysfunctions
The Masters-and-Johnson Approach Cognitive-behavioral therapy A female-male therapy team uses direct behavioral approaches to treat the couple during a two-week residential program which includes Sensate focus exercises Exercises in which sex partners take turns giving and receiving pleasurable stimulation in nongenital areas Copyright 2008 Allyn & Bacon

19 Treatment of Sexual Dysfunctions
The Helen Singer Kaplan Approach Psychosexual therapy Combines behavioral and psychoanalytic methods Improve sexual communication Eliminate performance anxiety Increase sexual skills and knowledge Sexual Desire Disorders Treatments include: Self-stimulation exercises combined with erotic fantasies Sensate focus exercises Enhancing communication Expanding repertoire of couple’s sexual skills Copyright 2008 Allyn & Bacon

20 Treatment of Sexual Dysfunctions
Testosterone replacement therapy Use of anti-anxiety medications Couples therapy Sexual Arousal Disorders Erectile disorder Sensate focus exercises are used to reduce performance anxiety Biological approaches to treatment of erectile disorder include surgery (i.e., vascular surgery or penile implants), medication (e.g., Viagra), and vacuum pumps Copyright 2008 Allyn & Bacon

21 Treatment of Sexual Dysfunctions
Female sexual arousal disorder Treatments involve sex education; identifying and modifying interfering thoughts; creating nondemanding situations; and, if necessary, working on problems in the relationship. Lack of sufficient lubrication may be remedied by the use of artificial lubricants. Biological treatments include a vacuum pump used on the clitoris, and medications also are being investigated. Copyright 2008 Allyn & Bacon

22 Treatment of Sexual Dysfunctions
Orgasmic Disorders Treatments include: Sensate focus exercises to reduce performance anxiety Use of the female-superior position Individual therapy (typically for women) involves directed masturbation programs which include Education Self-exploration and self-massage Giving oneself permission Use of fantasy Use of a vibrator Involvement of the partner Copyright 2008 Allyn & Bacon

23 Treatment of Sexual Dysfunctions
Premature ejaculation Partner uses the squeeze technique Tip of the penis is squeezed temporarily to prevent ejaculation An alternative method is the “stop-start” method Biological approaches to treatment of premature ejaculation include the use of psychiatric medications Copyright 2008 Allyn & Bacon

24 Treatment of Sexual Dysfunctions
Sexual Pain Disorders Dyspareunia Treatment includes medical procedures to treat infections Vaginismus Treatment involves the insertion of vaginal dilators of increasing size to help relax the vaginal musculature Woman controls the pace and depth of penetration Psychological therapy also may be needed Copyright 2008 Allyn & Bacon


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