Sexual Difficulties, Dissatisfaction, Enhancement, and Therapy Chapter Fourteen Sexual Difficulties, Dissatisfaction, Enhancement, and Therapy

Sexual Function Difficulties Sexual desires and activities reflect both emotional well-being and physical health Both men and women report occasional or frequent lack of desire, problems in arousal or orgasm, or painful intercourse There are many ways to enhance sexuality and create greater pleasure and intimacy

DSM–IV–TR Sexual dysfunction: a disturbance in sexual desire and in the psychological and physiological changes that characterize the sexual response cycle and cause distress and interpersonal difficulty Lifelong or acquired Generalized or situational Limitations 3

The International Definitions Committee Women’s Sexual Interest/Desire disorder Subjective Sexual Arousal Disorder Combined Genital and Subjective Arousal Disorder Genital Sexual Arousal Disorder Persistent Sexual Arousal Disorder Women’s Orgasmic Disorder Vaginismus Dyspareunia

Sexual Function Difficulties Men and women differ in the types of difficulties they report Men and women have differing experiences as they age Men and women both report fewer difficulties when they are married Heterosexual and homosexual men and women differ in the types of difficulties they report 4

2000 National Survey of Sexual Attitudes and Lifestyles Age Married vs. single Children in the home First sexual experience Communication about sex Health 4

Disorders of Sexual Desire Hypoactive sexual desire or inhibited sexual desire: low or absent sexual desire Inhibited sexual desire and marriage Sexual aversion: aversion to and avoidance of genital contact with a partner 4

Sexual Arousal Disorders Female sexual arousal disorder Male erectile disorder Persistent sexual arousal syndrome 5

Sexual Arousal Disorders What do the characteristics of these disorder say about the nature of arousal? Is arousal a biological or psychological process? What are the implications for treatment? 5

Orgasmic Disorders Female orgasmic disorder Male orgasmic disorder Inhibited ejaculation Delayed ejaculation Premature ejaculation 6

Sexual Pain Disorders Dyspareunia: genital pain associated with intercourse Anodyspareunia: pain occurring during anal intercourse Vaginismus: involuntary spasmodic contractions of the vaginal muscles

Other Disorders Peyronie’s disease: development of calcium deposits and fibrous tissue in the penis Priapism: prolonged and painful erection

Physical Causes of Sexual Difficulties Men: Diabetes Alcoholism/Drug use Lumbar-disc disease Atherosclerosis Spinal cord injuries Smoking Women: Diabetes Heart disease Hormone deficiencies Neurological disorders Alcoholism/Drug Use Spinal cord injuries 7

Psychological Causes of Sexual Function Difficulties Fatigue and Stress Ineffective sexual behavior Sexual anxieties Excessive need to please a partner Conflict within self Relationship causes 8

Sexual Function Enhancement Improving of the quality of one’s sexual relationship Self-awareness Intensifying erotic pleasure Changing a sexual relationship 2

Treating Sexual Function Difficulties Masters and Johnson: Cognitive-behavioral approach Kaplan: Psychosexual therapy Other non medical approaches PLISSIT model of therapy Self-help and group therapy Medical approaches Gay, lesbian, and bisexual sex therapy 9