Chapter 14 Sexuality Difficulties and Solutions

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

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.

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

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

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

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

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

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

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

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

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 20 - 30% men worldwide (ages 18 - 59) repeatedly experience PE

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

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

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

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

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

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

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

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

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

Sensate Focus Caption: The process of sensate focus, in which partners sensually explore each other’s body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.

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

Eros Clitoral Therapy Device Caption: The Eros Clitoral Therapy Device, approved by the FDA in 2000, works by increasing vasocongestion of the clitoris.

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

Masturbating with Partner Caption: Masturbating in the presence of a partner can be an effective way for an individual to indicate what kind of touching she or he finds arousing.

Electric Vibrator Use During Coitus Caption: The use of a vibrator for clitoral stimulation during coitus.

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

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

Penis Prosthesis Caption: An inflatable penile prosthesis.

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

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