© 2015 Dr. M.A. Woodman Department of Psychology Sexual Dysfunction © 2015 Dr. M.A. Woodman Department of Psychology

Causal Factors in Sexual Dysfunction

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Delayed Ejaculation A marked difficulty or inability to achieved desired ejaculation lasting more than 6 months during partnered sexual activities More common in men over 50 Only 75% of men report always ejaculating during sexual activity, >1% report problems lasting more than 6 months Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Erectile Disorder Failure to obtain or maintain erection during partnered sexual activities More common in men over 50 Most problems remit without professional intervention Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Female Orgasmic Disorder Delay, infrequency or absence of orgasm or reduced intensity of orgasm sensations lasting more than 6 months Wide estimates of prevalence: 10%-42% 10% of women do not report experience of orgasm Lifelong vs. acquired; generalized v. situational, also never; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Female Sexual Interest/Arousal Disorder Absent/reduced interest/arousal related to sexual activities, thoughts, encounters, cues, etc. Becomes persistent problem for relationships Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Genito-Pelvic Pain/Penetration Disorder Difficulties with a vaginal penetration during intercourse, b pain during intercourse, c fear or anxiety about pain or penetration, or contraction of pelvic floor muscles during sex lasting more than 6 months 15% of women report some pain during intercourse Lifelong vs. acquired; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM Sexual Pain Disorders •Dyspareunia •Vaginismus

Treatment of Vaginismus dilators

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Male Hypoactive Sexual Desire Disorder Persistent deficient or absent sexual thoughts, fantasies or desires lasting more than 6 months 6% of younger 18-24 and 41% of older men 66-74 report problems with sexual desire; persistent problem in only 1.8% of men Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Premature Early Ejaculation Persistent or recurrent pattern of ejaculation during partnered sexual activity within 1 minute following penetration or before individual wishes it lasting more than 6 months 20%-30% of men report concern about ejaculation speed; 1%-3% have persistent problem Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Substance/Medication-Induced Sexual Dysfuntion Some common causes: a alcohol, b sedative, hypnotic, or anxiolytic, c amphetamine or other stimulant, c cocaine Mild 25%-50% of sexual encounters, moderate 50%-75% or severe 75% or more

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013 Other Specified Sexual Dysfunction Other Unspecified Dysfunction

How common is sexual dysfunction? Laumann, Paik,& Rosen 1999 estimate about 43% of women and about 31% of men have experienced sexual dysfunction based on a national survey of Americans. This makes sexual dysfunction the most common psychological problem in US.

Sexual Dysfunction Assessed in a National Survey Laumann, Paik, & Rosen 1999 Males Females Female Orgasmic Disorder --  22.0-26.0% Male Orgasmic Disorder 7.0-9.0% -- Male Erectile Difficulty 7.0-18.0%% Hypoactive Sexual Desire 13.0-17.0% 30.0-32.0% Dyspareunia 8.0-21.0% Female Sexual Arousal Disorder 18.0-27.0%

Sexual Dysfunction Assessed in a National Survey Laumann, Paik, & Rosen 1999 Sexual dysfunction is highest among younger women, with 21 percent of women aged 18 to 29 reporting physical pain with intercourse. Twenty-seven percent reported experiencing non-pleasurable sex, and 16 percent reported sexual anxiety. Women aged 50 to 59 are one third as likely as younger women to experience pain during sex and half as likely to report non-pleasurable sex and sexual anxiety.

Sexual Dysfunction Assessed in a National Survey- Laumann, Paik, & Rosen 1999 Men experience greater difficulty as they age, with men aged 50 to 59 being three and a half times more likely to experience erection problems than the 18 to 29 age group. However, increasing age is not a factor for men who report climaxing too early, anxiety about performance and non-pleasurable sex. Married men and women report fewer problems with sex than those unmarried. Unmarried women are one and a half times more likely to have trouble climaxing than married women. Unmarried men are more likely to report lack of desire or erection problems than married men.

Sexual Dysfunction Assessed in a National Survey Laumann, Paik, & Rosen 1999 High school dropouts are the most likely to have sexual problems. Among women, 42 percent who did not complete high school reported lacking the desire for sex, while only 24 percent of female college graduates had such an experience. Among men, college graduates were two-thirds as likely to report climaxing too early as compared to men who did not complete high school.

Some psychological processes that contribute to sexual dysfunction problems

Specific techniques: 1. Increase Self-Understanding Education re: anatomy, physiology, sexual response cycle Instruction on how to masturbate Homework to masturbate in private & later in partner’s presence

Specific techniques: 2. Sensate Focus Exercises Both partners remove clothes One partner “gives” while the other “receives” & gives feedback Initially, no “sexual” touching gradually build up to touching genitals, orgasm & intercourse Gradual reawakening of sexual interest

Specific techniques: 3. Stop-Start Technique Manually stimulate penis until close to orgasm Stop stimulation until calmer Repeat May be done by a partner or by masturbation

Specific techniques: 4. Change position

Specific techniques: 5. Communication Why is it hard to talk about sex? People sometimes lack the specific language Use of “I” statements instead of speaking abstractly