Sexual Dysfunction © 2013 John B. Pryor, Ph.D. Department of Psychology Illinois State University

Causal Factors in Sexual Dysfunction

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

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

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

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

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

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

Treatment of Vaginismus dilators

Male Hypoactive Sexual Desire Disorder –Persistent deficient or absent sexual thoughts, fantasies or desires –lasting more than 6 months –6% of younger and 41% of older men 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

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

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

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

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.

MalesFemales Female Orgasmic Disorder % Male Orgasmic Disorder %-- Male Erectile Difficulty %-- Hypoactive Sexual Desire % % Dyspareunia % Female Sexual Arousal Disorder % 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.

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. Sexual Dysfunction Assessed in a National Survey Laumann, Paik, & Rosen 1999

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