Sexual Dysfunction © 2005 John B. Pryor, Ph.D. Department of Psychology Illinois State University

Causal Factors in Sexual Dysfunction

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994) Sexual Desire Disorders •Hypoactive Sexual Desire Disorder •Sexual Aversion Disorder

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994) Sexual Arousal Disorders •Female Sexual Arousal Disorder •Male Erectile Disorder

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994) Orgasm Disorders •Female Orgasmic Disorder •Male Orgasmic Disorder •Premature Ejaculation

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994) Sexual Pain Disorders •Dyspareunia •Vaginismus

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994) Sexual Dysfunction Due to a General Medical Condition Substance-Induced Sexual Dysfunction Sexual Dysfunction Not Otherwise Specified

How common is sexual dysfunction? Laumann, Paik, & Rosen (1999) estimate about 40% of women and about 30% of men have experienced sexual dysfunction based on a national survey of Americans. This makes dysfunction the most common psychological problem in US.

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, 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

Positive Feedback Loop Positive emotions Demand for Accurate perception of erection & arousal Demand for sexual performance Attention focused on erotic thoughts Positive Feedback Loop Desire Sex Increaseed autonomic arousal (sexual arousal) Attention focused increasingly on erotic thoughts Successful functioning

Negative Feedback Loop Negative emotions (anxiety) Demand for Inacccurate perception of erection & arousal Demand for sexual performance Cognitive interference: Attention on failure & other non-erotic ideas Negative Feedback Loop Avoid Sex Increaseed autonomic arousal (anxiety) Increaseed cognitive interference Dysfunction

Some typical components of behavior treatment programs for sexual dysfunction Education Redirection of sexual behavior Focus on giving sexual pleasure Graded sexual exposure Start with massage

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