1. Sexual Difficulties (B)
© Robert J. Atkins, Ph.D.

2. Endometriosis
Occurs when the cells of the lining of the uterus are disrupted, and often grow outside the uterus within the abdominal cavity.
Symptoms
Deep pelvic pain, painful menstruation, painful sex, abdominal pain when walking
Laparoscopic surgery

3. Female orgasmic disorder
Symptoms
Inability to climax at least half the time.
Treatment
Self and partner education on what is enjoyable
Use of a vibrator
Direct manual stimulation of the clitoris during intercourse.
Female initiated movements
(Woman on top position)

4. What are the general techniques common to all sex therapy?

5. Sexual Enhancement and Sex Therapy
Self-awareness
knowledge of beliefs, needs, and how body responds
self-examination
masturbation

6. Sexual Enhancement and Sex Therapy (cont.)
Communication
Sensate focus
touching & communicating without any goal  less pressure to perform
focus on non-genital touch
Cultural values and masturbation

7. Sexual Enhancement and Sex Therapy (cont.)
Fig The process of sensate focus, whereby partners sensually explore each other’s body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.

8. Sexual Enhancement and Sex Therapy (cont.)
Masturbation with partner present
to learn what feels good & teach partner
to allow sexual release
for women learning to experience orgasm with partner
to resolve male erectile difficulties

9. Sexual Enhancement and Sex Therapy (cont.)
Fig 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.

10. What are some specific Suggestions for Women
Becoming orgasmic
through self-stimulation
vibrator use
Eros clitoral therapy device
allow time, consider counseling

11. Specific Suggestions for Women (cont.)
Experiencing orgasm with a partner
sexual assertiveness important
masturbation in presence of partner
sensate focus activity
techniques to increase arousal

12. Sexual Enhancement and Sex Therapy (cont.)
Fig The back to chest position for genital sensate focus.

13. Specific Suggestions for Women (cont.)
Fig The use of an electric vibrator for clitoral stimulation during coitus.

14. Specific Suggestions for Women (cont.)
Fig Facilitating Orgasm: Complete the Sentence, “In addition to getting specific physical stimulation, I have often done the following to help me reach orgasm during sex with a partner.”

15. Specific Suggestions for Women (cont.)
Dealing with vaginismus
relaxation & self-awareness activity
gradual finger/dilator self-insertions
penile penetration
may require professional help

16. What are some specific Suggestions for Men
Strategies for delaying ejaculation
more frequent ejaculation
“Come again”
change positions
communication  slow down

17. Specific Suggestions for Men (cont.)
Strategies for delaying ejaculation
stop-start technique
stimulation to brink of orgasm
stop, wait for sensations to decrease
OR squeeze technique
training sessions required
woman above position most used

18. Specific Suggestions for Men (cont.)
Strategies for delaying ejaculation
medical treatment
small doses of antidepressants

19. Specific Suggestions for Men (cont.)
Dealing with erectile dysfunction
reduce anxiety (most common cause)
restore confidence with success
sensate focus or stop-start
final phase of treatment is intercourse

20. Specific Suggestions for Men (cont.)
Dealing with erectile dysfunction
medical treatment
Viagra: takes effect < 3 hours, requires physical stimulation, effect may depend on quality of relationship
newer drugs: Levitra and Cialis

21. Specific Suggestions for Men (cont.)
Dealing with erectile dysfunction
mechanical: suction pump, Rejoyn
surgical treatment
semi-rigid or inflatable implants
may alter sensations during erection
microsurgical vascular repairs

22. Specific Suggestions for Men (cont.)
Fig An inflatable penile prosthesis.

23. Specific Suggestions for Men (cont.)
Reducing male orgasmic disorder
behavioral approach used
sensate focus without ejaculation
ejaculation by any means
manual or oral stimulation by partner, to ejaculation
coital ejaculation

24. Treating Hypoactive Sexual Desire
Some suggestions same as other dysfunctions
encourage erotic responses
reduce anxiety
enhance sexual experiences
expand repertoire of activities

25. Treating Hypoactive Sexual Desire (cont.)
Multifaceted intervention may be required
goal = modify inhibited impulses
explore underlying relationship problems
often requires long-term professional help
medical treatment; testosterone supplementation

26. Seeking Professional Assistance
The PLISSIT model of sex therapy
1st level = permission to engage or not in specific sexual behaviors
2nd level = limited information corrected
3rd level = specific suggestions offered
4th level = intensive therapy

27. Seeking Professional Assistance (cont.)
Therapeutic approaches
psychosexual therapy

28. Seeking Professional Assistance (cont.)
What happens in therapy?
identify & clarify problems & goals
medical, sexual, relationship history
often given homework
NEVER includes sex with therapist

29. Seeking Professional Assistance (cont.)
Selecting a therapist
referral from trusted source
ask about credentials, training, & experience
interview: practicalities & "fit"