1. Sexual Difficulties, Dissatisfaction, Enhancement, and Therapy
Chapter Fourteen
Sexual Difficulties, Dissatisfaction, Enhancement, and Therapy

2. Sexual Function Difficulties
Sexual desires and activities reflect both emotional well-being and physical health
Both men and women report occasional or frequent lack of desire, problems in arousal or orgasm, or painful intercourse
There are many ways to enhance sexuality and create greater pleasure and intimacy

3. DSM–IV–TR
Sexual dysfunction: a disturbance in sexual desire and in the psychological and physiological changes that characterize the sexual response cycle and cause distress and interpersonal difficulty
Lifelong or acquired
Generalized or situational
Limitations 3

4. The International Definitions Committee
Women’s Sexual Interest/Desire disorder
Subjective Sexual Arousal Disorder
Combined Genital and Subjective Arousal Disorder
Genital Sexual Arousal Disorder
Persistent Sexual Arousal Disorder
Women’s Orgasmic Disorder
Vaginismus
Dyspareunia

5. Sexual Function Difficulties
Men and women differ in the types of difficulties they report
Men and women have differing experiences as they age
Men and women both report fewer difficulties when they are married
Heterosexual and homosexual men and women differ in the types of difficulties they report 4

6. 2000 National Survey of Sexual Attitudes and Lifestyles
Age
Married vs. single
Children in the home
First sexual experience
Communication about sex
Health 4

7. Disorders of Sexual Desire
Hypoactive sexual desire or inhibited sexual desire: low or absent sexual desire
Inhibited sexual desire and marriage
Sexual aversion: aversion to and avoidance of genital contact with a partner 4

8. Sexual Arousal Disorders
Female sexual arousal disorder
Male erectile disorder
Persistent sexual arousal syndrome 5

9. Sexual Arousal Disorders
What do the characteristics of these disorder say about the nature of arousal?
Is arousal a biological or psychological process?
What are the implications for treatment? 5

10. Orgasmic Disorders Female orgasmic disorder Male orgasmic disorder
Inhibited ejaculation
Delayed ejaculation
Premature ejaculation 6

11. Sexual Pain Disorders
Dyspareunia: genital pain associated with intercourse
Anodyspareunia: pain occurring during anal intercourse
Vaginismus: involuntary spasmodic contractions of the vaginal muscles

12. Other Disorders
Peyronie’s disease: development of calcium deposits and fibrous tissue in the penis
Priapism: prolonged and painful erection

13. Physical Causes of Sexual Difficulties
Men:
Diabetes
Alcoholism/Drug use
Lumbar-disc disease
Atherosclerosis
Spinal cord injuries
Smoking
Women:
Diabetes
Heart disease
Hormone deficiencies
Neurological disorders
Alcoholism/Drug Use
Spinal cord injuries 7

14. Psychological Causes of Sexual Function Difficulties
Fatigue and Stress
Ineffective sexual behavior
Sexual anxieties
Excessive need to please a partner
Conflict within self
Relationship causes 8

15. Sexual Function Enhancement
Improving of the quality of one’s sexual relationship
Self-awareness
Intensifying erotic pleasure
Changing a sexual relationship 2

16. Treating Sexual Function Difficulties
Masters and Johnson: Cognitive-behavioral approach
Kaplan: Psychosexual therapy
Other non medical approaches
PLISSIT model of therapy
Self-help and group therapy
Medical approaches
Gay, lesbian, and bisexual sex therapy 9