1. Chapter 14 Sexuality Difficulties and Solutions

2. Defining Sexual Difficulties
Sexual satisfaction is subjective
The way people are surveyed can skew results

3. How Physically Pleasurable is Your Relationship?
Caption: Men and women worldwide were asked “How physically pleasurable is your relationship?” The Pfizer Global Study of Sexual Attitudes and Behaviors, the first worldwide study of its kind, surveyed more than 26,000 men and women in 29 countries around the globe.

4. Prevalence of Sexual Problems By Selected Demographic Characteristics
Caption: Prevalence of sexual problems by selected demographic characteristics

5. Desire-Phase Difficulties
Hypoactive sexual desire disorder (HSDD)
Lack of interest in sexual activity
Usually temporary
Often due to relationship problems or internalized negative attitudes about sex
Very common
Desire Discrepancy
Sexual aversion disorder (SAD)
Extreme, irrational fear of sexual activity
Often due to sexual abuse or assault

6. Excitement-Phase Difficulties Women
Female genital sexual arousal disorder
Inhibited lubrication
Female subjective sexual arousal disorder
Physical signs of arousal are present, but feelings of sexual excitement and pleasure are absent or diminished
Combined genital and subjective sexual arousal disorder

7. Excitement-Phase Difficulties Persistent Sexual Arousal Disorder (PSAD)
Spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest
One or more orgasms do not relieve arousal
Arousal can persist for days
Individuals have normal physiological and psychiatric evaluations
Causes and treatment are unknown

8. Excitement-Phase Difficulties Male
Erectile Dysfunction (ED)
Lack of erection for at least 3 months
ED occurs in 1 in 5 men older than 20 years
Most often caused by combination of biological, psychological, and social factors

9. Male Erectile Dysfunction
Caption: The incidence of erectile disorder related to age (Kim & Lipshultz, 1997).

10. Orgasm-Phase Difficulties Female Orgasmic Disorder
Anorgasmia = absence of orgasm
Many cases are situational (situational female orgasmic disorder)
Influenced by cultural factors
Younger, unmarried and uneducated women most likely to experience difficulty with orgasm
For some, experiencing an orgasm is something learned

11. Have You Ever Had an Orgasm?
Caption: College students answer the question “Have you ever had an orgasm?”

12. Orgasm-Phase Difficulties Male Orgasmic Disorder
Male coital anorgasmia
Difficulty with orgasm during intercourse
Partner anorgasmia
Difficulty with orgasm by partner manual and oral stimulation
Premature ejaculation (PE)
Inability to control orgasm to either partners’ satisfaction
% men worldwide (ages ) repeatedly experience PE

13. Faking Orgasm
Common among women and men but usually discussed in reference to women
Reasons
Avoid disappointing or hurting partner
To get sex over with
Poor communication
Limited knowledge of sexual techniques
Attempt to hide deteriorating relationship

14. Have You Ever Faked an Orgasm?
Caption: College students answer the question “Have you ever faked an orgasm?”

15. Dyspareunia Painful Intercourse
Men
Infected or irritated foreskin
Pelvic or genital infections
Peyronie’s disease: fibrosis in penis
Women
Decreased lubrication
Infections in vagina and bladder
Vulvar vestibulitis syndrome
Endometriosis or STI
Gynecologic surgery, childbirth

16. Vaginismus Strong, involuntary contractions of outer third of vagina
Fear or ambivalence due to assault, hostility, pain, or sexual taboos
Vicious cycle can be created

17. Origins of Sexual Difficulties Physiological Factors
Hormonal, vascular, neurological
Good health habits = good sexual functioning
Chronic illnesses and disabilities
Medication effects

18. Origins of Sexual Difficulties Cultural Influences
Negative childhood learning
Sexual double standard
Narrow definition of sexuality
Performance anxiety

19. Origins of Sexual Difficulties Individual Factors
Sexual knowledge and attitudes
Self-concept
Emotional difficulties
Sexual abuse and assault

20. Origins of Sexual Difficulties Relationship Factors
Unresolved problems
Ineffective communication
Fears about pregnancy or STIs
Sexual orientation

21. Basics of Sexual Enhancement and Sex Therapy
Self-awareness
Communication
Sensate focus
Sexual orientation

22. Sensate Focus
Caption: The process of sensate focus, in which partners sensually explore each other’s body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.

23. Specific Suggestions for Women Becoming Orgasmic
Through self-stimulation
Vibrator use
Eros Clitoral Therapy Device
Allow time

24. Eros Clitoral Therapy Device
Caption: The Eros Clitoral Therapy Device, approved by the FDA in 2000, works by increasing vasocongestion of the clitoris.

25. Experiencing Orgasm With a Partner
Sexual assertiveness important
Masturbation in presence of partner
Sensate focus activity
Techniques to increase arousal

26. Masturbating with Partner
Caption: 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.

27. Electric Vibrator Use During Coitus
Caption: The use of a vibrator for clitoral stimulation during coitus.

28. Specific Suggestions for Men Delaying Ejaculation
More frequent ejaculation
“Come again”
Change positions
Communication
Alternative activities
Stop-start technique
Medical treatment

29. Dealing with Erectile Dysfunction
Psychological: reduce anxiety
Medical: Viagra, Levitra, Cialis, and others
Mechanical: suction pump
Surgical treatment : implants

30. Penis Prosthesis
Caption: An inflatable penile prosthesis.

31. Seeking Professional Assistance What Happens in Therapy?
Identify and clarify problems and goals
Medical, sexual, and relationship history
Often given homework
Never includes sex with therapist

32. Seeking Professional Assistance Selecting a Therapist
Referral from trusted source
Ask about credentials, training and experience
Interview: practicalities & “fit”