1. © 2016 Dr. M.A. Woodman Department of Psychology
Sexual Dysfunction
© 2016 Dr. M.A. Woodman
Department of Psychology

2. Causal Factors in Sexual Dysfunction

3. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2016
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

4. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

5. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

6. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

7. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

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

9. Treatment of Vaginismus
dilators

10. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

11. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

12. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
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

13. Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013
Other Specified Sexual Dysfunction
Other Unspecified Dysfunction

14. 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.

15. Sexual Dysfunction Assessed in a National Survey Laumann, Paik, & Rosen 1999
Males
Females
Female Orgasmic Disorder
--  %
Male Orgasmic Disorder % --
Male Erectile Difficulty %%
Hypoactive Sexual Desire % %
Dyspareunia %
Female Sexual Arousal Disorder %

16. 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.

17. 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, 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.

18. 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.

19. Some psychological processes that contribute to sexual dysfunction problems

21. 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

22. 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

23. 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

24. Specific techniques: 4. Change position

25. 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