1. Copyright, Corey E. Miller, 2002, 2003 1 Chapter Fourteen: Sexual Enhancement and Therapy

2. Copyright, Corey E. Miller, 2002, 2003 2 Sexual Enhancement Sexual enhancement - improvement of the quality of one’s sexual relationship Intensifying erotic pleasure –Sexual arousal –Alternatives to intercourse

3. Copyright, Corey E. Miller, 2002, 2003 3 Zilbergeld (1992): Six Requirements for Great Sex 1.Accurate information about sexuality 2.Orientation toward sex based on pleasure, such as arousal, fun, love, and lust, rather than performance and orgasm 3.Relationship allows each partner’s sexuality to flourish 4.Communication about sex, feelings, and relationships (verbally & nonverbally) 5.Being equally assertive about your own needs and those of your partner 6.Accepting, understanding, and appreciating differences between partners

4. Copyright, Corey E. Miller, 2002, 2003 4 Common Conditions for Great Sex Self-awareness - critical to enhancing your sexuality 1.Feeling Intimate 2.Feeling Sexually Capable 3.Feeling Trust 4.Feeling Aroused 5.Feeling Physically & Mentally Alert 6.Feeling Positive about Environment & Situation

5. Copyright, Corey E. Miller, 2002, 2003 5 Sexual Disorders and Dysfunctions Sexual dysfunction - a disturbance in sexual desire and in the psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty Lifelong - Acquired – after period of normal functioning Generalized – all situations Situational – specific situations

6. Copyright, Corey E. Miller, 2002, 2003 6

7. 7 Females Problems Decrease w/ age except lubrication Nonmarried Women 1 1/2 Times More likely to have Orgasm difficulties College Graduates half as likely to have problems w/ Orgasm, Anxiety African Americans more likely to have Low sexual desire African Americans more likely to find Sexual NOT pleasurable

8. Copyright, Corey E. Miller, 2002, 2003 8 Females Continued Women with low sexual activity are at a higher risk for low desire and arousal problems Rates are the same for Women who report same sex activity as those who do not Sexual arousal problems more likely among victims of sexual assault Sexual Dysfunctions negatively correlated with emotional satisfaction and happiness

9. Copyright, Corey E. Miller, 2002, 2003 9 Males Nonmarried men report higher rates for dysfunctions College graduates 2/3 as likely to report early orgasm and ½ as likely to report nonpleasurable sex and sexual anxiety Low sexual activity is NOT related to low desire and arousal problems Those that report some same sex activity more than twice as likely to experience premature ejaculation and low sexual desire

10. Copyright, Corey E. Miller, 2002, 2003 10 Males Continued Problems much more likely among victims as children Assaulters 31/2 times more likely to have erectile dysfunction Men reporting erectile dysfunctions and low sexual desire experience diminished quality of life Those with Premature ejaculation are not affected

11. Copyright, Corey E. Miller, 2002, 2003 11 Disorders of Desire Hypoactive sexual desire - HSD; also known as inhibited sexual desire; low or absent sexual desire Sexual aversion - phobic response to sexual activities or the idea of such activities Causes: –Negative Parental Attitudes –Trauma and Victimization

12. Copyright, Corey E. Miller, 2002, 2003 12 Sexual Arousal Disorders Female sexual arousal disorder - inability to maintain adequate vaginal lubrication; once termed “frigid” Male erectile disorder - inability to maintain an adequate erection –once termed “impotence”

13. Copyright, Corey E. Miller, 2002, 2003 13 Orgasmic Disorders Female orgasmic disorder - absence or delay of orgasm after normal sexual excitement ~25% of women unable to achieve orgasm in 12 months w/ partner Male orgasmic disorder - absence or delay of ejaculation after normal sexual excitement –Inhibited ejaculation –Delayed ejaculation

14. Copyright, Corey E. Miller, 2002, 2003 14 Sexual Pain Disorders Dyspareunia - genital pain associated with intercourse Vaginismus - involuntary spasmodic contractions of the vaginal muscles

15. Copyright, Corey E. Miller, 2002, 2003 15 Other Disorders Peyronie’s disease - development of calcium deposits and fibrous tissue in the penis Priapism - prolonged and painful erection

16. Copyright, Corey E. Miller, 2002, 2003 16 Physical Causes of Sexual Dysfunctions Men: Diabetes Alcoholism Lumbar-disc disease Atherosclerosis Spinal cord injuries Smoking Women: Diabetes Heart disease Hormone deficiencies Neurological disorders Alcoholism Spinal cord injuries

17. Copyright, Corey E. Miller, 2002, 2003 17 Psychological Causes of Sexual Dysfunctions Fatigue and Stress Ineffective sexual behavior Sexual anxieties Excessive need to please a partner –2/3 of Women faked O –1/3 of Men faked O Inner conflict –Upbringing –Internalized Homophobia Relationship problems

18. Copyright, Corey E. Miller, 2002, 2003 18 Masters and Johnson Cognitive-behavioral approach Majority of Sexual Dysfunctions caused by ignorance, faulty techniques, or relationship problems Sensate Focus – focus on giving and receiving pleasure – focus isn’t arousal Treatment of Premature Ejaculation - Squeeze Technique Treatment for Female Orgasmic Disorder – partner touches Vulva – she shows him what she likes Surrogate Partners

19. Copyright, Corey E. Miller, 2002, 2003 19 Treating Sexual Problems Helen Singer Kaplan - psychosexual therapy –Point our resistance and unconscious root of problem PLISSIT model of therapy –Permission – –Limited Information – focus on area of difficulty –Specific Suggestions - homework –Intensive Therapy