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Sexual Dysfunctions Chapter 15
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Learning Objectives Types of Sexual Dysfunctions
Origins of Sexual Dysfunctions Treatment of Sexual Dysfunctions
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Types of Sexual Dysfunctions
Persistent or recurrent difficulties in becoming sexually aroused or reaching orgasm People with dysfunctions Often avoid sexual opportunities Feel inadequate or incompetent Find it difficult to talk about
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Types of Sexual Dysfunctions
No precise figures on occurrence of sexual dysfunctions Surveys indicate Women report higher prevalence Prevalence increases with age Most prevalent for women are low sexual desire and difficulty reaching orgasm Least prevalent are pain disorders Many men report low sexual desire
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Types of Sexual Dysfunctions
DSM proposes four categories Sexual desire disorders Lack of interest in sex or aversion to sexual contact Sexual arousal disorders Failure to become adequately sexually aroused to engage in or sustain sexual intercourse Orgasmic disorders Difficulty reaching orgasm or reaching orgasms more rapidly than one would like Sexual pain disorders Persistent or recurrent experience of pain during coitus
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Types of Sexual Dysfunctions
Lifelong Acquired Sexual dysfunctions can be Generalized Occur in all situation Situational Occur only in some situations Sexual dysfunctions classified as
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When does a sexual problem become a sexual dysfunction?
Critical Thinking When does a sexual problem become a sexual dysfunction? How can concern about a sexual problem develop into a dysfunction?
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Sexual Desire Disorders
Hypoactive sexual desire disorder Little or no sexual interest or desire Absence of sexual fantasies Most commonly diagnosed sexual dysfunction Does not indicate physical inability More common in women than men Cause unclear
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Sexual Arousal Disorders
Male erectile disorder or erectile dysfunction Persistent difficulty achieving or maintaining an erection sufficient to complete sexual activity Can be situational or generalized May occur due to performance anxiety Anxiety concerning one’s ability to perform behaviors, especially behaviors that may be evaluated by other people May have physical causes
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Sexual Arousal Disorders
Female sexual arousal disorder Persistent difficulties becoming sufficiently lubricated in response to sexual stimulation Can be lifelong or situational May have physical causes Usually has psychological causes, such as anger, resentment, or trauma
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Orgasmic Disorders Female orgasmic disorder Anorgasmic
Never having reached orgasm Women who try to force an orgasm may assume a spectator role A role in which people observe rather than fully participate in their sexual encounters
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Orgasmic Disorders Male orgasmic disorder
This is also termed delayed ejaculation, retarded ejaculation, or ejaculatory incompetence
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Orgasmic Disorders Premature ejaculation Ejaculation occurs with minimal sexual stimulation and before the man desires it Hard to define what is meant by premature Rapid female orgasm Can women reach orgasm too quickly? It is not classified as a sexual dysfunction May result in sexual relationship issues Orgasmic disorders can have physical or psychological causes
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Sexual Pain Disorders Dyspareunia Vaginismus Vulvodynia
Persistent or recurrent pain during sexual intercourse which is commonly caused by lack of lubrication in women and genital infections in men Psychological factors such as guilt or anxiety could contribute to pain Vaginismus Involuntary contraction of the muscle surrounding the vaginal barrel Prevents penile penetration or makes it painful Caused by psychological fear of penetration Vulvodynia A gynecological condition characterized by vulva pain, burning sensations, irritation, and soreness Cause is unknown
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Origins of Sexual Dysfunctions
Biopsychosocial model Considering interaction of biological, psychological, and social factors in sexual dysfunctions
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Origins of Sexual Dysfunctions
Biological Causes Testosterone deficiency Hypogonadism Reductions with age Fatigue Medical conditions Heart disease, diabetes, MS, spinal cord injuries, surgical complications, hormonal problems
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Origins of Sexual Dysfunctions
Biological Causes HIV Therapy changes hormone levels Medications Hypertension SSRI’s Treat depression, panic disorder, OCD, anorexia Impair sexual arousal Substance use Marijuana, cocaine, alcohol, heroin, etc.
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Origins of Sexual Dysfunctions
Psychosocial causes Cultural influences More common in sexually repressive cultures Sexual double standard Negative sexual attitudes Psychosexual trauma Sexual victimization can negatively affect sexual arousal
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Origins of Sexual Dysfunctions
Psychosocial causes Sexual orientation Sexual dysfunctions within a heterosexual relationship can reflect a lack of heteroerotic interests Ineffective sexual techniques Include failure to diversify, brevity, and lack of communication Emotional factors Include fear of losing control, depression, and stress
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Origins of Sexual Dysfunctions
Psychosocial causes Problems in the relationship Communication problems Resentment Lack of sexual skills Irrational beliefs When one instance of erectile or orgasmic disorder leads to false, catastrophic beliefs Performance anxiety Can create a vicious cycle of failure and increased anxiety
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Treatment of Sexual Dysfunctions
A collective term for short-term behavioral models for treatment of sexual dysfunctions, which aim to Change self-defeating beliefs and attitudes Enhance sexual knowledge Teach sexual skills Improve sexual communication Reduce performance anxiety Sex Therapy Biological treatments
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Treatment of Sexual Dysfunctions
Psychosexual therapy Combines behavioral and psychoanalytic methods Improve sexual communication Eliminate performance anxiety Increase sexual skills and knowledge The Helen Singer Kaplan Approach
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Treatment of Sexual Dysfunctions
Sexual Desire Disorders Treatments include Self-stimulation exercises combined with erotic fantasies Sensate focus exercises Enhancing communication Expanding repertoire of couple’s sexual skills Testosterone replacement therapy Use of anti-anxiety medications Couples therapy
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Treatment of Sexual Dysfunctions
Male Sexual Arousal Disorders Erectile disorder Sensate focus exercises are used to reduce performance anxiety Biological approaches to treatment of erectile disorder Surgery (i.e., vascular surgery or penile implants) Medication (e.g., Viagra) Vacuum pumps
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Treatment of Sexual Dysfunctions
Female Sexual Arousal Disorder Sex education Cognitive therapy Create non-demanding situations Work on relationship problems Use of artificial lubricants Biological treatments Vacuum pump used on the clitoris Medications also are being investigated - controversial
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Treatment of Sexual Dysfunctions
Female Orgasmic Disorders Sensate focus exercises to reduce performance anxiety Use of the female-superior position Individual therapy (typically for women) involves directed masturbation programs which include Education Self-exploration and self-massage Giving oneself permission Use of fantasy Use of a vibrator Involvement of the partner
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Treatment of Sexual Dysfunctions
Male Orgasmic Disorder Increase sexual stimulation Decrease performance anxiety
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Treatment of Sexual Dysfunctions
Premature ejaculation Partner uses the squeeze technique Tip of the penis is squeezed temporarily to prevent ejaculation An alternative method is the “stop-start” method Biological approaches to treatment of premature ejaculation include the use of psychiatric medications
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Treatment of Sexual Dysfunctions
Sexual Pain Disorders Dyspareunia Treatment includes medical procedures to treat infections Vaginismus Treatment involves the insertion of vaginal dilators of increasing size to help relax the vaginal musculature Woman controls the pace and depth of penetration Psychological therapy also may be needed
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Are there any sex therapy methods that seem “over the top” to you?
Critical Thinking Are there any sex therapy methods that seem “over the top” to you? Explain.
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