1. What sexual difficulties could you have? © Robert J. Atkins, Ph.D.

3. Sexual problems are common.

4. Sexual problems if you are a woman

5. What if you can not climax? Female orgasmic disorder  Symptoms Inability to climax at least half the time.  Treatment Self and partner education on what is enjoyable Use of a vibrator Direct manual stimulation of the clitoris during intercourse. Female initiated movements  (Woman on top position)

6. What if sex hurts?  Vaginismus  Symptoms Involuntary spasmic contraction of the muscles surrounding the outer third of the vagina. Painful intercourse  Treatment Manual dialation Hegar dialators

7. What if you have deep pelvic pain?  Endometriosis  Occurs when the cells of the lining of the uterus are disrupted, and often grow outside the uterus within the abdominal cavity.  Symptoms Deep pelvic pain, painful menstruation, painful sex, abdominal pain when walking, etc.  Laparoscopic surgery

8. What if you are constantly turned on?  Persistent Sexual Arousal Syndrome (PAIS)  Frequent, intrusive sexual arousal  Tingling or other sensations – without sexual desire  Not always relieved by orgasm  Relatively rare diagnosis  Treatment Antidepressants sometimes helpful

9. What if you have pelvic inflammatory disease?  Symptoms Abdominal pain Pain during intercourse  Treatment Antibiotics

10. What if your vagina and vulva becomes inflamed ?  Vaginitis  Symptoms Inflammation and infection Redness Itching Irritation  Treatment Based on the cause Often antibiotic pills and creams

11. Do you remember?  What can you do if you can not climax?  What might cause painful vaginal contractions? How can you treat it?  What might cause deep pelvic pain?  What might cause redness and irritation in your vulva?

12. Sexual problems possible for both sexes (More for women)

13. What if the thought of sex makes you sick?  Sexual aversion disorder  Occurs when sexual activity is predicted  Symptoms Nausea High anxiety Sexual repulsion  Treatment Systematic desensition

14. What if you have no sexual desire?  Hypoactive sexual desire  Most difficult to treat  Symptoms Lack of sexual interest  Many causes Physical (e.g. medications) Psychological  Possible symptom of unresolved relationship problems

15. Hypoactive sexual desire (Cont.)  Treatment No “Viagra for women” Testosterone  Not FDA approved  Difficulties Dealing with whatever may be the cause  E.g. Menopause  Relationships

16. What if sex hurts? Dyspareunia  Symptoms Painful intercourse  Treatment Based on cause  Vaginismus  Vaginal dryness  STD’s  Foreskin tightness & irritation

17. Do you remember?  What are the symptoms of sexual aversion disorder?  What would cause you to lose interest in sex?  What would cause sex to hurt?

18. Sexual problems if you are a man

19. What is male arousal disorder? “ED” Erectile Dysfunction  Also called Impotence (older term)  Symptoms Inability to get an erection  Causes Restriction of blood flow into the penis High cholesterol High blood pressure Diabetes Prostate surgery Etc. Penile implants

20. Male arousal disorder (Cont.)  Treatment Medical  Viagra  Levitra  Cialis Squeeze technique Relationship difficulties

21. What are penile implants?  Men more satisfied with the inflatable prosthetic device than semi-rigid rods.

22. Penile implants  Semi-rigid rods

23. What is peyronie’s disease?  Symptoms Thickening of the length of the top of the shaft of the penis.  Treatment Surgery

24. What is premature ejaculation?  Symptoms Inability to delay ejaculation  Treatment Squeeze technique Avoid using the man above “Missionary” position.

25. What is male orgasmic disorder?  Also called ejaculatory incompetence (older term)  Symptoms Inability to ejaculate  Treatment Stimulation to produce ejaculation immediately after penetration Move penetration earlier and earlier.

26. Do you remember?  What can men do to last longer and avoid premature ejaculation?  What is it called if the penis bends up because of thickening on the top?  Do men prefer inflatable implants or semi-rigid rods for surgical E.D. treatment?