sexual dysfunctions

Sexual Dysfunctions

Chapter 15

Learning ObjectivesTypes of Sexual Dysfunctions

Origins of Sexual Dysfunctions

Treatment of Sexual Dysfunctions

Types of Sexual Dysfunctions

Sexual Dysfunction

s

• 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


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


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

DSM proposes four categories


• Lifelong• Acquired

Sexual dysfunctions can be

• Generalized• Occur in all situation

• Situational • Occur only in some situations

Sexual dysfunctions classified as

Critical ThinkingWhen does a

sexual problem become a sexual

dysfunction?

How can concern about a sexual problem develop into a dysfunction?

Sexual Desire DisordersHypoactive sexual desire disorder

Little or no sexual interest or desire

Absence of sexual fantasies

Most commonly diagnosed sexual dysfunctionDoes not indicate physical inability

More common in women than men

Cause unclear

Sexual Arousal DisordersMale 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

Sexual Arousal DisordersFemale sexual arousal disorder

Persistent difficulties becoming sufficiently lubricated in response to sexual stimulationCan be lifelong or situational

May have physical causes

Usually has psychological causes, such as anger, resentment, or trauma

Orgasmic DisordersFemale 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

Orgasmic DisordersMale orgasmic disorder

This is also termed delayed ejaculation, retarded ejaculation, or ejaculatory incompetence

Orgasmic DisordersPremature ejaculation

Ejaculation occurs with minimal sexual stimulation and before the man desires itHard to define what is meant by premature

Rapid female orgasm

Can women reach orgasm too quickly?It is not classified as a sexual dysfunctionMay result in sexual relationship issues

Orgasmic disorders can have physical or psychological causes

Sexual Pain DisordersDyspareunia

Persistent or recurrent pain during sexual intercourse which is commonly caused by lack of lubrication in women and genital infections in menPsychological 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


Biopsychosocial model

• Considering interaction of biological, psychological, and social factors in sexual dysfunctions


Biological Causes

Testosterone deficiency• Hypogonadism• Reductions with age

Fatigue

Medical conditions• Heart disease,

diabetes, MS, spinal cord injuries, surgical complications, hormonal problems


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.


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


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


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


• 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


• Psychosexual therapy• Combines behavioral

and psychoanalytic methods

• Improve sexual communication

• Eliminate performance anxiety

• Increase sexual skills and knowledge

The Helen Singer Kaplan

Approach


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


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


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


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


Male Orgasmic Disorder

• Increase sexual stimulation• Decrease performance

anxiety


Premature ejaculatio

n

• 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


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

Critical Thinking

Are there any sex therapy methods

that seem “over the top” to you?

Explain.

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