abnormal psych quiz chapter 11

•Premature ejaculation

-Behavioral procedures -Biological approaches •Delayed ejaculation -Behavioral procedures -Biological approaches

•ERECTILE DISORDER (ED)

-Characterized by persistent inability to attain or maintain an erection during sexual activity -Occurs in as much as 25 percent of the general male population Found in half of all adult men, whohave erectile difficulty during intercourse at least some of the time •Most cases of erectile disorder result from an interaction of biological, psychological, and sociocultural processes.

•PARAPHILIC DISORDER

-Diagnosis applied only when the urges, fantasies, or behaviors cause significant distress or impairment OR -When satisfaction of the disorder places the individual or others at risk of harm - either currently or in the past (DSM-5)

•Two dysfunctions affect this phase

-MALE HYPOACTIVE SEXUAL DESIRE DISORDER -FEMALE SEXUAL INTEREST/AROUSAL DISORDER

•The DSM-5 categorization of this disorder is controversial

-Many people believe that transgender experiences reflect alternative - not pathological - ways of experiencing one's gender identity -Others argue that gender dysphoria is a medical problem that may produce personal unhappiness

•Excitement phase of the sexual response cycle

-Marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing •Female sexual interest/arousal disorder may include dysfunction during the excitement phase •Male erectile disorder involves dysfunction in the excitement phase only •In men: erection of the penis •In women: swelling of the clitoris and labia and vaginal lubrication

•Diagnosis

-Medical procedures including measurement of NOCTURNAL PENILE TUMESCENCE (NPT) •Causes -Biological -Psychological -Sociocultural

•Three disorders of this phase

-PREMATURE EJACULATION -DELAYED EJACULATION -FEMALE ORGASMIC DISORDER

•Orgasm phase of the sexual response cycle

-Sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically

•Erectile disorder

-Treatments •Focus on reducing a performance anxiety and/or increasing stimulation •May include sensate-focus exercises such as the "TEASE TECHNIQUE" -Biological approaches •Improved with development of sildenafil (Viagra) and other erectile dysfunction drugs •Biological approaches have gained great momentum with the development of sildenafil (Viagra) and other erectile dysfunction drugs. •Most other biological approaches have been around for decades and include gels, suppositories, penile injections, and a vacuum erection device (VED). •These procedures are now viewed as "second-line" treatment.

•Sex therapists have moved beyond the Masters and Johnson approach •More attention paid to PERSISTENT SEXUALITY DISORDER, HYPERSEXUALITY, or SEXUAL ADDICTION

-Use of medications to treat sexual dysfunction not accepted by many therapists •Therapists now treat unmarried couples, those with other psychological disorders, couples with severe marital discord, the elderly, the medically ill, the physically handicapped, gay clients, and clients with no long-term sex partner. •The use of medications to treat sexual dysfunction is troubling to many therapists. •They are concerned that therapists will choose biological interventions, rather than a more integrated approach.

•Sexism, Viagra, and the Pill

-When public outcry arose over the contrast between coverage of Viagra for men and lack of coverage of oral contraceptives for women, laws across the United States finally began to change -Today 28 states require female contraceptive coverage by private insurance companies -The enacted Affordable Care Act (2013) included provisions that require all insurance companies to cover contraceptives - -BUT in the "Hobby Lobby" decision, the Supreme Court ruled in 2014 that corporation owners can refuse to provide such insurance coverage for their employees based on religious grounds -What is your reaction to this decision?

•Paraphilic Disorder

1.For at least 6 months, individual experiences recurrent and intense sexually arousing fantasies, urges, or behaviors involving objects or situations outside the usual sexual norms (nonhuman objects; nongenital body parts; the suffering or humiliation of oneself or one's partner; or children or other nonconsenting persons). 2.Individual experiences significant distress or impairment over the fantasies, urges, or behaviors. (In some paraphilic disorders—pedophilic disorder, exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder, and sexual sadism disorder—the performance of the paraphilic behaviors indicates a disorder, even in the absence of distress or impairment.)

•Delayed Ejaculation

1.For at least 6 months, individual usually displays a significant delay, infrequency, or absence of ejaculation during sexual activity with a partner. 2.Individual experiences significant distress.

•Female Orgasmic Disorder

1.For at least 6 months, individual usually displays a significant delay, infrequency, or absence of orgasm, and/or is unable to achieve past orgasmic intensity. 2.Individual experiences significant distress.

•Premature Ejaculation

1.For at least 6 months, individual usually ejaculates within 1 minute of beginning sex with a partner and earlier than he wants to. 2.Individual experiences significant distress.

•Desire phase of the sexual response cycle

Consists of an interest in or urge to have sex, sexual fantasies, and sexual attraction to others

•Psychological causes

•A general increase in anxiety, depression, or anger may reduce sexual desire in both men and women. •Fears, attitudes, and memories may contribute to sexual dysfunction. •Certain psychological disorders, including depression and obsessive-compulsive disorder, may lead to sexual desire disorders.

·SEXUAL DYSFUNCTIONS

·Are disorders in which people cannot respond normally in key areas of sexual functioning ·Involve as many as 30 percent of men and 45 percent of women in the United States, who suffer from such a dysfunction during their lives ·Are often interrelated to other dysfunctions

·The human sexual response has a cycle with four phases

·Desire ·Excitement ·Orgasm ·Resolution •Sexual dysfunctions affect one or more of the first three phases.

·Disorders of desire

·These disorders are among the most difficult to treat because of the many issues that feed into them ·Therapists typically apply a combination of techniques ·Affectual awareness, self-instruction training, behavioral approaches, and biological interventions

•Biological causes

•A number of hormones interact to produce sexual desire and behavior. •Abnormalities in their activity can lower sex drive. •These hormones include prolactin, testosterone, and estrogen for both men and women. •Sex drive can also be lowered by some medications (including birth control pills and pain medications), some psychotropic drugs, a number of illegal drugs, and chronic illness.

·FEMALE ORGASMIC DISORDER ·Characterized by persistent failure to reach orgasm, experiencing orgasms of very low intensity, or delay in orgasm ·Causes ·Biological ·Psychological ·Sociocultural

•Affects almost 25 percent of women; 10 percent or more have never reached orgasm; 9 percent reach orgasm only rarely •Women who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularly. •Female orgasmic disorder is more common in single women than in married or cohabiting women. •Most clinicians agree that orgasm during intercourse is not mandatory for normal sexual functioning. •Once again, biological, psychological, and sociocultural factors may combine to produce these disorders. •Because arousal plays a key role in orgasms, arousal difficulties often are featured in explanations of female orgasmic disorder. •Early psychoanalytic theory used to consider lack of orgasm during intercourse to be pathological; current evidence suggests that this is untrue. •Biological causes •A variety of physiological conditions: include diabetes and multiple sclerosis •Medications and illegal substances •Postmenopausal changes • Psychological causes •The psychological causes of female sexual interest/arousal disorder, including depression •Memories of childhood trauma and relationship distress •Postmenopausal changes may also be responsible •Sociocultural causes •Theory of female orgasmic problems resulting from sexually restrictive cultural messages challenged •Sexually restrictive histories are equally common in women with and without disorders •Cultural messages about female sexuality have been changing while the rate of female sexual dysfunction stays constant •For years, the leading sociocultural theory of female orgasmic problems was that they resulted from sexually restrictive cultural messages. •This theory has been challenged because: •Sexually restrictive histories are equally common in women with and without disorders. •Cultural messages about female sexuality have been changing while the rate of female sexual dysfunction stays constant. •Researchers suggest that unusually stressful events, traumas, or relationships may produce the fears, memories, and attitudes that characterize these dysfunctions. •Research has also linked orgasmic behavior to certain qualities in a woman's intimate relationships (such as emotional intimacy).

•FROTTEURISTIC DISORDER -Includes repeated and intense fantasies, urges, or behaviors involving touching and rubbing against a nonconsenting person -Usually begins in the teen years or earlier

•Almost always male, the person fantasizes during the act that he is having a caring relationship with the victim. •Acts generally decrease and disappear after age 25.

•Various theoretical explanations for paraphilic disorders; little formal supporting evidence •Treatments -Psychological and sociocultural treatments have been available the longest -Contemporary professionals also use biological interventions •ANTIANDROGENS •SSRIS

•Although theorists have proposed various explanations for paraphilic disorders, there is little formal evidence to support them. •None of the treatments applied to these disorders have received much research or been proved clearly effective. •Psychological and sociocultural treatments have been available the longest, but today's professionals are also using biological interventions. •ANTIANDROGENS Lower the production of testosterone •SSRIS: Serotonin-enhancing antidepressant medications •Some practitioners administer drugs called antiandrogens that lower the production of testosterone. •Clinicians are also increasingly administering SSRIs, the serotonin-enhancing antidepressant medications, to (hopefully) reduce the compulsion-like sexual behaviors. •These drugs also have a common side effect of lowered sexual arousal.

•Psychological causes

•Any of the psychological causes of male hypoactive sexual desire can also interfere with arousal and lead to erectile dysfunction. •One well-supported cognitive explanation for ED emphasizes PERFORMANCE ANXIETY and the SPECTATOR ROLE.

•PREMATURE EJACULATION (EARLY or RAPID) -Characterized by persistent reaching of orgasm and ejaculation within 1 minute of beginning sexual activity with a partner •Causes -Psychological -Biological

•As many as 30 percent of men experience premature ejaculation at some time. •Psychological causes •Psychological, particularly behavioral, explanations of this disorder have received more research support than other explanations. •The dysfunction seems to be typical of young, sexually inexperienced men. •It may also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal. •Biological factors •Genetic predisposition •Overactive and underactive serotonin receptors •Greater sensitivity or nerve conduction in the area of their penis •There is a growing belief among many clinical theorists that biological factors may also play a key role in many cases of this disorder. •One theory states that some men are born with a genetic predisposition. •A second theory argues that the brains of men with early ejaculation contain certain serotonin receptors that are overactive and others that are underactive. •A third explanation holds that men with this dysfunction experience greater sensitivity or nerve conduction in the area of their penis.

•Modern sex therapy principles and techniques

•Assessing and conceptualizing the problem •Mutual responsibility •Education about sexuality •Emotion identification •Attitude change •Elimination of performance anxiety and the spectator role •Increasing sexual and general communication skills •Changing destructive lifestyles and marital interactions •Addressing physical and medical factors

•1950s and 1960s: Behavioral therapy

•Behavioral therapists attempted to reduce fear by applying relaxation training and systematic desensitization •Had some success, but failed to work in cases where the key problems included misinformation, negative attitudes, and lack of effective sexual techniques •1970: Human Sexual Inadequacy •This book, written by William Masters and Virginia Johnson, revolutionized treatment of sexual dysfunctions. •This original "sex therapy" program has evolved into a complex approach. •Includes techniques from cognitive, behavioral, couples, and family systems therapies, along with a number of sex-specific techniques •More recently, biological interventions have also been incorporated

Most cases of low sexual desire or sexual aversion are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive

•Biological causes •Psychological causes •Sociocultural causes

•Biological causes

•Medical procedures have been developed for diagnosing biological causes of ED. •One strategy involves measuring nocturnal penile tumescence (NPT). •Men typically have erections during REM sleep; abnormal or absent nighttime erections usually indicate a physical basis for erectile failure.

•TRANSVESTIC DISORDER (TRANSVESTISM or CROSS-DRESSING)

•TRANSVESTIC DISORDER (TRANSVESTISM or CROSS-DRESSING) -Characterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal -May involve operant conditioning -Often confused with gender dysphoria, but the two are separate patterns

•Characteristics -Desire to change primary and secondary sex characteristics and acquire the characteristics of the other sex •Explanations -Biological

•Biological investigators have recently detected differences between the brains of control participants and participants with gender dysphoria. •Those with the disorder had heightened blood flow in the insula and reduced blood flow in the anterior cingulate cortex. •These brain areas are known to play roles in human sexuality and consciousness. •Cluster of cells in the hypothalamus called the bed nucleus of stria terminalis (BST) was only half as large in these people as it was in a control group of nontransgender men. •Usually, a woman's BST is much smaller than a man's, so in effect the male-assigned people with gender dysphoria were found to have a female-sized BST. •It may be that male-assigned people who develop gender dysphoria have a key biological difference that leaves them very uncomfortable with their assigned sex characteristics.

•MALE HYPOACTIVE SEXUAL DESIRE DISORDER

•Characterized by a lack of interest in sex and little sexual activity: physical responses may be normal. •Prevalent in about 16 percent of men. •While most cultures portray men as wanting all the sex they can get, as many as 18 percent of men worldwide have this disorder, and the number seeking therapy has increased during the past decade.

•FEMALE SEXUAL INTEREST/AROUSAL DISORDER

•Characterized by a lack of normal interest in sexual activity; rare initiation of or little excitement during sexual activity. •Reduced sexual interest and desire may be found in as many as 33 percenty of women. •It is important to note that many sex researchers and therapists believe it is inaccurate to combine desire and excitement symptoms into a single female disorder.

•Premature ejaculation has been successfully treated for years by behavioral procedures such as the "stop-start" or "pause" procedure. •Some clinicians use SSRIs, the serotonin-enhancing antidepressant drugs. •Because these drugs often reduce sexual arousal or orgasm, they may be helpful in delaying early ejaculation. •Many studies have reported positive results with this approach.

•Delayed ejaculation •Therapies to reduce this disorder include techniques to reduce performance anxiety and increase stimulation. •When the cause of the disorder is physical, treatment may include a drug to increase arousal of the sympathetic nervous system.

•GENITO-PELVIC PAIN/PENETRATION DISORDER

•Different approaches are used to treat severe vaginal or pelvic pain during intercourse. •Given that most cases are caused by physical problems, pain management techniques and medical intervention may be necessary. •Specific treatment for involuntary contractions of the vaginal muscles. •Practice tightening and releasing the muscles of the vagina to gain more voluntary control. •Overcome fear of penetration through gradual behavioral exposure treatment. •Most women treated using these methods eventually report pain-free intercourse. •Different approaches used to treat severe vaginal or pelvic pain during intercourse. •May include medical intervention

•Same hormonal imbalances that can cause male hypoactive sexual desire can also produce ED. •Most commonly, vascular problems are involved.

•ED can also be caused by damage to the nervous system from various diseases, disorders, or injuries. •The use of certain medications and various forms of substance abuse may interfere with erections.

·EXHIBITIONISTIC DISORDER ·Characterized by arousal from the exposure of genitals in a public setting ·Treatment ·Aversion therapy and masturbatory satiation ·May be combined with orgasmic reorientation, social skills training, or cognitive-behavioral therapy

•EXHIBITIONISTIC DISORDER •Characterized by arousal from the exposure of genitals in a public setting •Includes a desire to provoke shock or surprise, rather than initiate sexual contact •Usually begins before age 18 and is most common in males •Treatment •Generally includes aversion therapy and masturbatory satiation •May be combined with orgasmic reorientation, social skills training, or cognitive-behavioral therapy

•Sociocultural causes

•Each of the sociocultural factors that contribute to male hypoactive sexual desire has also been linked to ED. -Job and marital distress are particularly relevant. •For example, as many as 90 percent of men with severe depression experience some degree of ED. •Once a man begins to have erectile difficulties, he becomes fearful and worries during sexual encounters; instead of being a participant, he becomes a spectator and judge. •This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure.

•DSM-5 also includes a category called

•GENDER DYSPHORIA Pattern in which people feel that they have been born to the wrong sex and identify with the other gender

·SEXUAL MASOCHISM DISORDER ·Characterized by fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer; most fantasies begin in childhood ·Cause ·Seem to develop through the behavioral process of classical conditioning

•Information for image A celebration of S/M Sexual sadism and sexual masochism have been viewed by the public with either bemusement or horror, depending on the circumstances and events that surround particular acts of these paraphilias. On the light side, the annual Folsom Street Fair in San Francisco is a very large event that celebrates S/M and invites people (like this participant) to go on stage, display their trademark outfits and, in some cases, participate in whippings or spankings. •Only those who are very distressed or impaired by such fantasies receive the diagnosis. •Most masochistic fantasies begin in childhood and seem to develop through the behavioral process of classical conditioning.

•VOYEURISTIC DISORDER -Characterized by repeated and intense sexual urges to observe people as they undress or engage in sexual activity •Cause -Psychodynamic: Disorder involves seeking power -Behaviorists: Disorder is learned behavior

•Many psychodynamic theorists propose that those with voyeuristic disorder are seeking power. •Behaviorists explain the disorder as a learned behavior that can be traced to a chance and secret observation of a sexually arousing scene. •May involve masturbation during the act of observing or while remembering it later. •Vulnerability of discovery often adds to the excitement,.

•Sociocultural causes

•Many sufferers of desire disorders are feeling situational pressures. •Examples: divorce, death, job stress, infertility, and/or relationship difficulties •Cultural standards can set the stage for development of these disorders. •The trauma of sexual molestation or assault is especially likely to produce sexual dysfunction.

•GENITO-PELVIC PAIN/PENETRATION DISORDER -Occurs when enormous physical discomfort during intercourse are experienced by women much more often than men -May involve learned fear response, relationship difficulties, infection, disease

•Most clinicians agree with the cognitive-behavioral theory that this form of genito-pelvic pain/penetration disorder is a learned fear response. •A variety of factors can set the stage for this fear, including anxiety and ignorance about intercourse, exaggerated stories, trauma caused by an unskilled partner, and the trauma of childhood sexual abuse or adult rape. •Some women experience painful intercourse because of infection or disease. •Although psychological factors or relationship difficulties may contribute to this problem, psychosocial factors alone are rarely responsible.

·DELAYED EJACULATION ·Characterized by a repeated inability to ejaculate or by a very delayed ejaculation after normal sexual activity with a partner ·Causes ·Biological ·Psychological

•Occurs in 8 percent of the male population •Biological causes • Include low testosterone, neurological disease, and head or spinal cord injury •Medications, including certain antidepressants (especially SSRIs) and drugs that slow down the sympathetic nervous system, can also affect ejaculation •Psychological causes •Performance anxiety and the spectator role: cognitive factors involved in ED •Past masturbation habits •Male hypoactive sexual desire disorder •A leading psychological cause appears to be performance anxiety and the spectator role, the cognitive factors involved in ED. •Another psychological factor may be past masturbation habits. •This disorder also may develop out of male hypoactive sexual desire disorder.

•Patterns of gender dysphoria -Female-to-male -Male-to-female/ANDROPHILIC TYPE -Male-to-female/AUTOGYNEOPHILIC TYPE •Treatments types

•Patterns of gender dysphoria •Female-to-male: Behave in typically male pattern early on; sexually attracted to females in adolescence, but desire to be considered male •Male-to-female/ANDROPHILIC TYPE: Behave in typically female pattern from birth; effeminate; sexually attracted to males in adolescence; desire relationship with men who see them as women •Male-to-female/AUTOGYNEOPHILIC TYPE: Not sexually attracted to males but to fantasy of being female; developmental patterns •Types of treatment •Psychotherapy •Biological interventions •Hormone treatments •SEXUAL REASSIGNMENT (sex change) surgery

Gender Dysphoria

•People with this disorder persistently feel that they have been born to the wrong biological sex, and gender changes would be desirable • •Gender dysphoria is more than a variant lifestyle and is not a clearly defined medical problem (DSM-5)

normal sexual response cycle

•Researchers have found a similar sequence of phases in both males and females. Sometimes, however, women do not experience orgasm; in that case, the resolution phase is less sudden. And sometimes women experience two or more orgasms in succession before the resolution phase.

•Experts recognize two general categories of SEXUAL DISORDERS

•SEXUAL DYSFUNCTIONS Problems with sexual responses •PARAPHILIC DISORDERS Repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations

·SEXUAL SADISM DISORDER ·Characterized by repeated and intense arousal by the physical or psychological suffering of another individual; usually male ·Causes ·Theoretical explanations ·Treatment

•SEXUAL SADISM DISORDER •Arousal may be expressed through fantasies, urges, or behaviors. •Involves imagined total control over a sexual victim •Named for the infamous Marquis de Sade •Causes •Sadistic fantasies may first appear in childhood or adolescence; pattern is long-term. •Theoretical explanations •Behavioral: Appears to be related to classical conditioning •Psychodynamic and cognitive: Underlying feelings of sexual inadequacy •Biological: Possible brain and hormonal abnormalities •Aversion therapy is primary treatment.

•The last 40 years have brought major changes in the treatment of sexual dysfunction •Early twentieth century: Psychodynamic therapy

•Sexual dysfunction caused by a failure to progress through the stages of psychosexual development •Therapy focused on gaining insight and making broad personality changes; was generally unhelpful

•The definitions of various paraphilic disorders are strongly influenced by the norms of the particular society in which they occur

•Some clinicians argue that these behaviors should be considered disorders only when other individuals are hurt by them

•PEDOPHILIC DISORDER -Characterized by repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with children; person either acts on these urges or experiences clinically significant distress or impairment •Classic type •Hebephilic type •Pedohebephilic type •Causes •Treatments

•Some people are satisfied with child pornography. •Includes watching, fondling, or engaging in sexual intercourse typically with female children •Others are driven to watching, fondling, or engaging in sexual intercourse with children. •Evidence suggests that two-thirds of victims are female. •People with this disorder usually develop it in adolescence. •Some were sexually abused as children; many were neglected, excessively punished, or deprived of close relationships in childhood. •Most are immature, display distorted thinking, and have an additional psychological disorder. •Cause •Some theorists have proposed a related biochemical or brain structure abnormality but clear biological factors have yet to emerge in research. •Treatment •Most people with this disorder are imprisoned or forced into treatment. •Treatments include aversion therapy, masturbatory satiation, orgasmic reorientation, and treatment with antiandrogen drugs. •Cognitive-behavioral treatment involves relapse-prevention training, modeled after programs used for substance dependence.

Sexual Dysfunctions

•Some people struggle with sexual dysfunction their whole lives •For others, normal sexual functioning preceded the disorder •In some cases the dysfunction is present during all sexual situations •In others it is tied to particular situations

•FEMALE ORGASMIC DISORDER

•Specific treatments for this disorder include cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training. •Biological treatments, including hormone therapy or the use of sildenafil (Viagra), have not been consistently helpful. •Education advocated as course of action by some therapists. •Lack of orgasm during intercourse is not necessarily a sexual dysfunction, provided the woman enjoys intercourse and is orgasmic through other means. •For this reason, some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse.

•More recently, biological interventions have also been incorporated •Modern sex therapy: Short-term and instructive

•Therapy typically lasts 15 to 20 sessions. •It is centered on specific sexual problems rather than on broad personality issues.

•GENITO-PELVIC PAIN/PENETRATION DISORDER ·VAGINISMUS ·DYSPAREUNIA

•VAGINISMUS -- Some women experience involuntary contractions of the muscles of the outer third of the vagina; can prevent intercourse; learned fear response; infection •DYSPAREUNIA - Severe vaginal or pelvic pain during sexual intercourse; physical cause; childbirth

•FETISHISTIC DISORDER •Includes recurrent intense sexual urges, sexually arousing fantasies, or behaviors involving use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment. -Causes -Treatment

•Women's underwear, shoes, and boots are especially common; more prevalent in men than women, usually begins in adolescence •Researchers have been unable to pinpoint the causes of fetishistic disorder. •Behaviorists propose that fetishes are learned through classical conditioning. •Behavioral treatment •Aversion therapy •Masturbatory satiation •Orgasmic reorientation •Researchers have been unable to pinpoint the causes of fetishistic disorder. •Behaviorists propose that fetishes are learned through classical conditioning. •Behavioral treatment •Aversion therapy •Masturbatory satiation •Orgasmic reorientation •People with this disorder are sometimes treated with aversion therapy. •Another behavioral treatment is masturbatory satiation, in which clients masturbate to boredom while imagining the fetish object. •An additional behavioral treatment is orgasmic reorientation, a process that teaches individuals to respond to more appropriate sources of sexual stimulation.