Chapter 11 Disorders of Sex and Gender
directed masturbation training
A sex therapy approach that teaches women with female arousal or orgasmic problems how to masturbate effectively and eventually to reach orgasm during sexual interactions.
sexual reassignment or sex-change surgery
A surgical procedure that changes a person's sex organs, features, and in turn, sexual identity. Also known as sexual reassignment surgery.
erectile disorder
a dysfunction in which a man repeatedly fails to attain or maintain an erection during sexual activity
biological causes of low sexual desire
a high level of the hormone prolactin (in both sexes) a low level of of testosterone in men. and either a high or low level of the female sex hormone estrogen.
The decline of sexual activity in men age 60 and over is usually attributed to:
advancing age and failing health
tease technique
during sensate-focus exercises: partner keeps caressing the man, but if the man gets an erection, the partner stops caressing him until he loses it. Use oral or manual sex to achieve the woman's orgasm.
a person with ______ experiences severe pain in the genitals during sexual activity
dyspareunia
In this disorder males find it difficult to obtain an erection, maintain an erection, and/or achieve past levels of erectile rigidity during sexual intercourse.
erectile disorder
Men with this disorder are most often over the age of 50, largely because so many cases are associated with ailments or diseases of older adults.
erectile disorder
This male disorder involves dysfunction during the excitement phase only.
erectile disorder
nocturnal penile tumescence (NPT)
erection during sleep
The _____ phase of the sexual response cycle is marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing
excitement
Disorders of excitement
female sexual interest/arousal disorder (also disorder of desire) erectile disorder
Treatments for erectile disorder
focus on man's performance anxiety, increasing stimulation or both use range of behavioral, cognitive and relationship interventions. Tease technique Medications: Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) second line treatments: gel suppositories, injections of drugs into penis, vacuum erection device (VED)
The most favorite part of the sexual cycle in the majority of female participants
foreplay
Statistics of vaginismus
less than 1% of all women have vaginisums.
previous names of delayed ejaculation
male orgasmic disorder inhibited male orgasm
In this phase of the sexual response cycle a person's sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically.
orgasm
hypoxyphilia
people strangle or smother themselves (or ask their partner to strangle them) in order to enhance their sexual pleasure.
autoerotic asphyxia
people, usually males and as young as 10 years old, may accidentally induce a fatal lack of oxygen by hanging, suffocating, or strangling themselves while masturbating.
The belief that people with voyeurism are seeking to gain power over others by their actions is a ______ perspective
psychodynamic
treatment for gender dysphoria
psychotherapy but prefer biological interventions eventually. transgender adults change their sexual characteristics by means of hormone treatments. facial feminization surgery,
If low levels of alcohol may enhance the sex drive by lowering a person's inhibition, high levels will:
reduce it.
Treatment for delayed ejaculation
techniques to reduce performance anxiety and increase stimulation: one tx involves male masturbating in front of partner then inserting penis just short of orgasm, increasing the likelihood that he will ejaculate during intercourse.
desire phase
the phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and sexual attraction
orgasm phase
the phase of the sexual response cycle during which a person's sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically
excitement phase
the 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.
Sexual dysfunction and gender
30% of men and 45% of women suffer from dysfunction during their lives.
statistics of exhibitionistic disorder
-4.3% of men are exhibitionists, -1/3-half of all women have had direct contact with an exhibitionist or flasher -the urge to exhibit becomes stronger when there is a lot of free time or significant stress -begins before age 18 -usually men -typically immature and have difficulty in interpersonal relationships -30% married -30% divorced or separated -sex with wives unsatisfactory -have doubts about masculinity -strong bond to mother
Current trends in sex therapy
-treat clients who are living together but not married -treat sexual dysfunctions that arise from psychological disorders such as depression, mania, schizophrenia, and personality disorders. -no longer screen out clients with marital discord, the elderly, the medically ill, the physically handicapped, gay clients, or individuals who have no long-term sex partner. -pay more attention to excessive sexuality, (sometimes called persistent sexuality disorder, hyper sexuality, or sexual addiction)
statistics of voyeuristic disorder
-usually begins before age 15 and tends to persist -may masturbate when thinking about or during observation -humiliating the person being observed and the risk of being discovered adds to excitement -source of sexual excitement in fantasy -seeking to gain power over others -feel inadequate or sexually or socially shy -
psychological causes of erectile disorder
1-same as hypoactive sexual desire disorder 90% of all men with severe depression experience erectile dysfunction. 2-performance anxiety 3- spectator role
stages of sex therapy
1. Assessing and conceptualizing the problem 2. mutual responsibility 3. education about sexuality 4. Emotion identification 5. Attitude change 6. Elimination of performance anxiety and the spectator role. 7. increasing sexual and general communication skills 8. Changing destructive lifestyles and marital interactions 9. Addressing physical and medical factors
3 patterns of gender dysphoria
1. Female to male 2. Male to female - androphilic type - behave effeminately, often attracted to males, but prefer heterosexual men 3. Male to female - autogynephilic type - attracted to self as a female - behave in masculine way, but become aroused when cross-dressing - attracted to females - desire to become female
dx checklist of Genito-Pelvic Pain/Penetration Disorder
1. For at least 6 months, individual repeatedly experiences at least one of the following problems: -Difficulty having vaginal penetration during intercourse -significant vaginal or pelvic pain when trying to have intercourse or penetration -Significant fear that vaginal penetration will cause vaginal or pelvic pain -significant tensing of the pelvic muscles during vaginal penetration 2. Individual experiences significant distress from this.
Dx checklist for 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.
Female Sexual Interest/Arousal Disorder DX
1. For at least 6 months, individual usually displays reduced or no sexual interest and arousal, characterized by the reduction or absence of at least three of the following: -Sexual initiation or receptiveness-Excitement or pleasure during sex - Responsiveness to sexual cues -Genital or nongenital sensations during sex. 2. Individual experiences significant distress
DX checklist of erectile disorder
1. For at least 6 months, the individual usually finds it difficult to obtain, maintain and/or achieve past levels of erectile rigidity during sex. 2. Individual experiences significant distress
biological factors of premature ejaculation
1. Some men are born with genetic predisposition (91% of men who had premature ejaculation had 1st degree relatives with the disorder) 2. overactive serotonin receptors 3. greater sensitivity or nerve conduction in the penis area.
cycle of sexual response
1. desire, 2. excitement, 3. orgasm and 4. resolution (sexual dysfunctions affect one or more of the first 3 phases. Resolution consists simply of the relaxation and reduction in arousal that follow orgasm.)
Dx checklist gender dysphoria in adolescents and adults
1. for 6 months or more, individual's gender-related feelings and/or behaviors is at odds with those of his or her assigned gender, as indicated by two or more of the following symptoms: * Gender-related feelings and/or behaviors clearly contradict the individual's primary or secondary sex characteristics *Powerful wish to eliminate one's sex characteristics *yearning for the sex characteristics of another gender *powerful wish to be a member of another gender *Yearning to be treated as a member of another gender *firm belief that one's feelings and reactions are those that characterize another gender. 2. individual experiences significant distress or impairment.
Dx checklist 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 or nongenital body parts; the suffering or humiliation of oneself or one's partner; or children or other non consenting 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.)
Dx checklist 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.
male hypoactive sexual desire disorder DX
1. for at least 6 months, individual usually displays reduced or no sexual thoughts, fantasies, or desires. 2. Individual experiences significant distress about this.
Dx checklist 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 significan distress.
transgender statistics
1.5 million are transgender 0.5% of the population
Which is NOT given as a factor in the origins of female arousal and orgasmic disorders? 1- Religious upbringing 2- restricted in their dating as teenagers 3- engaging in masturbation in childhood 4- being told that "nice girls don't" enjoy sex
3- engaging in masturbation in childhood.
studies indicate that ____% of women have never had an orgasm.
10
Your friend, Samantha, tells you that she hardly ever has an orgasm during sexual intercourse. You tell your friend. "You may be experiencing female orgasmic disorder along with _______ of women who have never had an orgasm.
10%
statistics of delayed ejaculation
10% of men worldwide
research suggests that more than ______ of women suffer from dyspareunia to some degree.
14%
dyspareunia
14% of women suffer to some degree, typically enjoy sex and get aroused but find their sex lives very limited by the pain that accompanies what used to be a positive event. usually caused by injury to the vagina or pelvic ligaments during childbirth. the scar left by episiotomy can cause pain. 16% of women have severe vaginal or pelvic pain during intercourse for up to a year after giving birth. sometimes caused by penis colliding with hymen, vaginal infections, wiry pubic hair rubbing acainst the labia, pelvic dz, tumors, cysts, allergic reactions to the chemicals in vaginal douches and contraceptive creams, the rubber in condoms and diaphragms, and the protein in semen.
Modern sex therapy usually lasts ______ sessions
15-20
sexting statistics
20% of all cell phone users have sent a picture of themselves, 40% have received a sext. 1/2 of all who recieve a sexual image or text message save it. 25% of recipients forward the sexual photos that the recieve to others. 18-24 years old are the sexters Males sext 3-2 more often than females. 16% of sexter send their pictures to strangers step toward infidelity sexting can be constructive activiey adding dimension to marriage. enhancing in-person romantic relationship, creates more bonding and heightens sexual satisfaction in teh relationship.
statistics for female orgasmic disorder
25% have this problem to some degree 1/3 of postmenopausal women 10% of women have never had an orgasm 9% rarely have orgasms most women reach orgasm by direct stimulation of the clitoris
statistics of men and genito-pelvic pain/penetration disorder
3% of men suffer from pain in the genitals during intercourse, and many of these men also qualify for a diagnosis of genito-pelvic pain/penetration disorder
statistics of premature ejaculation
30% of men worldwide ejaculate early at some time. the duration of intercourse in society has increased over the decades which causes men more distress. usually younger men have this dysfunction but men of any age may suffer from it.
Which hormone has NOT been linked to hypoactive sexual desire? 1.- testosterone 2- estrogen 3- prolactin 4- oxytocin
4- oxytocin
Female orgasm statistics
90% learn to have an orgasm during masturbation 80% during caressing by their partners 30% during intercourse
masturbatory satiation
A behavioral treatment in which a client masturbates for a long period of time while fantasizing in detail about a paraphilic object. The procedure is expected to produce a feeling of boredom that becomes linked to the object.
sexual dysfunctions
A disorder marked by a persistent inability to funciton normally in some area of the sexual response cycle.
Female orgasmic disorder
A dys-function in which a woman persistently fails to reach orgasm, has very low intensity orgasms, or has very delayed orgasms.
Female sexual interest/arousal disorder
A female dysfunction marked by a persistent reduction or lack of interest in sex, as well as, in some cases, limited excitement and few sexual sensations during sexual activity.
Delayed ejaculation
A male dysfunction characterized by persistent inability to ejaculate or very delayed ejaculations during sexual activity with a partner.
transvestic disorder
A paraphilic disorder consisting of repeated and intense sexual urges, fantasies, or behaviors that involve dressing in clothes of the opposite sex, accompanied by clinically significant distress or impairment. AKA transvestism or cross-dressing
Which theory of conditioning has been used to help explain the origins of sexual masochism?
Classical conditioning
flibanserin
FDA approved drug used as a treatment for women distressed by low sexual desire.
vaginismus
IN genito-pelvic pain/penetration disorder, the muscles around the outer third of the vagina involuntarily contract, preventing entry of the penis. can prevent a couple from ever having intercourse. However some women with vaginismus enjoy sex greatly, have a strong sex drive, and reach orgasm with stimulation of the clitoris. they just fear the discomfort of penetration of the vagina.
two dysfunctions of the desire phase
Male hypo-active sexual desire disorder and female sexual interest arousal disorder.
male-to-female gender dysphoria: autogynephilic type
Not sexually attracted to males attracted to the idea of themselves being female. After puberty become sexually aroused when they cross-dress. Attracted to females during and beyond adolescence.
sex drive and drugs
Reduce: pain meds psychotropic drugs cocaine marijuana amphetamines heroin High levels of alcohol Increase: Low levels of alcohol
leading theorist on gender dysphoria
Richard Carroll
Sociocultural causes of low sexual desire
Situational pressure, divorce, death, job stress, infertility difficulties, having a baby. problems in the relationship-loss of affection, feel powerless and dominated. If one person isn't enthusiastic the other can lose interest. Individual needs for closeness. cultural standards: society equates sexual attractiveness with youthfulness, therefore they have low self-image or their attraction to their partner diminishes with age. trauma of sexual molestation or assault produces fears, attitudes and memories found in disorders of sexual desire.
Treatment for Genito-Pelvic Pain/Penetration disorder
Specific treatment for involuntary contractions of the muscles around the vagina typically involves two approaches. 1. Practice tightening and relaxing vaginal muscles until she gains more voluntary control over them 2. receive gradual behavioral exposure treatment some medical interventions have been used like botox to reduce spasms however this doesn't always work.
What do sex researchers and therapists believe about Female sexual interest/arousal disorder?
That it is inaccurate to combine desire and excitement symptoms into a single female disorder
self-instruction training in sex therapy
The client learns self-instructions that guide behavior, reduce anxiety and increase problem-solving ability. for example "I can allow myself to enjoy sex; it doesn't mean I'll lose control"
performance anxiety
The fear of performing inadequately and a related tension experienced during sex.
Which procedure is an effective treatment for early ejaculation
The stop start procedure
Which is NOT an accurate statement about men suffering from exhibitionistic disorder? 1. About 30% is married 2. They often have unsatisfactory sexual relationships with their wives. 3. The disorder begins before age 18.
They generally have great confidence in their masculinity
A revolution in the treatment of sexual dysfunctions occurred with the publication of ______'s landmark book human sexual inadequacy
William Masters and Virginia Johnson
who developed the cognitive-behavioral theory of erectile disorder
William Masters and Virginia Johnson (1970)
sex drive is determined by...
a combination of biological, psychological, and sociocultural factors, any of which may reduce sexual desire.
Gender dysphoria
a disorder in which a person persistently feels clinically significant distress or impairment due to his or her assigned gender and strongly wishes to be a member or another gender.
paraphilic disorder
a disorder in which a person's paraphilia causes great distress, interferes with social or occupational activities, or places the person or others at risk of harm - either currently or in the past
Premature ejaculation
a dysfunction in which a man persistently reaches orgasm and ejaculates within one minute of beginning sexual activity with a partner and before he wishes to.
CBT position on genito-pelvic pain/penetration disorder
a learned fear response, set off by a woman's expectaion that intercourse will be painful and damaging. Factors that may set the stage for this fear: anxiety, ignorance, exaggerated stories, about painful bloody first occasion interecourse is for women. Trauma caused by an unskilled lover who forces his penis into the vagina before the woman is aroused and lubricated, and the trauma of childhood sexual abuse or adult rape.
Male hypoactive sexual desire disorder
a male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity.
fetishistic disorder
a paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment
voyeuristic disorder
a paraphilic disorder in which a person has repeated and intense sexual desires to observe unsuspecting people in secret as they undress or to spy on couples having intercourse, and either acts on these urges with nonconsenting people or experiences clinically significant distress or impairment.
Pedophilic disorder
a paraphilic disorder in which a person has repeated and intense sexual urges or fantasies about watching, touching or engaging in sexual acts with children, and either acts on these urges or experiences clinically significant distress or impairment.
sexual sadism disorder
a paraphilic disorder in which a person has repeated and intense sexual urges or fantasies that involve inflicting suffering on others, and either acts on these urges with non-consenting individuals or experiences clinically significant distress or impairment.
frotteuristic disorder
a paraphilic disorder in which a person has repeated and intense sexual urges or fantasies that involve touching and rubbing against a nonconsenting person, and either acts on these urges with the nonconsenting person or experiences clinically significant distress or impairment.
sexual masochism disorder
a paraphilic disorder in which a person has repeated and intense sexual urges, fantasies, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer accompanied by clinically significant distress or impairment.
exhibitionistic disorder
a paraphilic disorder in which persons have repeated sexually arousing urges or fantasies about exposing their genitals to others, and either act on these urges with non-consenting individuals or experience clinically significant distress or impairment.
gender dysphoria
a pattern in which people feel that they have been born to the wrong sex, identify with the other gender, and experience significant distress or impairment as a consequence of these feelings.
orgasmic reorientation
a procedure for treating certain paraphilias by teaching clients to respond to new, more appropriate sources of sexual stimulation
transgender experiences
a sense that their actual gender identity is different from their assigned gender or a sense that it lies outside the usual male versus female categories.
spectator role
a state of mind that some people experience during sex, focusing on their sexual performance to such an extent that their performance and their enjoyment are reduced.
psychological (particularly behavioral) explanations of premature ejaculation
affects men who are young, sexually inexperienced awho haven't yet learned to slow down, control arousal, and extend the pleasurable process of making love. Usually happens during first sexual encounter. more experience=more control. may also be related to anxiety, hurried masturbation experiences (fear of being caught), poor recognition of one's own sexual arousal.
In a technique called __________, patients with low sexual desire visualize sexual scenes to uncover feelings of anxiety, vulnerability, and other negative emotions they may have concerning sex.
affectual awaremenss
techniques to treat disorders of desire
affectual awareness, cognitive self-instruction training, desire diary, read and view erotic content, fantasize about sex, encourage pleasurable shared activities (walking and dancing) if due to assault or molestation patient me be encouraged to remember, talk about, and think about the assault until the memories no longer arouse fear or tension. Biological interventions can have a role in the treatment for desire problems. (ex: hormone treatments)
drugs that interfere with sexual functioning
alcohol, opioids, sedative-hypnotics, cocaine, amphetamines, hallucinogens, marijuana, antidepressants, antipsychotics, diuretics, amyl nitrate, hypertension medications
psychosocial factors of genito-pelvic pain/penetration disorder
alone are very rare, but when they do happen it is due to penetration to an unaroused, unlubricated vagina.
Some clinicians treat early ejaculation with ______drugs as they often reduce sexual arousal or orgasm.
antidepressant
psychological causes of low sexual desire
anxiety, depression, anger have attitudes, fears or memories that contribute to their dysfunction, such as a belief that sex is immoral or dangerous. Fear of losing control, fear of pregnancy. Some with OCD can find contact with another person unpleasant.d
research shows that sexual dysfunctions among homsexual couples
are the same as those in heterosexual couples
If a person suffering from male-to-female gender disorder is not sexually attracted to other men, but rather is attracted to the "fantasy" of being female, then that person would be diagnosed with the ______type of gender identity disorder
autogynephilic
treatment to exhibitionistic disorder
aversion therapy or masturbatory satiation combined with orgasmicreorientation, social skills training, or cbt
Gradual behavioral exposure treatment for genito-pelvic pain/penetration disorder
begins by inserting increasingly large dilators in vagina at home and at own pace eventually ending with the insertion of her partner's penis.
treatments for premature ejaculation
behavioral procedures are the most successful stop-start or pause procedure SSRI's the serotonin-enhancing antidepressant drugs. (slow down ejaculation)
tx for sexual dysfunctions in the 50s and 60s
behavioral therapists tried to reduce fears that caused sexual dysfunctions through relaxation training and systematic desensitization. some success but not in cases where misinformation, negative attitudes and lack of effective sexual techniques
what factors combine to produce female orgasmic disorder?
biological, psychological and sociocultural factors.
Excitement in men
blood pools in the pelvis and leads to erection
female to male gender dysphoria
born female but appear or behave in a stereotypically masculine manner from early on sexually attracted to females, but not satisfied with lesbian relationships-want women to be attracted to them as men.
male-to-female gender dysphoria: androphilic type
born male but appear or behave in a stereotypically female manner from birth effeminate, pretty and gentle; avoid rough games, hate to dress in boys' clothing. sexually attracted to males, come out as gay but they want men who are attracted to women.
Mutual responsibility (stage of sex therapy)
both partners share the sexual problem regardless of who has the dysfunction. Both should be in therapy together.
types of pedophiles
classic type-prepubescent children hebephilic type-early pubescent pedohebephilic type-both early and prepubescent
Attitude change(stage of sex therapy)
cognitive therapy: sex therapists help patients examine and change any beliefs about sexuality that are preventing sexual arousal and pleasure. some of these mistaken beliefs are shared in our society and can result from past traumatic events, family attitudes, or cultural ideas
treatment for female orgasmic disorder
cognitive-behavioral techniques, self exploration, enhancement of body awareness and directed masturbation training. biological treatments include: hormone therapy or use of sildenafil (viagra) but not always helpful.
predictors of positive orgasm outcomes
dependable father, positive relationship with one's mother, affection between the parents, the mother's positive personality, and the mother's expression of positive emotions.
Psychological causes of female orgasmic disorder
depression, memories of childhood traumas, problematic childhood relationships, memories of an unhappy childhood or loss of a parent during childhood.
The ______ phase of the sexual response cycle consists of an interest in or urge to have sex, sexual attraction to others and sexual fantasies.
desire
behaviorists perspective and treatment of fetishistic disorder
development is set for fetishes by classical conditioning. sometimes treated with *aversion therapy*. electric shock given to participants when they imagined their objects of desire. *covert sensitization* people with fetishistic disorder are guided to imagine the pleasurable objet and repeatedly pair it with an imagined aversive stimulus until the object of sexual pleasure is no longer desired. *masturbatory satiation* client masturbates to orgasm while fantasizing about a sexually appropriate object, then switches to fantasssizing in detaial about fetishistic objects while masturbating again and continues the fantasy for an hour. the procedure is meant to produce feeling of boredome, which in turn becomes linked to the fetishistic object *orgasmic reorientation* teaches individuals to respond to more appropriate sources of sexual stimulation.
Biological causes of female orgasmic disorder
diabetes can damage the nervous system in ways that interfere with arousal, lubrication of the vagina and orgasm. MS, and the same drugs and medications that interfere with ejaculation in men, and to changes, often postmenopausal, in skin sensitivity and structure of the clitoris, vaginal walls, or the labia-the folds of skin on each side of the vagina.
Phillip has repeated and intense sexual urges to rub his genitals against women in crowded subways. He is probably suffering from:
frotteuristic disorder
assigned gender
gender to which one is born
Disorder of sexual pain
genito-pelvic pain/penetration disorder may include vaginismus or dyspareunia
biological perspective of gender dysphoria
heightened blood flow in the insula and reduced blood flow in the anterior cingulate cortex. these areas play roles in human sexuality and consciousness. male to femal sex changes relate to a cluster of cells in the hypothalamus called the bed nucleus of stria terminalis (BST). usually a woman's BST is smaller than a man's, so in effect the male-assigned people with gender dysphoria were found to have a female-sized BST.
emotion identification (stage of sex therapy)
help patients identify and express upsetting emotions tied to past events that may keep interfering with sexual arousal and enjoyment.
The typical person with transvestim is almost always
heterosexual
statistics of transvestic disorder
heterosexual male, began cross-dressing in childhood or adolescence. Very masculine in everyday life and alone when cross dresses. some visit bars or social clubs, some only wear a single item of women's clothing, such as underwear or hosiery under masculine clothes. others wear makeup and dress fully as women. Some involve their wives in their cross dressing. Transvestic disorder is often confused with gender dysphoria but are 2 seperate paterns.
low sex drive and estrogen
high levels of estrogen in birth control bills, low level of estrogen in postmenopausal women or women who have recently given birth can lower sex drive.
Investigators in Dutch study found an abnormality in the _____ of men with gender identity disorder
hypothalamus
In one form of sexual masochism,_______, people strangle or smother themselves (or ask their partner to strangle them) to enhance their sexual pleasure.
hypoxyphilia
Biological reasons for genito-pelvic
infection of vagina or urinary tract, a gynecological disease such as herpes, or the physical effects of menopause. Vaginismus, dyspareunia
Masturbatory sattiation
is one behavioral approach to treating fetishism
human sexual inadequacy
landmark book by William Masters and Virginia Johnson in 1970. Revolutionized treatment of sexual dysfunctions with sex therapy program
Biological causes of erectile disorder
like hypoactive sexual desire disorder hormones cal also produce this disorder. More commonly though it's a vascular problem damage to the nervous system as a result of diabetes, spinal cord injuries, ms, kidney failure or dialysis tx. The use of medications and drugs like alcohol and cigarette smoking may interfere with erections.
Sex drive and illness
long-term physical illness can also lower a person's sex drive. The reduced drive may be a direct result of the illness or an indirect result because of stress, pain, or depression brought on by the illness.
tx for sexual dysfunctions over 40 years ago
long-term psycodynamic therapy: therapists helped clients change personality and this would hopefully lead to improvement in sexual functioning. (typically unsuccessful)
biological reasons for delayed ejaculation
low testosterone level, neurological dz and head or spinal cord injuries may interfere with ejaculation. substances that slow down the sympathetic nervous system like: alcohol, some medication for high blood pressure and certain psychotropic medications. serotonin-enhancing antidepressant drugs appear to interfere with ejaculation in 30% of men who take them
antiandrogens
lower production of testosterone & reduce sex drive
Men with _____ persistently lack or have reduced interest in sex and in turn, display little sexual activity
male hypoactive sexual desire disorder
diagnosing biological causes of erectile disorder
measuring NPT, is useful in assessing physical factors. men have erections during REM, a healthy man with have 2-5 erections during sleep. lack of nightly erections indicate physical basis for erectile failure.
Which of the following has NOT been suggested as a possible cause of dyspareunia?
misshaped genitalia
Measuring _______ is useful in assessing whether physical factors are responsible for male erectile disorder.
nocturnal penile tumescence
statistic of erectile disorder
occurs in as much as 25% of the male population usually over the age of 50 (because of aliments or dz of older adults). 7% of men under 40 have the disorder 40% in their 60s, and 75% in their seventies and eighties 1/2 of all men experience erectile difficulty during intercourse at least some of the time.
Early ejaculation is defined as ejaculation within _____ min of beginning the activity and before he wishes for it to occur.
one
sociocultural causes of female orgasmic disorder
overly strict religious upbringing, punishment for childhood masturbation, no preparation for the onset of menstruation, restricted in their dating as teenagers, told that "nice girls don't" although now sexuality has been seen more positively rates of orgasmic disorder remains the same. stressful events, traumas relationships, fears, memories and attitudes . molested as children, raped at anytime. linked to the emotional involvement during first experience of intercourse and how long that relationship lasted, the pleasure felt and the length to that relationship, her current attraction to her partner's body, her marital happiness. erotic fantasies during sex helps with orgasm in women.
Vaginismus and dyspareunia are considered disorders of sexual:
pain
People with _____ have repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate, and they may behave inappropriately as well.
paraphilias
Assessing and conceptualizing the problem (stage of sex therapy)
patients are initially given a medical exam and are interviewed regarding sex history. sometimes includes a team: psychologist, urologist and neurologist.
affectual awareness
patients visualize sexual scenes in order to discover any feelings of anxiety, vulnerability, and other negative emotions they may have concerning sex
Paraphilias
patterns in which a person has recurrent and intense sexual urges, fantasies, or behaviors involving nonhuman objects, children, nonconsenting adults, or experiences of suffering or humiliation
psychological cause of delayed ejaculation
performance anxiety and spectator role, CBT factors also involved in erectile disorder. tries so hard to have sex he becomes unaroused, self-critical, and fearful. Past masturbation habits may develop out of male hypoactive sexual desire disorder
Education about sexuality (stage of sex therapy)
physiology and techniques of sexual activity are discussed, education materials, instructional books, videos and internet sites are given
Disorders of orgasm
premature ejaculation delayed ejaculation in men female orgasmic disorder
Sex therapy
program created by Virgina Johnson and William Masters. combines cbt, couple and family systems therapies to treat sexual dysfunction. Recently biological interventions like drug therapy are added to the mix.
Which type of cognitive-behavioral treatment has been used to treat pedophilic disorder
relapse-prevention training
paraphilic disorders
repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations that society deeps inappropriate.
Which phase of the human sexual response cycle is NOT affected by a sexual dysfunction? 1. desire 2. excitement 3. orgasm 4. resolution
resolution
sociocultural causes of erectile disorder
same as male hypoactive sexual desire disorder lost jobs, financial stress, marital stress, too little physical stimulation, trying to give the wife an orgasm through intercourse only. (increasing the pressure on the man to have an erection if the wife reaches orgasm manually or orally his pressure to perform is reduced)
Elimination of performance anxiety and the spectator role. (stage of sex therapy)
sensate focus or nondemand pleasuring: series of sensual tasks, sometimes called "petting exercises in which the partners focus on the sexual pleasure that can be achieved by exploring and caressing each other's body at home, without demands to have intercourse or reach orgasm. couples refrain from intercourse and are restricted to sensual massage of the body but not of the breasts or genitals.
As many as 90% of men with this disorder experience some degree of erectile dysfunction
severe depression
Treatment of genito-pelvic pain/penetration disorder when the cause is known (scar tissue, lesions or infection aftereffects)
sex therapy techniques may be tried to avoid putting pressure on injured area, medical interventions from topical creams to surgery may be tried but usually need to be combined with sex therapy to be effective.
General features of sex therapy
short-term and instructive, lasts 15-20 sessions. Centers on sexual problems rather than on broad personality issues.
To receive a diagnosis of either male hypoactive sexual desire disorder or female sexual interest/arousal disorder the individual must display reduced sexual interest for how long?
six months
excitement in women
swelling of the clitoris and labia as well as lubrication of the vagina
Addressing physical and medical factors (stage of sex therapy)
systematic increases in physical activity have proved helpful for persons with various kinds of sexual dysfunctions. try to address medical problem: lowering the dosage of medication, changing time of day drug is taken or turning to a different drug.
Increasing sexual and general communication skills (stage of sex therapy)
taught to use their sensate-focus skills and apply new sexual techniques and positions at home. They may, for example, try sexual positions in which the person being caressed can guide the other's hands and control the speed, pressure and location of sexual contact. They are taught to give instruction to each other in a nonthreatening, informative manner. and even broader training in communication.
changing destructive lifestyles and marital interactions (stage of sex therapy)
therapist encourages a couple to take steps to improve a situation that is having a negative effect on the relationship. for example distance themselves from in-laws, changing a job that is too stressful and improving conflict in the marriage.
stop-start or pause procedure
treatment for premature ejaculation: The penis is manually stimulated until the man is highly aroused. The couple then pauses until arousal subsides, and stimulation is resumed. Repeated several times before stimulation is carried through to ejaculation. eventually, the couple progresses to putting the penis in the vagina withdrawing and pausing when the man becomes highly aroused. usually cures premature ejaculation in a couple of months.
