Chapter 11: Sexual Dysfunctions

Biological causes of sexual dysfunctions

Abnormal hormone levels, certain drugs, and some medical illnesses.

Treatments for male hypoactive sexual desire disorder and female sexual interest/arousal disorder

Affectual awareness, self-instruction training, "desire diary" and hormone treatments.

Treatment for premature ejaculation

Stop-start, or pause procedure and SSRIs

Directed masturbation training

A sex therapy approach that teaches women with female arousal or orgasmic disorders how to masturbate effectively and eventually reach orgasm during sexual interactions.

What are the general features 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 communication skills 8. Changing destructive lifestyles and couple interactions 9. Addressing physical and medical factors

How common are sexual dysfunctions among men?

30%

How common are sexual dysfunctions among women?

45%

How long does a problem have to occur before it can be labeled a sexual dysfunction?

6 months

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.

Sildenafil (Viagra)

A drug used to treat erectile disorder that helps increase blood flow to the penis during sexual activity.

Premature Ejaculation (Early or rapid 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.

Female Orgasmic Disorder

A dysfunction 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 and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity.

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.

Delayed Ejaculation

A male sexual dysfunction characterized by persistent inability to ejaculate or very delayed ejaculations during sexual activity with a partner.

Fetishistic disorder

A paraphilia 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 significant distress or impairment.

How are sleep patterns used to determine whether a male has a biologically based erectile dysfunction?

A patient may be instructed to fasten a simple "snap gauge" band around his penis before going to sleep and then check it the next morning. A broken band indicates that he has had an erection during the night. An unbroken band indicates that he did not have nighttime erections and suggests that his general erectile problem may have a physical basis.

Gender dysphoria

A pattern in which individuals experience significant distress or impairment as a consequence of their transgender feelings.

Erectile Disorder

A repeated failure to attain or maintain an erection during sexual activity (excitement phase only).

Sensate focus (nondemand pleasuring)

A 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 - demands that may be interfering with arousal.

Genito-pelvic pain/penetration disorder

A sexual dysfunction characterized by significant physical discomfort during intercourse.

Spectator Role

A state of mind that some people experience during sex, in which they focus on their sexual performance to such an extent that their performance and their enjoyment are reduced.

Gender reassignment surgery

A surgical procedure that changes a person's sex organs and gender features. Also known as gender change surgery, gender confirmation surgery, and gender-affirming surgery.

What are the rates of premature ejaculation?

As many as 30 percent of men worldwide ejaculate early at some time.

Treatment of female orgasmic disorder

Cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training.

Current clinicians have added a ____ phase and no longer refer to the plateau phase.

Desire

Sexual Dysfunctions

Disorders in which people cannot respond normally in key areas of sexual functioning, make it difficult or impossible to enjoy sexual intercourse.

Nocturnal Penile Tumescence (NPT)

Erections during sleep.

What are the four stages of human sexual response (Masters and Johnson's)?

Excitement, plateau, orgasm, and resolution.

What is the cut-off point for diagnosing early ejaculation?

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

What causes disorders of desire?

Hormonal imbalances, vascular problems, damages to the nervous system as a result of diabetes, spinal cord injuries, multiple sclerosis, kidney failure, or treatment by dialysis. The use of certain medications and various forms of substance abuse.

What are the causes of premature ejaculation?

Inexperience with sex, infrequent sex, and genetic predisposition.

Vaginismus

Involuntary muscle contractions in the outer third of the vagina that prevent entry of the penis.

What is thought to be the PRIMARY cause of vaginismus?

Most clinicians agree with the cognitive-behavioral position that this form of genito-pelvic pain/penetration disorder is usually a learned fear response, set off by a woman's expectation that intercourse will be painful and damaging.

Self-instruction training

Patients learn to replace negative self statements with "coping statements", such as "I can allow myself to have enjoy sex; it doesn't mean I'll lose control."

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 as person has recurrent and intense sexual urges, fantasies, or behaviors involving nonhuman objects, children, nonconsenting adults, or experiences of suffering or humiliation.

Transgender

People who have a sense that their gender identity is different from the gender they were assigned at birth.

Pedophilic disorder

People who initiate sexual contact with children regardless of how troubled the individuals may or may not be over their behavior.

Treatment for genito-pelvic pain/penetration disorder

Practicing tightening and relaxing vaginal muscles to gain more control over them and gradual behavioral exposure treatment to help overcome the fear of penetration. Best assessed and treated with a team of professionals: gynecologist, physical therapist, and sex therapist and other mental health professional.

Paraphilic Disorders

Repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate. May lead to inappropriate behavior as well.

SSRIs

Serotonin-enhancing antidepressant drugs that reduce sexual arousal or orgasm.

Dyspareunia

Severe vaginal or pelvic pain during sexual intercourse.

What are the current trends in sex therapy?

Sex therapists treat diverse patients and are paying more attention to excessive sexuality. There is also a sharp increase of drugs and medical interventions for sexual dysfunctions (low sexual desire and erectile disorder).

Sociocultural and psychological causes of sexual dysfunctions

Specific fears, situational pressures, relationship problems, and the trauma of having been sexually molested or assaulted.

Treatment for erectile disorder

Tease technique, sildenafil (Viagra), and medical procedures such as gel suppositories, injections of drugs into the penis, a surgical implantation of a penile prosthesis, and a vacuum erection device (VED).

Treatment for delayed ejaculation

Techniques to reduce performance anxiety and increase stimulation.

Performance Anxiety

The fear of performing inadequately and a related tension experienced during sex.

Exhibitionistic disorder

The paraphilic pattern in which people act on urges to expose their genitals to others.

Tease technique

The partner keeps caressing the man, but if the man gets an erection, the partner stops caressing him until he loses it.

Stop-start or pause procedure

The penis is manually stimulated until the man is highly aroused.

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.

How common are disorders of desire?

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.

Factors outside our awareness can influence sexual attraction. For example, many people are attracted to people:

Whose smell suggests a different type of immune system from their own.

Hormones

are the basic building blocks of human sexual behavior.