18. Sexual Disorders and Sex Therapy Flashcards
(116 cards)
1
Q
Each disorder can be seen to vary along two dimension. What are they?
A
Lifelong Sexual Disorders: Occurs when the individual has always had the disorder.
Acquired Sexual Disorder: Occurs when the individual currently has the problem but not in the past.
2
Q
Can sexual disorders be situational or generalized?
A
They can be either.
Generalized is occurring in all situations.
Situational occurs in some situations but not in others.
3
Q
Types of Sexual disorders in men
A
- Male Hypoactive Sexual Desire Disorder (HSDD)
- Erectile Disorder
- Premature (early) ejaculation
- Delayed Ejaculation
4
Q
What is Male Hypoactive Sexual Desire Disorder?
Characteristics of it
A
- DEF: When the person does not have spontaneous thoughts or fantasies about sexual activity, and not interested in sexual activity.
- Persistent or recurrent low or lack of sexual thoughts or fantasies, AND low or absent interest in sex.
- This causes DISTRESS to the person.
- Not uncommon for men to report sexual desire.
5
Q
What are the complex problems of the definition of HSDD?
A
- Normal for a person to not experience sexual desire (E.g.., cannot expect to be turned on by every person)
- men experiencing ANXIETY about erection or ejaculation may lose interest in sex.
6
Q
Why is HSDD only diagnosed in men and not women?
A
Because for women, sexual desire and arousal are often linked.
BUT!
They were combined into a single disorder for women (Female sexual interest/arousal disorder). This decision is controversial
7
Q
Even if person doesn’t have HSDD, but wants sex less frequently than the partner, what can it lead to?
A
Discrepancy of sexual desire.
- It is a couples problem, NOT a sexual disorder.
8
Q
What is Erectile Disorder?
What are the other terms?
A
- DEF: Not able to have an erection or maintain one in almost or all occasions.
- Erectile dysfunction & Inhibited sexual excitement.
- Impotence still used by laypeople, but have negative connotation.
9
Q
Can erectile disorder be an acquired erectile disorder or a lifelong erectile disorder?
Can disorder be generalized or situational?
A
- Can be EITHER, lifelong( quite rare) OR acquired (depending if he has ever been able to maintain an erection.
- Disorder can be EITHER generalized OR situational (i.e., happen in certain kinds of stimulation or type of partner).
10
Q
Who is affected by Inhibited sexual excitement?
A
Surveys in North America and Europe, occur fewer than 10% of men under 40,
BUT,
increases about 30% of men in their 60’s
11
Q
What is Premature (Early) Ejaculation?
A
DEF: A man persistently orgasms and ejaculates sooner than desired sexual activity with a partner, and is significantly distressed about the problem
12
Q
Other terms of Premature Ejaculation?
A
- Early ejaculation
OR - Rapid ejaculation
13
Q
When is premature ejaculation too soon?
A
- One source says, it’s the occurrence of orgasming less than 1 minute.
- Psychiatrist and sex therapist believe it’s the absence of voluntary control of orgasm
14
Q
International Society for Sexual Medicine’s 3 part definition of Early Ejaculation
A
- Ejaculation that always occur prior or within 1 minute of vaginal penetration
- Not able to delay ejaculation
- Distress about the problem
15
Q
What thoughts did University men in New Brunswick report to delay early ejaculation?
A
- Sex negative (think of an unattractive TV personality)
- Sex positive (thinking “we’re in no hurry)
- Nonsexual and negative (think of a sad event, unpaid debt)
- Sex neutral (counting back from 100)
- Sexually incongruous
16
Q
What is Delayed Ejaculation?
A
Man is not able to orgasm, or it is greatly delayed when engaging in sexual activity with a partner, even with an erection, and he is distressed about it.
17
Q
Other term for Delayed ejaculation?
A
Male orgasmic disorder
18
Q
How common is Male orgasmic disorder?
A
- less common than premature ejaculation.
- more common in men over age 50
19
Q
Disorders in Women
A
- Female sexual interest/Arousal disorder
- Female orgasmic disorder
- Genito-Pelvic pain/penetration disorder
20
Q
What is Female sexual interest/Arousal disorder?
A
a lack or significantly reduced sexual arousal or arousal that causes significant distress.
- disorder CAN’T be because of psychological or relationship distress
21
Q
What does Female sexual interest/Arousal disorder effect in women?
A
Affects their sexual interest and thought, being her sexual desire.
22
Q
How common is Female sexual interest/Arousal disorder in women?
A
- Approx. 39% of Canadian women report diminished sexual desire.
- 8% find it distressing
- More common when women get older (10% experience it up to age 45; 50% of women over age 65)
23
Q
What is female orgasmic disorder?
A
Women having recurrent difficulty to orgasm, or reduced orgasm intensity during almost all sexual activity.
10% never experience orgasm ever
24
Q
What are other terms for female orgasmic disorder?
A
- Orgasmic dysfunction
- Anorgasmia
- Inhibited female orgasm
25
Can orgasmic dysfunction be lifelong or acquired disorder?
- it can be both.
- Common one is situational orgasmic disorder.
26
What is situational orgasmic disorder?
When a women has orgasms in some situations but not others.
27
What is Genito-pelvic/penetration disorder?
To anyone who as the 4 symptoms that typically occur together.
1. difficulty having intercourse/penetration
2. Genital and/or pelvic pain during intercourse
3. fear of pain associated with vaginal penetration
4. pelvic floor tension or tightening at attempting vaginal penetration (sometimes called dyspareunia)
28
How common is Genito-pelvic/penetration disorder in women and men?
20% of girls report the experience of it for at least 6 months.
about 2% of men experience the pain
29
What CAUSES sexual disorder?
- Physical causes
- Drugs
- Psychological causes
- Combined Cognitive and Physiological Factors
30
Physical causes in Erectile Disorder
- commonly for people with CVD, diabetes, or any vascular problems (problems of blood supply to penis)
- Hypogonadism (underfunctioning of testes, so testosterone is low)
- Any damage to lower part of spinal cord
31
Physical cause of Premature (early) ejaculation
- Caused more from psychological than physical factors.
- For some men, could be malfunctioning of ejaculatory reflex
32
Physical cause of delayed ejaculation
- related to variety of medical or surgical conditions (like MS, spinal cord injury and prostate surgery)
33
Physical causes of Female orgasmic disorder
- Most cases are psychological.
- severe illness, general ill health, or extreme fatigue.
- injury to spinal cord, can cause orgasm problems
34
Physical causes of genito-pelvic pain/penetration disorder, in women
- In women, its organic factors, such as psychosocial and interpersonal factors
- organic factors that may cause the disorder, include:
1. Disorders of vaginal entrance
2. Disorders of the vagina
3. Pelvic disorders
4. Dysfunction of the pelvic floor muscles
35
What influences the pain of genito-pelvic pain/penetration disorder?
psychological factors
36
Physical causes of genito-pelvic pain/penetration disorder, in men
organic factor can include:
- uncircumcised man
- poor hygiene
- material collect under foreskin
- allergic reaction to sperm cream or latex
37
Alcohol use with sexual disorders
People later stage of alcoholism, have frequent sexual disorders. Including:
- erectile disorder
- orgasmic disorder
- loss of desire
Person not alcoholic, but had too many drinks, engage in sexual interaction
38
Recreational drugs (alcohol and cocaine) myths
- high level of alcohol suppress sexual arousal
- repeated use to cocaine is associated with loss of sexual desire, orgasmic disorder and erectile problems
39
Cannabis use with sexual disorder
- research is limited, BUT
- many respondents report increased sexual desire, making sex interaction more pleasurable
- negative effects, being more sleepy, or less focused.
- reports steer more to positive experience
40
illicit or recreational drugs and sexual disorder
- said cocaine increase sexual desire, enhance sensuality and delay orgasm (not chronic though)
- stimulants: increase sexual desire, better orgasm control (some studies)
- crystal meth: When high, engage in risky sexual behaviour
- opiates: strong suppression on sexual desire and response
41
Psychological causes in sexual disorder
- predisposing factors: people's prior life experiences, like things that happened in childhood that now inhibit sexual response
- Maintaining factors: ongoing life circumstances, personal characteristics and characteristic of lovemaking that explain the problem
42
The psychosocial factors that maintain problems and sexual disorders in psychological causes
- myths or misinformation
- negative attitudes
- anxiety or inhibition
- cognitive interference
- individual psychosocial distress (like depression)
- behavioural or lifestyle factors
43
What is Spectatoring?
Term by Masters and Johnson
- one kind of cognitive interference.
- It's when person behaves like a spectator or judges their own sexual performance
44
What did David Barlow find when testing which anxiety and cognitive interference affect sexual functioning in functional and dysfunctional men (particularly with erectile dysfunction)?
Functional and dysfunctional men respond differently to stimuli in sexual situations.
Example: anxiety INCREASE arousal in functional men, but DECREASE in dysfunctional men, while watching erotic film
45
Why did dysfunctional men decrease in arousal in Barlow's study?
when in sexual situation, there's a performance demand.
- feel anxiety and other negative emotions, and thinking how awful its going to be when they're not erect or not getting aroused
46
Combined Cognitive and Physiological Factors
Barlow says people with sexual disorder, interpret their arousal as anxiety.
in addition, phyiological processes and cognitive interpretation forms a feedback loop
47
New views of women's sexual problems and their causes (4)
1. Sex problems in Sociocultural, political or economic factors
2. Sex problems relating to partner and relationship
3. Sex problems due to psychological factors
4. Sexual problems due to medical factors
48
Therapies for Sexual Disorders
- Behavioural Therapy: Helps with unhealthy behaviours. Assumption that sex problems are the result of prior learning, and maintained by reinforcement and punishment.
- CBT: Therapy, combines behaviour therapy and restructuring negative thoughts
- Mindfulness Therapy: Person focusing on the experience in the present moment, in calm and nonjudgmental way.
- Couples Therapy: Help couples understand and resolve the issue that they have.
49
What is Sensate focus exercising
Notion that touching and being touched are important forms of sexual expression and important form of communication
50
Specific Treatments for Specific problems
- Stop-Start Technique
- Masturbation
- Kegel Exercises
- Bibliotherapy & Videotherapy
51
Technique helps with men gain control over their ejaculation timing.
Stop-Start Technique
52
How does Stop-Start Technique work?
You manually stimulate the man's penis to erection, and then stop the stimulation before the point.
- At the gradual penis decline, partner resumes stimulation.
- This can extend in foreplay to 15 to 20 minutes
53
Used to exercise and strengthen the pubococcygeal muscle or PC muscle
Kegel exercises
54
Vaginal dilators used for women who have tensing or tightening pelvic floor muscle at attempt penetration
genito-pelvic pain
55
1. Using a self-help book to treat a disorder, and is effective for orgasmic disorder in women and other disorders in men and women
2. Therapy that is streamed over the internet to provide psychological counselling
1. Bibliotherapy
2. Videotherapy
56
Biomedical Therapies
- Drug treatment
- intracavernosal injection (ICI)
- suction devices
- surgical therapy
57
Types of Drug treatments
Viagra (lasts 8 to 10 hours)
- not make the person erect, but facilitates the physiological processes that produce erection when man is stimulated sexually.
Cialis, aka tadalafil (lasts 24 to 36 hours)
- like viagra, but shown to have no negative effects on sperm production
- Levitra and Zydena (other drugs like viagra)
58
Viagra for women?
Called Addyi
- first developed to be antidepressants, but didn't work well.
59
Intracavernosal injection (ICI)
for erectile disorder mainly in physical causes, and not responding to Viagra or successors
- injecting drug in corpora cavernosa of penis.
- Alprostadil ( a suppository placed in urethra or as a cream. Instead of using needle).
60
Suction Devices
Help with arousal disorders
- place tube over penis.
- the top hole of the tube is mouth sucked, or hand pump is used.
When firm erection is present, tube is removed and rubber band place on base of penis to maintain penis engorgement with blood.
61
Surgical Therapy
Can help some women with genito-pelvic pain, but focused on male sexual disorders.
Severe erectile disorder, surgery is used, and a penile prothesis is implanted (2 inflatable tubes along corpus spongiosum, with pump in scrotum).
- Man can literally pump up or inflate their penis so can have a full erection
62
Ways to avoid sexual disorders
1. Communicate with your partner
2. Try to stay in the moment
3. Relax and enjoy yourself
4. Be choosy about the situations that you have sex
5. Accept that disappointments will happen
63
HSDD and prevalence
hypoactive sexual disorder
- 6% ages 18-24
- 41% ages 66-74
- 2% have DISTRESS
64
dyspareunia
painful intercourse
65
vaginismus
reflexive spasm of the vag muscles sometimes so severe that intercourse is impossible
66
organic factors
physical factors such as disease or injury that cause sexual disorders
67
predisposing
experiences that were had in the past (eg: childhood) that now affect sexual response
68
maintaining factors
various ongoing life circumstances, personal characteristics, and lovemaking patterns that inhibit sexual response
69
cognitive interference
negative thoughts that distract a person from focusing on erotic experience
70
freud feelings about clit and vag orgasm
- Clitoral orgasm →immature (i.e., childish)
- Vaginal orgasm →mature (i.e., adult)
71
Kinsey (40s and 50s)
Females and males are similar in anatomy and physiology but females have “lesser sexual capacity”
72
Masters and Johnson (60s)
- Claimed that females’ and males’ orgasms are far more similar than different (i.e., physiologically the same)
- Claimed that females’ capacity exceeded males’ (i.e., ability to have multiple orgasms until total exhaustion)
73
sexual response cycle
1. excitement
2. plateau
3. orgasm
4. resolution
74
purpose of Multiple Orgasm
Evolutionary perspective: to encourage human beings to engage in sexual activity → rewarding
- Bonding → oxytocin released
No good explanation other than reward…
75
% of men who experience multiple orgasm
- Less than 10% in 20s
- Less than 7% in 30s
76
Kaplan’s Triphasic Model (1970s)
1. Desire (psychological)
a. Wanting to engage in sexual activity
2. Excitement (physiological)
a. vasocongestion of the genitals
3. Orgasm (physiological)
a. Muscular contraction
77
what's special about kaplan?
No psychological component in Masters & Johnson
78
dual control model
Inhibition and excitation vary widely.
- Excitation → accelerator
- Inhibition → the brakes
Most people fall in moderate range
- Results in good sexual functioning
- Extremes → causes problems to occur
Yellow → sexual tipping point
- Affects sexual decision making
79
number 1 reason why ppl have sex
“I was attracted to the person”
80
Circular Model of Sexual Response: 1. approach
1. Wanting to have sex to approach a positive
2. “fun, try new position, experience orgasm”
81
2. Avoidance
1. Want to avoid a negative
2. “so they’ll stop nagging you about sex”
3. More avoidance reasons → less satisfying sexual encounters
82
3. Sexual stimuli → environmental turn ons
- Touch, watching something erotic, etc.
- Can change over time and day to day
83
4. Context → physical space (feeling comfortable)
1. Environmental
1. Some are more sensitive → need things to be *******perfect*******
2. Interpersonal
1. How you are feeling about your partner
84
5. Brain
1. Biological
a. Medications, stress, fatigue
2. Psychological
b. Anxiety, body image
85
6. Sexual arousal
Can have a physiological response but not a psychological response
1. Physiological
a. Heart, breathing, erections
2. Psychological (most important)
a. Feeling “in the mood”
86
7. Responsive Desire & increased Arousal
In response to all other factors lining up and being present
87
8. Outcome
Intentionally broad → not labelled as orgasm
1. Physical
a. Orgasm
2. Emotional
a. Feeling closer to your partner
88
OTHER: Spontaneous Desire
NOT REQUIRED FOR SEX
- Can happen at any time
89
% of ppl experience sexual problem
70-75% of all people have experienced this
- almost all uni students
younger the person -> more distressing
90
Sexual problem categories
- Desire
- Excitement
- Orgasm
- Pain
91
who is more likely to experienece sexual disorder
chinese & asian groups
92
Provoked vestibulardinia
pain at the vestibule when provoked
93
prevalence of erectile disorder
- less than 10% under 40
- 30-50% 60-70
94
at-home remedies for premature ejaculation
doubling up on condoms, numbing creams, thinking about something else → sex negative, sex positive, nonsexual and negative, sex neutral, sexually incongruous
- Encouraged to remain focused on sensations and the stop-start technique
95
prevalence of premature
- 20-30% → 18-70
- 1-3% meet criteria for being under 1 min
96
New View Critique about Women in DSM
1. Diagnostic categories treat male and female sexuality as equivalent when they differ in important ways
2. They ignore the relational context of sexuality and desires for emotional intimacy
1. Focus on physiology
3. They ignore differences among women and naturally occurring variations in women’s sexuality
Should consider a number of factors → partner, religious, medical, etc. (more holistic view) when diagnosing
97
New View Proposed Categories
1. Sexual problems due to socio-cultural, political, or economic factors
2. Sexual problems relating to partner and relationship
3. Sexual problems due to psychological factors
4. Sexual problems due to medical factors
98
Biological Causes
Physiological
- General ill-health
- Chronic stress or fatigue
99
Medical
- Diabetes → erectile disorders
- Circulatory, cardiovasculatory → arousal
100
Drug
Alcohol, recreation, prescription
101
Psychological Factors
Negative attitudes & treatments
- Sexual activities, gender, body image, sex is shameful, etc.
- Often from religion, culture, society, parents
TREATMENT: psychoeducation, CBT
102
Relationship distress & TREATMENT
- Not feeling close to partner, spending time, etc.
TREATMENT: couples therapy
103
lifestyle & treatment
- Work schedules, kids, travel, couples on shift work that rarely see each other
TREATMENT: problem solving, scheduling
104
psychological distress &treatment
- Depression, anxiety
- Difficulty can cause distress or distress can cause difficulty
- Very common in sex therapy
TREATMENT: individual therapy
105
Techniques and communication
- Many people are not receiving proper stimulation
- Often causes difficulties with orgasm esp. for people with vulvas who don’t know what kind of stimulation they need to have an orgasm
TREATMENT: psychoeducation, couples therapy
106
anxiety
- Vast majority who come into sex therapy have some kind of anxiety about sex
- Result of negative experience or abuse, feeling anxious about performance, judging yourself, thinking your partner is judging you, etc.
TREATMENT: CBT
107
Myths and misinformation
- Clients believing something incorrect
- “having and sti means i can never have sex again”
TREATMENT: psychoeducation
108
Format of Sex Therapy
1. assessment (few sessions)
2. frequency of session decreses because homework
3. format
- check in about homework
- discuss implications
- assign new homework
4. ground rules (established early)
109
Sex Therapy: Sensate Focus (Master & Johnson)
1. self-exploration (10-15mins)
2. self-pleasuring (multiple weeks)
3. mutual pleasuring (couple)
- without breasts & genitals
- with breasts and genitals (pleasure)
- with breasts & genital (orgasm)
4. intercourse
110
PLISSIT model
P - permission
LI - limited information
SS -specific suggestions
IT - intensive therapy
111
Virginity Pledges
- later first vaginal intercourse, especially if peers also took pledge
- at least as likely (and in some studies, more likely) to have oral and anal sex
- less likely to use a condom
- equally as likely to have STIs
- ‘virgins’ who took the pledge were much more likely to have had anal sex than those ‘virgins’ who did not take the pledge
112
Effectiveness of Comprehensive Sex Ed in Canada
teen pregnancy rates have dropped 36% between 1996 and 2006
- lowest in switzerland
- USA teen pregnancy rates double those for Canada
- increased use of contraceptives
- decreasing teenage abortions rates
113
Broader social context…
More available because of internet, society is becoming more open to discussing about sexuality
114
Effectiveness of Comprehensive Sex Ed in Canada
Canada’s success attributed to more relaxed attitudes towards sex in general:
- better communication with parents
- improved sexual confidence
- better empowerment to seek services related to sexuality
115
While reducing risky behaviour, should also focus on positive aspects and other important issues:
- sexual self-esteem
- confidence and empowerment
- openness
- acceptance
- intimacy and love
- relationships
- pornography and media literacy
116
SOGI
Sexual Orientation and Gender Identity Team
- Following amendment to BC’s gender rights code
