Chapter 18 Flashcards
What is the definition of sexual disorders?
Problems with sexual response that cause a person mental distress
Did not appear in the DSM prior to 1980 (DSM III)
What are the 2 dimensions of sexual disorders?
Lifelong sexual disorder
-present since the person began sexual functioning
Acquired sexual disorder
-develops after a period of normal functioning
What is a generalized sexual disorder?
occurs in all situations were sexual functioning may occur
What is situational sexual disorder?
Occurs in some sexual situations but not in others
What are predisposing factor for sexual disorders?
experiences that people have had in the past that presently affect their sexual response
Eg. Sex negativity experienced as a child
What are maintaining actors of sexual disorders?
various on-going circumstances, personal characteristics, and lovemaking patterns that inhibit sexual response
Eg. Ineffective or lack of communication by the couple about sexual issues
What are the cognitive factors/cognitive interference of sexual disorder?
Negative thoughts that distract a person from focussing on the erotic experience
Eg. Spectatoring
Term coined by Master’s and Johnson as a factor that can contribute to the experience of a sexual disorder
Acting as an observer or judge of one’s own sexual performance and inhibits performance
What are some common feelings the sexual issues are faced?
May avoid sexual opportunities for fear of failure
May lack the communication skills to explore the issues with a partner
May anticipate sex will result in pain or frustration
May feel inadequate or incompetent “
- Guilt
- “Shame, frustration, depression, anxiety
- “Alone in their feelings
What is hypoactive sexual desire disorder?
Lack of interest in sexual activity
- low level of sexual desire (inhibited)
“response sexual desire considered
-Multiple physical and psychological causes “ Distressing to the individual
Can be temporary
What is discrepancy of sexual desire?
Discrepancy of Sexual Desire
“Communication issue that affects a couple
“Not a defined sexual disorder
Someone who wants sex 6 vs 2 timies a week
What is male hypoactive sexual desire disorder?
If the man’s low desire is explained by self-identification as an asexual, then a diagnosis of male hypoactive sexual desire disorder is not made.
What is erectile disorder?
““inability to have an erection or maintain an erection on almost all or all occasions”
- Lifelong or acquired
- Generalized or situational
May be caused by a variety of bio-psycho-social factors
- Isolated episodes are common
- Issue may create cycle of anxiety and/or depression
- Myths and misinformation -Negative attitudes about sexuality
Who is affected with erectile disorder?
Affects men under age 40
“10% of men
Affects men men in their 60’s
“30% of men
Most common disorder cited when sex therapy is sought by men
May lead to negative self talk
- Depressed state
- May avoid sexual encounters
What are the organic causes of ED?
"CHD "Diabetes "MS "Spinal Cord Injury "Radical Prostatectomy "Treatment for testicular cancer
Depends on the location of lesion
Does testicular cancer affect libido?
Testicular cancer doest affect libido, if only one testicle the testosterone decreases natural anyways but may be lower
What are the prostate cancer treatments?
! Surgery
! Cryosurgery
! Radiation
! Brachytherapy
What are testicular cancer treatments?
! Surgery
! Radiation
! Chemotherapy
May result in erectile dysfunction due to
“lower testosterone levels
“damage to the pelvic cavity
How can pharmacology assist with ED?
Advent of Viagra and Cialis (sildenafil) increased awareness about
erectile dysfunction
What are the difference biomedical therapies and drug treatments for ED?
Sildenafil
Drug may be obtained via internet/ underground economy
-Used recreationally and unsupervised
The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum
- Relaxes smooth muscle
- Allows for blood engorgement
New drugs such as Levitra (vardenafil) and Zydena (udenafil) are also PDE5 enzyme inhibitors like sildenafil
-Same mechanism of action -Slightly different formulations
What are the treatments for erectile disorder?
Biological approaches
- Urethral suppositories
- Intracavernosal Injections
- -used for organic causes that don’t respond to drug therapy
Muscle relaxants (e.g., Caverject) -Relax smooth muscle in the corpus cavernosum
What are vacuum devices?
Vacuum and elastic tension to maintain erection
What are surgical implants?
Mechanisms to allow for erection simulation eg malleable rods; pumps
ejaculation possible for some
What is intervention with cognitive behavioural therapy?
Treat Cognitive Interference
- negative thoughts that distract a person from focussing on the erotic experience
What are sensate focused exercises?
Pioneered by Masters and Johnson to:
- Reduce performance anxiety
- Series of structured exercises
To address myths and information they might have, be comfortable with sexuality, pay attention to what they have overlooked before
What is premature ejaculation?
“a man persistently has an orgasm and ejaculates sooner than desired during sexual activity with a partner and is significantly distressed about the problem”
How do we define early ejaculations?
30 seconds?
1 1⁄2 minutes?
10 pelvic thrusts?
Until partner orgasms?
What are the definitions from the international society for sexual medicine for premature ejaculation?
“Ejaculation that always occurs within one minute of vaginal penetration
-Time component
The inability to delay ejaculation
-Control component
Distress about the problem
-Distress component
What are the CBT strategies for delaying ejaculation?
Behavioural Therapy technique developed by Masters & Johnson
Develop awareness of imminent ejaculation
Slow down>change positions/ activity
Stop-start technique or Squeeze technique
Partner is a participant in the therapy
Gaining greater control over the Pubococcygeal Muscles
What is the pharmacological approach for delaying ejaculation?
small doses of antidepressants can assist some men
What is delayed ejaculation?
Consistently unable to orgasm” for a period of at least 6 months
Unable to orgasm
Orgasm is greatly delayed with partnered sexual activity
Leads to distress
No issues with erection or stimulation
How common is delayed ejaculation?
Diagnosis is rare
Less than 1% of men meet diagnostic criteria
Situational more common
-Eg Issue with penetrative sex but not solo sex or oral sex
What are the different kinds of sexual pain in men?
“Ejaculatory pain
“Penile shaft or testicular pain
” Pain in the glans of the penis
- phimosis
- paraphimosis
What is the difference between phimosis and paraphimosis?
Phimosis
“Most common cause of balanitis “ Home therapy may be prescribed “ 30 minute sessions
Paraphimosis
“ May require a surgical procedure
What is female sexual interest/arousal disorder?
the woman’s sexual interest or arousal is significantly reduced
-Subjective and or physiological
“ Psychological, physical, behavioural causes
What is the treatment for female sexual interest/arousal disorder?
Treatment " Sex education; changing cognitions " Bibliotherapy " Drug therapy -testosterone, sildenafil trials -"Eros -similar mechanism to vacuum pump used by men -" Gentle suction over clitoris
What are factors that contribute to sexual disorders?
Communication issues within the interpersonal relationship
Attachment Issues
Negative historical experiences
Lack of knowledge about female sexual arousal and
anatomy/physiology of arousal in women
Societal mixed messages and double standards of female sexuality
What is female orgasmic disorder?
” Recurrent difficulty having an orgasm or reduced orgasm intensity during almost all sexual activity
-Distress results from the issue
Cases may be situational or generalized
Life-long or acquired
What is anorgasmia?
the absence of orgasm
What is female orgasmic disorder?
Historical references by Freud about female orgasm
Consider anatomy, cultural definitions of sexual pleasure, and sexual scripts
Clitoral stimulation often involved in female orgasm
DSM 5 clearly states that the necessity of clitoral stimulation in order to reach orgasm precludes diagnosis of Female Orgasmic Disorder
What are cognitive behavioural therapies for self directed masturbation programs use to educate?
Education
Self-exploration
Self-massage
Giving oneself permission (assessing values)
Use of fantasy
Allowing, not forcing, orgasm Use of a vibrator Involvement of the partner
What is bibliotherapy?
Information
Learn anatomy of the female body
Read narratives of other women that have experienced similar challenges
One source can lead to other sources of practical information
Can demystify sexual issues
May encourage next steps in the therapeutic process
What is Genito-pelvic paint/penetration disorder?
This new DSM 5 category replaces two previously recognized disorders discussed in the DSM IV
Dyspareunia
Vaginismus
Rationale was that the two conditions typically occurred together
What is vaginismus?
Skilled client intake
Understanding biopsychosocial factors on an individual basis
Assess knowledge, myths and misinformation about the female anatomy and sexual pleasure
- Can be a maintaining cause
May require bibliotherapy
Treatment may involve vaginal dilators
-As used in transgender MtF confirmation surgeries
What are the 4 symptoms of of Genito-pelvic pain/penetration disorder?
“Difficulty with penetration/ intercourse
“Significant genital and/or pelvic pain
“Pain with penetrative sex
“Fear of pain associated with vaginal penetration with tension and muscle tightening
Can genito-pelvic pain/penetraiton disorder be generalized or situational?
May be generalized or situational -Most typically experienced over a variety of situations " Vaginal sex " Gynecological exams " Tampon use
What is a more appropriate classification for genito-pelvic pain/penetraiton disorder?
Critique as a sexual disorder since it occurs in non-sexual situations
“Pain disorder thought to be more appropriate
How can pain during penetrative sex can occur?
Can be due to the physical changes of menopause
Lower estrogen, progesterone and testosterone levels
“ Shrinking of the labia
“ Constriction of the vaginal canal
“ Decreased lubrication
“ Itchiness, dryness of the mucous membranes
what other kinds of disorders can females have?
” Disorders of the vaginal entrance
” Pelvic and uterine issues
” Spasms of the pelvic floor muscles
What are the physiological factors of sexual disorders?
" Fatigue " Infections "Chronic illnesses "Side Effects of prescribed medications, recreational drugs "General poor health
What are the cultural origins of sexual disorders?
Cultural factors
“Sex negativity
- Negative childhood learning
- Double standards for sex
- Limited definitions of sexuality
What are the relationship factor origins of sexual disorders?
“Lack of emotional intimacy
“Inadequate communication and/or ineffective sexual techniques
What are the individual origins of sexual disorders?
“Emotional well-being
“Irrational beliefs or performance anxiety
“ Experiences
How can work life balance and stress affect intimacy?
“Couples may schedule in love- making as they would with other activities
“Work-life balance especially challenging for women
-Carry more of the housework and
childrearing responsibilities even if
working outside the home
What are sexual disorders effect on long term relationships?
Maintaining a long-term relationship is challenging
Communication is the key
Therapy can assist with communication issues
Sex therapy is different that couples counselling
What do non distressed couples have?
- Good listening and communication skills
- Effective problem solving skills
- Many positive interactions and few negative interactions
- More realistic expectations about what relationships should be like
- Interpretations of partner’s behavior that are positive
- Common views on the sharing of roles and responsibilities in the relationship
What re the general treatment strategies?
Primary care practitioner to assess physical causes
Self-awareness
Gathering appropriate information
Address communication and relationship issues
Cognitive-Behavioral techniques
What is sex therapy?
Many helping professionals not adequately trained in sexual issues
Lack of regulation for use of term “sex therapist”
Should have a governing body for complaints/concerns
Some certified by Board of Examiners in Sex Therapy and Counselling in Ontario (BESTCO)
