Exam 4 Flashcards
History of Approaches to Sexual Dysfunction
Starts
1786
Sir John Hunter reports first treatment of erectile failure
1789: Sir John Hunter
Sends couples with unconsummated marriage, due to erectile dysfunction, to his secluded cabin, and FORBADE sexual contact.
- Unable to follow instructions.
1789: Sir John hunters solution?
- Remove the individual from anxiety (AKA. put in secluded cabin)
- Couple returned saying that they were not able to follow the instructions.
- Engineer a situation that anxiety can be lessened to the point where sexual function returns.
1890-1900: Kraft-Edbing
“Psychopathia Sexualis”
Kraft-Edbing: “Psychopathia Sexualis”
- Appallingly Victorian
- Psychopathia Sexualis is what he considered as perversions.
- His recommendation was to hot iron the clitoris of a masturbator.
( people is insane asylums would publicly engage in masturbation or same sex sexual activity)
1930-1965: Fruendian Psychoanalysis, Psychodynamic approaches
- Sexual problems are SYMPTOMS of unconscious conflict.
- Do NOT treat symptoms- identify and provide insight into their underlying unconscious conflictual basis.
( bring it into conscious)
Freud and Rapid Ejaculation?
Possibly due to unconscious view of castration.
1965-1990: Masters and Johnson
- Pragmatic, brief, symptom focused, behavioural therapy.
- Sexual problems are learned behaviours that are amenable to learned solutions.
Masters and Johnson: Obstetrician and Gynaecologist
- Asked to study prostitutes
- Began recording for lab studies- what their bodies were doing and how to repair problematic sexual function.
Masters and Johnsons Contribution:
- Appropriate for era with little understanding of sexual dysfunction.
- View that sexual function proceeds unless their anxiety, spectating, and ignorance.
- Get people to approach anxiety situation without provoking anxiety and spectating, it should no longer hinder sexual function.
Masters and Johnson Treatment ideology?
Treatment: Symptom focused
- Worked well
- Not well involved in neurology and vascular basis in ageing men.
1990-200: Sex versus Marital and Relationship Therapy- Disorders of sexual Desire : HELEN KAPLAN
- Notice that most patients don’t have orgasmic erectile, and pain problems ( they lack DESIRE)
1990-2019: Development of Pharmacotherapy
Sildenafil, tadalafil, vardenafil; flibanserin.
Drug therapy: thought that alpha blocker might be related to penile erection.
The sexual Response Cycle : Male and Female
Masters and Johnsons: Conceptualize that men are understanding of their diagnosis of sexual dysfunction.
Modern day approach:
- People can have disorders of sexual desire.
- They might have problems with arousal.
- They may also have orgasmic problems.
- May experience coital pain
( All are looked at in both masters and Kaplans work)
Hypoactive Sexual Desire Disorder(HSDD) (woman)
Persistent or recurrent deficiency ( or absence) of sexual fantasies and desires for or receptivity to sexual activity. (* Female sexual interest and arousal disorder)
“Hypo” means low - this person has low sexual desire. ( don’t initiate and not receptive)
Sexual Dysfunction Vs. Sexual Concern:
- The disturbance must cause marked distress or interpersonal difficulty.
- Must not be better accounted for by effects of a psychiatric disorder, medical disorder, or substance, or marked relationship difficulty.
- Must persist 6 months or more and must occur on all or almost all sexual encounters.
Sexual Arousal Disorder (woman)
Absent or reduced sexual arousal, genital sensations, excitement or pleasure during sexual activity.
Female Orgasmic Disorder
Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase.
Dyspareunia (woman)
Recurrent or persistent genital pain associated with sexual intercourse ( Outlet, deep)
Outlet Dyspareunia (woman)
Pain, not lubricated enough, yeast infection.
Deep Dyspareunia (woman)
Pain, b/c more underlying tissues.
Vaginismus
Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted.
Vulvodynia
Vulvar and vestibular “burning” or cutting type of pain; may be provoked or unprovoked.
*Genital-pelvic pain/penetration disorder.
Prevalence of Sexual Dysfunction: Sexual Problems and Distress in United States Women
- Desire disorder is MOST FREQUENT.
- Arousal: Common
- Orgasmic: Not common
- All Peak in women during or near menopause and all decline after menopause.
- Prevalence increases and distress decreases after menopause.
London ON ob-Gyn Waiting Room Series (woman):
47%- sexual desire lower than like
22%- partners being lower than liked.
23% - couples distressed because of sex.
**There are no negation training regarding sexual desire and frequency of sexual intercourse.
London ON waiting room serious (woman): Arousal and lubrication problems, lack of orgasm, painful intercourse:
- Arousal or lubrication problems: 28%
- Lack of orgasm: 35%
- Painful intercourse:24%
Sexual Dysfunction Problems:
- Almost 80% had one or more of the dysfunction problems .
- Only 16% discussed it with a physician.
Diagnosis of Male Sexual Dysfunctions: Hypoactive Sexual Desire Disorder (HSDD)
- Persistent or recurrent deficiency (or absence) sexual fantasies and desire for sexual activity.
Sexual Arousal Disorder (male)
Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.
Orgasmic Disorder
- Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.
- Persistent or recurrent delay in, or absence of orgasm following a normal sexual excitement phase.
(cum too fast or not at all)
Dyspareunia
Recurrent or persistent genital pain associated with sexual intercourse (e.e., Pyronies Disease- curvature of the penis - fibrous/painful penile eraction)
Prevalence of male sexual dysfunction? HSDD
18-19 : 14%
30-39: 13%
40-49: 15%
50-59: 17%
Prevalence of Male Sexual Dysfunction: ED ( trouble achieving or maintaining an erection)
18-19: 7%
30-39: 9%
40-49: 11%
50-59: 18%
Prevalence of Male Sexual Dysfunction: Rapid Ejaculation
18-19: 30%
30-39: 32%
40-49: 28%
50-59: 31%
Prevalence of Male Sexual Dysfunction: Unable to orgasm
18-19: 7%
30-39: 7%
40-49: 9%
50-59: 9%
Often interrelated diagnoses
Desire + arousal
- eg., orgasm phase problem could be the case that their primer problem is coital pain or lack of arousal.
- Often adaptions to partner’s sexual Dysfunction.
Lifelong vs. Acquired
- if its always been there, it would be very different in comparison
