Exam 4: Sexuality/Sexual Dysfunction Flashcards
what are the two general categories of sexual disorders?
sexual dysfunctions: problems w/ sexual responses
paraphilic disorders: repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations
what is the supposed third category of sexual disorders?
sexual challenges or limitations
- failure to integrate sexuality w/ personal values
- failure to integrate sexuality w/in intimate relationships
- limitations to embracing the full range of sexual expressiveness and fulfillment
sexual dysfunctions
- the person cannot respond normally in key areas of sexual functioning
- as many as 31% of men and 43% of women in the US suffer from such a dysfunction during their lives
- sexual dysfunctions are typically very distressing
- may lead to sexual frustration, guilt, loss of self-esteem, depression, or interpersonal problems
- these difficulties are often interrelated: many people w/ one difficulty (depression) experience another (lack of sexual desire) as well
how long do people experience sexual dysfunctions for?
- some struggle w/ it their whole lives (lifelong type)
- for others, normal sexual functioning preceded the disorder (acquired type)
- in some cases the dysfunction is present during all sexual situations (generalized type)
- in others it is tied to particular situations (situational type)
human sexual response cycle
-four phases:
- desire
- excitement (or arousal)
- orgasm
- resolution (or refraction)
-sexual dysfunctions affect one or more of the first 3 phases
gender similarities and differences in response cycle
-order of cycle is similar between men and women, but women may have multiple orgasms, while it is harder for men
general features of sex therapy
- modern sex therapy centers on specific sexual problems rather than broad personality issues
- emphasis on: psychoeducation about sexual anatomy and functioning, anxiety reduction, restructuring restrictive, punitive attitudes toward sex
- often includes couple-based interventions
general features of sex therapy (part 2)
-modern sex therapy focuses on:
- addressing physical and medical factors
- education about sexuality
- emotion identification
- change in attitudes and cognitions
- elimination of performance anxiety and the spectator role
- increasing sexual and general communication skills
- mutual responsibility
Disorders of desire
- desire phase of the sexual response cycle; consists of an interest in or urge to have sex, sexual fantasies, and sexual attraction to others
- disorders of sexual desire involve a lack of interest in sex and little initiation of sexual activity: 16% of men (male hypoactive sexual desire disorder) 33% of women (female hypoactive sexual desire disorder)
- DSM-5 combines female sexual interest/arousal disorder into one diagnostic category
- rationale and empirical evidence in support
- empirical/clinical evidence against this
disorders of desire (part 2)
a persons sex drive (level of desire) is determined by a combo of: psychological, sociocultural, biological factors, and any of these may reduce sexual desire
- most cases of low sexual desire are caused primarily by sociocultural and psychological factors
- however, biological conditions can also lower sex drive significantly
disorders of desire: psychological causes
- general increase in anxiety, depression, or anger may reduce sexual desire in men/women
- fears, attitudes, and memories may contribute to sexual dysfunction
- certain psychological disorders, including depression and OCD may lead to sexual desire disorders
- the trauma of sexual molestation or assault is especially likely to produce sexual dlysfunction
disorders of desire: sociocultural (and other contextual) causes
-attitudes, fears, and psychological disorders that contribute to sexual desire disorders occur w/in a social context
- many sufferers of desire disorders are feeling situational pressures
- ex: divorce, death, infertility
-cultural standards can set the stage for development of these disorders
disorders of desire: biological causes
a number of hormones interact to produce sexual desire and behavior
- abnormalities in their activity can lower sex drive
- these include prolactin, testosterone, and estrogen for both men and women
-sexual desire disorders may also be linked to levels of serotonin and dopamine
- sex drive can also be lowered by:
- some medications (including birth control pills and pain meds)
- some psychotropic drugs (especially SSRI anti-depressants)
- a # of illegal drugs
- physical illness (both chronic & acute)
specific interventions for disorders of sexual desire
- sexual desire disorders are among the most difficult to treat because of the many issues that feed into them
- therapists typically apply a combo of techniques, which may include:
- emotional awareness
- self-instruction training
- cognitive-behavioral techniques
- insight-oriented therapy
- biological interventions such as hormone treatments
disorders of excitement/arousal
- excitement phase of the sexual response cycle
- marked by changes in the pelvic region, general physical arousal, and increase in heart rate, muscle tension, BP and breathing rate
in men: erection of penis
-secretions from bulbourethral gland (cowpers gland)
in women: swelling of clitoris & labia and vaginal lubrication
what two things are needed for good sex?
- two Fs: fantasly and friction
- fantasy: erotic thoughts; facilitated by romance, intimacy, play, flirtation, non-genital touch
- friction: stimulation of genitals and other errogenous body parts: penis, clitoris, nipples, anus, perineum, scrotum
disorders of excitement/arousal: Erectile Disorder (ED)
- characterized by persistent inability to attain or maintain an erection during sexual activity
- this problem occurs in as much as 10% of general male population
- according to surveys, half of all adult men have erectile difficulty during intercourse at least some of the time
disorders of excitement/arousal: female sexual arousal disorder
- absence of vaginal lubrication
- may occur in up to 33% of women (as combined desire/arousal disorder)
psychological causes of disorders of excitement/arousal
any of the psychological causes of inhibited sexual desire can also interfere w/ sexual arousal
- performance anxiety and the spectator role:
- once a person begins to have arousal (or orgasmic) difficulties, they become fearful and worry during sexual encounters
- instead of being a participant, they become a spectator and judge
- this creates a vicious cycle: the original cause of the sexual difficulties become less important than the fear of failure
other psychological causes of disorders of excitement/arousal
- stress
- fatigue
- relationship conflict
- sexual inhibitions, anxiety, guilt
-psychological disorders: depression
biological causes of disorders of excitement/arousal
-the same hormonal imbalances that can cause male hypoactive sexual desire can also produce ED
- most commonly, vascular problems are involved:
- ED can also be caused by damage to nervous system from various diseases, disorders, or injuries
- differential diagnosis: assessing nocturnal penile tumescence
- men typically have erections during REM sleep
- abnormal or absent nighttime erections usually indicate a physical basis for erectile failure
-the use of certain meds and various forms of substance abuse may interfere w/ erections
psychosocial interventions for disorders of sexual arousal
-psychoeducation: about sexual anatomy, sexual arousal and stimulation, and sources of inhibition
- reducing performance anxiety and increasing effective stimulation:
- sensate focus exercises: progressive, nondemanding sensual -> sexual pleasuring
- cognitive restructuring: lowering the stakes
- behavioral reversal: acquiring proprioceptive awareness:
- learning what turns you (or your partner) on)
biological interventions for disorders of sexual arousal
biological approaches have gained widespread use w/ the development of sildenafil (Viagra) and other erectile dysfunction drugs
- most other biological approaches have been around for decades and include gels, suppositories, and penile injections
- these procedures are now viewed as second-line treatment
Disorders of orgasm
-orgasm phase of the sexual response cycle
- sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically
- for men: semen is ejaculated
- for women: the outer third of the vaginal walls contract
what are the 3 disorders of orgasm
- premature ejaculation
- delayed ejaculation
- female orgasmic disorder
premature ejaculation
persistent reaching of orgasm and ejaculation w/in one minute of beginning sexual activity w/ a partner
-as many as 30% of men experience rapid ejaculation at some time
psychological, particularly behavioral explanations for premature ejaculation
- these have received more research support than other explanations
- the dysfunction seems to be typical of young, sexually inexperienced men
- it may also be related to anxiety, hurried masturbation experiences or poor recognition of arousal
biological factor of premature ejaculation
-men w/ this dysfunction may have greater sensitivity in the area of their penis
delayed ejaculation
- repeated inability to ejaculate or very delayed ejaculation after normal sexual activity w/ a partner
- occurs in 8% of male population
biological causes of delayed ejaculation
low testosterone, neurological disease, and head/spinal cord injury
-meds, including certain antidepressants (especially SSRIs) can also affect ejaculation
psychological cause of delayed ejaculation
-leading psychological cause appears to be performance anxiety and the spectator role, the cognitive factors involved in erectile disorder
female orgasmic disorder
persistent failure to reach orgasm, experiencing orgasms of very low intensity, or delay in orgasm
- almost 24% of women appear to have this problem
- 10% or more have never reached orgasm
- an additional 9% reach orgasm only rarely
- women who are more sexually assertive and comfortable w/ masturbation have orgasms more regularly
- many clinicians argue that orgasm during intercourse is not mandatory for normal sexual functioning
- DKS: theres no reason for women to accept or resign themselves to the persistent absence of orgasms during sex
psychological causes of female orgasmic disorder
- the same causes of female sexual interest/arousal disorder may also lead to female orgasmic disorder
- memories of childhood trauma and current relationship distress may also be related
biological causes of female orgasmic disorder
- the same meds and physical disorders that contribute to desire/arousal disorders in women may also lead to female orgasmic disorder
- postmenopausal changes may also be a factor
treatment for premature ejaculation
-successfully treated by behavioral procedures such as the stop-start, pause, or squeeze procedure
treatment for delayed ejaculation
-treated w/ techniques to reduce performance anxiety and increase stimulation
treatment for female orgasmic disorder
-specific treatments include cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training
disorders of sexual pain
- characterized by enormous physical discomfort or genito-pelvic pain during intercourse (dyspareunia)
- experienced by women more often than men
- vaginismus: involuntary contractions of the muscles of the outer third of the vagina that interfere w/ penile penetration
psychological factors of disorders of sexual pain
-fear of sexual penetration
biological causes of disorders of sexual pain
-biological (disease, structural) causes should be ruled out
treatment for disorders of sexual pain
-treated w/ psychoeducation, progressive relaxation and (in females) vaginal dilators
paraphilic and fetish disorders
-intense sexual urges, fantasies or behaviors that involve objects or situations outside the usual sexual norms
- a diagnosis of paraphilic disorder should be applied only when the urges, fantasies, or behaviors:
- cause significant distress or impairment, OR
- when the satisfaction of the disorder places the individual or others of harm - either currently or in the past - as in: pedophilia or sadism/masochism
paraphilic and fetish disorders (part 2)
-both may be learned through classical conditioning
- fetishes are sometimes treated w/ aversion therapy, or covert sensitization
- an additional behavioral treatment is orgasmic reorientation, a process which teaches individuals to respond to more appropriate sources of sexual stimulation
transvestic disorder (cross-dressing) involves fantasies, urges, or behaviors involving dressing in the clothes of hte opposite sex in order to achieve sexual arousal (not gender dysphoria)
exhibitionism
- a specific paraphilia, fetish, and related disorder of arousal
- arousal from the exposure of genitals in a public setting
voyeurism
- specific paraphilia, fetish, and related disorder of arousal
- intense sexual urges to observe people as they undress or engage in sexual activity
frotteurism
- specific paraphilia, fetish, and related disorder of arousal
- fantasies, urges, or behaviors involving touching and rubbing against a non-consenting person
pedophilia
fantasies, urges, or behaviors involving sexual arousal from prepubescent or early pubescent children
masochism
fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer
sadism
-repeated and intense arousal by the physical or psychological suffering of another person
summary of paraphilias, fetishes, and related disorders of arousal
many of these are best explained through principles of learning (classical and operant)
- many but not all w/ these disorders have patterns of immature personality development and impaired interpersonal relationships
- the definitions of various paraphilic disorders are strongly influenced by the norms of the particular society
- some clinicians argue that, except when people are hurt by them, at least some paraphilias and other atypical patterns of arousal should not be considered disorders
gender dysphoria
-people w/ this disorder psychologically feel they have the wrong biological sex, and that gender change would be desirable
- controversial diagnosis:
- transgender experiences reflect alternative - not pathological - ways of experiencing ones gender identity
- or instead, gender dysphoria may be a medical problem that may produce personal unhappiness
-some adults w/ this disorder change their sexual characteristics by way of hormones; others opt for sexual reassignment (sex change) surgery
what did each DSM contain about sexual orientation?
DSM-I: homosexuality
DSM-II: sexual orientation disturbance
DSM-III: ego-dystonic homosexuality
DSM-III-R: sexual disorder NOS (could include persistent and marked distress about ones sexual orientation)
What does the APA think about sexual orientation?
they believe there is no consensus among scientists about the exact reasons why sexual orientation is the way it is; they believe most people experience little or no sense of choice about their sexual orientation
