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