Exam 4: Sexuality/Sexual Dysfunction Flashcards

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1
Q

what are the two general categories of sexual disorders?

A

sexual dysfunctions: problems w/ sexual responses

paraphilic disorders: repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations

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2
Q

what is the supposed third category of sexual disorders?

A

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
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3
Q

sexual dysfunctions

A
  • 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
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4
Q

how long do people experience sexual dysfunctions for?

A
  • 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)
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5
Q

human sexual response cycle

A

-four phases:

  • desire
  • excitement (or arousal)
  • orgasm
  • resolution (or refraction)

-sexual dysfunctions affect one or more of the first 3 phases

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6
Q

gender similarities and differences in response cycle

A

-order of cycle is similar between men and women, but women may have multiple orgasms, while it is harder for men

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7
Q

general features of sex therapy

A
  • 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
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8
Q

general features of sex therapy (part 2)

A

-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
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9
Q

Disorders of desire

A
  • 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
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10
Q

disorders of desire (part 2)

A

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
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11
Q

disorders of desire: psychological causes

A
  • 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
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12
Q

disorders of desire: sociocultural (and other contextual) causes

A

-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

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13
Q

disorders of desire: biological causes

A

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)
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14
Q

specific interventions for disorders of sexual desire

A
  • 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
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15
Q

disorders of excitement/arousal

A
  • 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

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16
Q

what two things are needed for good sex?

A
  • 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
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17
Q

disorders of excitement/arousal: Erectile Disorder (ED)

A
  • 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
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18
Q

disorders of excitement/arousal: female sexual arousal disorder

A
  • absence of vaginal lubrication

- may occur in up to 33% of women (as combined desire/arousal disorder)

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19
Q

psychological causes of disorders of excitement/arousal

A

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
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20
Q

other psychological causes of disorders of excitement/arousal

A
  • stress
  • fatigue
  • relationship conflict
  • sexual inhibitions, anxiety, guilt

-psychological disorders: depression

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21
Q

biological causes of disorders of excitement/arousal

A

-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

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22
Q

psychosocial interventions for disorders of sexual arousal

A

-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)
23
Q

biological interventions for disorders of sexual arousal

A

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
24
Q

Disorders of orgasm

A

-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
25
Q

what are the 3 disorders of orgasm

A
  • premature ejaculation
  • delayed ejaculation
  • female orgasmic disorder
26
Q

premature ejaculation

A

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

27
Q

psychological, particularly behavioral explanations for premature ejaculation

A
  • 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
28
Q

biological factor of premature ejaculation

A

-men w/ this dysfunction may have greater sensitivity in the area of their penis

29
Q

delayed ejaculation

A
  • repeated inability to ejaculate or very delayed ejaculation after normal sexual activity w/ a partner
  • occurs in 8% of male population
30
Q

biological causes of delayed ejaculation

A

low testosterone, neurological disease, and head/spinal cord injury

-meds, including certain antidepressants (especially SSRIs) can also affect ejaculation

31
Q

psychological cause of delayed ejaculation

A

-leading psychological cause appears to be performance anxiety and the spectator role, the cognitive factors involved in erectile disorder

32
Q

female orgasmic disorder

A

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
33
Q

psychological causes of female orgasmic disorder

A
  • 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
34
Q

biological causes of female orgasmic disorder

A
  • 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
35
Q

treatment for premature ejaculation

A

-successfully treated by behavioral procedures such as the stop-start, pause, or squeeze procedure

36
Q

treatment for delayed ejaculation

A

-treated w/ techniques to reduce performance anxiety and increase stimulation

37
Q

treatment for female orgasmic disorder

A

-specific treatments include cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training

38
Q

disorders of sexual pain

A
  • 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
39
Q

psychological factors of disorders of sexual pain

A

-fear of sexual penetration

40
Q

biological causes of disorders of sexual pain

A

-biological (disease, structural) causes should be ruled out

41
Q

treatment for disorders of sexual pain

A

-treated w/ psychoeducation, progressive relaxation and (in females) vaginal dilators

42
Q

paraphilic and fetish disorders

A

-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
43
Q

paraphilic and fetish disorders (part 2)

A

-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)

44
Q

exhibitionism

A
  • a specific paraphilia, fetish, and related disorder of arousal
  • arousal from the exposure of genitals in a public setting
45
Q

voyeurism

A
  • specific paraphilia, fetish, and related disorder of arousal
  • intense sexual urges to observe people as they undress or engage in sexual activity
46
Q

frotteurism

A
  • specific paraphilia, fetish, and related disorder of arousal
  • fantasies, urges, or behaviors involving touching and rubbing against a non-consenting person
47
Q

pedophilia

A

fantasies, urges, or behaviors involving sexual arousal from prepubescent or early pubescent children

48
Q

masochism

A

fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer

49
Q

sadism

A

-repeated and intense arousal by the physical or psychological suffering of another person

50
Q

summary of paraphilias, fetishes, and related disorders of arousal

A

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
51
Q

gender dysphoria

A

-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

52
Q

what did each DSM contain about sexual orientation?

A

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)

53
Q

What does the APA think about sexual orientation?

A

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