Lecture 8: Sexual Dysfunction Flashcards

1
Q

What is Sexual dysfunction?

A

is a persistent or reoccurring
- lack of sexual desire
- difficulty becoming sexually aroused
- ability to reach orgasm
-pain

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2
Q

What might be some reasons why people are hesitant to seek help?

A
  • they don’t want to talk about it
  • don’t want to see a doctor
  • may hide issues from partner
  • feel shame/guilt
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3
Q

What are the biological approaches/reasons for sexual dysfunction?

A

-Neurological disorders (MS)
-Spinal cord injuries
- Vascular issues (lg network of blood vessels)

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4
Q

What are the psychological approaches/reasons for sexual dysfunction?

A
  • Personal experiences that leave long-lasting implications
  • Mood disorders - depression
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5
Q

What are the social reasons influencing sexual dysfunction?

A
  • Religious beliefs, ethnicity, and culture all affect how we think about sex
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6
Q

What is an example of how culture impacts the interpretation of symptoms and diagnosis of sexual dysfunction?

A

Dhat syndrome from India
- semen is vital to body functionality
- when an individual is concerned/ worried about losing semen from ejaculation
- symptoms of anxiety, depression, weakness, fatigue, sleeplessness, palpitations and headaches
- treatment is usually medication with CBT

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7
Q

What criteria are required for a diagnosis of sexual dysfunction?

A
  • Must have occurred for 6 months or more
  • must occur 75 to 100% of the time
  • Must cause person significant distress
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8
Q

Sexual dysfunctions can be classified in four ways.

A

Lifelong = something always present since being sexually active

Acquired = did not have before, but you have it now for some reason.

Generalized = whatever the problem is, it happens constantly with every partner, by yourself, and generalized across all contexts.

Situational = you only have the problem with partners, or with certain partners and not others.

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9
Q

What are some of the sexual desire-related disorders?

for both male and female

A

*affects both men and women but is higher in women

  1. Male Hypoactive Disorder
  2. Female sexual interest/arousal disorder

◦Absence of sexual thoughts or fantasies

◦(Some) can still become physiologically aroused and orgasm when adequately stimulated

◦Still appreciate physical closeness/intimacy, but no interest in genital stimulation
* married women were twice as
likely to experience this
compared to single women

   * overall higher in married 
     couples

◦You share life stresses when you married

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10
Q

True or False:
There is no clear consensus among clinicians about how to define “low sexual desire”

A

True!
◦No standard level/ threshold of sexual desire
◦Always have individual differences

  • problem becomes apparent when there is a discrepancy between partners

◦Men are generally more interested in sex

◦Gay and lesbian couples may have fewer discrepancies

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11
Q

What changes occurred in the DSM for female hypoactive disorder and female arousal disorder?

A
  • both were combined as female sexual interest/arousal disorder
  • based on how sexual responses overlap for many women
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12
Q

Sexual Arousal Related Disorders

in males

A

Male Erectile Disorder
* Persistent difficulty in achieving or maintaining an erection sufficient to allow completion of sexual activity
* In most cases, the failure is limited to sexual activity with partners or with some partners and not others
◦Usually situational (partnered activity typically the problematic situation)
* Some men can attain erections but not sustain them
* Incidence increases with age
* medical problems are associated
◦Cardiovascular disease- can lead to problems with erection because of blood flow
◦Diabetes- can damage the blood vessels and nerves
Younger individuals- more likely psychological reasons

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13
Q

What are some of the reasons why performance anxiety can become a consistent issue?

A
  • the male will usually fear it occurring again
  • becomes stuck in a feedback loop
  • Embarrassment or shame

‣ Pressure on men to perform/ always want to have sex

  • Men as initiators
  • Need to be confident always
  • Creates performance anxiety (anxiety concerning one’s ability to perform behaviours, esp behaviours that people may evaluate)

◦Canʼt stop thinking about your previous bad experience

◦Happens again, perhaps because of the way that you think about it
◦Self-fulfilling prophesy

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14
Q

Which model looks at sexual response from a biological POV?
a)Master’s and Jhonson’s
b) Kaplan’s model
c)Basson’s model

A

a) Master’s and Jhonson’s

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15
Q

Based on the DSM-5, changes to female hypoactive desire disorder and female arousal disorder to merging female sexual interest and arousal disorder - what model can better explain this change? (potential short answer question)

A

*Master’s and Jhonson’s models saw a sexual response from a biological POV. Does not consider desire.

*Kaplan’s model is linear and views desire as coming before arousal.

ANSWER: *Basson’s intimacy model seems to be more in alignment with this new change to the DSM-5 because, for females in particular, arousal can occur first before desire. Whereas for men, it’s a linear progression; desire comes first, the arousal.

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16
Q

Study (1986): Does anxiety always interfere with sexual performance?
(short answer question) - explain what happened and the results.

A

Researchers attempted to stimulate performance anxiety in sexually functional male volunteers who were shown an explicit sexual film under one of three conditions:

1 = Contingent threat
- mimics performance anxiety
- hard to recreate - they would shock participants if they did not reach a certain arousal

2 = Noncontingent threat
- generalized anxiety
- shock was not dependent on arousal and can happen at anytime

3 = control group = no shock given, just watched erotic film

Results: Researchers hypothesized that the contingent threat group would have the lowest level of arousal, but in fact, they actually had the highest level of arousal. This was done with healthy males.

*In males with sexual dysfunction
- showed reduced levels of sexual arousal to threat conditions
- their attention would be so focused on negative outcomes that they could not process erotic cues from film
- fears of sexual function have distorted the basic natural response that they broke out in a cold sweat

◦Canʼt forget how to have an erection
◦ It is an automatic response!!

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17
Q

What are the 5 key factors of a model of erectile dysfunction in men?

A
  1. Negative vs Positive effect
    ◦Men who often experience problems with erections go into situations with negative affect
    ◦Men who donʼt experience issues went in with a positive affect
    ‣ Expectations of the situation have a significant influence on the erection
  2. Underreported sexual arousal/diminished self-control
    ◦Males who experience dysfunction UNDER reported sexual arousal
    ‣ Both groups had similar physiological arousal numbers
    ‣ Men underreported subjective arousal

3.Dysfunctional group felt they had lack of control
- they tend to attribute issues to diff factors
- healthy men will blame EXTERNAL facotrs
- problematic men will blame INTERNAL factors

  1. Distraced-related performance stimuli
    - if the distraction is related to performance (shock)
  2. Role of Anxiety
    - anxiety will INHIBIT arousal in men who have dysfunction
    - may facilitate arousal in healthy men
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18
Q

What are two types of disorders regarding female sexual arousal disorder that is suggested by Basson (2004)?

A
  1. Combined-arousal disorder
    - no subjective arousal/experience = no genital response
  2. Subjective arousal disorder
    - aware that genitals response physically to stimulation = no subjective arousal is felt
    * both physical and mental factors responsible
    *Physical
    ◦Diabetes- nerve damage
    ◦Loss of estrogen- lower arousal
    ◦Skin may be less sensitive to touch than other women
    *Psychological
    ◦Relationship issue
    ◦Past trauma
    ̶̶̶̶̶̶̶̶̶̶̶
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19
Q

Which of the following are orgasmic disorders?

a) Female orgasm disorder
b) Premature ejaculation
c) Delayed ejaculation
e) All of the above
f) a) only

A

e) All of the above!

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20
Q

Female Orgasmic Disorder

A
  • unable to reach orgasm or have difficulty reaching orgasm after adequate sexual stimulation
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21
Q

True or False?
A woman who reaches orgasm through masturbation rather than through intercourse has Female orgasmic Disorder.

A

False! They do not

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22
Q

Delayed ejaculation

A
  • very few men have never ejaculated
  • limited to sexual intercourse
    • if they have not ejaculated through intercourse, can be a problem
  • can be due to physical or psychological causes such as performance anxiety
23
Q

Premature ejaculation

A
  • Ejaculation occurs with minimal sexual stimulation, and before the man desires it
  • After ED in elderly men, PE is the most common male sexual dysfunction
  • Degree of rapidity varies
  • Some argue that the focus should be on whether the couple is satisfied with the overall duration of sexual activity,rather than a specific time period.
  • ejaculation needs to occur within a minute to be diagnose
24
Q

What are some false perceptions of how the media portrays sex?

A

Sex is seen as something that lasts for hours

Unrealistic for most people

One study on men found that penetration lasts for 8 minutes

One study on men and women found that sex overall lasts 25 min, foreplay was 20 min and sex was 5 min.

25
Q

Which of the following are Sexual Pain Disorders?

a) Vaginismus
b) Dyspareneuria
c) autonomic penile arousal
d) Only a & b
e) None of the above

A

d) only a and b

26
Q

Dyspareunia

A
  • a sexual pain disorder
  • A general type of pain through intercourse or persistent pain associated with any stimulation of the vaginal area
  • Common sexual dysfunctions
  • causes:
    ◦Inadequate lubrication
    ◦Infection
    ◦Low pain threshold compared to other women
    ‣ May not be genital specific
    ◦psychological factors
    ‣ Sexual trauma
    ‣ Restrictive family- sexual guilt and anxiety
    ‣ Self-report higher levels of pain in those who experience this because of psychological etiology
27
Q

Vaginismus

A
  • a sexual pain disorder
  • Involuntary contraction of the pelvic muscles that surround the outer one-third of the vaginal barrel, resulting in
    pain
  • Avoidance of penetration ** seems to be the key factor differentiating vaginismus from dyspareunia
    ◦Vaginismus occurs reflexively during attempts at vaginal penetration, making entry of the penis, fingers,
    dildo or any object (e.g., tampon) difficult or impossible
  • Many attribute this to psychological
  • But nerves may be too sensitive
28
Q

What is the difference between Vaginismus and Dyspareunia?

A

Vaginismus is when the muscles around the vagina involuntarily tighten, making penetration painful or impossible.

Dyspareunia refers to recurrent genital pain that occurs just before, during, or after intercourse. Unlike vaginismus, which primarily involves muscle tension, dyspareunia can have various causes. It may result from physical issues like infections, vaginal dryness, or injury, or it could be linked to psychological factors such as anxiety or relationship problems.

.

29
Q

What are some biological origins of sexual dysfunction?

A

Medical factors:
- heart disease (blood flow)
- Diabetes (damage to nerves for sexual arousal)
- Aging (Physical changes)
- Drugs (Depression meds often have a dampening effect on hormones that influence sexual desire/ arousal )

30
Q

What are some Psychosocial origins of sexual dysfunction that serve as predisposing factors?

A

Risk facotrs that can lead to sexual dysfunction:

◦Restrictive upbringing- this is why it is so important to educate children in an informative, open
environment
◦Traumatic early sexual experiences
◦Inadequate sexual info/myths (abstinence only programs)

31
Q

What are some Psychosocial origins of sexual dysfunction that serve as precipitating factors?

A

Factors that initiate or trigger the onset of the disorder:

. random failure
* Discord in relationship
* Infidelity
* Pregnancy/ Childbirth

32
Q

What are some Psychosocial origins of sexual dysfunction that serve as maintaining factors?

A

factors that may perpetuate or maintain dysfunction:

  • poor emotional intimacy
  • Performance anxiety
  • Guilt
  • Loss of attraction between partners
  • Restricted foreplay
33
Q

What are some common myths about sex (that might lead to sexual dysfunction)?

A
  • Size is everything
  • Depictions of bodies (pubic hair, body proportions) in movies and porn
    ◦Lead to body dysmorphia, anxiety disorders
  • frequency of sex
    ◦Perception and comparison leads to anxiety
  • Sexual scripts/ gender roles
    ◦Men need to always want sex
    ◦Women donʼt care about sex- women seen as slutty/abnormal for wanting to have sex
    ‣ Anxiety. Performance issues (psychological distress)
  • Orgasming at the same time
  • sex has to be crazy and wild all the time
  • People with disabilities/ elderly people donʼt want sex
  • Sex always has to end in orgasm- pressure
    ◦Orgasm is the be-all and end-all
    ◦performance anxiety and pressure to function
    ‣ Pressure for males to “give orgasm” for females to “have” orgasm
  • enjoy the moment!
  • Penetrative sex leads to orgasm
  • women need to be permissive (especially in partnered/ long term relationships)
    ◦Can lead to trauma
  • Experimentation
    ◦Might lead to anxiety around questioning your identity/ religious/family pressure and stigma
  • Multiple partners is seen as morally evaluated
    ◦Sex leads to pregnancy- anxiety and avoidance of sex
  • STIʼs
    ◦Misinformation can lead to infections “showering before and after means you donʼt need a condom”
  • sex exists in “one way” only
    ◦Increased specificity can lead to boredom, disinterest/ lack of arousal from partner
34
Q

What are some psychosocial features that differentiate from biological features in sexual dysfunction?

A
  • occurs at a younger age
  • onset is acute/sudden
  • situational
  • symptoms are intermittent
  • Desire is absent or varies
  • Organic risks are absent and varies
  • if the partner is the problem sexual dysfunction is seen early on
  • anxiety and fear is the primary cause
35
Q

What are some biological/organic features that differentiate from psychosocial features in sexual dysfunction?

A
  • occurs at a older age
  • onset is gradual
  • occurs all the time
  • symptoms are consistent
  • desire is present
  • organic risks are present
  • if the partner is a problem it’s a secondary factor
  • anxiety and fear is a secondary factor
36
Q

What model is the treatment for sexual dysfunction?

A

Permission
Limited
Information
Specialized
Suggestions
Intensive
Therapy

37
Q

What are treatments for problems related to sexual desire?

A

*Self-stimulation exercises combined with erotic fantasies
* Sensate focus exercises
* Enhancing communication
* Expanding couplesʼ repertoire of sexual skills
* Testosterone
* Treatment for depression
* Counselling or psychotherapy

38
Q

What are some treatments for sexual arousal?

A
  • Relaxation
  • Non-genital sensate-focus exercises
39
Q

What are some treatments for erectile disorder?

A
  • Oral medications (e.g., Viagra, Cialis)
  • Hormone (testosterone) treatment
  • Vascular surgery
  • Penile implants
  • Vacuum pump
40
Q

What are some treatments for female sexual interest/arousal disorder?

A
  • Sex education
  • Searching out and coping with possible cognitive interference
  • Working on relationship problems
  • Artificial lubricant
  • Testosterone skin patches
  • Eros clitoral suction device
  • Viagra
41
Q

What are some treatments for orgasmic disorders?
Specifically premature ejaculation

A
  • Sensate-focus exercises
  • Biological treatments
  • Squeeze technique
  • Stop-start method
42
Q

What are some treatments for pain disorders = Vaginismus

A
  • Behavioural exercises in which plastic vaginal dilators of increasing size are inserted to help relax the vaginal musculature (women controlled)
43
Q

What are some treatments for pain disorders = Dyspareunia

A
  • Cognitive-behavioural therapy
  • Biofeedback
  • Surgery
44
Q

Vasocongestin

A

When we become sexually stimulated, our bodies produce vaginal lubrication in females and erections in males.

45
Q

What is performance anxiety?

A

The fear of having repeated attempts of failing to have an erection and maintaining one.

46
Q

What is it called when women have never reached an orgasm through any sexual contact or masturbation?

A

anorgasmic or preorgasmic

47
Q

How long does a PE need to take place for the DSM-5 to diagnose it as an orgasmic disorder?

A

one minute within penetration

48
Q

What does the DSM-5 categorize all sexual pain disorders as?

A

genito-pelvic pain/penetration disorder

49
Q

What is the most common cause of pain during sex?

A

lack of lubriucation

50
Q

True or False?
In men, performance anxiety can either inhibit or trigger early ejaculation

A

true!

51
Q

True or False?
In women, performance anxiety can reduce vaginal lubrication and contribute to female orgasmic disorder

A

True!

52
Q

What is the PLISST model?

A
  • Allows health professionals and clients to differentiate b/t sex problems that can be resolved through basic education, counselling

Permission = therapist gives the client permission to talk about sexuality and personal concerns

Limited info = Some sexual problems may be rooted in myths and misinformation about sexuality. Providing a limited amount of correct information about sexual functioning is often a key step in resolving a problem.

Specific Suggestions = Once the basic nature of a sexual problem is identified, the therapist provides suggestions to help resolve it. The client may be encouraged to read books about sexual enhancement, for example, such as sex manuals, or to watch instructional sex videos or erotica.

intensive Therapy =If the first three levels of therapy are unsuccessful in solving the problem, a more intensive form of sex therapy may be required. At this point, a therapist who doesn’t specialize in sex therapy will refer the client to someone with advanced training in treating sexual dysfunction.

53
Q

What is the squeeze technique?

A

A form of treatment therapy for premature ejaculation where you place your thumb and other fingers around the penis and press down firmly in 15-20 min sessions gradually increasing threshold of holding off ejaculation