Sexual Disorders & Sex Therapy Flashcards
How “Normal” is a Sexual Problem?
Many people experience a sexual problem at some point in their their lives. but usually go away by themselves if they persist and cause distress then it turns into a disorder
e.g. last 6 months: 59% of men 68% of women
almost all university students have shown sexual problems
Sexual Disorders
Sexual problem categories
* Desire
* Excitement
* Orgasm
* Pain
Sexual disorder
* Lifelong(since they start having sex) vs acquired (it started later on)
* Situational vs generalized
Female Disorders
- Female sexual interest/arousal disorder (most common) - 36% but 8 % find distress
- Female orgasmic disorder - 10 - 42%/ 10% never experience orgasm
- Genito-pelvic pain / penetration disorder 8-15%
Female Sexual Interest/Arousal Disorder
- Female sexual interest/arousal disorder refers to a lack of or significantly reduced sexual interest or arousal that causes significant distress
- In fact, about 39 percent of Canadian women report diminished sexual desire
- Difficulties with arousal and lubrication are common.
- Roughly 10 percent of women up to
age 49 have problems with lack of desire; rates then increase to about 50 percent in women over 65
Female Orgasmic Disorder
- refers to a woman’s recurrent difficulty having an orgasm or reduced orgasm intensity during almost all sexual activity(it must be distressing)
- ex of situational orgsmic disorder:the women can orgasm with masturbation but not when stimulated by a partner
- 20% of women report difficulty with orgasms
- women who can orgasm from hand/mouth stimulation from a partner but not penetration should not be consider for this disorder
what causes ?
- general ill health, or extreme fatigue
- Injury to the spinal cord can cause orgasm problems
- most cases are primarily caused by psychological factors.
Genito-Pelvic Pain/Penetration Disorder
- refers to any one of four symptoms that typically occur together: difficulty having intercourse/penetration; marked genital and/or pelvic pain during penetration attempts (sometimes termed dyspareunia); fear of pain associated with vaginal penetration; and marked tension or tightening of the pelvic floor muscles during attempts at vaginal penetration
- 15 percent of women report recurrent pain during sexual intercourse.
- dyspareunia is common in girls between the ages of 12 and 19 who are engaging in intercourse; 20 percent of these girls reported experiencing regular pain during intercourse for at least six months
- it has to last at least 6 months to be consider a disorder
what causes?
-
Disorders of the vaginal entrance: Irritated remnants of the hymen; painful scars, perhaps
from an episiotomy or sexual assault; or infection of the Bartholin glands -
Disorders of the vagina: Vaginal infections; allergic reactions to spermicidal creams or the
latex in condoms or diaphragms; a thinning of the vaginal walls, which occurs naturally
with age or chemically induced menopause; or scarring of the roof of the vagina, which can occur after hysterectomy -
Pelvic disorders: Pelvic infection, such as pelvic inflammatory disease; endometriosis;
tumours; cysts; or tearing of the ligaments supporting the uterus - Dysfunction of the pelvic floor muscles:Higher pelvic floor muscle tone; lower vaginal flexibility; higher mucosal sensitivity; lower muscle strength
Male disorders
-
Hypoactive sexual desire
disorder- low sex disare (41%) 2% distress -
Erectile disorder!
(most commonly seek therapy)- with higher - Premature (early) ejaculation
- Delayed ejaculation
Hypoactive Sexual Desire Disorder(Man)
- low(Hypo) sexual desire
- is distressing to the individual
-
6 percent of young men, 41 percent 65+ report this problem. less than 2 percent of men
meet the criteria for a diagnosis
This disorder is only diagnosed in men because in women sexual desire and arousal are often linked. Thus, they were combined into a single disorder for women
discrepancy of sexual desire
a couple problem, not a sexual disorder
one partner wants sex considerably less frequently than the other partner does, there is a conflict, even if
neither partner is experiencing a sexual disorder.
Erectile Disorder
- Erectile disorder (ED) is the inability to have an erection or maintain one on almost all or all
occasions. - 10 percent of men under 40 but then increases to about 30 percent for men in their 60s(most common to seek treatment)
- What causes?
- Diseases associated with the heart and the circulatory system are particularly likely to be associated with erectile disorder
- diabetes mellitus
- eating disorder
- Any disease or injury that damages the lower part of the spinal cord may cause erectile
disorder
-stress and fetigue
-anxiety
Premature (Early) Ejaculation
- Premature (early) ejaculation occurs when a man persistently has an orgasm and ejaculates
sooner than desired during sexual activity with a partner and is significantly distressed about
the problem - the real problem is that the man with premature (early) ejaculation has little or no control over when he
orgasms - 15% of man have this difficulty
what causes?
* due to a malfunctioning of the ejaculatory reflexes
* local infection, such as prostatitis
Delayed Ejaculation
- Delayed ejaculation (also sometimes called male orgasmic disorder) is the opposite of rapid
(early) ejaculation. The man is consistently (for a period of at least six months) unable to
orgasm, or orgasm is greatly delayed when engaging in sexual activity with a partner, - 10 percent of men experience this problem
what causes
- multiple sclerosis, spinal cord injury, and prostate surgery
- most common with psychological factors
Alcohol
- short-term pharmacological effects,
- expectancy effects
- long-term effects of chronic alcohol abuse.
people who abuse alcohol, particularly in the later stages of alcoholism, frequently have sexual disorders,
typically including erectile disorder, orgasmic disorder, and loss of desire
Cannabis
- high doses and chronic use may have negative effects on desire, arousal, and orgasm
- In community studies, marijuana use has been
associated with orgasmic disorder and erection problems
Illicit or Recreational Drugs
- Chronic use of cocaine, however, is associated with loss of sexual desire, orgasmic disorders, and erectile disorders
- most negative effects on sexual functioning occur among those who regularly inject the drug
drugs increse of risky sexual behaviour(ex: not using condoms)
Prescription Drugs
- (SSRIs)- anti depressent, are associated with desire, arousal, and delayed orgasm problems in men and women. A few
New View Critique of the DSM
- Diagnostic categories treat male and female sexuality as equivalent when they differ in important ways
- They ignore the relational context of sexuality and desires for emotional intimacy(more in the physiological)
- They ignore differences among women and naturally occurring variations in women’s sexuality
problems with DSM diagnoses
(1) They treat male sexuality and female sexuality as
equivalent, when they differ in some important ways;
(2) they ignore the relational context of sexuality and desires for emotional intimacy;
(3) they ignore differences among women and naturally occurring variations in women’s
New View Proposed Categories
- Sexual problems due to socio-cultural, political, or economic factors
- ignorance and anxiety because of inadequate sexuality education, lack of access to health services, or other social constraints
- sexual avoidance or distress because of perceived inability to meet cultural norms regarding ideal sexuality (e.g., anxiety about one’s body or about sexual orientation)
- inhibitions caused by conflict between the norms of one’s culture of origin and those of the dominant culture; and
- lack of interest or fatigue caused by family and work obligations.
- Sexual problems relating to partner and relationsip
- sexual inhibition or **distress arising from betrayal or fear of the partner because of abuse; **
- discrepancies in desire or preferences for sexual activities
- ignorance or inhibition about sexual communications;
- loss of sexual interest as a result of conflicts over issues
- loss of arousal because of a partner’s health or sexual problems
-
Sexual problems due to psychological factors
- sexual aversion or inhibition of sexual pleasure because of past experiences of physical, sexual, or emotional
abuse
- personality problems with attachment or rejection, or depression or anxiety
- sexual inhibition caused by fear of sexual acts or their possible consequences, such as pain during intercourse or fear of pregnancy or STIs. - Sexual problems due to medical factors
- any number of medical conditions that affect neurological, circulatory, endocrine, or other systems of the body;
- pregnancy or STIs
- side effects of medications.
biophychosocial approch to understand health
biology :gender,olness,disability,
phychogy:personality,emotions,attitudes,learning/memory,behaviour,past trauma
social context: social support,family background, cultur, social class,education.
Biological Causes for health issues
- Physiological
- Medical - ex:diabilitis,injury
- Drug - ex: ant-depressents,alchool
Psychological Factors
-
Myths and Misinformation:Many people have beliefs about sexual activity that are incorrect, or they are unaware of sexual information (such as
the effects of aging on the sexual response) that is important to sexual functioning(ex:where the clitori is) -
Negative Attitudes:about sexual activity,
one’s own body, or one’s partner’s bod -
Anxiety: during sexual activity can be a source of sexual disorders. Anxiety may be caused by
negative or traumatic experiences in the past, such as child sexual abuse -
Cognitive interference i refers to thoughts that distract the person from focusing on the erotic
experience(ex:body image,performance) - Techniques and Communication
- Relationship Distress
- Lifestyleex: stress
-
Psychological Distresssexual
disorder may be one symptom of a more general psychological disorder
TREATMENTS
- Myths and Misinformation:
PSYCHOEDUCATION - Negative Attitudes
PSYCHOEDUCATION
CBT - Anxiety
CBT - Techniques and Communication
PSYCHOEDUCATION
, COUPLES THERAPY - Relationship Distress
COUPLES THERAPY - Lifestyle
PROBLEM SOLVING, SCHEDULING - Psychological Distress
INDIVIDUAL THERAPY
The Stop-Start Technique
The stop-start technique is used to help men increase their control over the timing of their ejaculation
- The partner manually stimulates the man to
erection - Then stops the stimulation before that point.
- Gradually the man loses his erection.
- The partner resumes stimulation, the man gets another erection
- the partner stops, and so on.
- After doing this three or four times, the man can allow himself to orgasm.
The man learns that he can have an erection and be highly aroused without having an orgasm.
Using this technique, the couple may extend their sex play to 15 or 20 minutes, and the man gains control over his orgasm
Masturbation
The most effective form of therapy for women with orgasmic disorder is a program of directed masturbation
Kegel Exercises
in women
- first to find her PC muscle
- the woman icontract the muscle ten times during each of six sessions per day.
- Gradually, she can work up to more.
These exercises seem to enhance arousal and facilitate orgasm by increasing women’s awareness of and comfort with their genitals
physiotherapy is effective at treating genito-pelvic pain and vaginismus in women
Bibliotherapy and Videotherapy
- Bibliotherapy refers simply to the use of a self-help book to treat a disorder
- Research shows that bibliotherapy is effective for
orgasmic disorders in women
Format of Sex Therapy
- Assessment
- Frequency of sessions
- Session format
- Ground rules
Behaviour Therapy
Behaviour therapy has its roots in learning theory. The basic assumption is that sex problems are the result of prior learning and that they are maintained by ongoing reinforcements and punishments (maintaining causes)
body mapping, Clients map out their own sensations by touching their body all over (usually first excluding breasts and genitals) to find out what parts of the body and what ways of touching produce pleasure
Sensate focus exercises are based on the notion that touching and being touched are
important forms of sexual expression and that touching is also an important form of
communication
Sex Therapy: Sensate Focus
-
Self-exploration
* looking at your own body - Self-pleasuring - touching own self
- without breasts & genitals
- with breasts & genitals (to pleasure)
- with breasts & genitals (to orgasm)
-
Mutual pleasuring(touching each other)
* without breasts & genitals
* with breasts and genitals (pleasure)
* with breasts & genital (orgasm) - Intercourse
to lesser anxiety/exposure therapy
mindfulness exploration
Cognitive-Behavioural Therapy
many sex therapists use a combination of the behavioural exercises and cognitive therapy
In cognitive restructuring, the therapist essentially helps the client restructure their thought patterns, helping him or her to become more positive
Couple Therapy
In couple therapy, the relationship itself is treated, with the goal of reducing antagonisms and tensions
between the partners and improving intimacy, empathy, and communication. As the relationship improves, the couple is better able to make the changes that will help resolve
the sex problem.
Mindfulness Therapy
Mindfulness therapy is a system of training people in mindfulness practices; one goal is to help people regulate their own negative emotions.
Mindfulness training helps individuals experiencing sexual problems to focus their attention on the present moment and create nonjudgmental present-moment sexual awarene
Biomedical Therapies
-
Drug teatment
- Viagra is taken by mouth approximately
one hour before anticipated sexual activity. It does not, by itself, produce an erection. Rather, when the man is stimulated sexually after taking Viagra, the drug facilitates the physiological processes that produce erection
- testoaterone treatmant can higheten sexual desire -
Intracavernosal Injection
- Intracavernosal injection (ICI) is a treatment for erectile disorders
- ICI is now used mainly in cases in which the erection
problem is due to physical causes and the man does not respond to Viagra
- it can cause eractions that dont go away -
Suction Devices
- A tube is placed over the penis
- . Once a reasonably firm erection is present
- the tube is removed and a rubber ring is placed around the base of the penis to maintain the penis’s engorgement with blood
- used for men with diabitis -
Surgical Therapy
- he surgery involves implanting a penile prosthesis. A sac or bladder of sterile fluid is implanted in the lower abdomen, connected to two inflatable tubes running the
length of the corpus spongiosum, with a pump in the scrotum.
- man can literally pump up or inflate his penis so that he has a full erection
- It should be emphasized that this is a radical treatment
- In another version of a surgical approach, a semirigid, silicone-like rod is implanted into the
penis
PLISSIT MODEL
a model of how to help others with their sexual problems (as it goes down, the need for training increses
Permision
LImited information
—
Specific Sugestion
Intensive Therapy
Avoiding Sexual Disorders
1. Communicate with your partner.
- Try to stay in the moment.
- Relax and enjoy yourself.
4.** Be choosy about the situations in which you have sex.**
- Accept that disappointments will occur.
