Sexual Dysfunction Flashcards
What is a sexual problem?
A sexual difficulty that the person identifies as a problem that causes them distress
(some people have low desire but not distress which is not a problem).
Categorized as problems with: desire, arousal, orgasm, sexual pain
What has happened to the DSM focus since Kaplin?
now that desire is added the DSM has expanded
What happened to the diagnosis of hypoactive sexual desire disorder in the DSM 5?
Now it is only for men; women has changed to sexual interest/arousal disorder
Why was sexual aversion disorder removed?
It can be explained better by other disorders
What happened to the diagnosis of dyspareunia?
in men its nothing and in women its genito-pelvic pain/penetration disorder
What 2 things are required for all clinical diagnoses?
the problem must occur for 6 months and it must cause distress/interpersonal difficulty
What is sensate focus therapy?
requires couple to redirect emphasis away from intercourse and focus on their capacity for mutual sensuality. Will often avoid sex and intimacy all together.
o No sex can happen the session.
o Take turns touching each other and say what you like/dislike
o Takes the pressure off of performance
Directed Masturbation
therapist provides instructions on how to use masturbation to overcome a specific problem.
o Just focussing on the sensations without the goal of having an orgasm.
Cognitive Behavioral Therapy
addressing problematic/incorrect thoughts and behaviors together
What is the fourth type of common sex therapy?
Learning verbal communication skills
What is touch mirroring ? Why is it a problem?
a problem with nonverbal
>If you want someone to touch you more gently you might start trying to touch your partner more gently, but that might not be what your partner wants. So then nobody is getting what they want.
What is new to the DSM?
Factors Related to Sexual Problems
- New to the DSM because of the new view of women’s problems
- Now for all disorders listed in the DSM, clinicians have to say if the problem is related to any of the 5 factors
What are Intrapsychic Factors?
- Pretty much everything
- Family messages about sex (not talking about it can even be a strong message)
- Lead to our views and values about sex
- Sexual experiences/abuse
- Self-esteem (if you don’t feel worthy of pleasure)
- Fear of consequences (STI, pregnancy, being called a slut)
- Stress/anxiety
- Guilt (if you received messages that sex is dirty and bad, often stems from religion)
- PTSD
- Cultural expectations that everyone should be sexually active and skilful and find sex easy and effortless create the foundation for performance anxiety
What are Intrapersonal/Relationship Factors
- Changes in sexual response are often related to relationship factors
- Poor communication (most common problem in therapy)
- Usually bad at conflict resolution (learned from observation during childhood)
- Which may result in anger and resentment
o because when one cannot express anger they will eventually be unable to express or experience passion
o Think about a couple fighting about how often, when and who should initiate sex? While it might be a fight about sex, sex might actually be a stand in - Conflicting sexual expectations
o We know what we want out of the relationship/sex and we expect that the other person feels the same, or we think they know what we want (can be frequency, type of sex, etc.) - Lack of trust
o Gut feelings/lack of trust/don’t feel safe can lead your body to shut down in that way - Lack of respect
- Fear of hurt or disappointment (fear of being betrayed again)
What are cultural/psychosocial factors?
- Huge, often invisible factors
o Because if you are born into it you don’t realize what you’re in without being aware, because we’re unaware of what we don’t know it can lead to conflicts in relationships - Ethnic background
- Religious background
o Which now Is incredibly different all across Canada due to the decline of protestant and roman catholic teaching and now there are less adults who identify as Christians, as well as numerous denominations popping up - Family
o When parents try to get their kids to not “touch themselves” - Social background/social circle
o Ex: if you were the only gay guy in your social circle and hid that/pushed it down for years can be harmful in the future - School education
o Mostly focused around consequences, nothing about healthy relationships
o In Canada its biology, avoiding STIs and not much about sexual feelings, desires or pleasures - Media (mainstream, social, porn)
o Reinforce unrealistic body images and performance expectations - Tiefer – Cultural variations in kissing behavior
o A couple, the woman’s Asian culture did not sexualize kissing and she found it repulsive. His culture thought it was passionate. - What is “normal” in one culture may not be in another
T or F? - “real” sex equals intercourse
False
T or F? Sexual satisfaction equals orgasm
False
T or F? - Bigger isn’t better (when it comes to breasts and penises)
True
T or F? - Sex goes downhill after marriage; it gets even worse when you have children. If that’s what you believe that’s probably what you’ll make happen
False
T or F? - A man always wants and is ready to have sex
False
What are 5 organic factors linked to sexual problems?
Neurological, Hormonal, Vascular, Recreational drug use, Prescription drug use
How can neurological damage affect someone’s sexual functioning?
o Any damage/problems to brain and spinal cords (MS) can affect the nerves connected to skin and gentiles
In terms of neurological factors, what can diabetes lead to?
peripheral neuropathy: which can affect sexual functioning by reducing blood flow to the genitals and eventually cause deterioration of nerve functioning (pain, weakness or numbness of nerve outside the CNS)
What are 2 hormonal factors?
o Hypothyroidism (low thyroid hormone levels) o Anemia (decreased in RBC due to iron deficiency)
What are 2 vascular issues that could affect blood flow and therefore genital arousal?
o Diabetes, cardiovascular disease
Recreational drug use includes alcohol and smoking. How does each affect sexual functioning?
Alcohol
♣ Reduce inhibition, but increase desire
♣ Reduces blood flow, lubrication
♣ So more desire, but less physiological response
Smoking
♣ Reduced blood flow
♣ Weed has been advocated to enhance sexuality
What types of prescription drug use can cause sexual dysfunctioning?
Anything affecting blood flow Antidepressants tend to delay orgasms
What is an aphrodisiac?
a substance alleged to induce sexual desire (there isn’t any true ones)
What is inadequate sex?
Meaning the sex, they are having is not the best for them. They are not having the sex they want to have.
What does quality sex require?
People to have enough self-knowledge about their desires and be able to discuss their needs and desires.
Masters and Johnsons had 5 points of criticism for their model; what were all 5 and explain.
- Developed the model before doing the research. So they sought people out who fit their premeditated model
- Assumption that physiology is universal . Called it “the human response cycle” not “a human response cycle”
- What is “effective sexual stimulation”?Never actually define what it is
- Participant selection bias – wanted to show that women were sexual too. Identical performance requirements for males and females. Not a representative class sample
- Participants trained on “responding” to various stimuli in the laboratory. “When female orgasmic or male ejaculatory failures develop in the laboratory, the situation is discussed immediately. Once the individual has been reassured, suggestions are made for improvement in future performance. Therefore, only concerned with people who responded the way they wanted people to respond and would coach them if not.
What classification system did the New View adopt instead of Masters and Johnsons model?
A biopsycho-social model. Not to say M&J model was not important but it was constrained to the physiological response.
Why did the New View lobby for change in the classification of sexual problems in the DSM? What did the new view argue?
The DSM only wanted to talk about disorders in the context of what the cause was
o The New View argued the cause of the sexual problems was what we needed to know to fix it rather than just focussing on the fact the the individual is not orgasming
What were the 4 new view classifications?
o Sexual problems resulting from sociocultural, political, or economic factors
o Sexual problems relating to partner and relationship
o Sexual problems resulting from psychological factors
o Sexual problems resulting from medical factors
Medicalization of sexuality affects who?
Men and Women
EVERYONE
Who medicalized ‘impotence’ with Viagra?
Klein and Morin