Task 2

Question 1

sexual problem/ difficulty

Answer 1

One does not experience sexually what one could or would like to experience

Question 2

Sexual dysfunction

Answer 2

When the sexual response is missing or diminished and when this goes along with sexual distress

19 %woman, 16 %men

Question 3

The leading problems for women are

Answer 3

lack of interest in sex, an inability to experience orgasm, problems with psychological arousal (especially vaginal lubrication), and pain during sex.

Question 4

For men

Answer 4

climaxing too early (premature ejaculation) is the leading problem, followed by anxiety about performance and a lack of interest in sex.

Question 5

Sexual disorders can be primary, secondary, or situational.

Answer 5

• A primary disorder is lifelong.
• A secondary disorder is one that appears after some period of normal function.
• A situational disorder is one that appears in some circumstances but not others.

• For example, for situational disorder  premature ejaculation might occur during partnered sex but not during masturbation.

Question 6

The causes of premature ejaculation are not well understood

Answer 6

learning or a dysfunction in certain receptors for the neurotransmitter serotonin.

Question 7

when is what plausible

Answer 7

Psychological theories  most plausible in cases where premature ejaculation is situational.

Biological theories  may account better for lifelong premature ejaculation that affects a man in all circumstances.

Question 8

Self-devised remedies:

Answer 8

• Masturbating to orgasm prior to partnered sex.
• Distracting himself during sex with irrelevant thoughts (such as doing mental arithmetic or imagining having sex with a person he’s not attracted to).
• Trying to bring his partner as close to orgasm as possible prior to coitus.
 Such remedies rarely work and they often prevent the man or his partner from having a rewarded sexual experience.

Question 9

therapy treatment

Answer 9

stop start method
SSrIS (prozac, Paxil, Zoloft)=> Paroxetine(Paxil)

• It is taken as needed 1 to 2 hours before a sexual encounter.
• Several studies have found it to be efficacious and safe, though it does have a range of potential side effects.

Question 10

Topical anesthetic

Answer 10

in the form of cream applied to the penis) can also be used to reduce sensitivity. This method is moderately effective in slowing ejaculation, but unless a condom is used, the anesthetic may also numb the woman’s vulva and vagina, impeding her ability to reach orgasm.

Question 11

delayed (or absent) ejaculation

Answer 11

difficulty achieving or inability to achieve orgasm or ejaculation (male orgsamic disorder)
=> common estimates 3% to 8% of male population
As with premature ejaculation, delayed ejaculation can be a lifelong problem or it may be acquired at some point in adult life.
masturbation using a tight grip and vigorous strokes, or who masturbate by rubbing their penis against bedding or rough surfaces.

o This can leave men insensitive to the gentler stimulation that is likely to be experienced during coitus. o This interpretation is contested by others who argue that these men masturbate often and vigorously because they have such difficulty experiencing orgasm any other way.
• Alternatively, too much viewing of pornography could be the cause,
Delayed ejaculation can also follow some traumatic life event, such as a relationship crisis. Or perhaps the man’s thought processes during sex are so distracting or negative that they interfere with sexual arousal.

Question 12

Treatment for delayed ejaculation

Answer 12

chnaging mans habits=>stopping mastrurbation,

sexual shame=> psychotherapy

biological causes, neurobiological damage, certain drugs( antidepressants)=> switching drug or adding a second drug

Question 13

Erectile disorder (ED)

Answer 13

a recurrent inability to achieve an adequate penile erection or to maintain it through the course of the desired sexual behavior – if such inability causes distress to the man or difficulty between the man and his partner.

The condition may be partial or complete, and it may be a primary, secondary, or situational disorder.
Although ED can certainly occur in young men, it becomes much more common as men age  It affects about one-half of all men over the age of 60 and the majority of men who are 70 or older.

Question 14

ED causes

Answer 14

• Behavioral/lifestyle factors (smoking, obesity)
• Medical conditions (diabetes)
• Drugs (antidepressants, recreational drugs)
• Injuries (spinal cord)
• Psychological factors(performance anxiety, depression, stress, relationship problems)
• Developmental issues (childhood trauma, religious taboos)

often its an interplay of physical and psychologic factors wich rein force each other

Psychological: relational, anxiety and inhibitions
Performance anxiety
Focus on the pleasure of the partner

Question 15

ed treatment

Answer 15

lifestyle changes, switching drugs, cock ring , sex therapy, sensate-focus exercise
cognitive therapy=> overcome, misconceptions, reduces performance anxiety, resolving relationship issues

► viagra, injections, vacuum-pump, prothesis

Question 16

ED dugs

Answer 16

viagra,Levitra, Cials, and Stendra.

highness responsiveness to nitric oxide=> the neurotransmitter responsible for penile erection , cannot respond if there is no nitric oxide

Question 17

ED & nitrci oxide

Answer 17

What this means is that simply swallowing a Viagra tablet does not produce an erection – there has to be sexual excitation as well. And if the nerves are not active – if they have been destroyed in the course of prostate surgery, for example – then Viagra is unlikely to work, no matter how sexually excited the man may feel.

Question 18

viagra in healthy individuals

Answer 18

In a study it was found that the drug was no different from the placebo in terms of the quality of the men’s erections or orgasms, but the men who took Viagra did experience a shorter refractory period after ejaculation before they could develop an erection again

Question 19

vacuum construction system

Answer 19

a device that creates a partial vacuum , drawing blood to the erectile tissue

Question 20

penile implant

Answer 20

• One kind s a semirigid plastic rod that keeps the penis permanently stiff enough for coitus.
o Relatively easy to insert but permanent erection may be difficult to conceal and therefore embarrassing in some circumstances.

• Another implant is hydraulic. It is filled from a reservoir that is implanted under the groin muscles. Pump and valves that control the filling and emptying are placed in the scrotum and can be accessed manually through the skin.
o It costs more and more prone to malfunction and the erect penis is usually not as long as it was originally. However, it is more discreet and produces a more natural-seeming erection.

Question 21

hypoactive sexual desire disorder.

Answer 21

low or absent interest in sex , when the condition causes distress

Question 22

hypoactive sexual desire disorder causes

Answer 22

asexuality, hormonal factors, a lack of attraction to partner , illness, disability, depression , or sex-negative attitudes

Question 23

hypoactive sexual desire disorder treatment

Answer 23

psychotherapy, relationship counseling, or behavioral sex therapy.

Question 24

dyspareunia In men

Answer 24

not listed in dsm 5, not common

Question 25

In women, the three early processes of physiological arousal

Answer 25

vaginal lubrication, engagement of the vaginal walls, and clitoral erection.

These processes are often accompanied by psychological arousal – the feeling of sexual excitement.

Question 26

treatment of female sexual arousal disorder

Answer 26

insufficient lubrication ( often after menopause)=> hormone treatment or over the counter lubrication

lack of clitoral erection( may be caused by disease that compromise blood vessels supplying genitals=> small pump (eros clitoral therapy device)= increases blood flow in clitoris and nearby structures

psychotherapy and sex therapy

Question 27

causes dyspareunia in women

Answer 27

• Developmental malformations, intersexed conditions, or a persistent unbroken hymen.
• Scars from vaginal tearing during labor or from episiotomy, hysterectomy, sexual assault, or female circumcision.
• Vaginal atrophy (a thinning of the vaginal walls that occurs with aging).
• Acute or chronic infections or inflammation of the vagina, internal reproductive tract, or urinary tract, including several STIs and pelvic inflammatory disease.
• Vulvodynia – a poorly understood condition in which pain is experienced when the vulva is even lightly touched.
• Endometriosis.
• Allergic reactions to foreign substances, such as latex, spermicides, or soap.
• Insufficient genital arousal, especially insufficient vaginal lubrication.
• Vaginismus.

Question 28

vaginusmus

Answer 28

Some women have no obvious vaginal abnormalities, and yet they cannot experience coitus  Penetration of the vagina by the penis, or by any other object, is impossible on account of some combination of anxiety, pain, and pelvic muscle spasm

The usual explanation for why penetration is impossible in vaginismus is that the nearby muscles – either those of the vaginal walls or the entire musculature of the pelvic floor – go into a spasm, so the outer third of the vagina is tightly closed.

Question 29

vaginusmus causes

Answer 29

Mental anticipation of pain is thought to be the main reason for the spasm, as if the body were conditioned to protect against penetration.
sex-negative attitudes, or early traumatic experience

a mix of psychotherapy and sex therapy are the currently favored options for treatment of vaginismus.

Question 30

anorgasmia

Answer 30

Some women experience considerable distress in their sex lives on account of a persistent difficulty in reaching orgasm ( rates low because many do not see it as distressful)

Question 31

anorgasmia causes & treatment

Answer 31

caused by drugs, especially by antidepressants and antihypertensive drugs. Such cases can usually be treated by adjusting dosage, switching drugs, or adding another drug to counteract the effect.

medical conditions / especially this ebringing neurological damage ( diabetes or multiple sclerosis ) can interfere with orgasm , menopause, anatomy of vulva

the coital alignment technique (CAT),

Question 32

Discrepant sexual desire

Answer 32

when the levels of sexual activity desired by two partners are very different.

Question 33

hypersexuality.

Answer 33

Excessive sexual desire or behavior spend several hours each day engaged in masturbation, reading or viewing pornography, participating in sex-related online chat rooms, using commercial phone sex services, seeking casual sex partners in bars, cruising the streets for prostitutes, or having anonymous sex with multiple partners in bathhouses or sex clubs.

Hypersexuality may include frequently repeated and seemingly involuntary involvement in masturbation, partnered sex, pornography use, telephone sex, and the like.

• They often feel that they have lost control of their own behavior.
• These activities may take over their lives as to destroy their careers and marriages and expose them and their partners to HIV and other sexually transmitted infections.
• A form of addiction preferred phrase is compulsive sexual behavior.

can follow the use of certain drug, brain injury , dementia (pathological)

psychological => causes of childhood sexual abuse or inculcated shame

SSRIs are the most common used drug for therapy
Such behaviors may be classed as compulsive disorders, and like other such disorders, they often respond well to SSRIs. The use of the term “sex addiction” to describe these conditions is controversial

Question 34

lack of sexu desire in woman is not always a problem

Answer 34

undesired for sex increases with age

ESTROGEN OR ANDROGEN TREATMENT MAY IMPROVE SEXUAL DESIRE IN WOMEN

The levels of these hormones drop when levels of body fat are very low as well as after menopause. In these circumstances, sexual desire often declines or disappears

sex therapy might also help

Question 35

adminsiatratin testoretsorn in women with low sexual desire

Answer 35

Administration of testosterone (via transdermal patches or implants) has been reported to increase interest in sex in women who are menstruating normally, in women who have low sexual desire as a side effect of treatment with antidepressants, and in women who are menopausal because they have had their ovaries removed.

Question 36

the dam 5

Answer 36

comprised major changes in the classification of sexual disorders, particularly for female sexual disorders.
DSM 1& 2 did not even include sexual disorder

Question 37

dsm 4 critique

Answer 37

• An overemphasis on genital response.
• Inadequate acknowledgement of relationships and partner factors.
• The lack of any defined severity or duration criteria.

Question 38

dem 5 classification of sexual disorders

Answer 38

a group of disorders that are typically characterised by a clinically significant disturbance of a person ability to sexually respond

they must persist for at least 6 months and musst be experienced on 75% -100% of sexual encounters

female arousal disorder and HSDD were deleted
a new disorder came - Femal sexual interest / arousal disorder

Question 39

– Female Sexual Interest/Arousal Disorder (FSIAD)

Answer 39

1) Absent/reduced interest in sexual activity.
2) Absent/reduced sexual/erotic thoughts or fantasies.
3) No/reduced initiation of sexual activity and typically unresponsive to a partner’s attempts to initiate.
4) Absent/reduced sexual excitement/pleasure during sexual activity on all or almost all… sexual encounters.
5) Absent/reduced sexual interest in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6) Absent or reduced genital or nongenital sensations during sexual activity on all or almost all… sexual encounters.

The criteria allow for the fact that there is variability in how sexual interest/arousal problems may be expressed. However, others have expressed concern that the new criteria will mean that some women who would have met criteria for DSM-4 diagnosis would no longer do so and would be excluded from treatment

Question 40

Attempts to gain FDA approval for testosterone patches (Intrinsa) and transdermal testosterone gel (Libigel) for menopausal and postmenopausal women with HSDD

Answer 40

• Intrinsa was rejected due to concerns over safety risks outweighing the efficiency  However, the European Medicines Agency approved it as a treatment for HSDD in women with surgically induced menopause.
• Libigel was not approved because of poor clinical efficacy data.

Question 41

Mindfulness-based therapies (MBT) for treating sexual dysfunctions

Answer 41

MTB could be effectively used in the treatment of female sexual dysfunction, specifically to improve sexual arousal/desire and satisfaction and to reduce sexual dysfunction associated with anxiety and negative cognitive schemas
1) Purposeful and conscious directing of attention to the current experience.
2) Inclusion of benevolence, compassion, and acceptance.
=> has a lot in common with sensate focus (focus on your and your partners needs)

Mindfulness techniques proved to be efficient in the improvement of mental condition (among other things, through reduction of anxiety and tension) in the course of other disorders.

Question 42

primary

Answer 42

pain has always been there

Question 43

secondar y

Answer 43

the pain has developed after a period of time without pain

Question 44

complaint ?

Answer 44

A. What is the problem?
B. Primary, secondary (gradually or suddenly)? C. Generalized, situational

Are there circumstances in which a complete sexual respons is
possible?
* Nightly responses
 * Masturbation
* Other partners

Situational: what are the preconditions to have pleasurable and satisfying sex??

Question 45

searching for reasons

Answer 45

-Start with open questions “What brought you here?”

Closed questions to make the complaint more concrete

Biological, psychological and social factors
– Family of origin
– Sexual development
– Relationship/relationship-history
– Personality
– Background: work, hobby, religion, life circumstances
– Previous treatment
– Tabacco/drugs/medication
– Observations

Question 46

sexual desire discrepancy

Answer 46

SDD: when two partners in an intimate relationship desire different levels or a different frequency of sexual activity (Zilbergeld & Ellison, 1980)

Sexual desire in a relationship -> relative, dyadic concept

SDD as inevitable in LT relationship -> SD fluctuates over time and contexts, normal variation, decline with relationship length (Baumeister & Bratslasvsky, 1999; Sims & Meana, 2010)

SDD does not necessarily cause distress and require treatment

Question 47

SDD what helps ?

Answer 47

Psycho-education, giving permission to talk, normalization

Reframe as couple problem

Normal experience in LT-relationships -> ↘ Distress and learn to cope

Develop realistic expectations -> Good Enough Sex Model (Metz & McCarthy, 2007): Desire for and quality of sex may vary from day to day

Question 48

specific devices to break routine & help SDD

Answer 48

Communication skills training -> openly talk about sexual wishes. Reduced arousability or specific preferences?

Broaden sexual repertoire. Sex is more than penetration -> ↑ sexual pleasure instead of frequency

Tune, balance, compromise -> wish list or wish box

Sensate focus: sexual touch, communication, sex as mutual
responsibility

Homework assignments: Schedule occasions for intimacy => challenge myth of spontaneous desire. Active search for sexual stimulation

Question 49

hypersexuality ( sex compulsion)

Answer 49

Especially men

Trapped in a sexual pattern

Inability to stop, lack of control Despite negative consequences For individual and environment

it is not an addiction
Strong demand on the therapist
=> must help to stop and control the addic=on

Therapist takes the lead, patient is dependen

Question 50

treating hypersexulaity

Answer 50

Limit addiction:
• Qualitative porn
• Thoughtful (mindful) masturbation

Self-image: (small) positive acts (non-relational and later relational)
Relationship-therapy: coping with sadness, anger, loss of confidence

Question 51

arousal problems

Answer 51

for example erectile disfunction

Question 52

erectile disfunction causes

Answer 52

Physical: vascular, neurological, medicines
Physical examination: nightly erections
► viagra, injections, vacuum-pump, prothesis

Psychological: relational, anxiety and inhibitions
Ø Performance anxiety
Ø Focus on the pleasure of the partner

Question 53

premature ejaculation

Answer 53

sexual contact hastily, under pressure, fast lifestyle
No control over reflex

focus on own sensations + controlling point-of-no-return

Resolutions
(stop-start, squeeze technique, medication: SSRI/dapoxetine)

Question 54

Deep dyspareunia

& superficial

Answer 54

deep pain

< somatic treatment (endometriosis) or switch position

Question 55

dypareunia & vagninusmu

Answer 55

Contraction of pelvic floor muscles

Question 56

dyspareunia/ vaginiuzsm etiology

Answer 56

Etiology:
– Fear of pain for first sexual contact
– Relational problem
– Physical(bladerinfectioons,fungal infections,episiotomy ,too agressive intimate hygiene)
– Fear of pain(unaroused intercourse)

Question 57

coping with sexual pain

Answer 57

Avoidance sexual activity (intimacy)

Persistence: continue with intercourse despite pain Alternative sexual activities (but don’t feel normal)

Question 58

dyspareunia biological teratment

Answer 58

Pharmaceutical treatment: anesthetic cream (lidocaïne), corticoseroïdcream, interferon injections and lubricants

Biofeedback-training of the pelvic floor muscles

Lasertherapy or operation: vestibulectomy

Question 59

multimodal Treatment of dyspareunia ( cognitive aspect)

Answer 59

Validating that the pain is real

Exploring treatment expectations and setting treatment goals (own need for
help, partner, relationship?)

Clinical interview -> patient and/or couple’s medical, psychosexual and pain history + identify the factors that may contribute to pain and pain-related distress

Clinical examination in which the women can observe via a handheld mirror

Psycho-education about the vicious circle of pain and the relation between
negative thoughts, feelings and pain

Question 60

multimodal treatment (physicall)

Answer 60

Pelvic floor therapy & dilators (relaxation)

 Pain stop (stopping with any activity that causes genital pain) to uncouple the
association between sex and pain

Engage in penetrative sex only when being sexually aroused enough because lubrication and relaxed pelvic floor muscles will make penetration more comfortable

Schedule sex to disrupt avoidance of intimacy -> Sensate focus exercises to practice touching and communicating about sex

Expanding their sexual repertoire (+ associations sex and pain; expect pleasure instead of pain)

Question 61

psychological treatment for dyspareunia

Answer 61

act & mindfulness

Non-judgemental moment-to-moment awareness -> learning to de-
center thoughts and feelings and focus attention on bodily sensations
– Decouple physical pain from emotional and cognitive experience
– Mindfulness often integrated in CBT protocols

Act - how to live a valued life despite pain

Question 62

treatment for sexual problem

Answer 62

Combine biological treatment, with psychotherapy and relationship therapy

Even in case of biological cause -> psychological factors determine coping with the dysfunction, excacerbation and maintenance of the problem

Sexual problem has an influence on and is influenced by the partner => impact on emotion regulation within the couple
(might think of taking the couple in as a therapist , take them in together ir seperate,discuss how to involve the partner

therapist taking innovative to talk about sex might act as permission