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• • • SEXUAL DYSFUNCTION When a person is frequently unable to experience a normal sexual response, leading to frustration and distress Normal: majority in their reference group. Vast cultural differences Not all “experts” agree. Historical changes. e.g.: clitoral orgasm only, not vaginal • e.g. Victoria era: women who experienced orgasm with their husbands were “sluts” Historical (Individual) Context • religion • trauma (abuse, assault, etc.) • homosexual experience • alcohol and drug use • sociocultural factors • stress • performance anxiety Women – 43% Men – 30% Young Women: mostly psychosocial Old Men: mostly organic Types of dysfunction: • Erectile dysfunction (“impotence”): can be primary or secondary • premature ejaculation – 29% • male orgasmic disorder (its opposite) Types: (Cont’d) • female orgasmic disorder (primary and secondary) – 25-35% • arousal disorder (menopause) • dyspareunia: painful intercourse • vaginismus: spasms of the vagina, making penetration impossible • vulvodynia: chronic irritation, burning, soreness of the vulva, without contact • vulvar vestibulitis: pain inside labia minora, introitus – by contact (penis, tampon, toy) Types: (Cont’d) • hypoactive sexual desire: little interest in sex • • • males: 16% females: 33% sexual aversion disorder • • males: 8% females: 21% Organic Causes of Erectile Disorder: • circulatory problems • heart disease • diabetes (38%) • medications (e.g., for hypertension) • alcohol, short and long term • recreational drugs Some causes of painful intercourse or dyspareunia – women:14-15% (vs. males 3%) • introitus scars • vaginal infections • STDs • allergies (e.g. latex, spermicides) • low estrogen • hysterectomy • uterine or vaginal prolapse Some causes of painful intercourse or dyspareunia – women:14-15% (vs. males 3%) • cancer • PID (pelvic inflammatory disease) • endometriosis • cysts • insufficient lubrication • not enough foreplay Some psychological causes: • anxiety • fear of sex • fear of failure • inability to let go (cognitive) • spectatoring • interpersonal problems • depression: interferes with sexual desire and orgasmic capacity • antidepressants: ditto • performance anxiety • spectatoring • poor communication • prior learning, conditioning, experience, e.g., rapid masturbation, punishment, sexual abuse, rape, witnessing something disturbing (childhood) • double standard • relationship dissatisfaction • problems with sexual orientation • stress • anxiety (pregnancy, body image, smells, loss of control, injury, being judged, rejection, consequences for relationship, STDs, being heard/seen, etc.) Biological factors: • testosterone deficiencies – very difficult to establish individual optimal levels • hyper or hypothyroidism • temporal lobe epilepsy • circulatory system pathology • neurological problems • Multiple Sclerosis (leads to male orgasmic disorder) • inadequate lubrication (leads to dyspareunia) • vaginal infections (leads to dyspareunia) • STDs (leads to dyspareunia) • prolapsed uterus (ditto) • cervical cancer (ditto) Biological factors (Cont’d): • endometriosis and PID (ditto) • diabetes • spinal cord injuries • antihypertension drugs • kidney disease • emphysema Common Drugs that affect sexual response: • antidepressants • antipsychotics • tranquilizers • alcohol • heroin • morphine • cocaine • marijuana Therapies: • behavioural • cognitive restructuring • couple therapy Other: • stop-start technique (for premature ejaculation) • numbing spray on penis • yoga technique: kundalini • masturbation (for female orgasmic disorder) • Kegel exercises (PC muscle) Medical Treatments: • Viagra, other drugs • inject vasodilators in corpora • surgery, prosthesis Masters and Johnson’s Sex Therapy: • acceptance of mutual responsibility • sexual dysfunction a couple’s problem • • no blame attached elimination of performance demands and anxiety • sexual intercourse prohibited during the therapy Masters and Johnson’s Sex Therapy: (Cont’d) • education • elements of anatomy and physiology • • • attitude change increasing communication sensate focus exercises: concentrating on pleasuring one small part of the body at a time • prescribing and practicing changes in behaviour Therapeutic steps for anorgasmic women: (women who can’t have orgasms) 1. Education, information 2. Self exploration 3. Kegels 4. Self-touching and self-stimulation. Masturbation 5. Assertive thoughts, giving self permission 6. Use of fantasy, books, video, audiotapes 7. Focus on sensations, not on goal 8. Bring in partner. Nondemanding sensate focus exercises – no intercourse 9. Partner stimulates women manually or orally to orgasm following her directions 10. Intercourse when she is ready Biological treatments for erectile dysfunction: • Surgery: to unblock vessels that supply blood to penis • Hormones: testosterone, if abnormally low (men and women) MIGHT help • Injections: muscle relaxants, into corpus cavernosum. Allows blood vessel muscles to relax and blood flows in • Suppositories: muscle relaxant into penis • Vacuum pump: increases blood flow into penis • Penile implants: permanent Biological treatments for erectile dysfunction: (Cont’d) • Pills: • • • • Viagra (sildenafil) Vasomax (phentolamine) relax blood vessel muscles Spontane (apomorphine) works at brain level to trigger erection Cialis (tadalafil) Biological treatments for erectile dysfunction: (Cont’d) • Side effects of Viagra (dose dependent): • • • • • • • • • • • headaches flushing indigestion nasal congestion visual distortions drug interactions dizziness eye pain hearing loss allergic reactions Vasomax fewer side effects (?) • must be bought by prescription, due to danger of heart attacks. Appendix A more recent approach, not involving medical intervention: Researchers interviewed couples who have great sex to glean what factors were important. 1. being present: totally immersed and intensely focused, no distracting thoughts, surrender to the moment 2. authenticity: free to be themselves, open about what they wanted, totally uninhibited 3. intense emotional connection: regardless of duration of relationship, powerful sense of intimacy throughout the sexual encounter 4. communication, expressing their pleasure, verbalizing what they want 5. transcendence: some people experience an altered state of consciousness Some yogic traditions enable these characteristics (kundalini)