Download Chapter Fourteen

Chapter Fourteen
Sexual Difficulties, Dissatisfaction,
Enhancement, and Therapy
Sexual Function Difficulties
• Sexual desires and activities reflect both
emotional well-being and physical health
• Both men and women report occasional or
frequent lack of desire, problems in arousal or
orgasm, or painful intercourse
• There are many ways to enhance sexuality
and create greater pleasure and intimacy
DSM–IV–TR
• Sexual dysfunction: a disturbance in
sexual desire and in the psychological
and physiological changes that
characterize the sexual response cycle
and cause distress and interpersonal
difficulty
• Lifelong or acquired
• Generalized or situational
• Limitations
The International Definitions
Committee
• Women’s Sexual
Interest/Desire
disorder
• Subjective Sexual
Arousal Disorder
• Combined Genital
and Subjective
Arousal Disorder
• Genital Sexual
Arousal Disorder
• Persistent Sexual
Arousal Disorder
• Women’s Orgasmic
Disorder
• Vaginismus
• Dyspareunia
Sexual Function Difficulties
• Men and women differ in the types of
difficulties they report
• Men and women have differing experiences
as they age
• Men and women both report fewer difficulties
when they are married
• Heterosexual and homosexual men and
women differ in the types of difficulties they
report
2000 National Survey of Sexual
Attitudes and Lifestyles
• Age
• Married vs.
single
• Children in the
home
• First sexual
experience
• Communication
about sex
• Health
Disorders of Sexual Desire
• Hypoactive sexual desire or inhibited
sexual desire: low or absent sexual
desire
• Inhibited sexual desire and marriage
• Sexual aversion: aversion to and
avoidance of genital contact with a
partner
Sexual Arousal Disorders
• Female sexual arousal disorder
• Male erectile disorder
• Persistent sexual arousal syndrome
Sexual Arousal Disorders
• What do the characteristics of these
disorder say about the nature of
arousal?
• Is arousal a biological or psychological
process?
• What are the implications for treatment?
Orgasmic Disorders
• Female orgasmic disorder
• Male orgasmic disorder
– Inhibited ejaculation
– Delayed ejaculation
– Premature ejaculation
Sexual Pain Disorders
• Dyspareunia: genital pain associated
with intercourse
• Anodyspareunia: pain occurring during
anal intercourse
• Vaginismus: involuntary spasmodic
contractions of the vaginal muscles
Other Disorders
• Peyronie’s disease: development of
calcium deposits and fibrous tissue in
the penis
• Priapism: prolonged and painful
erection
Physical Causes of Sexual
Difficulties
Men:
• Diabetes
• Alcoholism/Drug use
• Lumbar-disc disease
• Atherosclerosis
• Spinal cord injuries
• Smoking
Women:
• Diabetes
• Heart disease
• Hormone deficiencies
• Neurological
disorders
• Alcoholism/Drug Use
• Spinal cord injuries
Psychological Causes
of Sexual Function Difficulties
•
•
•
•
•
•
Fatigue and Stress
Ineffective sexual behavior
Sexual anxieties
Excessive need to please a partner
Conflict within self
Relationship causes
Sexual Function Enhancement
• Improving of the quality of one’s sexual
relationship
• Self-awareness
• Intensifying erotic pleasure
• Changing a sexual relationship
Treating Sexual Function
Difficulties
• Masters and Johnson: Cognitivebehavioral approach
• Kaplan: Psychosexual therapy
• Other non medical approaches
– PLISSIT model of therapy
– Self-help and group therapy
• Medical approaches
• Gay, lesbian, and bisexual sex therapy