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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