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Human Sexuality
Sexual Function Difficulties,
Dissatisfaction, Enhancement, and
Therapy
Sexual Desire and Activity


“ebb and flow”- natural to have highs
and lows in sexual desire and activity
Most report occasional sexual difficulties
(McCarthy & McCarthy, 2003)
Defining Sexual Function
Difficulties

What constitutes a sexual “problem”

Discourses on normality/abnormality

Cultural scripts

DSM-IV
Difficulties and Dissatisfaction

Difficulties: problems/issues with
sexual functioning


Inability to participate in sexual
relationships as we wish
Dissatisfaction: subjective response
to sexual difficulties
Sexual Dysfunctions

Disturbance in sexual desire and in the
physiological sexual response

Causes “distress”

“persistent or recurrent”
Female Sexual Dysfunction

Critique: often based on physical criteria

How should we measure female sexual
dysfunction?

Less research on female sexual problems

Role of psychological and contextual factors
Female Sexual Dysfunction

Need for greater focus on
2004):


(Basson, 2003;
Subjective sexual arousal
Female sexuality as distinctive/different
from male sexuality

Role of attachment, personal history, etc.
Female Sexual Dysfunction

Contextual/relational factors

Socio-cultural factors;

Cultural norms and ideals;

Inadequate information about female
sexuality
Survey Findings


National Health and Social Life Survey
1,749 women; 1,410 men


Women: 43% reported sexual difficulties
Men: 31% reported sexual difficulties
Survey Findings


Sexual dysfunction/difficulties are more
common in men and women who have
been sexually victimized
Both physical and psychosocial factors
were implicated
Sexual Desire Disorders


Lack of fantasies and desire for sexual
activity
Causes distress and interpersonal
difficulty
Sexual Desire Disorders:
HSD

Hypoactive sexual desire: lack of sexual
desire

Causes more stress in marriages than any
other sexual problem (McCarthy &
McCarthy, 2003)
Sexual Desire Disorders
HSD


Often transitory
May be associated with depression, stress,
and interpersonal difficulties

**high sex drive is not a disorder in the DSM**
Sexual Desire Disorders
Sexual Aversion

Sexual Aversion Disorder: aversion
to and avoidance of genital contact

Anxiety, fear, or disgust toward sex

Actions are taken to avoid sexual situations
Sexual Desire Disorder:
Sexual Aversion

Sexual Aversion Disorder

panic attacks and physical symptoms

past sexual trauma

negative parental reactions to sexuality

sexual pressure from a partner
Sexual Arousal Disorders

Female Sexual Arousal Disorder: lack of
physiological sexual response

Male Erectile Disorder: erectile
dysfunction;

associated with sexual/performance
anxiety, low excitement, potential medical
issues
Sexual Arousal Disorders

The disorder may have physical or
psychological roots
Orgasmic Disorders


2nd most common sexual problem, after
low sexual desire
Female Orgasmic Disorder; may be
related to negative/guilty attitudes
about sex, relationship problems
Orgasmic Disorder

Male Orgasmic Disorder: delay or
absence in orgasm; inhibited or delayed
ejaculation

Premature ejaculation

Often related to sexual anxiety
Sexual Pain Disorders

Sexual Pain Disorders: Genital pain
associated with intercourse;
psychological origins

Inadequate sex education, sexual trauma,
sexual guilt, relationship problems
Physical Causes of Sexual
Dysfunction: Men

Alcoholism, smoking, drug use

Diseases of the heart/circulatory system

Other physical illnesses

A side effect to certain medications
1994)
(Vine,
Physical Causes of Sexual
Dysfunction: Women

Diseases/chronic illnesses

Stress and fatigue

Hormonal changes
Sexual Dysfunction: Treatment

Accurate information about sexuality

Communication skills

Fostering positive sexual attitudes

“homework”
Treatment

Cognitive therapies:


Looking at sexual attitudes/beliefs
Addressing erroneous/unhealthy sexual
attitudes
Treatment

Behavioral components:

Addressing concrete behaviors

“homework”- sexual exploration


Partner exploration
Taking away sexual pressures
Couples therapy

Treating sexual dysfunction as a
relationship issue


Taking away blame
“Neutrality and mutuality”
Treatment

Addressing fear/anxiety associated with
sexuality


The client’s personal history
Performance anxiety
Sexual Addiction

Not in the DSM-IV



Does sexual addition exist?
What is it?
How is it treated?
Sexual Addiction

Sexual addiction/compulsive sexual
behavior

A form of impulse control disorder? (Barth
& Kinder, 1987)

Approximately 2 million sexual addicts in
the U.S. (Delmonico & Carnes, 1999)
Sexual Addiction

Continuing to participate in sexual behaviors
despite negative consequences (Bird, 2006)

Damaging to oneself and others

More likely to engage in risky sexual behaviors

Often report feelings of shame/isolation
Sexual Addiction

The Internet:

New arena for sexual addicts (Griffiths,
2001)


Pushing mild addicts into deeper addictions?
Affordable/anonymity (Cooper, 1998)
Sexual Addiction: Women

Female sexual addicts:

Relationship-oriented online sexual
behavior

often leading to real life sexual encounters
(Schneider, 2000)
Sexual Addiction: Women


Women report experiencing greater
shame than men
Women are less likely to engage in
group counseling/12 step programs
Sexual Addiction: Men


More prevalent in men
Gay/bisexual men are slightly more
likely to report sexual addiction (Cooper,
2000)
Sexual Addiction

Research suggests sexual addiction
often occurs with other psychological
disorders

Co-morbidity
Sexual Addiction

Sexual addicts: significantly more likely
to experience clinical depression (Weiss,
2004)

Tentative link: sexual addiction and
untreated ADHD (Schwartz, 2003)
Sexual Addiction

Link between loneliness and
pornography usage (Yoder, 2005)
Sexual Addiction

Sexual addiction and OCD


Individuals with both conditions experience
greater fear and avoidance regarding
thoughts
Less pleasure related to performing sexual
compulsions (Schwartz & Abramowitz, 2003)
Treatment of Sexual Addiction

Couples/family therapy

Medication (SSRIs)
Treatment of Sexual Addiction




Cognitive restructuring
Confrontation
Defining “sexual sobriety” and sexual
boundaries
Empathy/grief counseling