Download Ch.14_Sexual Difficulties

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Sexual difficulties
Coming Attractions!
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Dealing with sexual difficulties related to
Desire phase
 Excitement phase
 Orgasm phase


Painful intercourse

Sally has no interest in sex, never
fantasizes, and never initiates sex.

What questions would you ask her?

Janet feels sick to her stomach, sweats
profusely, and has to go to the bathroom
when partner asks about having sex.
She feels sex is gross, and disgusting,
and also has a fear of penetration.
 Diagnosis?
 Treatment?


Bill has trouble getting an erection when
his wife wants to make love.
What questions would you ask him?
 How would you separate psychological ED
from Physiological ED?
 How would you determine if it is primary,
secondary, or situational ED.


Jim had ED once, now he does not want
to have sex, and avoids his wife’s desire
for intimacy.
What is the problem?
 Treatment?

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Vanessa has had two children, and
gained some weight after the
pregnancies. Now, she just wants her
husband to “do what you need to”.
Diagnosis?
 Comments or questions for the couple?


Even with little foreplay Jeff ejaculates
within about 30 seconds after
penetration.
Diagnosis?
 Questions to ask to determine the cause?
 Suggested treatments?

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Josh can only last 5-10 minutes after
penetration before ejaculating.
Diagnosis?
 Treatment?

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, Twee has never been able to climax
with self stimulation or a partner.
Diagnosis?
 Questions you may ask?

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Than has been able to climax in the past,
but can not climax now since she moved
to her new job.

Diagnosis?

Eve found she can climax in a motel
room, but can not climax ht home.
Diagnosis?
 Treatment?


Dianna found that she can climax with
oral sex and masturbation, with not with
“real sex”.
Diagnosis?
 Treatment?


Michael has noticed the head of his
penis hurts during sex.
Diagnosis
 Treatment?

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Sarah complained that sex was painful
“deep inside”, and lubrication did not
seem to help.
What questions would you ask?
 Diagnosis?
 Treatment?


Janet complained that intercourse was
painful just as he was entering.
Questions?
 Diagnosis?
 Treatment?


Lucy complained of pain with intercourse
which began over the last five years
since she turned 48 years old.
Questions?
 Diagnosis?
 Treatment?


Sam complains of pain in his penis with
erection, and particularly if it is bent up or
down, or side to side?
Diagnosis?
 Treatment?

Sexual problems are common

Causes
Organic
 Cultural
 Individual
 Relationship

Most commonly reported sexual
problems

By men


Erectile dysfunction
By women
Inability to climax
 Lack of sexual desire

Medications related to sexual
problems
High blood pressure medications
 Depression & antipsychotics
 Barbiturates and narcotics

Emotional difficulties producing
negative affects on sexuality
Depression
 Extreme work stress
 Fear of intimacy

Types of sexual disorders
(summary)
Desire Phase
 Excitement phase
 Orgasm phase

Desire phase

Hypoactive sexual desire

Related to:




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Lack of trust
Lack of power and control
Imbalance in independence and dependence
Never fantasizes, rarely masturbates, never initiates sex
Sexual aversion disorder (SAD)
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Physiological symptoms



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Nausea
Sweating
Diarrhea
Irrationally fearful
Feel disgusted or repulsed by sexual activity
Excitement phase

Erectile dysfunction

Most likely to be physiologically based
(have an organic component)

Viagra

http://www.goaskalice.columbia.edu/1445.html
Primary
 Secondary
 Situational

Erectile dysfunction (ED) cont.
As many as 25% of cases are related to
medication side effects
 Tobacco appears to be one causative
factor
 Age - A man is 50’s = twice as likely to
experience ED as a man in his 20’s

Performance anxiety

Can turn a transitory problem into a
serious one
Sexual self confidence

Women who are least self-conscious
about their bodies as compared to
similarly shaped women were more
assertive with their partners
Orgasm phase - Men

Men

Premature
ejaculation


Squeeze technique
Ejaculatory
inhibition


Merc manual
http://www.merck.co
m/pubs/mmanual/se
ction17/chapter220/
220a.htm
Orgasm phase - Women

Orgasmic disorder (preorgasmic)
Primary
 Secondary
 Situational



E.g. Orgasm with masturbation, but not with oral
sex
Orgasmic with manual stimulation, but
not with intercourse is typical, not a
sexual dysfunction
Dyspareunia (For women)

Painful intercourse

Vaginismus
Hegar dilators
 Merc Manual


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http://www.merck.com/pubs/mmanual/section18/chapt
er243/243e.htm
Smegma

Smegma collecting under the clitoral hood may
cause discomfort when hood is moved during
sexual stimulation
Dyspareunia (For men)
Phimosis - tight foreskin
 Infected or irritated foreskin
 Peyronie’s disease - Fibroses in penis
 Pelvic or genital infections


E.g. STD’s
Deep pelvic pain in women
during intercourse

Caused by
Jarring of ovaries
 Stretching of uterine ligaments
 Endometrioses
 STD’s

Average duration of intercourse
for American couples

Five to ten minutes