Chapter Fourteen

1
Chapter Fourteen

• Sexual Difficulties, Dissatisfaction,
  Enhancement, and Therapy

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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

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DSMIVTR

• 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

4
The International Definitions Committee

• Womens Sexual Interest/Desire disorder
• Subjective Sexual Arousal Disorder
• Combined Genital and Subjective Arousal Disorder

• Genital Sexual Arousal Disorder
• Persistent Sexual Arousal Disorder
• Womens Orgasmic Disorder
• Vaginismus
• Dyspareunia

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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

6
2000 National Survey of Sexual Attitudes and
Lifestyles

• Age
• Married vs. single
• Children in the home

• First sexual experience
• Communication about sex
• Health

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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

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Sexual Arousal Disorders

• Female sexual arousal disorder
• Male erectile disorder
• Persistent sexual arousal syndrome

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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?

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Orgasmic Disorders

• Female orgasmic disorder
• Male orgasmic disorder
• Inhibited ejaculation
• Delayed ejaculation
• Premature ejaculation

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Sexual Pain Disorders

• Dyspareunia genital pain associated with
  intercourse
• Anodyspareunia pain occurring during anal
  intercourse
• Vaginismus involuntary spasmodic contractions of
  the vaginal muscles

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Other Disorders

• Peyronies disease development of calcium
  deposits and fibrous tissue in the penis
• Priapism prolonged and painful erection

13
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

14
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

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Sexual Function Enhancement

• Improving of the quality of ones sexual
  relationship
• Self-awareness
• Intensifying erotic pleasure
• Changing a sexual relationship

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Treating Sexual Function Difficulties

• Masters and Johnson Cognitive-behavioral
  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