Chapters 15

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Chapters 15 16The Nature and Origin of Sexual
Difficulties and Sex Therapy
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(No Transcript)
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Sexual Difficulties

• Desire
• Frequency
• Excitement
• Female Arousal
• Erectile Dysfunction
• Orgasm
• Pre-mature ejaculation
• Pain

• Lifelong
• Temporary
• w/ specific situations or partners - situational
• w/ all partners - generalized

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Sensate Focus

• Series of touching exercises
• Touching communicating without any goal
• focus on non-genital touch

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Desire Phase Difficulties

• Hypoactive Sexual Desire Disorder (HSD)
• Lack of interest in sexual activity
• Capable of orgasm
• Most frequent complaint to sex therapists
• Usually temporary

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Sexual Aversion Disorder

• (SAD)
• Extreme, irrational fear of sexual activity,
  feelings of discomfort, repulsion, disgust
• Compelling desire to avoid sexual situations
• May have physiological symptoms
• Often due to sexual abuse or assault

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Female Sexual Arousal Disorder

• Inhibited lubrication
• Apathy
• Anger
• Fear
• Ineffective stimulation
• Low estrogen levels

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Male Erectile Dysfunction (aka impotence) 30
mil. Amer. men

• Lack of an erection sufficiently rigid for
  penetrative intercourse to the satisfaction of
  both partners for 6 to 12 months
• Acquired vs lifelong

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Male Erectile Dysfunction
Incidence ? w/ age
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Erectile Dysfunction Medical Treatment

• Vasoactive medication
• Injected into cavernous bodies
• increased blood flow to penis

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Mechanical Devices for Erection

• Vacuum constriction device

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Mechanical Devices

• Rejoyn non prescription
• Penile support sleeve medical quality rubber
• Fits over penis
• Provides support necessary for intercourse
• Can fit on erect or flaccid penis

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Erection Surgical Treatment

• Semi-rigid or inflatable penile implants
• Semirigid

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Erection Surgical Treatmentinflatable penile
implants
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Premature Ejaculation (PE)

• Inability to consistently control orgasm to
  either partners satisfaction

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Specific Suggestions for Men

• Simple strategies for delaying ejaculation
• More frequent ejaculation
• Woman above position
• Man above increases muscle tension

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Lasting Longer

• Communication ? slow down
• Non-coital exploration
• Use other methods to produce orgasm
• Stop-Start technique
• Squeeze technique

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Lasting Longer - Medical treatments

• Meds for depression prolong intercourse for 20
  mins or longer
• SS cream
• Topical agent from extracts of 9 natural products
• May prolong length of time before ejaculation

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Female Orgasmic Disorder

• Anorgasmia absence of orgasm
• May or may not be satisfied w/ sex w/out orgasm
• Clitoral stimulation usually necessary

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Specific Suggestions for Women-Becoming Orgasmic

• Therapy based on progressive self-awareness
  activities
• Vibrator use
• Self-stimulation

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• Male (Coital) Orgasmic Disorder Inability to
  ejaculate during sex
• (8)
• Performance pressure
• Over-focus on partner
• Anger at partner
• Actual sex not comparable to fantasy required to
  ejaculate when masturbating
• Wants to deny partner satisfaction of his orgasm
• Repulsed by partner

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Dyspareunia

• Painful intercourse or discomfort during coitus
• Can be experienced by both men AND women
• More common in women

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Vaginismus 2 of women

• Strong, involuntary contractions of muscles in
  outer third of vagina
• Insertion of penis or finger can be very painful

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• Dealing With Vaginismus
• Relaxation self-awareness activity- gradual
• Dilators may be used
• Penile penetration
• May require professional help, more extensive
  therapy

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Cultural influences

• Narrowly defined sexuality sex for reproduction
  legacy sex coitus
• Sex synonymous w/ coitus!
• May cause neglect of other pleasurable
  experiences, coitus NOT only option!
• Kissing
• Touching
• Romance
• Dancing
• Talking
• Hygiene
• Tenderness
• Other generally erotic activities oral sex

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Origins of Sexual Difficulties Cultural
Influences

• Sexual double standard
• Polar expectations for males/females
• Diminishing but still somewhat prevalent
• Women avoid sexual excess
• Must inhibit or distort sexual desires
• Avoid stigma of slut, loose
• Men need to score
• Sign of manhood, virility
• Same sex couples more likely to escape struggle
  of gender role expectations

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Origins of Sexual Difficulties Cultural
Influences

• Negative childhood learning
• Sex is sinful attitude
• Common for folks w/ sexual problems to experience
  inhibition, guilt, shame, anxiety, disgust
• Sexual expression often reprimanded
• From VERY young age - leads to sexual conflict!
• Observation of parents/others
• Observe negative attitudes re sex and affection?
  May not be conscious of this!
• Likely have them too!

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Cultural influences

• Now okay for women to enjoy sex
• Her pleasure important!
• Am I pleasing her?
• Can lead to. performance anxiety
• Sex becomes work, interferes w/ sexual arousal
  and releaseis what Im doing working?
  DISTRACTED!!!!!!!
• If its not working, who is to blame?
• NEED TO COMMUNICATE
• Without communication, can lead to chronic
  problems!
• blame game, embarrassment, feeling of failure

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Emotional Problems/Sexual Abuse and Assault

• Emotional Difficulties have strong impact on
  sexuality (e.g. depression, general unhappiness,
  stress, life traumas, combat stress (PTSD), death
  of loved one or multiple loved ones (AIDS))
• Lack of sexual interest response common,
  flashbacks (smells, sights, sounds, feelings)
• Sexual abuse assault may create avoidance,
  fear, dread, etc
• sexual abuse is greatest contributor (re
  childhood exp) to adult sexual functioning
  problems

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Origins of Sexual Difficulties Relationship
Factors

• Relationship factors
• Unresolved problems
• Resentment, distrust, dependency, power struggle,
  sex used as weapon or held back
• Ineffective communication
• Need to learn needs and desires of partner
• They need to learn yours
• Takes time and EFFORT!
• Otherwise, base things on assumptions, wishful
  thinking

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Origins of Sexual Difficulties Relationship
Factors

• Fears about pregnancy or STDs
• Hard to enjoy sex when worried. Communicate
  about birth control/ STD prevention
• Concealment of sexual orientation
• Afraid of disapproval, try to pass

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• HAVING SEXUAL PROBLEMS?
• Get physical/gynecological/urological exam
• Can help rule out organic factors
• Organic factors
• Vascular, endocrine, neurological
• Illnesses disabilities
• diabetes, arthritis, cancer, multiple sclerosis,
  stroke, spinal-cord injury, cerebral palsy
  (see book for specific effects)

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• Variety of effects from illnesses
• Impairs nerves, hormones, neurological health,
  blood flow etc
• Related pain/fatigue/depression/self-perception/de
  formities distract/interfere/ limit sexual
  activities widely varying effects!!!
• Stress
• Can exacerbate organic influences on sexual
  functioning
• Limit sexual activities
• widely varying effects!!!

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• Medications 200 or so known to negatively
  affect sexuality
• Ask your doctor! They might forget!
• Psychiatric drugs
• ADs may decrease sexual interest, arousal and
  delayed/absent orgasm
• Viagra may help
• Antipsychotics lack of desire, erection,
  delayed/absent ejaculation/orgasm
• Tranquilizers (Valium, Zanax)
• Interfere w/ orgasmic response

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Organic Factors

• Psychoactive drugs
• Nicotine.Smoking leads to erectile difficulties
  (5X more likely to have erectile problems)
• Interferes w/ blood flow
• Constricts small vessels
• Impact on females not studied

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Individual FactorsSelf Concept

• Self concept feelings and beliefs we have
  about ourselves
• May have impact on relationships sexuality
• BODY IMAGE
• Can have HUGE influence on sexuality
• Comfortable w/ body better self-concept
  self-esteem
• Likely to have feelings of entitlement, sexual
  enjoyment

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Body Image

• Self-esteem and self-confidence correlated w/
  higher sexual satisfaction
• Western Society womens bodies looked at,
  evaluated, sexualized more often than mens
  bodies
• Thinness beauty equated w/ sexual desirability
• Female concerns over beauty begin at an early
  age!
• Boys and girls w/ same of body fat girls more
  likely to be satisfied w/ weight and body image!

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Body Image

• Due to factors mentioned
• Females more likely to be concerned about how
  body looks during sex!
• Feel particular positions emphasize fat
• Would rather be on bottom?
• Turn self off by own negative feelings of poor
  body image!
• Dont want to be touched where you look too fat
• Factors can all interfere w/ sexual experience

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Body Image

• Better you feel about your body, the better
  youll view yourself as a sexual partner
• Also more assertive
• More experiences
• Correlation does not causation!

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Body Image

• How big is influence of media on body image, what
  is attractive and desirable???
• Models
• 20 years ago models weighed 8 less than average
  women
• Today - models weigh 23 less!
• Now much bigger gap between actual and ideal!
• Marilyn Monroe vs. Calista Flockhart!
• Which do you prefer??????

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Body Image

• Lots of woman struggle to achieve standard of
  thinness
• Harder on themselves than others are, more
  worried than men about it
• Men may pursue more muscle mass
• Ideal male more muscular
• Exercise, steroids
• Playgirl centerfolds between 70s and 90s lost
  12 lbs fat and added 27 lbs muscle on average
• Need more studies on male body image and
  self-concept!

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Seeking Professional Assistance

• The PLISSIT model of sex therapy
• (permission, limited information, specific
  suggestions, intensive therapy)
• 1st level permission to engage or not in
  specific sexual behaviors
• 2nd level limited information corrected
• 3rd level specific suggestions offered
• 4th level intensive therapy

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Seeking Professional Assistance (cont.)

• Therapeutic approaches
• psychosexual therapy
• systems therapy

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Seeking Professional Assistance (cont.)

• What happens in therapy?
• identify clarify problems goals
• medical, sexual, relationship history
• often given homework
• NEVER includes sex with therapist

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Seeking Professional Assistance (cont.)

• Selecting a therapist
• referral from trusted source
• ask about credentials, training, experience
• interview practicalities "fit"

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• Individual factors may be unconscious!
• Begin forming in childhood, continues throughout
  lives
• Human reaction variespeople respond differently
  to similar situations!
• Sexual knowledge attitudes may be unconscious
• Direct influence on sexual expression
• More knowledge? Avoid potential future problems
• Esp. w/ accurate info
• More education? More sexual variety!
• Negative Attitude? Poor sexual responsiveness!
  turn off mechanism may have developed
  (suppression, or turn sexual emotions into
  negative feelings - anger, fear, distraction,
  guilt, etc.)

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• Antihypertensive drugs
• Desire, arousal, orgasm probs
• Anticancer gonadal damage, hormone reduction
• Some nonprescription drugs antihistamines,
  motion sickness and GI meds desire, arousal and
  erection problems
• Testosterone may increase genital sensation and
  subjective arousal in women w/ normal levels

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• For those w/ organic problems
• Improvise
• Let other senses take over
• Sexual encounters during optimal health periods
• Pain control methods
• Moist heat
• Pain meds
• Comfy positions for them
• Focus on positive, erotic, pain-free images
• Communicate! Explore! Experiment!

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Know yourself,express yourself

• Self-Awareness
• Communication towards intimacy
• Develop emotional maturity
• Helps you risk expressing yourself erotically
• Will help you more deeply know each other
• Requires courage, integrity and maturity to face
  yourself and convey self to partner!
• Takes time and practice!!!

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Basics of Sexual Enhancement and Sex Therapy

• Cautionary statements
• Self-help is often effective
• Professional help may be needed
• See an MD to assess physical causes