SEXUAL DYSFUNCTION

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• SEXUAL DYSFUNCTION
• When a person is frequently unable to experience
  a normal sexual response, leading to frustration
  and distress
• Normal majority in their reference group. Vast
  cultural differences
• Not all experts agree. Historical changes.
  e.g. clitoral orgasm only, not vaginal
• e.g. Victoria era women who experienced orgasm
  with their husbands were sluts

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• Historical (Individual) Context
• religion
• trauma (abuse, assault, etc.)
• homosexual experience
• alcohol and drug use
• sociocultural factors
• stress
• performance anxiety

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• Women 43
• Men 30
• Young Women mostly psychosocial
• Old Men mostly organic
• Types of dysfunction
• Erectile dysfunction (impotence) can be
  primary or secondary
• premature ejaculation 29
• male orgasmic disorder (its opposite)

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• Types (Contd)
• female orgasmic disorder (primary and secondary)
  25-35
• arousal disorder (menopause)
• dyspareunia painful intercourse
• vaginismus spasms of the vagina, making
  penetration impossible
• vulvodynia chronic irritation, burning,
  soreness of the vulva, without contact
• vulvar vestibulitis pain inside labia minora,
  introitus by contact (penis, tampon, toy)

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• Types (Contd)
• hypoactive sexual desire little interest in sex
• males 16
• females 33
• sexual aversion disorder
• males 8
• females 21

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• Organic Causes of Erectile Disorder
• circulatory problems
• heart disease
• diabetes (38)
• medications (e.g., for hypertension)
• alcohol, short and long term
• recreational drugs

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• Some causes of painful intercourse or
• dyspareunia women14-15 (vs. males
• 3)
• introitus scars
• vaginal infections
• STDs
• allergies (e.g. latex, spermicides)
• low estrogen
• hysterectomy
• uterine or vaginal prolapse

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• Some causes of painful intercourse or
• dyspareunia women14-15 (vs. males
• 3)
• cancer
• PID (pelvic inflammatory disease)
• endometriosis
• cysts
• insufficient lubrication
• not enough foreplay

9

• Some psychological causes
• anxiety
• fear of sex
• fear of failure
• inability to let go (cognitive)
• spectatoring
• interpersonal problems
• depression interferes with sexual desire and
  orgasmic capacity
• antidepressants ditto

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• performance anxiety
• spectatoring
• poor communication
• prior learning, conditioning, experience, e.g.,
  rapid masturbation, punishment, sexual abuse,
  rape, witnessing something disturbing (childhood)
• double standard
• relationship dissatisfaction
• problems with sexual orientation
• stress
• anxiety (pregnancy, body image, smells, loss of
  control, injury, being judged, rejection,
  consequences for relationship, STDs, being
  heard/seen, etc.)

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• Biological factors
• testosterone deficiencies very difficult to
  establish individual optimal levels
• hyper or hypothyroidism
• temporal lobe epilepsy
• circulatory system pathology
• neurological problems
• Multiple Sclerosis (leads to male orgasmic
  disorder)
• inadequate lubrication (leads to dyspareunia)
• vaginal infections (leads to dyspareunia)
• STDs (leads to dyspareunia)
• prolapsed uterus (ditto)
• cervical cancer (ditto)

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• Biological factors (Contd)
• endometriosis and PID (ditto)
• diabetes
• spinal cord injuries
• antihypertension drugs
• kidney disease
• emphysema

13

• Common Drugs that affect sexual response
• antidepressants
• antipsychotics
• tranquilizers
• alcohol
• heroin
• morphine
• cocaine
• marijuana

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• Therapies
• behavioural
• cognitive restructuring
• couple therapy
• Other
• stop-start technique (for premature ejaculation)
• numbing spray on penis
• yoga technique kundalini
• masturbation (for female orgasmic disorder)
• Kegel exercises (PC muscle)

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• Medical Treatments
• Viagra, other drugs
• inject vasodilators in corpora
• surgery, prosthesis
• Masters and Johnsons Sex Therapy
• acceptance of mutual responsibility
• sexual dysfunction a couples problem
• no blame attached
• elimination of performance demands and anxiety
• sexual intercourse prohibited during the therapy

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• Masters and Johnsons Sex Therapy (Contd)
• education
• elements of anatomy and physiology
• attitude change
• increasing communication
• sensate focus exercises concentrating on
  pleasuring one small part of the body at a time
• prescribing and practicing changes in behaviour

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• Therapeutic steps for anorgasmic women
• (women who cant have orgasms)
• Education, information
• Self exploration
• Kegels
• Self-touching and self-stimulation. Masturbation
• Assertive thoughts, giving self permission
• Use of fantasy, books, video, audiotapes
• Focus on sensations, not on goal
• Bring in partner. Nondemanding sensate focus
  exercises no intercourse
• Partner stimulates women manually or orally to
  orgasm following her directions
• Intercourse when she is ready

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• Biological treatments for erectile dysfunction
• Surgery to unblock vessels that supply blood to
  penis
• Hormones testosterone, if abnormally low (men
  and women) MIGHT help
• Injections muscle relaxants, into corpus
  cavernosum. Allows blood vessel muscles to relax
  and blood flows in
• Suppositories muscle relaxant into penis
• Vacuum pump increases blood flow into penis
• Penile implants permanent

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• Biological treatments for erectile dysfunction
  (Contd)
• Pills
• Viagra (sildenafil)
• Vasomax (phentolamine) relax blood vessel muscles
• Spontane (apomorphine) works at brain level to
  trigger erection
• Cialis (tadalafil)

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• Biological treatments for erectile dysfunction
  (Contd)
• Side effects of Viagra (dose dependent)
• headaches
• flushing
• indigestion
• nasal congestion
• visual distortions
• drug interactions
• dizziness
• eye pain
• hearing loss
• allergic reactions
• Vasomax fewer side effects (?)
• must be bought by prescription, due to danger of
  heart attacks.

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• A more recent approach, not involving medical
  intervention
• Researchers interviewed couples who have great
  sex to glean what factors were important.
• being present totally immersed and intensely
  focused, no distracting thoughts, surrender to
  the moment
• authenticity free to be themselves, open about
  what they wanted, totally uninhibited
• intense emotional connection regardless of
  duration of relationship, powerful sense of
  intimacy throughout the sexual encounter
• communication, expressing their pleasure,
  verbalizing what they want
• transcendence some people experience an altered
  state of consciousness
• Some yogic traditions enable these
  characteristics (kundalini)