Transcript Sexual Dysfunction and Therapy

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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
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e.g. Victoria era: women who experienced
orgasm with their husbands were “sluts”
Historical (Individual) Context
• religion
• trauma (abuse, assault, etc.)
• homosexual experience
• alcohol and drug use
• sociocultural factors
• stress
• performance anxiety
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)
Types: (Cont’d)
• 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)
Types: (Cont’d)
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hypoactive sexual desire: little
interest in sex
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males: 16%
females: 33%
sexual aversion disorder
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males: 8%
females: 21%
Organic Causes of Erectile Disorder:
• circulatory problems
• heart disease
• diabetes (38%)
• medications (e.g., for hypertension)
• alcohol, short and long term
• recreational drugs
Some causes of painful intercourse or
dyspareunia – women:14-15% (vs. males
3%)
• introitus scars
• vaginal infections
• STDs
• allergies (e.g. latex, spermicides)
• low estrogen
• hysterectomy
• uterine or vaginal prolapse
Some causes of painful intercourse or
dyspareunia – women:14-15% (vs. males
3%)
• cancer
• PID (pelvic inflammatory disease)
• endometriosis
• cysts
• insufficient lubrication
• not enough foreplay
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.)
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)
Biological factors (Cont’d):
• endometriosis and PID (ditto)
• diabetes
• spinal cord injuries
• antihypertension drugs
• kidney disease
• emphysema
Common Drugs that affect sexual response:
• antidepressants
• antipsychotics
• tranquilizers
• alcohol
• heroin
• morphine
• cocaine
• marijuana
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)
Medical Treatments:
• Viagra, other drugs
• inject vasodilators in corpora
• surgery, prosthesis
Masters and Johnson’s Sex Therapy:
• acceptance of mutual responsibility
• sexual dysfunction a couple’s problem
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no blame attached
elimination of performance demands and
anxiety
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sexual intercourse prohibited during the therapy
Masters and Johnson’s Sex Therapy: (Cont’d)
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education
• elements of anatomy and physiology
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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
Therapeutic steps for anorgasmic women:
(women who can’t have orgasms)
1. Education, information
2. Self exploration
3. Kegels
4. Self-touching and self-stimulation. Masturbation
5. Assertive thoughts, giving self permission
6. Use of fantasy, books, video, audiotapes
7. Focus on sensations, not on goal
8. Bring in partner. Nondemanding sensate focus
exercises – no intercourse
9. Partner stimulates women manually or orally to
orgasm following her directions
10. Intercourse when she is ready
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
Biological treatments for erectile
dysfunction: (Cont’d)
• Pills:
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Viagra (sildenafil)
Vasomax (phentolamine) relax blood vessel
muscles
Spontane (apomorphine) works at brain
level to trigger erection
Cialis (tadalafil)
Biological treatments for erectile dysfunction: (Cont’d)
• Side effects of Viagra (dose dependent):
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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.
Appendix
A more recent approach, not involving medical intervention:
Researchers interviewed couples who have great sex to glean
what factors were important.
1. being present: totally immersed and intensely focused, no
distracting thoughts, surrender to the moment
2. authenticity: free to be themselves, open about what they
wanted, totally uninhibited
3. intense emotional connection: regardless of duration of
relationship, powerful sense of intimacy throughout the
sexual encounter
4. communication, expressing their pleasure, verbalizing what
they want
5. transcendence: some people experience an altered state of
consciousness
Some yogic traditions enable these characteristics (kundalini)