Transcript Chapter Fourteen

Chapter Fourteen
Challenges to Sexual Functioning
Agenda
 Sexual Dysfunctions: Definitions, Causes,
and Treatment Strategies
 Discuss Sexual Desire Disorders
 Discuss Sexual Arousal Disorders
 Discuss Orgasm Disorders
 Discuss Pain Disorders
 Review Illness, Disability, and Sexual
Functioning
 Describe Resources for Getting Help
Self Reflection Exercise
Do NOT discuss. Write down your thoughts
privately.
If I were unable to have an orgasm or an
erection, what would I do?
If my partner were unable to have an
orgasm or an erection, what would I do?
If a friend were experiencing a sexual
dysfunction, what advice would I give to
him or her?
Sexual Dysfunctions:
Definitions, Causes, and
Treatment Strategies
Psychological Factors in Sexual
Dysfunction
Physical Factors in Sexual Dysfunction
Categorizing the Dysfunctions
Treating Dysfunctions
View “The Mango” Episode from Seinfeld
 What factors contribute to George’s inability
to have an erection?
 Why does the fact that Elaine faked orgasms
with Jerry bother him?
Sexual Dysfunctions: Definitions,
Causes, and Treatment Strategies
 The Diagnostic and Statistical Manual (DSM
IV-TR) classifies sexual dysfunctions
It provides descriptions, diagnoses,
treatments, and research findings
 Note: there is a distinction between Sexual
problems vs. sexual dysfunctions
Common sexual problems – not enough
foreplay, lack of enthusiasm, inability to
relax
Dysfunction – disturbance in the sexual
response that doesn’t go away by itself
Psychological Factors in Sexual
Dysfunction
 Psychological factors can interfere with
sexual functioning: fears, stress, anxiety,
depression, guilt, anger, partner conflict,
dependency, loss of control, time pressures,
distractions
 Performance fear – excessive need to please
a partner
 Spectatoring – acting as an observer or judge
of one’s own sexual performance
Physical Factors in Sexual Dysfunction
 Sexual dysfunction increases with age
 Disease, disability, illness, and use of
prescription and non-prescription drugs can
all lead to sexual dysfunctions
Categorizing the Dysfunctions
 Categorization helps determine appropriate
treatment strategies
Primary – one that always existed
Secondary – one that develops after a
period of adequate functioning
Situational – occurs during certain sexual
activities or with certain partners
Global – occurs in every situation
Treating Dysfunctions
 Medical history and workup are taken first to
determine physiological causes
 Evaluations of past sexual abuse or trauma
 Plan for treatment is made after causes have
been uncovered
 Treatment may involve several therapy types
 Highest success rates are 60% for primary
erectile disorder, 97% for premature
ejaculation, 80% for female orgasmic disorder
Sexual Desire Disorders
Hypoactive Sexual Desire
Treating Sexual Desire
Sexual Aversion
Sexual Desire Disorders
 Often considered the most difficult sexual
dysfunction category to treat
 Two types:
Hypoactive Sexual Desire
Sexual Aversion
Hypoactive Sexual Desire
 Diminished or absent feelings of sexual
interest in sexual activity
 Problem may be due to discrepancy in desire
between the partners
 33% of women, 16% of men report a lack of
interest; increases with age for women
 Secondary is more common than primary
 Psychological causes: lack of attraction to
partner, fear of intimacy/pregnancy,
relationship conflicts, depression, mental
disorders, negative body image
Hypoactive Sexual Desire
 Other causes: anorexia, sexual abuse, and
coercion, drug abuse
 Biological causes: hormonal problems,
illness, medication side effects
 Treatment: sex and marital therapy, cognitivebehavioral therapy, testosterone for those
with low levels
Sexual Aversion
 Strong disgust or fear to a sexual interaction
 Relatively rare; affects more women than
men
 Often associated with childhood sexual abuse
or trauma, as well as anorexia
 Need to uncover the underlying conflict
 Treatment: cognitive-behavioral therapy, goal
setting, homework assignments (alone and
with a partner)
Sexual Arousal Disorders
Female Sexual Arousal Disorder
Male Erectile Disorder
Sexual Arousal Disorders
 More commonly sexual arousal disorders are
secondary
 They occur even with enough focus, intensity,
and duration of sexual stimulation
 Two types:
Female Sexual Arousal Disorder
Male Erectile Disorder
CNN Video: Female Sexual Dysfunction
Female Sexual Arousal Disorder
 Inability to lubricate or stay lubricated
 Increases with age and is common after 50
 Physiological factors: lowered blood flow to
the vulva
 Psychological factors: fear, guilt, anxiety,
depression
 Treatment: Viagra™, vasoactive agents (pills,
creams), herbal drugs, EROS clitoral therapy
device, psychological therapy
The EROS-CTD is a handheld device that increases blood flow to the clitoris. The plastic cup is placed
directly over the clitoris.
Erectile Dysfunction: Clark
Male Erectile Disorder
 Persistent inability to get or keep an erection
sufficient for satisfactory sexual performance
 30 million men in the U.S.; increases with age
 Physiological factors: neurological, endocrine,
vascular, muscular problems
More common in older men (60+)
 Psychological factors: fear of failure,
performance anxiety
More common in younger men (20-35)
Male Erectile Disorder
 Nocturnal penile tumescence test
 Diagnostic tests examine erections that
naturally occur during REM sleep to
determine if the cause is physical (no
erection) or psychological (erection)
3 nights in lab attached to machines
RigiScan™ home device
Stamp tests
Male Erectile Disorder
 Most treatment options of any sexual
dysfunction
 Success rates range from 50-80%
 Psychological treatment: systematic
desensitization, education, sensate focus,
communication training, relationship therapy
Male Erectile Disorder
 Pharmacological treatment: Viagra™, Cialis,
Levitra
Relax penile muscles, dilate penile arteries
Erection does not occur without stimulation
Must be taken 15-60 minutes prior to
intercourse
Erections can last 4-48 hours
Many side effects
Male Erectile Disorder
 Hormonal treatments help those with low
testosterone levels
Testosterone patch applied to the scrotum,
gels & creams to other body parts
 Intracavernous injections are self-injected into
the corpora cavernosa, while the penis is
stretched, and causes the vessels to relax
Minor pain & possible priapism side effect
 Prostaglandin pellets put into penile opening
Male Erectile Disorder
 Vacuum Constriction Devices – suction is
used to produce erections
Flaccid penis is inserted into the pump & a
constriction ring is put on the base of the
penis after removing it from the vacuum
When the ring is removed, the penis will
become flaccid
Side effects: possible bruising, testicular
entrapment
Vacuum constriction devices, such as the ErecAid, are often used in the treatment of ED. A man places
his penis in the cylinder and vacuum suction increases blood flow to the penis.
Male Erectile Disorder
 Surgical treatments
Revascularization
Prosthesis implants allow for orgasm,
ejaculation, & impregnation
Semirigid rods – permanent erection,
but can be bent up & down
Inflatable devices – patient pumps it up
10-25% of patients remain dissatisfied,
dysfunctional, or sexually inactive
Orgasm Disorders
Female Orgasmic Disorder
Male Orgasmic Disorder
Premature Ejaculation
Retarded Ejaculation
Female Orgasmic Disorder
 Has been referred to as “frigidity”
 Delay or absence of orgasm following normal
sexual excitement
 A common complaint: 24% of women
 Those with female orgasmic disorder tend to
have more negative attitudes about
masturbation, feel more guilt about sex,
believe more sexual myths, & have difficulty
telling their partner their needs
Female Orgasmic Disorder
 Psychological factors: lack of sex education,
fear, anxiety, personality disorders
 Physical factors: chronic illness & disorders,
diabetes, neurological problems, hormone
deficiencies, prescription drugs, alcoholism
 Treatments: homework assignments, sex
education, communication skills, cognitive
restructuring, desensitization
Female Orgasmic Disorder
 Most effective treatment is masturbation
training
teach to masturbate to orgasm
 can include self-exploration, body
awareness, experimenting with touch,
vibrator, and/or with her sexual partner
 Systematic desensitization and bibliotherapy
help when there is a high amount of anxiety
Male Orgasmic Disorder
 Delay or absence of orgasm following normal
sexual excitement phase
 8% of men
 Psychotropic medications may be a cause
 Treatment: psychotherapy, changing
medications
Premature Ejaculation
 A man reaching orgasm just prior to, or
immediately after, penetration
 Not viewed as a problem in cultures where
only male pleasure is considered important
 Frequency: 30% of men in a given year
 Related factors: depression, drug/alcohol
abuse, personality disorders
Premature Ejaculation
 May create a biological advantage to
impregnate many women in a short amount
of time
 May be from early sexual experiences that
were rushed due to fear of being caught
conditioning an early ejaculation
 Men may be unable to accurately judge their
level of sexual arousal
Premature Ejaculation
 Treatments involve stimulating the penis until
just before ejaculation, alone or with a partner
 Squeeze technique – when stimulation is
stopped, pressure is applied to the base for
3-4 seconds, until the urge drops; repeated
 Stop-start technique – stimulation is stopped
until urge subsides; repeated many times
 Need to use the techniques for 6-12 months
 Improvements often subside within 3 years
The squeeze technique is often recommended in the treatment of premature ejaculation. Pressure is
applied at either the top or base of the penis for several seconds until the urge to ejaculate subsides.
Retarded Ejaculation
 A man may not reach orgasm during certain
sexual activities or may only ejaculate after
prolonged (30-45 minutes) stimulation
 Physical factors: diseases, injuries, drugs
 Psychological factors: strict religious
upbringing, unique masturbation patterns,
sexual orientation ambivalence
 Situational factors
 Difficult to treat; often use psychotherapy
Pain Disorders
Vaginismus
Dyspareunia and Vulvodynia
Vaginismus
 Involuntary contractions of the
pubococcygeus muscle surrounding the
vaginal entrance
 Makes penetration nearly impossible
 May be situation specific
 Contractions are in reaction to anticipated
vaginal penetration
 Common in sexually abused or raped women
 Often co-occurs with other sexual difficulties
Vaginismus
 Treatments
Dilators are used to help open and relax
the muscles, which is 75-100% effective
Education
Reduce anxiety and tension
Work through previous trauma
Dyspareunia and Vulvodynia
 Dyspareunia is pain during intercourse
 Pain may range from slight to severe
 May occur before, during, or after intercourse
 15% of women
 Men can experience pain in the testes or
penis
 Physical factors: allergies, infections
 Psychological factors
Dyspareunia and Vulvodynia
 Vulvar vestibulitis syndrome, a type of
vulvodynia, is a common cause of
dyspareunia in women
 Peyronie’s disease may be a leading cause of
dyspareunia in men
 Treatments: medical treatments,
psychotherapy, biofeedback, surgery
Illness, Disability, and
Sexual Functioning
Cardiovascular Problems
Cancer
Chronic Illness & Chronic Pain
Diabetes
Multiple Sclerosis
Alcoholism
Spinal Cord Injuries
AIDS & HIV
Mental Illness & Retardation
Illness, Disability, and Sexual
Functioning
 Physical illness can interfere with sexual
functioning due to physiological changes, as
well as psychological changes & relational
changes
 Disabled women have more difficulties,
however, research has focused on men
 Illnesses and disabilities:
Cardiovascular Problems
Cancer
Illness, Disability, and Sexual
Functioning
 …Continued
Chronic Illness and Chronic Pain
Chronic Obstructive Pulmonary Disease
Diabetes
Multiple Sclerosis
Alcoholism
Spinal Cord Injuries
AIDS and HIV
Mental Illness and Retardation
Cardiovascular Problems:
Heart Disease and Stroke
 Heart disease is the primary cause of death
in the U.S.
 A person can return to normal sex about 4-8
weeks after recovery, however, intercourse
tends to decrease
 Reasons for the decrease: fear, erectile
difficulties, depression, feelings of
inadequacy, loss of attractiveness, partner
becomes the caretaker
Cardiovascular Problems:
Heart Disease and Stroke
 Stroke – blood is cut off from part of the brain
 Can create memory, perceptual, & cognitive
problems, but usually not affect sexual
functioning
 Problems stem from: fear, worries about
attractiveness, stress, anxiety, some
erections may be crooked, jerking motions,
reduced sensation, communication problems
 May cause hypersexuality or hyposexuality
Cancer
Breast
Pelvic
Prostate
Testicular
Cancer
 Cancer produces feelings of shock,
depression, numbness, & fear
 Partners may change roles
 Cancer can decrease sexual activity, even if it
does not affect sexual organs
 Ostomies can be hard for many to accept
 Scars, loss of body parts, changes in skin &
hair, nausea, weight change, and
bloatedness can all inhibit sexual relations
Breast Cancer
 Much of a woman’s self-image can be
invested in her breasts
 Removal of all or part of a breast or both can
alter a woman’s self-image and sexual
identity
 Many women may wear a prosthesis,
undergo breast reconstruction, or have
implants
Pelvic Cancer and Hysterectomies
 Cancer of the vagina, cervix, uterus, &
ovaries can affect a woman’s sexual
response
 She may undergo a hysterectomy, which is
currently the most common medical
procedure in the U.S.
 The surgery may cause nerve damage
 It may also improve sexual functioning
Pelvic Cancer and Hysterectomies
 Removal of ovaries will create a hormonal
imbalance that can reduce lubrication, cause
mood swings, other bodily changes
 Removal of the uterus may decrease
pleasure during orgasm that was obtained
through contractions of the uterus
 If the vagina is shortened, it may make
intercourse more painful
 Some may mourn the loss of a body part,
female identity, or the ability to have kids
Prostate Cancer
 Most men will have enlargement of the
prostate gland as they age
 Prostate cancer is one of the most common in
men over 50
 Prostatectomy may be performed
May cause incontinence and necessitate a
catheter
May cause erectile dysfunction
Testicular Cancer
 A testicle may be removed (orchiectomy),
which can make a man feel that he has lost
part of his manhood and become concerned
about the appearance of his scrotum
 Prosthesis may take the place of the missing
testicle
 Penectomy may occur in rare cases of cancer
of the penis
Chronic Illness and Chronic Pain
 Arthritis, migraine headaches, & lower back
pain can make intercourse difficult or
impossible
Chronic Obstructive Pulmonary
Disease
 This includes asthma, tuberculosis, chronic
bronchitis, and emphysema
 Physical exertion may be difficult
 Perceptual and motor skills may be impaired
Diabetes
 Pancreas cannot make insulin or the body
cannot use the insulin that is produced
 Insulin processes blood sugar into energy
 Often creates many sexual difficulties
Erection difficulties, vaginitis, yeast
infections
 Many diabetic men receive penile prostheses
 Both physiological and psychological
problems often play a part
Multiple Sclerosis
 Breakdown of the myelin sheath that
surrounds & protects nerve fibers
 Symptoms: dizziness, blurred vision, muscle
spasms, loss of control of muscles, weakness
 60-80% of men with MS experience ED
 Women with MS may lack vaginal lubrication,
have difficulty attaining orgasm
 Many may be hypersensitive to touch
 Treatments: therapy, prostheses, lubrication
Alcoholism
 Alcohol is a nervous system depressant with
long & short term effects on sexual operations
 May impair spinal reflexes, decrease
testosterone, lead to erectile dysfunction
 In men may cause feminization,
gynecomastia, testicular atrophy, sterility, ED
 In women may cause decreased menstrual
flow, ovarian atrophy, loss of vaginal
membranes, miscarriages, infertility
Spinal Cord Injuries
 Damage can cut off impulses in areas served
by nerves below the damaged section
 Depending on where the injury occurred, &
the extent of the damage, a man may still be
able to have an erection through a reflex
action responding to stimulation, however, he
is not likely to orgasm or ejaculate
 Likely to make a person dependent on his/her
partner or caretaker
Spinal Cord Injuries
 Women can remain fertile and bear children
 Women may also lose sensation & ability to
lubricate
 Spinal cord injuries may create new
erogenous zones
 Typically, sexual activity decreases after the
injury
 Preferred sexual activities tend to change to
kissing, hugging, & touching
Spinal Cord Injuries
 Couples can still use their mouths & possibly
hands to pleasure their partner
 “Stuffing” may also be used
 Treatment methods include prosthesis
implantation, vacuum erection devices,
injection of vasoactive drugs, & Viagra™
AIDS and HIV
 Those infected often fear infecting others, are
shamed, and may stop all sexual activity
 Other may limit their sexual activity to
hugging, kissing, & touching
 Care needs to be taken to avoid exchanging
bodily fluids & keeping clean
 Sexual relations can still occur while
remaining safe
Mental Illness and Retardation
 Those with psychiatric disorders have been
treated as asexual or as perverts
 Those institutionalized are discouraged from
masturbating, though each institution differs
 Special sexuality education programs are
designed for those with mental retardation &
those that are developmentally disabled
 Denying sexuality in these cases is needless
 Sexual exploitation can also occur
Getting Help
 Seek help as soon as possible
 Most colleges have a student counseling
center
 You may wish to seek a sex therapist trained
by the American Association of Sexuality
Educators, Counselors, and Therapists
(AASECT)