Sexual Difficulties (B) © Robert J. Atkins, Ph.D.

Endometriosis Occurs when the cells of the lining of the uterus are disrupted, and often grow outside the uterus within the abdominal cavity. Symptoms Deep pelvic pain, painful menstruation, painful sex, abdominal pain when walking Laparoscopic surgery

Female orgasmic disorder Symptoms Inability to climax at least half the time. Treatment Self and partner education on what is enjoyable Use of a vibrator Direct manual stimulation of the clitoris during intercourse. Female initiated movements (Woman on top position)

What are the general techniques common to all sex therapy?

Sexual Enhancement and Sex Therapy Self-awareness knowledge of beliefs, needs, and how body responds self-examination masturbation

Sexual Enhancement and Sex Therapy (cont.) Communication Sensate focus touching & communicating without any goal  less pressure to perform focus on non-genital touch Cultural values and masturbation

Sexual Enhancement and Sex Therapy (cont.) Fig. 16.1 The process of sensate focus, whereby partners sensually explore each other’s body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.

Sexual Enhancement and Sex Therapy (cont.) Masturbation with partner present to learn what feels good & teach partner to allow sexual release for women learning to experience orgasm with partner to resolve male erectile difficulties

Sexual Enhancement and Sex Therapy (cont.) Fig. 16.3 Masturbating in the presence of a partner can be an effective way for an individual to indicate what kind of touching she or he finds arousing.

What are some specific Suggestions for Women Becoming orgasmic through self-stimulation vibrator use Eros clitoral therapy device allow time, consider counseling

Specific Suggestions for Women (cont.) Experiencing orgasm with a partner sexual assertiveness important masturbation in presence of partner sensate focus activity techniques to increase arousal

Sexual Enhancement and Sex Therapy (cont.) Fig. 16.4 The back to chest position for genital sensate focus.

Specific Suggestions for Women (cont.) Fig. 16.5 The use of an electric vibrator for clitoral stimulation during coitus.

Specific Suggestions for Women (cont.) Fig. 16.1 Facilitating Orgasm: Complete the Sentence, “In addition to getting specific physical stimulation, I have often done the following to help me reach orgasm during sex with a partner.”

Specific Suggestions for Women (cont.) Dealing with vaginismus relaxation & self-awareness activity gradual finger/dilator self-insertions penile penetration may require professional help

What are some specific Suggestions for Men Strategies for delaying ejaculation more frequent ejaculation “Come again” change positions communication  slow down

Specific Suggestions for Men (cont.) Strategies for delaying ejaculation stop-start technique stimulation to brink of orgasm stop, wait for sensations to decrease OR squeeze technique training sessions required woman above position most used

Specific Suggestions for Men (cont.) Strategies for delaying ejaculation medical treatment small doses of antidepressants

Specific Suggestions for Men (cont.) Dealing with erectile dysfunction reduce anxiety (most common cause) restore confidence with success sensate focus or stop-start final phase of treatment is intercourse

Specific Suggestions for Men (cont.) Dealing with erectile dysfunction medical treatment Viagra: takes effect < 3 hours, requires physical stimulation, effect may depend on quality of relationship newer drugs: Levitra and Cialis

Specific Suggestions for Men (cont.) Dealing with erectile dysfunction mechanical: suction pump, Rejoyn surgical treatment semi-rigid or inflatable implants may alter sensations during erection microsurgical vascular repairs

Specific Suggestions for Men (cont.) Fig. 16.6 An inflatable penile prosthesis.

Specific Suggestions for Men (cont.) Reducing male orgasmic disorder behavioral approach used sensate focus without ejaculation ejaculation by any means manual or oral stimulation by partner, to ejaculation coital ejaculation

Treating Hypoactive Sexual Desire Some suggestions same as other dysfunctions encourage erotic responses reduce anxiety enhance sexual experiences expand repertoire of activities

Treating Hypoactive Sexual Desire (cont.) Multifaceted intervention may be required goal = modify inhibited impulses explore underlying relationship problems often requires long-term professional help medical treatment; testosterone supplementation

Seeking Professional Assistance The PLISSIT model of sex 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

Seeking Professional Assistance (cont.) Therapeutic approaches psychosexual therapy

Seeking Professional Assistance (cont.) What happens in therapy? identify & clarify problems & goals medical, sexual, relationship history often given homework NEVER includes sex with therapist

Seeking Professional Assistance (cont.) Selecting a therapist referral from trusted source ask about credentials, training, & experience interview: practicalities & "fit"