Chapter 14: Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy © Radius Images/Alamy

Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy Sexual function difficulties: Definitions, types, and prevalence Physical causes of sexual function difficulties and dissatisfaction Psychology causes of sexual function difficulties and dissatisfaction Sexual function enhancement Treating sexual function difficulties

Sexual Function Difficulties: Definitions, Types, and Prevalence Sexual function dissatisfaction – Alternative term to sexual dysfunction Common outcome of a difficulty in sexual functioning Classifications of difficulties and dissatisfaction based on medical and feminist models DSM-IV-TR Working Group for a New View of Women’s Sexual Problems

Sexual Function Difficulties: Definitions, Types, and Prevalence DSM-IV-TR definition of sexual dysfunction Disturbance in sexual desire and in the psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty Working group for a new view of women’s sexual problems - Women-centered definition As discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience

Table 1: DSM-5 Sexual Dysfunctions/Disorders

Figure 1: Percentage of Sexually Active Men and Women in Britain, Aged 16-74; Reporting Selected Sexual Problems Lasting 3 Months or More in the Past Year

Figure 1: Percentage of Sexually Active Men and Women in Britain, Aged 16-74; Reporting Selected Sexual Problems Lasting 3 Months or More in the Past Year

Figure 2: Percentage of Self-Reported Sexual Functioning at Most Recent Partnered Sexual Event Among U.S. Adults Aged 18-59.

Figure 2: Percentage of Self-Reported Sexual Function Difficulties in the Past 12 Months Among U.S. Adults Aged 18-59, by Gender and Age

Figure 4: Percentage of Finnish Adults Who Indicated That They Feel Sexual Desire at Least a Few Times a Week

Figure 5: Percentage of Finnish Adults Who Indicated That If They Could Choose Freely They Would Like to Have Intercourse at Least Twice a Week

Other Disorders Anodyspareunia - Pain occurring during anal intercourse Peyronie’s disease - Condition in which calcium deposits and tough fibrous tissue develop in the corpora cavernosa within the penis Priapism - Prolonged and painful erection, occurring when blood is unable to drain from the penis

Physical Causes of Sexual Function Difficulties and Dissatisfaction in Men Diabetes Alcoholism Lumbar disc disease Multiple sclerosis Atherosclerosis Spinal cord injuries Prostate-cancer treatment Smoking Bicycle-induced sexual difficulties Diseases of the heart and circulatory system

Physical Causes of Sexual Function Difficulties and Dissatisfaction in Women Diabetes and heart disease Hormone deficiencies and neurological disorders General poor health, extreme fatigue, drug use, and alcoholism Spinal cord injuries Multiple sclerosis Dyspareunia Weak pubococcygeus - Pelvic floor muscle surrounding the urethra and the vagina Endometriosis, ovarian, uterine tumors, and cysts

Psychological Causes of Sexual Function Difficulties and Dissatisfaction Immediate causes Fatigue and stress Ineffective sexual behavior Sexual anxieties Spectatoring - Person becomes a spectator of her or his own sexual performance Excessive need to please a partner Conflict within self Internalized homophobia - Self-hatred because of one’s homosexuality Relationship causes

Sexual Function Enhancement Improving the quality of a sexual relationship Developing self awareness What is good sex? We feel good about ourselves, our partners, our relationships, and our sexual behaviors Discovering your conditions for good sex Doing homework exercises Mirror examination Body relaxation and exploration Masturbation Develop your own erotic “sexual voice” Kegel exercises Erotic aids or sex toys

Sexual Function Enhancement Intensifying erotic pleasure Developing bridges to desire Sexual arousal Alternatives to intercourse Changing a sexual relationship Focus on the tasks of daily living that you share Expand your repertoire of sexual behaviors Address issues with partner Deal with unresolved personal issues Do not become overly concerned with possible sexual problems Embrace a deeper connection

Treating Sexual Function Difficulties Masters and Johnson: A cognitive-behavioral approach The majority of sexual function problems are the result of sexual ignorance, faulty techniques, or relationship problems Treated difficulties using a combination of cognitive and behavioral techniques Treated couples rather than individuals Sensate focus - Focus on touch and the giving and receiving of pleasure

Table 2: Strategies to Cope With Sexual Difficulties

Treating Sexual Function Difficulties Treating male function difficulties Erection difficulties Early ejaculation Squeeze technique - Penis is brought manually to a full erection Male orgasmic disorder Treating female function difficulties Female orgasmic disorders Vaginismus

Common Erection Myths Erection is something that is achieved Men are sex machines, always ready, always hard During a sexual encounter, you get only one shot at an erection I blew it last time; I will never get it up again If I can’t have an erection, my partner can’t be sexually satisfied

Treating Sexual Function Difficulties Kaplan: Psychosexual therapy Modified Masters and Johnson’s behavioral treatment program to include psychosexual therapy Other nonmedical approaches PLISSIT model of therapy Permission, limited information, specific suggestions, and intensive model of therapy Self-help and group therapy

Table 3: Women’s Most Frequent Activities to Facilitate Orgasm During Intercourse

Treating Sexual Function Difficulties Medical approaches Lubricating jelly or estrogen therapy Microsurgery to improve a blood flow Viagra Homeopathic products

Gay, Lesbian, and Bisexual Sex Therapy Different issues than heterosexuals Homophobia, societal and internal, may be an issue Sex and HIV infection Require sex therapists to expand their understanding and treatment of sexual function problems

Final Thoughts Sexual function difficulties: Definitions, types, and prevalence Physical causes of sexual function difficulties and dissatisfaction Psychology causes of sexual function difficulties and dissatisfaction Sexual function enhancement Treating sexual function difficulties