Sexual Function Difficulties HsC 425 Professor Matza Sample Presentation Fall, 2014

Sexual Dysfunctions Sexual Desire Arousal Orgasmic Sexual pain Are sexual dysfunctions common?

Arousal Issues Sexual Arousal Disorder-the inability to respond normally during sexual arousal Symptoms in men include the inability to maintain an erection during a sexual act Symptoms for women include the inability to create vaginal lubrication to start or finish a sexual act

Sexual Desire Dysfunctions Most sexual problems stem from or thoughts and emotions Sexual desire disorder is a psychiatric condition marked by a lack of desire for sexual activity over a prolonged period Symptoms include the failure to initiate or respond to sexual stimulus.

Orgasm Dysfunctions Orgasmic dysfunction is when a person either can't reach orgasm, or has difficulty reaching orgasm when he/she is sexually excited. Orgasmic dysfunction is often found in women rather than in men. There can be many factors that stop a person from reaching orgasm including : a history of sexual abuse, drug abuse, hormonal imbalances, monotony in sexual routine, etc. Text

Sexual Pain Dyspareunia-refers to pain in the pelvic area during or after sexual intercourse. This can occur in both men and women. Causes-aggressive love making,premature sexual activity after surgery, genital tract infections Vaginismus refers to an involuntary spasm of the musculature surrounding the vagina causing it to close, resulting in penetration being difficult and painful, or impossible. Vaginismus causes-past sexual trauma or other psychological factors, or a long history of discomfort with sexual intercourse related to another disorder. Sometimes no cause can be determined.

Formal Diagnosis Statistics - Hypoactive Sexual Desire Disorder is one of the most common presenting problems in the practice of sex therapy. It is estimated that approximately 20% of men and 33% of women are affected by low or absent sexual desire. Sexual Desire Disorders is the most common type of female sexual dysfunction and often has a psychological or physiological cause.      

Psychological Disorders Hypoactive Sexual Desire (HSD) Lack of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty -Sexual Aversion Disorder -Persistent and recurrent aversion to and avoidance of genital contact with a partner that causes marked distress -Sexual contact may cause anxiety, disgust, or fear.

Of Sexual Dysfunction (Dissatisfaction) Psychological Causes Of Sexual Dysfunction (Dissatisfaction) Causes •Stress & Fatigue •Ineffective Sexual Behavior •Sexual Anxieties

Stress & Exhaustion Sexual Apathy/Disinterest Children Prolonged Illnesses Sexual Apathy/Disinterest “Commonplace Issues” Economic Hardships Financial Distress Long-term effects Lowered Sexual drives Reduced responsiveness

Ineffective Sexual Behaviors Substandard Sexuality Education Misinformation Negative Childhood Learning Parents’ attitudes toward sex, level of affectionate interaction with each other Religion Labeling sex as sinful or shameful Sexual difficulties Later in life Double- Standards Opposing sexual expectations for women and men create problems Men feel that they should want sex all the time, that asking for guidance from their partner isn’t ‘manly’ Women may learn to be sexually restrained for fear of being labeled a ‘slut,’ resulting in less exploration of their sexuality, not asking their partner for what they want

Sexual Anxieties Performance anxiety About not being able to achieve erection or orgasm Excessive needs to please a partner Perceived inability to meet expectations regarding “correct” Sexuality Cycle of Sexual Dysfunction One transitory problem with performance can cause a vicious cycle where anxiety about repeat problems causes problems next time Spectatoring -Evaluating one’s own sexual performance.

Sexual Anxieties Anxiety over pregnancy, STIs unwanted, or desired pregnancy Contracting a STI Problems accepting one’s sexual orientation Internalized Homophobia As a result of trauma Childhood Sexual abuse Adult Sexual assault Rape Guilt & Conflict

Relationship Problems Unresolved resentments trust issues disrespect for partner One partner feels pressured Over-dependency balance of togetherness and separateness Lack of Communication Conflicts within the Self Attachment Rejection Cooperation Entitlement

Psychosexual Therapy Identify the problem Educate people Modify Behavior Communication Find the sources of the problem Help counteract negative thought

Treating Sexual function Difficulties Behavior Modification Master and Johnson Cognitive-behavior approach Ignorance and relationship problems Treat couples rather than individuals

Kaplan Physchosexual Therapy Arousal and orgasmic difficulties Mild to midlevel sexual anxieties Behavioral will not work for more traumatic experiences ie. Sexual abuse

Psychosexual Therapy Information heterosexual couples Sexual Aversion Therapy for childhood trauma Sexual abuse Gender identity Greater Treatment efficiency Greater patient satisfaction

Psychosexual Therapy Brief sex therapy PLISSIT model 1 Giving Permission 2 giving limited information 3 Making specific suggestions 4 Undergoing intensive therapy Self-help Group therapy

LGBT Psychosexual Therapy Go to therapist that are LGBT Go with therapist that will be free of bias and value judgment

Drugs Lubricating gel or estrogen therapy Erection enhancing drugs Microsurgery for men to maintain erection

Physical Disorders -Men Erectile dysfunction: •Can no longer get or keep an erection for intercourse •Erection trouble from time to time isn't a problem •Usually caused by stress or exhaustion, but medical problems cause it too •May also be a sign of emotional or relationship problems

Physical Disorders -Men Male orgasmic disorder: Delay in or absence of an orgasm during intercourse It is considered to be rare Males with this disorder can have full erections and can have sex normally Fear of impregnation or guilt Antidepressants are the major type of medication that cause it

Physical Disorders -Men Priapism (Painful erections): Erections that last for more than four hours and occurs without sexual stimulation Two types low flow and high flow It is important that you seek medical care immediately Antidepressants or medications may cause some of these disorders

Physical Disorders -Women Vaginal dryness: The lack of a layer of moisture that coat the vaginal walls Affects many women Urinary frequency Recurrent urinary tract infections

Physical Disorders -Women Endometriosis: Tissue that normally lines the inside of the uterus grows outside of the uterus Could cause painful sex The exact cause is not certain Possible after a surgery, such as a C-section, endometrial cells may attach to a surgical incision. Possible to happen if one or more relatives with endometriosis

Sexual Function Enhancement Goal? To improve the quality of a sexual relationship. Development of Self Awareness What is Good Sex? We are raised with stereotypes on how to behave sexually.

Sexual but Not Sexual Woman Sexually Dominant Man Sexual but Not Sexual Woman

What’s a condition you require for good sex? Following these scripts may impede our unique responses and preferences. Therapist Carol Ellison defines “good sex” as the moment we feel good about ourselves, our partners, our relationships, and our behaviors. Discovering Conditions for Good Sex “In order to enjoy our sexuality we need to explore our conditions for good sex.” (Zilbergeld) Each individual has their own set of unique condition in order to attain good sex. Range of conditions may vary; type of situation need to be more relaxed, confident, excited, familiar to your experiences, etc. What’s a condition you require for good sex?

Homework Exercises! Sexual function - enhancement programs often assign certain exercises for couples to partake in. Mirror Examination - get naked in front of a mirror! Body relaxation and exploration - Explore your body after a relaxing shower.

Sexual Voice - Each person has their own voice Sexual Voice - Each person has their own voice. Especially important for woman. Masturbation - Use oils or lotion to enhance sensation.

Kegel exercises for women and men - Tightening of the P Kegel exercises for women and men - Tightening of the P.C muscle increases sexual awareness in women. Improves erection and ejaculatory control.

Erotic aids - Sex toys designed to enhance your erotic responsiveness Erotic aids - Sex toys designed to enhance your erotic responsiveness. Dildo’s, vibrators, fake vaginas or mouths, nipple clamps, oils, etc...

The End

Sexual Arousal Disorders Physiologic and subjective arousal may be unrelated, education is a key component in the treatment of female sexual arousal disorder Another treatment option is the Eros Clitoral Therapy Device, made by UroMetric  

Sexual Pain Disorders (Dyspareunia) Dyspareunia has many potential etiologies, including infection, vaginal atrophy, and endometriosis Addressing multidimensional and multidisciplinary and reflects the interplay o physiological, emotional and relational factors

Orgasm Disorders Anorgasmy has been successfully treated with directed masturbation, cognitive behavior therapy, and sensate focus Cognitive behavior therapy focuses on decreasing anxiety and promoting changes in attitudes and sexual thoughts, which increase the ability to achieve orgasm and to gain satisfaction from orgasm

Treatment Sexual Function Enhancement Treatment of Sexual Function Difficulties.