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

2. 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

3. 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

4. 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

5. Table 1: DSM-5 Sexual Dysfunctions/Disorders

6. 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

7. 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

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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Table 2: Strategies to Cope With Sexual Difficulties

20. 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

21. 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

22. 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

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

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

25. 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

26. 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