1. Sexual Difficulties Wide ranging in both source and consequences

2. Overview Big numbers The root of much anxiety Many causes – physiological and psychological Male bias Hope for help Gender Roles expectations and Sex for Procreation emphasis contribute

3. Physiological Causes A very complex collection of systems The first place to look Problems can arise from any one of three areas: 1) Hormonal 2) Neurological 3) Circulatory

4. Chronic Illnesses Long standing, pathological conditions affect us in many ways Associated pain, medications, fatigue and loss of function interfere

5. The Looming Epidemic Diabetes – the pancreas fails to produce adequate insulin Major source of male erectile problems due to nerve and circulatory damage - 50% of male victims, even retrograde ejaculation Alcohol heightens Women affected also

6. A common crippler Arthritis – progressive inflammation of the joints Pain, limitation of movement Little direct impact But tremendous blow to structures and overall well-being

7. More chronic illnesses Cancer Especially devastating, hitting all systems Treatments worsen Surgical procedures leave permanent challenges Worse yet, can afflict reproductive systems directly Multiple sclerosis, Strokes

8. Blindness/Deafness Little direct impact on sexual functioning Great effect on ability to communicate (deafness) and perceive (blindness) Do other, intact, senses compensate?

9. How do we cope? Acknowledge great potential impact on self-esteem? Acceptance Careful preparation Refashioning overall view of sexuality Exploration, innovation & patience Greater intimacy?

10. Medications A bigger and bigger problem every day Not always appreciated or even discussed Often alternative meds are available Psychiatric – (especially antidepressants) cause reduced desire, arousal and delayed or absent orgasm Antipsychotic and Tranquilizers also

11. Cultural Factors Childhood Negativity Sex is sinful vs. infants “crave erotic pleasure”(?) Adults discourage this natural expression Guilt results Parents model ambivalent attitudes towards sexuality

12. The Double Standard Still prevalent – 2001 study Masters & Johnson – pressure on women to deny their natural urges is “a major source of women’s sexual dysfunction” Men must be eager, ever ready capable of performing no tenderness all knowing

13. Gays and the Double Standard Already outside of cultural do’s and don’ts Immune to strict cultural expectations?

14. Culture and its Restricted View of Sexuality What’s normal? Sex is traditional intercourse Problem – little focus on female stimulation Huge $$ on Viagra while other aspects of sexuality are ignored

15. Performance Anxiety Some feel that they have to live up to some arbitrary societal standard rather than set their own The shifting target (What about fun?) Procreation Simultaneous orgasm Multiple orgasms G spot ecstasy

16. Crushing Ramifications The vicious cycle 1) a mere temporary problem can cause anxiety about the fear of “not living up" to perceived standards 2) a pattern develops 3) self-blame & withdrawal follow 4) escape learning worsens situation 5) big problems result

17. Individual Problems Ignorance often correlates with problems Knowledge has the opposite effect Self Concept relation between self confidence, sexual satisfaction, and sexual problems

18. More Individual Factors Body Image women are often scrutinized resulting in self consciousness accentuates dissatisfaction & negative view of capability/desirability men are given much more slack

19. Media/Entertainment Influence on Body Image Models are skinnier and skinnier Is that what men really want? Backlash Female athletes Weight thresholds

20. Emotional Difficulties Depression, anxiety all impair sexuality Karen Horney’s victory Even beneath clinical levels, unhappiness, dissatisfaction, exert negative influence

21. Sources of Emotional Problems Work, stress, death, war Inability to express feelings Fear of intimacy Normative male alexithymia

22. Sexual Abuse A breach of trust, consent Often causes problems Especially devastating for the young – a failure to enjoy a normal pace of development Classical conditioning at its worst and most powerful Even 2 – 4 times more pelvic pain

23. Particular Disorders Hypoactive Sexual Desire Most common problem for therapists “Lack of appetite” More women seem afflicted, but recently.. Can be situational Lifelong quite rare

24. Why aren’t they hungry? Often reflects unresolved relationship issues 1) man is only affectionate if intercourse will follow 2) poor communication/unresolved conflicts 3) not enough love, romance, intimacy 4) sex as a duty

25. Erectile Dysfunction The persistent lack of an erection sufficiently rigid for penetrative intercourse Formerly impotence – without power Label abandoned due to negative connotations Duration – problem must persist for 6-12 months

26. More ED Two types Acquired – of recent origin Lifelong – never capable Viagra – first marketed in 1998 huge boost in public awareness

27. Why? Incidence skyrockets with increasing age But 58% of men in their 50’s? Age alone isn’t responsible, but conditions associated with advancing age, such as: diabetes cardiovascular deficits increased cholesterol medications

28. Female Orgasmic Disorder Sufficient arousal, lubrication and enjoyment but no climax Can snowball Anorgasmia – the absence of orgasm Generalized lifelong – never experienced Situational - varies

29. FOD II Most do not experience orgasm before 18 5-10% never But when asked about the last year, 24% report Most likely to suffer: the young the uneducated the unmarried

30. More FOD Self-help books and videos have helped And remember, it is normal to miss without clitoral stimulation

31. Premature Ejaculation Ejaculating so rapidly that his and/or her pleasure is impaired Often causes intense distress Worse yet, can be progressive For 29% of males it’s a chronic condition

32. Why so soon? Physiological factors appear to influence Common characteristics; underestimate arousal very excited by penile stimulation ejaculate before full arousal

33. Dyspareunia Pain while engaging in intercourse Much more common for women But Peyronie’s disease is every man’s nightmare 60% of women experience at some point Caused by many factors – multidisciplinary approach works best

34. Vaginismus Involuntary spasmodic contractions of the muscles of the outer third of the vagina Problems with any penetration – even pelvic exam Often a conditioned response

35. Faking Orgasm 60% of females report they have done it at least once 75% of these have done it more than 50 times 10% too many times to count Unlike other problems – a conscious decision

36. Why do they lie? Want to get it over with Poor communication Limited knowledge Hide troubled relationship Need partner approval “I started faking, and now I don’t know how to stop!” Get counseling