1. Human Sexuality Sexual Function Difficulties,
Dissatisfaction, Enhancement, and Therapy

2. Sexual Desire and Activity
“ebb and flow”- natural to have highs and lows in sexual desire and activity
Most report occasional sexual difficulties (McCarthy & McCarthy, 2003)

3. Defining Sexual Function Difficulties
What constitutes a sexual “problem”
Discourses on normality/abnormality
Cultural scripts
DSM-IV

4. Difficulties and Dissatisfaction
Difficulties: problems/issues with sexual functioning
Inability to participate in sexual relationships as we wish
Dissatisfaction: subjective response to sexual difficulties

5. Sexual Dysfunctions
Disturbance in sexual desire and in the physiological sexual response
Causes “distress”
“persistent or recurrent”

6. Female Sexual Dysfunction
Critique: often based on physical criteria
How should we measure female sexual dysfunction?
Less research on female sexual problems
Role of psychological and contextual factors

7. Female Sexual Dysfunction
Need for greater focus on (Basson, 2003; 2004):
Subjective sexual arousal
Female sexuality as distinctive/different from male sexuality
Role of attachment, personal history, etc.

8. Female Sexual Dysfunction
Contextual/relational factors
Socio-cultural factors;
Cultural norms and ideals;
Inadequate information about female sexuality

9. Survey Findings National Health and Social Life Survey
1,749 women; 1,410 men
Women: 43% reported sexual difficulties
Men: 31% reported sexual difficulties

10. Survey Findings
Sexual dysfunction/difficulties are more common in men and women who have been sexually victimized
Both physical and psychosocial factors were implicated

11. Sexual Desire Disorders
Lack of fantasies and desire for sexual activity
Causes distress and interpersonal difficulty

12. Sexual Desire Disorders: HSD
Hypoactive sexual desire: lack of sexual desire
Causes more stress in marriages than any other sexual problem (McCarthy & McCarthy, 2003)

13. Sexual Desire Disorders HSD
Often transitory
May be associated with depression, stress, and interpersonal difficulties
**high sex drive is not a disorder in the DSM**

14. Sexual Desire Disorders Sexual Aversion
Sexual Aversion Disorder: aversion to and avoidance of genital contact
Anxiety, fear, or disgust toward sex
Actions are taken to avoid sexual situations

15. Sexual Desire Disorder: Sexual Aversion
Sexual Aversion Disorder
panic attacks and physical symptoms
past sexual trauma
negative parental reactions to sexuality
sexual pressure from a partner

16. Sexual Arousal Disorders
Female Sexual Arousal Disorder: lack of physiological sexual response
Male Erectile Disorder: erectile dysfunction;
associated with sexual/performance anxiety, low excitement, potential medical issues

17. Sexual Arousal Disorders
The disorder may have physical or psychological roots

18. Orgasmic Disorders
2nd most common sexual problem, after low sexual desire
Female Orgasmic Disorder; may be related to negative/guilty attitudes about sex, relationship problems

19. Orgasmic Disorder
Male Orgasmic Disorder: delay or absence in orgasm; inhibited or delayed ejaculation
Premature ejaculation
Often related to sexual anxiety

20. Sexual Pain Disorders
Sexual Pain Disorders: Genital pain associated with intercourse; psychological origins
Inadequate sex education, sexual trauma, sexual guilt, relationship problems

21. Physical Causes of Sexual Dysfunction: Men
Alcoholism, smoking, drug use (Vine, 1994)
Diseases of the heart/circulatory system
Other physical illnesses
A side effect to certain medications

22. Physical Causes of Sexual Dysfunction: Women
Diseases/chronic illnesses
Stress and fatigue
Hormonal changes

23. Sexual Dysfunction: Treatment
Accurate information about sexuality
Communication skills
Fostering positive sexual attitudes
“homework”

24. Treatment Cognitive therapies: Looking at sexual attitudes/beliefs
Addressing erroneous/unhealthy sexual attitudes

25. Treatment Behavioral components: Addressing concrete behaviors
“homework”- sexual exploration
Partner exploration
Taking away sexual pressures

26. Couples therapy Treating sexual dysfunction as a relationship issue
Taking away blame
“Neutrality and mutuality”

27. Treatment Addressing fear/anxiety associated with sexuality
The client’s personal history
Performance anxiety

28. Sexual Addiction Not in the DSM-IV Does sexual addition exist?
What is it?
How is it treated?

29. Sexual Addiction Sexual addiction/compulsive sexual behavior
A form of impulse control disorder? (Barth & Kinder, 1987)
Approximately 2 million sexual addicts in the U.S. (Delmonico & Carnes, 1999)

30. Sexual Addiction
Continuing to participate in sexual behaviors despite negative consequences (Bird, 2006)
Damaging to oneself and others
More likely to engage in risky sexual behaviors
Often report feelings of shame/isolation

31. Sexual Addiction The Internet:
New arena for sexual addicts (Griffiths, 2001)
Pushing mild addicts into deeper addictions?
Affordable/anonymity (Cooper, 1998)

32. Sexual Addiction: Women
Female sexual addicts:
Relationship-oriented online sexual behavior
often leading to real life sexual encounters (Schneider, 2000)

33. Sexual Addiction: Women
Women report experiencing greater shame than men
Women are less likely to engage in group counseling/12 step programs

34. Sexual Addiction: Men More prevalent in men
Gay/bisexual men are slightly more likely to report sexual addiction (Cooper, 2000)

35. Sexual Addiction
Research suggests sexual addiction often occurs with other psychological disorders
Co-morbidity

36. Sexual Addiction
Sexual addicts: significantly more likely to experience clinical depression (Weiss, 2004)
Tentative link: sexual addiction and untreated ADHD (Schwartz, 2003)

37. Sexual Addiction
Link between loneliness and pornography usage (Yoder, 2005)

38. Sexual Addiction Sexual addiction and OCD
Individuals with both conditions experience greater fear and avoidance regarding thoughts
Less pleasure related to performing sexual compulsions (Schwartz & Abramowitz, 2003)

39. Treatment of Sexual Addiction
Couples/family therapy
Medication (SSRIs)

40. Treatment of Sexual Addiction
Cognitive restructuring
Confrontation
Defining “sexual sobriety” and sexual boundaries
Empathy/grief counseling