Sexual dysfunction: problem with sexual response that causes significant psychological distress or interpersonal difficulty.

Four types of Sexual Disorders:

1) Desire Disorder: hypoactive sexual desire, sexual aversion

2) Arousal Disorders: erectile disorder female sexual arousal disorder

3) Orgasmic Disorders: rapid ejaculation, male orgasmic disorder, female orgasmic disorder.

4) Sexual pain Disorders: dyspareunia, vaginismus

**sexual disorders can fall into multiple grows, not exact.

Life Long sexual disorder: a sexual disorder that has been present since the person began functioning

Acquired sexual disorder: sexual disorder that develops after a period of normal functioning

Situational sexual disorder: a sexual disorder that a person has in some situation but not in others. (i.e with partner or different lover, in a house or on a beach) happen with partners of both sex

DESIRE DISORDERS

Hypo (LOW) active sexual desire (HSD): sexual disorder in which there is a lack of interest in sexual activity; low or inhibited sexual desire. Avoid situations that evoke sexual activities, don’t want sex or initiate. Most commonly reported in women (doesn’t change with age) some women report no sexual desire (increases with age). Men can experience this problem.

Libido: interest in sexual activity

Discrepancy of sexual desire: a sexual problem in which partners have considerably different levels of sexual desire.

Sexual  Aversion: strong aversion involving anxiety, fear or disgust about sexual interaction.

AROUSAL DISORDERS

Erectile disorder: the inability to have an erection or maintain one. Erectile dysfunction or inhibited sexual excitement. Can be lifelong, acquired, situational or generalized. 10% of men suffered from the problem and it increases with age. Can be fixed with therapy of medication (i.e Viagra)

Female sexual arousal disorder. Lack of response to sexual stimulation by women. Difficulties in woman’s perception of arousal and lack of vaginal lubrication. Different subtypes of disorder. Freq. Increases after menopause.

ORGASMIC DISORDERS

Premature ejaculation. Man has orgasm and ejaculates sooner than desired. Time of before ejaculation can vary greatly; but if a man feels that he has become greatly concerned about his lack of ejaculatory control and his partner agrees with this notion. Problem is common, close to 25%. Though many men find this a concern, a majority of female partners did not. Makes many men feel insecure and can actually cause men to stop having sex. Distractions are useful method in delaying ejaculation

Male orgasmic disorder. Delayed ejaculation..opposite of rapid ejaculation; men are unable to have orgasm though they have a full erection. Can be infrequent in consistence; usually oral or hand stimulation will correct the problem. Less common than premature ejaculation or increases with age. Some women react negative to this; men fake orgasm.

Female orgasmic disorder. Inability to orgasm. Can be lifelong or acquired, but usually situational. Many women can orgasm as a result of oral, hand or vibrator use, but sometimes not from penile penetration. Many women do not meet the criteria but still seek therapy.

SEXUAL PAIN DISORDERS

Painful intercourse (dyspareunia): genital pain during intercourse. Usually in women but can happen in men. Problem can be persistent, vary in intensity burning vs. sharp, or be non-sexual. In men, pain is in testes/ penis.

Vaginismus. Spastic contraction of outer third of vagina. Entrance of vagina can close. Painful intercourse can result in this and women with disorder avoid sex; not common.

WHAT CAUSES SEUXAL DISORDERS.

Biopsychosocial model: general model that argues that physical, psychological, and social factors ALL contribute to sexual disorders.

PHYSICAL CAUSES

Sexual disorders include organic factors (such as diseases and drugs)

Erectile Disorder: Caused by heart/ circulatory disease, diabetes, hypogonadism (low test from balls), but can also be caused by other problems such as depression, anxiety

Premature ejaculation. Most often a psychological condition. But some men may suffer from hypersensitivity or lost of nervous control.

Male/ Female Orgasmic Disorder, Painful Intercourse, Vaginsmus, are can also be caused by physical ailments.

Drugs- can all play a role is either augmenting or decreasing sexual desire indirectly.

Alcohol. High/ consistent consumption can have negative effects on person’s interpersonal relationships. Light consumption is a factor of actually pharmacological effects and expectancy effect (i.e alcohol will loosen them up)

Cannabinoids. Believed to be an aphrodisiac- it is not true. Chronic users are prone to decreased sex desire and orgasmic disorder

Cocaine. One drug of choice for enhancing sexual experiences. IT can increase sexual desire, sensuality, delay orgasm. Amphetamines/ crystal methamphetamines will also increase sex drive. But chronic use will decline sexual desire.

Opiates. Strong suppression of sexual desire and response.

Prescription Drugs. Psychiatric drugs- may affect sexual functioning; usually beneficial. Antidepressant. May cause desire and orgasm problem.

PSYCHOLOGICAL CAUSES

Separated into:

Predisposing factors: experiences that people have had in the past (i.e childhood) affect their sexual response now.

Maintaining factors: various factors, person characteristics and love making patterns that inhibit sexual patterns. 8 factors:

(1) Myths or misinformation. Misconception about sex and information

(2) Negative attitudes. About sex, their body, their partner’s body.

(3) Anxiety. During intercourse. Can be caused by negative/ traumatic experiences (i.e sexual child abuse) fear of unable to being able to perform.

(4) Cognitive interference. Thoughts the distract person from sexual experience. Will I be able to please her? Is my body beautiful enough to arouse him? STIs, relationship consequences. Spectatoring. One acts as a judge or observer of their own sexual performance- leads to sexual disorders.

(5) Distress/ Depression. Depressed individuals will experience low sexual desire; difficulty to become aroused.

(6) Behavioural and lifestyle factors. Can also affect sexual factors. Smoking, alcohol, obesity.

(7) Failure to engage in effective sexually stimulating behaviour. Can be due to ignorance, myths, misinformation, poor technique due to poor communication (partners expect each other to read each other minds).

(8) Relationship Distress. Disturbance in couple’s relationship, another leading causes of sexual disorders.

PREDISPOSING FACTORS

First traumatic sexual experience or sexual child abuse, negative communication about se in a family; children punished for masturbating.

Combined Cognitive/ Physiological Factors can be used to remedy these problems.

THERAPIES FOR SEUXAL DISORDERS

BEHAVIOUR THERAPY. Assumes the sexual problems are learned and maintained by reinforcements. Many people view sex as achievement and it can failed. Used by MASTER AND JOHNSON . Sensate focus exercise. Part of sex therapy in which partner caresses other parents and tell them what is pleasurable, there are no demands. Couple also educated on simple biological and physiological aspects of sex.

COGNITIVE-BEHAVIOURAL THERAPY. A form of therapy that combines behaviour therapy and restricting of negative thought pattern. Therapist will help client identify their negative thoughts and restructure them to positive.

COUPLE THERAPY. Help to fix poor communication and distress that are the maintaining factors for sexual disorders. As sexual relationship improves, the sex problem improves.

SPECFIC TREATMENTS FOR SPECIFIC PROBLEMS. (1) Stop-Start Treatment. Stop-start technique used in treatment of rapid ejaculation. Women stimulates male to erection and then stops; then return to stimulating. (2) Masturbation. Most effective form of therapy for women with primary orgasmic disorder is a program of directed masturbation. Sometimes recommended as therapy for men. (3) Kegel Exercises. Part of sex therapy for women with orgasmic disorder, woman exercises the muscle surrounding the vagina. Strengthen pubococcygeal (PC) muscle- controls the start/stop of urine. Allow a woman to grip her partner’s penis tighter. (4) Bibliotherapy. Use of self-help book to treat a disorder.

BIOMEDICAL THERAPIES. (1) Drugs. Use of drugs alone with cognitive-behavioural therapy. (i.e Viagra; erection disorder. Taken approx 1hr before sex, and helps to facilitate erection, doesn’t cause it. Side effects are uncommon, quite safe. Or Cialis, relaxes smooth muscles, facilitates engorgement. Or Levitra. Different formulation of Viagra. None negatively affect sperm production or sex hormone production. All of them act peripherally. Act on sites around penis.. Other drugs like Uprima, increase dopoamine production in brain. Viagra causes vasocongestion in women but doesn’t aid in promoting orgasms..women’s lack of orgasm usually is not physiological.(2) Intracavernosal Injection for Erectile Disorder. (ICI). Treatment for erectile disorders, inject drug into copora cavernosa of the penis. (vasodilators). Used as backup for men who don’t response to Viagra; help improves men’s confidence, reduces anxiety. But can cause priapism, prolonged erection that won’t go away. (4) Vacuum Pump. Tube placed over penis and produces enough suction draw blood to penis and cause erection. Then place band around base of penis to maintain engorgement. (5) Surgical Therapy. Surgery can help women with some types of dyspareunia. Proesthesis. Surgical treatment for erectile dysfunction, inflatable tubes are inserted into the penis. Man can pump his penis up.

Is sex therapy actually effective? No defined success rate. How do you count a person as successful? Rapid relapse rates in therapy, individuals often don’t have straight problems…lack controlled studies.  Adequate research has not been done into medication/ therapy. There is a trend of medicalize sexual disorders which neglects the individual’s need for psychological treatment.

FACTS:

1) Primary orgasmic dysfunction successfully treated with direct masturbation; secondary orgasmic..not so well

2) Vaginimus successful treated with progressive vaginal dilators

3) Squeeze technique is effective for treating premature ejaculation

AVOIDING SEXUAL DISORDERS:

Communicate with your partner

Concentrate on giving and receiving pleasure

Relax and enjoy yourself

Be choosy about the situation in which you have sex

Accept that disappointment will occur.

**No provinces have licensing or certification requirements to practise sex therapy.

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