Chapter Fourteen Sexual Dysfunctions and Sex Therapy

1. Chapter FourteenSexual Dysfunctions and Sex Therapy

2. Definitions of Sexual Dysfunctions - 1Table 15-1 Types of Sexual Dysfunctions in Women and Men

3. Definitions of Sexual Dysfunctions - 2 • Sexual Dysfunction: Impairment or difficulty that affects sexual functioning or produces sexual pain. • Medicalization of Sexual Dysfunctions: Emphasizes that sexual dysfunctions have a medical or biological basis rather than an emotional or relationship cause. • Sexual Disorder: Diagnosis that a disturbance in sexual desire or the psychophysiological components of one’s sexual response cycle cause significant distress and interpersonal difficulty.

4. Definitions of Sexual Dysfunctions - 3 • Lifelong Dysfunction/Primary Dysfunction: Sexual dysfunction that a person has always experienced. • Acquired Dysfunction/Secondary Dysfunction: Sexual dysfunction that a person is currently experiencing but has not always experienced. • Situational Dysfunction: Sexual dysfunction that occurs with one partner or in one situation only. • Generalized Dysfunction: Sexual dysfunction that occurs with all partners, contexts, and settings.

5. Causes and Contributing Factors in Sexual Dysfunctions - 1 • Organic Factors: Organic factors include physical illness, disease, or disability and its treatment. • Sociocultural Factors: In addition to physical or biological factors, sociocultural factors may also cause or contribute to sexual dysfunction. They include restrictive upbringing and religious training.

6. Causes and Contributing Factors in Sexual Dysfunctions - 2 • Psychological Factors • Child sexual abuse • Anxiety • Fear • Guilt • Depression and low self-esteem • Conflict concerning one’s sexual orientation • Relationship Factors: In some cases, relationship problems, such as anger, lack of trust, lack of intimacy, or lack of communication, can contribute to sexual dysfunctions.

7. Causes and Contributing Factors in Sexual Dysfunctions - 3 • Cognitive Factors Inadequate sex education can contribute to belief in such myths and to ignorance of sexual anatomy and physiology, which may also be related to sexual difficulties.

8. Causes and Contributing Factors in Sexual Dysfunctions - 4 • Personal Choices: Individual or Conjoint Therapy? Individuals might want their partners to become involved in the therapy for several reasons, including: • To prevent one partner from being identified as the “one with the problem,” • To explore relationship factors that may be contributing to the sexual problem, • To address the difficulties in dealing with the sexual problem.

9. Desire-Phase Dysfunctions • Hypoactive Sexual Desire Disorder: Persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts and/or desire for, or receptivity to, sexual activity, which causes personal distress. • Sexual Aversion Disorder: Persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner • Hyperactive Sexual Desire Disorder: Very high (hyperactive) sexual interest, which influences persons to behave as though they are driven to sexual expression and the pursuit of sex, which may have negative effects on the health, relationships, or career of the individual.

10. Arousal-Phase Dysfunctions - 1 • Sexual Arousal Disorder Female Sexual Arousal Disorder: Persistent or recurrent inability to attain or maintain sufficient sexual excitement or a lack of genital (lubrication/ swelling) or other somatic responses.

11. Arousal-Phase Dysfunctions - 2 • Sexual Arousal Disorder Male Erectile Disorder:Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection. Anxiety resulting from spectatoring may be a cause.

12. Orgasm-Phase Dysfunctions - 1 • Female Orgasmic Disorder: Persistent or recurrent difficulty, delay in, or absence of experiencing orgasm following sufficient stimulation and arousal. • Preorgasmia:Condition which implies that the woman will be able to achieve orgasm given sufficient context, stimulation, or training.

13. Orgasm-Phase Dysfunctions - 2 • Male Orgasmic Disorder • Inhibited Male Orgasm/Retarded Ejaculation/Male Orgasmic Disorder: Persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase. • Premature Ejaculation • Rapid Ejaculation/Premature Ejaculation: The persistent or recurrent onset of orgasm and ejaculation—with minimal sexual stimulation— before, on, or shortly after penetration.

14. Sexual Pain Dysfunctions • Dyspareunia: Recurrent or persistent genital pain associated with intercourse or attempts at sexual intercourse. • Peyronie’s disease: Curving or bending of the penis during erection/ • Urethritis: Inflammation of the urethra. • Vaginismus: Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration.

15. Approaches Used in Sex Therapy - 1 • Masters and Johnson’s Approach Treatment begins with assessment procedures, including a physical examination and interviews with therapists who took medical and personal histories. On the third day, the therapists met with the couple to discuss their assessment of the nature, extent, and origin of the sexual problem to recommend treatment procedures and to answer any questions.

16. Approaches Used in Sex Therapy - 2 • Kaplan’s Approach Assists the partners in achieving their sexual goals in as short a time as possible. Sessions are usually held once or twice a week while the partners continue to live at home. • The PLISSIT Model Approach Method of sex therapy that involves four treatment levels: • Permission • Limited information • Specific suggestions • Intensive therapy

17. Approaches Used in Sex Therapy - 3 • LoPiccolo’s Approach The three theoretical elements: • Systems theory • Integrated (physiological and psychological) planning • Sexual behavior patterns • The Cognitive Therapy Approach Method based on exploring more positive ways of viewing sex and sexuality to eliminate negative thoughts and attitudes about sex that interfere with sexual interest, pleasure, and performance.

18. Approaches Used in Sex Therapy - 4 • Cognitive Behavior Therapy Approaches Because positive sexual fantasies are associated with positive affect, general physiological arousal, and sexual arousal, cognitive behavior therapists encourage their use by asking the patient to deliberately identify arousing sexual fantasies.

19. Approaches Used in Sex Therapy - 5 • Sex Therapy Integration Move approach to sex therapy toward of integration of: • Biomedical factors • Couple functioning • Marital relationships • Broader social context (culture, history, and religion)

20. Approaches Used in Sex Therapy - 4 • Effectiveness of Sex Therapy Factors important in the effectiveness of sex therapy and the percentages of their contribution are: • The extra-therapeutic factor (40%) • The relationship factor (30%) • The placebo/hope/expectancy factor (15%) • The structure/model/technique factor(15%)

21. Approaches Used in Sex Therapy - 4 • Personal Choices: See a Male-Female Team or an Individual Therapist? Although many sex therapists recommend the dual-sex team approach, no studies have shown that this approach is more effective than individual male or female therapists.