Dealing with Sexual Difficulties: Desire, Excitement, Orgasm, and Painful Intercourse

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2. Sexual difficulties

3. Coming Attractions! • Dealing with sexual difficulties related to • Desire phase • Excitement phase • Orgasm phase • Painful intercourse

4. Sally has no interest in sex, never fantasizes, and never initiates sex. • What questions would you ask her?

5. Janet feels sick to her stomach, sweats profusely, and has to go to the bathroom when partner asks about having sex. • She feels sex is gross, and disgusting, and also has a fear of penetration. • Diagnosis? • Treatment?

6. Bill has trouble getting an erection when his wife wants to make love. • What questions would you ask him? • How would you separate psychological ED from Physiological ED? • How would you determine if it is primary, secondary, or situational ED.

7. Jim had ED once, now he does not want to have sex, and avoids his wife’s desire for intimacy. • What is the problem? • Treatment?

8. Vanessa has had two children, and gained some weight after the pregnancies. Now, she just wants her husband to “do what you need to”. • Diagnosis? • Comments or questions for the couple?

9. Even with little foreplay Jeff ejaculates within about 30 seconds after penetration. • Diagnosis? • Questions to ask to determine the cause? • Suggested treatments?

10. Josh can only last 5-10 minutes after penetration before ejaculating. • Diagnosis? • Treatment?

11. , Twee has never been able to climax with self stimulation or a partner. • Diagnosis? • Questions you may ask?

12. Than has been able to climax in the past, but can not climax now since she moved to her new job. • Diagnosis?

13. Eve found she can climax in a motel room, but can not climax ht home. • Diagnosis? • Treatment?

14. Dianna found that she can climax with oral sex and masturbation, with not with “real sex”. • Diagnosis? • Treatment?

15. Michael has noticed the head of his penis hurts during sex. • Diagnosis • Treatment?

16. Sarah complained that sex was painful “deep inside”, and lubrication did not seem to help. • What questions would you ask? • Diagnosis? • Treatment?

17. Janet complained that intercourse was painful just as he was entering. • Questions? • Diagnosis? • Treatment?

18. Lucy complained of pain with intercourse which began over the last five years since she turned 48 years old. • Questions? • Diagnosis? • Treatment?

19. Sam complains of pain in his penis with erection, and particularly if it is bent up or down, or side to side? • Diagnosis? • Treatment?

20. Sexual problems are common • Causes • Organic • Cultural • Individual • Relationship

21. Most commonly reported sexual problems • By men • Erectile dysfunction • By women • Inability to climax • Lack of sexual desire

22. Medications related to sexual problems • High blood pressure medications • Depression & antipsychotics • Barbiturates and narcotics

23. Emotional difficulties producing negative affects on sexuality • Depression • Extreme work stress • Fear of intimacy

24. Types of sexual disorders (summary) • Desire Phase • Excitement phase • Orgasm phase

25. Desire phase • Hypoactive sexual desire • Related to: • Lack of trust • Lack of power and control • Imbalance in independence and dependence • Never fantasizes, rarely masturbates, never initiates sex • Sexual aversion disorder (SAD) • Physiological symptoms • Nausea • Sweating • Diarrhea • Irrationally fearful • Feel disgusted or repulsed by sexual activity

26. Excitement phase • Erectile dysfunction • Most likely to be physiologically based (have an organic component) • Viagra • http://www.goaskalice.columbia.edu/1445.html • Primary • Secondary • Situational

27. Erectile dysfunction (ED) cont. • As many as 25% of cases are related to medication side effects • Tobacco appears to be one causative factor • Age - A man is 50’s = twice as likely to experience ED as a man in his 20’s

28. Performance anxiety • Can turn a transitory problem into a serious one

29. Sexual self confidence • Women who are leastself-conscious about their bodies as compared to similarly shaped women were more assertive with their partners

30. Orgasm phase - Men • Men • Premature ejaculation • Squeeze technique • Ejaculatory inhibition • Merc manual • http://www.merck.com/pubs/mmanual/section17/chapter220/220a.htm

31. Orgasm phase - Women • Orgasmic disorder (preorgasmic) • Primary • Secondary • Situational • E.g. Orgasm with masturbation, but not with oral sex • Orgasmic with manual stimulation, but not with intercourse is typical, not a sexual dysfunction

32. Dyspareunia (For women) • Painful intercourse • Vaginismus • Hegar dilators • Merc Manual • http://www.merck.com/pubs/mmanual/section18/chapter243/243e.htm • Smegma • Smegma collecting under the clitoral hood may cause discomfort when hood is moved during sexual stimulation

33. Dyspareunia (For men) • Phimosis - tight foreskin • Infected or irritated foreskin • Peyronie’s disease - Fibroses in penis • Pelvic or genital infections • E.g. STD’s

34. Deep pelvic pain in women during intercourse • Caused by • Jarring of ovaries • Stretching of uterine ligaments • Endometrioses • STD’s

35. Average duration of intercourse for American couples • Five to ten minutes