Chapter 15: Sexual Problems & Therapy

1. Chapter 15: Sexual Problems & Therapy For use with Human Sexuality Today (4th Ed.) Bruce King Slides prepared by: Traci Craig

2. Chapter Overview • Individual Differences • Sexual Therapy • Sexual Therapy Techniques • Sexual Problems • Male Sexual Problems • Female Sexual Problems • Avoiding Problems

3. Individual Differences • Different Expectations • Women seek affection and want to know what their partner thinks. • Men engage in sex because of their partner’s looks, body, and sexual attraction. • Men are goal(orgasm) directed; women pleasure directed • Menintimacy=sex • Women want men to take more time

4. Different Assumptions • Different initial experiences can lead to incorrect assumptions • Men take 2-3 minutes to reach orgasm during masturbation; women take longer. • Presuming that what feels good for you will feel good for your partner, may not be the best assumption. • Vigorous vs. gentle indirect stimulation.

5. Differences in Desire • Frequency perceived differently • Match is more important than absolute numbers • 3 X a week is fine if a couple feels it’s not more or less than they want • The same holds for 3 X a day and 3 X a year • Desire for sex varies within individual • Stress, fatigue can decrease desire

6. Differences in Preferred Behavior • Couple members may want to engage in different behaviors than their partner. • It does not mean that someone is perverted and/or the other is inhibited/repressed. • The problem is at the couple level. • Don’t play the blame game • Communicate about sex honestly

7. Sexual Therapy • Check credentials of therapists • Individuals who feel stress, anxiety, and it interferes with the ability to have a relationshiptherapy may help • Sex therapists do not have sex with clients. • Psychoanalysislong term treatment, cure via resolving childhood conflicts

8. Sexual Therapy • Cognitive-behavioral Therapy—focuses on behavioral problems, work with couples, effective for erectile and orgasmic problems. • Psychosexual Therapy—provide insight into historical cause, effective for low desire or aversion problems.

9. Sexual Therapy • Medical model—organic cause, treat with medication/surgery • PLISSIT model—permission, limited information, specific suggestion, and intensive therapy • Most people do not require the last step

10. Sexual Therapy Techniques • Medical History • Circulatory, hormone, CNS, alcohol/drug abuse, prescription interaction problems • Sexual History • Detailed, with coupleseveryone is involved • Systematic Desensitization—reduce anxiety • Self-awareness/masturbation—erotica/masturbation techniques

11. Sexual Therapy Techniques • Sensate Focusnondemand mutual pleasuring techniques • Sensate focus exercises reduce anxiety and teach mutual pleasuring • nongenital touching in nondemanding situations • Sexual surrogatesallows sensate focus experience for those without partners

12. Sexual Problems: Men & Women • Hypoactive sexual desire • Most common problem of couples • 33% of women and 15% of men • 20% of couples have a nonsexual marriage (less than 10 times per year) • Sex Drive, Sexual Wish, Sexual Motivation • Absence of sexual fantasies and desire, decreased arousal to stimuli

13. Sexual Aversion • Extreme Hypoactive Sexual Desire • Sexanxiety • Primary hypoactive sexual desire is more common in women than men • Secondary hypoactive sexual desire is often organic or past trauma • Negative sexual schemas • Relationship problems

14. Hypersexuality • APA does not recognize this as a problem. • WHOexcessive sexual drive • Sexual addiction • Behavior produces pleasure and allows escape, recurrent failure to control behavior and continuation of the behavior in spite of harmful consequences.

15. Hypersexuality • Sexual Compulsion—lack sexual control • Engage in sex to reduce anxiety/distress • Little or no emotional satisfaction • Paraphilic and nonparaphilic • Promiscuous behavior—interferes with normal daily living • Intimacy dysfunction in childhood

16. Painful Intercourse • Dyspareunia—Physical problem • More common in women. • Infections, phimosis, lack of lubrication, allergy to semen • Menerectile problems; Womenvaginismus • Painsomething physically wrong

17. Male Sexual Problems • Erectile disorder—inability to get or maintain an erection. • Primaryalways been a problem • Secondarynew problem • Global in all situations • Situationalspecific situation • Psychologically upsetting to men & women • Happens occasionally to almost all men

18. Erectile Dysfunction • Fatigue, stress, alcohol, drugs • APApersistent or recurrent and causes distress or interpersonal difficulty • Medical approachdrugs, devices, injections, implants • Not always ‘cures’psychological treatment may have better long term outcomes

19. Erectile Dysfunction • Performance anxiety is the most common psychological cause. • Life changeunemployment • Spectatoringobserving and evaluating one’s own responses, vicious cycle • Sensate focus and ‘teasing’ procedure • Wives can also be affected.

20. Premature Ejaculation • 30% of men report problem in past year • Absence of reasonable voluntary control • Early experiences involve rushing • Squeeze technique • Stop-start • Also useful for men who many not meet the definition, but wish to last longer and learn to control ejaculation.

21. Male Orgasmic Disorder • Difficulty reaching orgasm and ejaculating in a woman's vagina • Ejaculatory incompetence • Psychological—strict religious upbringing, fear of pregnancy, negativity/hostility toward partner, maternal dominance • Bridge maneuver • Let partners know what is arousing

22. Headaches After Orgasm • Benign coital cephalalgia • Exertion headaches • High blood pressure • Not a stroke or sign of serious problem • Contractions of scalp muscles and increased blood flow to the head, neck, and upper body.

23. Priapism • Long lasting erection (sometimes days) • Damage to valves regulating blood flow • Tumors, infection, chemical irritants • No desire for sex • Painful, inconvenient • Beta-agonist drug terbutaline is effective

24. Female Sexual Problems • Vaginismus—involuntary contractions of the vaginal muscles in the outer third of the vagina. Quite painful • Men attempting to penetrate will feel as though the penis is hitting a wall • Psychologicalanxieties, negative first experiences, religious upbringing, hostility or fear of men

25. Vaginismus • Treatment • Relaxation exercises • Systematic desensitization by gradual dilation of the vagina • Success rate approaches 100% • Traumas may require additional psychotherapy

26. Female Orgasmic Disorder • Problems reaching orgasm • Primary/absolute—never had an orgasm • Secondary—was orgasmic but not now • Situational—able to orgasm during masturbation but not intercourse. • Enjoy sex overall • Sufficient stimulation from partner?

27. Female Orgasmic Disorder • Women take longer to reach orgasm than men • Clitoral stimulation is often necessary • Associated with less education and more negative sexual attitudes and/or guilt • Women given less sexual freedom • Older women are more orgasmic than younger women (probably due to increased assertiveness)

28. Female Orgasmic Disorder • Sex may not be very ‘feminine’—sweating, odor, grimacing, noises ‘let go’ • Self awareness can help • Reduce performance anxiety—do not have expectations for orgasm every time • EROS-CTD—suction cup for the clitoris • Importance of Relationship Quality

29. Avoiding Sexual Problems • Open honest lines of communication with partners • Sexually healthy persons choose what they want to do • Sexual health begins in childhood with positive attitudes about one’s own body and sexuality