SEXUAL DYSFUNCTION

1. SEXUAL DYSFUNCTION • When a person is frequently unable to experience a normal sexual response, leading to frustration and distress • Normal: majority in their reference group. Vast cultural differences • Not all “experts” agree. Historical changes. e.g.: clitoral orgasm only, not vaginal • e.g. Victoria era: women who experienced orgasm with their husbands were “sluts”

2. Historical (Individual) Context • religion • trauma (abuse, assault, etc.) • homosexual experience • alcohol and drug use • sociocultural factors • stress • performance anxiety

3. Women – 43% Men – 30% Young Women: mostly psychosocial Old Men: mostly organic Types of dysfunction: • Erectile dysfunction (“impotence”): can be primary or secondary • premature ejaculation – 29% • male orgasmic disorder (its opposite)

4. Types: (Cont’d) • female orgasmic disorder (primary and secondary) – 25-35% • arousal disorder (menopause) • dyspareunia: painful intercourse • vaginismus: spasms of the vagina, making penetration impossible • vulvodynia: chronic irritation, burning, soreness of the vulva, without contact • vulvarvestibulitis: pain inside labia minora, introitus – by contact (penis, tampon, toy)

5. Types: (Cont’d) • hypoactive sexual desire: little interest in sex • males: 16% • females: 33% • sexual aversion disorder • males: 8% • females: 21%

6. Organic Causes of Erectile Disorder: • circulatory problems • heart disease • diabetes (38%) • medications (e.g., for hypertension) • alcohol, short and long term • recreational drugs

7. Some causes of painful intercourse or dyspareunia – women:14-15% (vs. males 3%) • introitus scars • vaginal infections • STDs • allergies (e.g. latex, spermicides) • low estrogen • hysterectomy • uterine or vaginal prolapse

8. Some causes of painful intercourse or dyspareunia – women:14-15% (vs. males 3%) • cancer • PID (pelvic inflammatory disease) • endometriosis • cysts • insufficient lubrication • not enough foreplay

9. Some psychological causes: • anxiety • fear of sex • fear of failure • inability to let go (cognitive) • spectatoring • interpersonal problems • depression: interferes with sexual desire and orgasmic capacity • antidepressants: ditto

10. performance anxiety • spectatoring • poor communication • prior learning, conditioning, experience, e.g., rapid masturbation, punishment, sexual abuse, rape, witnessing something disturbing (childhood) • double standard • relationship dissatisfaction • problems with sexual orientation • stress • anxiety (pregnancy, body image, smells, loss of control, injury, being judged, rejection, consequences for relationship, STDs, being heard/seen, etc.)

11. Biological factors: • testosterone deficiencies – very difficult to establish individual optimal levels • hyper or hypothyroidism • temporal lobe epilepsy • circulatory system pathology • neurological problems • Multiple Sclerosis (leads to male orgasmic disorder) • inadequate lubrication (leads to dyspareunia) • vaginal infections (leads to dyspareunia) • STDs (leads to dyspareunia) • prolapsed uterus (ditto) • cervical cancer (ditto)

12. Biological factors (Cont’d): • endometriosis and PID (ditto) • diabetes • spinal cord injuries • antihypertension drugs • kidney disease • emphysema

13. Common Drugs that affect sexual response: • antidepressants • antipsychotics • tranquilizers • alcohol • heroin • morphine • cocaine • marijuana

14. Therapies: • behavioural • cognitive restructuring • couple therapy Other: • stop-start technique (for premature ejaculation) • numbing spray on penis • yoga technique: kundalini • masturbation (for female orgasmic disorder) • Kegel exercises (PC muscle)

15. Medical Treatments: • Viagra, other drugs • inject vasodilators in corpora • surgery, prosthesis Masters and Johnson’s Sex Therapy: • acceptance of mutual responsibility • sexual dysfunction a couple’s problem • no blame attached • elimination of performance demands and anxiety • sexual intercourse prohibited during the therapy

16. Masters and Johnson’s Sex Therapy: (Cont’d) • education • elements of anatomy and physiology • attitude change • increasing communication • sensate focus exercises: concentrating on pleasuring one small part of the body at a time • prescribing and practicingchanges in behaviour

17. Therapeutic steps for anorgasmic women: (women who can’t have orgasms) • Education, information • Self exploration • Kegels • Self-touching and self-stimulation. Masturbation • Assertive thoughts, giving self permission • Use of fantasy, books, video, audiotapes • Focus on sensations, not on goal • Bring in partner. Nondemanding sensate focus exercises – no intercourse • Partner stimulates women manually or orally to orgasm following her directions • Intercourse when she is ready

18. Biological treatments for erectile dysfunction: • Surgery: to unblock vessels that supply blood to penis • Hormones: testosterone, if abnormally low (men and women) MIGHT help • Injections: muscle relaxants, into corpus cavernosum. Allows blood vessel muscles to relax and blood flows in • Suppositories: muscle relaxant into penis • Vacuum pump: increases blood flow into penis • Penile implants: permanent

19. Biological treatments for erectile dysfunction: (Cont’d) • Pills: • Viagra (sildenafil) • Vasomax (phentolamine) relax blood vessel muscles • Spontane (apomorphine) works at brain level to trigger erection • Cialis (tadalafil)

20. Biological treatments for erectile dysfunction: (Cont’d) • Side effects of Viagra (dose dependent): • headaches • flushing • indigestion • nasal congestion • visual distortions • drug interactions • dizziness • eye pain • hearing loss • allergic reactions • Vasomax fewer side effects (?) • must be bought by prescription, due to danger of heart attacks.

21. Appendix

28. A more recent approach, not involving medical intervention: Researchers interviewed couples who have great sex to glean what factors were important. • being present: totally immersed and intensely focused, no distracting thoughts, surrender to the moment • authenticity: free to be themselves, open about what they wanted, totally uninhibited • intense emotional connection: regardless of duration of relationship, powerful sense of intimacy throughout the sexual encounter • communication, expressing their pleasure, verbalizing what they want • transcendence: some people experience an altered state of consciousness Some yogic traditions enable these characteristics (kundalini)