Lec 15 - Problems

• Sexual Problems


  • More common in women than men
  • Almost every problem increases with age (except early ejaculation)
  • Most people don't seek help
• An understudied area is sexual problems in young people
• Sexual problems research is very gendered, heteronormative
• Sexual dysfunction


  • A persistent or recurring lack of sexual desire or difficulty becoming sexually aroused or reaching orgasm
  • May experience guilt, shame, frustration, depression or anxiety
  • May be difficult to talk about with partners, friends, health professionals
  • Lack of information a critical issue

  
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5)


  • Categorizes sexual dysfunction
  • Must have occurred for a period of 6 months or more
  • Happen 75 to 100% of the time
  • Cause significant distress
  • Categorized as lifelong or acquired
  • Categorized as generalized or situational
• Sexual Desire Disorders


  • Female sexual interest/arousal disorder
  • Male hypoactive sexual desire disorder
• Sexual Desire Disorders


  • Often report an absence of sexual thoughts or fantasies
  • May have no impact on sexual arousal or functioning
  • May enjoy sexual activity and experience orgasm
  • Desire discrepancy a major draw to therapy
  • May occur less commonly in same-gender relationships
  • Low testosterone, thyroid, epilepsy, anxiety and depression
• Sexual Aversion Disorder


  • Repelled by genital contact, drugs may be necessary
  • Sometimes treated with testosterone, often psychotherapy
• Erectile Disorder


  • Persistent difficulty in achieving or maintaining an erection sufficient to allow the completion of sexual activity
  • Mostly limited to activity with partners (thus situational)
  • Occasional problems are common (e.g., stress, alcohol)
  • Performance anxiety can worsen the concern
  • Affects ½ men 40-70
  • Believed physical causes 80%
  • Common causes are diabetes, alcohol, smoking, performance anxiety
• Sensate focus


  Stimulate to arousal but not ejaculation repeatedly so erection loss is not feared
• Treatment for men with Erectile Disorder

  • Surgery (open up blood vessels or insert implant)
  • Medication (injections or oral)
  • Pumps
• Female Sexual Interest/Arousal Disorder

  • Merged with desire problems
  • Difficulty becoming sexually excited or sufficiently lubricated in response to sexual stimulation
  • Sometimes lifelong, and alone and with partners – but mostly situational
  • Check for hormonal, neurological, or vascular problem but more often psychological/relational
  • May be associated with history of abuse
• Sensate focus


  Stimulate to arousal, focus on sensations to become aware of arousal
• Treatment for women with Female Sexual Interest/Arousal Disorder


  Eros pump, drugs (less effective to date)
• Orgasmic Disorders


  • Male Orgasmic Disorder – delayed orgasm
  • Premature Ejaculation – early or rapid ejaculation
  • Female Orgasmic Disorder – delayed orgasm
• Male Orgasmic Disorder


  • Lifelong or acquired, situational or generalized
  • Not taken seriously by some but very difficult to deal with
  • Side effect of drugs, neurological problem, guilt, resentment
• Treatment for Male Orgasmic Disorder

  Increasing stimulation and decreasing performance anxiety
• Premature Ejaculation


  • Early or rapid ejaculation – too quickly to permit they or their partners to fully enjoy sexual relations
  • Treated with squeeze technique, stop-start technique
• Female Orgasmic Disorder


  • If never experienced, labelled anorgasmia
  • Difficulty reaching orgasm with "adequate sexual stimulation"
  • Not a disorder if only never during intercourse
• Treatment for Female Orgasmic Disorder

  Education and masturbation
• Genito-Pelvic Pain/Penetration Disorder


  • Mostly experienced by women, half don't seek treatment
  • Location of pain can vary
  • Can be a sign that something is physically wrong – or inadequate lubrication
• Dyspareunia


  One of most common sexual dysfunctions and reasons why females seek treatment
• Vaginismus


  • Involuntary muscle spasm, fear of pain
  • Treated for infection, or dilators
• Vulvodynia


  • Intense vulvar pain, burning, irritation, soreness
  • Often no identifiable cause (nerve damage? Allergies?)
  • Cold compresses, local anaesthetics applied, estrogen or cortisone cream
• Sexual problems in males


  Less common, usually associated with infections
• How much desire is "normal"?
• When is lack of desire a dysfunction? Or a relationship problem? Or a partner's problem
• Imposes male model of "normal"
• How fast an ejaculation is premature?
• Reaction to the "medicalization" of sexuality
• So many things can feel better with information
• What's in the "normal range"?
• What techniques can be used to improve sex?
• Letting go of societal or gender norms
• Sexual problems (and their prevention/care) among transgender persons

  • Gender-affirming treatment can impact sexual desire and functioning
  • Can enhance body satisfaction
  • Surgery can be hugely helpful but also there is a recovery process and sometimes complications
  • Hormone treatment, physiotherapy, therapy can be helpful
  • Still adjustments related to physical body and social aspects of changed gender
  • Better body image is associated with sexual functioning and sexual satisfaction for everyone
  • Not feeling at home in your own body, not being able to be authentically yourself, can lead to the experience of sexual problems (but like with all of the other things discussed – to what degree are these sexual "problems" or sexual symptoms?)

  
• From the perspective that sexual exploration and experiences are a key developmental task for all young people
• Sex Therapy


  • Most common is cognitive behavioral, often draws on mindfulness
  • Attempts to change self-defeating beliefs and attitudes, teach skills, enhance knowledge, improve communication, reduce performance anxiety
• Sex Therapy Approaches


  • PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy)
  • Masters and Johnson (Behavioral change is the focus, Daily sexual homework assignments, Sensate focus exercises)
• Better Sex Through Mindfulness


  • 8 week program developed by Lori Brotto for women – but has been adapted for other populations
  • Psychoeducation (anatomy, arousal, myth busting)
  • Homework (mindfulness during daily activities)
  • Cognitive behavioral therapy approaches (the power of thoughts)
  • Mindfulness meditations
  • Body scans
  • Exploring pleasure and sexual tools
  • Planning for maintenance of practice
• Medications for sexual problems

  • For sexual desire – these have not been successful (Viagra, Addyi)
  • For erectile difficulties – drugs have been very successful (Viagra, Cialis)