Chapter 16 1) Sexual Dysfunctions: a set of disorders in which people have trouble engaging in and enjoying sexual relationships with other people A. Sexual response Cycle: 5 phases 1. Sexual Desire: the urge to engage in any type of sexual activity 2.Arousal Phase: excitement phase consists of a psychological experience of arousal and pleasure and the physiological changes knows as a) Vasocongestion: filling of the blood vessels and tissues with blood also known as engorgement or erection b) Myotonia: is muscular tension many muscles in the body may become more tense culminating in the muscular contraction known as orgasm 3.Plateau Phase: excitement remains at a high but stable level arousal and plateau phases are followed by orgasm. 4. Orgasm a)Refractory Phase: follows ejaculation the male annot achieve full erection and another orgasm. 5.Resolution: state of deep relaxation. a) Differences between male and female response patters is that there is greater variability in the female response pattern than in the male response pattern and men have a refractory period unlike women and their refractory period increases with age. To be diagnosed with a sexual dysfunction the difficulty must be more than occasional and it must cause significant or interpersonal difficulty. B. Sexual Desire Disorder: sexual desire is basically how much you want to have sex, lack of sexual desire is the most common complaint people have when seeking sex therapy 1. Hypoactive Sexual Desire Disorder: have little desire for sex they do not fantasize about sex or initiate sexual activity and this lack of sexual desire causes them distress or interpersonal difficulty. a) When you have pain during intercourse or an inability to have an orgasm, diagnosis a person receives focuses on the primary dysfunction rather than on the lack of desire. b) Generalized sexual desire disorder: a person who has little desire for sexual activity most of his or her life c) Situational sexual desire disorder: a person who lacks the desire to have sex with his or her partner but has sexual fantasies about other people. d) Sexual Aversion Disorder: they do not simply have a passive lack of interest in sex they actively avoid sexual activities when they engage in sex they may feel sickened by it or experience acute anxiety. C. Sexual Arousal Disorder: do not experience the physiological changes that make up the excitement or arousal phase of the sexual response cycle. 1. Female sexual arousal disorder: involves a recurrent inability to attain or maintain the swelling lubrication response of sexual excitement. 2. Male erectile disorder: inability to attain or maintain an erection until the completion of sexual activity. D. Orgasmic Disorders: 1. Female Orgasmic Disorder: or anargasmia experience a recurrent delay in or the complete absence of orgasm after having reached the excitement phase of the sexual response cycle. 2. Premature ejaculation: men who have this disorder persistently ejaculate with minimal sexual stimulation before they wish to ejaculate 3. Male Orgasmic Disorder: experience a recurrent delay in or the absence of orgasm following the excitement phase of the sexual response cycle. In most cases a man cannot ejaculate during intercourse. E. Sexual Pain Disorder 1. Dyspareunia: a genital pain associated with intercourse 2.Vafinismus: occurs only in women involved the involuntary contraction of the muscles surrounding the outer third of the vagina the spasms close the vagina making sex impossible. F. Causes of Sexual Dysfunctions: most common cause of one sexual dysfunction is another sexual dysfunction 1. Biological Causes: many medial illnesses can causes problems in sexual functioning in both men and women one of the most common contributor to sexual dysfunction is diabetes. Also cardiovascular disease multiple sclerosis and renal failure may also contribute. 2. Sexual dysfunction may be psychological response to the presence of disease (ex: a man who had a heart attack might fear having sex because he thinks he will have another) 3. Abnormally low levels of androgen (men) and high levels of estrogen and prolactin (women) can cause sexual dysfunction. 4. Hormones may have an indirect effect on sexual desire by affecting sexual arousal. a) Low levels of estrogen can cause decreases in vascongestion and vaginal lubrication. 5. Several prescription drugs can diminish sexual drive and arousal and interfere with orgasm including antihypertensive drugs, lithium and antipsychotic drugs. 6.Many recreational drugs including marijuana cocaine and nicotine can impair sexual function. 7. Substance induced sexual dysfunction: when a sexual dysfunction is caused by substance abuse. a) If a man is having nocturnal erection then changes are that his erectile problems have psychological origins. 8. Psychological Causes: our emotional well being and our belief and attitudes about sex greatly influence our sexuality. a) Psychological disorders: a number of psychological disorders can cause sexual dysfunction loss of sexual functioning is a common symptom in depression. b) People with anxiety disorders usually have sexual desire and functioning warnings this is very common with people with schizophrenia. 9. Attitudes and Cognitions: people who have been taught that sex is dirty or sinful may lack the desire to have sex they may also known so little about their bodies that they don?t know how to make sex pleasurable. a) Performance anxiety : people worry so much about whether they are going to be aroused and have orgasms that this worry interferes with sexual functioning. b) Being anxious and spectatoring distracts from sexual pleasure and interferes with sexual functioning. 10. Relationship problems: can cause sexual dysfunction a) Anoregasmia can be tied to lack of communication b) Anger distrust and lack of respect for ones partner can greater interfere with sexual desire. 11. Trauma: reduction in sexual desire and function often follow personal traumas. ( sexual Assault) 12. Cross-Cultural Differences: In India teach that loss of semen in detrimental to a mans health masturbation is strongly discouraged. a)In the US less educated and poorer men and women tend to experience more sexual dysfunction. G. Trends Across Life Span 1. Age related biological changes can affect sexual functioning adequate levels of testosterone are necessary for sexual desire in both men and women testosterone levels beginning to decline in 50?s for men. Diminished postmenopausal women can lead to vaginal dryness. 2.Treatments For Sexual Dysfunction a) Biological Therapies: 1. Medical Conditions that causes dysfunction can be treated. If medications are contributed to sexual dysfunction adjusting the dosage etc. 2. Stop using recreational drugs 3. Biological treatments with men with male erectile disorder: Viagra or Yohimbine 4. Antidepressant Trazadone and apomorphine affects dopamine levels 5. SSRI can cause sexual dysfunction (selective serotonin reuptake inhibitors) Bupropion appears to reduce the sexual side effects of SSRI and can be effective as an antidepressant on its own. 6.For men suffering from premature ejaculation antidepressants can be helpful 7.Hormone Therapy: use of testosterone increases sexual desire and help with hypoactive sexual desire disorder. 8. Psycotherapy: a. Individual and couples Therapy: set aside enough time so that they can engage in seduction rituals and satisfying sexual encounters. b. Scripts: expectations for sexual encounters 3. Sex Therapy: Designed to help individuals learn what their bodies for sexual satisfaction a. Sensate Focus Therapy: one partner is actively carrying out a set of exercises to stimulate the other partner while the other partner is a passive recipient. b. Stop and Start Technique and Squeeze Technique (for premature ejaculation) 1.Stop and Start Technique: where you stop stimulating yourself just before ejaculation he then relaxes and concentrates on the sensation in his body until his level of arousal declines 2.Squeeze Tech: Mans partner stimulates him to erection then applies a firm but gentle squeeze to his penis. c. Relaxation Technique (vaginismus) a women is taught to relax muscles at the opening of her vagina gradually she inserts larger dilators while practicing relaxation 4. Gay Lesbian and Bi: All sexual orientations deal with sexual dysfunction GLB may deal with homophobia which increases stress. The higher levels of mental health problems seem to be due to greater levels of stress in the lives of GLB a. Ego-dystonic homosexuality: the person did not want to be a homosexual 5.Many cultures have their own fold remedies for sexual dysfunction Couples therapy focuses on decreasing conflicts between couples over their sexual practices or other areas of their relationships Individual psychotherapy helps people recognize their sexual dysfunction and resolve these Paraphilas: Sexual Activity that involves 1) Nonhuman objects Fetishism: involves the use of inanimate objects which are the exclusive source of sexual arousal or gratification. Transvestism (form of fetishism) cross dressing in which heterosexual men dress in women?s clothing as their primary means of becoming sexual aroused. For some people fetishism are part of a larger pattern of atypical sexual behaviors including behaviors that have victims. 2) Non-consenting adults Voyeurism: secretly watching another person doing things in the nude must be repetitive over six months and be convulsive person being watched must be unaware. Exhibitionism: sexual gratification by exposing his or her genitals to involuntary observers Frotteurism: gains sexual gratification by rubbing against and fondling part of the body of nonconsenting person. 3) Suffering or humiliation of the person or the persons partner Sexual Sadism: A person gains sexual gratification by inflicting pain and humiliation on his or her sex partner Sexual Masochism: a person gains sexual gratification by suffering pain or humiliation during sex 4) Children Pedophila: sexual attracted to children and prefer to engage in sex with children rather than adults. Treatments of Paraphilia Aversion Therapy: extinguish sexual responses to objects or situations that a person finds arousing. A person might receive painful but harmless electric shock while viewing photos of what arouse him or her, Desensitization procedure may be used to reduce the persons anxiety about engaging in normal sexual encounters with other adults Cognitive Therapy: helps identify challenge and thought and situations that trigger their behavior Nonpredatory cognitive therapy: combines with behavioral therapy to help people learn more appropriate ways of approaching and interacting with people they find attractive. Gender Identity Disorder: Gender Identity: the perception of yourself as male or female it is a fundamental component of their self concept
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