Lecture Notes
Chapter 19 Sexual Disorders and Sex Therapy
Modified:
2006-07-18
What happens when sexual behavior is not possible? What effect does
that have on a person or couple? What are the main types of sexual
dysfunction? How can dysfunction be addressed through therapy? These
are some of the questions looked at in this section.
- Kinds of Sexual Disorders
- Male disorders
- Erectile Dysfunction
- formerly called impotence
- defined as inability to achieve erection during
intercourse
- Primary--rare
- Secondary--common
- Organic
- 10-20% of cases
- diabetes and other causes
- test by looking for nocturnal erections
- Therapy
- Drug therapy
- Viagra (sildenafil citrate)
- Cialis (tadalafil)
- Masters and Johnson use sensate focus (see
below)
- Premature Ejaculation
- Definitions
- Masters and Johnson--based on female orgasm
(problem)
- Kaplan--lack of voluntary control once high level
of arousal occurs
- Sociobiology of premature ejaculation
- monkey data
- premature ejaculation does not lower reproductive
success
- Therapy
- Masters and Johnson--squeeze technique
- Male Orgasmic Disorder
- inability to achieve orgasm during intercourse
- frustrating to both partners
- relatively rare
- Female Disorders
- Female Orgasmic Disorder
- inability to achieve orgasm during intercourse
- Primary (or pre-orgasmic)
- related to social issues
- self control
- lack of abandonment
- double standard
- Secondary
- Therapy
- values clarification
- pleasure is good
- permission to enjoy sex
- arousal techniques taught
- Kegel exercises
- vibrators
- systematic desensitization
- Female Sexual Arousal Disorder
- lack of response to sexual stimulation
- can be physical or subjective
- Painful Intercourse (dyspareunia)
- more females than males
- very common during first intercourse for females
- Vaginismus
- spastic contraction of outer third of vagina
- can prevent intercourse or cause painful
intercourse
- Disorders of Sexual Desire (hypoactive sexual desire)
- hard to define
- lack of normal interest in sexual topics
- also, discrepancy in sexual desire in a couple
- What Causes Sexual Disorders?
- Physical Causes
- organic factors are responsible for a minority of
cases
- Drugs
- Psychological Causes
- immediate
- anxiety
- fear of failure
- cognitive interference
- spectatoring
- failure to communicate
- failure to engage in effective sexually stimulating
behavior
- prior learning
- trauma associated with sexual behavior
- parental seductive behavior
- strict family upbringing
- punishment for sexual activity
- double standard
- Interpersonal Factors
- anger or resentment with partner
- sex as weapon
- intimacy problems
- Therapies for Sexual Disorders
- Insight therapy
- not good in terms of results
- insight is gained by no behavior change
- case histories
- Masters and Johnson
- couples only
- prohibit sexual contact at first
- teach "sensate focus"
- four way discussion
- high claimed cure rate
- their techniques have been widely adopted (see couple
therapy)
- Behavioral therapy
- based on learning theory
- Wolpe's systematic desentization technique (i.e., female
primary orgasmic disorder)
- works because sexual behavior is learned
- Cognitive behavioral therapy
- Couple therapy
- focus is on couple
- collection of therapies from many sources
- Specific techniques
- stop-start
- masturbation
- Kegel exercises
- Biomedical techniques
- drug treatments
- intracavernosal injection
- urethral insert
- suction devices
- surgically attached pump
- Practical Advice
- communicate
- don't spectate
- don't set goals
- discriminate as to ocassions for sex
- realize that failures will occur
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