When a person is frequently unable to experience a normal sexual response, leading to frustration
Normal: majority in their reference group. Vast cultural differences.
Not all "experts" agree. Historical changes. e.g.: clitoral orgasm only, not vaginal.
e.g. Victorian era: women who experienced orgasm with their husbands were "sluts".
Historical (Individual) Context
- trauma (abuse, assault, etc.)
- homosexual experience
- alcohol and drug use
- sociocultural factors
- performance anxiety
Women - 43%
Men - 30%
Young Women: mostly psychosocial
Old Men: mostly organic
- erectile: primary, secondary
- premature ejaculation - 29%
- male orgasmic disorder (its opposite)
- female orgasmic disorder (primary and secondary) - 25-35%
- arousal disorder (menopause)
- dyspareunia: painful intercourse
- vaginismus: spasms of the vagina, making penetration impossible
- hypoactive desire: little interest
- hypoactive sexual desire
- sexual aversion disorder
Organic Causes of Erectile Disorder:
- circulatory problems
- heart disease
- diabetes (38%)
- medications (e.g., for hypertension)
- alcohol, short and long term
- recreational drugs
Causes of Painful Intercourse (Women) or Dispareunia - 14-15% (vs. males 3%)
- introitus scars, infections, STDs
- vaginal infections, STDs, allergies, low estrogen, hysterectomy, uterine or vaginal prolapse, cancer
- PID, endometriosis, tumors, cysts
- fear of failure
- inability to let go (cognitive)
- interpersonal problems
Depression: interferes with sexual desire and orgasmic capacity.
Other psychological causes:
- performance anxiety
- poor communication
- prior learning, conditioning, experience e.g. rapid masturbation, punishment, sexual abuse, rape, witnessing something disturbing (childhood)
- double standard
- marital dissatisfaction
- problems with sexual orientation
- anxiety (pregnancy, body image, smells, loss of control, injury, being judged, rejection, consequences for relationship, STDs, being heard/seen, etc.)
- testosterone deficiencies - very difficult to establish individual optimal levels
- hyper or hypothyroidism
- temporal lobe epilepsy
- circulatory system pathology
- neurological problems
- other biological factors:
- 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)
- endometriosis and PID (ditto)
- spinal cord injuries
- antihypertension drugs
- kidney disease
Common Drugs that affect sexual response:
- cognitive restructuring
- couple therapy
- Stop-Start (for premature ejaculation)
- Masturbation (for orgasmic disorder)
- Kegel exercises (PC muscle)
- 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
- elimination of performance demands and anxiety
- sexual intercourse prohibited during the therapy
- 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 practicing changes in behaviour
Therapeutic steps for anorgasmic women: (women who can't have orgasms)
- Education, information.
- Self-touching and self-stimulation. Masturbation.
- Assertive thoughts, giving self permission.
- Use of fantasy, books, videos, 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.
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
Pills: Viagra (sildenafil) and Vasomax (phentolamine) relax blood vessel muscles. Spontane
(apomorphine) works at brain level to trigger erection.
Side effects of Viagra (dose dependent):
- nasal congestion
- visual distortions
- drug interactions
Vasomax fewer side effects.