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. Victorian era: women who experienced orgasm with their husbands were "sluts".

Historical (Individual) Context

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

Women - 43%

Men - 30%

Young Women: mostly psychosocial

Old Men: mostly organic

Types:

• 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
  • males: 16%
  • females: 33%
• sexual aversion disorder
  • males: 8%
  • females: 21%

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

Psychological causes:

• anxiety
• fear
• fear of failure
• inability to let go (cognitive)
• spectatoring
• interpersonal problems

Depression: interferes with sexual desire and orgasmic capacity.

Antidepressants: ditto

Other psychological causes:

• performance anxiety
• spectatoring
• 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
• stress
• anxiety (pregnancy, body image, smells, loss of control, injury, being judged, rejection, consequences for relationship, STDs, being heard/seen, etc.)

Biological factors:

• 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)
• diabetes
• spinal cord injuries
• antihypertension drugs
• kidney disease
• emphysema

Common Drugs that affect sexual response:

• antidepressants
• antipsychotics
• tranquilizers
• alcohol
• heroin
• morphine
• cocaine
• marijuana

Therapies:

• behavioural
• cognitive restructuring
• couple therapy

Other:

• Stop-Start (for premature ejaculation)
• Masturbation (for orgasmic disorder)
• Kegel exercises (PC muscle)

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
• 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 practicing changes in behaviour

Therapeutic steps for anorgasmic women: (women who can't have orgasms)

1. Education, information.
2. Self-exploration.
3. Kegels.
4. Self-touching and self-stimulation. Masturbation.
5. Assertive thoughts, giving self permission.
6. Use of fantasy, books, videos, audiotapes.
7. Focus on sensations, not on goal.
8. Bring in partner. Nondemanding sensate focus exercises - no intercourse.
9. Partner stimulates women manually or orally to orgasm following her directions
10. 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):

• headaches
• flushing
• indigestion
• nasal congestion
• visual distortions
• drug interactions

Vasomax fewer side effects.