v Sexual Dysfunctions

Ø Disorders involving either a disruption of the sexual response cycle or pain during intercourse

v Groups At Risk For Sexual Dysfunction

v Stages of the Normal Human Sexual Response Cycle

Ø Desire- Sexual urges occur in response to sexual cues or sexual fantasies

Ø Arousal or excitement- Subjective sense of sexual pleasure; Physiological signs of sexual arousal

Ø Plateau- Continued state of increased arousal before orgasm

Ø Orgasm- Sexual pleasures peaks and sexual tension is released as muscles in pelvic region contract

Ø Resolution- decrease in arousal and return to normal state

v Sexual Desire Disorders

Ø Hypoactive sexual desire disorder

§ Uninterested in sexual activity and sexual fantasy and a resulting low level of sexual activity

Ø Sexual aversion disorder

§ Persistent or recurrent extreme aversion to, and avoidance of, genital sexual contact with a sexual partner

v Sexual Desire Disorders: Causes

Ø Sexual history

Ø Current sexual practices

Ø Presence of general relationship conflicts

Ø Psychopathology

Ø Physical functioning

v Sexual Arousal Disorders

Ø Female Sexual Arousal Disorder

§ Persistent or recurrent ability to attain or maintain adequate vaginal lubrication and the swelling response of sexual excitement

Ø Male Erectile Disorder (Impotence)

§ Persistent or recurrent inability to attain or maintain an adequate erection

v Sexual Arousal Disorders: Causes

Ø Biological

Ø Psychological- due to high level of anxiety

§ Fear of sexual failure

§ Pressure to perform

§ Inability to abandon self to sexual feelings, “spectatoring”

Ø Sociocultural

v Orgasmic Disorders

Ø Female/Male Orgasmic Disorder

§ Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase

Ø Premature Ejaculation

§ Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it

v Female/Male Orgasmic Disorders: Causes

Ø Biological

Ø Psychological

Ø Sociocultural

v Premature Ejaculation: Causes

Ø “Common sense” perspective

§ Too sensitive to erotic sensations

Ø Psychological

§ Initially learned to have orgasm quickly

§ Male has not focused on sensations prior to ejaculation and therefore cannot control

v General Principles of Sex Therapy

Ø Assessment and conceptualization

Ø Mutual responsibility

Ø Education and sexuality

Ø Attitude change

Ø Elimination of performance anxiety and the spectator role

Ø Increasing sexual communication skills

Ø Changing destructive lifestyles and interactions

Ø Addressing physical and medical factors

v Paraphilias and Gender Identity Disorder

Ø What’s normative?

Ø Data from Social Organization of Sexuality (1994)

§ Masturbation (1x/week; 30% men, 8% women)

§ Sex with a stranger is appealing (4.1% men, 0.9% women)

§ Use of erotic material (41% men, 16% women)

§ Engaged in oral sex –lifetime (77% men, 70% women)

§ Engaged in anal sex – lifetime (25% men, 20% women)

v Paraphilias

Ø Recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause significant distress or impairment in important areas of functioning

v Types of Paraphilias

Ø Exhibitionism

§ Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one’s genitals to an unsuspecting stranger

Ø Fetishism

§ Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects

§ The fetish objects are not limited to articles of female clothing used in cross-dressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation

§ Transvestic Festishism

· Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing

Ø Frotteurism

§ Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person

Ø Pedophilia

§ Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)

§ The person is at least 16 years and at least 5 years older than the child or children

Ø Voyeurism

§ Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity

Ø Sexual Masochism

§ Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer

Ø Sexual Sadism

§ Intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person

v Paraphilias: Theory and Treatment

Ø The Behavioral perspective

§ Classical conditioning

§ Operant conditioning

§ Treatment – Counter conditioning

· Covert sensitization

· Masturbatory satiation

· Orgasmic reorientation

v Gender Identity Disorder

Ø A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex)

Ø Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

Ø The disturbance is not concurrent with a physical intersex condition

Ø The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning