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Lecture 16

Psychology 2075 Lecture 16: Sexual Disorders and Sex Therapy
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6 Pages
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Department
Psychology
Course Code
Psychology 2075
Professor
William Fisher

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History of Approaches to Sexual Dysfunction • 1786: Sir John Hunter, MD, reports first treatment of erectile failure o Tell couple that they cannot have sexual contact, or must stop when they feel aroused o Eventually will be unable to follow instructions • 1890-1900: Krafft-Edbing, "Psychopathia Sexualis" o Focus on sexual perversions o Rx: hot iron to clitoris of masturbator • 1930-1965: Freudian psychoanalysis, psychodynamic approaches o Sexual problems are symptoms of unconscious conflict o Do not treat symptoms -- identify and provide insight into their underlying unconscious conflict basis. Multiyear iatrogenic treatment of clitoral orgasm, rapid ejaculation • 1965-1990: Masters and Johnson o Pragmatic, brief, symptom focused, behavioural therapy o Sexual problems are learned behaviours that are amenable to learned solutions • 1990-2000: Sex versus Marital and Relationship Therapy o Disorders of sexual desire: Helen Kaplan • 1990-2000: Pharmacotherapy of Sexual Dysfunction o Slidenafil, tadalafil, vardenafil; testosterone; flibanserin (viagra/cialis) Sexual Response Cycle • Can have dysfunction in o Desire phase o Arousal phase o Orgasm phase o Coital pain Definitions of FSD: DSM-IV-TR • Sexual Aversion Disorder: persistent or recurrent extreme aversion to, or avoidance of, all (or almost all) genital sexual contact with a sexual partner • Hypoactive Sexual Desire Disorder (HSDD): Persistent or recurrent deficiency (or absence) of sexual fantasies and desire for sexual activity Sexual Arousal Disorder: Persistent or recurrent inability to attain, or to maintain until completion • of the sexual activity, an adequate lubrication-swelling response of sexual excitement • Dyspareunia: recurrent or persistent genital pain associated with sexual intercourse o Vestibulodynia: vulvar and vestibular "burning" or "cutting" type of pain; may be provoked or unprovoked o Vaginismus: recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted • Disturbance must cause marked distress or interpersonal difficulty and must not be better accounted for by the effect of another (non-sexual) psychiatric disorder, medical disorder, or substance Prevalence of Sexual Dysfunction: Sexual Problems and Distress in US Women • Highest at 50-59 years • Waiting room reports o Inhibited sex desire • 47% women say they have inhibited sex desire • 22% of partners say the women have inhibited sex desire • 23% of couples say they have frequent dissatisfaction about how often they have intercourse o 28% women say they have arousal or lubrication problems o 35% women experience lack of orgasm o 24% women experience painful intercourse • 79% women show concern but only 16% talk to doctors Definitions of MSD: DSM-IV-TR • Sexual Aversion Disorder: persistent or recurrent extreme aversion to, or avoidance of, all (or almost all) genital sexual contact with a sexual partner • Hypoactive Sexual Desire Disorder (HSDD): Persistent or recurrent deficiency (or absence) of sexual fantasies and desire for sexual activity • Sexual Arousal Disorder: Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection • Orgasmic Disorder o Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it o Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase • Dyspareunia: recurrent or persistent genital pain associated with sexual intercourse (e.g., Peyronie's disease) • Disturbance must cause marked distress or interpersonal difficulty and must not be better accounted for by the effect of another (non-sexual) psychiatric disorder, medical disorder, or substance Prevalence of Male Sexual Dysfunction: Sexual Problems of US Men • Age does not have much of an effect on male sexual dysfunction Sexual Dysfunction • Diagnostic Axis o Often interrelated diagnoses • Desire disorder + arousal disorder o Often related to partner diagnosis • ED (HIS) with HSDD (HERS) = Theirs • Co-occur and must find what is the primary disorder • History o Lifelong vs acquired o Global vs situational o Presentation vs discovery o Predisposing Factor • Antisex upbringing, past sexual trauma o Precipitating Factor • Partner demands, new child o Perpetuating Factor • Couple conflict, power struggles • Intake Interview o Diagnostic Factors • Desire, arousal, orgasm, pain • Lifelong vs acquired, global vs situational, presenting vs discovery • Primary complaint? Interactive couple disorder? o Personal, Sexual, Relationship, Medical History • Predisposing, Precipitating, Perpetuating Factors o Couple and Individual Interviews • Couple dynamics? Individual disclosures? • Qualifying Information o Anything else I should know • Incest • Fetish • Sexual orientation • Psychopathology • Substance use • Find partner attractive? • Love partner? Etiolo
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