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University of Waterloo

SEXUAL DYSFUNCTION AND THERAPY Types/diagnosis – DSM-IV  Diagnosed via sexual response cycle  Can be acquired (primary) or life long (secondary)  Situational sexual disorder – only occurs in some situations. Sexual dysfunctions  Desire problems – common o Inhibited sexual desire or hypoactive (HSD)  Lack of interested in sexual activity.  If one partner wants to have sex less frequently than the other = discrepancy of sexual desire  Reported in W in early 30s, and in M in their mid-late 40s  When women’s emotional needs are not met, their sexual desire decreases o Sexual aversion  Strong aversion involving anxiety, fear, or disgust to sex and actively avoids any kind of genital contact with partner o Hypersexual – nymphomania (F); satyriasis (M)  Not in DSM-IV but may be symptomatic of another disorder (e.g., manic episode, personality disorder)  Arousal problems o Lubrication problems/female sexual arousal disorder  Lack of response to sexual stimulation o Erectile disorder/inhibited sexual excitement  Inability to have and/or maintain an erection  Can be lifelong or acquired  Orgasm difficulties – majority in M + J o Anorgasmia (preorgasimc)/inhibited female orgasm  Woman in unable to have an orgasm – common in younger W o Inhibited ejaculation  Orgasmic disorder  Male: delayed/retarded ejaculation – cannot have an orgasm even though he is highly aroused and has had a great deal of sexual stimulation.  Rapid ejaculation/premature ejaculation  Man ejaculates too soon and feels he cant control when he ejaculates o Definitional issues: when is it a problem?  Sexual pain disorders o Dyspareunia/painful intercourse  Mostly experienced by F o Vaginismus – psychosomatic  Spastic contraction of the muscles surrounding vaginal entrance, sometimes making penetration impossible. o Coital pain Causes  Organic factors – physical factors e.g., disease, injury etc o ~50% of ED due to organic factors (alone or in combination)  Heart disease, diabetes, hypogonadism, hyperprolactinemia o Premature ejaculation  Malfunction of ejaculatory reflexes  Local infection e.g., prostatitis  Drugs o Alcohol – ED, loss of desire, orgasmic disorder o Illicit drugs –orgasmic disorder, low testosterone, delayed orgasms o Prescription drugs – dry orgasm, delayed orgasm,  Psychosocial causes (singer Kaplan) o Predisposing factors – experiences that people have had in the past that now affects their sexual response  Result in negative effects later on. o Maintaining factors – various ongoing life circumstances and love making patterns that inhibit sexual response  Myths and misinformation – leads to sexual script  Negative attitudes  Anxieties such as fear of failure – can be due to childhood abuse  Cognitive interference – thoughts that distract the person from focusing on the erotic experience; attention problem  Spectatoring – M+J = person behaves like spectator of his/her own sexual performance.  Individual psychological distress e.g., depression  Behavioural or lifestyle factors e.g., alcohol, smoking  Failure to engage effective, sexually stimulating behaviour due to failure of partners to communicate  Relationship distress e.g., frequent arguments between couple  Causes can often interact Treatment  Behaviour therapy – based on learning theory; focus is on the problem behaviour and how it can be changed. o Sex problems are the result of prior learning and are maintained by ongoing reinforcements and punishments o M + J devised therapy to eliminate goal-oriented sex  Senate focus exercise – one partner caresses the other, the other communicates what is pleasurable, and there are no performance demands  Cognitive behavioural therapy – combines behaviour therapy and restructuring of negative thought patterns o Cognitive restructuring is useful in addressing negative attitudes and cognitive interference.  Couple therapy o Sexual and performance anxiety reduction o Education and cognitive intervention o Script assessment and modification o Conflict resolution and relationship enhancement o Relapse prevention and training  Specific treatments for specific problems o Start-stop technique/squeeze (M+ J) = rapid ejaculation o Masturbation – F with orgasm problems o Kegel exercises –involuntary urination during sex (for F) o Bibliotherapy (LoPiccolo & Heiman) – use of self help book to treat disorder o Drug treatments – Viagra o Intravernosal injection – ED – vasodilator drugs injected into corpora cavernosa of the penis o Vacuum device – sexual arousal disorder o Penile prosthesis – surgical treatment for ED; inflatable tubes are inserted into penis  Singer-Kaplan – psychosexual therapy (immediate & remote; behavioural, then insight oriented)  Annon – P-LI-SS-IT Model o P – Permission =therapist gives permission to do what patient is already doing; alleviates unnecessary suffering e.g., guilt because of masturbation o LI - Limited Information = usually enough o give correct anatomical and physiological information but at times more education is necessary o SS - Specific Suggestions = practical hints or exercises tailored to individuals’ case e.g., mutual pleasuring o IT - Intensive Therapy = long term intervention addressing complex underlying causes.  Kleinplatz – great sex o Being in the moment o Connection with partner o Sexual, erotic intimacy with trust o Communication and empathy o Authenticity o Transcendence & transformation – “high” o Exploration & risk-taking o Vulnerability ATYPICAL SEXUAL VARIATIONS Definition issues  Variation of disorder o Statistical definition – rare, not practiced by many people o Sociological definition – violates norms of society o Psychological definition – discomfort, inefficiency, bizarreness o Medical approach – DSV-IV  8 paraphilias  Impairs relationships – paraphilia (recurring, unconventional sexual behaviour that is obsessive and compulsive)  Distress  Illegality o Victim (pedophilia)/victimless (sadism, masochism) o Invasive (voyeurism)/non-invasive (fetish-inanimate)  Extensions of normal behaviour? o Normal –abnormal continuum: not distinct categories o When the preference for an object becomes a necessity, it starts becoming abnormal, and when it substitutes a human, it is a paraphilia  Compulsive sexual behaviour – disorder in which the person experiences intense sexually arousing fantasies, urges, and associated sexual behaviour. o 4-step cycle which intensifies each time it is repeated:  Preoccupation – can’t think of nothing other than sexual act  Rituals – enacts certain rituals that are prelude to addictive act  Compulsive sexual behaviour – enacted  Despair – addict falls into a feeling of hopelessness and despair Fetishism  Person’s fixation on some object other than another human being and attachment of great erotic significance to that object. o Media fetish – fetish whose object is anything made of a particular substance, such as leather o Form fetish – fetish whose object is a particular shape, such as high-heeled shoes  Why do people become fetishists? o Learning theory – result from classical conditioning, in which a learned association is built between the fetish object and sexual arousal and orgasm. o Cognitive psychology – serious cognitive distortion in that they perceive an unconventional stimulus as erotic. o Sexual addiction – especially for the compulsive types Transvestism  Practice of deriving sexual gratification from dressing as a member of the other gender; transvestic fetishism.  Drag queen – male homosexual who dresses in women’s clothing  Female impersonator – man who dresses up as a woman as part of a job in entertainment.  Transvestite – heterosexual man who dresses in female clothing to produce or enhance sexual arousal. o Have 4 basic motivations:  Sexual arousal – conditioned association between sexual arousal and women’s clothing  Relaxation – need a break from the confining pressured male role  Role playing – great sense of achievement from being able to pass as a woman in public  Adornment – women’s clothes are more colorful and beautiful Sadism and masochism  Sexual sadist – person who derives sexual satisfaction form inflicting pain, suffering, or humiliation on another person  Sexual masochist (S-M) – person who derives sexual satisfaction from experiencing pain  Bondage and discipline – use of physical or psychological restraint to enforce servitude, from which both participants derive sexual pleasure  Dominance and submission – use of power consensually given to control the sexual stimulation and behaviour of the other person  ~65% of university students fantasize about S-M Voyeurism and scoptophilia  Introduction o Humans: visual o 93% Men and 81% women – watch partner undress o Consensual vs. non-consensual viewing  Definitions o Voyeurism – watching an unsuspecting victim disrobe o Scoptophilia – watching people having sex  Diagnosable disorder o Ongoing interest o Distress/impairs relations o Avoids consent issue  Criminal offense? o No specific CCC offence o Mischief and trespass at night o Canadian government: considering CCC addition o 2 proposed types?  For a sexual purpose, victim not naked  No sexual purpose, victim naked o Canadian submission is positive.  Research on voyeurs? o Case studies o Self-referrals/court-referrals  Theoretical explanations o Motives for peeping  Psychoanalytic  Social learning  Sociobiological  Love map  Developmental representation or template in the mind and in the brain depicting the idealized lover and the idealized program of sexual and erotic activity projected in imagery or actually engaged in with that lover  Courtship disorder  There is a species-typical courtship process in humans consisting of four phases o Looking for and appraising potential sexual partners o Pretactile interaction with those partners, such as by smiling at and talking to them o Tactile interaction with them, such as by embracing or petting o Then sexual intercourse  Biological dysfunction o What kind of person would do this? o Are they from another planet? o Quantitative vs qualitative difference  Research questions o How likely would normal students be to engage in voyeurism and scoptophilia? o Would women and men differ in their peeping? o Would the risk of being caught be deterrent to peeping?  Social constraints/social controls  Methods o Students from 3 human sexuality classes were given 2 scenarios:  You see someone who you find VERY attractive. The person does not suspect that you can see him or her. He/she begins undressing (voyeuristic)  He/she begins to have sex with another attractive person (scoptophilic) o How likely to watch? 0-100% likelihood o Risk of being caught is 1 of 3:  No chance, 10% chance, 25% chance  Results o Normal students likelihood of peeping  70% for voyeurism, 45% for scoptophilia o Gender differences  Men and women were equal for voyeurism (both ~70%)  Men were more likely to look for scoptophilia (M ~70%, W ~40%) o Risk of being caught: daringness and danger  Voyeurism: no chance (0%) > looking relative to 10% or 25%  Scoptophilia: 10% chance < likely to look o Generally:  Voyeurism > scoptophilia  Risk of being caught stakes > 0%, rates decreased  W in scoptophilia group < all others  M in 10% scoptophilia group = anomalies (n=6)  Summary: o M and F students = voyeurism. If discovery is possible, rates decrease o M > F scoptophilia o M voyeurism = scoptophilia o F voyeurism > scoptophilia  Limitations o Samples > liberal?  Other study: 54% vs 78% voyeurism o Self-reported/scenario = real life? o Not serious: fun class activity  Theoretical implications o Fear of sanctions = decisions to peep o Gender differences (fear of sanctions)? o Voyeurism vs scoptophilia – less harmful/invasive? (particularly by F) o Gender differences less extreme than literature suggests o Supporting social learning theory? Exhibitionism (flashing) – Indecent exposure  Person who derives sexual gratification from exposing his genitals to others in situations in which this is inappropriate.
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