Chapter 13 Summary- human sexuality.docx

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Family Relations and Human Development
FRHD 2100
Tuuli Kukkonen

Chapter 13 Summary: Sexual Dysfunction Sexual Dysfunction- A persistent or recurring lack of sexual desire or difficulty becoming sexually aroused or reaching orgasm. - Temporary or occasional problems with sexual response do not qualify as sexual dysfunctions - A person is not considered to have a sexual dysfunction unless the problem persists over time and causes some type of distress - People with sexual dysfunctions may feel inadequate or incompetent which can diminish ones self esteem - May experience shame, frustration, guilt, depression and anxiety - Many are often too embarrassed to bring up issues of sexual dysfunction with their physicians Prevalence of Sexual Problems and Dysfunctions: - One of the best sources of information regarding sexual problems among women in Canada is the “Canadian Contraception Study” o This survey asked women if they had experienced three types of sexual difficulty: low sexual desire, painful intercourse and lack of orgasm during intercourse. o Most common problem was sexual desire (43%) o Married women reported more sexual difficulties than single women did o Married women were twice as likely to report low desire as unmarried women o Second most common problem was difficulty with orgasm (24 %) o Painful intercourse (15 %) of the surveyed women - Survey of 40-80 year old men and women o 23 % of men experienced rapid ejaculation o 16 % had problems with erection o 30 % of women reported lack of interest in sex o 24 % reported difficulties with vaginal lubrication - Another survey of only men (aged 40-80) o 49 % experienced some degree of erectile dysfunction o The higher the average of the participants in the study the higher the percentage of reported erectile dysfunction - Sexual problems are common with the adult Canadian population - Survey of people between the ages of 40-64 o More than half were often too tired to have sex o 42 % were too stressed to have sex o 40 % did not have time for sex - Tanya Hill (Researcher from the University of Guelph) o Study on 17- 24 year old women o ¾ felt sexually frustrated some of the time o 9 % felt frustrated often o The most frustrating situations  Lack of orgasm  Unaffectionate partners  Unavailability of partners  Refusal of partners to have sex Types of Sexual Dysfunctions: - The most widely used system for classification of sexual dysfunctions is the Diagnostic Statistical Manual, they fall into four categories Sexual-desire disorders lack of interest in sex or aversion to sexual contact Sexual-arousal disorders in men these involved difficulty in obtaining or sustaining erections, in women these involve insufficient lubrication. Orgasmic Disorders Persistent problems with reaching orgasm. Or reaching orgasm more quickly than the individual would like. Women are more likely to experience difficulty in obtaining orgams, men are more likely to orgasm too quickly. Sexual Pain disorders Both men and women may suffer from dyspareunia (painful sex). Women may experience vaginismus, or involuntary contraction of the muscles that surround the vaginal barrel which prevents of makes penetration painful. Classification: - Classified as lifelong or acquired - Generalized or situational Generalizedoccur in all situations Situational affect sexual functioning only in some situations i.e. during partnered sexual activity but not during masturbation or with another sexual partner. Sexual Desire Disorders - Involve lack of sexual desire or aversion to genital sexual activity - Hypoactive people who have little or no sexual desire, they often report an absence of sexual thoughts and fantasies - This problem is more common for women compared to men - Some individuals with a lack of sexual desire are still able to become sexually aroused and reach orgasm when adequately stimulated - Many also will enjoy sexual activity, even if they are unlikely to initiate it - Many appreciate the affection and closeness of physical intimacy but have no interest in genital stimulation - Hypoactive sexual desire is one of the most commonly diagnosed - Clinicians and researchers find it difficult in defining “low sexual desire” - It’s been speculated that gay and lesbian couples may have fewer discrepancy troubles than heterosexual couples Sexual-Aversion Disorder - Becoming overly anxious in sexual situations because these situations trigger feelings of shame - Histories of erectile can cause sexual aversion in men - Histories of sexual trauma such as childhood rape or sexual abuse can cause sexual aversion later in life, especially among women - In the past problems with arousal were referred to as impotence in men and frigidity in women - Today this disorder is referred to as “erectile dysfunction” in men and “female sexual- arousal disorder” in women Vasocongestion Engorgement of blood vessels with blood which swells the genitals and breasts during sexual arousal. o Produces lubrication in women and erection in men o People with sexual arousal disorders fail to achieve or sustain the erections or lubrication necessary to facilitate sexual activity Male Erectile disorders: - Characterized by persistent difficulty in achieving or maintaining an erection sufficient to allow completion of sexual activity - In most cases the failure is limited to sexual activity with partners or with some partners and not others (situational) - In rare cases the dysfunction is found during sexual activity, including masturbation (generalized) - Some men are unable to attain erections with their partners, while others can achieve but not sustain erections - Incidence of erectile dysfunction increases with age - 30 % of men in their 40s have some degree of E.D, 40 % in their 50s and 65 % in their 60s - Fatigue, too much alcohol, anxiety and other factors may cause occasional erectile dysfunction Performance anxiety Anxiety concerning one’s ability to perform behaviours, especially behaviours that may be evaluated by other people. o The more anxious and concerned one becomes about his ability to have an erection the more likely they are to suffer from performance anxiety. o The emphasis on sexual prowess in our culture may cause one to view occasional erectile problems as being catastrophic o Depression, lack of self-esteem and problems with relationships all can arise from those with this particular disorder o A common belief is that sexual arousal is much simpler for men than for women, however some studies have shown that men’s sexual arousal is also complex and that there is considerable variation in what men find arousing. Female Sexual-Arousal Disorder: - These women can be categorized into two categories: o Those with combined-arousal disorder o Those with subjective-arousal disorder - Combined-arousal disorder Experience no subjective arousal and feel no genital response. - Subjective arousal disorder Are aware that their genitals physically respond to stimulation, but feel no subjective arousal. - Genital-arousal disorder a small minority of women can become aroused by many different kinds of stimuli but don’t find stimulation of their genitals arousing. These women can still be highly interested in sex and become subjectively aroused as long as they experience non-genital stimulation. - This disorder may have physical causes; therefore a thorough evaluation by a medical specialist is recommended I.e. diabetes mellitus may lead to diminished sexual excitement because the clitoris degenerate and the blood vessels become damaged. - Research has suggested that the skin of some women with sexual-arousal disorder are less sensitive to touch than the skin of women without these problems. - Female sexual-arousal disorder more often has psychological causes - Childhood sexual abuse is especially prevalent among women with sexual-arousal disorder; victims find it difficult to respond sexually to their current partners. Orgasmic Disorders: - Includes female orgasmic disorder, male orgasmic disorder and premature or rapid ejaculation - Delayed or inability to achieve orgasm during sexual activity is more common among women Female Orgasmic Disorders - These women are unable to reach orgasm or have difficulty reaching orgasm after what would usually be adequate sexual stimulation. - Women who have never reached an orgasm through any means are referred to as “anorgasmic” or “pr-orgasmic” - A women who reaches orgasm through masturbation or oral sex may not reach orgasm during intercourse (would not be referred to as an orgasmic disorder) - 93 % of women sometimes or usually needed direct clitoral stimulation during intercourse to reach orgasm Male Orgasmic Disorder - Also been called “delayed ejaculation” - This problem may be lifelong, acquired or situational - Very few men have never ejaculated - Male orgasmic disorders may be caused by physical problems such as multiple sclerosis or neurological damage that interferes with neural control of ejaculation. - Can also be caused by a side effect of a particular drug Rapid Ejaculation - Also referred to as pre-mature ejaculation - Ejaculate too quickly to permit themselves or their partners from fully enjoying sexual relations - Most men with this condition ejaculate just before or immediately after a few penile thrusts - A study conducted found that of the sample men, the intercourse lasted about 8 minutes before ejaculation - Majority of men with R.E will not discuss it with their doctors - Both men and women reported lower sexual satisfaction as a result of R.E - Women tended to underestimate how seriously their male partners viewed R.E Sexual Pain Disorders Dyspareunia - Traditionally has been defined as painful intercourse - Also includes persistent pain associated with any stimulation of the vaginal areas - Most research has focused on heterosexual couples - Painful intercourse is less common among men - Dyspareunia is one of the most common sexual dysfunctions and a common complaint among women seeking gynecological services - The location of the pain can vary - Few doctors and therapists are properly trained to talk about dyspareunia - Vulvalgesiometer can measure the severity of pain experienced by women - Pain is a sign that something is wrong-physically or psychologically - Women with this disorder have been found to have lower tolerances for pain which suggests that hypersensitivity may contribute to this problem in some women. - Based on these findings researchers believe that dyspareunia shoud be categorized as a pain disorder rather than a sexual dysfunction and should be assessed and treated like other pain disorders. - Some researchers have found that women who believe their pain is due to psychosical factors report higher levels of pain and more sexual problems than women who believe their pain is due to physical causes. - Many women are taught coping strategies for managing pain Causes: - Can result from physical caused - Emotional factors - Interaction of both causes - Most common cause of pain is inadequate lubrication (additional foreplay or artificial lubrication can help) - Vaginal infections and STIs may also produce genital pain - Allergic reactions to spermicide, latex materials found in condoms can also result in genital irritation - Pain during deep penetration may be caused by edometriosis, pelvic Inflammatory disease or structural disorders of the reproductive organs. - Psychological factors such as unresolved guilt, anxiety or sexual trauma can also be a factor which may inhibit lubrication, cause involuntary contraction of the vaginal musculature which makes penetration painful or uncomfortable. Vulvodynia - A gynecological condition characterized by vulva pain, particularly a chronic burning sensation, irritation and soreness. - Although vulvodynia can give rise to pain during vaginal penetration they are not considered sexual dysfunctions - Does not require any kind of external contact for the pain to be triggered Vulvar vestibulis pain that can be experienced through both sexual and non-sexual contact at the entrance of the vagina (at the vulvar vestibule) o Women with this disorder often seek treatment because they are experience pain when penetration is attempted. Causes: - Repeated yeast infections - Hormonal changes - STIs - Allergies - Urinary tract infections - Sexual abuse - Low self-esteem - Anxiety - Obsessional focuses on pain Origins of Sexual Dysfunction: Biopsychosocial model An approach to explaining dysfunction that looks at the interactions of biological, psychological and sociocultural factors. Biological causes: - Sexual desire is stoked by testosterone, which is produced by men in the testes and by both men and women in the adrenal glands - Women may experience low sexual desire if their adrenal glands are surgically removed - Some medications such as those used to control anxiety or hypertension may reduce desire - People with sexual dysfunctions are advised to undergo physical examinations to determine whether their problems are biologically based I.E men with erectile dysfunctions may be asked to participate in sleep clinics to see if they are able to obtain an erection during sleep o This technique is referred to as “ penile tumescence” o Healthy men usually have erections during REM sleep which occurs every 90-100 minutes o Men with biologically based E.D do not typically have nocturnal erections. o Physical examination and assessment of hormone levels can uncover the root causes of some cases of sexual dysfunctions. Hypogonadism An endocrine disorder that reduced the output of testosterone - The reduction in testosterone levels that occurs in middle and later life may explain the gradual decline in male sexual desire - Low sexual desire and erectile difficulty is common among men with Hypogonadism Health Problems and sexual dysfunctions: - Researchers have found that health problems can contribute to all kinds of sexual dysfunctions in men, and sexual pain in women. - Painful sex often reflects an underlying infection Medical conditions that affect sexual response; - Heart disease - Diabetes mellitus - Multiple sclerosis - Spinal cord injury - Complications from surgery - Hormonal problems - Medications used to treat hypertension and some psychiatric drugs - Cardiovascular problems (affect the flow to and from the penis) - Erectile dysfunction linked to men with large waists, physical inactivity and too much alcohol consumption  these can all lead to high cholesterol which can impede the blood flow to the penis - Sexual functioning in women is less affected by CVD - For both men and women hypertension (high blood pressure) and the drugs used to treat it can negatively affect sexual functioning Aging: - Pre-monopausal (women who are coming close to entering menopausal years) and post-menopausal women produce less vaginal lubrication - Vaginal walls become thinner with age, which can cause pain during intercourse - Stereotypes about older men and women can produce performance anxiety - Men who burn more than 200 calories a day during physical activity cut their risk for E.D almost in half - MS a disease in which nerve cells lose the protective coatings that facilitate the transmission of neural messages may cause E.D in men - Chronic kidney disease, hypertension, cancer heart disease, emphysema can all impair erectile response. - Endocrine disorders impair testosterone production -
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